Where do Republicans stand on Medicare?

In a recent Op Ed, Tom Deloe, a member of Democracy for America's Healthcare task force, wrote about the decline in life expectancy in the United States, the richest country in the world. He identified three reasons. The Covid 19 pandemic is one, when 1.1 million Americans died. The second is the mental health crisis: Americans aged 45 to 54 are dying at abnormally high rates due to mental health disorders and drug or alcohol addiction. The third reason is the lack of access to health care.

Medicare is an essential program that provides health insurance and access to health care for millions of Americans. It includes Part A, which covers inpatient hospital care, and Part B, which covers doctor's services, outpatient care, and preventive services. Medicare Advantage plans are private health insurance plans that offer the benefits of Original Medicare, plus additional benefits, such as prescription drug coverage.

Medicare began on July 30, 1965, when President Lyndon B. Johnson signed the Medicare and Medicaid Act into law. The act created two new government health insurance programs, Medicare for people aged 65 and older and Medicaid for low-income people.

During his State of the Union address in February, President Biden said, "Some Republicans want Medicare and Social Security to sunset," and pledged to prevent Republicans from cutting those programs. His claim was immediately met with boos from the Republicans, who called it a lie. In an appearance on Face the Nation on CBS in January during the debt ceiling negotiations, Speaker of the House Kevin McCarthy was asked, "Are you willing to consider any reductions to Social Security and Medicare?" McCarthy replied, "The one thing I want to say, we take Social Security and Medicare off the table."

But just a few months later, McCarthy announced he was launching a commission tasked with looking at budget cuts – and he suggested Social Security and Medicare could come under his scalpel. In June, the Republican Study Committee, a group that counts over 70 percent of House Republicans as members, called for a number of changes to Medicare in its 2024 budget proposal. For example, it would repeal the Affordable Care Act's expansion of Medicare eligibility for more people with low incomes and repeal the ACA's provision that allows Medicare to negotiate lower drug prices. It would create a "premium support" program that would give seniors a fixed amount of money to help them purchase private health insurance.

Repealing the ACA's expansion of Medicare eligibility would leave millions of Americans without health insurance; already 85 million Americans are uninsured or underinsured. Repealing the ACA's drug price negotiation provision would make prescription drugs more expensive for seniors, and the "premium support" program would give seniors less choice and control over their health care.

As of March 2023, there were 65,748,297 people enrolled in Medicare. Most Americans are worried about the future of Medicare. Eight in ten adults say they are worried that Medicare will not be able to continue to provide at least the same level of benefits in the future. Democrats, independents, and Republicans all report similar levels of concern around the future of Medicare, as do most adults regardless of age. Nearly 90 percent of adults ages 50-64 say they are worried about the future of Medicare, including 44 percent who are "very worried," perhaps because they are the ones who are closest in age to be relying on the program in the near future.

Every year, the Medicare Trustees report provides an estimate of when the Medicare Hospital Insurance Trust Fund (Part A) will not have enough money to pay full benefits. The most recent report suggests 2028 will be the year when the trust fund will be depleted, including the Medicare Hospital Insurance (Part A) trust fund, which pays for inpatient hospital stays, a skilled nursing facility, home health, and other Part A services.

Funding for Medicare comes primarily from general federal revenues (46 percent), payroll tax revenue (34 percent), and premiums paid by the beneficiaries (15 percent). A number of changes to Medicare have been proposed to address Medicare's fiscal challenges, such as raising the age of Medicare eligibility. But to sustain Medicare for the long run, policymakers may consider adopting broader changes to the program that could include both changes in payments to health care providers and Medicare Advantage plans or reductions in benefits, and additional revenues such as payroll tax increases or new sources of tax revenue.

The ultimate solution, of course, is universal health care. The United States does not have universal healthcare due to a combination of historical, political, economic, and ideological factors. Unlike many other developed countries that implemented universal healthcare systems after World War II, the U.S. did not adopt a similar approach. Instead, our healthcare system has evolved through a combination of private and public initiatives, leaving it more fragmented – and more expensive.

Mark Berg is a community activist in Adams County and a proud Liberal. His email address is [email protected].