One group who loses from PPACA-those folks on Medicare Advantage

Patients enrolled in the Medicare Advantage ( MA) program will loose under PPACA.

The Chief actuary of CMS in his Jan 10, 2010 letter ( see here) estimated that enrollment in the MA program would decrease from the current 13.7 million to 9.2 million by 2015, a decrease of 4.5 million due to changes in the MA program as outlined in section 3201 of PPACA. Other estimates are significantly higher -up to 7 million.

The displaced MA patients can go to regular Medicare but they will need to buy Medicare supplement policy to approximate the coverage they received in their MA plan. I don't see the AARP, who supported the health care bill, complaining about that as they will be available to act as broker for those deals and they supported passage of PPACA. Many of the current MA patients signed with MA because they decided they could not afford the medicare supplement policies.These folks will have more out of pocket payments now if they still cannot afford the extra insurance.

So, for some of the MA patients there will be either the increased cost of a Medicare supplement or paying the 20% typically not paid for by Medicare out of pocket or simply forgoing some medical care.

If one accept accept a utilitarian perspective, then throwing some under the bus to get more to ride inside is might be considered acceptable figuring that more folks are helped than those who are injured. Leaders and spokespersons for AMA and ACP have expressed pride in their roles in supporting a bill that they characterize as furthering "social justice". Millions of seniors will be forced out of Medicare Advantage with the associated financial loss and many more Medicare seniors will have decreased access to primary care physicians as the insurance exchange,newly insured compete for a shrinking population of primary care physicians for which PPACA offers no substantive solution. A insurance card is not equivalent to medical care. If the thought leaders in AMA and ACP think past stage one and consider the longer term effects of the health care bill, will their claim of furthering social justice be validated? I would enjoy hearing what they would say.