Age Gap: The GOP’s Generational Weapon In The Medicare Fight
To senior citizens at town hall meetings angry or worried about their plan to convert Medicare to a private insurance scheme, Republicans have a simple answer: It’s not about you. You’ll be fine. This is for “the next generation.”
The next generation is everyone 55 or under, since the plan would not start for ten years and would affect only newly eligible seniors. The stated logic of the ten-year delay is that it takes time to put the system in place and that people need time to plan. But if “premium support” (a euphemism right up there with “enhanced interrogation”) were ever going to work, it could be implemented as quickly as the Affordable Care Act (four years) or Medicare’s prescription drug coverage (two years). Presumably, the delay is mostly a political kludge, intended to avoid a backlash from those now or soon to be dependent on Medicare by affecting only those young enough to be giving little thought to retirement health coverage.
But the line they chose is more than a gimmick: The 55-and-over cutoff marks a sharp and significant generational divide. Those over 55 will continue to benefit from one of the triumphs of social insurance in the Great Society, while the rest of us will be on our own, with a coupon for private health insurance. If you consider what it means to be 55 years old in 2011, you’ll see the significance of the line.
Today’s 55-year-old was born in 1956. That’s not generally considered a major break in the generations. It’s smack in the middle of the Baby Boom (the peak of the boom, in fact), with almost a decade to go before the first Gen-Xers were born, dreaming of Winona Ryder. But the difference between early and later Boomers, especially in their experience of the economy, is dramatic.
A baby born in 1956 would have graduated from high school in about 1974, from college in 1978 or so. Look at almost any historical chart of the American economy, and you see two sharp breaks in the 1970s. First, in 1974, household incomes, which had been rising since World War II, flattened. Real wages started to stagnate. The poverty rate stopped falling. Health insurance coverage stopped rising. Those trends have continued ever since.
Second, a little later in the decade, around the time today’s 55-year-olds graduated from college (if they did—fewer than 30 percent have a four-year degree), inequality began its sharp rise, and the share of national income going to the bottom 40 percent began to fall. Productivity and wages, which had tended to keep pace, began to diverge, meaning that workers began seeing little of the benefits of their own productivity gains. The number of jobs in manufacturing peaked and began to drop sharply. Defined benefit pensions, which provide a secure base of income in retirement, began to give way to 401(k)s and similar schemes that depend on the worker to save and the stock market to perform. While the benefits of higher education rose, college tuitions started to rise even faster. Those trends, too, have continued.
If there was ever going to be a generational war in this country, that high school class of ’74 would be its Mason-Dixon line. It’s the moment when Bill Clinton’s promise—“if you work hard and play by the rules you’ll get ahead”—began to lose its value. Today’s seniors and near-seniors spent much of their working lives in that postwar world, with their incomes rising, investments gaining, their health increasingly secure, and their retirements predictable. Everyone 55 and younger spent his or her entire working life in an economy where all those trends had stalled or reversed. To borrow former White House economist Jared Bernstein’s phrase, it was the “You’re On Your Own” economy. Finally, those 55-year-olds are spending several of what should be their peak earning years, years when they should be salting away money in their 401(k)s and IRAs, in a period of deep recession and very slow recovery.
The Ryan plan, in other words, delivers to the older generation exactly what they’ve had all their lives—secure and predictable benefits—and to the next generation, more of what they’ve known—insecurity and risk. It’s hardly the first generational fight the GOP has started. The previous one was just last fall, when they campaigned for Medicare, and against the $500 billion in cuts (mostly by getting rid of the overgenerous subsidies to private insurers in an experimental program) passed as part of the Affordable Care Act. With an off-year electorate that was overwhelmingly older, they could put all their bets on the older side, knowing that seniors would see little benefit from the Affordable Care Act and were naturally worried about any change to the health system they enjoyed.
Heading into the 2012 election, however, the electorate is likely to shift back to one in which younger and middle-aged voters vote in proportion to their share of the population, so a “Mediscare” campaign won’t work. This time, the GOP hopes to play both sides of the generational war, gambling that while seniors want security, younger voters never expected the certainty of Medicare, just as they don’t expect reliable pensions or Social Security benefits, and thus will embrace a plan that sounds innovative, flexible, and market-based. Contending that the only alternative to premium support is the end of Medicare entirely, they are offering a generation that is accustomed to getting less than their parents a little bit, rather than nothing.
This strategy is a variation on the generational conflict the Bush Administration tried to launch in 2005 over Social Security privatization. Although it never reached the level of specificity that Ryan achieved, the calculus was the same: Younger voters would welcome the opportunity to take advantage of the stock market for their retirement, rather than the stodgy and predictable system their parents and grandparents liked.
That wager didn’t work, however: It turned out that older voters were terrified of Social Security privatization and younger voters unenthusiastic. Within five months, the radical move that every pundit thought was a near-certainty when George W. Bush declared “I’ve got political capital and I intend to use it,” had disappeared, never even introduced as legislation. And despite this week’s relaunch of the Ryan plan, it’s likely to end in the same result. If Social Security is any precedent, younger voters will be indifferent, while older voters won’t believe they’re exempt. The Republicans will again walk away from the conflict, hoping to get credit for being “serious” without bearing a political price for the error.
For Democrats, the defeat of the Ryan plan, like the failed Social Security privatization before it, will be regarded as a great victory, and an opportunity to get a fresh start with worried older voters. But they should not ignore the generational divide revealed by Ryan’s cutoff. If progressive politics has nothing to offer the late Boomers and the generations that follow except the same old programs, and nothing that responds to their distinctive experience of the economy, then eventually they’ll fall for one of these gimmicks from the right.
By: Mark Schmitt, The New Republic; Senior Fellow, Roosevelt Institute, May 20, 2011
Republicans Ignored Warnings On Paul Ryan Plan
It might be a political time bomb — that’s what GOP pollsters warned as House Republicans prepared for the April 15 vote on Rep. Paul Ryan’s proposed budget, with its plan to dramatically remake Medicare.
No matter how favorably pollsters with the Tarrance Group or other firms spun the bill in their pitch — casting it as the only path to saving the beloved health entitlement for seniors — the Ryan budget’s approval rating barely budged above the high 30s or its disapproval below 50 percent, according to a Republican operative familiar with the presentation.
The poll numbers on the plan were so toxic — nearly as bad as those of President Barack Obama’s health reform bill at the nadir of its unpopularity — that staffers with the National Republican Congressional Committee warned leadership, “You might not want to go there” in a series of tense pre-vote meetings.
But go there Republicans did, en masse and with rhetorical gusto — transforming the political landscape for 2012, giving Democrats a new shot at life and forcing the GOP to suddenly shift from offense to defense.
It’s been more than a month since Speaker John Boehner (R-Ohio) and his lieutenant, Majority Leader Eric Cantor (R-Va) boldly positioned their party as a beacon of fiscal responsibility — a move many have praised as principled, if risky. In the process, however, they raced through political red lights to pass Ryan’s controversial measure in a deceptively unified 235-193 vote, with only four GOP dissenters.
The story of how it passed so quickly — with a minimum of public hand-wringing and a frenzy of backroom machinations — is a tale of colliding principles and power politics set against the backdrop of a fickle and anxious electorate.
The outward unity projected by House Republicans masked weeks of fierce debate, even infighting, and doubt over a measure that stands virtually no chance of becoming law. In a series of heated closed-door exchanges, dissenters, led by Ryan’s main internal rival — House Ways and Means Committee Chairman Dave Camp (R-Mich.) — argued for a less radical, more bipartisan approach, GOP staffers say.
At a fundraiser shortly after the vote, a frustrated Camp groused, “We shouldn’t have done it” and that he was “overridden,” according to a person in attendance.
A few days earlier, as most Republicans remained mute during a GOP conference meeting on the Ryan plan, Camp rose and drily asserted, “People in my district like Medicare,” one lawmaker, who is now having his own doubts about voting yes, told POLITICO.
At the same time, GOP pollsters, political consultants and House and NRCC staffers vividly reminded leadership that their members were being forced to walk the plank for a piece of quixotic legislation. They described for leadership the horrors that might be visited on the party during the next campaign, comparing it time and again with former Speaker Nancy Pelosi’s decision to ram through a cap-and-trade bill despite the risks it posed to Democratic incumbents.
“The tea party itch has definitely not been scratched, so the voices who were saying, ‘Let’s do this in a way that’s politically survivable,’ got drowned out by a kind of panic,” a top GOP consultant involved in the debate said, on condition of anonymity.
“The feeling among leadership was, we have to be true to the people who put us here. We don’t know what to do, but it has to be bold.”
Another GOP insider involved to the process was more morbid: “Jumping off a bridge is bold, too.”
Time will tell whether the Medicare vote, the most politically significant legislative act of the 112th Congress thus far, will be viewed by 2012 voters as a courageous act of fiscal responsibility — or as an unforced error that puts dozens of marginal GOP seats and the party’s presidential candidates at serious risk. That question might be answered, in part, this week during a special election in New York’s 26th Congressional District, in which Republican Jane Corwin appears to be losing ground to Democrat Kathy Hochul.
The GOP message team is already scrambling to redefine the issue as a Republican attempt to “save” Medicare, not kill it.
But the party’s stars remain stubbornly misaligned. Presidential hopeful Newt Gingrich candidly described the Medicare plan as “right-wing social engineering” — only to pull it back when Ryan and others griped. And Priorities USA Action, an independent group started by two West Wing veterans of the Obama administration, was out Friday with its first ad, a TV spot in South Carolina using Gingrich’s words to savage Mitt Romney for saying he was on the “same page” as Ryan.
“The impact of what the House Republicans have done is just enormous. It will be a litmus test in the GOP [presidential] primary,” said former White House deputy press secretary Bill Burton, one of the group’s founders.
“I couldn’t believe these idiots — I don’t know what else to call them — they’re idiots. … They actually made their members vote on it. It was completely stunning to me,” said former Pennsylvania Gov. Ed Rendell, a Democrat who worked hard to win over the western part of his state, which has among the highest concentration of elderly voters in the country.
It was also the site of some of the Democrats’ worst losses in 2010 — three swing House seats Democrats hope to recapture next year, largely on the strength of the Medicare argument.
“Look at [freshman House members in the Pittsburgh-Scranton area], they make them vote on this when they’re representing one of the oldest districts in the country?” Rendell asked.
“We have a message challenge, a big one, and that’s what the polling is showing,” conceded Rep. Patrick McHenry (R-N.C.), a former Karl Rove protégé who enthusiastically backed the Ryan plan. “There’s no way you attack the deficit in my lifetime without dealing with the growth of Medicare. Do we get a political benefit from proposing a legitimate solution to a major policy problem? That’s an open question.”
The House Republican leadership had hinted at an emerging plan to tackle entitlement reform on Feb. 14 — the day Obama released his budget without reforms to Medicare, Medicaid and Social Security.
Cantor caught Hill reporters by surprise when he said, nonchalantly, that the Republican budget would be a “serious document that will reflect the type of path we feel we should be taking to address the fiscal situation, including addressing entitlement reforms.”
But there were also internal motivations in the decision to go big on Medicare, rooted in Boehner’s still tenuous grasp of the leadership reins, according to a dozen party operatives and Hill staffers interviewed by POLITICO.
Republican sources said Boehner, who has struggled to control his rambunctious new majority, needed to send a message to conservative upstarts that he was serious about bold fiscal reform — especially after some of the 63 freshmen rebelled against his 2011 budget deal that averted a government shutdown.
Then there’s the ever-present friction between Boehner and Cantor, who, along with Minority Whip Kevin McCarthy (R-Calif.), has positioned himself as the next generation of GOP leadership and champion of the conservative freshman class.
Boehner’s camp said the speaker has always supported the Ryan approach — which would offer vouchers to future Medicare recipients currently younger than 55 in lieu of direct federal subsidies — and proved his support by voting for a similar measure in 2009.
“Boehner has said for years, including leading up to the 2010 election, that we would honestly deal with the big challenges facing our country,” said his spokesman, Michael Steel. “With 10,000 Baby Boomers retiring every day, it is clear to everyone that Medicare will not be there for future generations unless it is reformed. The status quo means bankruptcy and deep benefit cuts for seniors. It’s clear who the real grown-ups in the room are. We’ve told the truth and led, while the Democrats who run Washington have cravenly scrambled and lied for partisan gain.”
But that message hasn’t always been quite that clear. On several occasions, Boehner has seemed squishy on the Ryan budget. In talking to ABC News, Boehner said he was “not wedded” to the plan and that it was “worthy of consideration.”
Still, even if Boehner had opposed the plan — and his top aide, Barry Jackson, expressed concerns about the political fallout to other staffers — he probably couldn’t have stopped the Ryan Express anyway, so great was the push from freshmen and conservatives.
That’s not to say some of the speaker’s allies from the Midwest didn’t try. Camp and Ryan hashed out their differences in a series of private meetings that, on occasion, turned testy, according to several GOP aides. Camp argued that the Ryan plan, which he backed in principle — and eventually voted for — was a nonstarter that would only make it harder to reach a bipartisan framework on real entitlement reform.
A few weeks later, Camp told a health care conference that, from a pragmatic legislative perspective, he considered the Ryan budget history. “Frankly, I’m not interested in talking about whether the House is going to pass a bill that the Senate shows no interest in. I’m not interested in laying down more markers,” he said.
House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) also made the case for a more moderate approach — but his principal concern was the Medicaid portion of Ryan’s plan, an approach he believed wouldn’t do enough to reduce burdens of indigent care on states.
But even as Democrats high-five over the possibility of Medicare-fueled political gains, Republicans are trying to muster a unified defense. Cantor, for his part, stumbled by suggesting to a Washington Post reporter that the Ryan Medicare provisions might be ditched during bipartisan debt negotiations being led by Vice President Joe Biden.
Cantor later clarified his remarks and claimed he still backed the Ryan principles, but no GOP staffer interviewed for this article believed the Medicare overhaul has any realistic chance of passage.
By: Glenn Thrush and Jake Sherman, Politico, May 23, 2011
Health Reform in Massachusetts: Self-Serving For Mitt But Also True
Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.
Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.
Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.
Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.
Other significant accomplishments:
The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.
The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.
The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.
Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.
There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.
Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.
What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.
Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.
The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.
By: Editorial, The New York Times, May 20, 2011
The Truth About Waivers: Protecting Coverage For Millions Of Americans
Today, you might have seen news stories about waivers from certain provisions of the Affordable Care Act. There has been no shortage of confusion and deliberate obfuscation on this issue and we want to ensure you have the facts.
Under the Affordable Care Act, we have implemented new rules that phase out, by 2014, health insurance companies’ ability to slap restrictive annual dollar limits on the amount they will pay for your care. But between now and 2014, we also want to make sure workers are able to maintain their existing insurance, because on their own they would likely be shut out of the individual market or face unaffordable options. To do that, the Affordable Care Act allows the Department of Health and Human Services to issue temporary waivers from the annual limit provision of the law if it would disrupt access to existing insurance arrangements or adversely affect premiums, causing people to lose coverage. So far, we have granted 1,372 of these waivers to employers, health plans, and others in all 50 states, covering less than 2 percent of the insurance market and protecting coverage for more than 3.1 million Americans. We have been completely transparent about this process, announcing the waiver process in a regulation last summer, publishing clear guidance on the application process on our website, and posting a list of waivers we have granted on our website.
These temporary waivers will not be available beginning in 2014 when annual limits are banned and all Americans will have affordable coverage options. And millions of Americans – including many small business owners – will be able to shop for affordable coverage in new competitive marketplaces.
Some have raised questions about waivers that were recently granted to companies in California. So there’s no confusion, here are the facts:
- A company called Flex Plan Services is a third-party administrator that provides benefit administration services for employers in a number of states, including: California, Washington, Alaska, and Georgia. One type of plan they administer is known as a health reimbursement arrangements (HRA or employer contributions to a tax free account). Many of the company’s clients are hotels, restaurants and home health agencies, all of whom employ low-wage workers.
- On March 23, Flex Plan Services submitted 92 waiver requests on behalf of 45 employer clients. On April 4, 2011, HHS approved the request.
- HHS applied the same standard to the application from Flex Plan Services that it uses when reviewing any application for a temporary waiver. Waivers are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage.
- In addition, enrollees must be informed that their plan offers coverage with a restricted annual limit.
- No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy.
The Affordable Care Act puts an end to many of the worst insurance company practices including refusing to sell a policy to a family because someone had cancer or a child has asthma; cancelling coverage when a patient files claims because of an unintentional mistake in their paperwork; and slapping annual or lifetime limits on how much care you can receive. When these rules are fully in place in 2014, our country will be much better off and the cost of coverage will be within reach for the millions of Americans who now live day to day without coverage, worrying about an injury or an illness that could plunge them into bankruptcy. To get from today’s broken system to tomorrow’s patient-centered system takes time and patience through a reasonable transition period. But, together, we will get there.
By: Richard Sorian, Asst. Sec for Public Affairs, HHS, The White House Blog, May 17, 2011
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