About half the funds to pay for the nation's new $940 billion health law will come from reduced federal government spending on the Medicare program - and, although it's too early to gauge the impact on the 45 million Medicare beneficiaries, the idea is creating anxiety among many of them.
Much of the worry - from both supporters and critics of the health insurance overhaul - centers on the government's plans to cut payments for Medicare managed-care policies called Medicare Advantage. These plans, offered through private companies, cover 1.5 million Californians and just over 10 million nationwide.
"I'm concerned about what changes in services might occur. I'm also concerned about the rise in premiums because I'm on a real fixed income," said Ralph Miller, 69, of Vallejo, a longtime Kaiser member who favors the new law. "I'm just worried about what kind of impact it's going to have on my bottom line."
Jed Christensen, 75, of Napa who describes himself as a conservative Republican, said he expects his health care costs to go up. "We're not getting the answers. I'd like to know so we can budget for this."
The new law proposes $136 billion in cuts to Medicare Advantage over the next decade. The U.S. Centers for Medicare and Medicaid Services started the process this month by announcing plans to freeze Medicare Advantage reimbursements to insurers for 2011 at this year's rates.
The cuts could have a disproportionate impact in California because a greater percentage of the Californians on Medicare - 34 percent compared with the national average of 23 percent - choose Medicare Advantage policies because of the state's long history and familiarity with health maintenance organizations, or HMOs, like Kaiser Permanente.