The Republicans are having trouble reaching consensus on a plan to replace the Affordable Care Act (ACA), and the Democrats understandably are not inclined to help. Searching for areas of agreement at this point seems like a waste of legislators’ valuable time. Perhaps a more productive approach would be for each member of Congress to ask, “What do I want so much that I would be willing to accept something I really loathe in exchange?” Here are two suggestions.
Fee-For-Service Medicare Versus Medicare Advantage
What Speaker of the House Paul Ryan (R-WI) and some other congressional Republicans presumably want for Medicare is premium support—a system in which traditional fee-for-service (FFS) Medicare is treated as just another health plan that competes on a leveled playing field with Medicare Advantage plans. Democrats seemingly would like for the Medicare program to be placed on firm financial footing, rather than dealing with annual Trustees’ reports announcing the wavering date when the trust funds will be exhausted. Both sides know that the simplest way to provide a sound financial foundation for the Medicare program, although not the most efficient, is to raise payroll taxes for Part A (possibly adding a means-tested out-of-pocket premium) and increase income taxes and premiums for Parts B and D.