At the American Prospect:
The Affordable Care Act did in fact reduce spending on Medicare. It did so through a variety of means both large and small, but the two biggest savings came through an end to the overpayments taxpayers were giving to private insurance companies through Medicare Advantage, and reduced payments to hospitals. The hospitals agreed to those reductions in large part because the fact that the ACA insures so many more people means that they’ll make up the income elsewhere, by not having to treat so many uninsured patients who can’t pay. Those two items make up about two-thirds of the Medicare savings in the ACA; the rest comes from a measures like reduced payments to some other providers and a crackdown on Medicare fraud. But none of the savings involve taking anything away from beneficiaries.
Not only that, the opposite is true. Romney is partly right that the money from these savings is going to people other than seniors, since some of it does go toward expanding coverage for people who aren’t on Medicare. But some of those savings also goes to pay for increased benefits for Medicare beneficiaries. The ACA provides preventive care for seniors with no cost-sharing (i.e., no co-pays or deductibles), which the government says 16 million seniors took advantage of in the first half of this year. It also closed the prescription drug “doughnut hole,” saving many beneficiaries hundreds of dollars in drug costs. What that means is that under the “cuts” to Medicare from the ACA, seniors now have more benefits than they did before. The savings have also extended the life of the Medicare trust fund.
So while the ACA did cut Medicare, it did so in ways that didn’t reduce benefits for seniors, and increased those benefits in other ways. Romney is now saying he’ll “restore” the money to Medicare by repealing the entire Affordable Care Act, which actually means imposing more costs on seniors (re-opening the doughnut hole, bringing back cost-sharing in preventive care).
. . . if Mitt Romney were to succeed in repealing the ACA, Medicare’s cost problem would worsen considerably. His answer is that we can solve the problem by 1) waiting for the market to bring down costs, and 2) forcing seniors to pay more for whatever the market doesn’t take care of.
That then leads to the most significant practical difference in the approaches taken by Obama and Romney. Through the Affordable Care Act, Obama uses a variety of means–dozens of them, actually–to attempt to bring down costs within the existing program. But he does it while retaining Medicare’s guarantee of coverage. Romney, on the other hand, explicitly refuses to entertain changes within Medicare itself. He doesn’t propose changing the way Medicare pays for care, or suggest any pilot programs or any incentives to lower costs. Instead, he hopes that that competition with private insurers is all that’s necessary to bring those costs down. If that doesn’t work, his plan will shift more and more of the expense onto the seniors themselves. One approach says we can shape this program to make it work as well as possible and use it to leverage the kind of changes we’d all like to see in the broader health care market. The other says if we just get government out of the way, the market will produce optimal results on its own. The Obama approach includes some uncertainty; improving on a large and complex government program isn’t easy, and it’s likely that some of the reforms in the ACA will work better than others. So it’s possible it won’t succeed. But if Romney was right, the private insurance market would already be outperforming Medicare. And we know that hasn’t happened.