in November elections and both parties are trying to win support by
using health-care issues — often combined with scare tactics.
WASHINGTON — The 2012 presidential election hinged on women voters and
minorities, but 2014 is the year for seniors. That explains why both
parties are fiercely competing for their attention — especially when
it comes to health care, both Medicare and the Affordable Care Act.
Seniors rule in midterms. In presidential years, other groups come to
the fore. But older voters are reliable voters who show up in the
off-season, while some of those other groups tend to stay home. This
year, 57 percent of the electorate will be over 50 years old, said
Democratic pollster Celinda Lake. That’s up from 43 percent in 2012.
Ms. Lake is pleased with this, because Democrats are polling well on
two issues seniors care a lot about: Social Security and Medicare. In
the March Battleground Poll, which she worked on with Republican
pollster Ed Goeas, older Americans who are likely voters favored
Democrats on Social Security and Medicare by 7 points.
“Our advantage with seniors is a turnaround” compared with the
previous Battleground Poll in January, Lake said. In 2012, President
Obama lost the vote of those aged 50 and over. In sheer numbers of
seniors likely to turn out, “If President Obama ran in the 2014
electorate, we would have had President Romney,” she said.
But in this cycle, Democrats have a perfect punching bag on their top
issues in the Republican budget plan released April 1 by House Budget
Committee chairman Paul Ryan (R) of Wisconsin. The plan would repeal
the Affordable Care Act (ACA) and change Medicare to a system of
government-paid premium supports for plans that seniors choose.
“Seniors really get socked,” Rep. Chris Van Hollen, (D) of Maryland,
said of the Ryan budget, which has no chance of passing the Senate but
shows Republican priorities. Van Hollen is the top Democrat on the
Concretely, repealing the ACA would mean rolling back expanded free
preventive care for seniors, including an annual checkup and other
exams. It would mean reopening the so-called “doughnut hole” in
prescription drug coverage — resulting in higher drug costs. And
abandoning Medicare’s fee-for-service system for premium payments
removes a guarantee of affordable coverage. House minority leader
Nancy Pelosi (D) of California dubbed the
GOP budget proposal “millionaires over Medicare.”
But Republicans claim an advantage over Democrats on President Obama’s
signature health-care law, which is still highly unpopular with
seniors. The ACA — “Obamacare” — hurts seniors, they insist. Obamacare
featured heavily in the special election in Florida’s 13th district in
March, when Republican David Jolly narrowly defeated Alex Sink to win
a congressional seat that depended on turnout. One TV ad by the U.S.
Chamber of Commerce, which backed Jolly, warned of Medicare cuts under
“Canceled health plans. Higher premiums. Medicare cuts. People losing
their doctors. A disaster for families and seniors. For Alex Sink, the
priority is Obamacare. Not us,” the narrator intoned.
To make their case, Republicans focus on an estimated $156 billion in
cuts over 10 years to a program called Medicare Advantage, which they
have long championed. That’s a private health insurance alternative to
Medicare, regulated by the government, that often includes benefits
such as hearing aids, eyeglasses, and even health-club memberships.
Nearly 16 million people are enrolled in this program — accounting for
30 percent of all Medicare beneficiaries.
Obamacare aims to bring the federal dollars spent to subsidize
Medicare Advantage more in line with what is spent on patients under
traditional Medicare. The federal government began reducing payments
for Medicare Advantage in 2012, and will finish by 2017, when it
expects to reach a rough parity between the two programs nationwide.
But Republicans — and worried Democrats in Congress, as well as
insurers — recently put a lot of pressure on the administration to
temper the cuts. This week, the government announced it had refigured
an estimated 1.9 percent planned cut to Medicare Advantage into a 0.4
percent increase in federal payments to the program for 2015.
Republicans, though, continue to rail against it.
What the messaging from both parties has in common is that it’s mostly
negative. Because Americans are unhappy with both parties, it’s hard
for either one to run a victory lap. Not unusually, finger-pointing
often leaves out context. For instance, the Ryan budget does indeed
call for a changeover to premium supports, but it’s for those entering
into the system 10 years from now — in 2024. Meanwhile, many experts
say that, at some point, Democrats will have to pay the piper of
national debt and seriously rein in entitlements.
At the same time, cuts to Medicare Advantage are — so far — not as
dire as Republicans make them out to be. One reason is that the
program continues to grow in popularity. More enrollees mean more
premiums, which mean more profits for insurers, which mean less
pressure to raise premiums.
A study by the Kaiser Family Foundation finds only a $4 increase in
average monthly Medicare Advantage premiums for 2014, compared with
2013, if someone stays in their current plan. This year, the average
number of plans being offered is 18 — last year it was 20. The cap on
out-of-pocket expenses is expected to be more noticeable this year,
though, as it is up by a national average of $464.
The caveat here is that these are national averages, and Medicare
Advantage differs from county to county. Some people are indeed losing
their doctors or experiencing other disruptive changes.
“In January, I sat down with a group of local doctors to talk about
all this,” said Rep. Bill Johnson (R) of Ohio, in a March 15 GOP
response to President Obama’s weekly radio address. “One told me that
many seniors in our area who need to see a specialist will now have to
drive up to Cleveland or Pittsburgh to receive care. Another cited
hundreds of cases in which patients were blindsided by these changes.”
Who is likely to win this health-care message war? Democratic pollster
Lake believes her party has the advantage. Every day that goes by and
seniors see the real benefits of the ACA, is a good day for Democrats,
On the other hand, just 35 percent of those 65 and older support the
new health-care law, while 56 percent oppose it, according to a March
Pew Research Center survey. That’s a lot of proving to do between now