By Ceci Connolly
Washington Post Staff Writer
Sunday, August 9, 2009
Senior citizens are emerging as a formidable obstacle to President Obama's ambitious health-care reform plans.
The discontent in the powerful and highly organized voting bloc has risen to such a level that the administration is scrambling to devise a strategy to woo the elderly.
Obama's task will not be easy. Proposals to squeeze more than $500 billion out of the growth of Medicare over the next decade have fueled fears that his effort to expand coverage to millions of younger, uninsured Americans will damage elder care. As a result, barely one-third of seniors support a health-care overhaul, several polls found.
"People have gotten more and more worried," said Nancy LeaMond, a vice president at the 50-and-over advocacy group AARP, which will unveil a pro-reform TV and print ad campaign Monday. "They are very concerned about the myths they keep hearing that care will be rationed and they won't have access to doctors."
One mailing from the 60 Plus Association, which bills itself as a "conservative alternative to AARP," warns that the proposed Medicare changes will mean "longer wait times at hospitals and doctors offices, less money for new treatments, restrictions on care, prescriptions and what's best for you -- the patient!" Officials at the Virginia-based group did not respond to several messages last week.
Conservative talk-radio shows have raised the prospect of euthanasia based on a provision to reimburse doctors through Medicare for counseling sessions about end-of-life directives.
And comments posted on former Alaska Republican governor Sarah Palin's Facebook page Friday said that people would have to "stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care."
There are no such "death panels" mentioned in any of the House bills.
From the raw numbers, it appears seniors are the net losers under bills approved by three House committees last week. The legislation trims $563 billion out of Medicare's growth rate over the next 10 years while pumping in about $320 billion. Without any changes, the program is expected to cost about $6.4 trillion over the same period.
But three retiree groups and several independent policy analysts say most of the proposed savings affect providers, rather than beneficiaries, and have the potential to improve quality over the long term. Discounts for prescription drugs, higher reimbursements for many doctors and elimination of co-payments for preventive services are some of the ideas advocates applauded.
"I don't see anything that will affect beneficiaries' access to care, though some of it will depend on implementation," said Joseph Baker, president of the Medicare Rights Center, a nonprofit group focused on older Americans.
Senior citizens have long had doubts about Obama. Voters 65 and older were the only age group to choose Sen. John McCain (R-Ariz.) in last year's presidential election, according to exit polling that looks at four common age groups. Those polls show McCain won seniors 53 percent to 45 percent.
"They are more risk averse; they wanted more experience and less change," said Democratic pollster Celinda Lake, who tracks retiree attitudes. In health-care reform, seniors see "very rapid change and in an area they don't want change."
The overhaul Obama envisioned would expand insurance coverage to about 46 million people. But the elderly have comprehensive coverage through the federal Medicare program, which cost $453 billion this year. For seniors, health reform represents a threat to care they like, said Lake.
"They only want to hear one thing: that their Medicare benefits won't be affected," she said. It is a message, she added, that has not been conveyed adequately by Obama, congressional Democrats and "third-party validators."
Administration officials said Saturday that they are considering several options for reaching out to skeptical seniors, including a "myth-busting" Web site and public appearances by the president.
Diane Rowland, executive vice president of the nonprofit Kaiser Family Foundation, said the House legislation does not "address all of the issues in Medicare that seniors would like to see addressed," including money for long-term care. But discounts on prescription drugs and provisions that would extend the Medicare Trust Fund for at least five years are "an attempt to reassure the Medicare population."
Under the bills, insurance companies that sell managed-care plans known as Medicare Advantage would take the largest hit. The independent Medicare Payment Advisory Commission has recommended reducing payments under Medicare Advantage, noting that insurance plans that were touted as being more efficient should not cost 14 percent more than the traditional fee-for-service Medicare policy.
Insurers say the extra money provides benefits such as eye care, dental and gym memberships -- benefits that could be eliminated if the 10-year, $156 billion reduction occurs. Though the industry's lobbyists have spoken against the change, the criticism has been muted in the hopes that health-care reform will deliver millions of new customers.
Hospitals would also receive smaller-than-anticipated payments under the House plans. One provision would slash payments to hospitals that have high readmission rates. Medicare estimates that 19 percent of the unpleasant, costly readmissions are "preventable." Another proposed change would "bundle" fees for packages of care such as knee replacement to encourage medical teams to coordinate care from an initial assessment through surgery and rehabilitation.
The hospital industry has pledged to make $155 billion in reductions over the next decade as part of health reform and AARP has endorsed the changes.
But the organization, which has a separate business unit that sells insurance, has objected to some proposals, including an Obama-backed plan to empower an independent advisory board to decide Medicare coverage and payment policies.
Rep. Eric Massa (D-N.Y.) said tightening provider payments could lead to access problems for patients.
"We will force doctors to decline Medicare patients," he said after a raucous town-hall meeting in Upstate New York. "If we believe these savings are there, let's test the concept. But we can't hinge the entire funding of this bill on these not-yet-seen savings."