The Starting Line – The Huge Impact of the Republican Medicare Plan in the San Diego Area; It Ain’t Pretty

Sorry, gang, I’m taking a day off today. I had a little medical “procedure” yesterday, and need to take a day off from typing. I’ll be back tomorrow. In the meantime, I hope you’ve got a rather large cuppa joe at your side, because I’m sharing a report issued by the Democratic Staff of the House Committee on Energy and Commerce that details just what the “Republican Budget” has in mind for seniors and people with disabilities who happen to live in the San Diego area.

The budget passed by House Republicans in April 2011 makes radical changes to Medicare. The Republican plan raises costs for seniors and individuals with disabilities enrolled in Medicare, reduces their benefits, and puts private insurance companies in charge of the program.  For current beneficiaries, important benefits – such as closing the hole in  Medicare’s drug coverage – would be immediately eliminated.  For individuals age 54 and under, Medicare’s guarantee of comprehensive coverage would be replaced with a “voucher” or “premium support” to buy private health insurance.  By design, this federal contribution does not keep pace with medical costs, shifting thousands of dollars in costs onto the individual.

This analysis shows the immediate and long-term impacts of these changes in the San Diego metro area.  The Republican proposal would have adverse impacts on seniors and disabled individuals in the region who are currently enrolled in Medicare.  It would:

• Increase prescription drug costs for 33,400 Medicare beneficiaries in the region who enter the Part D donut hole, forcing them to pay an extra $329 million for drugs over the next decade.

 • Eliminate new preventive care benefits for 432,000 Medicare beneficiaries in the region.

 The Republican proposal would have even greater impacts on individuals in the San Diego metro area age 54 and younger who are not currently enrolled in Medicare.  It would:

 • Deny 2.8 million individuals age 54 and younger in the region access to Medicare’s guaranteed benefits. 

 • Increase the out-of-pocket costs of health coverage by over $6,000 per year in 2022 and by almost $12,000 per year in 2032 for the 548,000 individuals in the region who are between the ages of 44 and 54.

 • Require the 548,000 individuals in the metro area between the ages of 44 and 54 to save an additional $128 billion for their retirement – an average of $180,000 to $287,000 per individual – to pay for the increased cost of health coverage over their lifetimes. Younger residents of the metro area will have to save even higher amounts to cover their additional medical costs. 

 • Raise the Medicare eligibility age by at least one year to age 66 or more for 307,000 individuals in the district who are age 44 to 49 and by two years to age 67 for 2.3 million individuals in the district who are age 43 or younger.

The Republican Medicare Proposal

On April 15, 2011, House Republicans passed their budget proposal (H. Con. Res. 34) for FY 2012.  Their budget would make three major changes in Medicare.

First, the Republican budget significantly cuts spending on Medicare by eliminating benefits and shifting costs to seniors and individuals with disabilities. These reductions in benefits and cost shifts affect both current and future Medicare beneficiaries. By 2050, the Republican budget would cut Medicare nearly in half, corresponding to about $20 trillion in cuts in today’s dollars, according to projections by the nonpartisan Congressional Budget Office.

Second, the Republican budget ends traditional Medicare for individuals age 54 and younger. Seniors who become eligible for Medicare in 2022 would no longer be allowed to join the traditional Medicare program; instead, they would receive a federal  ontribution, sometimes  called a “voucher” or “premium support,” to use to purchase private insurance coverage.

According to CBO, the private insurance coverage would cost 50% more than traditional Medicare in 2022.  The value of the federal contribution would increase at the rate of inflation, which is a slower rate than the increase in health care costs.  Over time, because of the higher cost of private plans and the reduced value of the federal contribution, beneficiaries would be forced to pay an ever-growing portion of their health care costs.  By 2032, CBO estimates that beneficiaries would be required to pay 68% of their health care under the Republican plan, compared to about 25% under traditional Medicare.

Finally, the Republican budget increases the eligibility age for Medicare, which is currently 65.  Beginning in 2022, the eligibility age increases by two months each year, until it reaches age 67 in 2033.  These changes will mean that millions of Americans will have to wait an extra two years until they can receive Medicare benefits.

Impacts on Current Medicare Beneficiaries in the San Diego Metro Area

The Republican leadership has asserted that “if you’re a person who is 55 years of age or older, there’s no change in Medicare for you” and that “we protect Medicare for current seniors.”1 In fact, the Republican plan would immediately cut benefits for thousands of seniors and individuals with disabilities in the region. Statement of Congressman Paul Ryan, Congressional Record, H2825 –H2826 (April 14, 2011).

Higher drug costs.  The Affordable Care Act, which Congress enacted last year, reduces drug costs for seniors and the disabled on Medicare by closing the gap in prescription drug coverage known as the “donut hole.”  This year, beneficiaries who use between $2,840 and $6,450 worth of prescription drugs will receive a 50% discount on those brand-name drugs; by 2020, the donut hole is completely eliminated.

The Republican budget repeals the provisions in the Affordable Care Act that close the donut hole.  This will increase costs for the 33,400 Medicare beneficiaries in the metro area who  entered the donut hole last year.  For the average beneficiary, the cost increase will be $520 this year and more than $9,800 over the next decade.  The total increase in drug costs for Medicare beneficiaries in the region will be $17 million this year and $329 million over the next decade.

 Elimination of new preventive care benefits.  The Affordable Care Act provides Medicare beneficiaries with free preventive care benefits starting January 1, 2011. The new preventive benefits include a free annual wellness visit and the elimination of any deductible or co-payment for preventive services such as breast or colon cancer screening.  The Medicare Actuary estimates that the free preventive care, combined with other cost saving measures in  the Affordable Care Act such as changes in provider reimbursement, will save the average beneficiary $2,500 over the next decade.

 There are 432,000 seniors and individuals with disabilities in the metro area that are currently enrolled in Medicare.  Under the Republican plan, they would no longer be entitled to free preventive care or benefit from the other cost-saving provisions in the Affordable Care Act.  In the aggregate, the Republican plan would increase their spending by $1,084 million over the next decade.

 Impacts on Future Medicare Beneficiaries in the San Diego Metro Area

The implications of the Republican budget on individuals who are not yet enrolled in Medicare are even greater than the adverse impacts on current beneficiaries.  In effect, the Republican budget eliminates Medicare as we know it for anyone age 54 or younger.

Elimination of Medicare’s guaranteed benefits.  Medicare provides essential guaranteed benefits for all who qualify and enroll – the right to basic health coverage, including coverage for doctor and hospital visits, stays in skilled nursing facilities, home health care, and other health care needs; the right to go to any doctor or hospital that accepts Medicare; and strict protections that do not require older Medicare enrollees to pay higher premiums.

The Republican budget eliminates these guaranteed benefits for anyone age 54 or younger.  It replaces the entitlement of coverage with a federal contribution of diminishing value that the  individual can use to purchase health insurance on the private market.  This change will affect 2.8 million individuals in the district, which is 79% of the district’s population.  Starting in 2022, all new enrollees in Medicare will be forced to buy private insurance using under-funded federal contributions, with no guarantees that they will receive the health care benefits they need.

Increased annual costs.  The private health plans required under the Republican budget would cost more than today’s Medicare, and the federal contribution provided to purchase the plans would not cover all costs of care.  According to the nonpartisan Congressional Budget Office, a newly enrolled beneficiary in 2022 would face out-of-pocket costs that are $6,000 higher than their costs under traditional Medicare.  By 2032, these out-of-pocket costs would be approximately $12,000 more than traditional Medicare.

In the metro area, there are 548,000 individuals who will enroll in Medicare for the first time between 2022 and 2032.  Under the Republican plan, their cumulative out-of-pocket costs for Medicare coverage during their first 20 years of program eligibility would increase by $178 billion compared to their costs under traditional Medicare, an increase of 235%.

Increased retirement burdens.  The Center for Economic and Policy Research did an analysis of the additional savings that today’s 44 and 54 year-olds would need to cover their increased out-of-pocket costs for health coverage under the Republican budget.  According to the Center, the average 54 year-old would need to save an extra $180,000 by age 65 to pay for the extra costs.  For today’s 44 year-olds, the additional savings required would be $287,000.

There are 548,000 individuals in the region between ages 44 and 54.  Using the Center’s methodology, they would have to save a total of $128 billion more over their working lives to pay for the increased cost of their health coverage after they turn 65.

Increase the Medicare eligibility age.  Beginning in 2022, the Republican budget increases the age at which seniors obtain Medicare eligibility, raising the eligibility age two months per year from its current level of 65 until the eligibility age reaches 67 in 2033.  There are 2.6 million individuals in the district age 49 or younger who would have to wait at least one extra year to join Medicare.  There are 2.3 million individuals age 43 or younger who would have to wait two extra years to join Medicare.

Data sources:  Data on Medicare enrollment and the number of seniors in the Part D donut hole was obtained from the Centers for Medicare and Medicaid Services.  Data on the age distribution of district residents was obtained from the U.S. Census.  Data on increased costs for Medicare enrollees under the Republican plan was obtained from the Congressional Budget Office and the Medicare Actuary and the Center for Economic and Policy Research.  Data on increased savings needed to pay for health care costs under the Republican budget was obtained from the Center for Economic and Policy Research (CEPR and are based on CEPR analysis of CBO data.  The analysis includes data for all Congressional districts either fully or partially in the San Diego metro area.

On This Day: In 1831 Nat Turner, a former slave, led a violent insurrection in Virginia. He was later executed. In 1959 Hawaii became the 50th state. U.S. President Eisenhower also issued the order for the 50 star flag. In 1965 Barry McGuire’s “Eve Of Destruction” was released.

 Eat Fresh! Today’s Farmers’ Markets: Coronado (1st St. & B Ave., Ferry Landing) 2:30 – 6 pm, Escondido  (Grand Ave. btw Juniper & Kalmia St.) 2:30 – 6:00 pm , Mira Mesa  (Mira Mesa High School 10510 Reagan Rd.) 3–7 pm, Morena District   (1240 West Morena Blvd.) 3 – 7 pm, Otay Ranch – Chula Vista (2015 Birch Rd. and Eastlake Blvd.) 4 –8 pm, PacificBeach  (Bayard & Garnet) 2 – 6:30pm.

I read the Daily Fishwrap(s) so you don’t have to… Catch “the Starting Line” Monday thru Friday right here at San Diego Free Press (dot) org. Send your hate mail and ideas to DougPorter@SanDiegoFreePress.Org    Check us out on Facebook and Twitter.


Doug Porter

Doug Porter was active in the early days of the alternative press in San Diego, contributing to the OB Liberator, the print version of the OB Rag, the San Diego Door, and the San Diego Street Journal. He went on to have a 35 year career in the Hospitality business and decided to go back into raising hell when he retired. He's won awards for 'Daily Reporting and Writing: Opinion/Editorial' from the Society of Professional Journalists in 2013, 2014 and 2015. Doug is a cancer survivor (sans vocal chords) and lives in North Park.
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  1. avatarJEC says

    Adding a little more dirt to this mud; when you turn 65 and if you do not have a qualified health plan (employer provided) you are compelled to sign up for Medicare. If you do not the Medicare fee – now $99 per month – increases 10% for each MONTH you delay signing up – $109, $119, $131 etc. – a monthly charge against your Social Security check for the rest of your life. Ain’t it great!

  2. avatar says

    One of the other preventive services you will lose under the Ryan plan is a “free” colonoscopy which is the main preventive screening for colon cancer. I had one this year, and, although it was free, there were several other things that went along with it that weren’t free such as the facility charge, pre and post procedure doctor’s visits etc etc. I kept getting bills for months, but this was nothing compared to what I would have paid if the procedure itself wasn’t free.

    With the Ryan plan you will basically be at the mercy of the health insurance corporations who will go back to booting you out if you get sick and not covering you or charging exhorbitantly for preexisting conditions.