Two of the central promises of President Barack Obama's health care overhaul law are unlikely to be fulfilled, Medicare's independent economic expert told Congress on Wednesday. The landmark legislation probably won't hold costs down, and it won't let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. His office is responsible for independent long-range cost estimates.
Foster not only works for the Obama administration but is also in fact the administration's principal authority on Medicare and Medicaid spending. Elsewhere, he has estimated that, under Obamacare, the cost of Medicaid would more than double by the end of this decade, from $405 billion in 2010 to $840 billion in 2019 -- as Obamacare would add what Foster estimates to be "about 20 million" people to the Medicaid rolls. Moreover, he has warned that, under Obamacare, Medicare's reimbursement rates to health care providers would fall below even the notoriously low Medicaid reimbursement rates, thereby seriously jeopardizing Medicare enrollees' access to care.
Obamacare's more than $2 trillion price tag in its real first decade (aside from relatively minor changes made through the "reconciliation" process, this chart shows how Obamacare's spending would proceed) would be paid for, to the extent that it actually would be paid for, through a relatively even blend of tax increases and Medicare cuts. As Foster makes clear, you can't cut something that deeply without feeling the results in a profound way.
Dr. Herbert Pardes, president and CEO of New York-Presbyterian Hospital, the 6th-ranked hospital in the world according to U.S. News and World Report, echoes this opinion, warning: "I think there's a very real concern about having adequate numbers of Medicare doctors." Pardes says, "I think they [patients] will see delays in the timing of their appointments. I think a number of doctors who've been frustrated because of the Medicare fee level will actually stop taking Medicare [patients]. So that's a real worry for all of us."