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Fact Check: Ryan on the Ryan plan

Rep. Paul Ryan acknowledged this morning on MSNBC’s Morning Joe that Medicare played a role in the Republicans’ loss in NY-26.

“The president and his party have decided to demagogue” the issue, the Wisconsin Republican said, calling the campaign against his budget plan “Mediscare.”

When asked to clarify if he believed the “demagoguing” of Medicare played a role, Ryan said, “That’s a big part of it.” He added, that Democrats are “scaring seniors that their current benefits are going to be affected.”

He also acknowledged on Morning Joe, “People in the Republican Party are nervous because of these kinds of ads,” referring to a Web video depicting him throwing an elderly woman in a wheelchair off a cliff. “You should have seen how many takes it took to make that work,” he joked. He argued, as President Obama did during the health-care debate, that the biggest hurdle is that this is a complicated issue that is difficult to explain. “Once people learn the facts, we are fine,” he claimed.

So what are the facts?

1. Would Medicare continue to exist?

It’s true that anyone 55 and older would not be affected under Ryan’s plan, so a video depicting someone currently older than 55 being thrown off a cliff is misleading.

But Ryan claimed that Medicare would continue to exist. The more important question, however, is in what form?

When asked by one of the Morning Joe panelists, “For people who are 54 years of age or younger, when they're 70 years of age, are they dealing and negotiating with an insurance company?”

“No,” Ryan responded.

“Or are they dealing with Medicare?”

“It's Medicare.”

But as the Congressional Budget Office wrote in its analysis of Ryan’s plan:

“People who turn 65 in 2022 or later years and Disability Insurance beneficiaries who become eligible for Medicare in 2022 or later would not enroll in the current Medicare program but instead would be entitled to a premium support payment to help them purchase private health insurance.”

In other words, traditional Medicare would, in fact, be phased out for those 54 and younger. They would be significantly impacted. Lost in the back and forth of the exchange with Ryan was that in the same answer, he went on to outline just how much Medicare would change – albeit not explicitly.

“You select the plan that you want,” he said. “You can't be denied. And then Medicare subsidizes your plan. That's how it works for a lot of insurance arrangements. For federal workers, Medicare Advantage and plenty of others work like this. Medicare subsidizes a plan you choose.”

Those who are 65 by 2022, would select private insurance from an exchange system – something similar to that of the health-care overhaul passed last year. Then, the CBO writes: “The premium support payments would go directly from the government to the plans that people selected.”

This would significantly impact those 54 and younger. CBO:

“Under the proposal, the gradually increasing number of Medicare beneficiaries participating in the new premium support program would bear a much larger share of their health care costs than they would under the traditional program. … That greater burden would require them to reduce their use of health care services, spend less on other goods and services, or save more in advance of retirement than they would under current law.”

In short, in 10 years, people would pay more for health care when they’re seniors under the Ryan plan than they would under traditional Medicare.

And because participation in Medicare would be voluntary, CBO says the number of uninsured seniors would increase:

“[C]osts to individuals (beyond those covered by the premium support payment) would be higher under the proposal than under traditional Medicare, and some individuals would therefore choose not to purchase insurance … the number of older Americans without health insurance would be higher.”

2. Did the idea for “premium support” come from a Bill Clinton commission?
Ryan also claimed on Morning Joe that the idea for “premium support” “came from Bill Clinton's bipartisan commission to save Medicare.” He added that the “Brookings Institution first coined the phrase ‘premium support.’”

While it is true that Alice Rivlin, a senior fellow at Brookings and Clinton’s former Office of Management and Budget director, worked with Ryan on coming up with the idea of “premium support,” there are two key differences. She told Ryan she could not support his plan, according to comments she made to Politico last month, because:

1)     Seniors do not have a choice between staying with traditional Medicare or not
2)     The increases in the amount of subsidies are too small

“She said seniors would have the choice between keeping their current form of Medicare or choosing to enter the pool,” Politico wrote. “In Ryan’s version, he did not keep the beneficiaries with the choice to keep what Rivlin called the ‘default option.’”

And: “The other main difference is in the rate of growth in subsidies for beneficiaries entering the new exchange system. ‘In the Ryan version, he has lowered the rate of growth and I don’t think that’s defensible,’ Rivlin said. ‘It pushed too much of the cost onto the beneficiaries.’”