After years of ceding the issue of Medicare's future to Democrats, Republicans have begun fighting back, emboldened by the unpopularity of President Obama’s health reform law among seniors and the rising prominence of the debate now that GOP presidential candidate Mitt Romney has chosen Rep. Paul Ryan, R-Wis., as his running mate.
This election is already featuring so-called “Medi-scare” attacks from both sides. In the now-bipartisan sport of Medicare-baiting, Democrats will tell voters that Republicans want to “end Medicare as we know it,” while Republicans will say that it’s Democrats who have already voted for $700 billion in cuts for current beneficiaries by passing health care reform.
Romney has begun highlighting the reform law’s Medicare cuts in his stump speech and a television advertisement launched on Tuesday. Mike Shields, political director of the National Republican Congressional Committee, circulated a memo on Tuesday urging candidates to tackle Medicare head-on.
“We want this fight,” the memo says. “Any opportunity we have to talk about ObamaCare, and the $700 billion in Medicare cuts that paid for it, is an opportunity we will never pass up.”
Democrats see Medicare reform as an obvious political winner. The plan that Ryan and Romney both support—to convert the government-run program into a defined contribution plan in 10 years—polls terribly with seniors, who are wary of any changes to the program. Details aside, Democrats have historically held a strong advantage over Republicans when voters are asked who they trust to protect Medicare benefits.
But many Republican strategists think the issue can be a winner for the party this time around. Seniors dislike changes to Medicare, but they also dislike the president’s health reform law. The talking points making the rounds aim to turn the tables on the Democrats, by highlighting cuts to Medicare that were part of the law.
“The more we’re up in their grill, the less they can lie and demagogue,” said Rick Wilson, a Florida-based GOP media consultant, in an e-mail. “For the [Democrats'] Medicare attack to work, it takes frightened, hunkered-down Republicans who refuse to engage.”
Dan Adcock, director of government relations and policy at the National Committee to Preserve Social Security and Medicare, said he is skeptical that the Republican "Medi-scare" attacks will work. He thinks critiques of the health reform law are losing currency as more seniors see that any cuts under the law haven’t harmed them.
“We’re moving the needle in terms of senior support for the Affordable Care Act as they’re seeing their Medicare benefits weren’t cut,” he said.
The Affordable Care Act achieved most of its savings through cuts to future Medicare growth. The law cut subsidies to private insurers who offer Medicare Advantage plans, reduced future increases in hospital pay, and cut special funding to safety-net providers that care for the uninsured. The law also sets a limit on spending growth per beneficiary, and tasks an independent board with fiddling with provider payment rates if growth exceeds the cap. The Obama administration likes to point to those cuts as protecting the future of the program by extending its solvency by eight years, according to the most recent report from Medicare’s trustees.
Those savings come out primarily on the provider side, but they have already started kicking in. Republicans have been noting that difference—the Ryan-Romney plan would not affect any current seniors, while the Obama law changes the program for current beneficiaries.
Romney, already, has gone on a Medicare offensive, arguing several times since the Ryan selection that the president’s plan would cut the program while his would preserve Medicare. On CBS’s 60 Minutes on Sunday, he seemed incredulous when asked whether his ticket’s proposal, which would partially privatize the program, would be a political liability among seniors.
“There is only one president that I know of in history who robbed Medicare $716 billion to pay for a new risky program of his own that we call 'Obamacare,' ” he said. “Think of that.”
The Romney plan would fundamentally alter the structure of the program, which has been run since its inception as an entitlement program for all seniors. Instead of the current, government-run insurance program, Romney would like to use Medicare to give seniors fixed-value vouchers, which they can apply toward the purchase of traditional Medicare or private coverage. Romney—and Ryan, whose similar plan initially omitted the public option—say that choice and competition will drive down prices. But critics charge that the system will shift costs to seniors if the cost of coverage doesn’t keep up with the cost of the voucher.
Groups sympathetic to the Democrats think the Republicans face an uphill climb on the issue.
“I think that this is substantively an important issue for progressives and Democrats,” said Neera Tanden, president of the Center for American Progress and a former domestic-policy director during Obama’s 2008 campaign. “But it also seems to be, politically, a difficult issue for Republicans to mine. I don’t think people think about the Republican Party as the savior of Medicare.”
But Shields believes that the party has cracked the code on how to neutralize Medicare as an issue. In a special election in Nevada last year, now-GOP Rep. Mark Amodei pushed back against Democratic ads alleging he would cut Medicare with his own ads accusing rival Kate Marshall of wanting to gut the program, and featuring his Medicare-enrolled mother as a supporter.
In a PowerPoint presentation that Shields delivered to campaign managers and Capitol Hill offices called “How We Won Seniors,” he walked through that campaign’s strategy. Amodei started off at a 28-percent deficit on Medicare among seniors, but rose to a 7-point advantage by Election Day.
“Republicans can win the Medicare fight,” he says in the presentation, which uses the election as a case study for future races. “We’ve proved it.”