Word To Democrats: Be Careful On Entitlement Reform

A few Republicans are publicly divorcing themselves from Grover Norquist, which is a good sign. But not enough Republicans are yet ready to absorb fully the meaning of the GOP’s defeat on November 6.

As President Obama has said several times now, if the last election had one clear message, it was that the wealthiest Americans, those who have been doing pretty well despite a sluggish economic recovery, need to “pay a little more” in taxes and thus get things started in terms of fixing our long-term fiscal problems.

On Sunday, John McCain’s lap dog, Sen. Lindsey Graham, clearly abandoned Grover Norquist and his infernal tax pledge. I have heard replayed numerous times the following excerpt from Graham’s appearance on ABC’s This Week With George Stephanopoulos:

I will violate the pledge, long story short, for the good of the country, only if Democrats will do entitlement reform.

In context, though, Graham was not endorsing an increase in marginal tax rates (“I agree with Grover, we shouldn’t raise rates,” he said), but only an increase in revenues by other means, like capping deductions for wealthy families (“If you cap deductions around the $30,000, $40,000 range, you can raise $1 trillion in revenue,” he claimed). But, so be it. In whatever form, it is clear that some Republicans, feeling the heat of November 6, are starting to warm up to an increase in federal revenues and it seems likely that more, perhaps enough to get a deal done, will follow.

Now comes the “if Democrats will do entitlement reform” part.

Appearing with Lindsey Graham on ABC’s This Week was Sen. Dick Durbin, a Democrat who signed onto the Simpson-Bowles deficit reduction plan.

He said a couple of things that illustrate the problems for President Obama and the Democrats, in terms of getting a deal that Democrats like me can support. First, Durbin suggested that Social Security shouldn’t be part of a larger budget deal since it is funded separately and “does not add one penny to our debt.” It’s pretty clear that most Democrats feel the same way. They believe that the relatively simple fixes for Social Security don’t belong in the discussion going on now. So, leave that program out of it.

Then we have this:

DURBIN: Medicare is another story. Only 12 years of solvency lie ahead if we do nothing. So those who say, “Don’t touch it, don’t change it,” are ignoring the obvious. We want Medicare to be there for today’s seniors and tomorrow’s, as well. We don’t want to go the Paul Ryan route of voucherizing it, privatizing it, but we can make meaningful reforms in Medicare and Medicaid without compromising the integrity of the program, making sure that the beneficiaries are not paying the price for it, except perhaps the high-income beneficiaries. That to me is a reasonable approach…

STEPHANOPOULOS: Does that include raising the age for Medicare eligibility?

DURBIN: Here’s my concern about that, George. What happens to the early retiree who needs health insurance before that person’s eligible for Medicare? I had it happen in my family, and I’ll bet a lot of your viewers did, as well. We’ve got to make sure that there is seamless coverage of affordable health insurance for every American. My concern about raising that Medicare retirement age is there will be gaps in coverage or coverage that’s way too expensive for seniors to purchase.

STEPHANOPOULOS: Is that a fair point, Senator Graham?

GRAHAM: Not really. I don’t think you can look at entitlement reform without adjusting the age for retirement, like Tip O’Neill and Ronald Reagan did. It goes to 66, 67 here pretty soon for Social Security. Let it float up another year or so over the next 30 years, adjust Medicare from 65 to 67 over the next 30 years, means test benefits for people in our income level. I don’t expect the Democrats to go for premium support or a voucher plan, but I do expect them to adjust these entitlement programs before they bankrupt the country and run out of money themselves. So age adjustment and means testing for both Social Security, Medicare I think is eminently reasonable. And all those who’ve looked at this problem have done that over time.

Democrats would, of course, agree to means-testing entitlements. No doubt about that. But raising the eligibility age for retirement and old-age health care? Not so fast.

Paul Krugman, a leftish economist, is definitely opposed to the idea, as he indicates in this short post, his generalized objection based primarily on the differences in life expectancy between economic classes (folks with lower earnings don’t tend to live as long as those with higher earnings, thus raising the eligibility age would have a disproportionately harmful effect on lower wage earners).

There have been more specific objections to raising the age, including these:

  • folks with physically demanding jobs would likely be forced to hang on another few years to keep their insurance;
  • cost-shifting to retirees who won’t have adequate income to absorb the increase;
  • an increase in the number of uninsured Americans (especially among low-income groups, including African-Americans and Hispanics);
  • the obvious increase in the cost to those employers who offer health care benefits to retirees (the employer plan would become the primary payer), which would, among other things, discourage employers from offering such retirement plans.

Now, an astute reader might suggest that some of these objections could be answered by provisions already in place in the Affordable Care Act. In fact, I heard a commentator this weekend suggest that raising the eligibility age for Medicare was no big deal since ObamaCare will provide coverage for those seniors who can’t afford it.

Well, that turns out to be partially true, at least according to a study done by the Kaiser Family Foundation, which looked at raising the age in the context of the Affordable Care Act (it assumed an increase in the Medicare eligibility age to 67 that would go into effect in 2014, just for simplicity). I suggest all those interested in this topic read that study, but its conclusion was as follows (highlights mine):

Previous studies conducted prior to the enactment of the 2010 health reform law concluded that raising the age of Medicare eligibility would produce significant federal savings, but would also increase the number of uninsured older adults and shift risk and additional cost onto retirees who lack health insurance and onto employers that offer retiree health plans. Our analysis, which takes into account the coverage expansions and subsidies in the ACA, finds that net federal savings to the federal government would be considerably lower than previously estimated because the federal government would incur new costs associated with expanded coverage for 65- and 66-year olds under Medicaid and premium tax credits and cost-sharing assistance for lower-income individuals in the new health insurance Exchange.

We estimate that nearly one-third of the 65- and 66-year-old adult population who would be affected by an increase in the age of Medicare eligibility [about 5 million people]—those with low incomes who would qualify for Medicaid or generous premium tax credits and cost-sharing assistance through the Exchange—would face lower out-of-pocket costs than they would have paid under Medicare in 2014 as a result of this policy change –generally those with incomes below 300 percent of the FPL [federal poverty level]. However, two-thirds would face higher out of-pocket costs, on average, due to higher premium contributions for employer-sponsored coverage and for coverage in the Exchange. The shift of adults ages 65 and 66 from Medicare to the Exchange is also projected to increase premiums that would be paid by adults younger than age 65 in the Exchange, as older adults enter the Exchange risk pool. In addition, Part B premiums paid by the elderly (ages 67 and over) and by disabled Medicare beneficiaries would be expected to increase, as the healthiest and lowest-cost segment of the Medicare population is removed from the Part B risk pool and shifted to the Exchange or to employer-sponsored plans. States and employers are also expected to see increased costs.

The study warns:

Given the magnitude of the changes that we estimate would occur by raising the Medicare eligibility age, this analysis underscores the importance of carefully assessing the distributional effects of various Medicare reforms and savings proposals to understand the likely impact on beneficiaries and other stakeholders.

It’s just not as simple as Republicans, like Lindsey Graham above, make it. And Democrats need to be careful about getting giddy over a possible Republican retreat on raising revenues and under the influence of such giddiness make a bad agreement on entitlements.

In short, Democrats need to remember who their constituents are.

4 Comments

  1. When the rich wage war, it’s the poor who die. – Jean-Paul Sartre

    Like

  2. janice reed

     /  November 26, 2012

    ALWAYS!!!!!!!!!!!!!!!

    Like

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