“The Austerity Trap”: What Raising The Medicare Eligibility Age Really Means
After a campaign in which Republicans attempted to pillory Barack Obama for finding $716 billion in savings from Medicare (via cuts in payments to insurance companies and providers but not cuts to benefits), those same Republicans now seem to be demanding that Obama agree to cuts in Medicare benefits as the price of saving the country from the Austerity Trap, a.k.a. fiscal cliff. Oh, the irony! You’d almost think that they weren’t really the stalwart defenders of Medicare they pretended to be.
And there are some hints that the Obama administration is seriously considering agreeing to raise the Medicare eligibility age from 65 to 67 as part of this deal. It’s a dreadful idea, and as we discuss this possibility, there’s one really important thing to keep in mind: Medicare is the least expensive way to insure these people. Or anybody, for that matter. In all this talk of the bloated entitlement system, you’d be forgiven for thinking Medicare was some kind of inefficient, overpriced big government program. But the opposite is true, and that’s why raising the eligibility age is such a dreadful idea.
Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
What we’d be doing is taking people off Medicare, the most efficient and inexpensive option for them to have insurance, and putting them into the individual market, which works less well and costs more. When we start talking about this in more detail, that’s what Republicans should really be forced to address.
If you want more details on the implications of raising the eligibility age, you should be reading Jonathan Cohn and Sarah Kliff. But it’s important that we keep the big picture in view as the Austerity Trap deal takes shape. If anything, we should be putting more people on Medicare—that would save money and improve health in the system overall (you may recall that when the ACA was being debated one of the proposals was to allow people over 50 to buy in to Medicare, an idea we should bring back). There’s an argument being made that raising the eligibility age may not be a good idea, but the administration has to give Republicans something, and it’s not that big a deal. If that’s the case that wins the day, we should be clear about exactly what it means: a more expensive health care system, exactly the opposite of what everybody says they want.
By: Paul Waldman, Contributing Editor, The American Prospect, December 10, 2012
“It Doesn’t Have To Be This Way”: Walmart Plans To Deny Health Care Benefits To New Employees
Why the ACA can’t kick in soon enough, part the infinite: the Huffington Post is reporting that, according to a new policy that will take effect in January, Walmart will begin denying health insurance to new employees who work less than 30 hours a week. It will also reserve the right to cut health benefits for certain groups of current employees who work less than 30 hours. Walmart workers, like many retail employees, often have shifts and hours that vary from week to week, according to seasonal business cycles, so even workers who are currently working 30 hours or more could be affected.
Let’s not forget that Walmart is the nation’s largest private employer, so this change is hugely important. And it’s important not only in itself, but in the spillover effect it could have on the employment policies of comparable retailers.
The Huffington Post observes that the point of the new policy is to opportunistically take advantage of certain aspects of Obamacare:
Among the key features of Obamacare is an expansion of Medicaid, the taxpayer-financed health insurance program for poor people. Many of the Walmart workers who might be dropped from the company’s health care plans earn so little that they would qualify for the expanded Medicaid program, these experts said.
“Walmart is effectively shifting the costs of paying for its employees onto the federal government with this new plan, which is one of the problems with the way the law is structured,” said Ken Jacobs, chairman of the Labor Research Center at the University of California, Berkeley.
This is yet one more example of why last week’s historic worker protests against Walmart were so important. I’ll add this reminder: it doesn’t have to be this way. Some highly profitable players in the retail game which are comparable to Walmart, such as Costco, manage to treat their workers decently. The reason Walmart runs its business in such a reprehensible manner is because it actively chooses to do so.
By: Kathleen Grier, Washington Monthly Political Animal, December 2, 2012
“Medicaid Is the Real Target”: Mitt Romney’s Priorities, Aid For The Rich, Paid For By The Poor
Since August, when Mitt Romney chose Paul Ryan as his running mate, the two campaigns have fought a fierce battle over who is the most stalwart protector of Medicare. In the first presidential debate, Romney assailed President Obama for his $716 billion in Medicare cuts, and Ryan did the same in last week’s vice presidential face-off. Likewise, the Obama campaign has hit Team Romney for the Ryan plan and its Medicare “premium support”—which, if implemented, would gradually replace traditional Medicare with subsidized, regulated private insurance.
The irony is that—in the short term, at least—Medicare will stay unchanged, regardless of who wins the election. Seniors are among the most mobilized voters in the electorate, and there’s too much political risk involved in making big, immediate changes to Medicare. For that reason, Medicare reform plans on both sides are backloaded and will take time to unfold.
The same isn’t true of Medicaid, the other major federal health-care program. The primary constituency for Medicaid—poor and working-class families—lacks the clout and influence of seniors. And while the Obama administration expanded the program in the Affordable Care Act, it has also made Medicaid a ripe target for conservative cuts to social insurance.
This means that, as Mother Jones’ Kevin Drum pointed out last week, Medicaid, not Medicare, is the actual flashpoint in this election. Romney has promised to “block grant” the program, giving states more flexibility in dealing with eligibility and benefits. Some states would use this as an opportunity to innovate. But as Drum notes, just as many would use it as an excuse to drop health coverage for poor people:
Lots of states, especially poor states in the South, don’t have much interest in experimenting. They just want to slash eligibility for Medicaid. Given the freedom to do it, they’d adopt what Ed Kilgore calls the “Mississippi model,” cutting off coverage for a family of three earning anything over $8,200. For all the talk of fresh thinking and new solutions, what they really want to do is simple: They want to stop providing medical care for poor people.
Admittedly, this is a little speculative. It’s possible—albeit, unlikely—that a future governor of South Carolina or Alabama might want to use the new flexibility to improve services for lower-income people. With that in mind, it’s also worth noting the extent to which Romney’s block-grant plan involves a massive cut to overall Medicaid spending. The Center on Budget and Policy Priorities finds that with a Paul Ryan-style block grant in place, overall Medicaid spending would decline by one-third over the next decade. When you put this in the context of Romney’s budget proposals—which include new defense spending and a promise to protect Medicare—and his promise to repeal the Affordable Care Act, the result is a $1.5 trillion reduction in Medicaid spending by 2022. These cuts would add an additional 14 to 19 million people to the ranks of the uninsured, on top of the 30 million people who would lose coverage as a result of full Obamacare repeal.
It’s his approach to Medicaid, more than anything else, that reveals Mitt Romney’s priorities—aid for the rich, paid for by taking relief from the poor.
By: Jamelle Bouie, The American Prospect, October 15, 2012
“And The Rich Get Richer”: Massive Insurance Industry Profits For Republicans In Ryan Medicare Scheme
Insurance companies that would benefit from a Medicare privatization program supported by GOP candidates Mitt Romney and Paul Ryan and nearly every congressional Republican are filling their campaign coffers and raising questions about whom they really work for – constituents or big insurance and Wall Street donors. The privatization scheme, designed by Ryan, would end Medicare as we know it and leave seniors without protection from soaring out-of-pocket medical costs.
The insurance industry and HMOs so far in the 2012 election cycle have given at least $14 million in campaign contributions to U.S. House members who voted for the Ryan plan to privatize Medicare, according to a new report prepared by Public Campaign Action Fund and Health Care for America Now utilizing data downloaded and coded by the Center for Responsive Politics. Mitt Romney, the Republican presidential candidate, has received $2.7 million from insurance interests this cycle alone. Taking the long view, members of Congress who voted for the Ryan budget collected $49.7 million in campaign contributions from the insurance industry over their careers – far more than those voting against the plan, the report said.
For the insurance industry, the political spending is an investment that could reap enormous returns. The market value of Wall Street-run health insurance companies will increase by $12 billion to $25 billion if the Republicans win the Senate and the White House, and by 2030 the industry would post $16 billion to $26 billion in increased annual profits attributable to the Medicare privatization, the report said.
“Americans want quality and guaranteed Medicare, but when we have a Congress on the auction block, they’ll put Medicare on the chopping block,” said David Donnelly, executive director of Public Campaign Action Fund. “This report allows voters to connect the dots for themselves by showing the members of Congress who voted for Ryan’s plan to privatize Medicare while scooping up checks from the insurance industry that would benefit.”
“The Republican plan to privatize and voucherize Medicare would increase costs for seniors and turn the most effective and cost-efficient health insurance program over to the insurance industry,” said Ethan Rome, executive director of Health Care for America Now, the nation’s largest grassroots health care advocacy organization. “It’s disturbing, though not surprising, that the GOP is bankrolled by the insurance industry – the special interests that would reap staggering profits from this plan. When the GOP and health insurance companies win, consumers lose.”
New polling shows that seniors are extremely sensitive about the alliance between the health insurance industry and the Republican Party. More than half – 55 percent – of voters said they would be less likely to vote for a candidate who supports the budget that includes the privatization scheme, according to Democracy Corps, Greenberg Quinlan Rosner Research and Public Campaign Action Fund. But that swelled to 70 percent when voters were asked if they would be less likely to vote for that candidate if he or she also took thousands in campaign donations from insurance executives, lobbyists and political action committees.
“Along with their systematic effort to undermine Medicare, the Republicans are working to repeal the Affordable Care Act and decimate Medicaid,” Rome said. “The GOP’s plan is to put seniors and their families at the mercy of the private health insurance industry without adequate coverage, without their choice of doctor and without protection from huge new out-of-pocket costs.”
“Policy in Washington is too often decided by those who give the most money at the expense of everyday Americans,” said Donnelly. “Insurance interests are pouring money into campaigns because it’s in their narrow interest to privatize Medicare and maximize profits. The problem is, Americans of all political stripes don’t have the same power and influence to shape policy. That’s why we have to hold our members of Congress accountable and it’s why we need fundamental changes to our campaign finance system.”
By: Adam Smith, Health Care For America Now, October 10, 2012
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