Health-Care Reform: The AARP Perspective

11/12/2007. A meeting of the Medical Services Committee, for Mount Vernon At Home, a group of senior citizens who are working to create a nonprofit organization that will provide services to its members.
11/12/2007. A meeting of the Medical Services Committee, for Mount Vernon At Home, a group of senior citizens who are working to create a nonprofit organization that will provide services to its members. (Dayna Smith/ftwp)
David Certner
Legislative Policy Director, AARP
Wednesday, August 19, 2009; 12:00 PM

David Certner, legislative policy director at AARP, was online Wednesday, Aug. 19, at Noon ET to discuss health-care, the lobbying group's support of President Obama's agenda and recent reports that approximately 60,000 senior citizens have canceled their membership because they fear Medicare benefits will be reduced in order to support health-care overhaul.

A transcript follows.


David Certner: My name is David Certner, the Legislative Policy Director for AARP. We hope to have a lively and informative discussion about issues related to health care reform.


Scottsdale, Ariz.: Mr. Certner: Do your loyalties lie with seniors' best interests or with AARP's insurance sales? I had a very bad experience with United Healthcare in 2000 when they kicked out individual policy holders. (7,500 of us in Arizona alone!) As a breast cancer survivor, I could not buy health insurance at any price. For several years I had to be without insurance -- SCARY! Needless to say, I'm extremely thankful for Medicare and I am hoping that we will pass STRINGENT regulations against discriminating for previous disease AND that we will have a public option. Without regulation, the insurance companies will stick the government with all of the "risky" people.

David Certner: AARP is driven by its members best interests, as it is with every debate. We have both those who are on Medicare, and who are looking to strengthen the program, including looking to lower their costs, keep their doctors, and get better drug coverage. And as you note, we have members who are not yet eligible for Medicare, who either want to keep the insurance they have, or who are desperately trying to find insurance in the individual market. About 1 of every 4 60-year-olds can't even get insurance because of a pre-existing medical condition -- and we agree with you that this must change.


Dime Box Texas 77853: Why doesn't AARP poll members to find out how many of do not support Obama Health Care plan? You will lose a lot more than 60,000 members over this issue by saying that your members are in support if you don't show proof. I know of no one who has studied the plan that supports it including me. Are you representing me and the retirees I know or some liberal agenda?

David Certner: First, AARP has not endorsed any particular plan. Second, we have done significant outreach to our members, both through polling, research, town halls, and the large amount of calls and e-mails we receive. Third, we have volunteer leaders who are all over the country that provide us feedback from every state. We continue to fight for health care changes that our members tell us they care about, such as holding down costs, strengthening Medicare, access to the doctor of your choice, affordable health insurance, and lower cost drugs.


Dallas, Tex.: Dear David,

Two quick questions/concerns:

1) Disabled and under age 65 - What is AARP's position here with the new proposals?

2) Prescription Drug Coverage - Many of the disabled (like myself) reach the "doughnut hole" gap in Q1 of each year. Then no more medicine. It was better before Part D as the Drug Companies offered accommodating PAP assistance plans. What is the position here?


Dallas, TX

David Certner: For those under 65, as you know, some disabled persons are eligible for Medicare. This will not change, and we support the current coverage. For those not eligible for Medicare, we strongly support doing away with insurance company practices that prevent those with a existing medical condition from getting insurance.

For those with high drug costs, we strongly support closing the so-called doughnut hole (or coverage gap in part D) -- that is a provision now included in the House bills.


Ridgefield, Conn.: Why is AARP supporting a program that MUST take from Medicare to provide insurance for other groups? AARP is a lobby group for seniors, period! AARP should be making sure seniors are protected from the absurd rules in the proposed House bill.

David Certner: First, AARP has not endorsed any particular bill. We are working with the Administration, and Members of Congress from both sides of the aisle to craft the best bill possible for our members.

AARP opposes any cuts to Medicare benefits. We do support savings in the Medicare program that will help lower costs, such as those changes that will weed out waste and inefficiency in the program. We agree 100% that older Americans must be protected in any reform bill, and we are working to ensure we get an improved Medicare program.


Arizona: Mr Certner, I can understand that the administration has to take the high road in the current debate over health-care reform. But why does AARP feel the need to be civil about the outright lies told by those opposed to any reform at all? Why not just label the lies as what they are -- political gamesmanship that has nothing at all to do with health care?

David Certner: We think lively debate over health care reform is important. Unfortunately, some have chosen to simply attempt to scare people with non-existent myths. This is unfortunate, as it takes away from the real debate we should be having over improving care and lowering costs. We have tried to provide the facts to our members, and dispel some of the myths that have arisen -- please go to our web site to see more info (


Doniphan, Neb.: Who will decide which tests, procedures, and medications are wasteful, inefficient, or unnecessary? In my opinion, these decisions must be made by the physician and patient. Third party interference is rationing. To say that Medicare spending will be cut by 10 per cent WITHOUT rationing is a BIG FIB.

David Certner: We completely agree that decisions should be made by the patient and the doctor -- without the interference of government or your insurance company. Rationing is not a part of these bills, and if it were, AARP would reject it. We do believe -- and our members who have had experience with the health care system generally agree -- that health care is delivered inefficiently today, with too many wasted tests and procedures that not only do not improve health, but often harm it.


Medicare Q: My employer pays 85% of private insurance coverage for retirees who have worked here 15 years at retirement. May I use this coverage after retirement, or is there a requirement that I go to Medicare?

David Certner: If your employer provides you retiree coverage, you may keep that coverage prior to Medicare, at Medicare age, that coverage is usually done as a supplement to Medicare. However, please note that your employer is normally permitted to reduce or even cancel those benefits at any time.


Washington, D.C.: Does AARP want end-of-life counseling and care covered by Medicare?

David Certner: AARP supports reimbursing a doctor under Medicare if the individual CHOOSES to have that conversation with their doctor -- this is a way for an individual to make sure that their choices are respected. There should be no interference from the government nor an insurance company.


Brookeville, Md.: Why isn't AARP out there trying to kill this bill? It contains a half a trillion dollars in cuts to Medicare. That is part of the "bending the curve" options, including incentive payments to physicians to give euthanasia advice. This is atrocious government policy, and it is clear to me the idea is to gut Medicare to pay for the younger generation of uninsured. Surely as a group representing the elderly, you cannot support euthanasia?

David Certner: AARP has not endorsed any bill. But no bill would provide for euthanasia -- an outrageous idea that we would reject. It is also important that we take smart steps to hold down health care costs across the board, including in Medicare. However, we would oppose any cuts to Medicare benefits, and pending bills would not cut any benefits -- indeed, some benefits, such as the Rx benefit, would improve. Health care already accounts for over 1 out of every 6 dollars in the economy and is ever growing. We cannot continue to afford the current trend of ever increasing health care costs.


Baltimore, Md.: How do you help educate your members, a segment of the population that seems to be easily susceptible to outlandish misinformation, both in this debate as well as in general (scams, etc), as evidenced by the 60K members who have left. This number just leaves me speechless.

David Certner: We continue to do the best we can to get the facts out to our members, including town halls, local meetings with AARP members, advertising, our publications, our web site and direct mail. While we regret that we have lost members -- some of whom probably do not fully understand AARP's position -- we are happy to report that we have gained over 400,000 new members over this same time period. We will continue our work to fight for a better health care system on behalf of our members.


Choice: The idea of choice is a red herring. I am 71. I have Medicare. I want a doctor; I got it. I want a choice of medical treatment; I got it. I never had either choices under private insurance. I do NOT want a choice of insurance. Medicare is fine for me. We should give it to everyone. It is so much more efficient than private insurance, it will cost us no more than what we are now paying.

We don't have a choice of fire departments, do we?

David Certner: Medicare already provides a choice of traditional Medicare or private options -- although most choose traditional Medicare and as you note, are quite happy with it. Those under age 65 would like to also have access to affordable health care choices, and we believe that should be a key goal of any health care reform bill.


Washington, D.C.: Can AARP do more to help quell these "death panel" and other nonsensical stories that distort what health care reform is intended to do....and also to make it clear to all those who are screaming against reform that the CURRENT system already rations care, and will only get more expensive and inaccessible in the not-too-distant future unless we as a nation act to put in place a more workable system?

David Certner: Hopefully by now the myth of "death panels" is, pardon the pun, dead. We will continue to try to dispel myths and similar scare tactics so we can get back to the real debate over providing affordable quality health care to all Americans. Our age 50+ AARP members not yet eligible for Medicare who cannot get health insurance already know a bit about "rationed" care when no one will sell them an insurance policy because of a pre-existing medical condition.


Bellevue, Wash: Good afternoon. Is the AARP in favor of doing away with Medicare Advantage plans? My congressman has told seniors in his district that the savings the President hopes to glean from Medicare, including getting rid of Medicare Advantage plans, would mean that Medicare would no longer have coverage for durable medical equipment. I'm pretty sure that is a lie. What do you think?

David Certner: AARP believes that Medicare beneficiaries should continue to be able to choose a private so called "Medicare Advantage" plan. However, the government now provides extra subsidies to these private insurance companies paid for in part by taxpayers and all other Medicare beneficiaries in the form of higher premiums. We believe these extra subsidies should be eliminated, and the plans should continue to compete based on cost and quality, including bonus payments for those plans that do a better job. It will be up to these private plans to decide future coverage.


Albuquerque: Even if health insurance reform forbids insurance companies from denying coverage to persons with pre-existing conditions, insurance companies can functionally deny such coverage simply by pricing those of us (who doesn't have some condition by the age of 50?) out. What do you recommend the reform ought to include to protect us from such functional discrimination?

David Certner: While prohibiting insurance companies from denying coverage to those with pre-existing conditions is important, you are correct that is not the only insurance practice which is objectionable. Insurance companies also vary their premiums based on age, and can charge 7 times or more for an older person -- making the insurance unaffordable. AARP supports strict limits on so called "age rating", and current pending bills would include such restrictions, which we believe is crucial to affordability.


Washington, D.C. area: AARP represents its members' interests. But who is supposed to represent the interests of young Americans (18-30) who have to pay for this health care? From your perspective, does the fight ever seem a little one-sided? Whenever budget cuts are needed it's a given that one area is off limits - Medicare. Are generations of older Americans just going to keep sticking it to the younger generations to pay for their health coverage?

David Certner: The larger point is that health care costs are growing too fast for everyone -- since older Americans are large health care users, they know this directly. In fact, those on Medicare spend an average of 30% of their income on health care costs. We need an improved health care system, including better coverage and reduced costs, so that affordable health insurance is available for everyone -- including a stronger Medicare program for those who will, someday, be eligible.


Arlington, Va.: Does AARP support tort reform as part of finding efficiencies, ending waste, and bending the cost curve in our health system?

David Certner: Last question. We believe we do need a better system to both benefit patients that have been harmed, and fix the system errors that led to malpractice in the first place. We have supported a different model than the current one.


David Certner: I would like to thank everyone for a hopefully informative chat on the key issues for health care reform. AARP will continue to fight to strengthen Medicare, reduce health care costs, and ensure affordable care. Please visit us as for more information.


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