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Please, Pretty Please: Not the Eligibility Age Again

Next week President Obama will propose, one more time, a plan for reducing the budget deficit. And that plan may include cuts to Medicare.

I’ve written about the policy merits of this approach before: Sensible, careful reductions in what Medicare pays for services can make the program more efficient and sustainable, without sacrificing the ability of seniors to get quality, timely care. That’s largely what the Affordable Care Act does, notwithstanding the conservative caricature of “death panels.” 

But cruder, harsher cuts to Medicare are dangerous. That’s particularly true of a proposal that would make seniors eligible for Medicare at 67, rather than 65. 

I honestly don't know whether that particular idea is still in the mix. (Media reports, along with TNR sources, suggested that it was under consideration earlier in the week.) But just in case it is, here’s what I wrote over the summer, when the proposal first got a lot of attention:

A few months ago, the Kaiser Family Foundation published a report on how such a change would play out. According to that report, some 65- and 66-year-olds could still get insurance from employers, assuming they could still work. But the rest would have to get coverage from Medicaid or the new insurance exchanges. For some of those seniors, particularly those with low incomes, the result would be better cost protection than they enjoy now. But, depending on their source of insurance, many would lose the stability, security, and physician access that Medicare, virtually unique in our insurance market, provides.
Meanwhile, premiums for employer sponsored insurance and Part B coverage would rise, because the population in each pool would become older and, as a result, sicker. Although the Kaiser report didn’t say it, taking younger seniors out of Medicare in this way would also nudge the health care system further away from universal pooling of risk. And that's not to mention the fact that it's risky to even think about this at a time when the threat to repeal the Affordable Care Act, by law or court ruling, remains credible. Without that law in place, many seniors would end up without insurance coverage of any kind. ...
One reason reaching the age of 65 is such a relief to so many people is that it represents their chance, finally, to get out of the world of private health insurance and into Medicare. For the most part, it means the end of jumping between sources of coverage of wondering constantly which doctors will see them. (Despite what you may have heard, doctors are still more likely to take Medicare than private insurance.) Medicare has its problems but for most seniors it offers peace of mind that other sources of coverage simply don’t, at precisely the age when many of them are first experiencing serious health problems. Postponing the age at which seniors can get that security is not going to make them happy.

So the implications for policy are bad. And the implications for politics? Even worse, particularly given what we've seen this week.

As everybody knows, Republicans hammered Democrats in the 2010 midterms by attacking the Affordable Care Act's Medicare cuts, never mind how reasonable wonks like me thought they were. But when the newly elected Republicans voted for the Paul Ryan budget, which proposes much deeper cuts and would effectively end the program was we know it, the GOP seemed to relinquish whatever political advantage it had gained on the issue. A special election in upstate New York, in which a Democrat won and the Ryan budget figured prominently, seemed to confirm that.

But will the pattern hold? The Weekly Standard's John McCormack doesn't think so, based on the results of this week's special election for a Nevada House seat. And he makes a pretty good case. In that election, the Democratic candidate, Kate Marshall, made a big deal about the Ryan budget and Medicare. The Republican candidate, Mark Amodei, responded by suggesting that cuts to reimbursements – i.e., the kind in the Affordable Care Act – were actually more dangerous.

Amodei won handily. I would argue Amodei’s argument is wrong, on the merits, and I've seen nothing to make me think Amodei “won” the Medicare argument. But it sure looks like he didn’t lose it -- or, at least, it looks like he didn't lose it by enough to sink his candidacy. 

It's just one election, so I don't want to read too much into it. Maybe Obama could make the Ryan-Medicare argument stick, in a way a congressional candidate couldn’t. But proposing changes to Medicare benefits and eligibility would surely make that task harder, particularly since they are the sorts of simple, tangible changes that seniors and near-seniors would grasp instantly -- and remember on Election Day.