Washington Watch
As the 2016 presidential primaries and the nomination fights move to the political front burner, a look at the health care and Medicare policies of the candidates raises questions of how far the candidates and their parties want to go in pushing for changes.
Republican presidential candidates are sharply divided over whether to seek drastic changes to Medicare, Social Security and other entitlement funds at the same time as Congressional Republicans continue to push repealing Obamacare.
Democratic presidential candidate Hillary Clinton is advocating dramatically increasing Alzheimer’s disease funding while her chief rival, Sen. Bernie Sanders, D-Vt., wants to get rid of Obamacare altogether by replacing it with a single-payer government-funded “Medicare for all,” system.
More than five years after the president’s health law was enacted, the Republican Party still has no unifying health care platform and only can agree on one thing – they want Obamacare gone. Congress has tried to repeal the legislation more than 60 times with the most recent attempt vetoed by President Obama in early January.
Where the Republican candidates stand on the details of replacing Obamacare, and their views of how they would change Medicare and Social Security are left to theoretical discussions with vague suggestions and hardly any specifics.
Their views are often in sharp contrast with the plan of new House Speaker Paul Ryan, R-Wis., to pursue a “bold alternative agenda” that would include major changes to entitlement programs.
Several of the candidates, including former Florida Gov. Jeb Bush, Ohio Gov. John Kasich and Florida Sen. Marco Rubio, are battling to be seen as in solidarity with Ryan, while others like Donald Trump are vying for grassroots voters.
What’s important is to remember what happened in 2012, when then-Republican presidential nominee Mitt Romney and Ryan, his running mate, faced withering Democratic attacks after endorsing sweeping overhauls of Medicare and Social Security that proved wildly unpopular.
“This is the biggest fault line in the party: whether Republicans should be talking about reducing benefits,” conservative economist Stephen Moore told the Washington Post recently. “Republicans have fallen on their sword for 30 years trying to reform Social Security and Medicare, but the dream lives on — and it makes everyone nervous. Some see a political trap; others see it as necessary,” Moore argues.
Ryan, the Wisconsin Republican who became Speaker of the House last fall after John Boehner abruptly resigned, has long supported proposals that would privatize Social Security, slash Medicaid and convert Medicare to a voucher-based program, in which private insurance would be purchased with federal subsidies. Ryan’s renewed push to change entitlements to voucher programs has Democrats salivating at reviving criticisms they’ve used against Ryan in the past as a motivator to turn out Democratic voters.
Republican candidates’ views
Both Republicans and Democrats count on seniors as reliable voting blocs in their primary nominations contests, and seniors can be counted on to turn out for the November election.
What are the Republican candidates saying about Medicare and Social Security? First, let’s put things in context.
While almost all the Republicans have pledged to repeal and replace the president’s health care plan, it’s important to remember that before the Affordable Care Act (ACA) became effective in 2014, insurance companies were allowed to exclude people from purchasing insurance due to pre-existing health conditions. While this impacts people of all ages, it’s a particular problem for those nearing retirement age, who are more likely to have pre-existing conditions and less likely to be eligible for work-based health care plans.
So politicians advocating replacing Obamacare are in effect, suggesting a return to no coverage for those with pre-conditions, unless they offer details about what they decide to replace it with. Few have offered specific, detailed plans.
Most of the Republican candidates, including Bush, Sen. Ted Cruz, R-Tex, Kasich, Ben Carson and Sen. Marco Rubio, R-Fla., all favor privatizing Social Security, raising the retirement age and cutting benefits, if not ending Medicare altogether, based on what they’ve said so far along the campaign trail and on their websites. Only Donald Trump and Mike Huckabee, among the Republicans, disagree.
Trump and former Arkansas governor Huckabee, have challenged the need for sweeping changes and have repeatedly warned against riling up seniors unnecessarily. But while Trump says he opposes cuts to Medicare, he strongly advocates repealing the ACA, without offering specific recommendations on what he would put in its place. He says he will replace it with something better – his exact words are “everybody’s going to be taken care of.” Trump supported a single-payer health care system, like Canada, but he has since backtracked, speaking instead about a private system.
But Trump has used the issue to bash Carson, the retired neurosurgeon, for advocating reforms to Medicare. “Ben wants to get rid of Medicare,” Trump said recently. “You can’t get rid of Medicare. It’d be a horrible thing to get rid of. It actually works. You get rid of the fraud, waste and abuse — it works.”
Carson’s position on Medicare has shifted several times. Initially he said he wanted to replace Medicare altogether with a private voucher system using health savings accounts for seniors. But his call for abolishing Medicare drew a firestorm of criticism and Carson backed away. Now he says he favors health savings accounts but would allow seniors to keep traditional Medicare if they prefer.
Carson has described Obamacare as the “worst thing since slavery,” and while he favors repealing it, he does not offer any specific proposals on how he would replace it and has not clarified his views on exclusions due to pre-existing conditions
Huckabee, during recent Republican debates, has described plans by other candidates to revamp Medicare and Social Security as “theft.” His solution is to drive down costs by getting rid of entitlement fraud and abuse.
“People are sick of believing that the government is never going to really address this,” Huckabee said during a debate in Colorado. “But let me tell you who not to blame. Let’s quit blaming the people on Social Security. Let’s quit making it a problem for them. It’s like them getting mugged and then us saying, ‘Well, we’re going to mug you some more.’”
Other GOP presidential candidates have introduced plans to overhaul Social Security and Medicare that are more along the lines of Speaker Ryan’s thinking. Bush says he would encourage “private saving to reduce dependency on the government,” to revamp Social Security. His plan would gradually increase the retirement age for full benefits by a month each year beginning in 2022 when the retirement is already set to rise to 67.
Under Bush’s plan, which to his credit, is detailed, the retirement age would rise to 68 by 2034 and to 69 by 2046. While Bush favors repealing the ACA, he indicates he would favor covering those with pre-existing conditions, but hasn’t offered specifics on that idea.
New Jersey Gov. Chris Christie regularly brings up Medicare and Social Security on the campaign trail, casting himself as a truth-teller. Like Bush, Christie would make changes to the eligibility age and also says he would means-test both Medicare and Social Security, slashing Social Security benefits for anyone earning more than $80,000 a year and end the benefits altogether for people earning more than $200,000.
Christie’s controversial idea to means-test Social Security would reduce or cut payments entirely for those who continue to earn income in retirement. His view is the program should be insurance for only those who really need it.
Rubio also supports means-testing the programs and changing the eligibility requirements for future beneficiaries. But he has not released any detailed plans. Like Ryan, he has said he favors transitioning Medicare to a premium support system, giving seniors a fixed amount to purchase health insurance and then giving them the option of either Medicare or a private provider. But he has not taken a position on allowing exclusions for pre-existing conditions in his statements favoring repeal of Obamacare.
Sen. Ron Paul, R-Ky, the eye doctor and libertarian Republican, favors repealing Obamacare, but hasn’t taken specific positions on Medicare. He says he supports free market principles and opposes government intervention in health care, a position one could infer that he’d let the insurance companies decide whether or not to allow exclusions for pre-existing conditions. He has not spelled out a position on that issue.
Kasich also favors repealing Obamacare, but he regularly points out that policies he’s enacted in Ohio have improved the quality and delivery of care for his state’s residents, something he pledges to bring to the whole nation. Kasich gets regularly criticized by Republicans for his decision as governor to take the federal government’s money and expand Medicaid to over half a million Ohioans – including children, the mentally ill and the drug addicted.
Former Hewlett-Packard CEO Carly Fiorina, a breast cancer survivor, advocates repealing Obamacare and says she’s opposed to government intervention in health care. She’s not specific on her plans for Medicare, other than saying that the government needs to get its house in order first before tackling entitlement programs like Medicare.
Sen. Ted Cruz, R-Tex, says he would raise Medicare’s eligibility age to save money. He advocates repealing Obamacare and regularly points to his steadfast opposition to it during his Senate term. He has proposed specific legislation that would allow people to buy health insurance across state lines, long a Republican health policy goal that ironically is contained as a provision under Obamacare. Cruz would repeal the President’s health care law and offers some specifics on how he would replace it, although it’s unclear if it allows the prohibition of exclusions due to pre-existing conditions.
The Democrats’ views
As contrasted with the Republicans, Democratic candidate Hillary Clinton would oppose efforts to repeal Obamacare but does advocate Medicare delivery reforms to improve value and quality of care. She strongly opposes privatization of Medicare and would allow Medicare to negotiate prescription drug costs to help drive them down, something currently Medicare is prohibited from doing.
Clinton wants to expand regulation of insurance companies and drug makers to protect consumers from shocking medical bills and dramatic drug price increases. She and her Democratic rival, Sen. Bernie Sanders, D-Vt., favor different proposals, but both strongly support guaranteed paid family leave. Clinton would provide up to 12 weeks paid leave from work to be a family caregiver or to recover from an injury or illness. Sanders would pay for his proposal differently. None of the leading Republican presidential candidates favor guaranteed paid leave, if they’ve taken a position at all.
Clinton has also advocated for a strong Alzheimer’s disease funding increase – more than doubling the almost $900 million that Congress approved earlier this year. She sees this as one of the most important issues to seniors in this election. Clinton is proposing a $2 billion a year investment, which she argues will ultimately save money, paid for by changes in the tax code. Alzheimer’s is the sixth leading cause of death in the United States and one of the most expensive burdens on the health care system, with Medicare costs expected to quadruple in 2050, accounting for an astonishing one in three Medicare dollars.
Sanders has a very different view of Obamacare than Clinton. He wants to “repeal and replace” the ACA altogether, like the Republicans. But instead he wants to greatly expand the federal government’s role in health care, moving to an all-inclusive government-run “single-payer” plan loosely modeled on how health care is financed in Canada and most of Western Europe.
Sanders would put the federal government in charge of most of the U.S. health care system with states acting as administrative subcontractors, what he describes as “Medicare for all.” He would incorporate Medicare, Medicaid and much of Obamacare into the new system, promising that patients would have no gaps in coverage. But he would eliminate things like insurance premiums, deductibles and copays, paying for it with additional taxes. He suggests that would result ultimately in savings for consumers. Sanders, like Clinton, favors allowing Medicare to negotiate prescription drug costs but goes further, urging Americans to be allowed to import their drugs from Canada to help drive down costs.
Former Maryland Gov. Martin O’Malley is pushing to expand Social Security, arguing that boosting monthly benefits for seniors is needed as well as giving a Social Security tax credit to families who care for elderly parents. He strongly rejects efforts to raise the retirement age, arguing it’s a back-door way to cut benefits for lower-income workers.
Also contributing to this column were US News and World Report ; the Washington Post; Politico; CBS News; AP; the NY Times; the LA Times and the Columbus Dispatch.
