113th Congress, Vote 177; House of Representatives #96

Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024.

Official Title: Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024.

H.Con.Res 96: Paul Ryan’s budget for 2015 fiscal year
Passed by the House April 10, 2014, 219-205 (8 abstaining).

Synopsis: In April 2014, Rep. Paul Ryan (R, Wisconsin) published The Path to Prosperity, his fiscal year 2015 budget resolution. It was generally regarded as a symbolic measure, more a declaration of Conservative fiscal values than a genuine attempt at a bipartisan budget proposal. And Senate Democrats had clarified that they didn’t plan to pass a budget for the 2015 fiscal year, as they had already reached a two-year spending agreement in late 2013.

Ryan’s budget would cut about $5.1 trillion in government spending over a decade, and healthcare would account for more than half of the overall savings. The overall implications of the budget proposal are far-reaching, but this synopsis looks at the impact on Medicare if H.Con.Res. 96 were to be enacted:

• Starting in 2024, Medicare would switch to a "premium support" model for new enrollees, providing a fixed government contribution that seniors could use to purchase traditional fee-for-service Medicare or a private option via a Medicare exchange. If the enrollee selects a plan that costs more than the government’s contribution, the enrollee would pay the difference. Premium support payments would be made directly to the insurance carriers. Wealthy seniors would have to pay a larger share of their own premiums, while low-income seniors would receive additional help covering out-of-pocket costs.
• Starting in 2024, the eligibility age for Medicare would gradually increase from 65 to 67.
• Starting in 2024, traditional fee-for-services Medicare would have a single deductible (currently, there’s a deductible for Part A and another deductible for Part B).
• Part B and Part D premiums are already higher for higher-income beneficiaries, but H.Con.Res 96 would expand this until 25 percent of Medicare beneficiaries are paying increased premiums based on their incomes.
• The ACA would be repealed, including the sections that pertain to Medicare beneficiaries.

Why supporters pushed for this bill

• Balancing the budget over the coming decade is a primary component of H.Con.Res 96, and supporters of reduced government spending liked that aspect of the budget proposal.
• Those who prefer a privatized approach to Medicare were generally supportive of Ryan’s proposal. Free-market proponents noted that the premium support stipends would drive competition and innovation in the private Medicare market.
• Changes to the Medicare system wouldn’t take effect until 2024, so people who are 55 or older in 2013 would still be covered under traditional Medicare once they reach age 65 (although they’d be allowed the option to join the new premium support program outlined in H.Con.Res 96). This helped to avoid controversy among current Medicare beneficiaries and those who will age into the program in the next few years.

Why opponents tried to stop the bill

• Repealing the ACA is a key component of H.Con.Res. 96. The ACA has been closing the donut hole in Medicare Part D, and has also provided free preventive care and annual wellness exams for Medicare enrollees. These benefits would disappear if the ACA were to be repealed.
• The Center on Budget and Policy Priorities noted that transitioning to Ryan’s proposed "premium support" Medicare model would result in reduced access to traditional fee-for-service Medicare in areas where private plans are less expensive than traditional Medicare. This could make it more difficult for seniors to keep their doctors, since private plans tend to have narrow networks (as opposed to traditional Medicare, which includes 96 percent of providers who offer Medicare-covered services).
• Premium support payments could be used for private plans or traditional Medicare, but the former would be more likely to attract healthier enrollees, thus gradually driving up costs for traditional Medicare.
• The National Committee to Preserve Social Security and Medicare strongly opposed H.Con.Res 96, stating that the budget "ends traditional Medicare and achieves savings for the federal government by shifting costs to Medicare beneficiaries" in a variety of ways, including the loss of coverage for 65- and 66-year-olds once the Medicare eligibility age is increased.
• But among fiscal conservatives – including some members of congress – Ryan’s budget resolution didn’t go far enough. It wasn’t scheduled to reach a balanced budget until 2024, and fiscal conservatives wanted more swift action towards a balanced budget.

04/10/2014

Status: House passed

More: select a member to see his or her other key Medicare votes.