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The latest Democratic effort to paint Republicans as Medicare destroyers is a bit more nuanced than previous attempts that have faced our Truth-O-Meter and it points to a core truth about Medicare -- although not one that would make every Democrat happy.
On the eve of a visit to the Granite State by GOP presidential hopeful Jon Huntsman, Democratic Party chair Ray Buckley said, "he [Huntsman] has even signed on to the GOP's extreme proposal to end Medicare as we know it, which would deny guaranteed benefits to 980,000 Granite Staters."
For this fact-check, we're going to examine whether Huntsman supports the Republican Medicare plan from U.S. Rep. Paul Ryan and whether it indeed would end "guaranteed benefits" to the 980,000 people.
The Huntsman campaign told us that Huntsman considers the Ryan plan a "good step forward." The Democrats quote him telling ABC News that "I would have voted for it." If Huntsman wanted to put some distance between himself and the Ryan plan, he’s had his opportunities and he hasn’t done it. So Buckley is correct on this point.
And as for the 980,000, that is roughly the population of people in New Hampshire under 55, the age group that would be affected by the Ryan plan. (It leaves current Medicare intact for people 55 and older.)
Democrats elsewhere have ended up on the wrong end of the Truth-O-Meter for saying that Republicans "voted to end" Medicare. The Ryan proposal would certainly make fundamental changes in Medicare. It turns Medicare from a defined benefit program into a defined contribution program so by definition, benefits would no longer be the foundation from which everything else follows.
The Ryan plan says "future Medicare recipients will be able to choose from a list of guaranteed coverage options, and they will be given the ability to choose a plan that works best for them." So there will be a list of benefits but beyond that, the plan provides few details. Also, according to a Congressional Budget Office analysis, people would end up paying more for health care under the Ryan plan. That might not be the same as being denied coverage for a particular service, but people may opt out of coverage to save money.
Where Democrats get into the most trouble is in their use of the word "guaranteed". It’s a loaded word and unpacking it takes us to the nut of the Medicare conundrum. The New Hampshire state committee got its language from the analysis of the Ryan plan by the Democratic staff of the House Energy and Commerce Committee. That report refers frequently to guaranteed benefits, as in "Medicare provides essential guaranteed benefits for all who qualify and enroll."
In assessing the impacts of the GOP plan, House Democrats refer to an analysis of the Ryan proposal from the Congressional Budget Office, the nonpartisan body that crunches numbers for Congress. Curiously, the CBO letter never speaks of benefits as guaranteed. Instead, it uses the term "standardized benefit," which the CBO describes as the most average level of services used by the most typical Medicare patient.
Other analysts also shun the word "guaranteed." Paul Ginsburg, president of the Center for Studying Health System Change, an independent research group cited by both Republicans and Democrats, said in the context of Medicare, "I’ve never heard the word ‘guaranteed’ before," adding that, "policy wonks like me talk in terms of Medicare being a defined benefit program."
Ginsburg means that written into the actual Medicare law, you are entitled to those services. To Joe Baker, president of the Medicare Rights Center, a group that views health care as a basic human right, the situation is clear. "The Medicare program does guarantee a set of benefits," Baker said.
For our purposes at PolitiFact, the difference between an entitlement and a guarantee feels pretty small and it seems reasonable to use the terms interchangeably.
But if the Democratic vocabulary is sound, it also masks a challenge that confronts Democrats just as much as Republicans -- how much is the country willing to pay for Medicare in the future? Or to put it another way, are those guaranteed benefits as rock solid as the Democratic language implies? When they talk about 980,000 New Hampshire residents losing benefits, that includes kids who are babies today. The Democrats would have us believe that what Washington promises today will be in place 65 years from now.
Even Joe Baker with the Medicare Rights Center said that "Congress could rewrite the law and say we are not covering this service or that service from this day forward." That’s simply a legal fact of life. So the "guarantee" Buckley refers to is not ironclad.
Bob Moffit, a health care economist with the conservative Heritage Foundation, goes further. Moffit argues that the Democrats’ signature health care law, the Affordable Care Act, has already put the wheels in motion to undermine the services that Democrats say they want to protect.
Moffit zeros in on the law’s measures to rein in Medicare spending. The law already includes $400 billion in provider cuts over ten years and it pegs program dollars to an inflation rate and economic growth as measured by GDP. The general consensus is that to avoid blowing past those limits will require even deeper cuts in how much Medicare pays doctors and hospitals. The ACA has a mechanism to explore those kinds of savings -- the Independent Payment Advisory Board. It would be able to recommend provider payment cuts that would be put on a fast-track through Congress. If Congress failed to act, the recommendations would go into place.
"The net effect might be," Moffit said, "you might have a rich benefit package, but if the physician payment is too low, you just don't get those services because no one will provide them to you at the Medicare price."
By Moffit’s logic, the Democrats offer no more of a guarantee than the Republicans. He said the Democrats would use the back door of lower reimbursement rates and it would be the providers turning people away, not the government.
Ginsburg disagrees with Moffit. "It’s a legitimate point to be raising," Ginsburg said, "but it has never happened." For hospitals, Medicare is such a large part of their business, even in the face of lower reimbursement they find ways to deliver the care. Their other choice, dropping out of Medicare altogether, would be a financial disaster.
But when it comes to the long view on Medicare, Ginsburg doesn’t let the Democrats off the hook. He believes the country can’t afford Medicare as we know it. "The Democrats disappoint me," he said, "in not coming up with their alternative that addresses the affordability problem."
The New Hampshire Democratic Party Chair said Huntsman supports a GOP Medicare plan that would deny guaranteed benefits to 980,000 Granite Staters. He’s right about Huntsman's position and the number of New Hampshire residents that would be affected.
But he ignores that there is the possibility that the current benefits could be trimmed and he is exaggerating the facts about the Ryan plan. Many details about the plan are still unclear, particularly what would be covered.
The use of the word "guarantee" suggests something more certain in the future than is supported by the current state of the economy and the health care law. It suggests that hard choices for somebody don’t lie ahead and that’s not very likely.
We rule the statement Half True.
New Hampshire Democratic Party, Ray Buckley, Ray Buckley statement on Jon Huntsman, accessed Sept. 6, 2011
House Budget Committee, Path to Prosperity, accessed Sept. 6, 2011
Congressional Budget Office, Letter on Ryan Plan, accessed Aug. 31, 2011
Interview with Paul Ginsburg, president, Center for the Study of Health System Change, Sept. 1, 2011
Interview with Robert Moffit, senior fellow, Heritage Foundation, Sept. 1, 2011
Kaiser Family Foundation, The Independent Payment Advisory Board, accessed Sept. 2, 2011
Interview with Joe Baker, president, Medicare Rights Center, Sept. 1, 2011
Interview with Robert Woodward, University of New Hampshire - Whittemore School of Business, Sept. 1, 2011
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