In response, the GOP is doubling down on the idea that today’s seniors won’t be affected. That’s partly true. Ryan’s plan to convert Medicare into a limited insurance subsidy, the most controversial aspect of the budget, wouldn’t take effect until 2022.
But the proposal would also repeal last year’s health care law, which means reopening a coverage gap in Medicare’s prescription-drug benefit that the statute closed. The gap, commonly called the “doughnut hole,” requires seniors to pay 100 percent of any prescription costs after the annual total reaches $2,840 and until it hits $4,550. Those who spend more or less have at least three-quarters of the costs covered. Under the 2010 health law, Medicare will pay 7 percent of the cost of generic drugs and 50 percent on name-brand pharmaceuticals; by 2020, the doughnut hole will be closed.
If Congress were to pass Ryan’s plan and repeal the law, as House Republicans want, the 3 million to 4 million seniors left in the doughnut hole each year would immediately face significant out-of-pocket costs. They and all other Medicare beneficiaries would also lose access to a host of preventative-care benefits in the health care law, including free wellness visits to physicians, mammograms, colonoscopies, and programs to help smokers quit.
Perhaps more jolting, the Republican budget would cut spending on Medicaid—health care for the poor—much of which goes to long-term care for the elderly. Some 9 million seniors qualify for both Medicare and Medicaid benefits, and about two-thirds of all nursing-home residents are covered by Medicaid. The GOP budget proposes cutting some $744 billion from Medicaid over 10 years by turning the system into block grants that limit federal contributions and give states more choice in structuring benefits. No one knows exactly which Medicaid services states would choose to cut back, but senior citizens account for a disproportionate share of Medicaid outlays and would almost certainly bear some of the burden.
“We know that two-thirds of the dollars in Medicaid go to people who are disabled or over 65, so this is the big funder of long-term care in this country,” said David Certner, AARP’s legislative-policy director. “We also know this could have an impact on home- and community-based care, which is the kind of care individuals prefer the most [and] often the ones that will be cut first.”
Ah, but big Republican donors often own nursing home chains, so I’m sure it’ll all work out!