It would also end Medicare as we know it, replacing the program's guarantee of health coverage with a "premium support," in other words a voucher that recipients would have to take out to the private market, or use to purchase traditional Medicare. In addition, it would limit the growth rate of Medicare spending for new beneficiaries from year to year, starting in 2023. The limit, or cap, it establishes is likely to not keep up with increases in health care costs. Over time, that voucher would become worth less and less, meaning that seniors had to pay more and more out of their own pocket in order to keep up with the cost increases in health care. The CBO has an alarming scenario:
[F]ederal Medicare expenditures on behalf of an average new beneficiary would be $400 to $700 (6 to 11 percent) less in 2023, $1,200 to $2,200 (14 to 23 percent) less in 2030, and $5,900 to $8,000 (35 to 42 percent) less in 2050 than under current law.It also raises the eligibility age for Medicare starting in 2023. Because it repeals the Affordable Care Act, it reopens that prescription drug donut hole and would increase seniors' prescription costs. It'd also do away with the free preventative care and annual checkups for seniors.
That's just part of what it would do to Medicare. Less known is what it'd do to Social Security:
Beyond that, the cuts it would make to the federal workforce would be made in the Social Security Administration, too, meaning that the current backlog for disabled people applying for the disability program gets longer, and service for all Social Security recipients is made worse. Which makes the Republicans' job of dismantling Social Security that much easier—make the public disgruntled about the service they're getting, and erode the program's popularity.
- In a radical departure from the way Social Security changes have been legislated since 1935, the Republican budget would force Congress to fast-track legislation determining the future of Social Security. Within two months of the president submitting Social Security legislation, Congress would have to consider it “under expedited procedures.”
- In a second, unprecedented change, the Republican budget would force the president and Congress to legislate changes that make Social Security solvent in any year Social Security is not in 75-year balance. The new requirement that the Republicans seek to impose is simply another way of forcing changes the American people reject. Projections over seventy-five years by their nature lack certainty. Projections of Social Security's solvency change every year, which means that Ryan's plan could force big changes to Social Security based on very short-term variations in the program's finances.
This is a direct and sustained attack on two of the programs that have saved generations of disabled and older Americans from having to face lives of poverty and degradation, programs that Republicans have hated since they were established. It's really quite simple: The Ryan/Boehner/Romney vision for America is an America without Social Security and Medicare.