-RETIREMENT AGE. Romney supports increasing the retirement age over time, indexed to increases in life expectancy. The Ryan plan keeps the age of eligibility at 65. Polling suggests that raising the age of eligibility is one of the few Medicare savings measures that doesn’t upset seniors. A February survey from the Kaiser Family Foundation found that 63 percent would support gradually increasing the eligibility age as a way of reducing the deficit.
-THE POOREST SENIORS. The Wyden-Ryan plan has provisions to address the needs of the so-called “dual eligibles,” poor, frail seniors who are enrolled in both Medicare and Medicaid. The dual population is both vulnerable and expensive to treat. Duals would still have a choice of plans, but would get additional funding to pay for premiums, copayments, and deductibles. Romney has not yet specifically addressed the dual population, though he has indicated that poorer seniors would get more generous vouchers than seniors with higher incomes.
-RISK ADJUSTMENT. The Ryan plan indicates that premium credits will be adjusted based on which seniors choose different insurance products, a measure designed to prevent one plan’s prices from spiraling out of control just because it includes older, sicker patients. Traditional Medicare could be at particular risk. Romney has been silent on the question of risk adjustment so far. "The language sounds more like a voucher than a risk-adjusted payment, which could penalize older or sicker seniors," said former Congressional Budget Office Director Alice Rivlin, who has developed her own Medicare reform proposal, in an email.
On the whole, these are wonky distinctions, likely to be of interest to policy experts, but not the public. Public opinion on Medicare slants heavily in favor of the status quo, a fact that could make any renewed emphasis on the program a political liability.
“What Americans care about is they want to change Medicare,” said Mollyann Brodie, Kaiser’s pollster. And, she adds, they don’t much like it.