The claim: "Ann Kirkpatrick raided Medicare to pay for Obamacare."
-- Republican congressional candidate Jonathan Paton, in press releases and ads.
The facts: Ann Kirkpatrick did vote for the Affordable Care Act (sometimes called "Obamacare") in March 2010.
The questions: Does Obamacare cut funding to Medicare, and, if so, in what ways? And how, if at all, does Paton propose to rein in Medicare spending?
The context: About 60 percent of the $585 billion spent on Medicare last year came from general taxes -- i.e., not from payroll taxes paid by employees and businesses. That percentage is not expected to go up in the next decade, but overall spending is projected to rise by several hundred billion dollars a year as Baby Boomers age, according to the most recent long-term budget projection by the nonpartisan Congressional Budget Office.
Here's what nonpartisan, nonprofit Factcheck.org, of the Annenberg Public Policy Center, states on the matter:
-- Republicans claim the president's $716 billion in total "cuts" to Medicare over the next decade hurt the program's finances. But the opposite is true. These cuts in the future growth of spending prolong the life of the Medicare trust fund, stretching the program's finances out longer than they would last otherwise. The reductions come primarily in reimbursement rates to hospitals and physicians for certain kinds of cases.
-- It's true that experts, including Medicare's chief actuary, doubt that some of those spending cuts will actually be implemented. But if they are, Medicare would spend less each year than it had been expected to otherwise, allowing Medicare to stretch further the income it receives from payroll taxes and premiums.
-- The biggest savings from the Affordable Care Act come from reductions in the future growth of payments to hospitals -- about $415 billion over 10 years.
To reach the $716 billion goal, Medicare proposes:
-- Cutting payments to hospitals when patients are re-admitted (including for things like hospital-acquired infections)
-- improving reporting
-- seeking advice from a board on how much to pay for what services
-- cutting payments to Medicare Advantage plans
-- paying physicians more when patients with serious problems remain healthy
-- targeting fraud
NO COMPREHENSIVE ALTERNATIVE
Paton has not outlined any comprehensive system of new health care policies that he supports. He proposes to repeal the Affordable Care Act, or "Obamacare."
He proposes limiting malpractice awards in lawsuits and having consumers buy insurance across state lines -- competition that is now absent from the marketplace.
"The problem is that we're not doing any of that now, and we've done nothing to cut costs except for insurance companies doing their own version of rationing or their own version of denial and rationing on the one hand," he told the Daily Sun. "And the government now, under Obamacare, is going to be doing the same thing, and they will be doing that with Medicare as well - clearly they are, because they have to pay for it one way or the other."
The Affordable Care Act opens new options for small businesses and individuals to shop for insurance from private insurers. It is somewhat different than what Paton proposes in a couple of ways.
If the legislation stands, it would require some insurance plans to cover more than they cover now (up to 80 percent of a patient's costs, for example, rather than more minimal amounts in "catastrophic" plans).
As to tort reform, Texas capped the amounts juries could award patients in litigation against physicians for malpractice some years ago, at $250,000, an article in The New Yorker by Atul Gawande reported in 2009. The number of lawsuits decreased substantially, Gawande reported.
Yet McAllen, Texas, had the most expensive health care costs in the nation in 2009.
Gawande tracked this not to malpractice costs but to more health care providers in that city competing to provide more pacemakers, do more surgeries, schedule more specialist visits and order more tests -- some of them unnecessary. In a similar-sized city several hundred miles away -- El Paso -- a more coordinated and cooperative health care community cut costs in half.
REJECTS OTHER WAYS TO CUT COSTS
As for other ways to slow Medicare's rising costs, several proposals by members of both parties would cap the growth in Medicare spending at a rate tied to the gross domestic product plus 0.5 percent.
Another would increase the Medicare eligibility age from 65 to 67, reducing Medicare spending by about 5 percent.
Paton said he does not support either of those proposals.
Another proposal would offer retirees a federal voucher to purchase private insurance, and some have called for replacing Medicare entirely with private insurance plans.
Paton said he opposes any plan to privatize Medicare or reduce benefits for current seniors.
But even though Paton says he would vote to repeal the Affordable Care Act, he says he does support the provision that requires either private insurers or a government-subsidized insurance exchange to sell affordable insurance to people with significant health problems, such as heart disease and cancer, even though they have been denied coverage in the past.
The Affordable Health Act has insurers able to afford to offer this new benefit because of the new policies they will write for healthier people as required in the law. Or, the government-funded exchanges will offer it.
Paton has not said specifically how insurers would offer affordable benefits to those with expensive, pre-existing conditions if Obamacare and its insurance coverage mandate are repealed.