Medicare

House Budget Committee Chairman Paul Ryan (R-Wis.) is set to release his latest budget proposal on Wednesday, but the political battle over his Medicare proposals has already begun. 

As it has in previous years, Ryan's budget will call for repealing most of the Affordable Care Act and partially privatizing the Medicare program. And Democrats are already planning to make the budget a centerpiece of their 2014 campaign ads.

"In terms of this indictment of the Republicans of being very much out of step with voters, Medicare is indeed central to that," pollster Geoff Garin said on a Monday call organized by the Democratic Senate Campaign Committee. "Congressman Ryan's approach to Medicare is out of sync with the electorate."

Ryan, the 2012 vice presidential candidate for the Republican Party, could also take heat from some of his wonkier critics over his approach to the ACA. His budget will call for repealing sections of the law that provide new healthcare benefits to the uninsured, but leave in place its Medicare cuts — the same Medicare cuts Ryan and Mitt Romney criticized so intently during the presidential campaign. 

Democrats are already attacking the Medicare plan, and the partisan warfare is sure to escalate Tuesday. Ryan will hold a news conference on his proposal at 10:30 a.m.

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This week will reopen one of the biggest political battles of the past two years as lawmakers debate the future of Medicare.

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Sen. Marco Rubio (R-Fla.) pushed the federal Medicare agency on Friday to scale back its proposed cuts to private Medicare Advantage plans.

The insurance industry is aggressively fighting the cuts, and has been looking for lawmakers to take up their case with the Centers for Medicare and Medicaid Services (CMS).

Rubio urged CMS Friday to use different assumptions about how Medicare will pay doctors next year — a change that would almost certainly lead the agency to scale back its proposed 2.2 percent cut.

"On behalf of my constituents in Florida who rely on Medicare Advantage to receive their Medicare benefits, I am deeply concerned that if CMS fails to reverse its preliminary decision on this critically important issue, many MA enrollees may experience disruptions in their health care benefits and choices," Rubio wrote.

Health and Human Services Secretary Kathleen Sebelius on Thursday credited President Obama's healthcare law with a recent slowdown in medical spending.

The Congressional Budget Office has projected a significant slowing in the growth of Medicare spending and healthcare costs more generally. 

The slowdown came as a surprise — but a welcome one — to many policy wonks, following several years in which medical costs outpaced wages and overall inflation. 

According to two members of the House Budget Committee, the age could be 55 or 56.

The House Budget Committee has not decided if it will change Medicare benefits for people 55 years and older in its fiscal blueprint due out Tuesday, Republican members of the panel said.

Reps. Bill Flores (Texas) and Rob Woodall (Ga.) said that the choice about when to begin overhauling the program's benefit structure is still up in the air.

"We have not made a final decision yet," Flores said Wednesday. "It's possible we'd keep [the age] at 55. It's also possible it could be set at 56."

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The health insurance industry is beginning a ferocious lobbying offensive aimed at warding off major cuts to Medicare payments.

Congressional Democrats were practically salivating Tuesday at the news that Rep. Paul Ryan (R-Wis.) might propose bigger Medicare cuts in his next budget outline. 

Ryan might change his plan to affect more people who are near retirement, which skeptics see as abandoning the promise to protect anyone 55 or older. That has been a key part of the sales pitch for the Ryan plan, and the primary weapon against Democratic charges that the proposal would hurt seniors.

Bringing more people into the new system would likely help Ryan save more money from Medicare, potentially moving his proposal closer to balancing the budget without deep cuts to defense or discretionary spending. But it could also open up a new line of attack from Democrats, who have already hammered the Ryan plan in campaign ads.

Centrist Republicans are unhappy with the potential change, because they've defended their votes for the Ryan plan largely by noting that it wouldn't affect anyone 55 or older.

Senate Democrats on Tuesday released a list of statements Republicans have made defending the Ryan plan, including this one from Speaker John Boehner (R-Ohio): "We’ve put forward our plan. And our plan said that no one 55 or older would have any changes to their current plan.”

Boehner was noncommittal about the possible changes during a Tuesday news conference, saying only that "we’ll let them work it out and see what outcome they get."

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Key Republican lawmakers reassured hospitals Tuesday that they would not push to overhaul Medicare's flawed doctor payment formula with more provider cuts.

Reps. Kevin Brady (R-Texas) and Charles Boustany (R-La.) said structural changes to Medicare should help pay to repeal Medicare's sustainable growth rate (SGR), a major priority in the healthcare world. 

"I'm tired of going through the same old dance," said Brady, who leads the Ways and Means Subcommittee on Health. "My goal is to not pay for this by continuing to squeeze providers." 

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