People pass outside the debate hall before the vice presidential debate… (David Goldman / Associated…)
As Vice President Joe Biden and Wisconsin Rep. Paul Ryan meet in tonight’s vice presidential debate, here is a guide to understanding the Medicare charges and counter-charges from the two campaigns.
Q: Will former Massachusetts Gov. Mitt Romney and Ryan really “voucherize” Medicare?
A: President Obama and Biden have repeatedly used this charge to describe the Medicare plan advanced by the Republican contenders. It is partially true.
The Romney-Ryan proposal, which builds on plans passed by House Republicans, would scrap the current Medicare system, which guarantees all seniors access to a government program with a defined set of benefits. Instead, Medicare beneficiaries entering the program after 2022 would get a fixed amount of federal money to buy either a private insurance plan or the traditional Medicare plan.
The fixed payment is effectively a voucher, though proponents of such plans prefer the term “premium support.”
Q: Does that mean seniors will still be guaranteed Medicare under the Romney-Ryan plan?
A: Not necessarily. While the Romney-Ryan plan preserves Medicare as an option, the voucher will not necessarily be adequate to pay for it.
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Under the GOP plan, the value of a voucher will be tied to available plans in different areas in the country, assuring that it is valuable enough for the two lowest-cost options. If a senior wants a more costly health insurance plan, he or she would have to pay the difference.
That means that if Medicare is not one of the two low-cost options, the voucher would not be adequate to guarantee Medicare coverage.
Q: Will the Romney-Ryan plan mean seniors will have to pay more than $6,000 out of their pockets for healthcare?
A: No. This charge from the Democrats is based on Ryan’s 2011 Medicare plan, which would have eliminated the existing Medicare program altogether.
Q: Will seniors currently in Medicare lose any benefits under the Romney-Ryan plan?
A: Yes. Romney and Ryan would not create the new voucher system until 2022. But the two men have also pledged to repeal Obama’s healthcare law and slash federal spending on the Medicaid program for the poor.
That means that seniors would immediately lose several benefits in the new law, including additional aid for prescription drugs and access to preventive care without co-pays.
Cutting Medicaid would probably affect millions of low-income seniors who rely on Medicare and Medicaid because Medicaid helps pay for nursing home care.
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Q: Will Obama cut $716 billion out of Medicare?
A: Sort of. The new healthcare law reduces future spending on Medicare by cutting payments to hospitals and other providers. Medical providers agreed to these cuts in exchange for the law’s program to expand health insurance coverage, which is projected to reduce the number of people they care for who cannot pay.
Ryan backed the same savings in his 2013 budget plan, but he has since said he would restore them, aligning himself with Romney’s promise.
Q: What impact will the cuts have on people in the program?
A: The cuts do not directly affect benefits available to seniors on Medicare. But some experts have warned that they could force some providers to go out of business or stop treating Medicare beneficiaries.
Doctors and other providers have said for years that they would drop Medicare, but these threats have rarely materialized, in part because seniors are important patients to many providers. The independent Medicare Payment Advisory Commission has found in recent years that elderly Medicare patients have had about as much trouble finding a doctor as Americans ages 50-64 with private insurance.
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Q: What happens if the cuts are restored?
A: The board of trustees has projected that Medicare’s main trust fund will start running a deficit in 2016. That would force the program to cut payments to providers or trim benefits to seniors. Romney and Ryan have not said how they would prevent that from happening.
Q: What about this new board that Republicans say will tell seniors what kind of treatments they can get?
A: That is a myth. The new healthcare law creates a 15-member panel – known as the Independent Payment Advisory Board – that is appointed by the president and confirmed by the Senate. It is charged with recommending ways to control Medicare spending if spending increases faster than expected.
The independent experts on the board can suggest cuts to how much the federal government pays healthcare providers. But the board is prohibited by law from cutting benefits or rationing care.
Congress can also vote to overturn the board’s proposals. If lawmakers do not act, the proposals go into effect automatically.
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