Democrats had been counting on taking aim at Paul Ryan’s Medicare plan.
By DAVID NATHER | 7/31/11 11:25 PM EDT
President Barack Obama’s health care law has high negative ratings, and they’re not getting any better. But House Budget Committee Chairman Paul Ryan’s Medicare plan has high negatives, too — and they’re not healing either.
It’s almost enough to suggest that the two plans will just cancel each other out as liabilities in 2012, with the Democrats and Republicans fighting to a draw as they try to scare voters to their side. The big health care question of the election would be: Whose albatross is bigger?
In all likelihood, though, the Ryan plan may be more damaging to the Republicans than the health reform law is to the Democrats. That’s because voters have more of a history of switching their votes over Medicare than they do over health care in general, according to independent health care experts.
That’s why Democrats are so nervous about what might happen to Medicare as a result of the debt ceiling crisis. In their eyes, the Ryan plan had completely turned the tables for 2012. It was going to be about Ryancare, not Obamacare.
But now that Obama has put some big Medicare changes on the table as he tried to negotiate with Republicans — such as raising the eligibility age, increasing premiums and changing deductibles and co-payments — some Democratic operatives are worried that the tables will become unturned.
“I definitely think it muddies the waters,” said Democratic pollster Anna Greenberg. “I do think that no matter what happens, things have gotten murkier.”
How badly could a pre-election Medicare savings deal muddy the waters? A June poll by the Pew Research Center for the People and the Press found that most seniors think it’s more important to keep current benefits in Medicare and Social Security than to reduce the deficit. But the difference was especially lopsided among older voters who are Democrats or lean Democratic: Eighty-one percent of those seniors said it’s more important to leave their benefits alone.
“We have these giant debates about health care reform, and there’s greater intensity on the right about it. But we haven’t seen it really cut through as a voting issue,” said Drew Altman, president and chief executive officer of the Kaiser Family Foundation. “As a voting issue, Medicare always trumps health care reform.”
Republicans don’t dispute that seniors will vote on health care in larger numbers than other voters, but they’re not sure the Ryan plan was enough to completely tip the scales.
For one thing, health care isn’t going to be the main issue in 2012 — because “everyone is going to be laser-focused on the economy and jobs,” according to GOP pollster David Winston. But when voters do think about health care, he said, they’re also going to be concerned about the Medicare savings in Obama’s health care law — and whether it cuts Medicare payments to doctors so much that seniors won’t be able to find doctors who will treat them.
“The challenge for both sides is going to be to explain how Medicare will work in the future and how it can stay viable,” Winston said. “Clearly, Ryan is trying to explain that. The president, on the other hand, I don’t think ever understood people’s concerns.”
If it were just a contest over which health care plan has alienated more people — and that alone could determine which one will have more sway in 2012 — it would be a closer call.
Before Ryan’s plan came out, 2012 was shaping up to be a referendum on the health care law, with Republicans running against it as a Big Government overreach and Democrats trying to convince voters that they’ll see big benefits when the major changes kick in — like better health coverage options and more efficient health care. The challenge, of course, is that nobody will see the biggest changes until 2014 at the earliest.
The health reform law has plenty of supporters, but there’s no question that it has polarized the public, and the general outlines of public opinion haven’t changed in a long time. The people who like the law kind of like it — but the people who don’t like the law really hate it.
In a CBS News poll in June, 37 percent of Americans approved of the law, while 48 percent disapproved. But the intensity was stronger among those who don’t like the law. Just 14 percent strongly approved of the law, while 23 percent somewhat approved of it. On the other side, though, 33 percent strongly disapproved of the law, while 15 percent somewhat disapproved of it.
That doesn’t mean most Americans want it repealed, though. A Bloomberg poll in June found that 35 percent of Americans want to get rid of the law, but 51 percent want to “see how it works” — perhaps with small changes — and 11 percent want to leave it alone.
But the intensity of the opponents’ dislike of the health care law doesn’t necessarily mean a lot of votes will change because of it, independent health care analysts say. That’s more likely to happen on Medicare, which has a direct effect on a smaller group of voters — seniors — who will switch their votes if they don’t like what they’re hearing.
Medicare has been by far the most important health care issue for older voters in past presidential elections, according to figures compiled for POLITICO by the Kaiser Family Foundation. In 2004, for example, 79 percent of voters age 65 and older said Medicare should be a top priority for the next president and Congress — far more than any other age group.
If Medicare turns out to be a bigger voting issue than health care reform, the Ryan plan would spell real trouble for Republicans – just as it was the health reform law’s $500 billion in Medicare savings, not the rest of the law, that doomed congressional Democrats among senior voters in 2010.
A Kaiser Family Foundation poll in June found that the general public is evenly split on Ryan’s proposal, which would turn Medicare into a program that pays limited subsidies to help seniors choose from a selection of private health plans. Seniors, however, were overwhelmingly opposed: 57 percent of those 65 and older wanted to keep Medicare the way it is.
And the Bloomberg poll found that 57 percent of Americans expected to be worse off if Medicare were to be replaced with subsidies to help seniors buy private health insurance. Only 34 percent thought they would be better off.
The public’s opinion of the health reform law is “so polarized that nobody’s going to move back and forth on it in the general election,” said Robert Blendon, an expert on health care public opinion at Harvard University. “But the Medicare proposal has the potential to move significant numbers of voters.”
Ryan’s office didn’t respond to requests for comment. But Ryan has said the polls that show the biggest backlash against his plan don’t describe it well and that it gets more support when surveys describe it accurately.
At the very least, public opinion on the Ryan plan may be more in flux than it is on the health reform law. “They’re still working through what they think of the Ryan plan,” said Winston, the Republican pollster. “They’ve pretty much worked through what they think of Obamacare.”
The debt ceiling crisis may rewrite the script for the presidential election anyway, with broader questions about government spending and political leadership. But at the level of House races, at least, Democrats are sure that Ryan’s Medicare plan gave them at least an outside chance of regaining control of the House.
“I could see it being a very important wedge issue” in swing districts in states such as Pennsylvania, Iowa and Illinois, in which older voters will have more clout to determine the outcome of the races, Greenberg said.
Republican strategists say the health reform law is still likely to damage Obama and the Democrats, though. John Feehery, who was a top aide to former House Speaker Dennis Hastert, said it will feed into a general feeling among swing voters that the nation is going broke and can’t afford a health care program of this scale — or the bureaucracy that will come with it.
“We live in a divided country. We don’t have a consensus on what to do about health care. And that’s the problem with what Obama did,” Feehery said. “He didn’t try to build consensus. He just tried to please half the country.”
Still, the health care law’s supporters are confident that nothing will be as damaging in 2012 as the House Republicans’ vote for the Ryan plan last spring — which they’re still describing as a vote to “end Medicare.” And even if Obama strikes a deal with Republicans to get some savings out of Medicare before the election, they say, it won’t completely cancel out their ability to campaign against the Republicans who voted to completely restructure the program.
“There’s a difference between using a scalpel and a meat cleaver,” said Eddie Vale, a spokesman for Protect Your Care, an advocacy group that supports the health reform law.
“It could take some of the edge off” of the campaign against the Ryan plan now that Obama has opened the door to some Medicare savings, Vale said. “But I don’t think it changes the fundamental debate.”
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