齐心协力:权利辩论背后的人

在我们尚不清楚选举对健康改革的影响之前,专家们已经在削弱严重削弱国家债务和赤字的努力前景。三个国家委员会正在敲定减少债务和控制应享权利支出的建议,将两项为老年人,残疾人和低收入美国人,足彩预测网补助和足彩预测网保险以及社会保障服务的大型卫生计划置于新的十字准线之下。政策辩论。

就在昨天,政府 ’由厄斯金·鲍尔斯(Erskine Bowles)和艾伦·辛普森(Alan Simpson)主持的国家财政责任与改革委员会发布了建议草案,最终建议应在年底之前提交。同样在昨天,彼得森-皮尤预算改革委员会发表了一份报告,建议修改预算程序规则以帮助减少国家债务。下周,两党政策中心’由Pete Domenici和Alice Rivlin主持的减少债务工作组有望发布他们的建议。

这三个团体都在应对非常现实的挑战。国家债务已攀升至13.7万亿美元,联邦赤字已接近1.4万亿美元。 CBO称,社会保障和强制性健康计划(Medicare,Medicaid和CHIP)的支出约占联邦预算的40%,并且由于支出的增加,该支出将在25年内从今天的GDP的大约10%增长到25%。人口老龄化和足彩预测网保健费用上升。尽管很少有人可以通过立法程序获得公开支持,但实际上尚不清楚。

这些问题的讨论几乎总是从以下方面来进行:“hard choices” to reduce spending, increase taxes, or both.  On the spending side of the ledger, many say the 艰难的选择 won’这样做是出于政治现实,包括老年人强烈反对足彩预测网保险或社会保障的任何变化。中期选举只是最近的例子,说明了高级选民的重要性。总的来说,民主党人会抵制这些计划的削减,而共和党人会抵制任何新的税收。

但是,基于合法的政策依据,尤其是在足彩预测网保险方面,这些选择也很困难。他们之所以如此努力,最重要的原因是,许多参加Medicare的老年人和残疾人的收入很低,并且已经为今天的足彩预测网保健付出了很大一部分收入。要求多数受益人多付或少付,这将是困难的,甚至并非不可能。这是应享权利/减少赤字辩论中缺少的要素:沃伦·巴菲特(Warren Buffet)不是典型的足彩预测网保险受益人。取而代之的是,原型是一个患有多种慢性疾病的老年妇女,其收入不到25,000美元,并且将其收入的15%以上用于足彩预测网保健。这些计划中的人们以及他们生活中的现实被排除在讨论之外。

在足彩预测网保险中,将近一半(47%)的老年人和残疾人的收入低于联邦贫困线的两倍(2008年,个人收入低于20,800美元,夫妻收入低于28,000美元)。妇女,非裔美国人和拉丁裔足彩预测网保险受益人的贫困率甚至更高。在65岁以下的800万足彩预测网保险残疾人中,三分之二的收入低于贫困率的两倍。 与足彩预测网保险计划中的其他人相比,残疾受益人面临着更严重的获取问题.

PIT-Exhibit1.gif与非老年人相比,享受Medicare的人在家庭预算上的支出已经比非老年人支出大得多:约占14%,而2006年为4%。 根据我们的分析,老年人和残疾人在足彩预测网保险中自付费用的中位数支出(占收入的比例)一直在增加,从1997年的12%上升到2006年的16%以上—生活在贫困线以下的人(21%)和贫困率在100%至200%之间的人(23%)的比率更高。

Exhibit2_2.gif一些“hard choices” to be considered may not affect the most vulnerable elderly and disabled, for example proposals that ask higher-income seniors to pay more. The health reform law has already moved further in this direction by increasing the number of higher-income beneficiaries who will pay higher 足彩预测网保险 premiums.  Additional efforts to raise costs for higher-income beneficiaries could stir up strong political opposition.  一些old ideas may need to be re-evaluated in a post health reform world.  For example, proposals to save money by pushing back the retirement age for 足彩预测网保险 to 67 may save money for 足彩预测网保险, but may not make as significant a dent in federal spending as once envisioned if the 65 and 66 year olds with incomes below 400 percent of poverty become eligible for government tax credits, or for 足彩预测网补助, under health reform.One of the biggest issues likely to emerge is where to draw the line in terms of who should be asked to pay more if policies slow the growth in 足彩预测网保险 by shifting costs to beneficiaries, either directly or indirectly.  Who is wealthy enough to pay more?  Are adequate protections in place to shield seniors with modest incomes from financial hardship and cost-related access problems?  Legislators took one cut at this apple in health reform.  The recently enacted health reform law established premium subsidies to limit the financial burden on families with incomes up to 400 percent of the poverty line.  The leaders participating in the different debt and deficitreduction commissions and the experts assisting them are certainly aware ofthese challenges, although they have not really been part of the public discussionto date.If new policies are proposed to rein in entitlement spending and reduce the deficit, it seems only reasonable to include the following criterion among others for evaluating proposals: do no harm to the financial security or access to care for elderly and disabled beneficiaries living on low and modest incomes.  Indeed, given the high out-of-pocket costs these groups have, and the large share of their incomes they already pay for health care, a comprehensive approach might well seek to improve circumstances for these most vulnerable groups, while also advancing “hard choices”用于减少赤字的权利计划。