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Wyden's Medicare collaboration with Ryan puts him center stage for 2012

When Sen. Ron Wyden, D-Ore., formed a partnership last December with House Budget Committee Chairman Paul Ryan on a Medicare redesign, some Democrats grumbled in dismay.

Here was a prominent Democrat – a man with more than 30 years of experience in working on issues of concern to seniors and the former director of Oregon Legal Services for the Elderly – sitting on stage at a Bipartisan Policy Center event with Ryan, whom he called “my colleague and genuine friend.”

Sen. Ron Wyden, D-Ore., in the past has called for a fundamental restructuring of the Medicare entitlement.
Sen. Ron Wyden, D-Ore., in the past has called for a fundamental restructuring of the Medicare entitlement.Susan Walsh / AP

The Oregon Democrat joined the Wisconsin Republican in calling for a fundamental restructuring of the Medicare entitlement.

Sitting next to Ryan at the Bipartisan Policy Center event, Wyden said,  “There’s a window of opportunity here, a chance to change the conversation, lower the decibel level ... and see if we can bring together progressives and conservatives” to create a system in which people on Medicare choose a private-sector health plan or traditional Medicare, if they want.

Wyden said their plan was “a model driven by choices and competition, here with traditional Medicare, and approaches that would come from the private sector, innovation that the private sector offers. We believe it’s going to work ... .”

He added later at that event that their plan “makes some of the old discussion potentially irrelevant.”

If the cost containment built into the Wyden-Ryan plan works, as they think it will, then a device such as the Independent Payment Advisory Board – the outside panel of cost cutters set up by the Affordable Care Act – “almost becomes irrelevant,” Wyden said.

He added, “My hope is – in terms of politics – is that the president and anybody who is a candidate for president would be interested in looking at this.” 

Wasn’t Wyden, some Democrats asked, giving political cover to Ryan, the Republican leader on budget and spending issues? And why was he doing that?

The questions seemed especially pointed, given that only six months earlier, Democrats had successfully used the Ryan budget proposal – including his ideas for redesigning Medicare – as an issue to help defeat Republican Jane Corwin in a special House election in upstate New York.

“Despite Wyden's claims otherwise, the Wyden-Ryan plan ends Medicare as we know it, plain and simple,” said Rep. Pete Stark, D-Calif., last December. “If these two get their way, senior citizens' health coverage will depend on what big insurance offers and what seniors – most of them on modest, fixed incomes – can afford.”

The Wyden-Ryan plan would “undermine rather than strengthen Medicare," White House Press Secretary Jay Carney told a Dec. 15 news conference.

Now that Ryan is Mitt Romney’s running mate, those Democrats might have even more reason to grumble, especially if Romney keeps using Wyden’s collaboration with Ryan as a symbol of courageous bipartisanship, as he did on Monday in Miami.

“One of the things I like about Paul Ryan is he’s demonstrated ... an ability to work across the aisle, to find people who have a common purpose, who may disagree on some issues, but find enough common ground to get things done," Romney said. "For instance him coming together with a plan to save Medicare for future generations – no change to current Medicare beneficiaries or people near retirement, but for future beneficiaries, he and Senator Wyden have come together. This is the kind of bipartisanship we need more of, not less.”

After Romney touted the Wyden-Ryan partnership on Saturday, saying that Ryan had “found a Democrat to co-lead a piece of legislation” to save Medicare, Wyden issued a statement to rebut Romney on this point.

Romney, he said, “is talking nonsense. Bipartisanship requires that you not make up the facts. I did not ‘co-lead a piece of legislation.’ I wrote a policy paper on options for Medicare. Several months after the paper came out I spoke and voted against the Medicare provisions in the Ryan budget. Governor Romney needs to learn you don't protect seniors by makings things up, and his comments today sure won't help promote real bipartisanship.”

Wyden’s sudden prominence in the 2012 campaign makes it all the more important to be clear about exactly what the Oregon Democrat has and has not endorsed.

Wyden did join with Ryan in proposing changes in Medicare that would allow people enrolled in the program to choose from among insurance plans offered by private sector insurers.

As Wyden explained in an op-ed piece for The Huffington Post last March: “Wyden-Ryan doesn't privatize Medicare because Medicare beneficiaries already have the option of enrolling in private health insurance plans. Wyden-Ryan makes those private plans more robust and accountable by forcing them to – for the first time – compete directly with traditional Medicare.”

People in Medicare would get “premium support” payments from the government to help pay the premiums in those privately-run Medicare plans.

Wyden added that “Wyden-Ryan would adjust premium support payments each year to reflect the actual cost of health insurance premiums. In addition, low income seniors, including dual-eligibles (those eligible for both Medicare and Medicaid) will receive additional benefits to cover out of pocket costs – ensuring that seniors have the same choices regardless of income.”

Wyden said private plans might be able to “devise a way to provide the same health benefits as traditional Medicare for less money.” In that case, “a senior might have to pay extra if he or she still wants to enroll in the government option. But if you could get the exact same benefits for less money, why would you want to pay more?”

He emphasized that Wyden-Ryan wasn’t a finished piece of legislation but “simply a policy paper intended to start a conversation” about how Democrats and Republicans could restructure Medicare.

As Wyden noted in his rebuttal of Romney, he opposed Ryan’s budget blueprint when the Senate voted on it on May 16, just as every other Democratic senator and five Republicans, Susan Collins and Olympia Snowe of Maine, Scott Brown of Massachusetts, Rand Paul of Kentucky, and Dean Heller of Nevada, did. (Heller and Brown face competitive re-election battles this November.)

One reason Wyden voted “no” on Ryan’s budget – even though he’d worked with Ryan on Medicare redesign – is that other federal entitlement program that is crucial to the ailing elderly: Medicaid, which covers the cost of nursing home care for elderly and disabled people.

The Ryan budget turned over the federal share of Medicaid payments to the states – “block-granting” in budget lingo – allowing each state to tailor its own Medicaid program to suit its population, but also reducing program outlays.

Wyden complained that Ryan and other Republicans made a mistake in trying to alter Medicaid. “By block-granting Medicaid, they put at risk the most vulnerable seniors, the seniors who need nursing home care that is paid for by Medicaid, and since Medicaid is a Federal-State program, by block-granting it, we put at risk the most vulnerable seniors,” he said on the Senate floor.

Democratic strategists think the same game plan that they used to beat Corwin in that New York special election last year can work against other Republicans this fall – especially those who’re on the record having voted for Ryan’s fiscal year 2013 budget blueprint.

But for some Democrats, Wyden’s willingness to join Ryan in arguing that “a model driven by choices and competition” will work and “makes some of the old discussion potentially irrelevant” – is, at best, a kind of off-message dissonance and at worst a form of heresy.