Democrats with a wary eye toward November have been behind many of the last-minute, non-technology-related changes to the Affordable Care Act in the past few months. When people received letters in the mail last fall notifying them that their insurance plans had been canceled, many senators wrote to Health and Human Services asking for a reprieve. The Obama administration acquiesced. Many states decided to cancel plans anyway -- it just made sense if the aim was to keep premiums down long-term, instead of racking up a quick PR boost.
But lately, some Democrats who are vulnerable in the midterms have been campaigning against the White House's newest proposed health-care change -- the slow shifting of federal funds away from the Medicare Advantage plan.
Medicare Advantage is a privatized version of the government insurance program for adults over 65, offering perks like gym memberships and care coordination. It has long been championed by Republicans -- who have always wanted to make Medicare a more privatized operation -- and derided by Democrats -- who said it was an inefficient money suck. But amid troubling signs of Democrats potentially losing the Senate, many legislators have switched to supporting the privatized Medicare plan.
On Monday, vulnerable Democratic incumbents won their fight, as the Centers for Medicare and Medicaid Services announced that instead of the proposed 2 percent cut to insurer payments, they would boost payments for Medicare Advantage for the second year in a row, by 0.4 percent. The office said the change was due to a reassessment of Medicare costs and the relative health of new sign-ups (Medicare Advantage consumers tend to be younger than other Medicare enrollees).
The health-care reform law met its budget in part through the anticipated Medicare cuts, which were supposed to make sure the private plans had similar costs for the government as the preexisting Medicare system. But enrollment in Medicare Advantage grew by 9 percent last year, meaning there is a larger number of people who don't want the cuts, which translated into heavier lobbying of vulnerable Democrats.
Insurance companies make a lot of profit off of these plans, and showed a willingness to attack Democrats in close races for supporting Medicare Advantage cuts. In the Florida special House election, the United States Chamber of Commerce ran an ad completely devoted to candidate Alex Sink's support of Medicare Advantage cuts, which they tied to support for Nancy Pelosi and a lack of interest in Florida's considerable elderly population.
American Health Insurance Plan's Coalition for Medicare Choices launched their biggest-ever marketing push against potential cuts, spending lots on advertising and grassroots campaigning. Local newspapers have been writing stories about the proposed cuts, detailing the exact number of seniors who would be affected in their state. The moment feels a bit like the sequester -- cuts are being tallied and criticized, and one party is being leveled with 98 percent of the blame.
Hence the dilemma for Dems, who have a vested interest in keeping the Affordable Care Act afloat, but also don't want to endanger their chances of getting re-elected. And in midterm elections, older voters are the last people you want to infuriate. They are among the voters history shows we can count on to vote in off-year elections while most of America tunes out.
Last week, 22 Democrats spoke on the House floor, begging the Obama administration not to cut payments. Arkansas Sen. Mark Pryor, who has faced millions of dollars worth of attack ads already this year, joined the Democratic opposition. Other political leaders signed letters or simply voiced their opposition to the legislated cuts.
They weren't all Blue Dogs either. Sens. Chuck Schumer and Michael Bennett, who both play major roles in election fundraising and strategy for Democrats, came out against the cuts. Schumer did not vote for the private Medicaid expansion in 2003, saying much of it was ''a total sellout to the pharmaceutical industry.'' Only 11 Democratic senators voted for privatizing part of Medicare. The House vote was 220-215.
Massachusetts Sen. Ed Markey -- known for holding more liberal views than many of his fellow Senate Democrats -- has also voiced support for keeping things the way they are.
Most Democratic legislators seem to be on the same page on this issue. Just as they're hoping that a few years from now, seniors will tell politicians to get their hands off their Obamacare, they are deeply worried they are about to face the same pressures on Medicare Advantage, which is just over a decade old.
However, there's another long-term electoral issue to take into account. If the last-minute, midterm-minded fixes to the Affordable Care Act end up driving premiums higher than projected or altering the expected cost of the program, these same Democrats will have played a part in it. And regardless of whether the Democrats who voiced objections to the Medicare Advantage cuts had said anything last week, they would have faced attacks from their opponents and insurance lobbyists. A quick floor speech or letter was never going to change the Republican Party's chosen theme of this election cycle.
By continuing to treat the legislation as a malleable thing, however they could be ensuring that it doesn't work as well in the long term, with ramifications that would last far beyond the midterms. However, thinking beyond the latest election has never been Congress's strong suit.