Is It Really True That Romney, Ryan, and Obama Backed the Same Medicare Cuts?

by Reihan Salam

Jake Tapper has an ABC News column on Medicare cuts:

Voters might be left with the impression that Romney and Ryan have both opposed the cuts. The truth is that Ryan himself endorses them in his signature budget plan – the same plan Romney has said he would sign as president if it reached his desk.

Those Medicare savings -achieved through reduced provider reimbursements and curbed waste, fraud and abuse, not benefit cuts – appear in the House Republicans’ FY 2013 budget, which Ryan authored.

His plan would in part repeal the entirety of the Affordable Care Act — except the reductions in Medicare spending now at the center of debate, according to analysts with the nonpartisan Kaiser Family Foundation.

Where Romney and Ryan find shelter for their new line of attack is in what they claim they’d do with the savings. As the ad suggests, they don’t want the money to underwrite Obamacare, but for deficit reduction or other spending instead.

“We’re the ones who are not raiding Medicare to pay for Obamacare,” Ryan said tonight in his first solo interview with Fox News Channel’s Brit Hume.

But in an added twist through all of this – further complicating the picture in a way that voters might not be aware – Romney asserts that the Romney-Ryan ticket is running on his budget proposal, not Ryan’s, and he would restore those cuts. [Emphasis added]

It is worth noting, however, that Ryan has also voted to repeal PPACA, including its Medicare savings. One assumes that Ryan knew what he was doing, i.e., delaying the realization of Medicare savings into the future. Romney has called for leaving current retirees and near-retirees untouched. 

So why did Ryan include PPACA savings in his FY 2013 budget? My understanding is that this was a matter of convenience relating to the CBO’s scoring conventions. Had Ryan reversed the Medicare savings in his budget, he’d have to find offsets despite the fact that he intended to apply the savings to extending the life of the Medicare trust fund.* (Note: I find trust fund accounting maddeningly complex, so there will be more on this to come.)

As you might remember from the debate over Charles Blahous’s Mercatus Center paper on the fiscal consequences of PPACA, there is a great deal of controversy and confusion regarding how we should think about the Medicare trust fund. Should its exhaustion be a source of concern or is it an accounting illusion? Those who think the Medicare trust fund matters will see Ryan’s FY 2013 budget as meaningfully different from PPACA’s use of Medicare savings to offset the cost of coverage expansion.

There is a reasonable case to be made that Ryan, having voted to repeal PPACA in one instance and having applied its Medicare savings to the extension of the Medicare trust fund, consistently favors shoring up the Medicare program for current retirees, not using savings to fund coverage expansion.* This is presumably why Ryan is perfectly comfortable embracing Romney’s position, which is that PPACA’s Medicare savings should be reversed to shore up Medicare.   

My own view — which is not politically popular — is that we should introduce a Wyden-Ryan-style Medicare reform on a far faster timetable, which is quite different from the views advanced by the Obama White House and the Romney-Ryan campaign.