Obama Medicare plan: No voucher but maybe a bill

RICARDO ALONSO-ZALDIVAR,Associated Press

Monday, September 24, 2012

WASHINGTON (AP) — He'll never turn Medicare into a voucher, but if you are lucky enough to be financially comfortable in retirement, odds are you'll pay higher premiums under President Barack Obama's plan. It's not just the 1 percent who'll feel the pinch.

And take note, baby boomers: The Medicare you get won't be quite as generous as what your parents' generation enjoys. A higher deductible here, a new co-payment there, and the tweaks add up.

With the future of Medicare on the line in the presidential election, The Associated Press asked the Obama campaign five questions about how his plans for seniors' health care would affect critical issues of costs and benefits. (The AP also sent Republican Mitt Romney a set of questions, and the responses are the subject of a companion report.)

Unlike Romney, Obama is not calling for a major Medicare remake. Most of the president's cost-cutting ideas are incorporated in his health care law, and will phase in unless Romney wins and makes good on his pledge to repeal it. Other Obama proposals are drawn from government advisory groups or bipartisan commissions seeking consensus on how to reduce deficits.

It doesn't mean they're pain-free. AARP gave a thumbs-down to this year's Obama budget, citing Medicare cost shifts.

If Obama is re-elected and plunges into deficit negotiations with congressional Republicans, he will be pushed for greater Medicare savings, by cutting payments to service providers or squeezing more from recipients.

"Neither one of (the candidates) is going to basically lay his cards on the table before the election," said former AARP CEO Bill Novelli, now at Georgetown University in Washington. "Obama is going to have to raise the price of benefits, whether by hundreds or thousands, I don't know. Where else is the money going to come from, besides printing it?"

Some Medicare questions for consumers to watch, along with answers from the Obama campaign and the views of several experts:

Q: What new costs can seniors expect under Obama's plan for Medicare?

A: You may need a CPA degree to understand the complicated details of changes proposed by the president.

Broadly speaking, Obama would raise monthly premiums for retirees making $85,000 or more ($170,000 for married couples). He also would hit newly joining baby boomers with a series of fees.

Currently only about 5 percent of beneficiaries pay higher, income-based monthly premiums for outpatient coverage under Medicare Part B and even fewer pay higher premiums for prescription drug coverage.

Under Obama's proposal, a growing share of seniors would pay the higher premiums over time. He'd also bump up the premiums paid by higher-income beneficiaries by 15 percent.

After about 20 years, the top 25 percent of Medicare recipients would be paying higher, income-based premiums.

An analysis by the nonpartisan Kaiser Family Foundation estimates that in 2017, a single retiree with income of $86,000 would pay $447 more in premiums for Medicare's outpatient and prescription drug coverage. A married couple with income of $175,000 would pay about $894 more in that year.

As for the fees on newly joining baby boomers, they'd face a $25 increase in their annual outpatient deductible (initially for a few years only), some limits on the use of 'Medigap' insurance to fill in gaps left by Medicare, and a new home health co-payment in certain cases.

Think of these proposals as the president's opening bid in budget talks.

Q: Hasn't Obama also hinted he might be willing to increase the eligibility age for Medicare?

A: In budget negotiations with Republicans last year, Obama indicated a willingness to consider gradually raising the eligibility age to 67, from 65 now. Romney supports the idea. But the president has since walked it back.

"President Obama has always been willing to make hard choices to confront big challenges, and sometimes that means listening to other ideas," said campaign spokesman Adam Fetcher. "But (Obama) believes we can strengthen the future of Medicare without raising the eligibility age."

Translation: The idea is not quite off the table, and Obama, if re-elected, will again face the choice in budget negotiations.

"I think it will continue to be analyzed," said Don Berwick, Obama's first Medicare chief. Berwick believes there is a downside to postponing Medicare eligibility, because a sizable number of future retirees would join the program in weaker health.

"As an administration official, I was not impressed that it would save money for the (Medicare) trust fund," said Berwick. "But I would say it will continue to be studied."

Q: Medicare's in-house economic analysts have warned that cuts in Obama's health care law could eventually drive some hospitals into the red. The health care industry is pushing for repeal of a Medicare cost-control board in the law, saying more cuts will reduce access for seniors. What will Obama do if seniors start having problems getting the care they need?

A: The administration says that's unlikely to happen. Cuts are being introduced gradually, and dozens of pilot programs are testing ways to provide better care for less money. Health care costs are in a lull, buying time to make changes. Studies indicate there is plenty of waste to be cut.

"The president will continue to make sure that seniors have access to the benefits they have earned," Fetcher.

But if Obama's advisers are wrong and the system starts to seize up, most experts believe Congress would intervene. "Congress is always going to step in if there is a real perception that quality and access for Medicare beneficiaries would suffer broadly," said Mark McClellan, who ran Medicare for President George W. Bush.

Q: Obama's health care law already increases the Medicare payroll tax for individuals making over $200,000. What's to rule out a broader tax increase?

A: McClellan says that's always a risk, particularly because Obama's health care law funnels the higher Medicare payroll tax into providing coverage for working-age uninsured people.

"Because those revenues are dedicated to the coverage expansion, everything else being equal, the government is going to need more revenue to cover the cost of the (Medicare) program," he said. "If that money had been used for deficit reduction, or to increase the life of the trust fund, the government would have more existing resources."

The White House says there are no plans to propose higher Medicare taxes.

Q: The administration pulled the plug on a new long-term care insurance program because of financing problems. How does Obama plan to address this unmet national need in his second term?

A: The campaign says Obama is willing to work with anyone who has good ideas about long-term care, and that Medicaid and Medicare will continue working to help seniors who want to stay in their own homes, instead of going into nursing facilities.

But Novelli said paying for long-term care remains a huge problem for middle-class elders and their families.

Obama "may have to punt, they may not want to go there," said Novelli. "But, yes, as a society we've got to go there."

More like this story

RobHunterJohnson 7 months, 4 weeks ago

Sounds like a plan, something Mitts Group is very short on! Rob

RobHunterJohnson 7 months, 4 weeks ago

Just look above at the Blue Link, Romeny Medicare Plan: Key Details still in Flux. Rob

wyriontair 7 months, 4 weeks ago

I'm curious to know how many who comment on Obamacare actually have read it. Unless this is repealed we are all going to suffer with higher costs, taxes, less care and the list goes on. I spent weeks reading that thing, continuously referring to the tax code and Constitution and the only reason it was deemed Constitutional was through the tax code NOT the Commerce Clause.

clingingredneck 7 months, 4 weeks ago

I work in the Healthcare Insurance Industry. What Obamacare is going to do is put all healthcare insurance out of business and move us to a single payer system. People who can't afford to pick up their medicine cannot afford his "reasonable" expense of a premium. I lost my healthcare the week after Obamacare passed. They dropped me due to changes passed under Obamacare because I was diabetic. They no longer had to insure me. I could not get insurance. I called McCaskills office to find out what my options were and they told me about the pool insurance. Their "reasonable premium" was $1700.00 per MONTH! I called back and asked them what they were thinking. Her staff's exact response was "Well it is available. If you can't make that payment its not OUR fault."

Get prepared. As this thing goes further into effect you will all start to feel it. Why do you think he pushed the implementation to the year AFTER the election?

tonto_goldberg 7 months, 4 weeks ago

You say that like it was a bad thing. Government takeover of health insurance could not possibly make things worse than they are now. The healthcare insurance industry is the biggest organized crime in US history. Arbitrary and capricious decisions cost people their health and their savings every day, and it's all done under the protection of very gullible state regulators.

Does it bother you that a clerk with (maybe, at most) a GED in the basement of some call center gets to make your most basic medical decisions for you? It bothers me a lot. Bring on your name-calling, but we will be healthier under Obamacare.

asb 7 months, 4 weeks ago

The government wouldn't be much good at composing music, but when it comes to armies, roads, healthcare, social security, consumer protection, environmental regulation, and many other social functions, there's no better performer. Your take is that the government is evil and so cannot do anything right. That is a pathology. The government has skill, roles, and responsibilities that don't scale to the private sector, and healthcare is one that has come into the government's area of responsibility. Is it the insurance and medical industries' fault? some would say so, that greed and lack of regulation are the culprit and that all we need to do to the present system is keep it open and fair. Others would say that healthcare has become so large in our lives, and so prone to profiteering, that government must have a larger role. I think the rate of explosive growth of the cost of care, and the cost of insurance make it imparative that government have the ACA type role. Any private version would be unmanageable, due to scale rather than the private sector's ills, and would drain our economy - both sins of which you claim the government is most guilty of. You are mistaken. Some type of government involvement in management, regulation, and funding of health care is now needed. Tweak it all you want, but you cannot take away the need.

RobHunterJohnson 7 months, 4 weeks ago

I thought you resided in the Great state of TN? Rob

RobHunterJohnson 7 months, 4 weeks ago

Clingeredneck looks like we have your motive now "I WORK IN THE HEALTH CARE INSURANCE INDUSTRY" If you work for the insurance company and they won' t insure you we are all doomed! Why don"t you call up your Senators Lamar Alexander, or Bob Corker. I have been without Insurance, and it was over $2000 a quarter in 1990 for Blue Cross Blue Shield, That was the moment that I started voting DEMOCRATIC, and you should too! Rob

eileen10 7 months, 4 weeks ago

That is a bit confusing redneck. Four days ago you said you left Missouri a long time ago and now live in Tn. so why would you call McCaskills office?

Sequoia 7 months, 4 weeks ago

Because he's making all this up?

tonto_goldberg 7 months, 4 weeks ago

That's a safe bet. That poster gets too many things wrong about making money and paying taxes in the two states.

eileen10 7 months, 4 weeks ago

When I researched Obamacare I referred to articles I call "Obamacare for dummies". It's the simplified versions and I found his plan to be very good. Maybe not perfect but at least we have something and so far it's been great for me but I can only speak for myself.

spelchek 7 months, 4 weeks ago

eileen, the new Obamacare taxes and Bush tax cuts begin and end the first day of 2013. The largest tax increase in history (on the middle class I might add). Your "very good" won't last much longer.

atr.org/days-taxmageddon-a7203

Guess what Obama inherits from himself if he wins?

tonto_goldberg 7 months, 4 weeks ago

Pants on fire! Obamacare is nowhere near the biggest tax increase in history. Do you want a list of references for all the times this GOP lie has been debunked?

spelchek 7 months, 4 weeks ago

To be fair I did mention the Bush tax cuts (plus the many other increases mentioned in the link). Please leave a link debunking my link.

asb 7 months, 4 weeks ago

No it isn't, and read something other than the FRight Wing blogs and smear engines you thrive on . . .

spelchek 7 months, 4 weeks ago

My link isn't a blog. It names tax increases on the way pulled from straight from open records that anyone can find for themselves if they'd just look.

eileen10 7 months, 4 weeks ago

Oh boy. I can honestly say you did not make my day but better to find out now than get slapped in the face later. What does he inherit if he wins?

RobHunterJohnson 7 months, 4 weeks ago

eileen10, I have made up my mind actually over the weekend with the Dead People voting Rebuttal, she has lost all credibility with me, I am tired of people like clinging redneck, a couple weeks ago there was a Bransweiger, the posts are gone now but she was playing a game too. These people are playing a good Poker Hand, but if you click on her link, go to her comment page, read her posts, ( I did ) and her story starts to fit the article. Rob

tonto_goldberg 7 months, 4 weeks ago

Princess Multi-nics again? Read fast - the NT hates to hear about people with numerous screen names. We know who they are, and they know who they are.

eileen10 7 months, 4 weeks ago

I know right away who Bransweiger was.

eileen10 7 months, 4 weeks ago

oops. Make that "knew"

online_editor 7 months, 4 weeks ago

If you want to e-mail rbrown@newstribune.com with your suspicions, I'll take a look. Generally, there has to be a preponderance of internal evidence before we assume someone's using multiple accounts for mischief. (I won't describe precisely what that consists of, lest someone try to work around it.) When there are conclusive signs, yes, we'll act. When the evidence is less conclusive, we fall back to judging whether or not the post or account is complying with forum policies, regardless of who's behind it. When there's uncertainty, it's wiser to focus on the nature of what's being said, such as whether it's consistently inflammatory or off-topic, not worry so much about whether or not person A is the same as person B. Meanwhile, when it comes to someone possibly posting inconsistencies from the same account, your reactions are the best check and balance on that. Not a perfect process, but it does help. --Rick Brown, online editor, News Tribune

tonto_goldberg 7 months, 4 weeks ago

Don't just delete my post. Do something about the problem.

eileen10 7 months, 4 weeks ago

Okay Rob. I see what you mean.

eileen10 7 months, 4 weeks ago

spelchek, I went to the site and into some other sites and theres a lot of conflict. It gets to the point that I don't know whose telling the truth in these news articles and who isn't. The dems say one thing the rep the other. The best I can come up with is we will find out soon enough.Talk about a rip roaring headache (not literally) jusy confusing as hell.

spelchek 7 months, 4 weeks ago

Justice John Roberts says the "penalty" is a tax, thus making Obamacare constitutional. 6 million uninsured will be hit with the tax. I leave you a left leaning link to eliminate any worry of bias.

huffingtonpost.com/2012/09/19/obamacare-cbo-report_n_1898370.html

jcguy25 7 months, 4 weeks ago

They will get the tax only if they continue to choose to not purchase health insurance from either a private insurer or one of the state pools. That's the penalty, so the entire 6 million people will not be hit with a penalty.

spelchek 7 months, 4 weeks ago

Not a penalty, a tax. SCOTUS says so. Are you above the SCOTUS? This administration (Claire McCaskill / Democrats) will go down in history as the conceivers of taxing it's people if they decide not to purchase a product government deems necessary. If that's not a loss of liberty I don't know what is.

eileen10 7 months, 4 weeks ago

I still feel Pres. Obama is the best man for the job though.

asb 7 months, 4 weeks ago

Obama has had problems, but has not failed as a President. Your hatred of him is a pathology (note the trend here) and is misleading when you join a discussion. Affirmative Action is bad? now we're getting somewhere on your approach. California is a failure? Grace, short-term economic stress aside (and it's being fixed as we twitch) California is one of the largest economies in the world, and still actually growing in spite of the T-pardy attemptes to shut it down. Same with Illinois, problems for sure, but digging out, just like the rest of the world. Your conviction that all is lost and that evil runs the world is sympomatic of depression and anxiety that should be treated.

Sequoia 7 months, 4 weeks ago

Best health care in the world. Durr de durr!

theatlanticwire.com/national/2012/09/doctors-perform-surgery-wrong-body-part-about-40-times-week/57200/

eileen10 7 months, 4 weeks ago

Doctors do mess up. When someone was going in for surgery the other nurses and I would make sure there was no mistake by writing on the body part with a washable marker. If thr right leg was to be removed a "yes" would be on that leg and a "no" on the left one. Nurses know left from right but the poor doctors get confused : )

3336 7 months, 4 weeks ago

The Affordable Care Act not Obamacare is better than b4 mainly because now Seniors can get preventive care at no extra cost and the donut hole w/b closed. Also now we can purchase Generic drugs for $4 at several different locations, also if you have a pre-exsisting illness you can get insurance. If you have not traveled the road with these particuliar concerns you have no idea how much this helps. Now, of course I'm speaking of help for several different concerns not just for a few. Also, when we speak of those who do not have ins. we seem to think it w/put a burden on those who have ins, however, we already pay more because the cost is passed on to us. Now, seems like to me the INSURANCE COMPANIES are the culpits because they have not lower our cost. So anyway just a word from experiences in my life but of course perhaps I'm the only one!!!!

Sequoia 7 months, 4 weeks ago

Anyone interested in the cost of health care needs to listen to this radio program:

thedianerehmshow.org/shows/2012-09-19/dr-marty-makary-unaccountable-what-hospitals-wont-tell-you-and-how-transparency-can

The reason health care costs are so high? Hospitals are like hotels: the more beds you fill, the more money you make. It's over-treatment. Corporate managers push doctors to see more patients, do more surgeries, while neither the patient nor the doctor know how much the "treatment" actually costs... you can't tell me that is the "free market." In many rural areas, there is only one hospital. What choice does the patient really have? When Docs get bonuses for more surgeries (lawyers will know the phrase "eat what you kill."). Who can a patient trust?

Look at all the incentive to recommend pointless surgery. Look at all the incentives to push doctors to the breaking point (did you know a doctor operating on little sleep might as well be drunk?).

Follow the money. Always. The corporate model is driving costs. And they got you repeating the refrain that "Obamacare" is "tyranny." Don't be a sucker!

I don't know whether the current healthcare law is going to address the real issue. At least it is a start. The choice in this election is between a start and nothing.

Good doctors don't like the current more-is-better system. More good docs need to speak out.

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