Medicare in the Crosshairs

House approval came on a straight party vote with no Democrats and all but four Republicans voting in favor.

The bill also cuts billions of federal dollars from the Medicaid program, which not only provides health care for the poor but pays for most Americans' nursing home care. And it largely repeals President Obama's signature health care law. That may include eliminating certain popular aspects of the law, such as prohibiting insurance companies from denying coverage to people with preexisting medical conditions, allowing young adults to stay on their parents' health policies until age 26, helping small businesses to cover employees, and gradually closing the "doughnut hole" in Medicare's prescription drug benefit.

Republicans say the changes are necessary to reduce the national debt, which will soon hit the legal ceiling of $14.3 trillion: "Unless something is done, the red ink is going to destroy our economy," Ryan told the House. Democrats and consumer groups counter that the bill lowers taxes for the wealthy at the expense of services for the old, poor and sick.

Although the bill is unlikely to progress in the Senate, it may have already changed a key political dynamic. In the 2010 elections, Republicans won the greater share of older Americans' votes, in part by arguing that the health care reform law would harm Medicare by cutting $500 billion from the program over time. Now, in the run-up to 2012, their plan to dramatically change Medicare provides a major issue for Democrats to attack. "This will be a very difficult issue for Republican leaders," says Blendon. "They may need to rethink [their policy] if there isn't a change of attitude among seniors."

As a group of House and Senate leaders of both parties, led by Vice President Joe Biden, began budget talks May 5, AARP launched a campaign to protect Medicare and Social Security from harmful cuts. "AARP recognizes the importance of confronting out nation's fiscal challenges," said CEO A. Barry Rand in a statement. "But as leaders begin to hammer out solutions … we remind them that at stake are the health and financial security of real people — not just figures on a federal balance sheet."

Patricia Barry is a senior editor with the AARP Bulletin.