Politico.com

By DAVID NATHER |
8/8/11 11:08 AM EDT

Okay, super committee — ready to cut some entitlements?

Oh, stop making those excuses. Like, “We haven’t been appointed yet.” Or, “We like our town halls
quiet.” The super committee is going to have to come up with at least $1.2
trillion in spending cuts by Nov. 23, and it’s going to be awfully hard to get
that without dipping into the

So the super committee is going to need a list of the standard ideas that are already “out
there” — and POLITICO has come up with an options book to get the committee
members started. It’s a lot like the real options book the super committee is
likely to use, except that it’s in English.

There’s a pretty long menu of ideas to choose from, thanks to the work that’s already been done by
the bipartisan negotiations led by Vice President Joe Biden. And the supers
will also be able to draw from the suggestions of other bipartisan groups, like
President Barack Obama’s fiscal
commission and the Senate Gang of Six.

So without further ado, here’s the starter list of health care options for the super committee —
along with the thought balloons that we can expect to be appearing over the
heads of the Democratic and Republican members of the panel.

OPTION: Crack down on Medicare fraud and abuse.

What it does: As proposed by Obama’s fiscal
commission, the idea is to give CMS more authority and more funding to track
down fraud in Medicare payments.
What it saves: $9 billion over 10 years, according to the
fiscal commission.
What the Democratic members will say: “That’s great. Can we go
now?”
What the Republican members will say: “Sit down.”

OPTION: Raise the Medicare eligibility age

What it does: Gradually increases the eligibility age from 65 to 67.
What it saves: $124.8 billion over 10 years, according to the Congressional Budget Office.
What the Republican members will say: “Obama was willing to do
it when he was negotiating. And it gets you $125 billion.”
What the Democratic members will say: “Guess we could say we
didn’t ‘cut benefits.’ We’ll get back to you. And thanks a lot, Obama.”

OPTION:
Restructure Medicare benefits

What it does:
Streamlines
Medicare’s maze of co-pays and deductibles and saves money by doing it. Obama’s
fiscal commission recommended setting one annual deductible of $550 for
Medicare hospital and doctors coverage. Seniors would have to pay 20 percent
coinsurance — that is, 20 percent of the costs — for any expenses above that.

What it saves: $110 billion over 10 years, according to the
fiscal commission.

What the Republican members will say: “It was good enough for
Alan Simpson and Erskine Bowles.”

What the Democratic members will say: “We’re pretty sure we
said we weren’t going to touch seniors’ Medicare benefits.”

OPTION: New
rules for Medigap plans

What it does: Restricts how much the
Medigap plans can cover, so seniors aren’t shielded from as much of the
cost-sharing charges they’d have to pay otherwise. Obama’s fiscal commission
suggested banning the plans from covering the first $500 in charges. And after
that, seniors would have to pay half of the next $5,000 in cost-sharing fees.

What it saves: $38 billion over 10 years, according to the
fiscal commission.

What the Republican members will say: “This is the only way to
make seniors more sensitive to the price of their health care. If it’s all
covered, they won’t care what’s being spent, and they won’t ask the tough
questions about whether their doctor is overcharging — or whether that extra
test is really necessary.”

What the Democratic members will say: “They’re seniors.
They’re going to need health care. All this will do is make it harder for them
to get it.”

OPTION: Fix
the Medicare physician payment formula

What it does:
Rewrites
the current Sustainable Growth Rate formula, which has an enormous backlog of
payment cuts that are about to hit doctors — because Congress postpones the
cuts with a temporary legislative “doc fix” every time the cuts are supposed to
happen.

What it saves: Ha ha! Funny. It’s going to cost money — about
$358 billion over 10 years, according
to CBO. But it’s what provider groups are going to want the supercommittee
to do. Otherwise, their payments are going to be cut by 29 percent if there’s
no fix to the current formula by the end of the year.

What the Republican members will say: “That would be a good
idea for Bizarro Supercommittee, where the idea is to spend money. It’s not a
good idea for us.”

What the Democratic members will say: “Well, the American
Medical Association did support health care reform. Hmm … How much does raising
the eligibility age save, again?”

OPTION: Raise
Medicare Part B premiums

What it does: Seniors would have to start
paying 35 percent of their premium costs, rather than the current 25 percent.

What it saves: $241 billion over 10 years, according to CBO.

What the Republican members will say: “It was good enough for
Joe Lieberman. He had it in his
Medicare plan with Tom Coburn.”

What the Democratic members will say: “Joe Lieberman … Nope,
the name doesn’t ring a bell.”

OPTION:
Cut hospital payments for bad debts

What
it does:
Gradually gets rid of the Medicare payments that reimburse hospitals for unpaid
co-payments and deductibles that they haven’t been able to collect from
patients.

What it saves: $14 billion to $26 billion over 10 years, according to
the Biden group.

What the Republican members will say: “Not bad — and the hospitals
supported ‘Obamacare’ anyway.”

What the Democratic members will say: “That’s right — the hospitals did support
health reform. We’re not ready to have a bunch of angry, betrayed hospital
lobbyists in our offices.”

OPTION:
Nursing homes/home health cuts

What
it does: Charges
higher co-payments or just cuts payments to skilled nursing facilities and home
health care. The Biden group was looking at this option.

What it saves: $50 billion over 10 years, according to the Biden group.

What the Republican members will say: “Decent chunk of change.”

What the Democratic members will say: “Sure, and while you do that, we’ll
just work on some attack ads with old people in nursing homes. And by the way,
don’t we want seniors to get health care at home?”

OPTION:
Premium support pilot program

What it does: Obama’s fiscal commission proposed testing the idea of
“premium support” — House Budget Committee Chairman Paul Ryan’s idea for
reforming Medicare — by trying it out in the Federal Employees Health Benefits
Program, which gives health coverage to federal workers. It would give these
workers a subsidy for their coverage that grows slowly from year to year,
saving money along the way.

What it saves: $18 billion over 10 years.

What the Democratic members will say: “You know, we’re not really ready
to let Paul Ryan off the hook so fast. Ask us again after the election.”

What the Republican members will say: “What do we need a demo for? Let’s
just do the real thing.”

OPTION:
Medicaid block grants

What
it does: Turns
Medicaid from an open-ended entitlement into a block grant, with much more
flexibility for states to decide what they will and won’t cover with it.

What it saves: Ryan’s
version would have saved $750 billion over 10 years. If the block grant
were restricted to just Medicaid’s long-term care coverage — not its acute care
services — CBO says it could save between $187 billion and $287 billion,
depending on how much the block grant is allowed to grow from year to year.

What the Republican members will say: “Rick Perry and Haley Barbour will
be very happy! And Rick Perry may or may not be running for president.”

What the Democratic members will say: “Sure. Can we just chew on some
nice, crunchy broken glass while we’re at it?”

OPTION:
Medicaid “blended” matching rate

What
it does:
Obama’s idea for cutting Medicaid spending without restructuring the program is
to change the federal matching formula. The proposal would replace a variety of
different rates with a single “blended rate” for each state.

What it saves: $100 billion over 10 years, according to the target set
by the Biden group.

What the Republican members will say: “That just shifts costs to the
states, and doesn’t give them any more flexibility to hold their costs down.”

What the Democratic members will say: “No block grants? Great. Moving
right along.”

OPTION:
Drug rebates for Medicare-Medicaid “dual eligibles”

What
it does: Makes
drug companies give rebates to people who are eligible for both Medicare and
Medicaid — just as they already have to give rebates to people who get their
drugs through Medicaid.

What it saves: $49 billion over 10 years, according to the fiscal
commission.

What the Republican members will say: “PhRMA says this would just be
price controls, and we agree. And one of our favorite health analysts, Douglas
Holtz-Eakin, says it would
make prescription drug premiums for seniors rise even higher.”

What the Democratic members will say: “Time for the drug companies to
pitch in.” “Except they did support health reform.” “Shhh.”

OPTION:
Repeal the CLASS Act

What it does: Gets rid of the new long-term care insurance program
created by the health reform law. It was one of the main recommendations of the
Senate Gang of Six.

What it saves: So, funny thing — it costs $86 billion over 10 years.
That’s because it will spend a few years collecting premiums before it starts
paying any benefits. But don’t be fooled, Senate Budget Committee Chairman Kent
Conrad says — it will start costing money down the road.

What the Republican members will say: “It’s a new entitlement, and it’s
going to be a drain on the Treasury because there’s no way it can pay for
itself. Get rid of it.”

What the Democratic members will say: “It’s Ted Kennedy’s legacy. And
the law says it has to sustain itself.” “But maybe it can’t sustain itself. And
Kent Conrad wants to get rid of it.” “So … umm … we’ll get back to you.”

This
article first appeared on POLITICO Pro
at 5:34 a.m. on August 8, 2011