Surprise! HHS pilot program to send 2 million poor seniors from Medicare into ... "voucher" programs

I know that every campaign promise Barack Obama makes has an expiration date … but this is ridiculous.  The confetti is barely off the floor at the Time Warner Cable Arena in Charlotte, North Carolina after Obama’s acceptance speech, and already we find out that he’s flip-flopped.  Remember this part of the speech, in which he attacks the Paul Ryan plan to apply free-market reform and cost controls to Medicare?

And I will — I will never turn Medicare into a voucher.

No American should ever have to spend their golden years at the mercy of insurance companies. They should retire with the care and the dignity they have earned. Yes, we will reform and strengthen Medicare for the long haul, but we’ll do it by reducing the cost of health care, not by asking seniors to pay thousands of dollars more. And we will keep the promise of Social Security by taking the responsible steps to strengthen it, not by turning it over to Wall Street.

Expiration date — the very next day, courtesy of some fine reporting by National Journal’s Margot-Sanger-Katz [see update]:

In his convention speech in Charlotte, President Obama vowed to block the Republican Medicare reform plan because “no American should ever have to spend their golden years at the mercy of insurance companies.”

But back in Washington, his Health and Human Services Department is launching a pilot program that would shift up to 2 million of the poorest and most-vulnerable seniors out of the federal Medicare program and into private health insurance plans overseen by the states.

The administration has accepted applications from 18 states to participate in the program, which would give states money to purchase managed-care plans for people who are either disabled or poor enough to qualify for both Medicare and Medicaid. HHS approved the first state plan, one for Massachusetts, last month.

Bear in mind that Ryan’s plan made the vouchers optional; seniors could choose the traditional government-run Medicare plan or opt for a private insurance plan from a federal exchange of approved insurers.  Ryan also allows all seniors to choose, and didn’t force the poorest seniors to take the voucher option.  Not only will Obama push just the poorest seniors into this plan, in some states they’d have to know to opt back in to traditional Medicare:

California is already counting on more than $500 million in budget savings from its own program this year. Most states are proposing to automatically enroll people. Those who don’t want to participate would need to opt out. The Massachusetts plan includes that feature.

Talk about leaving seniors — the poorest seniors! — “at the mercy of insurance companies.”   And why has HHS decided to roll out this pilot program?  As Paul Ryan has argued all along, the competition will drive down costs, especially given the headaches associated with government bureaucracy for dual-qualified seniors:

Potential cost savings are a big incentive for states. Patients who qualify for both federal health programs are a costly population and include many who need nursing-home care or other expensive services. About 40 percent of Medicaid’s costs go toward patients who are also eligible for Medicare. Advocates of the pilot program also say it could lead to better coordination of care for patients who often struggle to navigate the two different programs.

Don’t get me wrong — this sounds like a good program to test.  In fact, it sounds a lot like the Medicare Advantage program that Obama gutted to pay for his Medicaid expansion in ObamaCare.  It’s similar to the approach Ryan wants to use to drive down costs, except that Ryan didn’t propose to use the poor as guinea pigs to test it out.  And he certainly didn’t propose his plan quietly while hypocritically railing against private insurance and Wall Street just as the program got ready to start.

Update: A couple of commenters object to my description of this as a “voucher” program — but that’s how Democrats describe Ryan’s plan, and that doesn’t have “vouchers,” either.  It’s a premium-support plan in a federal exchange of insurance plans approved by Medicare for coverage.  That’s what Medicare Advantage did too, and Obama raided it to pay for the Medicaid expansion in ObamaCare.  This plan doesn’t even have the federal exchange that Ryan envisioned, but fifty different exchanges doling out federal dollars.  Like I wrote, the plan and the experiment is worth trying, but it’s precisely the kind of push into private insurance that Obama swore the day earlier he’d never do … and he’s doing it with the poorest seniors with only an opt-out in some states rather than the opt-in that Ryan’s plan provided.  I’ll put quote marks on “voucher” in the headline, but this mechanism only differs from Ryan’s in that the exchanges get managed by the states rather than Medicare.

If Obama supporters don’t like the term “vouchers” or want to gripe about its accuracy, look first to the beam in thine own eye.

Update II, 9/10/12: Usually, I try to mention the name of the publication when I link, and especially when the reporter does really good work.  Margot Sanger-Katz did a great job in catching this, and I completely forgot to mention her name and National Journal’s.  I’ve fixed it, albeit a couple of days late.

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