In battle for crucial senior vote, health care could be decisive

The 2012 presidential election hinged on women voters and minorities, but 2014 is the year for seniors. That explains why both parties are fiercely competing for their attention – especially when it comes to health care, both Medicare and the Affordable Care Act.

Seniors rule in midterms. In presidential years, other groups come to the fore. But older voters are reliable voters who show up in the off-season, while some of those other groups tend to stay home. This year, 57 percent of the electorate will be over 50 years old, says Democratic pollster Celinda Lake. That’s up from 43 percent in 2012.

 Ms. Lake is pleased with this, because Democrats are polling well on two issues seniors care a lot about: Social Security and Medicare. In the March Battleground Poll, which she worked on with Republican pollster Ed Goeas, older Americans who are likely voters favored Democrats on Social Security and Medicare by 7 points.

“Our advantage with seniors is a turnaround” compared with the previous Battleground Poll in January, Lake said. In 2012, President Obama lost the vote of those aged 50 and over. In sheer numbers of seniors likely to turn out, “If President Obama ran in the 2014 electorate, we would have had President Romney,” she says.

But in this cycle, Democrats have a perfect punching bag on their top issues in the Republican budget plan released April 1 by House Budget Committee chairman Paul Ryan (R) of Wisconsin. The plan would repeal the Affordable Care Act (ACA) and change Medicare to a system of government-paid premium supports for plans that seniors choose.

“Seniors really get socked,” Rep. Chris Van Hollen, (D) of Maryland, says of the Ryan budget, which has no chance of passing the Senate but shows Republican priorities. Mr. Van Hollen is the top Democrat on the Budget Committee.

Concretely, repealing the ACA would mean rolling back expanded free preventive care for seniors, including an annual checkup and other exams. It would mean reopening the so-called “doughnut hole” in prescription drug coverage – resulting in higher drug costs. And abandoning Medicare’s fee-for-service system for premium payments removes a guarantee of affordable coverage. House minority leader Nancy Pelosi (D) of California dubbed the GOP budget proposal “millionaires over Medicare.”

But Republicans claim an advantage over Democrats on President Obama's signature health-care law, which is still highly unpopular with seniors. The ACA – “Obamacare” – hurts seniors, they insist. Obamacare featured heavily in the special election in Florida’s 13th district in March, when Republican David Jolly narrowly defeated Alex Sink to win a congressional seat that depended on turnout. One TV ad by the US Chamber of Commerce, which backed Mr. Jolly, warned of Medicare cuts under Obamacare.

"Canceled health plans. Higher premiums. Medicare cuts. People losing their doctors. A disaster for families and seniors. For Alex Sink, the priority is Obamacare. Not us," the narrator intoned. 

To make their case, Republicans focus on an estimated $156 billion in cuts over 10 years to a program called Medicare Advantage, which they have long championed. That’s a private health insurance alternative to Medicare, regulated by the government, that often includes benefits such as hearing aids, eyeglasses, and even health-club memberships. Nearly 16 million people are enrolled in this program – accounting for 30 percent of all Medicare beneficiaries.

Obamacare aims to bring the federal dollars spent to subsidize Medicare Advantage more in line with what is spent on patients under traditional Medicare. The federal government began reducing payments for Medicare Advantage in 2012, and will finish by 2017, when it expects to reach a rough parity between the two programs nationwide.

But Republicans – and worried Democrats in Congress, as well as insurers – recently put a lot of pressure on the administration to temper the cuts. This week, the government announced it had refigured an estimated 1.9 percent planned cut to Medicare Advantage into a 0.4 percent increase in federal payments to the program for 2015. Republicans, though, continue to rail against it.

What the messaging from both parties has in common is that it’s mostly negative. Because Americans are unhappy with both parties, it's hard for either one to run a victory lap. Not unusually, finger-pointing often leaves out context. For instance, the Ryan budget does indeed call for a changeover to premium supports, but it’s for those entering into the system 10 years from now – in 2024. Meanwhile, many experts say that, at some point, Democrats will have to pay the piper of national debt and seriously rein in entitlements.

At the same time, cuts to Medicare Advantage are – so far – not as dire as Republicans make them out to be. One reason is that the program continues to grow in popularity. More enrollees mean more premiums, which mean more profits for insurers, which mean less pressure to raise premiums.

A study by the Kaiser Family Foundation finds only a $4 increase in average monthly Medicare Advantage premiums for 2014, compared with 2013, if someone stays in their current plan. This year, the average number of plans being offered is 18 – last year it was 20. The cap on out-of-pocket expenses is expected to be more noticeable this year, though, as it is up by a national average of $464.

The caveat here is that these are national averages, and Medicare Advantage differs from county to county. Some people are indeed losing their doctors or experiencing other disruptive changes.

"In January, I sat down with a group of local doctors to talk about all this," said Rep. Bill Johnson (R) of Ohio, in a March 15 GOP response to President Obama's weekly radio address. "One told me that many seniors in our area who need to see a specialist will now have to drive up to Cleveland or Pittsburgh to receive care. Another cited hundreds of cases in which patients were blindsided by these changes."

Who is likely to win this health-care message war? Democratic pollster Lake believes her party has the advantage. The election is still a long way off. Every day that goes by and seniors see the real benefits of the ACA, is a good day for Democrats, says Lake. Meanwhile, the Ryan budget is about the future. There’s nothing tangible to disprove Democratic claims about a future under the GOP, she says.

On the other hand, just 35 percent of those 65 and older support the new health-care law, while 56 percent oppose it, according to a March Pew Research Center survey. That’s a lot of proving to do between now and November.