House Republicans struggle to find allies across the aisle for Medicare overhaul

House Republicans are struggling to make the case that their proposed Medicare overhaul has broad support.

The GOP has been ramping up its argument that Democrats have, in the past, supported “premium support” reforms despite the party’s united attacks against the proposal ahead of the November elections. They are trying to persuade voters that Republicans have a bipartisan plan to save the program from bankruptcy, while painting Democrats as hypocrites out to scare seniors.

{mosads}The effort until now had focused mainly on Clinton administration officials and Sen. Ron Wyden (D-Ore.), who co-authored a Medicare reform proposal with Rep. Paul Ryan (R-Wis.) last year. This past week, however, the Ways and Means Committee changed tactics after unearthing a 2003 vote in favor of premium support by the chairman of the Democratic Congressional Campaign Committee.

“What’s the main difference between the premium support model Rep. [Steve] Israel [(D-N.Y.)] supported and the one he opposes today? Answer: The premium support plan that Rep. Israel supported would have impacted current seniors, whereas the premium support model in the House Republican Budget would not impact current seniors or anyone over the age of 54,” Republicans on the Ways and Means Committee said in a statement. 

“Despite the rhetoric from Democrats like Rep. Israel, premium support has a long history of Democrat support,” the Republicans said.

Israel was one of just nine Democrats who voted in June 2003 for the House version of the Medicare prescription drug bill, which barely squeaked by on a 216 to 215 vote. The House bill would have required the Medicare program to directly compete with private plans starting in 2010, but that provision was jettisoned when the bill was reconciled with the Senate version.

Israel’s office called any comparison between the prescription drug bill — the biggest expansion of Medicare benefits since 1965 — and Ryan’s Medicare overhaul “laughably disingenuous.”

“Congressman Israel voted to expand Medicare to offer prescription drug benefits, and that is the exact opposite of the last two Republican budgets that end the Medicare guarantee,” said spokeswoman Samantha Slater. “It’s apples and oranges, and desperate at that.”

In a floor speech at the time, Israel said he reserved the right to vote against the final version of the bill after it emerged from conference negotiations with the Senate.

“Is this plan flawed? I believe it is,” Israel said before voting for the House bill. “I believe the Senate plan, supported by [former Sen.] Ted Kennedy [(D-Mass.)], is much better. But we can’t get near that plan unless we go to a House-Senate conference. And we can’t go to a House-Senate conference unless we pass this bill today.”

Republicans have also failed to get mileage out of Wyden’s cooperation with Ryan last December. While the Medicare proposal in the House-approved budget retains the Ryan-Wyden plan’s option for seniors to stay in traditional Medicare, it contains several differences that have enabled Wyden to stop shy of endorsing Ryan’s reforms.

Wyden told The Hill that he doesn’t support Ryan’s call to raise the Medicare eligibility age and said it would be “a real leap” for him to support the lower cap on premium growth in Ryan’s blueprint. Still, he continues to support the idea of premium support.

“I haven’t backed off the white paper, that’s the main thing,” Wyden told The Hill. “I’m not in charge of the House Republican budget. I’m still for the white paper.”

Henry Aaron, a Brookings Institution scholar who invented premium support 20 years ago with Robert Reischauer, said he’d be surprised if Republicans came up with a detailed Medicare proposal that Wyden could get behind.

“The Ryan–Wyden plan is not a plan. It is a press release, so vague in its description that it could mean many and quite different things,” Aaron told The Hill via email. “Given what Ryan has said in his latest budget proposal, I would be amazed if he and Wyden could come to agreement on legislative language.”

Aaron said Republicans are free to use the term “premium support” now that it’s in the public domain, but stresses that what he had in mind when he coined it was far different. He said his model had three characteristics to distinguish it from vouchers, which would lose their value over time: linking the premium support to a health cost index; limiting plan offerings to a small number “so that beneficiaries could have a shot at rational choice”; and “rigorous regulation of sales together with effective risk adjustment to minimize competition based on risk selection.”

“No current plan has all three,” Aaron said, “and, in my view, the prospects of getting all three in a single plan that could be enacted and enforced are nil, in the current political climate.”

Reischauer, a former director of the Congressional Budget Office under Clinton whom Republicans often tout as a premium support champion, professed similar misgivings about the latest Ryan proposal.

He said his goal was to create “incentives to provide better care without increasing costs,” rather than simply “bringing down costs,” which he said is the stated goal of the Republican budget.

“None of the current proposals have the detail that one would need to make a considered judgment about their viability or desirability,” he added. Still, he said, it would be “essential” to adjust the annual growth in premium support to the growth of medical costs, at least in the first five or 10 years, which would be far higher than Ryan’s cap of gross domestic product plus 0.5 percentage points. 

“Otherwise,” he said, “you could be creating something that has pernicious impacts on millions of elderly people.”

Another former Clinton official quoted by Republicans as a premium support champion spoke more positively about the Ryan-Wyden plan. 

“I strongly support the Ryan-Wyden proposal,” former Budget Director Alice Rivlin told The Hill. “The budget resolution is just that — a budget resolution, not a full legislative proposal. It is a starting point for a negotiation over details and legislative language.”

Rivlin’s comments offer a stark contrast with last year, when she took issue with Ryan after he claimed she supported his first iteration of premium support, which didn’t retain traditional Medicare as an option.

“I don’t actually support the form in which he put it in the budget,” Rivlin told Politico at the time. “We had worked together but the version that’s in the budget resolution is not one that I would subscribe to.”