THE BLOG
06/15/2010 07:50 pm ET Updated May 25, 2011

The Sore Loser Republicans Can't Stop Saying "No"

Nobody likes a sore loser. But congressional Republicans, who have not yet come to terms with the election of Barack Obama, cannot get over the passage, with not a single one of their votes, the health insurance reforms called the Patient Protection and Affordable Care Act.

Thus the Republicans plan to campaign this summer to repeal the law, which they call unpopular. They have not read the latest polls, which say otherwise. The Wall Street Journal poll found that 55 percent want the reforms to have a chance to work. A Vanity Fair poll found that 42 and percent would keep all the provisions. That may be why the Republicans won't say, specifically, which provision should be repealed.

If they did, they would have to support denying insurance coverage to children with pre-existing conditions like asthma or diabetes, which is outlawed by the reforms. Or perhaps the Republicans would force middle class parents to buy separate policies for their adult children; the reforms would cover them until age 26. How about getting rid of the provisions lowering the Part D cost of drugs, gradually closing the infamous "doughnut hole" or paying for cancer-preventive screenings? Or maybe the Republicans simply don't want coverage that will be available at low cost for the 40 million men, women and children who have no insurance.

More than a dozen state Republican attorneys general have taken a different tack-a fool's errand, paid for by taxpayers, which pleads that the courts to stop the reforms and declare unconstitutional the provision mandating that all of us purchase insurance (with and without help from the government), the better to create a healthy risk pool.

I don't have a clue how Republican dominated courts may rule, but chances are the mandate will stand, for each state similarly requires drivers to buy insurance. State laws regulating real estate, also require the purchase of homeowners insurance. Becoming eligible for Social Security generally means automatically becoming a beneficiary for Medicare Part A, and Medicare sets a stiff penalty if beneficiaries do not sign up for Part B or Part when they are first eligible and have no equivalent coverage.

The latest whine of the sore loser is the Republican criticism of the perfectly straight-forward brochure from Health and Human Services (HHS) Secretary Kathleen Sibelius, explaining the admittedly complicated many faceted law, which will take years to have full effect. Republicans call it "propaganda," as if their flacks never heard of such a thing. Her biggest boo-boo, according to the Republicans was her defense of the law's reduction of the slush fund for Medicare Advantage plans, which George W. Bush gave us as part of the GOP effort to privatize Medicare.

Said Sebelius: "Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than Original Medicare...The new law levels the plying field by gradually eliminating Medicare overpayments to insurance companies. " More important, she added, "If you are in a Medicare Advantage plan you will still receive guaranteed Medicare benefits."

That has not been the case with MA insurers, for in April, the Government Accountability Office reported that in 43 percent of MA plans, more than half the beneficiaries were in the "average or poor health group," meaning they did not receive the best of care. The reforms will hold all private insurers to a higher stand, mandating that 85 percent of premium income be spent on care. Perhaps the Republicans would repeal that provision. The Medicare Rights Center has documented the complaints from the thousands of patients who have disenrolled from their MA plans, many because they were denied the benefits they thought they had.

Here is an example of how ridiculous the sore loser can get. In Britain, the heavy use of alcohol poses a serious health problem for the nation and its National Health Service. As a result, Britain's National Institute for Health and Clinical Excellence (NICE), which produces guidance on public health, suggested the nation's doctors question and screen patients on their use of alcohol, the better to understand and treat their health problems and their addiction.

It sounds reasonable. But according to Don McCanne of Physicians for a National Health Plan, America's Health Insurance Plans (AHIP), a leader in the resistance to the American health reforms, picked on Britain's socialized health program and blasted NICE for requiring doctors "to invade the privacy of every one of their patients by submitting them to a questionnaire on alcohol use." There is no such requirement, but McCanne says AHIP is simply doing its conservative Republican thing, defending the "waste of the superfluous insutsnce industry" in order to discredit any health reform as "socialist." I guess we should call this the "booze panel" scare.

Putting aside such silliness, it would be worth understanding how HHS intends to enforce the laws, something advocates have worried about because insurance companies have signaled their intent to poke holes in the reforms. Thus, according to Kaiser Health News, the administration has appointed four watchdogs, with plenty of experience dealing critically with insurance companies. The new director of the Office of Consumer Information and Insurance Oversight is Jay Angoff, a former Missouri commissioner. They'll be watching for unseemly premium increases, denials and cancellations of coverage and fraudulent sales pitches.

Finally, there is good news for Medicare Advantage, as well as original Medicare beneficiaries who can get eaten alive by deductibles, co-payments and other out-of-pocket costs. The reforms included changes for the better, including lower costs, in the 10 standard Medigap
plans that are now offered in most, but not all states.

The plans with increasing benefits range from A, the most basic, B,C,D, and F, the most popular, G, which is similar to F, and K. L M and N. You can check them out at www.medicare.gov .Depending on the level of coverage one needs and can afford, these plans are designed to fill the gaps in Medicare by paying co-insurance, co-payments, some deductibles and even needed blood transfusions, ambulance service. Medigap plans cover you through the nation and some plans include travel and overseas coverage. With such a policy, many beneficiaries pay virtually nothing towards the cot of their care. And Medicare plus Medigap can end up costing less than Medicare Advantage, which does mot have a great record when you're really sick

Write to saulfriedman@comcast.net Friedman also writes for www.timegoesby.net