Monday, February 20, 2012

Last Call

Republicans may have hidden their plan to end Medicare and replace it with vouchers with a presidential election year in the cards, but it doesn't mean they've given up.   There's too much money at stake for their corporate overlords, and when there's big enough money, there's Blue Dogs willing to crap on the carpet.

Republicans want to turn Medicare into a subsidized private insurance structure and cut costs on the beneficiary side. This concept — dubbed “premium support” by backers and “vouchers” by critics — would end the coverage guarantee and give seniors a fixed amount to shop for insurance on a private exchange. If the subsidy is too small, tough luck; they’re on their own.

The Ryan budget aimed to replace traditional Medicare with this concept. But after voting overwhelmingly for it last year, Republicans have grown conscious of the political reality that it’s too radical to pass, and are offering up gentler versions of its core components. Two months ago Ryan himself teamed up with Sen. Ron Wyden (D-OR) to unveil a new blueprint that keeps traditional Medicare alive as an option in the exchanges and has less harsh benefit cuts. Last week Sens. Tom Coburn (R-OK) and Richard Burr (R-NC) rolled out a more fully developed version of a similar plan, containing provisions clearly aimed at enticing Democrats.

The idea was first proposed by former Sen. Pete Domenici (R) and former Clinton budget director Alice Rivlin before Ryan ran with it. Wyden is the only Democrat to support the concept — the White House and Dems otherwise remain strongly opposed to any version of it.

Contrary to Republican claims, Democrats do have a plan to keep Medicare solvent: the plan is to keep its single-payer structure and cut costs on the provider side. The health care reform law lays the framework for such a mechanism starting in 2014 called the Independent Payment Advisory Board (IPAB), a panel of 15 presidential-appointed and senate-confirmed members that has the authority to restrict provider payments without congressional approval. (The theory is lawmakers won’t do it on their own.)

But keeping IPAB alive will be a hard slog. One reason is Republicans are determined to smother it in its cradle: they’ve threatened not to confirm any members to the board, and it’s unlikely Dems will have a filibuster-proof Senate majority anytime soon. The second reason is that health industry opposition to IPAB is so vociferous and united that some Dems are running away from it and signing on to GOP legislation to repeal the panel.

So keep a careful eye on this.  Just like the Consumer Financial Protection Bureau, Republicans have every intention of making sure the mandated plan they agreed to and that was signed into law can never function.  To do it, they will need the Blue Dogs that are left.  And both sides know it.

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