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President Barack Obama wasted little time deriding Mitt Romney’s Medicare plan as a "voucher program" while talking entitlements in the first presidential debate.
"First of all, I think it's important for Gov. Romney to present this plan that he says will only affect folks in the future," Obama said during the Oct. 3, 2012, debate at the University of Denver. "And the essence of the plan is that you would turn Medicare into a voucher program. It's called premium support, but it's understood to be a voucher program."
In the past, PolitiFact has found Obama’s "voucher" characterization reasonable, though as Obama noted, Republicans prefer "premium support."
Merriam-Webster defines a voucher as "a written affidavit or authorization … a form or check indicating a credit against future purchases or expenditures; a coupon issued by government to a parent or guardian to be used to fund a child's education in either a public or private school."
The plan pushed by Romney’s running mate, U.S. Rep. Paul Ryan, isn’t exactly a coupon, but it’s not so far off.
Democrats have attacked Ryan’s Medicare reform ideas since he presented his first version in early 2011. Ryan has since tweaked his ideas, and Romney indicated in a summer interview that he agrees with Ryan’s most recent plan, which Ryan presented as part of his fiscal year 2013 budget proposal.
Under the current system, the federal government pays doctors and hospitals fees for particular services. That would end under the Romney-Ryan Medicare plan. Instead, beneficiaries would have the choice of receiving a fixed subsidy from the federal government that could go toward a private insurance plan or a plan similar to traditional Medicare. We should note the plan would only apply to people who are under 55 today, not current seniors.
The private plans would comply with standards set by the federal government. The amount a beneficiary receives would be based in part on the second least-expensive plan available on the health insurance exchange.
We don’t know with certainty whether the premium subsidy would be able to cover the same set of benefits as traditional Medicare, or how much it would add to out-of-pocket costs to beneficiaries, because the nonpartisan Congressional Budget Office hasn’t released a detailed analysis, as it did for an earlier version of Ryan’s proposal when he provided the office with more substantial details.
Some experts in health policy say there are marked differences between the terms "voucher" and "premium support." While there are technical differences that may matter to health-policy professionals, these are not the type of differences that most beneficiaries would see as significant. In recent years, the definitions of "premium support" and "vouchers" have become almost indistinguishable.
Generally, we think "voucher program" is a fair way of describing to voters the vision for Medicare under a Romney-Ryan administration. We rate Obama’s claim Mostly True.
Barack Obama, remarks during the first presidential debate, Oct. 3, 2012
PolitiFact, "Do Mitt Romney and Paul Ryan want to turn Medicare into a voucher program?," Aug. 16, 2012
PolitiFact Florida, "Obama radio ad says Ryan-Romney plan will end Medicare and replace it with a voucher," Aug. 22, 2012
Mitt Romney Medicare plan website
Barack Obama, remarks by the President and First Lady at a campaign event in Davenport, Iowa, Aug. 15, 2012
David Axelrod, interviewon CNN’s State of the Union, Aug. 12, 2012
David Axelrod, email to supporters, Aug. 11, 2012
WBAY ABC-TV-2 (Green Bay, Wis.), "Mitt Romney Talks Medicare in Exclusive Interview with Action 2 News," Aug. 16, 2012
Brookings Institution, "Premium Support: A Primer," Dec. 16, 2011
National Bipartisan Commission on the Future of Medicare, "Building a Better Medicare for Today and Tomorrow" (final version), March 16, 1999
Congressional Budget Office, analysisof original Ryan plan, April 5, 2011
Congressional Budget Office, "The Long-Term Budgetary Impact of Paths for Federal Revenues and Spending Specified by Chairman Ryan," March 2012
Kaiser Family Foundation, "Comparison of Medicare Premium Support Proposals," accessed Aug. 15, 2012
Fiscal Times, "What to Call Ryan's Private Medicare Plan," April 27, 2012
Fiscal Times, "Rivlin-Domenici Put Medicare on a Weight Loss Diet," Nov. 18, 2010
House Ways and Means Committee, hearing on Medicare premium support proposals, April 27, 2012 (accessed via Nexis)
Heritage Foundation, "Medicare Reform Stage 2: Moving to a Premium Support System" (news release), Nov. 28, 2011 (accessed via Nexis)
Urban Institute, "Can Competition Improve Medicare? A Look at Premium Support," 1999
Robert Moffit, "Saving the American Dream: Comparing Medicare Reform Plans," April 4, 2012
Robert Moffit, "Premium Support: Medicare’s Future and Its Critics," Aug. 7, 2012
Henry Aaron, "Medicare Reform: Rhetoric vs. Substance" (paper)
PolitiFact, "Throw-granny-from-the-cliff ad says Paul Ryan plan would privatize Medicare," May 25, 2011
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