After tax 'reform,' GOP finds new target: Health care

The GOP-crafted tax changes are about as popular as a root canal with Americans. A recent poll found the vast majority of voters do not believe their own taxes would be reduced. But Congress can’t move fast enough to deliver more “reform” to the people.

Next on the agenda: health insurance programs covering 100 million Americans.

“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and deficit,” said House Speaker Paul Ryan last week. Programs such as Medicare and Medicaid “are the big drivers of debt so we spend more time on the health-care entitlements, because that’s really where the problem lies, fiscally speaking.” 

Yes, the federal government does spend a lot — about 25 percent of the total budget — on Medicare and Medicaid. Providing health insurance to seniors, low-income people, children and nursing home residents isn't free.

The money for surgeries, drugs, cancer screenings, hospitalizations and other care does not grow on trees. It comes from tax revenue. That is the same revenue the country would have $1.5 trillion more of if Congress abandoned its tax-cutting proposal. 

Alas, now the country is left wondering what Ryan's "entitlement reform" will look like. Iowans should demand specifics from their members of Congress. Do not accept hollow rhetoric about “cutting spending” and “reining in costs.” Insist on details. Access to health care is a matter of life and death. 

Individual lawmakers should specify, for example, the “right” amount to spend on health care for one-third of Americans. If elected officials know the government is spending too much, they must know how much they want to spend. They should share the amount with constituents. 

To put in perspective the cost of insuring an individual, Iowa paid about $8,600 to $11,500 to cover the private health and dental insurance for a state lawmaker with single coverage this year. The family plans cost about twice as much. (Under a new law, lawmakers will pay more toward the cost of their coverage next year.)

A Medicaid recipient in Iowa cost $6,223 in 2014, according to data gathered by the Kaiser Family Foundation. Per person spending on Medicare was less than $11,000 that year.

Is that too much for Ryan and other members of Congress? If so, they should specify how much less they want to spend and how that will be accomplished. 

They also might want to stop trying to kill Obamacare if they're really serious about improving the solvency of Medicare. The Affordable Care Act made important changes to slow health spending and generate revenue to pay for care.  

These changes include: reducing payments to some medical providers, establishing a board to recommend Medicare spending reductions, increasing payroll taxes on higher-income Americans to fund Medicare Part A (hospital insurance), and requiring wealthier seniors to pay more for a drug benefit. The ACA also created incentives for hospitals to reduce preventable readmissions and create accountable care organizations to improve our return on investment.

Repealing Obamacare, which the GOP has sought to do, would be fiscally disastrous. 

Don’t believe us. Believe the Congressional Budget Office, cited by both Democrats and Republicans to analyze the impact of legislation. The CBO has estimated a full repeal of the Affordable Care Act would increase Medicare spending by $802 billion over a decade. 

The phrase "entitlement reform" has historically been code for proposals to privatize, dismantle, shift to block grants or cut government programs. Let's hope the GOP does not revisit those ideas. True reform requires generating revenue to pay for health care and implementing reasonable measures to hold down costs.

In other words, what Obamacare is doing.   

This editorial is the opinion of The Des Moines Register’s editorial board: David Chivers, president; Carol Hunter, executive editor; Lynn Hicks, opinion editor; and Andie Dominick, editorial writer.