AGA Washington Insider

A policy blog for GIs

Biden and Ryan Spar Over Medicare During Vice Presidential Debate

Vice president Joe Biden and Republican vice presidential nominee Paul Ryan conducted a vigorous debate during which they clashed over domestic issues, including the Patient Protection and Affordable Care Act (PPACA) and Medicare reform. 


Rep. Ryan, R-WI, chair the House Budget Committee, is the architect of the Republican budget plan that passed the House, which would revamp Medicare and Medicaid. He defended his and Governor Mitt Romney’s proposal to reform Medicare to make it solvent and argued that their proposal is not a voucher program, but would provide premium support to seniors allowing them to go on the open market to purchase health insurance. Their proposal would also increase the retirement age and means test, asking wealthier seniors to pay more for their care. Their plan would be implemented in 10 years and would not impact people aged 55 and older.

Vice President Biden, however, attacked the Romney-Ryan proposal, which, while based on Rep. Ryan’s plan, would also allow seniors to keep traditional Medicare, something Ryan’s original proposal did not include. The amount of premium support would grow at the same rate as inflation plus 0.5 percent, which critics argue would not cover health-care costs and would shift costs to seniors. Democrats argue that private insurers will cherry pick healthy seniors and leave traditional Medicare to pick up the tab for the sickest patients, therefore making the program more vulnerable.

Ryan continued his criticism that Obama cut more than $700 billion from Medicare to “pay for Obamacare.” However, Biden countered that the $700 billion went back into Medicare to help sustain the program and to pay for things like prescription drug benefits, prevention and wellness. 

Colorectal Cancer Screening Benefit

The PPACA provides, for the first time, coverage of colorectal cancer screenings for Medicare beneficiaries and privately insured patients without cost-sharing. However, AGA has been lobbying Congress and the administration, along with the American Cancer Society and ASGE, to fix the cost-sharing problem that occurs when a patient’s coinsurance is no longer waived after a screening colonoscopy becomes therapeutic. Rep. Charlie Dent, R-PA, has introduced H.R. 4120, the Removing Barriers to Colorectal Cancer Screening Act, which would waive the cost sharing regardless of the outcome in the screening encounter. We are hopeful that Congress will address this issue in the lame duck session of Congress since it is becoming a deterrent for patients being screened. 


Ryan also assailed the PPACA for its inclusion of the Independent Payment Advisory Board (IPAB), which he stated would tell patients who they can see and what treatments they can have. The AGA opposes IPAB because of its lack of oversight and the disproportionate impact it will have on physicians since hospitals and other Medicare Part A providers are exempt for the first ten years. However, IPAB still faces an uphill battle since appointees need to be confirmed by the Senate, which in this political climate is no guarantee.


With less than a month to go before the election, health care will continue to play a key role in the debate over what role government should play. Stay tuned for more updates on the election and how it will impact gastroenterology.


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