Independent Payment Advisory Board

Will Dems Help GOP Quash Obama's Plan To Save Medicare?

Sahil Kapur | February 29, 2012, 5:31AM

Republicans are poised to advance repeal Wednesday of a critical provision in the health care reform law designed to preserve traditional Medicare -- and they've enlisted a number of key House Democrats for the cause. Victory isn't imminent, as Senate Dems aren't biting, but the growing defections help the GOP's long-term push to privatize Medicare.

With Medicare's trust fund set to be empty by about 2024, dramatic cost-cutting measures will ultimately be required. Republicans want to achieve this by transforming Medicare into a "premium support" program in which seniors are given a voucher to buy their own private insurance. President Obama has a different idea, and has already enacted the framework for it: a panel called the Independent Payment Advisory Board (IPAB), set to take effect in 2014, comprising 15 appointed experts tasked with holding down Medicare payments to providers -- without cutting benefits.

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Independent Payment Advisory Board

Why Republicans Are Fighting To Repeal Obama's Medicare Cost-Cutting Board

Sahil Kapur | February 28, 2012, 5:29AM

House Republicans are poised to advance legislation this week to repeal President Obama's Medicare cost-cutting board, a provision enacted in the health care reform law. The Energy & Commerce Committee is set to mark it up this Wednesday, and the repeal bill already has enough cosponsors to pass the House. It's not expected to survive the Senate or Obama's veto pen, but the debate over this provision cuts to the heart of the battle over how to save Medicare in the long run.

Some background: The Independent Payment Advisory Board (IPAB) is set to take effect in 2014, and would comprise 15 President-appointed and Senate-confirmed experts charged with holding down Medicare per-beneficiary spending by restricting reimbursements to providers. It is forbidden from cutting payments to beneficiaries. Congress can override the panel is by passing an alternate way to save the same amount of money, or with a three-fifths Senate majority. The health care industry has been outspoken in its hatred for IPAB. Republicans are united in their effort to kill it, and even some House Dems are on that page.

The question now is: Why is the party that's hell-bent on reining in Medicare pushing to repeal this powerful tool for doing just that? Part of it is to score political points by slicing off a key piece of the Affordable Care Act. But more importantly, Republicans don't want to keep Medicare in its current form. Many of them don't think that's feasible. They want to transition it to a privatized model a la the Paul Ryan plan, where seniors get a fixed subsidy -- or "premium support" -- to buy their own insurance on a private exchange.

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Medicare Privatization

How Republicans Could Still Succeed At Privatizing Medicare

Sahil Kapur | February 20, 2012, 4:55AM

Rep. Paul Ryan (R-WI)

Republicans may be backing off their famously toxic plan by Paul Ryan to privatize Medicare, but they've doubled down on the broader concept and are taking strategic steps to get there over time. Democrats currently have the upper hand in their battle to protect traditional Medicare for the future, but unless they thwart the GOP's drumbeat and build support for their alternate vision, it may not be for long.

There's little disagreement that Medicare is currently on an unsustainable trajectory, with costs spiraling out of control thanks in part to aging baby boomers. Democrats and Republicans both want to rein in Medicare spending, and the two sides increasingly agree that per-beneficiary outlays should be held down to per-capita GDP plus 1 percent, a substantial reduction from projections. But they strongly disagree on how to get there.

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Tom Coburn

The GOP's Tactful Pivot From Ryan Medicare Plan -- And Why It's Important

Sahil Kapur | February 17, 2012, 6:03AM

Republicans are continuing their gradual pivot away from the Paul Ryan Medicare plan they once voted for overwhelmingly -- another tacit admission that the blueprint is too radical to pass. But they haven't given up on the concept -- far from it. In fact, they're searching for more tactful ways to bring it to fruition.

The latest evidence came Thursday, when Republican Sens. Tom Coburn (OK) and Richard Burr (NC) rolled out a sweeping new plan that would transition Medicare to a subsidized private insurance system while giving seniors the option to remain in the traditional government-run program -- think "Obamacare" exchanges with a public option.

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Paul Ryan

Ryan: Even If Obama Wins We Don't Need To Change Our Tax Philosophy

Brian Beutler | February 16, 2012, 11:06AM

Sen. Ron Wyden (D-OR), and Rep. Paul Ryan (R-WI)

The consensus among GOP leaders, and really leaders of both parties, is that the two biggest issues dividing the parties -- how much wealthy Americans should pay in taxes, and how the health care safety net should be structured -- will be decided by the elections in November.

The implication is that if Republicans win convincingly, the country will have provided them a mandate to further reduce taxes and roll back Medicare, Medicaid and the health care law.

But what happens if President Obama and the Democrats walk away with the prize? Will Republicans agree to increase, fairly significantly, the amount of money flowing into the Treasury?

Er, um. Maybe.

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Payroll Tax Cut

Paul Ryan: Yes, Payroll Tax Fight Hurt GOP

Brian Beutler | February 16, 2012, 10:15AM

Rep. Paul Ryan (R-WI) speaks during a press conference on the debt ceiling in Washington, D.C. on August 1, 2011

With the ink drying on a final deal, one of the highest profile Republicans in Congress said the December and February fights over extending the payroll tax cut and other expiring provisions through the end of the year have hurt Republicans -- at least in the short term.

"It's a tough issue because they had to compromise... But yeah, I think the payroll tax deal, from a political perspective, certainly caused damage because it muddled the differences [between the parties," House Budget Committee Chairman Paul Ryan (R-WI) told reporters at a breakfast roundtable hosted by the Christian Science Monitor. "It got us down into a skirmish, where the differences got muddled, which is I think what the President loves."

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Barack Obama

CHART: Don't Buy The GOP Hype On Obama Budget Deficits

Brian Beutler | February 15, 2012, 5:40AM

President Barack Obama and Vice President Joe Biden

Republicans have taken to describing President Obama's budget as "deficits built to last" -- a play on Obama's call for an economy built to last. The implication: hand the government over to us, and we'll rid the budget of this deficit scourge. Put aside for a moment that wiping out deficits too fast would be economically disastrous, leading to rocketing unemployment rates. The truth is there are plenty of budget proposals out there, including Paul Ryan's "Path To Prosperity," which was endorsed by nearly every Republican in Congress. And these also project significant deficits well into the future.

Of course, Obama's budget is very substantively different from Paul Ryan's Path to Prosperity. Obama's would draw down deficits over the coming decade with a mix of proposed tax increases on high income earners and corporations, already enacted spending cuts, and additional cuts to health care spending and other programs. But it maintains the basic shape of the existing safety net over the long term. Ryan's calls for huge cuts to the safety net, for making Medicaid a block grant program, and, after a decade, for phasing out Medicare. But he proposes significant tax cuts at the same time.

And even with all that slashing, just what does that do to the projected deficit? The chart below tells you quite starkly:

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Budget

The Truth Behind The GOP's '1000 Days Without A Budget' Canard

Brian Beutler | February 14, 2012, 10:17AM

Harry Reid (D-NV) and Mitch McConnell (R-KY)

Turn on any cable news channel this week and you'll very likely hear a top Republican froth in anger over the fact that Senate Democrats haven't passed a budget in more than 1000 days.

This particular talking point has been around for months -- long before the Senate crossed the 1000 days threshold. Now that it's budget season, Republicans hope it pops, filters up into mainstream news coverage, and sows doubt in the minds of voters who don't understand the Congressional budget process, and don't realize how unimportant, and in most crucial respects false, the line is. Alternatively, they hope Senate Dems get spooked and move ahead with a budget document that exposes their differences and leaves them open to political attack -- but has no impact on policy whatsoever.

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Paul Ryan

Are Republicans About To Commit Medicare Suicide?

Brian Beutler | February 7, 2012, 5:40AM

Rep. Paul Ryan (R-WI) speaks during a press conference on the debt ceiling in Washington, D.C. on August 1, 2011

It's shaping up to be spring 2011 redux. Just under a year ago, Republicans -- euphoric after a midterm election landslide, and overzealous in their interpretation of their mandate -- passed a budget that called for phasing out Medicare over the coming years and replacing it with a subsidized private insurance system for newly eligible seniors.

The backlash was ugly. But Republicans seem to have forgotten how poisonous that vote really was, and remains...because they're poised to do it again. This time they're signaling they'll move ahead, with a modified plan -- one that, though less radical, would still fundamentally remake and roll back one of the country's most popular and enduring safety net programs.

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