FARGO - It's a confusing, 974-page law that's been kicked around like a political football since President Barack Obama signed it into law on March 23, 2010.
North Dakota's candidates for U.S. Senate have wrangled over it in debates and campaign ads.
But who's telling the truth about the Patient Protection and Affordable Care Act, commonly known as Obamacare?
To sort through the rhetoric, The Forum consulted FactCheck.org, which bills itself as a nonpartisan, nonprofit "consumer advocate" for voters that aims to reduce the level of deception and confusion in U.S. politics.
FactCheck.org is a project of the Annenberg Public Policy Center of the University of Pennsylvania. In 2010, FactCheck.org won an award from the Society of Professional Journalists for reporting on deceptive claims made about the health care law.
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$716 billion question
U.S. Rep. Rick Berg, R-N.D., claims Obamacare will take $716 billion out of Medicare.
Former North Dakota Attorney General Heidi Heitkamp, a Democrat, has called that "the biggest fib in this whole campaign."
Here's what FactCheck.org says:
"Republicans claim the president's $716 billion 'cuts' to Medicare hurt the program's finances. But the opposite is true. These cuts in the future growth of spending prolong the life of the Medicare trust fund, stretching the program's finances out longer than they would last otherwise."
FactCheck.org says it's true that experts, including Medicare's chief actuary, doubt that some of those spending cuts will actually be implemented.
"But if they are, Medicare would spend less each year than it had been expected to otherwise, allowing Medicare to stretch further the income it receives from payroll taxes and premiums."
FactCheck.org acknowledges that to some voters, it may sound counter-intuitive that cutting money from Medicare would improve its finances, and it explains how it would work:
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"The biggest savings from the Affordable Care Act come from reductions in the future growth of payments to hospitals - about $415 billion over 10 years. That's Medicare Part A. Income for Part A comes mainly from payroll taxes. If Medicare doesn't need to spend that income immediately, it's credited to Part A's trust fund, and Medicare gets a Treasury bond that it can cash in later. Anytime Medicare needs to cash in that bond, Treasury must pay it. Even if Treasury spent the original money on something else, it must pay the bond.
"So, campaign claims that imply that Obama has taken money out of Medicare, and Medicare won't ever get it back, are simply not true."
Solvency of Medicare
Berg has said Obamacare will bankrupt Medicare within 12 years. Heitkamp counters that repealing Obamacare, as Berg wants to do, will make the system insolvent in four years.
According to FactCheck.org:
"Without the spending cuts in the Affordable Care Act, the Part A trust fund was expected to be exhausted in 2016. With the ACA cuts, that date was pushed back to 2024," FactCheck states.
The official government website Medicare.gov also states that the Affordable Care Act ensures the protection of Medicare for years to come.
"The life of the Medicare Trust fund will be extended to at least 2029 - a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance," the website states.
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Deciding for patients?
Berg has said the law would create an unelected board that will decide what care is covered and what's not, and that it will "ration care for seniors."
But the law specifically states that the Independent Payment Advisory Board can't ration care or determine which treatments Medicare covers, FactCheck.org points out, citing the act: "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary costsharing (including deductibles, co-insurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria."
Still, the board, which will consist of 15 health care experts nominated by the president and confirmed by the Senate, will have the authority to make cuts to Medicare if annual spending is greater than the targets set in the law. Congress can reject the board's recommendations, but it will need a supermajority in the Senate to do so.
Berg is far from alone in his criticism of the board. More than 70 House Democrats opposed the board when the law was being drafted, keeping it out of the House version of the bill, and the American Medical Association adopted a resolution calling for its repeal, the Washington Post reported.
Frontier amendment
Heitkamp has said her No. 1 reason for not wanting to repeal Obamacare is the "frontier amendment," which corrects longtime inequalities in Medicare reimbursement rates for doctors and hospitals in North Dakota and several other heavily rural states.
Berg has said the provision could be reintroduced if Obamacare were repealed. Heitkamp argues it wouldn't pass on its own in the current political climate in Congress.
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Heitkamp has accused Berg of voting against the frontier amendment when he was in the state House of Representatives in 2003. Berg acknowledges he voted against a resolution he felt wasn't fair for North Dakota but points out he supported a separate resolution that he says supported the frontier amendment.
Heitkamp's campaign says Berg opposed the resolution with the stronger language. It stated:
"That the Fifty-eighth Legislative Assembly urges the Congress of the United States to increase Medicare reimbursement for health care providers, to use an appropriate amount of the federal budget to equalize Medicare rates within North Dakota and within the nation, and to delay implementation of the proposed Medicare ambulance reimbursement fee schedule."
The resolution Berg supported stated:
"That the Fifty-eighth Legislative Assembly urges Congress to make immediate changes in those Medicare policies that discriminate against senior citizens who reside in rural states and to implement national benefit and service provider policies that are more uniform in their application."
Readers can reach Forum reporter Mike Nowatzki at (701) 241-5528
