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B5
The truth is that no one can preserve Medicare as we know it. There isnt a prayer that your fathers Medicare will be around in 10 years. BOB LASZEWSKI,
a health care consultant
A national debate has exploded over Medicare, which provides health care to seniors. Today, we explore all aspects of the program and how President Obama and GOP nominee Mitt Romney differ on reform.
KEY QUESTIONS
Medicare costs have been increasing for years. Seniors are living longer than they did in 1965 and their medical care is costing more than the premiums paid into the program.
THE PLANS
Republicans and Democrats agree that any effort to keep Medicare alive for future generations requires a slowdown in spending so that expenses match up with revenue coming in. The two sides have starkly different philosophies about how to make that happen.
OBAMA
Made changes to Medicare in the Affordable Care Act to extend the life of Medicare to 2024. He eliminated subsidies to private Medicare Advantage plans and slowed the rate of spending.
KEY QUESTIONS
ROMNEY-RYAN PLAN
Q: Obama says Romney wants to end Medicare as we know it. Is that true? A: Not really. The original budget plan written by Ryan and passed by House Republicans would turn Medicare into a premium support plan. Seniors would have a fixed government subsidy with which to purchase private insurance. But the new version of that plan includes an option to retain traditional Medicare coverage. Q Does Ryans plan affect people on Medicare today, as the latest online ad by the Obama campaign implies by showing seniors in a seated exercise class and referring to Floridas massive retirement population? A: No. It would not begin until 2023. That means todays seniors, plus those 55 and older, would be exempted from the new system. And by the time theres a deal on any plan, a 10-year exemption likely would include people younger than 55 today. Q: Wouldnt the Ryan plan raise the Medicare eligibility age to 67? A: Yes, by 2034, but the eligibility age for Social Security already is headed to 67.
ROMNEY
Wants to repeal Obamas bill, which would mean Medicare would run out of money again in 2016. Romney says hell pass new changes that will strengthen Medicare, but he hasnt said what they would be.
NURSING HOMES
After senior citizens have exhausted their personal financial resources, Medicaid takes over to cover the cost of nursing home care. In fact, Medicaid currently picks up the tab for about half of all nursing home costs. On average, that can be $50,000 a year or more. ROMNEY: Ryans plan cuts $800 billion from Medicaid over the next decade almost a 40 percent reduction and turns the money over to the states. Just as health care for the poor varies now from state to state, so too would the amount a state pays toward nursing home care. OBAMA: The White House also has proposed spending less on Medicaid over the next decade, but its a much smaller reduction about $60 billion.
Heres the hole Seniors pay all of the cost until they reach $4,550. ($1,750)
RYANS PLANS
Paul Ryan introduced budget plans in 2011 and 2012 that dramatically cut taxes and spending. Each plan also proposed changes to Medicare and Medicaid, which pays for many seniors nursing home expenses. The first plan passed on April 15, 2011, on a 235 to 193 vote. No Democrats voted for it. The second plan passed on March 28, 2012, on a 228 to 191 vote. Again, no Democrats voted for it. In both years, the Democratic-controlled Senate rejected the Ryan plan. CURRENT SENIORS AND 55+: Remain in Medicare. YOUNGER THAN 55 NOW: When they retire after 2022, seniors receive a fixed amount (premium support) from the government to buy a private health insurance plan. The Congressional Budget Office says this plan would increase seniors out-of-pocket expenses by an average of $6,400 annually.
KEY:
Patient paid Insurer paid $2,800 Seniors then pay 25 percent of the bill until they hit $2,800. $310 Seniors pay the rst $310 of their drug costs.
THE REGISTER
Its not uncommon for seniors to take a dozen or more prescriptions over the course of a year, so a lot of people hit the hole in the past about 4 million.
RYAN (2011)
THE COST
Amount the federal government will spend on Medicare in the 2012 budget year, about 13 percent of the national budget.
$485 BILLION
HOW ITS FUNDED Seniors pay a monthly premium and it varies depending on their income. Medicare also gets money by taxing workers 1.45 percent of their pay.
MEDICARE ENROLLMENT
Medicare enrollment (in millions) Medicare enrollment as percentage of the population
RYAN (2012)
1970 1975 1980 1985 1990 2000 2005 2010 2015 2020 2030
20.4 24.9 28.4 31.1 34.2 39.6 42.5 47.2 53.9* 62.3* 79.0*
Sources: Centers for Medicare and Medicaid Services, AARP, Kaiser Health News, U.S. Census Bureau.
COMPILED BY JEFFREY BRUNER, KELLI BROWN AND KATIE KUNERT / THE DES MOINES REGISTER WITH CONTRIBUTIONS FROM USA TODAY AND ASSOCIATED PRESS
CURRENT SENIORS AND 55+: Remain in Medicare YOUNGER THAN 55 NOW: When they retire after 2022, seniors receive a fixed amount from the government to buy a private health insurance plan or stay in Medicare. If seniors stay in Medicare and a comparable private plan is less expensive, seniors must pay the difference. The Congressional Budget Office has not scored this plan to determine how much out-of-pocket expenses would increase. HOW MUCH DO SENIORS GET? Romney and Ryan would give low-income seniors more generous support, but neither has offered specifics.
PREMIUM SUPPORT