The mandate to buy health insurance is the one thing everyone seems to know about Obamacare. Without the mandate, insurance companies cannot afford to offer coverage to everyone irrespective of their heath condition.  If the mandate is deemed unconstitutional by the Supreme Court, they will then need to decide if everything that comes under the Affordable Care Act must also be canceled.

Here are some of the Medicare-related parts of the Affordable Care Act that would go down with Obamacare. The list is provided by  Patients Aware.org.

IN GENERAL, through a long list of programs and policies, the Affordable Care Act saves Medicare about $450 billion in the first decade, mostly through agreed upon reductions in payment rates for inpatient hospitals, long-term care hospitals, home health services, skilled nursing facilities, and other providers, as well as reduced subsidies to private Medicare Advantage plans.

PART D
• Closes the donut hole in the Part D prescription drug program.
• Provides a 50 percent discount for brand name drugs beginning in 2011 for seniors in the donut hole, regardless of income.

MEDICARE
• Eliminates cost-sharing for proven preventive services.
• Provides a comprehensive annual wellness visit and personalized prevention plan.
• Improves seniors’ access to primary care by providing bonus payments to primary care providers.
• Establishes initiatives to encourage the development of a more efficient health care delivery, especially for seniors with multiple chronic conditions.
• Provides transition services to high-risk Medicare beneficiaries when they are discharged from the hospital.
• Helps seniors living in rural areas by making sure their physicians are adequately paid.

MEDICARE ADVANTAGE
• Phases down subsidies for Medicare Advantage plans over time so that, on average, plans will ultimately receive payments comparable to what it would cost traditional Medicare to cover the same seniors.
• Requires all Medicare Advantage plans to spend at least 85 percent of revenue on senior care rather than profits or overhead, beginning in 2014.

MEDICARE FRAUD
• Includes new resources and tools to protect taxpayer dollars by preventing fraud in Medicare and Medicaid.
• Allows the Department of Health and Human Services to share IRS data to help screen and identify fraudulent providers.
• Strengthens oversight of Durable Medical Equipment providers.
• Increases overall funding for the Health Care Fraud & Abuse Control Fund to $700 million over the next decade.

Under health care refom, preventative services regulations require coverage for a broad category of preventive services, including:

• immunizations
• blood pressure and cholesterol screenings
• diabetes screening for hypertensive patients
• various cancer and sexually transmitted infection screenings
• depression screenings
• tobacco cessation programs
• obesity screening and counseling, as well as other services

Plans can no longer charge a patient a co-payment, coinsurance or deductible for these services when they are delivered by an in-network provider.

Additionally, on August 1, 2011, the Department of Health and Human Services (HHS) issued new guidelines on Women’s Preventive Health Services that require non-grandfathered group and individual health benefit plans (including Student Health Plans) and issuers to provide preventive services without cost sharing. This regulation applies to group health plans in the first plan year that begins on or after August 1, 2012 (in the Individual market, by policy year). These services include:

• well-woman visits;
• screening for gestational diabetes;
• human papillomavirus (HPV) DNA testing for women 30 years and older;
• sexually-transmitted infection counseling;
• human immunodeficiency virus (HIV) screening and counseling;
• FDA-approved contraception methods and contraceptive counseling;
• breastfeeding support, supplies, and counseling; and
• domestic violence screening and counseling.

Yesterday, I was talking with a client who has a Medicare supplement Plan F and a stand-alone Part D plan.  Kathy was telling me how tough things are financially now that her husband, who is 70, got laid off from his job.

Kathy and her husband are living on their Social Security, and their combined income is around $23,000 per year.  She said they spend $9,600 on their Medicare premiums, their Medicare supplements, their Part D plans, and drug co-pays all together.  They are going through their retirement savings to keep their heads above water.

Kathy told me that politicians in Washington don’t seem to realize how frightening the future is for people like her and her husband.

Later in the day, I read about the latest proposal by Republican Congressman Paul Ryan to privatize Medicare and push more costs onto elderly and disabled Americans.  The central ideas in the Republican plan are:  1) Limit government responsibility for the cost of Medicare;  2) Make people covered by Medicare pay more of their health care costs;  3) Turn Medicare over to private insurance companies (turning the program into a for-profit business).

Rick Ungar, who writes a blog for Forbes, wrote a review of the latest Republican plan for Medicare, and I share some of his thoughts with you:

The proposal would create an Obamacare style health exchange system (seriously) where seniors would go shopping for their health insurance policies. And just as is the case with Obamacare, insurance companies seeking to participate on the exchanges would be required to follow federal government regulatory standards and meet minimum coverage requirements in their offerings.

…the Ryan plan turns on the concept of government provided subsidies, in the form of vouchers, to assist seniors in paying for their care.

…According to the non-partisan Congressional Budget Office (CBO), under the Ryan proposal, a senior aged 65 could end up paying 68 percent of the cost of their health care out of their own pocket by the year 2030. That’s quite a change from how things work today with good, old-fashioned Medicare—and it is a change that should frighten even the most stalwart small-government fanatic.

…The only way RyanCare makes any sense is if we are prepared, as a society, to let our elderly die because they have been priced out of the health care market. That may be okay with some of you – but it will never be okay with me and it will never be okay with America’s senior citizens, now or in the future.

Then I thought about Kathy and her husband, two people who worked hard all their lives and saved some (but probably not enough) money for their retirement. They are very frightened by the future because they’re spending around 40% of their income on health care costs and coverage. They are spending down their retirement savings for their living expenses – and they don’t know how long their retirement funds will last.

Republicans are positioning their Medicare plan by saying Americans who are 55 and older won’t be affected by changes to the program. Republicans are betting that current senior citizens will say, “I’ve got mine,  so I don’t care about younger people”. But I’m betting that a lot of people like Kathy and her husband – who are very conservative when it comes to politics – understand how financially tough the current Medicare system is, and would not wish an even more costly program on anybody, especially their children and grandchildren.