Campaign Debate Over Medicare Could Ripple Out To Deficit Reduction Talks Next Year


If polls continue to show public support eroding for Medicare premium support and Medicaid block grants, Republicans might have a difficult time pushing those reforms next year during the deficit reduction debates, some health care lobbyists and political science experts said, but others countered that even if Republicans lose their White House bid, GOP vice presidential candidate Paul Ryan might return to the House a formidable national figure able to push for those changes. Democrats are pouncing on recent Washington Post/Kaiser polls indicating that Republican proposals for Medicare and Medicaid are faring poorly in swing states, and the GOP is swinging back by pointing out that Democrats have been in favor of premium support plans for decades.

Romney's choice of House Budget Committee Chair Paul Ryan (R-WI) as his running mate thrust health care reform to the forefront of the campaign, and recent polls by The Washington Post show that voters in battleground states trust the president on health care more than Romney. In Florida, 53 percent of voters trust Obama to do a better job with Medicare, compared with 38 percent of those who favor Romney, and 65 percent of Florida voters said they prefer maintaining a system that guarantees benefits over paying seniors a fixed amount of money to buy help buy either private coverage or Medicare. In Ohio, the president is leading 56 percent to Romney's 37 percent on Medicare. Polling on Medicaid is nearly identical.

Nationwide, Obama's health overhaul seems to be growing in popularity, too, according to a Kaiser Family Foundation poll. Fifty-two percent of the public trust Obama “to do a better job” in determining Medicare's future and 32 percent pick Romney. The same polling by Kaiser in July put that spread at 44 percent for Obama and 34 percent for a Republican presidential nominee.

Ryan is allowed to keep his seat in the House if Romney loses, and lobbyists and political science professors say that could set up an interesting dynamic. They note that Ryan and GOP Majority Leader Eric Cantor (R-VA) undermined House Speaker John Boehner (R-OH) when he tried to negotiate with the president on deficit reduction. Boehner and House GOP leadership did not push Ryan’s budget, but Ryan’s budget passed the House anyway.

David Canon, a political science professor at the University of Wisconsin, said that if Romney and Ryan lose, Ryan’s negotiating position with the president will clearly be weaker. “If, as our Republican Governor Scott Walker says, 'elections have consequences,' then the consequence of a Democratic victory would be that their ideas on the budget should get a boost in congressional negotiations,” he said.

But Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said that's not necessarily true. When Inside Health Policy contacted Blendon several days before the polls were released, Blendon said, even if the GOP were to narrowly lose, Ryan would return a hero if the House were to remain under Republican control and Republicans were to pick up a couple of seats in the Senate. In that scenario, the GOP would likely view the loss as Romney's fault, a matter of the wrong messenger delivering the right message, he suggested. Ryan would likely be considered a leader as the party heads into tough negotiations, he added. Blendon expects that Ryan has his eyes on the 2016 race, and to succeed, Ryan cannot be seen as blocking everything. That approach works when trying to make a first-term president look ineffective, but during a second Obama term, Republicans would have to build a record of wins, Blendon said. Ryan would have to compromise, yet still push through the majority of the GOP agenda, he said.

Blendon did not change that assessment when contacted after the polls were released, but he was more pessimistic. Although it's still too early to predict the outcome of the election, he said Romney now needs a major, national event to turn the tide that seems to be against the GOP's plans for Medicare. The GOP ticket must overwhelming win the over-50 voters to secure Florida because Romney is much less popular among younger voters, he said. But the importance of Medicare reforms is growing in importance, and Blendon said that by choosing Ryan as a running mate, Romney cannot distance himself from the House-passed budget that Ryan introduced and that includes the Medicare premium support and Medicaid block grants.

If Romney loses and Republicans also lose seats in the Senate and the House, Republicans will likely determine that the message was to blame, not the messenger, and that could change how they negotiate on health reforms next year, Blendon said.

But a Republican health care consultant said Republicans would likely continue to push for premium support, and he added that premium support is a vague and increasingly politicized term. For example, the Affordable Care Act provides tax credits to help individuals afford private health insurance. That could be considered a form of premium support, he said. Medicaid block grants are a similar issue. States need more control of their budgets and traditional block grants are one way to do that, but there are less traditional block-grant type approaches that also would give states more control over Medicaid spending.

A Democratic lobbyist said there has been a trend among Republicans downplaying the importance of polls because of what they perceive to be a left-wing bias, and that could make it less likely that they would view a loss as a rejection of their health care policies. That means that, in the event Romney loses, there might be a faction within the party that would argue that it wasn't the GOP's health reform ideas that lost the election so much as the presidential candidate. That would set up a conflict within the party over whether the GOP should back off of the Medicare premium support. Boehner would have to gauge that situation to determine what would allow him to keep his post, and he might need the votes of the most-conservative wing to do that, the lobbyist said.

Democrats are turning up the heat on Medicare, and the GOP does not seem to be backing down.

House Minority Leader Nancy Pelosi on Tuesday (Oct. 2) will focus on Ryan's Medicare plan at a forum called Saving Medicare for Seniors Today and in the Future. Pelosi said last week that the election was about three issues: “Medicare, Medicare and Medicare." The Democratic Congressional Campaign Committee is out with its third independent expenditure campaign TV ad against Rep. Chris Gibson (R-NY) that ties him to Romney and his Medicare reform plans. “Chris Gibson put his party first when he voted to end the Medicare guarantee,” the ad states. “Gibson would make seniors pay thousands more, while millionaires get more tax breaks."

Meanwhile, the top Republican on the Senate Finance Committee, Sen. Orrin Hatch (UT), issued a primer on competitive bidding that plays up historical bipartisan support for premium support proposals, including one by GOP vice presidential candidate Paul Ryan and Sen. Ron Wyden (D-OR). The report points to private Medical Advantage and drug plans to bolster a call for private insurance. -- John Wilkerson ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )


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