Florida's senior senator, Democrat Bill Nelson, saddles his Republican challenger, Rep. Connie Mack IV, with the Ryan plan. Mack voted for one version of Ryan's proposed budget, but skipped a second vote.
In the 18th Congressional District, which includes parts of Palm Beach County and all of Martin and St. Lucie counties to the north, Republican Rep. Allen West has in multiple statements embraced his two votes for the Ryan model. But West's initial general election ads don't mention that, as he pledges not to balance the budget on seniors' backs.
Democratic challenger Patrick Murphy said Medicare "is the clear distinction" in the race. Murphy, West's Democratic challenger, said a plan that moves from a "guarantee" to private premium subsidies "is not the same as keeping our Medicare promise." Tim Edson, West's campaign manager, retorted, "If you don't have a plan, don't criticize ours."
That maneuvering and voters' reactions highlight how difficult it is to understand — and how easy it is for a candidate to manipulate — the complexities of health care economics and policy.
Glenn Basile, who retired to West Palm Beach after decades as a New York City public school teacher, recalled future President Ronald Reagan lambasting Medicare as a "socialist" threat before President Lyndon Johnson signed the new law. "Has it not always been the Republican point of view to do away with Medicare?" he asked. Basile, 63, said he has voted Republican for president before.
Yet Republicans are right that Ryan has not proposed imposing vouchers on current Medicare beneficiaries, with no one 55 or over being affected by any changes. And the congressman says he would still want future seniors to have the options of government coverage.
Ted D'Alessandro, 64, said Obama's 2010 law will only exacerbate the nation's lopsided financials. Yet the self-described libertarian said the overhaul includes "good things" like barring insurers from denying coverage based on existing conditions and allowing young adults longer stays on family policies. Both provisions add cost to any coverage pool.
The law does not lower the bottom-line of future Medicare spending but reallocates some of what would have been spent under old rules. The reductions come mostly from payments to providers and private insurers who offer plans in lieu of traditional Medicare. The money will cover annual physicals, preventive care and more generous prescription drug coverage. Republicans argue that fewer physicians and hospitals will accept Medicare, meaning fewer services. Obama argues that better access to preventive care and drugs will prevent more expensive hospitalizations.
Ryan's budget presumes some of the same savings found in Obama's law. But Ryan would steer the money back to Medicare's trust fund, a move Republicans pitch as more responsible than spending it elsewhere.
Jean Siciliano is an 85-year-old who came to Palm Beach County from Long Island, N.Y. She said her fellow seniors are less swayed any of the Medicare arguments than strategists and younger voters might assume. They formed their politics long ago, she said, proudly declaring her GOP allegiance.
"I'm set," she said of her Medicare benefits. "They won't come after me. I'm worried about my children. What'll they get? How will they pay for it? ... I don't think any of the politicians know the answer."
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