Ryancare: Obamacare For Seniors

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The plan would essentially end Medicare.” – Wall Street Journal, April 4, 2011

Not a single Republican voted for the Patient Protection & Affordable Care Act (“PPACA”) that was enacted into law last year despite the fact the legislation does everything possible to add transparency and keep the free market system of health insurance viable in America. Republicans portray the legislation as a massive government takeover of healthcare even though creating exchanges to purchase private health insurance policies (the cornerstone of the healthcare law) is actually a Republican idea.

Now the healthcare legislation that Republicans want to repeal has become the cornerstone of the Republican plan for Medicare. “Obamacare” (as Republicans prefer to call the PPACA), is the backbone of “Ryancare,” the Medicare and Medicaid plan introduced by House Budget Committee Chairman Paul Ryan on April 5 as part of his 2012 fiscal year budget plan.

Traditional Medicare will disappear for people born in 1957 and later under Ryan’s plan for people who start to become eligible for Medicare in 2022.(1) Instead, seniors will be required to select a private health insurance policy from a national exchange set up by the federal government. The Affordable Care Act originally had a national exchange too since a national exchange is more cost efficient and would have uniform regulations versus setting up separate exchanges in all 50 states, but then Republicans complained that states rights were being curtailed.

Another gripe Republicans have with the healthcare law is that when the exchanges go into effect in 2014 the federal government will regulate minimum coverage standards for four levels of insurance policies with states having the option to set additional regulations. Yet the federal government will also regulate what insurance policies can be sold in the exchange under Ryan’s plan!(2)

In Ryancare, seniors will receive a government subsidy (or what Ryan prefers to call “premium support”) which is sent directly to the insurance company selling the policy the beneficiary has selected.(3) Yet Republicans don’t like that the Affordable Care Act provides healthcare coverage for all Americans by providing “premium support” in the state-based exchanges as well as full coverage for families up to 138% of the poverty level through Medicaid. Ryan’s budget assumes that the Affordable Care Act will be repealed. (Traditional Medicare would remain under the Affordable Care Act.)

Ryancare also raises the age to qualify for Medicare by two months when the plan starts in 2022 which continues to rise an additional two months per year until the eligibility age reaches 67 in 2033. (People born in 1957 who turn 65 in 2022 won’t be eligible for Medicare until two months after their 65th birthday. People born in 1962 who turn 65 in 2027 will not actually be eligible for Medicare until 2028, and people born in 1968 and later will not qualify for Medicare until their 67th birthday.)

Ryan likes to compare his plan to Medicare Advantage which costs the government about 15% more than traditional Medicare’s fee for service. Like Medicare Advantage, chronically ill seniors in Ryan’s plan will receive a larger premium support payment toward their private insurance policy. But unlike Medicare Advantage where seniors of all ages pay the same premium for a given plan, under Ryancare insurers are only required to charge the same premiums for enrollees of the same age. The top 8% of income earning seniors will receive reduced premium support levels.

Ryancare’s premium support is projected to start at $8,000 per year for 65 year olds in 2022 and average $15,000 for all ages (depending upon the beneficiary’s age and health status). According to a calculation by the Centers for Medicare and Medicaid Services, the average amount spent on Medicare beneficiaries in 2009 was $11,743. Premium support increases in Ryan’s plan are tied to the CPI-U rather than the rate of healthcare inflation.

So it’s not surprising that after reviewing Ryan’s plan, the nonpartisan Congressional Budget Office (CBO) concluded that “most elderly people would pay more for their health care than they would pay under the current Medicare system.” And the CBO notes that “administrative costs (including profits) and payment rates to providers are higher for private plans than for Medicare.” That $8,000 premium support stretches a lot further on traditional Medicare than with a private insurance policy as the government’s level of premium support would grow more slowly. In sum: “CBO’s estimates of the impact of the proposal on Medicare beneficiaries’ spending for their health care are subject to substantial uncertainty.”

Republicans succeeded in scaring seniors that providing healthcare for Americans under 65 would put their benefits at risk which helped them win the midterm elections despite the fact that seniors have already received several benefits from the Affordable Care Act. If Ryan’s “patient-centered reforms” are so great for seniors, why does he go to great lengths to emphasize that people 55 and older will not be affected by his plan as the current Medicare system will remain in place for them?! (4)

Since Ryancare is basically Obamacare for seniors, wouldn’t it make more sense to create a bipartisan solution by merging Ryancare with Obamacare in 2014 which would spread the risk pool and extract greater cost savings for the government? Of course the best deal of all would be to put all Americans in traditional Medicare as one giant risk pool but that wouldn’t please Ryan’s biggest campaign contributors.

Here’s why current Medicare beneficiaries and people who are between the ages of 55 and 64 now would be adversely affected if Ryan’s plan became law:

Ryan’s plan requires that all of the additional benefits seniors are receiving, the consumer protections people 64 and younger have just gotten and the benefits that all people will receive starting in 2014, will be rescinded if Republicans repeal the healthcare law.

Many people believe that Medicaid is only for the poor despite the fact that two thirds of Medicaid spending is for the elderly and the disabled, with about 40% of all Medicaid spending for “dual eligibles” (the elderly and disabled who are covered under Medicare and Medicaid). 33% of Medicaid spending going towards paying long term care costs, with 60% of those costs paying for nursing home care.(5)

Currently the federal government contributes 57 cents of every dollar the states spend on Medicaid. Under Ryancare starting in 2013, states would receive $750 billion over 10 years towards Medicaid, an amount the CBO says “would be significantly lower than under current law.” (6) The “upside” to the downside in funding according to Ryan is that the money from the federal government will be distributed to states in the form of block grants that will give states the “flexibility” to spend the block grants as they see fit.

Many states might decide to just stop funding their portion of Medicaid. Or states could decide to “defund” Medicaid for seniors. In other words, the federal government in Ryan’s plan is keeping its hands clean of making end of life decisions. Ryancare “empowers” the states and the health insurance companies to be the “death panels” who dictate end of life “choices” for seniors who have depleted their life savings for medical care.

The biggest unknown at this juncture is how receptive people under 55 would be to Ryancare. People are willing to pay Medicare taxes for the promise (like Social Security) that it will be there for them when they become eligible. But will they feel the same way if they know they will pay taxes and have to save a lot more money to pay for their medical care not only in their senior years but even years before that if the healthcare law is repealed?

Seniors who voted Republican in the midterm Congressional election with the belief that doing so would protect their government run healthcare should begin to see the irony here.(7) If Ryancare is enacted, the fate of their healthcare coverage will rest in the hands of Americans under the age of 55 who might not be too happy about being taxed to pay for healthcare for seniors who helped repeal their chance at obtaining/accessing better and more affordable healthcare coverage in 2014.

The whole problem with the Affordable Care Act is that its greatest benefits do not begin until 2014 because Democrats were afraid of an even bigger backlash if they didn’t “pay” for the legislation. Ryan’s claim that he will save $725 billion over 10 years by repealing the Affordable Care Act excludes the $230 billion in savings projected by the CBO the law will save over 10 years. Although it’s difficult to measure, these estimates do not include the savings from a healthier freshman class of seniors entering Medicare.

Under Ryan’s FY2012 budget, Medicare costs over the next 10 years are projected to be $7.39 trillion vs. $6.46 trillion in President Obama’s FY2012 budget proposal.(8) In wanting to repeal the healthcare legislation, Ryan’s plan repeals the medical board that will evaluate the most effective treatments for the lowest cost (what Republicans like to call the “rationing board”). Ryan says that his plan will save money by bringing “free market competition” to Medicare but if that were true, Medicare Advantage plans would not cost the government more money than traditional Medicare!

Republicans will have to vote to raise the debt ceiling as Ryan’s plan doesn’t pay off the deficit until close to the middle of the century and as the WSJ’s David Wessel observes, “by making the ludicrous assumption that federal spending (now about 24% of GDP) will be cut to 14.75% of GDP by 2050.” And Ryan plans to achieve this feat by lowering corporate and individual tax rates without eliminating all tax deductions and corporate welfare.

Which means that in order to do all that, Ryancare will require everyone but the most affluent Americans to have the “flexibility” to do more with a LOT less.

This is not just a budget, this is a cause.” – Paul Ryan introducing his “Path to Prosperity” budget at a press briefing, April 5, 2011

Born with his Sun (self-identity) conjunct Venus in Aquarius, money matters are indeed a cause rather than a budget to Paul Ryan. Budgets are filled with numbers but a cause is a budget filled with ideological rhetoric to replace numbers that don’t add up. The CBO’s letter would have been a more appropriate Appendix than an assessment by the highly partisan Heritage Foundation which is part of Ryan’s cause.

The Sun conjunct Venus in Aquarius endows Ryan with a pleasant demeanor and the potential to appeal to a broad spectrum of the populace. Ryan’s Sun/Venus squaring Jupiter in Scorpio and Saturn in Venus-ruled Taurus reflects his ascent to chair the House Budget Committee and the potential to higher positions in government or in the world of finance.

Ryan’s Sun and Venus form a harmonious relationship to Uranus the planetary ruler of Aquarius. Ryan was born with Uranus in Venus-ruled Libra, the sign ruling relationships and the art of negotiation and compromise. But Ryan seems all too eager to allow assertive Mars which is strong in its home sign Aries and opposing Uranus in Libra, to take charge with a “my way or the highway” approach with his proposals when discussing the issues with politicians in the opposing party. And with Jupiter and Saturn currently in opposition in the sky and drawing the enormous ideological divide between the two political parties into even starker contrast, Ryan is the lightning rod (Aquarius) as the personification of this divide since he was born with Jupiter opposite Saturn.

With his natal Mars/Uranus opposition and the fact that Ryan was experiencing a Mars return when he introduced his budget last week coupled with the fact that Mars and Uranus in Aries were exactly conjoined in the sky at that time, the press is calling his Medicare plan “courageous” and “bold.”(9) Yet how much courage does it really take to propose a plan that would need to pass Congress with enough votes to override President Obama’s assured veto since his bill depends upon repealing the healthcare law this year?

With the Sun, Venus, Jupiter, and Saturn in fixed signs (in a T-square), Ryan tends to be too rigid (fixed) as these planets are in signs that preside over fiscal matters. Aquarius represents special interest groups, Scorpio rules debt, taxes, insurance, entitlements and all types of welfare. And Taurus rules revenue. Ryan’s optimistic (Jupiter) assumptions project that lower taxes and entitlement spending coupled with private insurance policies (Scorpio) will shrink the deficit (Saturn) while increasing revenue (Taurus).

Ryan’s Sun/Venus square Jupiter combined with the Sun/Venus making a favorable aspect to Neptune in Jupiter-ruled Sagittarius reflects his overly idealistic and high expectations that his “pro growth” plan is truly the “Path to Prosperity” for America. (How Sun/Venus square Jupiter is that - especially for the wealthiest Americans and corporations?!) These planetary energies also reflect that Ryan’s plan is more “cause” than budget as his plan calls for loosening various industry regulations on the premise it would generate more jobs and boost the economy.

One of Rep. Ryan’s favorite phrases that he has frequently used long before it became overused by Congressional leaders and the President in the past week is the need to have “an adult conversation” about restraining Medicare and Medicaid spending. (Ryan was born with Mercury in Saturn-ruled Capricorn, so his communication style tends to be serious and authoritative.)

I’ll be the first person to agree with Ryan that an “adult conversation” is long overdue when it comes to issues that are part of Pluto’s domain. With Pluto’s energies pronounced April 2-15 as Pluto turned retrograde April 9, Washington is talking nonstop about Pluto-ruled subjects (debt/deficits, taxes, entitlements, corporate welfare, reproductive rights and abortion) on a superficial level when Pluto requires delving deep beneath surface appearances.

With Pluto in the structural sign Capricorn which rules government, corporations, and the elderly (2008-2024), you can bet that whether by choice or by force, all of these will be profoundly transformed in one way or another. As Uranus in Aries moves closer to forming seven exact squares to Pluto during 2012-2015, the “unexpected uncertainty” that Uranus is known for will inject various types of “shock therapy” that forces America to come face to face with the dark and taboo topics that the lord of the underworld presides over.

WARNING! Real adult conversation ahead; turn back now if you’re in denial! (I’ll get to Neptune in a minute).

Let’s start with the other thing Pluto rules (death) and work our way back to life. The bulk of the billions of dollars the government spends on healthcare go to pay for end of life care. Yet none of the proposals to reduce healthcare spending by either party is specifically targeted to address the high cost of end of life care.

Our society must make a judgment call as to the value that each additional month of life is worth. (The U.K. government puts a value equivalent of around$35,000 per month for end of life care.) One month of life for one person could cost the equivalent of 10 years of health insurance coverage for another. There is a tradeoff in providing healthcare for the masses vs. extraordinary end of life care for the few.

No political party can provide an unlimited budget for end of life care anymore. The philosophical difference (Jupiter) between the two political parties is that Republicans under Ryancare want to enforce end of life choices through strictly economic means. Seniors unable to afford the highest premium plans will find their end of life “choices” severely limited (i.e. rationed; Saturn). Under the Democrats approach, Medicare will judge the effectiveness of end of life treatments and make allocation judgments based on their findings. With Jupiter in Aries opposing Saturn in Libra together with the USA experiencing a Saturn return and Saturn squaring the USA’s Sun in Cancer now, the public can no longer delay deciding which scenario makes more sense.

Although this issue is not specifically addressed in Ryan’s plan, Pluto rules sex and reproductive issues as death precedes life. Republicans are doing everything they can to restrict abortion and yet they also want to restrict access to family planning and birth control choices which blocks the ability to achieve the goal that everyone should share: that every baby born is a wanted baby. The financial and societal cost of women having babies they do not want has become too great. Republicans want to protect fetuses, yet when the fetus grows into a baby that is born, that baby might be denied healthcare coverage. Birth control is a far cheaper and more palatable cost than abortions but abortions are far cheaper than the cost to the government for birth and child care.

Pluto rules nuclear energy. Since America split the atom in WWII, our nation has become split and even more divided over the ensuing decades. Whether it is healthcare coverage or the wealth gap between the plutocrats and the rest of the nation, Pluto in Capricorn is bringing that stark divide oozing up from below the surface; with Uranus squaring Pluto it could easily become explosive.

At its lowest level Neptune prefers to block out Pluto’s intensity and taboo topics as well as Saturn/Capricorn’s harsh reality. Neptune’s propaganda tries to convince the masses that there’s freedom in separation despite the fact that Neptune is the dissolver of boundaries. Neptune entered its home sign Pisces on April 4 until August 4, and returns to Pisces February 3 until 2026. At its highest manifestation, Neptune in Pisces is a compassionate energy that understands how everything and everyone is interconnected. Making one segment of the population sacrifice to benefit another will ultimately harm the nation’s wellbeing overall. Lifting environmental regulations will generate more pollution that will adversely affect our food supply and our health which will ultimately weaken the economy.

Chairman Ryan introduced his Medicare plan during Mercury retrograde (and Mercury-ruled Gemini is the ruler of the chart for when he began his news conference). Mercury retrograde is the wrong time to introduce a completely new plan unless the goal is to repeal existing legislation.

Mercury is a dualistic energy which means multiple issues are in play here. Repealing the Affordable Care Act is one, and I suspect that repealing Medicare and Medicaid is the second component as Ryan’s natal Sun opposes the Sun in Leo when President Johnson signed Medicare into law in 1965. The Medicare Act’s progressed Sun in Virgo (healthcare) squares the USA’s natal Mars in Gemini now and will exactly conjoin the USA’s natal Neptune in 2012.(10) Taking action to “repeal” legislation can wear many masks – legislation, court rulings, or gradually dissolving the law in ways that are much more subtle until it completely disappears.

Every Saturday The Wall Street Journal features a “Number of the Week.” Yesterday’s number was 141% which represents “how much more the U.S. spends on health care, per person, than the average OECD nation” – and that was as of 2008. “Annual public and private healthcare spending in the U.S. stands at $7,538 a person, 2.41 times the OECD average.” However, the WSJ was not specific as to whether this amount is per insured person or for the entire U.S. population. That could leave the cost per insured person to actually be much higher.

Yet for all the money the U.S. spends on healthcare, average U.S. life expectancy is 77.9 years vs. the OECD average of 79.4 years. And Paul Ryan and politicians on both sides of the aisle should note that:

The OECD estimates that if the U.S. reached the efficiency level of the best-performing countries, the government could save the equivalent of 2.7% of economic output every year. That’s enough to solve about a third of the U.S.’s budget-deficit problem.

And help more Americans be healthier too!

(1)Ryancare will also cover those who qualify for Medicare through disability starting in 2022.

(2)The minimum coverage standards that will be established under the healthcare law will not define what types of medical services are covered but will specify that each plan level will cover a certain percentage of expected medical expenses. As a hypothetical example, let’s say the cheapest policy available covers 65% of medical expenses with the policyholder responsible for paying the difference.

(3) Ryan originally called the government subsidy a voucher but renamed it “premium support” after “voucher” did not test well in focus groups.

(4)Seniors and the disabled enrolled in Medicare before 2022 will be given the option to enroll in Ryancare.

(5) “Fiscal Health Hinges on Containing Costs of Care” by David Wessel, WSJ March 31, 2011.

(6)Ryan’s plan would increase the amount of the Medicaid block grants which would increase annually based on population growth and the CPI-U.

(7)Democrats had hoped by front loading the Affordable Care Act with benefits that seniors would immediately begin receiving would help to assuage their fears about the legislation.

(8)See WSJ chart comparison of budget plans in “Budget Talks Head to Brink,” WSJ April 6, 2011.

(9)Mars returns to its natal position about every two years.

(10) A mathematical calculation that moves the planets forward in time as a method of prediction.

Paul Ryan: January 29, 1970 time unknown Janesville, Wisconsin

Ryan Press Briefing: April 5, 2011 10:33 AM EDT Washington, DC

USA: July 4, 1776 5:10 PM LMT Philadelphia, PA

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