Rep. Ribble's Top Medicare "Facts" Are All Falsehoods

June 10, 2011 12:52 pm ET

In an op-ed published yesterday in the Green Bay Press Gazette, Tea Party freshman Rep. Reid Ribble (R-WI) claims that "there has been a vigorous and organized attempt to distort the Republican's fact-based plan to save Medicare." He then proceeds to vigorously distort facts by enumerating three lies regarding Medicare, including scare tactics related to rationing and the overall solvency of the program.

CLAIM: The Affordable Care Act Appoints An Advisory Board To Ration Medicare

Ribble: "Starting Next Year, President Barack Obama Will Appoint A Panel Of 15 Nonelected Bureaucrats To Price-Control And Ration Medicare For Current Seniors." From an op-ed by Rep. Reid Ribble (R-WI) in the Green Bay Press Gazette:

Fact No. 1 - Medicare changed drastically with the newly enacted Obamacare law. Starting next year, President Barack Obama will appoint a panel of 15 nonelected bureaucrats to price-control and ration Medicare for current seniors. Our plan repeals Obamacare and doesn't force 15 nonelected bureaucrats between doctors and their patients. [Ribble Op-Ed, Green Bay Press Gazette, 6/9/11, emphasis added]

FACT: Independent Payment Advisory Board Is Prohibited From Rationing Care, Increasing Taxes, Or Changing Medicare Benefits

The Affordable Care Act Specifies That The Advisory Board "Shall Not Include Any Recommendation To Ration Health Care." According to "Ryan says Obama's proposed budget 'commits seniors to bureaucratically rationed health care.' In fact, the new health care law states that the advisory board to which Ryan refers 'shall not include any recommendation to ration health care.' Furthermore, the board members are to be primarily doctors, economists and other outside experts, not Washington bureaucrats." [, 5/6/11]

IPAB Cannot Ration Care, Increase Taxes, Change Benefits Or Eligibility, Or Increase Premiums And Cost-Sharing Requirements. According to the Kaiser Family Foundation: "The Board is prohibited from submitting proposals that would ration care, increase taxes, change Medicare benefits or eligibility, increase beneficiary premiums and cost-sharing requirements, or reduce low-income subsidies under Part D. Prior to 2019, the Board is also prohibited from recommending changes in payments to providers and suppliers that are scheduled to receive a reduction in their payment updates in excess of a reduction due to productivity adjustments, as specified in the health reform law." [Kaiser Family Foundation, May 2010] "It's Wrong To Say That The Advisory Board Will Ration Care." addressed Rep. Paul Ryan's (R-WI) claim that IPAB rations care:

Ryan twice warns of Obama's plan to "ration" health care for the elderly. He also says, "The greatest threat to the health security of America's seniors is the President's plan to deeply and systematically ration Medicare."

Ryan spokesman Conor Sweeney told us in an e-mail that the claim of rationing refers to funding for the Independent Payment Advisory Board created by the federal health care law. But it's wrong to say that the advisory board will ration care or that it will be run by bureaucrats, as we wrote when Sarah Palin made a similar claim.

The Patient Protection and Affordable Care Act says the advisory board "shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums." Also, the board isn't made up of Washington bureaucrats. The 15 voting members will be appointed by the president in consultation with congressional leaders; they must include doctors and other health care professionals, economists and health care finance experts, and representatives of consumers and seniors, as the American Medical Association explains. There will also be three non-voting members: the Health and Human Services secretary, and the administrators of the Centers for Medicare and Medicaid Services and the Health Resources and Services Administration. [, 5/6/11, emphasis added]

For much more, read our full IPAB primer.

CLAIM: Medicare Will Go Bankrupt In Nine Years

Ribble: "By Its Own Admission, Medicare Will Go Bankrupt In Less Than Nine Years." From an opinion editorial by Rep. Reid Ribble (R-WI) in the Green Bay Press Gazette:

Fact No. 2 - Taking no action is the surest way to end Medicare. By its own admission, Medicare will go bankrupt in less than nine years. Something must be done to modernize this program. The Republican budget actually increases spending every year on Medicare payments, but it bends the cost curve down, saving the program for future generations. [Ribble Op-Ed, Green Bay Press Gazette, 6/9/11, emphasis added]

FACT: Medicare Trustees Actually Say Program Is Solvent For 13 Years (After The Affordable Care Act Extended Medicare Solvency By Eight Years)

Medicare Trustees Report Shows Affordable Care Act Extends The Life Of Medicare Through 2024. According to the Huffington Post:

The Medicare trust fund will last eight years longer than it would have without the passage of last year's health care law, the program's trustees announced Friday in a report.

The nonpartisan lead actuary for Medicare, Rick Foster, estimated that without the health care overhaul, the program's trust fund would have run dry by 2016. With the law in effect, Foster projected, the trust fund will last through 2024.


Health and Human Services Secretary Kathleen Sebelius highlighted the boost reform gave to Medicare. "Over the next 75 years, Medicare's Hospital Insurance costs are projected to be about 25 percent lower due to the new law," she said in a statement. "And without the historic deficit reduction in the Affordable Care Act, Medicare would have gone bankrupt in 2016 -- only five years from now." [Huffington Post, 5/13/11, emphasis added]

Foster: Affordable Care Act Extends The Life Of Medicare By Eight Years. In an interview with Slate's David Weigel, Richard Foster, the chief actuary of the Centers for Medicare & Medicaid said: "Under current law...including the Affordable Care Act, we're estimating that the trust fund would be exhausted in 2024. In the absence of the savings under the Affordable Care Act, a corresponding date of exhaustion would be 2016. So the Affordable Care Act, in the new projection, postpones the exhaustion by eight years. That's down from 12 years in last year's projection." [Slate, 5/16/11]

CLAIM: GOP Medicare Plan "Makes No Changes For Those 55 Years Or Older"

Ribble: "Our Plan Makes No Changes For Those 55 Years Or Older." From an opinion editorial by Rep. Reid Ribble (R-WI) in the Green Bay Press Gazette:

Fact No. 3 - Our plan makes no changes for those 55 years or older. For the younger generation, Medicare will function as a premium support system, similar to the insurance plan Congress receives. Just like the Medicare Advantage or the Medicare Prescription Drug Benefit program seniors use today, we offer seniors a choice of Medicare approved insurance plans with guaranteed coverage benefits. Medicare then subsidizes the costs of those plans - a lot less for the wealthy and a lot more for those who are low income or sick. [Ribble Op-Ed, Green Bay Press Gazette, 6/9/11, emphasis added]

FACT: For Current Seniors, Republican Plan Would Reopen Medicare "Donut Hole"...

"Path To Prosperity" Reopens Medicare "Doughnut Hole," Forcing Millions Of Seniors To Pay Higher Drug Costs "Immediately." From the National Journal: "[T]he GOP is doubling down on the idea that today's seniors won't be affected. That's partly true. Ryan's plan to convert Medicare into a limited insurance subsidy, the most controversial aspect of the budget, wouldn't take effect until 2022. But the proposal would also repeal last year's health care law, which means reopening a coverage gap in Medicare's prescription-drug benefit that the statute closed. The gap, commonly called the "doughnut hole," requires seniors to pay 100 percent of any prescription costs after the annual total reaches $2,840 and until it hits $4,550. Those who spend more or less have at least three-quarters of the costs covered. Under the 2010 health law, Medicare will pay 7 percent of the cost of generic drugs and 50 percent on name-brand pharmaceuticals; by 2020, the doughnut hole will be closed. If Congress were to pass Ryan's plan and repeal the law, as House Republicans want, the 3 million to 4 million seniors left in the doughnut hole each year would immediately face significant out-of-pocket costs." [National Journal, 6/3/11, emphasis added]

...And Encourage Healthy Seniors To Leave Medicare, Weakening The Program For The Most Vulnerable

Once Republican Voucher Program Begins In 2022, Healthy Seniors Still On "Traditional" Medicare Would Have Incentive To Leave - Endangering The Program For Less-Healthy Beneficiaries. From the National Journal: "The policies in the House GOP budget, if enacted, would begin affecting millions of seniors almost immediately by increasing their costs for prescription drugs and probably long-term care. Further, Medicare costs could rise over time if healthier seniors choose to abandon the traditional benefit program. [...] The plan to grandfather traditional Medicare for those older than 55 could also have negative consequences for current seniors: In 2022, when the limited-subsidy program would be introduced, seniors who qualified for traditional Medicare would be allowed to switch to the new program. If healthier or younger beneficiaries make the change to lower their out-of-pocket costs, those still participating in Medicare would be part of an insurance pool that is less healthy and more expensive. To cover those higher per-person costs, Medicare might well be forced to either raise premiums or limit reimbursements to health care providers-which could prompt many to stop taking Medicare patients." [National Journal, 6/3/11]

Centrist Think Tank: Despite Republican Claims, "Current Beneficiaries Are Not Protected In The Ryan Budget." According to a report from Third Way by David B. Kendall, Senior Fellow for Health and Fiscal Policy and Ryan McConaghy, Director of the Economic Program:

Despite promises to the contrary, current beneficiaries are not protected in the Ryan budget. Under the Republican proposal, traditional Medicare would quickly become second-class medicine. It would "wither on the vine," as then-House Speaker Newt Gingrich described a similar GOP effort in 1995.

The traditional Medicare plan, which covers three-fourths of today's beneficiaries, relies on its huge size to keep costs down. Doctors and hospitals are not required to participate in it, but they have little choice if they wish to treat any seniors, who are the nation's biggest health care consumers.

Fewer doctors would participate in the traditional Medicare plan if there were an alternative. The traditional plan pays physicians about 20% less than private health insurance plans. Today, that is essentially a discount for the large volume of Medicare patients. Under the Ryan budget, it would become a reason for doctors to leave the traditional plan.

By 2030, only 55% of Medicare beneficiaries would still be eligible for traditional Medicare according CBO. Actual enrollment would be less than half of Medicare beneficiaries because many seniors would continue to enroll in private health care coverage under Medicare Advantage. By 2040, traditional Medicare would have only about 20% of Medicare beneficiaries. [, 4/14/11, internal citations removed for clarity, emphasis added]

FACT: GOP Plan's Cuts To Medicaid Would Affect Seniors Immediately

9 Million Seniors Receive Medicaid As Well As Medicare. From the National Journal: "Some 9 million seniors qualify for both Medicare and Medicaid benefits, and about two-thirds of all nursing-home residents are covered by Medicaid." [National Journal, 6/3/11]

GOP Budget Cuts $744 Billion From Medicaid Over The Next Decade. From the National Journal: "Perhaps more jolting, the Republican budget would cut spending on Medicaid-health care for the poor-much of which goes to long-term care for the elderly. [...] The GOP budget proposes cutting some $744 billion from Medicaid over 10 years by turning the system into block grants that limit federal contributions and give states more choice in structuring benefits. No one knows exactly which Medicaid services states would choose to cut back, but senior citizens account for a disproportionate share of Medicaid outlays and would almost certainly bear some of the burden." [National Journal, 6/3/11, emphasis added]

Click here to read much more about the Medicaid block grants in the GOP budget.

CLAIM: GOP Budget Will Make Medicare "Similar To The Insurance Plan Congress Receives"

Ribble: "For The Younger Generation, Medicare Will Function As A Premium Support System, Similar To The Insurance Plan Congress Receives." From an opinion editorial by Rep. Reid Ribble (R-WI) in the Green Bay Press Gazette:

Fact No. 3 - Our plan makes no changes for those 55 years or older. For the younger generation, Medicare will function as a premium support system, similar to the insurance plan Congress receives. Just like the Medicare Advantage or the Medicare Prescription Drug Benefit program seniors use today, we offer seniors a choice of Medicare approved insurance plans with guaranteed coverage benefits. Medicare then subsidizes the costs of those plans - a lot less for the wealthy and a lot more for those who are low income or sick. [Ribble Op-Ed, Green Bay Press Gazette, 6/9/11, emphasis added]

FACT: Comparing Ryan Plan For Medicare To Congressional Insurance Plan Is "False And Misleading"

Washington Post Gives GOP Lawmakers "Two Pinocchios" For Comparing Ryan's Medicare Changes To Congress' System. According to Washington Post fact-checker Glenn Kessler:

The comparison to Congress is obviously a well-crafted applause line. Republican members of Congress have used it repeatedly in recent weeks, with many of the statements focusing on the question of choice. In that narrowly tailored fashion, there are indeed similarities, though one wonders why any reference needs to be made to Congress. Many employer-sponsored plans offer employees a variety of health-care options.

The focus on "a system just like members of Congress and federal employees have" suggests that this would be something better than the typical employee plan. But it will not have a key feature of the current plan - a promise that the government will pick up 75 percent of the health-care tab. [...]

We don't mean to pick on Ryan, since this line is clearly from a set of GOP talking points, but he is the author of the plan. We think the reference to the health plan for members of Congress gives a false and misleading impression to ordinary people.

Two Pinocchios

[Washington Post, 4/29/11, emphasis original]

Ryan "Went Too Far" In His Claim That Changes To Medicare Would Be 'Just Like The One That I Have As A Member Of Congress.' According to

Ryan also went too far in claiming that his proposal to change Medicare would give future beneficiaries a system that "works just like the one that I have as a member of Congress." [...]

So, while the government's contribution for insurance for members of Congress stays basically the same, proportionally, the contribution would actually decline over time for future Medicare beneficiaries. And the percentage the government would pay for seniors is also much lower than what the government pays for federal employees. [, 4/19/11]