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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Brief Note on What Ryan-Wyden Actually Does



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Over the weekend, there has been a frenzy of highly misleading reports about Ryan-Wyden, most of them filed by people who are genuinely confused. Fortunately, the Bipartisan Policy Center has provided a helpful description:

Ryan’s budget introduces a competitive bidding system, backstopped by a cap on per beneficiary growth of 0.5 percentage points faster than the economy (GDP+0.5%). This reform is very similar to the proposal that he advanced in December 2011 with Senator Ron Wyden (D-OR), except that the annual growth cap is now set at GDP+0.5% instead of GDP+1%.

Seniors would be able to choose between traditional fee-for-service Medicare (FFS) and various private healthcare plans on a newly established, regulated Medicare Exchange, similar in structure to those created by the ACA. In each region, healthcare plans would be paid based on the cost of the second-least expensive approved private plan or FFS, whichever is less costly, risk-adjusted for the health status of their enrollees. The cost of this plan would establish the “benchmark” government payment in each locality. Therefore, the amount that the government contributes would be tied to the cost of health care in a given area.

Beneficiaries who choose to enroll in a plan that is more expensive than the benchmark – even if that plan is FFS – would be required to pay the incremental additional cost. A beneficiary who enrolls in the least-expensive approved plan would be rebated the full difference in cost from the benchmark.

Additionally, if costs per enrollee continued to grow faster than the cap of GDP+0.5%, seniors would have to pay an additional premium to make up the difference. For reference, CBO projects Medicare to grow at GDP+0.8% per beneficiary from 2023-2032 and GDP+1.7% thereafter under current law, which assumes that the cuts from the ACA remain in place and are effective.

I believe the annual growth cap was changed from GDP+1% to GDP+0.5% to match a budget proposal from the Obama White House. In my view, the Obama White House and Chairman Ryan have settled on too tight a global budget.

There are many other aspects of the Ryan budget proposal that I consider less than perfect, e.g., defense expenditures are maintained at a very high level, the Medicaid block grants are not structured as well as they should be, discretionary spending levels might be too low, and the revenue component is less than ideal. Yet it does strike me as a good starting point for negotiations. Over time, Ryan has been willing to modify his Medicare proposal in response to constructive criticism, and my sense is that he and his allies would be willing to negotiate over revenues, etc., if the principle of structural Medicare reform were embraced.



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