Obamacare Will Play A Role In Determining What Care Patients Get
The media "fact check" business is incredibly tiresome given how pedantic and downright inaccurate it is, but I wanted to weigh in on this one before it hardens. The LA Times somehow thinks that the ACA (aka Obamacare) will have no effect on determining what care patients can get, and consequently dings Romney for saying it will. There isn't a single honest health economist out there who agrees with the LA Times on this one.
First, the "exchange" market place that the ACA creates explicitly regulates the services covered by private insurance plans. Changes in these sorts of regulations have a direct effect on what care patients get -- if insurance does not pay for something, you can be sure most doctors will not do that thing. You can get some hint of this if you recall the stories about Obamacare requiring health plans provide contraceptives for "free."
Second, as both Romney and Obama acknowledged in their debate tonight, the ACA establishes the Independent Payment Advisory Board (IPAB), which is responsible for implementing the $700 billion+ cuts to Medicare -- the government health insurance plan for the elderly -- imposed by the ACA. The IPAB will consist of 15 unelected bureaucrat/experts and it will require a 3/5ths majority of Congress to undo their decisions. The vast bulk of these cuts start after 2014, which is why this has not yet become a big issue (until the debate tonight, that is).
It is true that the IPAB is not allowed to "ration" care , but they have to find some way to cut that money (and no, there's not enough in "waste, fraud, and abuse" to fund it unless you mean something very expansive by "waste"). Most expert observers believe that IPAB will do two things to cut that money: (1) reduce payments to Medicare Advantage plans, which means that up to a quarter of the elderly population of the U.S. may have to start looking for a different insurer; and (2) cut payments to doctors who take Medicare patients. The main consequence of the second strategy will be that it will be harder for elderly patients to find care even though they are covered by Medicare. Thus, the LA Times notwithstanding, Obamacare will have the effect of determining what care patients receive.