The Trump administration and Republicans in Congress have an undeniably poor record on health care. In addition to repeatedly threatening to repeal the Affordable Care Act (ACA) and pushing for devastating cuts to programs such as Medicaid and the Children’s Health Insurance Program (CHIP), majority leaders have increased costs for consumers and undermined critical protections for all individuals who need comprehensive health care coverage. Recognizing that Medicare funding and health care more broadly are top priorities for voters, however, Republicans are deploying last-minute scare tactics to manipulate voters ahead of the upcoming midterm elections. Congressional Democrats, they claim, are looking to gut Medicare in order to pay for Medicare for All.
In August, Rep. Bruce Poliquin (R-ME) began running an ad campaign that calls his Democratic challenger, Jared Golden, a “radical liberal politician [whose] risky scheme will end Medicare as we know it.” Rep. Claudia Tenney (R-NY) has been running similar ads, which portray her opponent’s support for Medicare for All as a dangerous “scheme that could bankrupt Medicare.” On September 6, 2018, former Governor of Florida and current senatorial candidate Rick Scott (R) tweeted, “If you want to protect Medicare, vote Republican. If you want a socialist experiment with Medicare, by all means vote Democrat.”
Even President Donald Trump has adopted this messaging. In August, the president threatened that Democrats are seeking to “raid Medicare to pay for socialism.” At a September rally in Montana, he claimed that Democrats are “going to hurt your Social Security so badly, and they’re killing you on Medicare.”
Multiple news outlets, including The Washington Post, The New York Times, and Vox have debunked all these claims. Republicans—not Democrats—are seeking to restructure Medicare. Despite rhetoric from the Trump administration and Republicans in Congress, Medicare for All proposals have two goals: 1) to improve health care coverage for seniors currently relying on Medicare; and 2) to ensure that every U.S. resident has access to comprehensive health care coverage.
This column outlines Republican efforts to take funds away from Medicare before highlighting the true goals of Medicare for All proposals.
Republican leaders still have their eyes on Medicare cuts
GOP lawmakers have made repeated threats to Medicare during Trump’s presidency. In June, House Republicans proposed a $537 billion cut to Medicare over the next 10 years. This was quickly shot down by leaders in the party, who recognized that the cuts would be a nonstarter for Democrats. More recently, a Republican-led state lawsuit primarily seeking to discredit the validity of the ACA is also threatening to take essential prescription drug benefits from seniors by reinstating the doughnut hole. The doughnut hole policy resulted in seniors paying thousands of dollars out of pocket for their medications and was eliminated by the Democrats under the ACA.
While the Democratic Party has a deep history of seeking to protect and expand Medicare, Republicans have aimed for years to radically transform the program into a voucher system. Various iterations of premium support models have been proposed in a variety of GOP budget plans, such as the 2012 Romney-Ryan plan. However, all of these proposals work to achieve federal savings by shifting costs to beneficiaries either through capping the voucher amount that seniors receive to purchase private plans or increasing traditional Medicare premiums. Both scenarios would increase out-of-pocket costs for seniors, many of whom are already struggling to make ends meet on fixed incomes.
Entitlement reforms
Still, Republican lawmakers see Medicare as an opportunity for budget cuts. After passing the Tax Cuts and Jobs Act in late 2017, majority leaders in Congress quickly turned to the possibility of so-called entitlement reform to pay for the $1.5 trillion deficit incurred by the law. Republicans generally use the phrase “entitlement reform” to describe efforts to make changes to programs such as Medicare and Social Security that often result in funding cuts. In December 2017, House Speaker Paul Ryan (R-WI)—a notorious proponent of premium support for Medicare—said, “I think the president is understanding that choice and competition works everywhere in health care, especially in Medicare … This has been my big thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”
Recognizing the backlash after multiple attempts to repeal the ACA, however, Republicans have largely put entitlement reform on hold. But the Trump administration and its allies in Congress are not giving up just yet. In an interview earlier this month, top Trump adviser and National Economic Council Director Larry Kudlow said, “As far as the larger entitlements, I think everybody is going to look at that probably next year. I don’t want to be specific, I don’t want to get ahead of our own budgeting, but we’ll get there.”
Medicare for All proposals expand health care access and add new benefits to traditional Medicare
After failing to repeal the ACA, the Trump administration has actively sought to sabotage the law, threatening health coverage for millions of people. As a result of the ACA’s uncertain future, Democrats have put forward new approaches to protect and expand access to health care. These ideas range from strengthening the ACA’s marketplaces to guaranteeing health care for all U.S. residents, such as Medicare for All.
Medicare for All gained prominence during Sen. Bernie Sanders’ (I-VT) 2016 presidential run, and 16 Democratic senators have since endorsed the proposal. Indeed, many leaders in the party have announced support for Medicare for All in some capacity; it even scored a recent endorsement from former President Barack Obama. Given the broad popularity of Medicare, it is unsurprising that Medicare for All proposals have also received overwhelming support from the public. Unlike Republican proposals to reform Medicare, there isn’t a Medicare for All proposal that rolls back benefits for current or future enrollees; in fact, many proposals build on the Medicare program to add critical benefits that the program does not currently offer to beneficiaries.
Sen. Sanders’ legislation guarantees Medicare for All by making the government a single payer for health care. A new, improved Medicare program would replace the current program and enhance benefits for seniors, adding vision, dental, and hearing benefits that the current Medicare program does not provide. Moreover, the new program would eliminate premiums and other out-of-pocket costs for current Medicare beneficiaries. Far from harming Medicare beneficiaries, the Sanders bill would represent the greatest advancement in financial security for seniors since Medicare was first enacted in 1965.
Medicare Extra
Republican attacks on Medicare for All also miss the mark with respect to the Medicare for All plan proposed by the Center for American Progress. This plan, known as Medicare Extra, guarantees a choice of Medicare for All. In contrast to the Sanders bill, the CAP plan creates a new program alongside the current Medicare program and allows seniors to either remain in the current Medicare program or choose to enroll in the new program. Like the Sanders bill, CAP’s proposal enhances benefits for seniors, adding vision, dental, and hearing benefits to both the current Medicare program and the new program. The CAP plan would also significantly lower the premiums and out-of-pocket costs of current Medicare beneficiaries who switch to Medicare Extra, though it does not lower these costs as dramatically as the Sanders bill. Unlike the Sanders bill, the CAP plan would enhance benefits for seniors who need long-term services and supports—a critical benefit that the current Medicare program does not provide.
Conclusion
While Republicans are claiming that their party seeks to protect Medicare, their previous efforts to sabotage the ACA suggest that they will likely change their tune after the election. Republicans have done everything in their power to frame Medicare for All proposals as costly and unrealistic, and now they are trying to pit Medicare beneficiaries against supporters of Medicare for All to maintain control in Congress.
The United States currently spends more money on health care than every other industrial country in the world. Democratic leaders in Congress recognize the value of lowering these costs by expanding Medicare—a highly efficient and widely popular health care program—to ensure that all U.S. residents have access to quality, affordable health care.
Madeline Twomey is the special assistant for Health Policy at the Center for American Progress.