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Q: I supported health care reform and was so elated when it passed, however . . . Now I hear of cuts in payments to doctors for Medicare. Many doctors refuse Medicare patients already, but with more cuts there will be no medical care for seniors. Supplement plans won't cover anything that Medicare doesn't cover, or doctors that don't take Medicare. Health insurance for seniors is a near impossibility. So does health care reform mean health care on the back of seniors?

A: No. Many people with Medicare have heard that their doctors are facing a substantial decrease in their Medicare payments. This decrease is unlikely to actually happen and is unrelated to health reform. In fact, the Affordable Care Act provides a 10 percent increase in Medicare payments for primary care providers.

The problem with doctors’ payments and Medicare stems from a payment mechanism for doctors called the sustainable growth rate (SGR) enacted by Congress in 1997. After a few years, it became evident that the payment formula was flawed and was leading to steep reductions in Medicare’s payments to doctors. In response, Congress has delayed these reductions from happening almost every year for the last seven years. Unfortunately, Congress has not replaced the formula with a new one. As a result, doctors now face a more than 20 percent payment reduction if Congress does not act. It’s very likely that Congress will pass another extension that prevents the payment reductions from actually taking place. Hopefully, over the next year or so, Congress will come up with a longer-term solution.

There have been some media reports that people with Medicare are having a hard time finding doctors. But, a recent study by the Medicare Payment Advisory Committee—the committee that advises Congress on how Medicare should pay for services—shows that people with Medicare are not having a harder time finding doctors then the privately insured population. People with all forms of insurance sometimes have trouble finding a doctor, because there are not enough primary care doctors and other types of doctors in some parts of the country. To address that, the Affordable Care Act makes significant investments in new and existing programs that will increase the number of health care providers and clinics where people will be able to get needed health care services.

The Affordable Care Act dedicates $11 billion over the next 5 years to build new and expand existing community health clinics. It also dedicates $1.5 billion to bring more primary care providers to areas where there is a shortage of these providers. The health reform law also makes key investments in creating new or expanding existing scholarship, loan repayment, and training programs to attract more people to become doctors, nurses, dentists, and other health care professionals. Finally, the law establishes new workforce commissions at the state and federal levels that will be responsible for monitoring the health care workforce, determining what needs there may be and where, and advising Congress on how best to address any needs of the health care system.

Unfortunately, opponents of the Affordable Care Act have been relentless in their attacks and seniors and people with disabilities have been disproportionately subjected to lies and misinformation leaving them with the impression that health care was improved for others at their expense. But that isn't true. Medicare has been improved through the Affordable Care Act. The long-term sustainability of the program has been extended by 12 years and people with Medicare will see improvements to their benefits, including closing the prescription drug doughnut hole and free preventive services like cancer screenings.

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