Republicans routinely claim that shrinking the government’s involvement in health care would eliminate waste, inefficiency and significantly lower health care costs. But during the debate over the Affordable Care Act, these same politicians lambasted Democrats for cutting $500 billion from Medicare and Medicaid, and specifically argued that the government’s overpayments to private health insurance plans participating in Medicare Advantage (MA) were essential for preserving seniors’ access to services — particularly in rural areas. “The fact of the matter is, the bottom line, is that these are 10 million people that are going to lose benefits. And that’s what it boils down to,” Sen. Orrin Hatch (R-UT) warned during the mark-up process in the Senate Finance Committee.

Since President Obama signed reform into law, however, the GOP’s doomsday predictions have gone unrealized, and today a new report from the Government Accountability Office (GAO) shows that some private plans are still abusing the system and reporting higher patient severity than is actually supported by medical records. As a result, the government is paying private insurers substantially more than it spends on traditional fee-for-service Medicare:

GAO found that diagnostic coding differences exist between MA plans and Medicare FFS. Using data on beneficiary characteristics and regression analysis, GAO estimated that before CMS’s adjustment, 2010 MA beneficiary risk scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. The higher risk scores were equivalent to $3.9 billion to $5.8 billion in payments to MA plans. Both GAO and CMS found that the impact of coding differences increased over time. This trend suggests that the cumulative impact of coding differences in 2011 and 2012 could be larger than in 2010.

In contrast to GAO, CMS estimated that 3.4 percent of 2010 MA beneficiary risk scores were attributable to coding differences between MA plans and Medicare FFS. CMS’s adjustment for this difference avoided $2.7 billion in excess payments to MA plans. CMS’s 2010 estimate differs from GAO’s in that CMS’s methodology did not include more current data, did not incorporate the trend of the impact of coding differences over time, and did not account for beneficiary characteristics other than age and mortality, such as sex, health status, Medicaid enrollment status, beneficiary residential location, and whether the original reason for Medicare entitlement was disability. [...]

GAO’s findings underscore the importance of both CMS continuing to adjust risk scores to account for coding differences and ensuring that those adjustments are as complete and accurate as possible.

In other words, Republicans were wrong in trying to preserve the government’s subsidies for private insurers during the health care battle and they’d be foolish to stand in the way of more reforms now. Medicare Advantage can only be a viable option for seniors if it can help control health care spending. Eliminating waste, fraud and abuse from the program is crucial to improving Medicare’s sustainability and bending the cost curve.

Via Politico’s Pulse, a new report from John McDonough, formerly the executive director of Health Care for All, identifies 15 similarities between Romneycare and Obamacare:

As Families USA Executive Director Ron Pollack — whose group published the comparison — told Pulse, the Romney and Obama plans “are fraternal, and almost appear like identical, twins,’ Pollack said. ‘It is therefore quite strange for Gov. Romney to criticize, and to claim he will repeal, legislation that mirrors his own creation.” Read the full report here.

Don’t tell Mitt Romney or the Republicans who argue that Romneycare is the blueprint for the Affordable Care Act, but a new analysis of Massachusetts’ 2006 health care reform published yesterday in Health Affairs finds that the law has lowered the number of uninsured, increased employer-sponsored coverage, and reduced first-time emergency department visits. Here are the full results in four graphs:

1) Health insurance coverage among nonelderly adults in Massachusetts increased from 86.6 percent in 2006 to 94.2 percent in 2010. More than two-thirds of nonelderly adults (68.0 percent) also reported coverage through an employer. This is significantly higher than the level in 2006 (64.4 percent), before health reform:

2) In 2010 compared to 2006, nonelderly adults were more likely to have a usual place to go when they were sick or needed advice about their health (up 4.7 percentage points), and were more likely to have had a preventive care visit (up 5.9 percentage points), a specialist visit (up 3.7 percentage points), multiple doctor visits (up 5.0 percentage points) and a dental care visit (up 5.0 percentage points):

3) During the 2006–10 period there were drops in the shares of adults reporting a hospital stay and using the emergency department—the first shifts in those measures since 2006:

4) There have been gains in the affordability of care for adults since 2006, as evident in a lower burden from out-of-pocket health care spending (excluding premiums) and less unmet need for care because of cost. The share of nonelderly adults who reported high levels of out-of-pocket health care spending (10 percent or more of family income) was lower in 2010 (6.1 percent) than in 2006 (9.8 percent):

The state is still experiences gaps in coverage and Gov. Deval Patrick (D) is urging lawmakers to control costs by adopting reforms that reward providers for delivering care more efficiently But overall, “The Bay State’s 2006 health reform initiative has continued to fare well despite a severe economic downturn and the continued escalation of health care costs in the state” and the very dire predictions of many conservative pessimists.

The latest Kaiser Family Foundation tracking poll finds that Americans are still split on their support for the Affordable Care Act, “with a slightly higher share expressing an unfavorable (44 percent) rather than a favorable view (37 percent).” Half of all respondents still said they “prefer to either expand the law (31 percent) or leave it in its current form (19 percent), while slightly fewer would like the law repealed, either outright (22 percent) or repealed and replaced with a Republican‐backed
alternative (18 percent).”

Interestingly, the survey also explores why so many — 67 percent — oppose the individual mandate: the most common reasons offered in their own words include that the government shouldn’t be able to force people to do something they don’t want to do (30 percent), that health insurance is too expensive (25 percent), and complaints about the fine for non‐compliance (22 percent):

That top reason sounds an awful lot like a GOP talking point and may say more about the public’s general weariness for larger government than its distaste for this particular provision. But once the requirement kicks in and Americans realize that the law offers a wide array of coverage options without any singular government mandated plan, their trepidation about paying a penalty for going uninsured will likely dissipate.

An earlier Kaiser poll found that people become more supportive of the mandate once they learn more about it. Support substantially grew, for instance, once voters are told that “without the mandate, people might wait until they are seriously ill to obtain coverage, driving up insurance costs for everyone.” Another pro-mandate argument tips the public even more in favor of the provision: “Sixty-one percent of those surveyed support it when told most Americans would still get their coverage through their employers and thus wouldn’t be affected by the mandate.”