Kelly Ayotte’s Assault on Retirees

While in Washington, Senator Kelly Ayotte mastered the game “follow the leader.” Ayotte has unflinchingly supported the Republican leadership’s continual assault on Medicare. Ayotte has worked with Republicans to attempt to raise the age of eligibility for Medicare while voting against legislation that would prevent Medicare turning into a voucher system.

Beyond altering the program, Ayotte voted three times to slash $430 billion dollars from the Medicare program.

Kelly Ayotte’s support of a plan to raise the eligibility age to 67 and turn Medicare into a voucher program would be devastating for New Hampshire seniors who depend on the program. Ayotte’s lockstep support of Washington Republicans’ anti-senior agenda further demonstrates that Ayotte is no longer representing Granite State interests in Washington.

Background:

Cuts

Ayotte Thrice Voted For $430 Billion In Medicare Cuts

2015: Ayotte Voted To Make $430 Billion In Unexplained Cuts To Medicare, As Part Of The FY 2016 Conference Report Budget Resolution. In May 2015, Ayotte voted for the FY 2016 conference report budget resolution which, according to the Congressional Conference Report, “The agreement proposes the same amount of Medicare savings reflected in the Senate-passed fiscal year 2016 budget as a target to extend the life of the Hospital Insurance trust fund and tasks the committees of jurisdiction in the House and Senate with determining the specific Medicare reforms needed to bring spending levels under current law in line with the budget.” According to Bloomberg, the Senate’s original budget, “avoided a plan to partially privatize Medicare that the U.S. House of Representatives embraced in its budget [and] instead call[ed] for $430 billion in spending cuts without explaining where they would be made.” The vote was on the Conference Report; the Conference Report passed by a vote of 51 to 48. [Senate Vote 171, 5/5/15; Conference Report, 4/29/15; Bloomberg, 3/27/15]

2015: Ayotte Voted To Make $430 Billion In Unexplained Cuts To Medicare, As Part Of The Senate’s FY 2016 Budget Resolution. In March 2015, Ayotte voted for the Senate’s FY 2016 budget resolution, which, according to Bloomberg, “avoided a plan to partially privatize Medicare that the U.S. House of Representatives embraced in its budget [and] instead call[ed] for $430 billion in spending cuts without explaining where they would be made.” The Senate adopted the budget resolution by a vote of 52 to 46. [Senate Vote 135, 3/27/15; Bloomberg, 3/27/15; S. Con. Res. 11, 4/7/15]

2015: Ayotte Voted Against Restoring Roughly $430 Billion In Unexplained Medicare Cuts In Senate Republicans’ FY 2016 Budget. In March 2015, Ayotte voted against an amendment to the Senate’s FY 2016 budget resolution that, according to Sen Debbie Stabenow (D-MI) in the Congressional Record, would have “reject[ed] the $435 billion in Medicare cuts that are in this budget resolution.” The amendment was rejected by a vote of 46 to 54. [Senate Vote 111, 3/26/15; Congressional Record, 3/26/15; Congressional Actions, S. Con. Res. 11]

Retirement Age

2012: Ayotte Voted To Consider Sen. Pat Toomey’s Proposed Budget That Increased The Medicare Eligibility Age To 67 By 2034. In May 2012, Ayotte voted to consider the Ryan budget Medicare plan, as part of Sen. Pat Toomey’s (R-PA) proposed budget resolution covering fiscal years 2013 to 2022. According to a press release from Sen. Toomey, his budget contained a provision that “Adopts the long term Medicare reform plan included in the House FY 2013 budget (effective 2023).” According to the Congressional Research Service, “The (Ryan) budget proposal would gradually increase the Medicare eligibility age to 67. Beginning in 2023, the age of eligibility for Medicare would increase by two months each year until it reached 67 in 2034.” The vote was on a motion to proceed to consider the resolution; the motion failed by a vote of 42 to 57. [Senate Vote 99, 5/16/12; Senator Pat Toomey press release, 4/18/12; CRS, 3/29/12]

2012: Ayotte Effectively Voted To Increase The Medicare Eligibility Age To 67 By 2034 As Part Of The FY 2013 Ryan Budget. In May 2012, Ayotte effectively voted to increase the Medicare eligibility age to 67 by 2034, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2013 to 2022. According to the Congressional Research Service, “The budget proposal would gradually increase the Medicare eligibility age to 67. Beginning in 2023, the age of eligibility for Medicare would increase by two months each year until it reached 67 in 2034.” The vote was on a motion to proceed to consider the House-passed budget resolution, which the Senate rejected by a vote of 41 to 58. [Senate Vote 98, 5/16/12; CRS Report #R42441, 3/29/12; Congressional Actions, H. Con. Res. 112]

2011: Ayotte Effectively Voted For FY 2012 Ryan Budget, Which Raised The Medicare Eligibility Age To 67 By 2033. In May 2011, Ayotte effectively voted for increasing Medicare eligibility to 67 by 2034, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2012 to 2021. According to CBO, “Starting in 2022, the age of eligibility for Medicare would increase by two months per year until it reached 67 in 2033.” The vote was on a motion to proceed to consider the House-passed budget resolution, which the Senate rejected by a vote of 40 to 57. [Senate Vote 77, 5/25/11; CBO, 4/5/11]

Vouchers

Ayotte Voted At Least Four Times To Replace Medicare With A Voucher Program

2015: Ayotte Effectively Voted Against Making It Harder To Privatize Medicare, Turn It Into A Paul Ryan-Style “Premium Support” Program Or Reduce Benefits, By Requiring 60 Votes In The Senate. In March 2015, Ayotte effectively voted against an amendment to the Senate’s FY 2016 budget resolution that, according to Politico, would have “make it tougher to turn Medicare into something resembling Ryan’s so-called ‘premium support’ plan.” According to Congressional Quarterly, “The Bennet amendment would [have] create[d] a 60-vote point of order against any legislation that would privatize Medicare, reduce guaranteed benefits, increase out of pocket expenses or turn the program into a premium-supported plan.” The vote was on a motion to waive a budget point of order against the proposed amendment. The Senate rejected the motion by a vote of 46 to 53. Afterwards, the presiding officer sustained the point of order, killing the amendment. [Senate Vote 90, 3/25/15; Politico, 4/4/15; Congressional Quarterly, 4/25/15; Congressional Actions, S. Con. Res. 11]

2013: Ayotte Voted For Replacing Medicare With A Premium Support Plan As Part Of The FY 2014 Ryan Budget. In March 2013, Ayotte voted for replacing Medicare with a premium support plan, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2014 to 2023 According to the House Budget Committee, “Beginning in 2024, for those workers born in 1959 or later, Medicare would offer them a choice of private plans competing alongside the traditional fee-for-service option on a new Medicare Exchange. Medicare would provide a premium-support payment either to pay for or to offset the premium of the plan chosen by the senior.” The vote was on the House Republicans’ fiscal year 2014 budget resolution, which Senate Budget Committee chairwoman Patty Murray offered as a substitute amendment to the Senate’s fiscal year 2014 budget resolution. The Senate rejected the amendment by a vote of 40 to 59. [Senate Vote 46, 3/21/13; House Budget Committee, 3/12/13]

  • CBPP: Ryan’s Medicare Policies in FY 2014 Budget “Essentially The Same As Those In Last Year’s Ryan Budget.” According to the Center on Budget and Policy Priorities, “The Medicare proposals in the 2014 budget resolution developed by House Budget Committee Chairman Paul Ryan (R-WI) are essentially the same as those in last year’s Ryan budget.” [CBPP, 3/15/13]

  • A Similar Provision in Ryan’s FY 2013 Budget Created A Medicare Exchange Where Beneficiaries Could Choose From Private Insurance Or A Fee For Service Model. According to CRS, “Individuals who become eligible (based either on age or disability) for Medicare beginning in 2023 would be given the option of enrolling in a private insurance plan or a traditional fee-for-service option through a newly established Medicare exchange. These plans would be required to offer standard benefits that are at least actuarially equivalent to traditional fee-for-service benefits, and to accept all people eligible for Medicare who apply regardless of age or health status. [CRS, 3/29/12]

  • Ryan’s Budget Would Have Benchmarked Premium Support Amount To The Second Lowest Premium On The Medicare Exchange. According to the House Budget Committee, “The benchmark plan would be either the second-least-expensive private plan or fee-for-service Medicare, whichever cost less. If a senior chose a more expensive plan than the benchmark, he or she would pay the difference between the subsidy and the monthly premium. And if a senior chose a plan less expensive than the benchmark, he or she would receive a rebate for the difference. Medicare would offer higher payments depending on the patient’s health history and the cost of living. And it would require private plans to cover at least the actuarial equivalent of the benefit package offered by the fee-for-service option.” [House Budget Committee, 3/13]

  • Ryan’s Budget Would Have Resulted In Increased Out-Of-Pocket Premiums For Seniors If The Cost Of Insurance Rose Quicker Than GDP Growth Plus 0.5 Percent. According to the Center on Budget and Policy Priorities, “Since under the Ryan budget, Medicare would no longer make payments to health care providers such as doctors and hospitals, the only way to keep Medicare cost growth within the target of GDP growth plus one-half percentage point would be to limit the annual increase in the amount of the premium-support vouchers. As a result, the vouchers would purchase less coverage with each passing year, pushing more costs on to beneficiaries. Over time, seniors would have to pay more to keep the health plans and the doctors they like, or they would get fewer benefits.” [Center on Budget and Policy Priorities, 3/15/13]

  • If So, Seniors Would Have To Pay More Or Receive Less Benefits With Each Passing Year. According to the Center on Budget and Policy Priorities, “Since under the Ryan budget, Medicare would no longer make payments to health care providers such as doctors and hospitals, the only way to keep Medicare cost growth within the target of GDP growth plus one-half percentage point would be to limit the annual increase in the amount of the premium-support vouchers. As a result, the vouchers would purchase less coverage with each passing year, pushing more costs on to beneficiaries. Over time, seniors would have to pay more to keep the health plans and the doctors they like, or they would get fewer benefits.” [Center on Budget and Policy Priorities, 3/15/13]

2012: Ayotte Voted To Consider Sen. Pat Toomey’s Proposed Budget That Included The Ryan Budget’s Plan To Convert Medicare Into A Premium Support Plan. In May 2012, Ayotte voted to consider for the Ryan budget Medicare plan, as part of Sen. Pat Toomey’s (R-PA) proposed budget resolution covering fiscal years 2013 to 2022. According to a press release from Sen. Toomey, his budget contained a provision that “Adopts the long term Medicare reform plan included in the House FY 2013 budget (effective 2023).” The vote was on a motion to proceed to consider the resolution; the motion failed by a vote of 42 to 57. [Senate Vote 99, 5/16/12; Senator Pat Toomey press release, 4/18/12]

2012: Ayotte Effectively Voted To Replace Medicare With A Premium Support Plan As Part Of The FY 2013 Ryan Budget. In May 2012, Ayotte effectively voted to replace Medicare with a premium support plan, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2013 to 2022 According to the House Budget Committee, “For those workers currently under the age of 55, beginning in 2023, those seniors would be given a choice of private plans competing alongside the traditional fee-for-service option on a newly created Medicare Exchange. Medicare would provide a premium-support payment either to pay for or offset the premium of the plan chosen by the senior.” The vote was on a motion to proceed to consider the House-passed budget resolution, which the Senate rejected by a vote of 41 to 58. [Senate Vote 98, 5/16/12; House Budget Committee, 3/20/12; Congressional Actions, H. Con. Res. 112]

  • Ryan’s Budget Created A Medicare Exchange Where Beneficiaries Could Choose From Private Insurance Or A Fee For Service Model. According to the Congressional Research Service, “Individuals who become eligible (based either on age or disability) for Medicare beginning in 2023 would be given the option of enrolling in a private insurance plan or a traditional fee-for-service option through a newly established Medicare exchange. These plans would be required to offer standard benefits that are at least actuarially equivalent to traditional fee-for-service benefits, and to accept all people eligible for Medicare who apply regardless of age or health status. [CRS, 3/29/12]

  • Ryan’s Budget Would Have Benchmarked Premium Support Amount To The Second Lowest Premium On The Medicare Exchange. According to the House Budget Committee, “The second-least expensive approved plan or fee-for-service Medicare, whichever is least expensive, would establish the benchmark that determines the premium-support amount for the plan chosen by the senior. If a senior chose a costlier plan than the benchmark plan, he or she would be responsible for paying the difference between the premium subsidy and the monthly premium. Conversely, if that senior chose a plan that cost less than the benchmark, he or she would be given a rebate for the difference. Payments to plans would be risk-adjusted and geographically rated.” [House Budget Committee, 3/20/12]

  • Ryan’s Budget Would Have Resulted In Increased Out-Of-Pocket Premiums For Seniors If The Cost Of Insurance Rose Quicker Than GDP Growth Plus 0.5 Percent Causing Seniors To Pay More Or Receive Less Benefits. According to the Congressional Research Service, “The proposal suggests that program cost growth would be mitigated through the competitive bidding process; however, should that not occur, the proposal would limit annual per capita premium support increases to nominal GDP growth plus 0.5 percent. Should actual costs exceed this amount, Medicare beneficiaries would pay increased premiums to make up the difference. The proposal would limit the impact of these increases for low-income enrollees, with Medicaid continuing to pay for the out-of-pocket expenses for dual-eligibles (those who qualify for both Medicare and Medicaid), and additional funding would be provided in savings accounts for those who meet certain low-income limits but do not qualify for Medicaid. As a result, the vouchers would purchase less coverage with each passing year, pushing more costs on to beneficiaries.” According to the Center on Budget and Policy priorities, “Over time, seniors would have to pay more to keep the health plans and the doctors they like, or they would get fewer benefits” [CRS, 3/29/12; Center on Budget and Policy Priorities, 3/28/12]

2011: Ayotte Effectively Voted For FY 2012 Ryan Budget, Which Replaced Medicare With A Premium Support Plan. In May 2011, Ayotte effectively voted for replacing Medicare with a premium support plan, as part of House Budget Committee Chairman Paul Ryan’s (R-WI) proposed budget resolution covering fiscal years 2012 to 2021. According to the Congressional Research Service, “Under the new system, Medicare would pay a portion of the beneficiaries’ premiums, i.e., provide ‘premium support.’ The payments would be adjusted for age, health status, and income and would be paid directly by the government to the insurance plan selected by the Medicare beneficiary. In addition, plans with healthier enrollees, would be required to help subsidize plans with less healthy enrollees.” The vote was on a motion to proceed to consider the House-passed budget resolution, which the Senate rejected by a vote of 40 to 57. [Senate Vote 77, 5/25/11; CRS Report #R41767, 4/13/11]

  • Wall Street Journal: Ryan Plan “Would Essentially End Medicare.” According to the Wall Street Journal, “Republicans will present this week a 2012 budget proposal that would cut more than $4 trillion from federal spending projected over the next decade and transform the Medicare health program for the elderly, a move that will dramatically reshape the budget debate in Washington. […] The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills. Mr. Ryan and other conservatives say this is necessary because of the program’s soaring costs.” [Wall Street Journal, 4/4/11]

  • Ryan’s Budget Eliminated Traditional Medicare And Created A Medicare Exchange On Which Seniors Could Purchase Private Plans. According to the Congressional Research Service, “Individuals who become eligible (based either on age or disability) for Medicare in 2022 and later years would not be able to enroll in the current Medicare program. Instead, they would be given the option of enrolling in a private insurance plan through a newly established Medicare exchange.” [CRS Report #R41767, 4/13/11]

  • Under Ryan’s Medicare Plan, Size Of Premium Support Payment Would Be Reduced In Line With Each Recipient’s Income. According to CBO, “The premium support payments [in the Ryan budget] would also vary with the income of the beneficiary. People in the top 2 percent of the annual income distribution of the Medicare-eligible population would receive 30 percent of the premium support amount described above; people in the next 6 percent of the distribution would receive 50 percent of the amount described above; and people in the remaining 92 percent of the distribution would receive the full premium support amount.” [CBO, 4/5/11]

  • The Budget Would Index The Premium Support Amount To Overall Consumer Prices. According to the CBO, “[T]he proposal would convert the current Medicare program to a system under which beneficiaries received premium support payments—payments that would be used to help pay the premiums for a private health insurance policy and would grow over time with overall consumer prices.” [CBO, 4/5/11]

  • April 2011: CBO Estimated That, In 2022, When Voucher Plan Went Into Effect, Ryan’s Medicare Plan Would More Than Double A Typical 65-Year-Old Medicare Beneficiaries’ Out-Of-Pocket Costs, Increasing Them By $6,350 Per Year. According to the Center on Budget and Policy Priorities, “CBO also finds that this beneficiary’s [a typical 65-year-old] annual out-of-pocket costs would more than double — from $6,150 to $12,500. In later years, as the value of the voucher eroded, the increase in out-of-pocket costs would be even greater.” [Center on Budget and Policy Priorities, 4/7/11]