Too Much Focus on Medicare — and not Enough on Medicaid?

The nation’s political parties are battling over health care again. But “ObamaCare” isn’t at issue, at least not directly.

It’s what the presidential candidates would — purportedly — do to the Medicare program.

High-Profile Attacks Center on Possible Medicare Changes

As the Nov. 6 election draws closer, both parties are seizing on Medicare as a key issue to win swing voters. And based on recent rhetoric, both Barack Obama and Mitt Romney are either trying to eviscerate the program — or are our last hope to save it.

To fund the Affordable Care Act, the president “took [billions of dollars] away from Medicare,” Republican vice presidential nominee Paul Ryan charged at last week’s Republican National Convention. “Seven hundred and sixteen billion dollars, funneled out of Medicare by President Obama.”

“What’s missing from the Romney-Ryan plan for Medicare is Medicare,” HHS Secretary Kathleen Sebelius responded on Tuesday night, speaking at the Democratic National Convention. “Instead of the Medicare guarantee, Republicans would give seniors a voucher that limits what is covered, costing seniors as much as $6,400 more a year.”

There are important differences between Republicans’ and Democrats’ Medicare plans, especially on key technical issues like the speed of shifting the program away from fee-for-service payments. But as fact-checkers have descended on the campaigns — finding misstatements in Ryan’s charges and Sebelius’s counter-claims — they’ve also uncovered that the candidates’ Medicare proposals aren’t as wildly different as they appear on first blush. Neither plan involves rolling back benefits or coverage for current beneficiaries. And Romney’s proposed changes to the program, while largely unspecified, have dropped the dramatic overhauls once floated by his running mate Ryan.

Candidates’ Real Differences Are on Medicaid

But the candidates, their surrogates and even the fact-checkers would agree: The parties are poles apart on their plans for the Medicaid program.

Democrats have sought to protect and grow the program; as “Road to Reform” has examined, Medicaid is at the center of Democrats’ health reform law. The ACA contains the most significant Medicaid changes in a generation — new standardized requirements, additional federal payments, and an eligibility expansion that could add as many as 16 million uninsured Americans to the program. Enrollment in California’s Medi-Cal program alone is projected to grow by nearly two million within the next seven years.

However, Republicans plan to move the Medicaid program in the opposite direction; party leaders have pledged to dismantle the ACA and roll back its Medicaid expansion. And while Romney has moved to distance himself from Ryan’s Medicare proposal, he has endorsed his running mate’s idea of converting Medicaid into a block-grant program. The Urban Institute has suggested the changes could lead as many as 27 million Americans to lose coverage.

“In pure dollar terms, the difference comes down to this,” the New York Times reports. “Ryan has proposed cutting federal spending on Medicaid by $810 billion over 10 years. Mr. Obama’s expansion plan, by contrast, would cost an additional $642 billion over the same period,” according to Congressional Budget Office estimates.

Why Medicare is so Discussed — and Medicaid is so Overlooked

There are practical reasons why Medicare, once again, has emerged as a hot-button issue around election time: Its beneficiaries are among the nation’s most engaged voters.

Using Census Bureau data, AARP projects that about 70% of Americans who are 65 and older will vote in the coming election; in contrast, a little more than half of all Americans who are between the ages of 18 and 34 are likely voters. AARP also projects that “older Americans” will make up more than half of all voters in this fall’s election.

And compared to Medicaid, which has historically been a safety net for the poor and disenfranchised, Medicare has more immediacy for millions of middle-class Americans. While the average U.S. resident may not need or use the program today, he or she likely has a family member who receives Medicare benefits — and there’s an expectation Medicare will be there in the future.

Will Medicaid emerge as a key topic ahead of November, or will Medicare remain in the spotlight? “Road to Reform” will continue to track what the candidates say — and don’t say — about health policy. Meanwhile, here’s what else is happening around the nation.

Medicaid Expansion

  • Georgia Gov. Nathan Deal’s (R) recent decision to opt out of the federal health reform law’s Medicaid expansion could leave thousands of the state’s low-income residents without health coverage and raise costs for state hospitals, which already provide about $1 billion in uncompensated care annually (Teegardin, Atlanta Journal-Constitution, 8/30).
  • Officials in some of Texas’ most populous counties are considering plans to expand Medicaid coverage, despite Gov. Rick Perry’s (R) decision to opt out of the expansion under the Affordable Care Act. George Hernandez, CEO of University Health System in San Antonio, developed the idea of county-led Medicaid expansion and has been discussing the option with officials in Bexar, Dallas and Houston (Aizenman, Washington Post, 8/26).

Administration Actions

Effects on Employers

  • None of the 512 employers that responded to a survey by consulting firm Towers Watson said they are “very likely” to drop insurance coverage for employees in 2014 and direct them to the health insurances exchanges created by the Affordable Care Act (Kliff, “Wonkblog,” Washington Post, 8/28). In a separate survey of 440 mid- to- large-sized firms, 88% of respondents said they do not plan to discontinue health insurance coverage for their full-time workers in the foreseeable future (Insurance Journal, 8/28).

In the Courts

  • Last week, a federal judge dismissed an evangelical university’s lawsuit against the federal contraceptive coverage rules because the school does not face an immediate threat of having to offer the coverage (UPI, 8/28). The rules, which are being implemented under the Affordable Care Act, require most employers to cover contraceptive services without copayments or deductibles (Inside Higher Ed, 8/28).

Related Topics

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