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Obama Medicare plan: No voucher but maybe a bill

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"President Obama has always been willing to make hard choices to confront big challenges, and sometimes that means listening to other ideas," said campaign spokesman Adam Fetcher. "But (Obama) believes we can strengthen the future of Medicare without raising the eligibility age."

Translation: The idea is not quite off the table, and Obama, if re-elected, will again face the choice in budget negotiations.

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"I think it will continue to be analyzed," said Don Berwick, Obama’s first Medicare chief. Berwick believes there is a downside to postponing Medicare eligibility, because a sizable number of future retirees would join the program in weaker health.

"As an administration official, I was not impressed that it would save money for the (Medicare) trust fund," said Berwick. "But I would say it will continue to be studied."

Q: Medicare’s in-house economic analysts have warned that cuts in Obama’s health care law could eventually drive some hospitals into the red. The health care industry is pushing for repeal of a Medicare cost-control board in the law, saying more cuts will reduce access for seniors. What will Obama do if seniors start having problems getting the care they need?

A: The administration says that’s unlikely to happen. Cuts are being introduced gradually, and dozens of pilot programs are testing ways to provide better care for less money. Health care costs are in a lull, buying time to make changes. Studies indicate there is plenty of waste to be cut.

"The president will continue to make sure that seniors have access to the benefits they have earned," Fetcher.

But if Obama’s advisers are wrong and the system starts to seize up, most experts believe Congress would intervene. "Congress is always going to step in if there is a real perception that quality and access for Medicare beneficiaries would suffer broadly," said Mark McClellan, who ran Medicare for President George W. Bush.

Q: Obama’s health care law already increases the Medicare payroll tax for individuals making over $200,000. What’s to rule out a broader tax increase?

A: McClellan says that’s always a risk, particularly because Obama’s health care law funnels the higher Medicare payroll tax into providing coverage for working-age uninsured people.

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"Because those revenues are dedicated to the coverage expansion, everything else being equal, the government is going to need more revenue to cover the cost of the (Medicare) program," he said. "If that money had been used for deficit reduction, or to increase the life of the trust fund, the government would have more existing resources."

The White House says there are no plans to propose higher Medicare taxes.

Q: The administration pulled the plug on a new long-term care insurance program because of financing problems. How does Obama plan to address this unmet national need in his second term?

A: The campaign says Obama is willing to work with anyone who has good ideas about long-term care, and that Medicaid and Medicare will continue working to help seniors who want to stay in their own homes, instead of going into nursing facilities.

But Novelli said paying for long-term care remains a huge problem for middle-class elders and their families.

Obama "may have to punt, they may not want to go there," said Novelli. "But, yes, as a society we’ve got to go there."

Copyright 2014 The Salt Lake Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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