In Debate 3 GOP Presidential Candidates Say They Would End Medicare / Medicaid or Shift It to States or Vouchers

The Republican Presidential candidates participated in a nationally televised debate on November 12, 2011, hosted by CBS News and held at Wofford College in Spartanburg, South Carolina.

While the subject of this debate was foreign policy and national security, in some of their responses, three of the candidates nevertheless shed further light on their positions on health care and Medicare and Medicaid.

During the second half of the debate, the U.S. Senators from South Carolina, Lindsay Graham and Jim Demint, were each given the opportunity to ask a question of the candidates.

Senator Demint asked the following question (quoted from the CBS Transcript of Part 2 of the debate):

Jim Demint: Thank you. And thank you all for being in South Carolina tonight. Federal spending and debt are not only our greatest economic problems, they’re our largest national security problem. Yet the president and the Congress continue to spend and borrow at record levels. Just adjusting the spending on existing federal programs will not solve the problem. What federal functions will you eliminate or return to the states in order to balance our budget?

Michelle Bachman’s Responses

From the CBS Debate Transcript, here are quotes from the responses given to Senator Demint’s question by Michelle Bachman:

Michelle Bachmann: I wanna thank you for as– asking that question, because that really is the number one issue that’s facing the country. …

So what would I cut? I think, really, what I would wanna do is be able to go back and take a look at Lyndon Baines Johnson’s The Great Society.

The Great Society has not worked, and it’s put us into the modern welfare state. If you look at China, they don’t have food stamps. If you look at China, they’re in a very different situ– they save for their own retirement security. They don’t have pay FDC. They don’t have the modern welfare state. And China’s growing. And so what I would do is look at the programs that LBJ gave us with The Great Society, and they’d be gone. [emphasis supplied]

Earlier, in response to a question asking what, if any, cuts she would make in military spending, Michelle Bachman said that she would “reform Tri-Care” (the military medical system), and also stated “I’ll repeal Obama Care.” See CBS Debate Transcript, Part 2.

What Would It Mean to Eliminate All Great Society Programs?

Here is a list of some the programs that were established as part of LBJ’s Great Society initiative, which Ms Bachman said she would attempt to eliminate:

  • Medicare — The Social Security Act of 1965, part of LBJ’s Great Society programs, authorized Medicare and provided this federal funding for many of the medical costs of older Americans;
  • Medicaid – Medicaid was created on July 30, 1965 under Title XIX of the Social Security Act of 1965;
  • The Social Security Acts of 1965 and 1967 which significantly increased benefits, expanded coverage, and established new programs to combat poverty and raise living standards;
  • The Civil Rights Act of 1964, which forbade job discrimination and the segregation of public accommodations;
  • The Voting Rights Act of 1965 assured minority registration and voting, and outlawed poll taxes and literacy tests that had been used to prevent African Americans from voting;
  • The Economic Opportunity Act of 1964, which created an Office of Economic Opportunity (OEO) to oversee a variety of community-based antipoverty programs;
  • The Food Stamp Act of 1964 (which expanded the federal food stamp program) for the poor and disadvantaged;
  • And, many other programs.

Assuming that Rep. Bachman meant what she said — “what I would do is look at the programs that LBJ gave us with The Great Society, and they’d be gone” — then apparently she would attempt to eliminate all of the above programs.

Mitt Romney and Jon Huntsman’s Responses

In response to Senator Demint’s above-quoted question, Mitt Romney, like Michelle Bachman, specifically said he would end the Patient Protection and Affordable Care Act (the “Affordable Care Act”), the health reform law passed by Congress and signed by President Obama in 2010, which Gov. Romney, like many Republicans, referred to as “Obama Care.”

In addition, both he and Jon Huntsman said they would shift Medicaid to the states, apparently signifying that they would end the federal government’s funding of this program providing medical insurance coverage to the poor and disabled. And, Gov. Huntsman specifically endorsed the Paul Ryan Budget Plan, which would overturn the Affordable Care Act and end Medicare as we know it for those currently 55 years old or younger, as explained further below.

From the CBS Transcript, here are quotes from the responses given to Senator Demint’s above-quoted question by Mitt Romney and Jon Huntsman:

Mitt Romney: Absolutely. Right now, we’re spending about 25 percent of the economy at the federal level. And that has to be brought down to a cap of 20 percent. I’ll get that done within my first term, if I’m lucky enough to get elected. How do you do that?

One, it’s eliminating programs. A lot of programs we like, but we simply can’t afford. The first we will eliminate, however, we’re happy to get rid of. That’s Obama Care. And that’ll save us $95 billion a year by my fourth year.

Other programs we like: the Endowment for the– for Humanities, the National Endowment for– for the Arts– Public Broadcasting. These are wonderful– features that we– we have of the government. But we simply can’t go out and borrow money from China to pay for them. They’re not that essential.

In terms of returning programs to the states: Medicaid, a program for the poor, should be returned to the states. Let the states manage it. And if we grow it, at inflation plus one percent, we’ll save $100 billion a year by returning that to the states. And finally, we have to make the federal government more productive. It is just way too over– over-burdened with– with excessive personnel. I’ll reduce the personnel by at least ten percent, and link the pay of federal employees with the pay in the private sector. We should not pay government workers more than the people–

. . .

Jon Huntsman: Thank you, Senator Demint. It’s an honor to be with you in your state . . .
My speech was a very short one on debt and spending. It’s three words: The Ryan Plan. I think The Ryan Plan sets out a template that puts– everything on the table. Medicaid– like– Governor Romney, I’d send back to the states. . . .

. . .

Gov. Huntsman, thus, specifically endorsed the Paul Ryan Budget Plan, which would overturn the Affordable Care Act, and end Medicare as we know it for those now 55 years old or younger, replacing it by a flat annual payment program under which future seniors would be required to purchase private medical insurance on their own, as explained below.

What the Paul Ryan Budget Plan Would Do to Medicare

The Paul Ryan Budget Plan endorsed by Mr. Huntsman, and earlier endorsed by virtually all of the Republican Presidential candidates, includes a proposal to eliminate Medicare as we know it for all individuals now 55 years old or younger, and replace it with a system in which each senior would be required to buy their own health insurance from a private insurance company on the private insurance market. Individuals of Medicare-eligible age (which would be raised to 67 years old and eventually to 69.5 years old) could receive a right to designate a private insurance company to receive a flat annual payment amount to be applied toward purchase of private health insurance, which the senior would be required to purchase from that company on his or her own.

The Ryan Budget Plan (as found on the Republicans’ House Budget Plan website), states in part:

“For future Medicare beneficiaries who are now under 55 or younger (those who first become eligible on or after 1 January 2021), the proposal creates a standard Medicare payment to be used for the purchase of private health coverage. … The payment will be made directly to the health plan designated by the beneficiary… Each Medicare beneficiary becomes eligible for the payment by enrolling in a health insurance plan. . . . . . When fully phased in, the average payment is $11,000 per year (the average amount Medicare currently spends per beneficiary), and is indexed for inflation by a blended rate of the CPI and the medical care component of the CPI. For affected beneficiaries, the payment replaces all components of the current Medicare Program (Medicare fee-for service, Medicare Part B, Medicare Advantage, and Medicare Part D).” [From page 50-51 of the Ryan Plan (p. 60-61 of the PDF copy found on the Ryan Budget Plan website]

If private insurance turns out not to be available to the senior in the private market, or not available at a premium covered by the proposed annual payment amount, then under the Ryan Plan, there would be no guaranteed medical insurance coverage for seniors as under Medicare. If the senior is unable to afford the available insurance and therefore unable to enroll in insurance, apparently the annual payment amount would also then not be available to him or her. As quoted above, the Ryan Plan would require actual enrollment in a private health insurance plan in order to be eligible for the flat payment, which would then be paid only to the private insurance company, not to the beneficiary.

The Medicare payment amount that a senior could receive would also be limited by income:

“beneficiaries with incomes below $80,000 ($160,000 for couples) receive full standard payment amounts; beneficiaries with annual incomes between $80,000 and $200,000 ($160,000 to $400,000 for couples) receive 50 percent of the standard; and beneficiaries with incomes above $200,000 ($400,000 for couples) receive 30 percent.” [From page 51 of the Ryan Plan; page 61 of the PDF copy linked above]

The Ryan Plan’s proposal to replace Medicare with this right to designate a private insurance company to receive a flat annual payment amount toward purchase of one’s own health insurance in the private insurance market has commonly been referred to in the press as a “voucher system.”

In addition to replacing Medicare with this voucher system, as reported by ABC News, the Ryan Budget Plan would also “completely overturn the new health care law,” the Affordable Care Act, as well as make major changes to Medicaid.

Shifting Medicaid to the States – What Would this Mean?

As quoted above, both Mitt Romney and Jon Huntsman said in Saturday night’s debate that they would shift Medicaid to the States, apparently ending the federal government’s role in Medicaid.

Medicaid, as presently constituted, is a partially federally program to provide medical care and long-term care to certain low-income individuals and families. As explained by the U.S. Centers for Medicare & Medicaid Services, “Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services.” Financing for the program is shared by the federal government and the states, with the federal government setting certain rules and requirements that must be satisfied by the states in order to qualify for the federal share of this funding.

As stated by LongTerm.org, a site operated to provide long-term care insurance quotes,

“Medicaid pays for a majority of our nation’s nursing home care costs. Unlike Medicare, Medicaid will pay for both skilled and custodial care. Medicaid pays for physician-approved hospital stays, medical care, prescription drugs, and skilled nursing home care. (There are exceptions in certain states)”

It is not completely clear what in detail Mr. Romney and Mr. Huntsman meant when they said they would shift Medicaid to the states. However, based on their remarks, as quoted above, it appears that they meant to end federal funding for Medicaid and shift this cost entirely to the states, presumably leaving it up to each individual state as to whether they would provide any comparable medical or long-term care insurance coverage for low-income individuals.

With the current well-publicized budgetary shortfalls in so many of the states, it is unclear to what extent any such medical care for low-income individuals would continue to be available if the federal government were to end its funding of Medicaid. According to the nonprofit Center on Budget and Policy Priorities:

“… very large state fiscal problems remain. The recession brought about the largest collapse in state revenues on record, and states are just beginning to recover from that collapse. As of the first quarter of 2011, revenues remained roughly 9 percent below pre-recession levels…. states still are addressing very large budget shortfalls. In fiscal year 2012 some 42 states and the District of Columbia have closed, or are working to close, $103 billion in budget gaps. These gaps come on top of the large shortfalls the states faced in fiscal years 2009 through 2011. States will continue to struggle to find the revenue needed to support critical public services like education, health care, and human services for a number of years.”

It is noteworthy that as part of the litigation brought by 26 states with Republican governors or attorneys general challenging the Affordable Care Act, these states objected to the federally funded expansion of Medicaid to cover low-income individuals that the law required as a condition to the states’ receiving federal Medicaid funding. The Eleventh Circuit Court of Appeals addressed these arguments in its decision in the litigation, upholding this federal mandate as well within Congress’ powers to impose, as a condition to providing federal funds.

Thus, at least 26 states have already objected to expansion of Medicaid coverage for low-income individuals, even when funding is to be provided by the federal government.

Ending “Obama Care” (the Affordable Care Act) — What would this mean?

As quoted above, Mitt Romney, Jon Huntsman (who endorsed the Ryan Plan) and Michelle Bachman all said they would also eliminate what they call “Obama Care” (the Patient Protection & Affordable Care Act, which is the health reform law passed by Congress and signed by President Obama in 2010). This is a position that all of the Republican Presidential candidates have taken in previous position statements and debates, as reported by numerous sources, including the Associated Press, the Daily Herald, and Fox News, among others.

The U.S. Eleventh Circuit Court of Appeals, in its decision striking the individual insurance mandate in the Affordable Care Act, but upholding the rest of the law, provided a lengthy and quite thorough summary of the programs contained in the Affordable Care Act, which the 11th Circuit upheld.

Among these programs listed by the 11th Circuit Court as implemented by the Affordable Care Act, which all of the Republican Presidential candidates have said they would eliminate, are:

  • Elimination of “pre-existing conditions” exclusions from private insurance policies, starting in 2014, providing guaranteed health insurance coverage for all, regardless of health condition;
  • Free preventive care services, without deductibles, copays, or other cost-sharing requirements, effective now;
  • Minimum coverage requirements for insurance policies — which must explain coverage in plain English and provide at least a standard “essential health benefits package”;
  • Requirement that insurers allow dependent children to remain on their parents’ policies until age 26, effective now;
  • Elimination of lifetime dollar limits on essential health benefits under insurance policies, and prohibition of annual dollar limits on insurance coverage, starting in 2014;
  • Guaranteed renewability of insurance policies, so insurance companies cannot drop you when you become sick;
  • Limitation on waiting periods for insurance coverage;
  • Prevention of insurance companies from varying premiums within a geographic area based on gender, health status or other impermissible factors;
  • Requirement that insurance companies in the large group market spend at least 85% of their premium revenue on patient care (and no more than 15% on overhead) and requirement that insurance companies in the individual and small group markets spend at least 80% of their revenue on patient care (and no more than 20% on overhead);
  • Limitation on “unreasonable” premium hikes by insurance companies, subjecting them to review by HHS starting in 2010, and requiring that insurance companies must justify any such premium increases;
  • Prohibition on insurance companies from rescinding coverage except for fraud or intentional misrepresentation of material fact;
  • Prevention of excessive health insurance premium charges by requirement that insurance companies, in setting premiums, consider all individual-market enrollees in their health plans to be members of a single risk pool, and consider all small group enrollees as being in the same risk pool with all other small group enrollees;
  • Establishment of a temporary high risk pool program to provide immediate coverage for individuals denied coverage because of preexisting health conditions, until preexisting condition exclusions are outlawed in 2014;
  • Establishment of state-run health insurance exchanges to provide transparent access to affordable health insurance policies to individuals and small businesses who do not have insurance through large employer plans;
  • A federal tax credit for premiums to help individuals and families afford health care coverage — available to all individuals and families (1) with household incomes between 1 and 4 times the federal poverty level, (2) who do not receive health insurance through an employer, and (3) who purchase health insurance through an exchange;
  • A variety of federal cost-sharing subsidies to individuals who enroll in a qualified health plan sold through an Exchange — provisions, which along with the Exchanges and federal tax credits, are predicted to make insurance available to 9 million people in 2014 and to 22 million by 2016;
  • Anti-fraud and other cost-saving provisions to help reduce the future costs of Medicare, thereby addressing the nation’s future budgetary deficit, while at the same time linking reimbursement to outcomes, closing the “donut hole” in Medicare prescription drug coverage, and providing several other new Medicare benefits;
  • Incentives to encourage intelligent use of health care information technology and promote integration of care;
  • New federal grants for (1) improving women’s health, (2) health care delivery system research, and (3) medication management services in treatment of chronic diseases;
  • Many more benefits and provisions, described at length in the 11th Circuit’s opinion (pages 11-53 and in the 13 page Appendix A to the opinion).

More Information

The full transcript of Part I and Part 2 of the November 12, 2011 Republican Presidential debate is provided by CBS News, the host of the debate.

See also the HelpingYouCare™ resource pages on VoicesForCare™, including:

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Copyright © 2011 Care-Help LLC, publisher of HelpingYouCare™.

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4 comments to In Debate 3 GOP Presidential Candidates Say They Would End Medicare / Medicaid or Shift It to States or Vouchers

  • jessicapeck14

    I believe this is correct. I also believe this is the kind of plan that we are likley to end up with, though somewhat less generous as it will be forced on us by our creditors who won’t give a hair about healthcare for seniors and the needy.

  • Veta Clark

    We do not need any changes that would cost the seniors more, they can hardly make it now. Veta Clark

  • Carly EngageAmerica

    The federal health law, which will expand coverage to 30 million currently uninsured Americans, will have little effect on the nation’s rising health spending in the next decade. Health spending will grow by an average of 5.8% a year through 2020. The nation is expected to spend $4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year. In 2014, when the major coverage expansions of the health law begin to take effect, national
    health spending is expected to grow 8.3%.

    If the Super Committee cannot agree upon a plan or comes up short in savings, automatic cuts would be made to Medicare providers. In response to these cuts there is already a growing trend in hospital consolidation where private payers are charged more to make up for the public payers’ lower reimbursement levels. With the institution of ObamaCare, this cost shifting will continually become more pronounced, raising premiums for the privately insured.

    In order for this not to occur, reforms in several areas of Medicare can be implemented that would save $9.4 trillion by 2035 when compared with Congressional Budget Office (CBO) baselines. The government should implement cost caps (approximately $5,500) on catastrophic illness. This would reduce the use of secondary policies and decrease overutilization of medical resources. Also, the government needs to implement an additional premium on beneficiaries to cover deficits within the Hospitalization Insurance Program – it cannot receive funds from general government revenues to finance its deficits, and will be insolvent by 2020, according to the CBO. Furthermore, beneficiaries’ contribution toward Part B of Medicare should be increased gradually from 25% to 35% to reduce the fund’s reliance on general tax revenues. The same policy should be implemented for Part D of Medicare. Finally, benefits for the wealthiest recipients should gradually be phased out.

  • The 99%

    NO – What we need to control costs is a Medicare For All option! An option where anyone, at any age, could pay fair market rate premiums to be insured by Medicare. This would:

    (1) Provide a dependable and superior health insurance coverage option for all,

    (2) Thereby bring more healthy insured, paying fair, market rate premiums, into the Medicare System, which would strengthen the solvency of Medicare, and at the same time,

    (3) By providing competition to the private insurers, control health insurance premium costs for those privately insured, and

    (4) Help control the costs of medical care because providers would have to accept reasonable reimbursement rates and stop price-gouging and billing at excessive rates for needless services.

    This should be coupled with incentives for preventive medicine and results-based payment models for providers, as well as laws to prevent cost-shifting by providers or insurance companies.

    Basically, what you call “Obama Care” went a long way, but it did not go far enough to solve the problem of rising medical costs. Instead of, or in addition to, the individual insurance mandate, it should have included a Medicare For All option.

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