Republicans kicked up their efforts to attack Democrats on Medicare from the left this afternoon when Rep. Paul Ryan (R-WI) appeared on Fox News to argue that it’s actually the Affordable Care Act that “ends Medicare as we know it”:
RYAN: Millions of dollars of negative ads are being run to try and scare seniors and trying to confuse seniors. You know, the irony of this Bill, is with all this Mediscare that the Democrats are running, it’s Obamacare itself that ends Medicare as we know it. Obamacare takes half a trillion dollars from Medicare — not to make it more solvent but to spend on this other government program, Obamacare. And then it creates this 15 panel board of unelected, unaccountable, bureaucrats starting next year to price control and ration Medicare for current seniors.
It does no such thing. The ACA reduced annual increases in payments to hospitals, skilled nursing facilities, home health agencies, and other institutions to spur productivity and cut overpayments to private insurers that are not delivering value for Medicare dollars. It used that money to expand coverage to 32 million Americans — many of whom were receiving uncompensated care at these institutions — to extend the life of the Medicare program and invest in new demonstration projects that aim to encourage providers to deliver quality care more efficiently. Seniors’ guaranteed benefits are in no way affected.
The “15 panel board,” as Ryan calls it, is actually the Independent Payment Advisory Board (IPAB). It will include individuals from across the health care field, all of whom will have to be confirmed by the Senate. Significantly, their proposal to reduce spending cannot “include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums…increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and co- payments), or otherwise restrict benefits or modify eligibility criteria” (Section 3403 (page 409) of the Affordable Care Act stipulates.)
Policy wonks believe that the board and the payment reforms can help reduce costs in a transparent process and Ryan himself proposed a very similar commission in 2009 and maintains many of the ACA’s Medicare cuts in his plan. In fact, Ryan’s Patients’ Choice Act (PCA) sought to establish “two governmental bodies to broadly apply cost effectiveness research” and had more teeth than the ACA, including provisions to allow for penalties for physicians who did not follow the guidelines.”