Medicare is getting heavy scrutiny

Among the Medicare proposals are reduced reimbursement rates for health care providers and some higher costs for patients, along with higher premiums for wealthier seniors. Democrats on the committee have suggested new copayments for patients for clinical lab services and home care.

Certner says the committee also is considering making medigap policies more expensive. Critics of medigap argue they encourage older people to use more health services and drive up costs. But Certner says seniors are unlikely to tell doctors not to do medical tests that the doctor thinks are necessary.

Raising premiums for the wealthy could add about 15 percent to the costs of Medicare Parts B and D, Certner says. The hike likely would affect the beneficiaries earning more than $85,000 who already pay higher premiums.

"Medicare is a heavily subsidized program. Wealthier people don't need to be subsidized that much," Bixby says.

But Richtman worries that higher premiums for the wealthy make Medicare more like a welfare program, which could undermine its widespread public support.

A poll released this week asked people what they would least like to see cut. "Medicare and Medicaid" was the most popular answer, followed by Social Security and defense spending. On options like closing tax loopholes and cutting farm subsidies, more people favored cutting than protecting.

The poll was sponsored by George Washington University and Politico, a Washington newspaper that focuses on government and politics.

A more major change to Medicare — raising the eligibility age — is fading as a possibility because it's so controversial, Bixby says. Also, it would raise little money during the next 10 years because it likely would take a while to implement.

"It's common sense. People are living longer, working longer," says Brian Darling, senior fellow for government studies at the Heritage Foundation. With growth rates of 5 percent to 6 percent a year — well above inflation — Medicare needs to be reined in, he says.

Medicaid has not been center stage, but a Democratic proposal recently suggested $50 billion in cuts, including a tax on providers. Few details have been released.

Much of the committee's work has been done in secret, and Darling says that's a mistake.

"Trying to steamroll the American people with unpopular changes to taxes and entitlement reform is not democratic," Darling says.

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