What Ryan's Prescription on Healthcare Could Mean for New Yorkers

Monday, August 13, 2012

House Budget Committee Chair Paul Ryan (R-WI) unveiling his 2012 budget proposal last week. (Getty)

In choosing Wisconsin Congressman Paul Ryan as his running mate, Mitt Romney is putting the fate of much of the American healthcare system at the top of this year's political agenda. In the New York metro area, where healthcare is a dominant industry and an expensive proposition for consumers and taxpayers, whichever policy prevails will be uniquely felt.

Privatized Medicare

Democrats and Republicans agree that federal spending on healthcare is growing unsustainably. But the two sides have very different ideas for bolstering the vast entitlement system. In adding Rep. Ryan to the GOP ticket, Romney will spend a lot of the campaign talking about Medicare, the federal medical coverage for the elderly.

While Romney and Ryan's plans aren't identical, they're more similar than different in that both want to use private insurance companies to administer Medicare. Ryan and many Republican leaders have also made it clear they want individual patients to "have more skin in the game," shifting the system from a benefit dispensary to more of a contributor model, where seniors would receive subsidies to buy coverage.

A frequent criticism of Ryan's plan is that the subsidies or vouchers won't be adequate to cover medical expenses -- especially in a high-cost are like this metropolitan area, despite whatever geographic adjustments come from Washington. The Congressional Budget Office estimated seniors could shoulder up to 68 percent of their medical costs under Ryan's 2011 proposal. Ryan and his staff maintain the subsidies will adequately cover expenses, and insurers will have a strong incentive to deliver a product people can afford.

Although not much information exists on how much people in each state would shoulder in projected costs, there are longstanding complaints that Medicare's geographic formula doesn't adequately cover the real cost of providing medicine in the New York region.

The Ryan plans don't focus on specific spending cuts in healthcare, instead leaving decisions about how to trim hospitals, doctors or pharmaceutical companies to private insurance companies, a decade or so from now. This is in direct contrast to Obama and the Democrats, who aim to drive down costs by reducing unnecessary and redundant treatments and tests - ultimately, paying providers less. Providers don't like the idea of earning less, but they also stand to increase their number of new patience that the Affordable Care Act would bring into the system.

Changes for Medicaid

Medicaid, the healthcare program for low-income people, would change even more radically under the Ryan plan. Unlike Medicare, Medicaid is a joint federal-state program, and would continue to be one, but Ryan would convert it to a system of block grants. Medicaid expenditures would be tightly capped, and states would receive much less money than they currently get from the federal government.

Under the Affordable Care Act, the Medicaid enrollment stands to grow modestly in New York and potentially quite a bit in New Jersey, if Governor Christie decides to expand the program.

In line with the stated Romney/Ryan effort to the ‘repeal Obamacare’ agenda, Ryan's ideas would turn Medicaid into a system of block grants, turning over a fixed – and ultimately much smaller – amount of money to states, where the care would be administered. One study of the proposed Medicaid block grant system has New York and New Jersey both losing 12 percent of their federal funding - a substantial drop, but nowhere near as big as in many places.


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Comments [8]

Dean M from NC

I am a doctor and PPACA is a disaster waiting to happen. This article states that there will be more paients for doctors. We already see patients at maximum capacity each day. What is your usual wait time in the office or the emergency room? I like many doctor have stopped taking MEDICARE, MEDICAID, and most TRICARE, although we try to accomidate the military. This president wants to add 30 million new patients. Where are they going to go for care. The emergency room thats where. 83% of doctors in one study have declared an intent to decrease there practice or stop practicing with full implementation of the PPACA. I will not be one unless I am mandated to see low reimbursement patients like the mandated electronic medical record which costs doctors annual licensing fees up to 15K or more. There are not enough doctors now.

Aug. 19 2012 02:42 PM
bocheball from NYC

In re to Joy, what's bleeding the system, no pun intended, is the overwhelming greed of the insurance companies. They are the true devils of healthcare, sucking money from patients and doctors, the ugly and useless middleman. Why not disband insurance companies and make the bureaucracy a non profit run by the government? Also put pressure on pharmaceutical companies to lower fees.

NY State is currently developing a one payer system where no monies would be exchanged between doctor and patients, but there would be a tax based on your income to enroll, which would give you the right to see the doctor of your choice. Doctors would choose to be part of the system or not,
deciding if their reimbursements would be adequate. The hope being that the overwhelming amount of residents would buy in and thus the majority of doctors would enroll. Cuomo has come out in support of this. Essentially this system would a state run Medicare for all, with tax revenue to support it. Read this link for more info:

Aug. 16 2012 03:55 PM
Bob Whitehair from Little Neck, NY

This article requires major grammatical, punctuation, syntax, and other editing. Makes me wonder too about the validity of the facts. Edit it and I will read it. Otherwise you are wasting everyone's time.

Aug. 15 2012 07:17 AM

The ny area is fortunate to have many top healthcare resources; some are able to assist those uninsured and/or too poor to pay even the 20% of Medicare. Those people need and deserve Medicaid.
The solution is a drastically BETTER healthcare delivery system. Surely we have citizens who can design a workable solution; they might NOT be in congress. Problems--and solutions ,are different in the diverse situations from coast to coast, north to south, rural to urban.
The challenge is to work together for better healthcare for all. It cannot be political.

Aug. 14 2012 09:59 PM
Joy from Dix Hills

I am in the health insurance industry and have been for 28 years. Your article does not point out that Pres Obama is cutting medicare and medicaid by hundreds of thousands of dollars right now. Most doctors won't take it anymore! They pay doctors nothing and more and more are dropping out. Obama care is a disaster! We don't hear this President toting this victory do we? I've been watching an industry over the past 3 years get destroyed by this president's policies. He can not blame George Bush for this. It has caused so many people to loose coverage not to mention all the job losses! The new health care laws that are creeping into place and are horrible. I am advising seniors every day on how to protect their nest eggs. To watch people loose so much is frightening. So why not write about this instead of how Romney's going to hurt Medicare, and all the negatives I really haven't read one negative proposal from this team. I read a lot. I think it can't get worse than what it is now no way! We need to get people off medicaid but until they can they need to get jobs! How do you suppose we start to do this? Bring money back to this country with people like Mitt Romney who know the way! Did you ever think why a man with such wealth would even want this job as President, he is a Pisces and he is does not seem like a power hungry politician, he already has a nice life, being President seems like a hassle to me. I think he needs to do this, because of his love for this country, it's funny George Washington was a Pisces too. So let him get the jobs back and strengthen this country back. Read what good things Romney and Ryan want to do like revise the tax codes, that's big! though you hear nothing about this. Eliminate capital gains for everyone this will be the best tax break of them all! And finally raise the threshold on inheritance taxes ..and oh my God is this a big one, but no one is talking about that, they will be! When they see what's going to happen soon. Yes a lot of very regular middle class people are going to see more of their money going to taxes by a lack of leadership in our Government for the past 4 years and keeping him around another 4 years most certainly spells disaster for this country, my vote is for Romney!

Aug. 14 2012 09:09 PM
David Adler from DC

Mr. Mogul,

The CBO analysis that you cite analyzes Ryan's 2011 plan for Medicare reform, which is leaps and bounds different from his 2012 proposal. Under the 2012 version of the plan (included in Ryan's FY 2013 budget), seniors in 2023 would maintain access to same level of benefits that they receive today for the same price. You can read this primer for a fuller explanation:


Aug. 14 2012 07:11 PM
Catherine from UWS

Terrific coverage as usual, Fred.Thanks for it.(if this item stays on the site for awhile...I'm sure you've already picked up on 1) the "patience" spelling, and 2) the word order in the last paragraph's 'repeal Obamacare' section.

Aug. 14 2012 06:30 PM
Eve from NJ

Correction needed. Quoting from above here: "Providers don't like the idea of earning less, but they also stand to increase their number of new patience that the Affordable Care Act would bring into the system."

The correct word is patients, not patience.

Aug. 14 2012 06:18 PM

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