Medicare reform and the ACA are linked, ctd.

As I wrote in December, the key to evaluating the merits of Wyden-Ryan or any other premium support-based reform of Medicare is what will be done about the Affordable Care Act (more here and here). I meant this largely in a political economy sense–the entire health system needs reforming, and a key issue is what we will do (or won’t do) to expand insurance coverage to the uninsured and move to improve care throughout the system. Medicare and the care of younger persons are linked because they receive care from the same general health care system, but also because it is young workers (many of whom are uninsured) who pay payroll taxes to support the Medicare program. I have never gotten why this seems like a disconnect to some, or that reductions in spending on Medicare would be inappropriate to use to finance coverage expansions for younger persons (the children and grand children of Medicare beneficiaries!).

Austin Frakt has a nice post looking more technically at the issue of the linkage between the ACA and Wyden-Ryan; specifically, how increased cost savings achieved by the ACA enables a premium support approach such as Wyden-Ryan to achieve the maximal savings possible in the Medicare program. Thus, whether they realize it or not, proponents of premium support in Medicare need for the ACA succeed. Of course, there could be replacement of the ACA that could similarly succeed, but there is no evidence that such a plan will come about.