Analysis: Democrats hit reset on health care

[September 27, 2011]  WASHINGTON (AP) -- Democrats are hitting the reset button on health care for next year's elections.

Weary of getting pounded over the new health overhaul law, President Barack Obama and his party are changing the subject to Medicare.

Obama signaled last week he's on board with the shift. His latest debt plan for Congress omitted an increase in the Medicare eligibility age, a proposal he'd put on the table in earlier discussions with House Speaker John Boehner. Gone was the consensus-seeking compromiser as Obama threatened to veto Medicare beneficiary cuts unless Congress also raises taxes on the rich.

Publicly, Republicans say bring it on. While they were nervous over the skeptical public reaction to their Medicare privatization plan this spring, they now insist they can hold their own in a debate. After all, Obama himself has publicly acknowledged Medicare is headed toward insolvency.

It's hard to see anything but the economy mattering to voters in 2012, but Medicare may be different.

It's perennially a top issue for older voters, who turn out more regularly than younger people.

Voters 60 and older have swung between Republican and Democratic candidates over the last six House elections, according to Robert Blendon, a professor at the Harvard School of Public Health who tracks public opinion on health care.

"On the Medicare side, anything that looks like a major change in the existing program would be very threatening to whichever party is identified with it," Blendon said.

In 2010, Democrats paid the price for using $500 billion in Medicare cuts to finance coverage for the uninsured under Obama's health care overhaul. Older voters saw tapping Medicare as a threat, and they helped deliver the House to Republicans.

Democrats want to return the favor in 2012, and they believe the House-passed GOP budget gives them a way.

The plan by Budget Chairman Paul Ryan, R-Wis., called for replacing Medicare for future retirees with a voucher-like payment. Current retirees -- about 48 million beneficiaries -- could still keep the Medicare they know. People now 54 and younger would use their government payment to pick from a range of regulated private insurance plans.

An analysis by the Congressional Budget Office found that within 20 years, 65-year-olds would on average be on the hook for more than two-thirds of their health care costs, almost a mirror-image of the financial split between current beneficiaries and Medicare.

As expected, the House plan went nowhere in the Democratic-led Senate.

No harm, no foul?

Not if Democrats have their way. Their message to seniors: The Ryan budget will become reality if the GOP wins the White House and full control of Congress.

"This is not a theoretical issue, it is a place where Republicans have taken votes that are very unpopular," Democratic pollster Celinda Lake said. "It would be foolish of Democrats to waffle on this issue."

The House budget would have also kept Obama's Medicare cuts, the $500 billion that Republicans accused Obama of "raiding" the program for. And it would have repealed a provision of the health care law that is starting to bring down costs for seniors with high prescription drug bills.

Republicans say they're not backing down. According to the top domestic policy expert for 2008 GOP presidential candidate John McCain, his party was right to take on Medicare, but the timing was off.

"The lesson of the House budget was that it's premature to start offering solutions when you haven't educated the American people on why you can't sustain the status quo," said economist Douglas Holtz-Eakin, now president of the American Action Forum, a conservative public policy center.

Holtz-Eakin doesn't think Republicans harmed themselves. The Medicare trustees, among other neutral parties, have provided ample evidence of the program's long-term financial problems. If Obama and the Democrats are going to criticize Republicans for offering a solution, they have to spell out a fix of their own. And those fixes almost surely would require painful cuts for beneficiaries.

"If the status quo is untenable, and it is, then (Obama) has an obligation to produce some reforms," said Holtz-Eakin. "Otherwise, he's defending something that's broken, and raiding it, to boot."

The top GOP presidential candidates have jousted with one another over who would be quicker and more effective in overturning Obama's health care law. Less clear is what they would do about Medicare.

Minnesota Rep. Michele Bachmann voted for the House budget, but she hints that as president she might make some changes to the plan.

Texas Gov. Rick Perry has been getting criticized for comparing Social Security to a Ponzi scheme. His stance on Medicare could prove just as controversial. A law he signed this year calls for the federal government to turn over Medicare and Medicaid to groups of states.

Former Massachusetts Gov. Mitt Romney praises the House GOP budget as an honest attempt to save Medicare. He says his own plan will differ but share the same objectives.

GOP candidates have the luxury now of playing to an audience of conservative primary voters, but Democratic pollster Lake says that won't last.

"Cutting Medicare is a much more dicey proposition in the general election," she said. "Medicare is popular even among the people who think it's in trouble."

[Associated Press; By RICARDO ALONSO-ZALDIVAR]

Ricardo Alonso-Zaldivar covers health care issues for The Associated Press.

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