Democrats are pushing for Medicare cuts on a scale not seen in years to underwrite health care for all. Many seniors now covered under the program don't like that one bit.
Seeing a political opportunity, Republicans have accused President Barack Obama of trying to use Medicare as a piggy bank to finance his top domestic priority — putting the president on the defensive on a highly sensitive issue.
At an AARP town hall meeting earlier this week, Obama went out of his way to address "a misperception" that the Democratic bills in Congress would cut medical benefits for the elderly.
"Nobody is talking about reducing Medicare benefits," Obama said. "Medicare benefits are there because people contributed into a system. It works. We don't want to change it. What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund that could be used more effectively to cover more people and to strengthen the system."
Such assurances haven't stopped Republicans from stepping up their criticism.
"Using massive cuts to Medicare as a way to pay for more government-run health care isn't the kind of change Americans are looking for," Senate Republican leader Mitch McConnell of Kentucky said Thursday in a speech on the Senate floor. "Americans want savings from Medicare to be used to strengthen Medicare, not to create a system that would ... lead to a government takeover of health care."
Political role reversal
The dueling sound bites frame a political role reversal.
When the Republicans were in power, their attempts to cut Medicare to reduce government spending ran into a wall of opposition from Democrats. Now that Democrats are in control, they're calling for hundreds of billions in Medicare cuts to help the uninsured get coverage.
The House bill — the congressional proposal that has advanced the most — would reduce projected increases in Medicare payments to providers by more than $500 billion over 10 years, a gross cut of about 7 percent over the period. But the legislation would also plow nearly $300 billion back into the program, mainly to sweeten payments to doctors.
That still leaves a net cut of more than $200 billion, which would be used to offset new federal subsidies for workers and their families now lacking health insurance. Those uninsured workers also pay the taxes that go to support medical care for the elderly.
Despite the cuts, the seniors' lobby is supporting the House legislation. But AARP says that's as far as the cost-cutting should go. The group says it's troubled by a proposal recently embraced by Obama to create a special advisory panel that would regularly recommend more savings, with authority to force Congress to act on them. AARP says the costs board should also have to take into account effects on quality of care and access before making any recommendations.
"What we hear from our members is that to them Medicare savings sounds like cuts," said Nora Super, AARP's chief health care lobbyist. "Our members over 65 really value their Medicare program ... and numbers like $500 billion are huge numbers, so that is really scary to our members."
Seniors' concerns have been showing up in opinion polls.
A Pew Research Center poll released Thursday found notably lower support among people 65 and older for the health care proposals in Congress. Twenty-nine percent of seniors said they "generally favored" the plans, compared to 38 percent of the total. Similarly, an NBC News/Wall Street Journal survey found that 28 percent of seniors said Obama's plan was a good idea, compared with 36 percent of all respondents.
Obama and the Democrats say the cuts are needed to curb wasteful spending fattening the budgets of Medicare managed care plans, hospitals and other providers. Indeed, experts at the Health and Human Services Department estimate that the House bill would extend the solvency of Medicare's giant hospitalization trust fund by five years, from 2017 to 2022.
An analysis for the Kaiser Family Foundation found that private insurance plans operating through Medicare would bear 32 percent of the overall cuts, while another 37 percent would be distributed among hospitals and other service providers. But that's not what seniors seem to be hearing.
‘Politically responsive group’
"I believe they are hearing that their benefits are going to be really restricted," said Robert Blendon, a professor at the Harvard School of Public Health, who follows public opinion on health care issues. "If that's the case, it will really cause some problems for lawmakers over the summer because seniors are the most politically responsive group, and they're the ones who on a day-to-day basis confront ill health and medical expenses."
House Majority Leader Steny Hoyer, D-Md., says Republicans are distorting the facts on a complex issue. "Medicare is going to be available for seniors — at the levels they need," he said.
But Sen. Orrin Hatch, R-Utah, said Republicans aren't going to drop the issue. "I think there's going to be a rebellion in this country when seniors find out," he said.