United Against Health Law, Medicare Reforms Divide GOP Presidential Candidates

United Against Health Law, Medicare Reforms Divide GOP Presidential Candidates

KHN's Mary Agnes Carey and Marilyn Werber Serafini talk with Jackie Judd about Tuesday's New Hampshire GOP primary. The GOP field is united in their opposition against Obama's Health Law, but differences remain in how they would reform Medicare.

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JACKIE JUDD: Good day, this is Health on the Hill. I'm Jackie Judd.

Another day, another state. The Republican presidential candidates have moved on to South Carolina where the next primary will be held January 21st. Last night in New Hampshire, in Mitt Romney's victory speech, he again promised to roll back the health care overhaul law.

(ROMNEY SOUNDBITE: This president has enacted job-killing regulations; I’ll eliminate them.  He lost our AAA credit rating; I’ll restore it. He passed Obamacare; I’ll repeal it. )

JACKIE JUDD: Repealing so-called "Obamacare" is an issue that unites the GOP candidates. What separates them from each other in terms of health care policy? Here to answer that question: Kaiser Health News reporters Mary Agnes Carey and Marilyn Werber Serafini.  Welcome to you both.

The common ground is repeal Obamacare.  But what separates them, it seems to me, is the issue of Medicare.  Most of the comments of the candidates tee off the Ryan plan, which was proposed in the House; the linchpin being a voucher system, which would put seniors into the private marketplace as opposed to a government-run medical care system.  What are the differences then, on that plan?

MARILYN WERBER SERAFINI:  This is where the candidates have talked about their differences.  The differences are relatively minor; they're not huge differences.  They all believe in this general concept of less government, of the government limiting the amount of money that it spends on Medicare.  Currently it's an entitlement – that doesn't happen.   So we had Huntsman and we had Santorum immediately come out and support the Ryan plan.  We also had Romney say that he would sign a bill that was the Ryan Plan.  He said he would prefer to have his own legislation, put his own mark on it, but he would sign it.  You also had Newt Gingrich who came in and was very critical initially; he believed that it was important to give seniors the choice to stay in traditional Medicare.  

MARY AGNES CAREY:  And then when Paul Ryan modified his plan, which he did last month with Ron Wyden, a Democratic senator from Oregon – when fee-for-service was added to the mix, then Newt Gingrich was more complimentary to the Ryan program.

MARILYN WERBER SERFAINI: And Romney was also then more on-board.

MARY AGNES CAREY:  Exactly.  And to be fair, Gov. Romney also proposed his own modified version of Ryan a few months ago, so Ryan is definitely the linchpin.  But we have some Republican candidates that are talking about Medicare in different ways.  For example, Ron Paul has said Medicare is fine for current beneficiaries; he wants younger folks to get their care in a different way in the private market when they reach their senior years.   And Rick Perry has suggested maybe states could do a better job than the federal government at running Medicare. 

JACKIE JUDD:  Medicare has proven to be treacherous territory for politicians in the past.  Older citizens don't have to see a change to the program – for the most part.  How much of what's being debated during the primary season, how real is it?

MARY AGNES CAREY:  I think it's absolutely real.  There are so many pressures on the budget with entitlements.  We have more baby boomers coming in and flooding the system.  Fiscal conservatives want to see an answer on entitlements.  They want to hear Republican candidates talking about it. 

So I think this is absolutely a sign of what's in play, not only in the election, but in 2013 and beyond.

MARILYN WERBER SERAFINI:  Right.  Ask any Republican who freshman came in in 2010 if they think it’s real, and they will say:  Medicare won me my election.  A lot of them do actually say that.

It all comes back to the health care law that passed.  Republicans made a big deal about in 2010 in saying:  Look, the Democrats took $500 billion out of your Medicare program.  And the seniors responded.  That was a very salient message with seniors in the 2010 election. That's when the Republicans took control of the House, and lot of the Republican freshman who came in do attribute that to that message. 

JACKIE JUDD:  To some degree, it was Michele Bachmann, who dropped out after Iowa, who really drove the issue about what to do with health care policy in the future.  She's gone now.  Does it seem to either of you that a little bit of the air has been let out of this issue on the campaign trail in the past week or so?

MARY AGNES CAREY:  I think it has.  Michele Bachmann was always the one jabbing on who favored the individual mandate and looking at different positions that they had.  I also think that the candidates are looking at the electorate.  The economy is the predominant issue. 

The Associated Press did an exit poll in New Hampshire, saying that only 5 percent of people who voted said health care was their top concern.  So while we may not hear as much about this now as the primaries continue, when you get to the general election, where Republicans want to repeal President Obama’s signature policy achievement, the health care law, then I think it will be center stage again.

MARILYN WERBER SERAFINI:  It's also important to remember that while health care might not be the top issue for Republicans in the primary, it never is.  And it's not this time, as well.  As Mary Agnes said, it's the economy; it's all about the economy. 

However, you have to remember that seniors – Democrats and Republicans – care very deeply about their Medicare.  And it doesn't take much to make a difference in an election.

JACKIE JUDD:  Final question: A little bit of a reality check.  When Michele Bachmann was still in the race and she would talk about repealing "Obamacare," she said it in the context of:  We need to elect x number of Republican senators so we can control both the Senate and the House in order to repeal.

What is the reality of any of the candidates, should they become president, being able to roll the law back?

MARILYN WERBER SERAFINI:  First of all, what we haven't talked about is we've got a Supreme Court decision coming that could –

JACKIE JUDD:  There is that.

MARILYN WERBER SERAFINI:  – There is that.  That could have a bearing on this.

But even so, even if the Republicans take control of the Senate, which is not really expected to happen, any party in charge really needs 60 votes really to be able to do anything.  Moreover, even if you can roll back a piece of this, there are benefits that are already in place – popular benefits that are already in place.  Even some of the candidates as they go around talking about wanting to repeal, they say:  Well, I do like this element, and I do like that element.

JACKIE JUDD:  So there's more nuance to it.

MARILYN WERBER SERAFINI:  I think that's right.

MARY AGNES CAREY:  Absolutely.  I agree. 

JACKIE JUDD:  Thank you so much, both of you:  Marilyn Werber Serafini and Mary Agnes Carey.

Jan 11, 2012