Obama Rated Higher in Trust on medicare

August 23, 2012

In Poll, Obama Is Given Trust Over Medicare

By and DALIA SUSSMAN

NY Times

The Romney-Ryan proposal to reshape Medicare by giving future beneficiaries fixed amounts of money to buy health coverage is deeply unpopular in Florida, Ohio and Wisconsin, according to new polls that found that more likely voters in each state trust President Obama to handle Medicare.

The Medicare debate was catapulted to the forefront of the presidential campaign this month when Mitt Romney announced that his running mate would be Representative Paul D. Ryan of Wisconsin, who is perhaps best known for proposing a budget plan, supported by Mr. Romney, to overhaul Medicare to rein in its costs.

After more than a week of frenzied campaigning on the issue, Medicare ranks as the third-most crucial issue to likely voters in Florida, Ohio and Wisconsin — behind the economy and health care, according to new Quinnipiac University/New York Times/CBS News polls of the three swing states. The Republican proposal to retool the program a decade from now is widely disliked.

Roughly 6 in 10 likely voters in each state want Medicare to continue providing health insurance to older Americans the way it does today; fewer than a third of those polled said Medicare should be changed in the future to a system in which the government gives the elderly fixed amounts of money to buy health insurance or Medicare insurance, as Mr. Romney has proposed. And Medicare is widely seen as a good value: about three-quarters of the likely voters in each state said the benefits of Medicare are worth the cost to taxpayers.

“On Medicare, I don’t like the Paul Ryan plan,” said Beverly McLaren, 72, an independent from St. Petersburg, Fla., who said in a follow-up interview that Medicare worked well for her and that she planned to vote to re-elect Mr. Obama. “I can’t see how it will help at all, and we’ll have more out-of-pocket expenses, and I’m not really clear how it will work.”

About 60 percent of independent voters in the three states support keeping Medicare as it is today, as do at least 8 in 10 Democrats. Republicans are closely divided on the issue in Florida and Ohio, but in Wisconsin, Mr. Ryan’s home state, a majority of Republicans support changing it along the lines he has proposed.

The polls — the first in this series of swing-state surveys taken since Mr. Ryan joined the Republican ticket — showed that at least in Mr. Ryan’s home state, he may be helping Mr. Romney. A majority of likely Wisconsin voters said they approved of the way Mr. Ryan has handled his job in Congress, and 31 percent said his selection made them more likely to vote for Mr. Romney, while 22 percent said it made them less likely to do so. The race appears to have tightened a bit in both Florida and Wisconsin in recent weeks.

In Florida and Wisconsin, where Mr. Obama had led Mr. Romney by six percentage points in polls conducted before the selection of Mr. Ryan, the race is essentially tied. Mr. Obama is ahead in Florida by 49 percent to 46 percent and in Wisconsin by 49 percent to 47 percent — differences within the polls’ margin of sampling error of plus or minus three percentage points. Mr. Obama retains a six-point advantage in Ohio, where he leads Mr. Romney 50 percent to 44 percent, unchanged from last month’s survey.

The polls were largely conducted before the uproar over remarks on rape and abortion made by a Republican Senate candidate in Missouri, Representative Todd Akin, which officials in both parties agree could alter the dynamic of the race, especially among women. Mr. Obama enjoys solid support of a majority of women in each of these three states, the surveys found, but in Wisconsin his healthy lead among women has narrowed since the last poll and now trails the levels of the 2008 election, when he won the state.

The polls’ findings on Medicare underscore the risk Mr. Romney took when he chose Mr. Ryan to be his running mate. Mr. Ryan rose to prominence among conservatives who lauded his willingness to propose unpopular measures to balance the budget and cut the rising costs of Medicare — costs officials in both parties agree are on an unsustainable path. But while the polls found that Mr. Romney enjoyed a wide advantage in all three states on the question of who is better equipped to tackle the budget deficit, it found that he lagged on other questions voters feel strongly about — including who is better equipped to handle health care, Medicare and foreign policy. Some voters give them credit for campaigning on a politically contentious issue.

“It may be political suicide, but at least Romney and Ryan are willing to stand up and say we can’t keep shoveling money into this program and other programs like this,” said Michael Behnke, 59, an independent from Solon, Ohio.

When it comes to the running mates, Mr. Ryan comes out ahead with independents. On balance, they feel more favorable toward Mr. Ryan but have a more negative view of Vice President Joseph R. Biden Jr., who has drawn criticism in recent days for saying that Mr. Romney’s policies would unchain the financial sector and “put y’all back in chains.” But many voters in Florida and Ohio said they did not yet know enough about Mr. Ryan to form an opinion — and many in all three states said the choice of running mate would have no impact on their votes.

The polls were conducted by telephone (landline and cellphones) from Aug. 15 through Tuesday among 1,241 likely voters in Florida, 1,253 likely voters in Ohio and 1,190 likely voters in Wisconsin. All three are states Mr. Obama won, but where Republicans have since made gains in state and local elections.

Mr. Romney has taken pains to stress that his Medicare plan would not change the benefits for people 55 or over. But voters over 55 have strong feelings about it, including in Florida, the electoral-vote-rich state where Republicans will hold their convention next week.

Jim Ryan, 75, a retired executive from Bradenton, Fla., who is an independent, said it was an important issue because he and his wife were on Medicare.

“We’re enjoying the benefits now, and the Paul Ryan program of making it into a voucher system would change things,” he said. “I know it’s not intended to apply to people in our age group, but I’m concerned about the future. I think it’s a wonderful program, and I’ve got middle-aged children and I don’t want to see the program destroyed. It’s probably one of the best programs sponsored by the federal government that we’ve ever had. It does have to be made fiscally sound, but there are ways to do that without destroying the whole concept or the substance of it.”

Mr. Romney has been attacking Mr. Obama for counting on $716 billion in Medicare savings to help pay for his health care law — savings that Mr. Ryan also counted on in his budget plan but which Mr. Romney has promised to restore. The poll underscored how unpopular deep cuts to Medicare are.

Only about a tenth of the voters in each state said they would support major reductions in Medicare spending to reduce the federal deficit. Nearly half of the voters in each state said they would support minor reductions, and about a third said they would not support any reductions at all.

Reporting was contributed by Marjorie Connelly, Allison Kopicki, Marina Stefan and Megan Thee-Brenan.

NY Times – Medicare Issue Hot in Campaigns

August 14, 2012

Two-Way Jabs on Medicare Recast Races for Congress

By

WASHINGTON — In one tight Florida House race, a hastily assembled TV commercial to begin airing Wednesday takes aim at a top target of Democrats, highlighting his votes “to end Medicare as we know it.”

Republicans in Montana are advertising on behalf of their Senate candidate, noting his stance against a Republican plan “that could harm the Medicare program.” House Republican strategists are advising their lawmakers to try to stay on the offensive over Medicare and steer clear of words like privatization.

The fight over Medicare, the popular federal health care program for older Americans, is rapidly intensifying in House and Senate races around the nation after the selection of Representative Paul D. Ryan as the Republican vice-presidential candidate. Congressional Democrats and some analysts say that development could transform the fight for control of Congress, given his role as the author of a House-approved budget plan that would reshape Medicare.

“A House budget plan is a House budget plan,” Senator Patty Murray of Washington, the chairwoman of the Democratic Senatorial Campaign Committee, said Tuesday. “But all of the sudden the architect and definer of that has the potential of sitting in the White House, and that is really frightening to people.”

Despite political anxiety expressed privately by some Republican strategists about Mitt Romney’s choice of Mr. Ryan, other top Republicans say that they welcome the fight over Medicare and that they believe they can win a national debate over the future of entitlement programs. They intend to paint the Democratic Party as the one putting Medicare at risk by failing to come up with a plan to keep it solvent as a wave of baby boomers approaches retirement age.

Mr. Romney said Tuesday that he would, if president, restore Medicare cuts that both President Obama and Congressional Republicans have backed and unveiled a new campaign advertisement trying to drive home that point.

“Paul Ryan and Republicans are the only ones who have stepped up with proposals,” said Senator John Cornyn of Texas, head of the National Republican Senatorial Committee. “These issues were going to come up anyway, and you might as well have your best and most articulate spokesman on the field making the case for it, and that is Paul Ryan.”

Mr. Ryan’s new prominence has abruptly thrust Medicare into the top tier of issues, but it was always going to be a theme in the 2012 House and Senate elections and was already playing a role in advertising.

Democrats had long intended to assault Republicans who voted for the Ryan budget in 2011 and 2012 and were trying to find a way to figuratively put Mr. Ryan on the ballot with his colleagues. Now Mr. Ryan will literally be on the ballot, and top Democratic strategists say that in picking him, Mr. Romney has given Medicare a huge boost as a driving issue that could lift Democrats in dozens of close races.

“Mitt Romney has given us a lot to work with,” said Representative Steve Israel of New York, chairman of the Democratic Congressional Campaign Committee. “It was becoming challenging to try to nationalize the Ryan budget, and Mitt Romney just handed that to us.”

House Democrats moved quickly on Tuesday to try to cash in. In a high-profile South Florida race, the Democratic candidate, Patrick Murphy, prepared a new ad against the Republican incumbent, Allen B. West, that highlighted Mr. West’s two votes for the Ryan budget while asserting that Mr. Murphy would “fight for seniors, protect Medicare.”

While the new commercial does not specifically mention Mr. Ryan, strategists said it was fashioned to capitalize on his joining the race for the White House. It is also the leading edge of what is likely to be a flurry of ads, Web activity and aggressive political advocacy as the two parties compete to shape the narrative on Medicare.

In addition to helping bankroll Mr. Murphy’s ad, the Congressional committee began automated phone calls in the districts of 50 Republican incumbents who voted for Mr. Ryan’s budget, which would turn Medicare into a voucher program for future retirees. In Nevada, a labor group is buying online ads that say the Romney-Ryan ticket would drive up costs for older Americans.

As Democrats pushed the idea of a political windfall, top Republicans say they believe the worry about Mr. Ryan is overheated. They say they were already bracing for a Medicare line of attack and are more than ready for it.

“We’ll take any opportunity to talk about Obamacare and the Medicare cuts that were included in it,” said Paul Lindsay, a spokesman for the National Republican Congressional Committee, who said that Republicans had learned how to contend with the issue after having debated it for more than two years already.

In a private message to candidates, House Republican leaders sought to allay any concern by providing material on how to respond to inquiries on Medicare, suggesting that candidates make the case that Democrats have their own lightning rod of a running mate: the new health care law.

The message also advises Republicans to choose their words carefully and emphasize “strengthen” and “protect” over phrases like “every option is on the table.”

Despite the Republicans’ confidence in their ability to counter the Democrats, the Senate race in Montana offered evidence that some party leaders recognize that the Ryan budget could be a liability.

The state party there paid for an advertisement on behalf of Representative Denny Rehberg, a Republican who is in a close race with Senator Jon Tester, a Democrat. It lauds Mr. Rehberg for his votes against the Ryan budget, a stance that the advertisement said showed his independence in partisan Washington.

The ultimate impact of the Ryan pick on Congressional races will become clearer in the days ahead.

“Certainly more Democrats are more enthusiastic than they were last week,” said Jessica Taylor, a senior analyst for the nonpartisan Rothenberg Political Report. “But whether it moves a ton of races, we are going to have to wait and see.”

Michael D. Shear and Sarah Wheaton contributed reporting from New York.

 

Medicaid Expansion May Lower Death Rates, Study Says

July 25, 2012

 

By

NY Times

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law. The Supreme Court ruling on the law last month effectively gave states the option of accepting or rejecting an expansion of Medicaid that had been expected to add 17 million people to the program’s rolls.

Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.

The New England Journal study reflects a recent effort by researchers to get around that problem and allow policy makers to make “evidence-based decisions,” said Katherine Baicker, an investigator on the study who served on former President George W. Bush’s Council of Economic Advisers.

“I think it’s a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage,” said Karen Davis, the president of the Commonwealth Fund, a nonpartisan research foundation. “Actual mortality studies are few and far between. This is a well-done study: timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need.”

The study, conducted by researchers from Harvard’s School of Public Health, analyzed data from three states that had expanded their programs in the last decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities. The new law also expands coverage to a similar population nationally.

Researchers looked at mortality rates in those states — New York, Maine and Arizona — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that did not put such expansions in place.

The number of deaths for people age 20 to 64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states, said Dr. Benjamin D. Sommers, a physician and an assistant professor of health policy and economics who was an author of the study.

In the five years before the expansion, there were about 46,400 deaths per year, while in the five years after the expansion, there were about 44,900 deaths per year. During the same period, death rates in the four comparison states increased, said Dr. Sommers, who began a yearlong stint as an adviser to the federal Department of Health and Human Services after research for the study was completed, but before its publication.

When researchers adjusted the data for economic factors like income and unemployment rates and population characteristics like age, sex and race, and then compared those numbers with neighboring states, they estimated that the Medicaid expansions were associated with a decline of 6.1 percent in deaths, or about 2,840 per year for every 500,000 adults added.

While the data included all deaths, not just deaths of Medicaid recipients, the decline in mortality was greatest among nonwhites and people living in poorer counties, groups most affected by expanded Medicaid coverage.

“I can’t tell you for sure that this is a cause-and-effect relationship,” that the Medicaid expansion caused fewer non-elderly adults to die, Dr. Sommers said. “I can tell you we did everything we could to rule out alternative explanations.”

Several experts with varying views on the Affordable Care Act said the study, which was completed long before the Supreme Court hearings on the law, was conducted by highly qualified researchers who carefully analyzed the available data. Still, they and the study’s authors pointed to limitations in the data, noting that the mortality figures represent county-level statistics, not individual deaths.

“They are trying really hard with the data that they have available, but at the end of the day it doesn’t really compensate for the fact that you don’t have the data you want, which is individual mortality rates and what happens to people with change in coverage over time,” said Gail Wilensky, a health economist who headed Medicare and Medicaid during the administration of the elder President George Bush. In addition, when the researchers looked individually at each of the three states, the only state with a statistically significant decline was in the largest state, New York, and she questioned whether every state would have the same experience.

Douglas Holtz-Eakin, president of the American Action Forum, a Republican-oriented group, said the study was “well done” and “brings more evidence in about the benefit side” of Medicaid, but he wondered if the results could be generalized. The three states studied voluntarily expanded their Medicaid programs, presumably confident they could pay for the expansion, and had enough doctors accepting Medicaid to treat additional beneficiaries. Other states may be less able to afford it, he said, and it is possible that “having a piece of paper that says you’re on Medicaid doesn’t do any good because they can’t see anybody.”

Nonetheless, experts said, the results support those of another Medicaid study being conducted by some of the same researchers in Oregon. Oregon expanded its Medicaid program in 2008, but, without money to cover everyone at first, chose 10,000 people by lottery. Dr. Baicker and her colleagues, comparing those who got Medicaid with those who did not, have so far found that Medicaid recipients see doctors more often, and report better health and better financial stability.

The New England Journal study, published online several weeks before the print edition because of its relevance to the current debate, also found that people added to Medicaid in the three states reported better health and were less likely to delay getting care.

While the data did not describe specific causes of death, researchers found declines in two broad categories of deaths — those caused by disease and those caused by accidents, injuries and drug abuse, possibly suggesting that even accident victims may get or seek more extensive care if they are insured.

“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”

Janet M. Currie, director of the Center for Health and Well-Being at Princeton, said the new study, combined with the Oregon research, should help transform the Medicaid debate into one about dollars, rather than over whether covering poor people improves health.

“This says, well there is benefit to giving people insurance,” Dr. Currie said. “Maybe you don’t want to pay the cost, but you can’t say there’s no benefit.”

 

Supreme Court ruling expected to leave 3 million without health care access

By , Herald-Tribune
/ Wednesday, July 25, 2012

By ROBERT PEAR

WASHINGTON — The Congressional Budget Office said Tuesday that the Supreme Court decision on President Barack Obama’s health care overhaul would probably lead to an increase in the number of uninsured and a modest reduction in the cost to the federal government, compared with estimates before the court ruling.

The court said, in effect, that a large expansion of Medicaid envisioned under the 2010 law was a state option, not a requirement.

As a result, the budget office said, it now predicts that 6 million fewer people will be insured by Medicaid, the federal-state program for low-income people. But half of them, it said, will probably gain private insurance coverage through health insurance exchanges to be established in all states.

On balance, the budget office said in a new report, “about 3 million more people will be uninsured” in 2022.

With the increase in the number of uninsured, the budget office lowered its estimate of costs to the federal government.

“The insurance coverage provisions of the Affordable Care Act will have a net cost of $1,168 billion over the 2012-2022 period — compared with $1,252 billion projected in March 2012 for that 11-year period — for a net reduction of $84 billion,” or about 7 percent, the budget office said.

The federal government will subsidize coverage for most people buying insurance through the exchanges, and the per-person cost to the federal government will be higher than if they were in Medicaid, the report said.

“For the average person who does not enroll in Medicaid as a result of the court’s decision and becomes uninsured, federal spending will decline by roughly an estimated $6,000 in 2022,” said Douglas W. Elmendorf, director of the Congressional Budget Office.

Moreover, Elmendorf said, “for the average person who does not enroll in Medicaid as a result of the court’s decision and enrolls in an exchange instead, estimated federal spending will rise by roughly $3,000 in 2022 — the difference between estimated additional exchange subsidies of about $9,000 and estimated Medicaid savings of roughly $6,000.”

The latest estimate from the Congressional Budget Office establishes a new political and fiscal reality against which future health care proposals will be measured. It also provides grist for election-year debates in campaigns for the White House and Congress.

In addition, the budget office said that repealing the new health care law, as House Republicans have repeatedly tried to do, would add $109 billion to federal budget deficits over the next 10 years. Specifically, it said, repeal of the law would reduce spending by $890 billion and reduce revenues by $1 trillion in the years 2013 to 2022.

The House has voted more than 30 times to repeal part or all of the 2010 law or to choke off money needed for various provisions, including coverage of the uninsured.

Democrats in the Senate have vowed to preserve the law, representing the largest expansion of social insurance in more than 40 years. And White House officials say Obama would veto repeal legislation if it ever got to his desk.

The new numbers are the latest of several updates issued by the budget office since March 2010, when Congress gave final approval to the health care legislation.

At that time, the budget office predicted that the measure would provide coverage to 32 million people, leaving 23 million uninsured.

In addition, the budget office said then that the expansion of coverage would cost $938 billion over 10 years, from 2010 to 2019. But, it said, the expense would be more than offset by revenues from new taxes and fees and by savings squeezed from Medicare and other government programs. Taken together, it said, the health care and revenue provisions of the legislation would reduce deficits by a total of $124 billion in the first decade.

Democrats have repeatedly cited those estimates when Republicans attack the law as creating a costly new entitlement.

However, Republicans assert that the true costs will be much higher than the initial estimates indicated. First, they note, the major costs — from expanding Medicaid and providing subsidies for the purchase of private insurance — will not show up until 2014.

In addition, Republicans say, the projected savings in Medicare may be impossible to achieve because, under the law, Medicare payments to health care providers would fall further and further behind the providers’ costs.