Summary

The conservative 60 Plus Association has launched a flurry of ads against 16 Democrats, many of them in tight House races. The group is spending more than $5 million – from donors whose identities it doesn’t have to disclose – to run the ads saying the lawmakers "betrayed" their constituents by voting for the health care overhaul signed into law earlier this year. That’s a matter of opinion, of course. But most of the ads also make statements that can’t be backed up, lack important context or are wrong.

Some of the ads say that the law means "seniors could lose their doctors" or that it "threatens seniors’ ability to keep their own doctor." But what the ads are talking about here has nothing to do with the new health care law. Some doctors have said they may stop accepting Medicare patients because of scheduled payment cuts set in motion by a 1997 law, cuts that are unaffected by the new statute.

All of the ads say that the new law cuts $500 billion from Medicare. It’s true that the law would restrain future growth of the program, but this isn’t cutting from existing spending. And the amount is spread over 10 years, totaling about 7 percent of what Medicare was projected to cost over that decade.

Many of the ads feature seniors saying the law will "hurt the quality of our care." But the law specifically forbids cuts in the basic package of Medicare benefits, and even adds some new features, such as wellness checkups. It also closes the "doughnut hole" gap in the prescription drug benefit.

Analysis

The ads have been rolled out over the last week in the congressional districts of Reps. Paul Kanjorski, Chris Carney and Kathy Dahlkemper in Pennsylvania; Tim Bishop and Scott Murphy in New York; Alan Grayson, Allen Boyd and Suzanne Kosmas in Florida; Steve Kagen and Ron Kind in Wisconsin; John Boccieri in Ohio; Ann Kirkpatrick, Harry Mitchell and Gabrielle Giffords in Arizona; and Joe Donnelly in Indiana. Roy Herron, a state lawmaker in Tennessee who is running against Republican Stephen Fincher, is the only non-incumbent so far who is a target of the ads.

The wording is very similar, but not identical, in the ads, which feature "local voices," according to 60 Plus. The group, which has sponsored other ads that we have called false opposing the health care law, claims to be "nationally recognized as the conservative alternative to the liberal AARP."

Rx: Lose Your Doctor?

Six of the ads say that "seniors could lose their doctors," or some variation of that language, as a result of the law. That’s not true.

[TET ]

60 Plus Association Ad: "Hurts – Kagen"

Person #1: Steve Kagen betrayed Wisconsin seniors.

Person #2: Instead of protecting us , he supported Nancy Pelosi’s liberal agenda.

Person #3: Kagen voted for Pelosi’s health care bill…

Person #1: …which cuts $500 billion from Medicare.

Person #2: That threatens our ability to keep our doctors…

Person #4: …and keep our health plans like we were promised.

Person #5: These cuts will hurt the quality of our care.

Person #2: Steve Kagen voted against Wisconsin seniors…

Person #1: …now it’s time for us to vote against him.

Announcer: 60 Plus Association is responsible for the content of this advertising. [/TET]

The ads are referring to scheduled cuts in Medicare reimbursement to doctors, which are steep enough to have caused some doctors to end participation in the program. But that’s not something in the new health care law. The cuts are mandated by a formula set up by the 1997 Balanced Budget Act.

Although the ads cite an April report from the office of the chief actuary of the Centers for Medicare and Medicaid Services as support for this claim, that report actually discusses cuts the law makes in payments to other providers, such as hospitals and nursing homes – not doctors. The required cuts could make it difficult for some such providers to stay in business, the report says, "possibly jeopardizing access to care" from those institutions for seniors.

But that report and another CMS document issued in August also note that Congress has a habit of negating such cuts. In fact, the August report says with respect to the legislated payment cuts to hospitals and other such non-physician providers, "Congress is very likely to legislatively override or otherwise modify the reductions in the future to ensure that Medicare beneficiaries continue to have access to health care services."

After all, the report notes, look what lawmakers have done to scheduled cuts to doctors’ pay that were mandated by the 1997 law: "Congress has overridden all of the scheduled reductions [for physicians] from 2003 to November 2010," the report says. And for the hospitals and other providers covered by the new law: "Congress would presumably act to adjust Medicare payment rates as necessary" before the providers withdrew from the program.

So, number one, the new law has nothing to do with scheduled physician payment cuts, the threat of which some doctors say is driving them out of Medicare. Two, since 2003 Congress hasn’t let those scheduled cuts happen anyway. And three, that’s exactly why CMS says cuts to other, non-physician providers that are in the law aren’t likely to happen either.

We spoke with Ellen Griffith Cohen, a CMS spokeswoman, and she reminded us that the most recent scheduled cut for physicians was a steep one: 21.3 percent. It was postponed in June for the fourth time, she noted – after it had briefly gone into effect – and Congress even gave the docs a 2.2 percent increase. (The latest postponement and the raise are only good through Nov. 30, she told us, meaning Congress will have to act again or doctors will get 23.5 percent less for a procedure come Dec. 1 than they did the day before.)

That $500 Billion Knifing

Every one of the ads notes that the law cuts Medicare by $500 billion. But that’s misleading, as we’ve pointed out time and again. The law calls for $555 billion in cuts in future growth of the program – over 10 years. The total projected cost of Medicare over that time, according to the nonpartisan Congressional Budget Office, is $7.1 trillion, even with the cuts.

CBO predicts that federal outlays for Medicare in fiscal year 2020 will be $929 billion, compared with projected spending of $519 billion this year. So the program isn’t being cut below existing levels, or even stopped in its tracks. It will simply grow slightly less than it would have otherwise – about 7 percent less.

Quality of Care

Most of the ads have seniors saying the new law "will hurt the quality of our care."

But in fact, Medicare’s basic benefits package will be getting better. The new law says seniors will be entitled to free preventive care. Also, the law closes a "doughnut hole" in the Part D prescription drug plan that prevented coverage of medication costs after an individual and his or her plan had spent $2,830. Coverage resumed after the beneficiary spent $4,500 out-of-pocket. The law gradually shrinks the gap until, by 2020, it’s gone.

In addition, the law specifically protects seniors’ benefits. Section 3601 says that nothing in the statute "shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act" (that’s the part of the U.S. Code that establishes the Medicare program). It’s true that about one-quarter of Medicare recipients could lose some or all of the additional benefits that they receive through what are called Medicare Advantage plans, but that’s not the same as getting lower quality care. And the vast majority of seniors will see benefits increase.

The ad running against veteran lawmaker Kanjorski, as well as some of the others in 60 Plus’ sights, says that he "voted for Nancy Pelosi’s big government health care plan." Whether it’s a "big government" plan or not is opinion. 60 Plus chose its words with a bit more care than those who say the law creates "government-run health care," for example. But we’ll note, once again, that just as before the law, private physicians, hospitals and other providers will continue to be the main sources of medical care in the U.S. And except for those who are Medicare and Medicaid beneficiaries, people will be covered by private insurers. Because the law requires everyone to have health insurance, in fact, insurers will have more customers than ever before.

Most of the ads conclude with someone looking at the camera and pretending to tell the targeted lawmaker, "You’re fired!" Our question is, who gets fired for making misleading ads?

— by Viveca Novak

Sources

Grayson, Audrey. "Docs Bailing Out of Medicare, Medicaid." ABC News. 8 July 2008.

Foster, Richard. "Estimated Financial Effects of the Patient Protection and Affordable Care Act, as Amended." Office of the Actuary, Centers for Medicare and Medicaid Services, Department of Health and Human Services. 22 April 2010.

Shatto, John D. and M. Kent Clemens. "Projected Medicare Expenditures under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers." Office of the Actuary, Centers for Medicare and Medicaid Services, Department of Health and Human Services. 5 Aug 2010.

Novak, Viveca. "Misdirection from Crossroads GPS." FactCheck.org. 30 Aug 2010.

Congressional Budget Office. "The Budget and Economic Outlook: An Update." August 2010.

Span, Paula. "In the Doughnut Hole? The Check’s in the Mail." The New York Times. 18 June 2010.

Cohen, Ellen Griffith. Spokeswoman, Centers for Medicare and Medicaid Services. Interview with FactCheck.org. 16 Sept 2010.

Wolf, Richard. "Doctors Limit New Medicare Patients." USA Today. 21 June 2010.

Pepitone, Julianne. "Congress Reverses Medicare Cuts." CNN.money.com. 24 June 2010.

Ohlemacher, Stephen. "Congress votes to spare doctors Medicare cut — for now." The Associated Press. 24 June 2010.

Herszenhorn, David. "House Passes Plan to Stop Medicare Cuts to Doctors." The New York Times. 24 June 2010.