Tom Carper, U.S. Senator for Delaware

Affordable Care Act Frequently Asked Questions

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Will my Medicare benefits be cut?
The health care reform law does not cut any benefits that are required under the Medicare program. In fact, Congress added benefits to the Medicare program such as annual wellness exams. The law also eliminates out of pocket costs for recommended preventive care services and screenings. return to top
I am a senior on Medicare Part D Prescription Drug Plan. When will I get help with my prescription drug costs?
The law will addresses the so-called "donut hole," which is the gap in Medicare Part D prescription drug coverage that can leave seniors paying as much as $3,500 out of pocket for costly medications until catastrophic coverage kicks in. This year, the law provides a $250 rebate check to all seniors who hit the "donut hole" during 2010. Beginning in 2011, the law provides a 50 percent discount on brand name drugs purchased in the "donut hole" and fills this coverage gap by 2020. return to top
Are members of Congress "exempt" from participating in reforms included in the law?
No; quite the opposite. Members of Congress currently purchase health insurance benefits through the Federal Employees Health Benefit Program, along with about 8 million other federal employees and their families. Under the law, members of Congress and Congressional staff will have to purchase their health insurance coverage through the newly created Exchanges with the same rules and regulations that apply to other individuals participating in the Exchange. return to top
What is in the bill that I haven't already heard about in the media?
What got lost in that firestorm were positive, albeit lesser known, provisions that will help Americans lower their health care costs by incorporating healthy habits into their lifestyles. This is important because we know that when people take better care of themselves, their health care costs go down.

One of these provisions is one that I worked very closely on. Last year, I led a bipartisan effort to require chain restaurants to list calories on their menus and menu boards, and provide additional nutritional information upon request. return to top
What is an "Exchange" and how will it work?
You are probably hearing a lot about Exchanges; but if you have Medicare, you will not use these Exchanges. Through the health care reform law, states and/or regions will set up an Exchange, which is an online marketplace where Americans without insurance will be able to purchase coverage, possibly with the help of a tax subsidy based on their income level. In short, it is a place for consumers to shop for health insurance, with the assurance that they will get a quality product with a guaranteed level of benefits. Because the Exchanges will encourage a large purchasing pool with lower administrative costs, a wide range of health care coverage should be available at a reasonable price. return to top
I am a retired senior and have my current prescription drug plan through my former employer, but I hear that I will be forced onto the government prescription drug plan from the new law. Is this true?
No. No one will be forced into a government prescription drug plan under the health care reform law. For more information on the new health reform law please visit here and here. return to top
Does the Senate health care bill increase the national debt?
No. If fact, the nonpartisan Congressional Budget Office has estimated that the legislation (the Affordable Care Act) will actually reduce the federal deficit by $124 billion in the first decade and up to $1.2 trillion in the second decade. return to top
How can you improve services and cut $500 billion out of Medicare?

One of the best ways to improve the quality of Medicare services and ensure that we have the money to maintain it for our children and grandchildren is to reduce waste, fraud and abuse and make Medicare more efficient and effective. As we worked to improve Medicare we identified areas of "fat" to trim that would make Medicare work better and save taxpayers money while maintaining all of the Medicare benefits that seniors depend on. I believe we've been very successful in that effort and the nonpartisan Congressional Budget Office has stated that there is $455 billion of savings from Medicare in the Affordable Care Act.

One of the ways our health care reform law saves taxpayers money is by making changes to the Medicare Advantage program, which allows private insurers to offer seniors private Medicare plans in lieu of traditional Medicare. Medicare Advantage is not widely used in Delaware, but it is prevalent in some states.

Before health reform became law, the federal government overpaid the insurance companies that offer Medicare Advantage plans by an average of 14 percent, and much more in some areas of the country. In other words, private plans were paid an average of 14 percent more to offer the exact same benefits as the traditional Medicare program. These private plans gamed the current Medicare payment system in ways that drive up the cost of Medicare. These overpayments have made Medicare Advantage a very profitable line of business for some of the nation's largest health insurance companies but it hasn't been a good use of taxpayer dollars. That's why I believe we did the right thing by reducing these over payments to private insurance companies who offer Medicare Advantage plans.

In addition to curbing these overpayments to private insurance companies, we also realized some of the $455 billion of savings from the Medicare program by making the health system more efficient. In general terms, the more efficient you are, the less money you spend. The Affordable Care Act includes several policies that will save the Medicare program money, not by cutting programs or reducing the quality of care, but by promoting care coordination and more efficient ways to deliver health care services. Here are a few examples:

  • Establishes pilot programs that will bundle health care provider payments as a lump sum fee, instead of paying a fee for each service. This will encourage care coordination, efficiency and general costs savings for the Medicare program.
  • Establishes a Centers for Medicare and Medicaid Services Innovation Center to develop and expand new patient-centered payment models to encourage evidence-based, coordinated care for Medicare and Medicaid.
  • Encourages hospitals and doctors to get it right the first time by reducing unnecessary hospital readmissions through payment reductions for hospitals with high preventable readmission rates for select conditions. Nearly 20 percent of Medicare patients who are discharged from the hospital are readmitted within 30 days. Estimates have shown that the Medicare program spent $12 billion on potentially preventable hospital readmissions in 2005.
  • Hospital acquired conditions, such as preventable infections, are among the top ten leading causes of death in the U.S. and drive up costs of health care by $28 to $33 billion per year. The Affordable Care Act will adjust payments for hospitals with high rates of hospital acquired conditions.
  • Establishes a voluntary Medicare shared-savings program (also called accountable care organizations), which allows health care providers to coordinate care across health care settings and share savings.
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How does the law go after Medicare fraud and abuse?
Each year, billions of dollars needed for our senior's medical care is siphoned off by crooks defrauding the system. For example, the FBI has found cases across the nation, where organized crime sets up fake companies posing as medical equipment suppliers, bills Medicare and collects millions in fraudulent payments. Reducing this kind of fraud and abuse in Medicare, and throughout the federal government, is a top priority of mine and something I've worked on for several years. I successfully fought for several important tools to help curb fraud and abuse in Medicare and Medicaid that were ultimately included in the health reform law.

The new law establishes stricter rules for screening health care suppliers, and also changes Medicare laws so payments are withheld when there is credible evidence of fraud. Medicare and law enforcement agencies will also develop smarter electronic databases to better track the hundreds of millions of dollars in daily payments to health care providers. This will allow for improved techniques where patterns of fraud are uncovered using advanced technology, as well as allowing Medicare to find billions of dollars in waste due to simple payment errors.
I am also very excited that the new health care law will require the expansion of an innovative and successful tool, developed for use in the private sector, to recover improper payments made to Medicare providers. Recently, a pilot program recouped almost a billion dollars in Medicare overpayments by contracting with private companies skilled at rooting out waste in the health care system. The new law will expand the recovery audit contractor program for all of Medicare, as well as Medicaid. This program comes at a very inexpensive cost to the federal government, with fees paid to private sector auditors based on a small percentage of the recovered funds. return to top
What is the Patient Centered Outcomes Research Institute? Is this based off of Great Britain's National Institute for Health and Clinical Excellence (NICE) and won't this lead to rationing of health care?
The health care reform law creates a new, private, non-profit entity called the Patient Centered Outcomes Research Institute (PCORI). The Institute was developed after working with stakeholders from across our health care system and its goal is to provide better information on which treatments are the most effective, in a way that benefits both doctors and their patients. It is not based off of the UK's National Institute for Health and Clinical Excellence (NICE) and there are several important ways in which they differ.

The PCORI explicitly prohibits rationing of care and it will not interfere with the patient-doctor relationship. Unlike the UK's NICE, any findings from the PCORI are prohibited from being used as mandates on practice guidelines or coverage decisions. Additionally, the new law contains patient safeguards so that coverage decisions made by the U.S. Department of Health and Human Services cannot be based on age, terminal illness, or an individual's quality of life preference. In other words, the research from the PCORI will not lead to any rationing of care - the Institute is prohibited, by law, from forcing doctors, insurance companies, or the Department of Health and Human Services to change their practice guidelines or coverage decisions.

I recognize that the personal relationship between a doctor and a patient is sacred and the new law maintains and strengthens that relationship. With more information about which treatments are effective and which are not, doctors will be able improve their patients' health outcomes. return to top