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Comparison of Medicare Premium Support Proposals

This brief provides a side-by-side comparison of recent proposals to transform Medicare into a premium support program and slow the future growth in Medicare spending.

These proposals each would convert Medicare from a defined benefit program, in which beneficiaries are guaranteed coverage for a fixed set of benefits, to a defined contribution or “premium support” program, in which beneficiaries are provided a fixed federal payment to help cover their health care expenses.

The brief compares the premium support provisions of these proposals, including how the level of premium support for beneficiaries would be determined; whether traditional Medicare would remain an option; what protections would be provided for low-income beneficiaries; and whether and how the proposals would cap federal spending on Medicare. These differences have important implications for Medicare beneficiaries, the federal budget, health care providers, and private health plans.

  • Rep. Paul Ryan in “The Path to Prosperity: A Blueprint for American Renewal,” as released on March 20, 2012;
  • S. 2196, the “Congressional Health Care for Seniors Act of 2012,” as introduced by Sen. Rand Paul, and co-sponsored by Sens. Lindsey Graham, Mike Lee, and Jim DeMint, on March 15, 2012;
  • Sens. Richard Burr and Tom Coburn in “The Seniors’ Choice Act,” released on February 16, 2012;
  • Sen. Ron Wyden and Rep. Ryan, as proposed in “Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future,” released on December 15, 2011; and
  • Former Senator Pete Domenici and Dr. Alice Rivlin, in “The Domenici-Rivlin Protect Medicare Act,” initially released on November 1, 2011 and updated on June 15, 2012.

The descriptions in this side-by-side comparison are based on summaries released by sponsors of each proposal; legislative language is not available at this time. The Foundation has a number of other resources related to deficit-reduction proposals affecting health care, including Medicare and Medicaid.

Brief (.pdf)