Democrats and Republicans often seemed to be speaking different languages today when they tried to discuss the Medicare Advantage program.
The program came up during the second part of the health care summit, after participants returned from lunch.
President Obama said he convened the summit partly to see if Republicans and Democrats could get past their talking points and engage in a real exchange of ideas. But the summit participants ended up bringing up many of the same arguments they have been using on each other for the past year.
Medicare Advantage plans are Medicare managed care or fee-for-service plans run by private insurers. They fill the coverage gaps left by the traditional Medicare program and are usually cheaper for participants than paying for traditional Medicare coverage along with Medicare supplement insurance. Democrats have argued that the Medicare Advantage plans are cheaper partly because the government has been subsidizing them.
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The Senate health bill, the House health bill and the new Obama health proposal call for cutting the Medicare Advantage subsidies and cutting Medicare provider reimbursement rates.
Rep Paul Ryan, R-Wis., said he believes the Obama proposal is similar to the Senate health bill.
The Senate bill “treats Medicare like a piggy bank,” Ryan said. “It raids a half a trillion dollars out of Medicare, not to shore up Medicare solvency, but to spend on this new government program….Millions of seniors who have chosen Medicare Advantage will lose the coverage that they now enjoy.”
Sen. Charles Grassley, R-Iowa, suggested that cutting Medicare provider reimbursement rates could cause many medical facilities to shut down. “You’ve got to have a health care system left to serve the people we’re promising health care to,” Grassley said.
Obama and other Democrats would not agree that cuts in Medicare Advantage funding are cuts in Medicare funding.
“We’re not talking about cutting benefits of — under the Medicare program as is required under law,” Obama said. “What we’re talking about is Medicare Advantage.”
Many Republicans agree with Democrats that using tax dollars to subsidize the current version of Medicare Advantage is not a great idea, Obama said.
“You can make an argument that whatever savings we get out of Medicare Advantage should not go to filling the [Medicare Part D prescription drug program] donut hole, for example, that’s a legitimate argument,” Obama said. “You can make an argument that it should go just to deficit reduction. Those are all legitimate arguments. But my point is that the savings that are obtained here are from a program in which insurance companies are making a lot of money, but seniors who are in these kinds of programs are not better off. And the 80% of the people who are not in these programs are paying an extra 90 bucks a year to subsidize the folks who are in them, and that just doesn’t seem like a good deal for them or for the taxpayer.”
Obama also responded to complaints about the length of the Democratic health bills. “We’d love to have a 5-page bill,” he said.
But making a serious effort to help large numbers of Americans takes a large, complicated bill, because health care is complicated, and each issue is connected with other issues, Obama said. To help people with preexisting conditions, for example, the government has to do something about health coverage, he said.
Obama recalled that, while he was running in the Democratic presidential primary, he opposed the idea of requiring individuals to buy health insurance. Later, he said, he decided that a mandate is necessary to keep people from paying for coverage only when they are sick, and make bans on medical underwriting economically viable.
Democrats are right to oppose calls to scrap the current health bills and draft a new version, Obama said.
“‘Starting over,’ they suspect, means, ‘not doing much,’” Obama said. “Politically speaking, there may not be a reason for Republicans to want to do anything.”
If Republicans are serious about health reform, they ought to come up with ways to improve the current bills, and come up with ideas for helping large numbers of uninsured Americans and people with preexisting conditions, Obama said.