Dems again seek to stick Paul Ryan Medicare reform plan with ‘voucher’ label

What’s in a name?

No less than President Obama’s reelection, Democrats hope — if they can just get the dreaded “voucher” label to stick to Republicans’ Medicare overhaul.

House Budget Committee Chairman Paul Ryan (R-Wis.) prefers “premium support.” The difference might seem like some arcane bit of inside-the-Beltway trivia, but Democrats will be repeating the V-word from now through November as they try to persuade seniors that Ryan wants to give them a worthless piece of paper that will leave them holding the bag as their healthcare costs skyrocket.

{mosads}”Republicans want to end the Medicare guarantee,” House Minority Whip Steny Hoyer (D-Md.) said Thursday at a health law anniversary rally, “and turn Medicare into a voucher program.”

Ryan, visibly irritated, blasted Democrats during his committee’s mark up of the budget this week.

“I’d like to debunk the tired political attacks on the Republican efforts to save and strengthen Medicare,” he said. “First, we keep hearing the word voucher, premium support, as if there’s some interchangeable word.

“A voucher is like going to the mailbox and getting a check in the mail… Premium support is: You get a list of guaranteed coverage options that are pre-selected, in this case by Medicare,” Ryan said.

Democrats don’t disagree. They just don’t think that’s what Ryan’s plan does.

“The idea behind premium support is that you, the beneficiary, are receiving an amount to support the premium you have to pay … so as healthcare costs go up and premiums go up, the premium support goes up proportionally,” said Rep. Chris Van Hollen (D-Md.), the top Democrat on the Budget Committee.

“Their proposal is not premium support because it delinks the value of the voucher from the cost of healthcare,” Van Hollen said. “That’s how they save money, by not having premium support. That’s why a voucher is a better metaphor, because it’s sort of like a fixed amount you’re getting. It will increase a little bit, but if healthcare costs go up … you’re going to have to pay out of pocket the rest.”

In effect, what Ryan’s plan really amounts to depends on whether his gambit works out.

The proposal calls for seniors to be given a choice between traditional Medicare and an array of private plans. By forcing insurers to compete for seniors’ business, the thinking goes, health plans will demand lower prices from doctors, hospitals and drug makers, making healthcare delivery more efficient and forcing prices down.

“We believe that under competitive bidding you would see lower (prices) than what would happen under current law,” Budget Committee staff director Austin Smythe said at the mark-up.

In case those savings don’t materialize, however, the Ryan plan creates a backstop. Federal Medicare spending won’t be allowed to grow faster than the rate of GDP growth plus 0.5 percentage points.

During the mark up, Ryan argued that’s not so different from President Obama’s vision. Under the healthcare reform law, a 15-member board — the Independent Payment Advisory Board (IPAB) that the House voted to repeal this week — would recommend cuts to provider reimbursements if federal health spending grew faster than a target amount.

Those recommendations would lead to rationing, Republicans say, as more and more doctors turned down Medicare patients they could no longer afford to see.

Democrats counter that it’s Ryan’s plan that hurts seniors: If competition among plans doesn’t cut costs, seniors will have to pay more and more out of their own pocket as the value of their voucher dwindles.

The nonpartisan Congressional Budget Office calculated that Ryan’s proposal would cut spending on new enrollees by 35 percent by 2050 compared to current projections and warned that “beneficiaries might face higher costs.”

An earlier iteration of the Ryan proposal, which he coauthored with Sen. Ron Wyden (D-Ore.), addressed the possibility that healthcare costs would grow faster than the Medicare spending growth cap.

“To offset an increase in the cost of Medicare beyond the growth limit,” their white paper says, “Congress would be required to intervene and could implement policies that change provider reimbursements, program overhead, and means-tested premiums.”

The new Ryan budget contains no such language.