A position that worked to the GOP’s advantage last year puts them in a bind this time around. Medicare criticism may haunt GOP

The Republican Party and its allies funneled millions into TV ads last year accusing Democrats from Pennsylvania to Missouri of “gutting Medicare” and “hurting seniors” — charges that compelled older voters to swing en masse toward the GOP.

But now, as Republicans move to tackle the country’s gaping debt, they are weighing changes to Medicare — from higher premiums to spending caps — that open them to the same attacks they leveled only months ago against Democrats over the health care law.


And Democrats haven’t forgotten it.

“I can imagine a lot of frustration from the president that when he chose to do Medicare savings that will be less impactful, these guys viciously attacked him for rationing health care and hurting seniors,” said Neera Tanden, a former administration aide who worked on the health care law and chief operating officer of the Center for American Progress. “At the end of the day, there is a [campaign] battle plan for attacking Medicare savings, and it was written by Republicans.”

Republican leaders vow to begin taming entitlement programs this year. Beyond declarations that “everything is on the table,” details are scarce on what House Budget Committee Chairman Paul Ryan will include in his upcoming budget and what a bipartisan Senate group is considering for a deficit reduction package. But several high-profile reports on the debt recommended changes to Medicare that could force hundreds of billions in cuts from the system beyond the $500 billion supported by Democrats in the health care law.

Republicans face unsavory options on Medicare: Retreat from their fiscal promises and push only superficial tweaks; tackle it with a massive overhaul such as vouchers that can be framed as something other than cuts; or enact politically treacherous cuts and higher premiums that invite the same attacks that played so well against Democrats last year.

Whatever the details, a position that worked to the GOP’s advantage last year puts them in a bind this time around.

It’s yet another political trap in the bid to rein in the long-term debt, an undertaking that could include benefit reductions to Medicare, Medicaid and Social Security, tax increases, an overhaul of the tax code and cuts to defense and discretionary spending. But the fight over Medicare is particularly fraught because it bears the raw scars of the two-year debate over health care reform, wounds that bleed into the already delicate talks on the debt.

“I can guarantee you that our organization will be talking about it,” said Maria Freese, director of government relations and policy for the National Committee to Preserve Social Security and Medicare. “They have themselves in a bit of a box.”

The bipartisan Senate deficit-reduction group is working from reports issued by two key groups, according to sources: the White House fiscal commission and a Bipartisan Policy Center task force led by Democratic economist Alice Rivlin and former Sen. Pete Domenici (R-N.M.). Between the groups, there were recommendations to increase cost-sharing, reduce payments to hospitals and transition to a system that charges higher premiums if costs rise faster than established limits.

But Republicans caution that few, if any, members are openly calling for cuts to the universal health care program for senior citizens.

“I don’t think anyone has a desire to cut Medicare, but there are ways of streamlining it to be more efficient,” said Sen. Orrin Hatch (R-Utah), the ranking member on the Finance Committee, which oversees the program. “There is an awful lot of waste, an awful lot of fraud, an awful lot of over-prescribing and over-providing. Sooner or later, we’ve got to get to all those things. I think you could find billions and billions of dollars.”

In the halls of Congress and on the TV airwaves, Republicans nailed Obama and congressional Democrats for backing almost $500 billion in reduced Medicare spending over the next decade, mostly by trimming subsidies for Medicare Advantage, a privately administered program.

The National Republican Senatorial Committee and Crossroads GPS, one of the biggest third-party spenders last year, tried picking off Democrats across the country with ads specifically attacking their votes on Medicare.

“When Obama and [Nancy] Pelosi cut hundreds of billions from Medicare, Conway still said yes,” stated an NRSC ad against Senate Democratic nominee Jack Conway in Kentucky. “Big Government running health care. Big cuts to Medicare. Jack Conway took their side.”

It paid off: Conway lost, and across the country, seniors backed Republicans over Democrats, 59 percent to 38 percent, compared with an even split in 2008, according to CNN exit polls.

The party has kept the attack in rotation. When Obama campaigned for Sen. Bill Nelson (D-Fla.) last week in Florida, the NRSC went after the senator for defending the health care law, “including its $500 billion in Medicare cuts.”

Texas Sen. John Cornyn, the NRSC chairman, said the attack doesn’t put Republicans in a box as they try to deal with entitlements.

“Nobody is interested in cutting benefits from Medicare,” Cornyn said. “But we all recognize there is a lot of wasted money.”

Republicans argue there is a difference between the two debates. Last year, they took issue with what they described as a Democratic “shell game” on health reform. They relied on Medicare cuts — some of which may or may not materialize, given the whims of Congress — to help fund a new entitlement of guaranteed federal subsidies for 30 million uninsured Americans.

Asked about inconsistency between the debates, Sen. Tom Coburn (R-Okla.) said of the fiscal commission recommendations: “That is eliminating fraud and waste, not cutting Medicare benefits.” Coburn is one of six senators participating in the bipartisan deficit-reduction talks.

Scarred by the health care debate, Democrats aren’t eager to embrace more Medicare cuts. Some want to hold back until the health law is implemented, since they believe there are greater cost savings than the $500 billion that the Congressional Budget Office would recognize.

Freese said any serious effort to reform Medicare will require measures that can be easily framed as cuts to beneficiaries and medical providers, even if that’s not how the proponents choose to describe it.

“There is only so much waste, fraud and abuse you can get out without people lifting an eyebrow at you,” Freese said. “There is no way to do it without significant impact on seniors.”