Fighting Fraud and the Consequences of Defunding the Affordable Care Act

Today, the Department of Health and Human Services will make an important announcement about the new steps it is taking to fight waste, fraud and abuse in the Medicare program.  The new anti-fraud efforts were made possible by the Affordable Care Act, and they will build on the Administration’s existing efforts to save money for Medicare beneficiaries, strengthen the Medicare program and protect taxpayer dollars. 

But if some opponents of health reform in Congress get their way, these common sense rules will be stopped dead in their tracks.

Opponents are threatening to defund the Affordable Care Act, which would effectively handicap implementation and enforcement of these new rules that would help crack down on criminals and protect seniors.

This is just one example of the consequences of defunding the Affordable Care Act and one of the many reasons why we can’t afford to roll back the new law. If opponents of reform get their way, new anti-fraud policies aren’t the only provisions that will be prevented from moving forward.

Consumers Would Suffer: This week, critical new consumer protections in the reform  take effect. The Patient’s Bill of Rights:

• Bans discrimination against kids with pre-existing conditions.
• Allows young adults to remain on their parents’ plan until their 26th birthday.
• Prohibits insurance companies from cutting off your coverage when you’re sick if you made a mistake on your application.
• Prohibits insurance companies from putting a lifetime limit on the amount of coverage you may receive, and the use of annual limits will be restricted until they are banned completely in 2014.
• And if you join a new plan:
  • You have the right to choose your own doctor in your insurer network. 
  • Your insurer is banned from charging more for emergency services obtained outside of their network. 
  • You will be guaranteed the right to appeal insurance company decisions to an independent third party. 
  • You will receive recommended preventive care with no out-of-pocket cost.  Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered, and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance.

If the Affordable Care Act is defunded, the Patient’s Bill of Rights would be an empty promise. There would be no federal oversight of insurance companies’ compliance with the Patient’s Bill of Rights, leaving consumers exposed to insurance industry abuses.  Defunding or repealing of the Affordable Care Act, will breakdown critical consumer protections and cost savings, and insurance companies would—once again—have free rein to hijack premiums.

Employers Would Pay More for Insurance Benefits: The Affordable Care Act includes $40 billion in tax credits to help as many as four million small businesses that provide health benefits to their employees. If the Affordable Care Act was repealed or defunded, small businesses would lose out on these credits.

The law also includes cost savings measures that will improve the quality of care and could save up to $3,000 per worker for large businesses that would not go forward if the Affordable Care Act was repealed or defunded. 

And private health insurance Exchanges that give small businesses the same buying power as larger businesses would never be established if the law is rolled back.

States Would Be Denied Tools to Hold Insurance Companies Accountable: Across the country, 46 states are using new resources provided by the Affordable Care Act to strengthen their oversight of health insurance premiums and crack down on unjustified rate hikes. If the Affordable Care Act was defunded or repealed, additional resources to protect consumers from premium hikes would disappear.

And state efforts to establish private health insurance exchanges where consumers would have access to affordable insurance and the same choices as members of Congress would come to a halt.

The Bottom Line: For too long, consumers have struggled to get the care they need and insurance companies, not doctors and patients have been in control of your health care. Businesses have struggled under the weight of high health care costs. And we have all suffered as premiums have skyrocketed.

The Affordable Care Act helps move us forward and strengthens our health care system. Now is not the time to go back.

Stephanie Cutter is Assistant to the President for Special Projects