The House Republican budget unveiled Tuesday by Rep. Paul Ryan of Wisconsin would repeal President Barack Obama's health care overhaul in its entirety. But the proposed changes don't end there. The plan, which would slash federal spending by about $5 trillion over 10 years, also calls for rethinking Medicare and Medicaid. Here's an overview:
_ People now 54 and younger would not get the same Medicare coverage their parents and grandparents have. Instead, future retirees would get a fixed amount from the federal government to buy insurance from a range of regulated private plans. The federal payment would go directly to the health insurance plan. Starting in 2022, the eligibility age for Medicare, now 65, would be gradually increased until it reaches 67 in 2033.
_ Seniors already on Medicare and people within 10 years of retirement would be able to go into the traditional program as it exists today. Once the new program is set up in 2022, beneficiaries in traditional Medicare would be free to switch, but they would be under no obligation to do so.
_ The government Medicare payment – called "premium support" by Ryan and a voucher by critics – would be adjusted so that beneficiaries whose health gets worse would receive more. Wealthier retirees would get a lower subsidy, and lower-income beneficiaries would receive extra help with their out-of-pocket costs. The payments would be indexed for inflation, but at a level that's expected to be lower than the current rate of increase in medical costs. Medicare now covers about 47 million retirees and disabled people.
_ Medicaid, which covers about 50 million low-income and severely disabled people, would be turned over to the states. Washington would send each state a lump sum to cover services from prenatal care for low-income women to nursing homes for Alzheimer's patients. The block grant would allow each state to design its Medicaid program according to local needs.
_ Low-income people would lose their current federal right to Medicaid. Safeguards would be spelled out in subsequent legislation, but it's conceivable that states could stop accepting new applications in an economic downturn.
_ The GOP budget does not propose any changes to employer-provided health insurance, which now covers about 150 million Americans. But it does call for a debate about tax breaks generally, and one of the major ones is the tax-free status of health care benefits on the job.