Members of the House Budget Committee voted 19-18 late Wednesday for a measure, a Fiscal Year 2013 budget resolution proposal, that could repeal the Patient Protection and Affordable Care Act (PPACA) and change the way the traditional Medicare program serves younger workers.
The vote was so close because two Republicans, Justin Amash, R-Mich., and Tim Huelskamp, R-Kan., opposed the measure, arguing that it would cut the federal budget deficit too slowly.
House Budget Chairman Paul Ryan, R-Wis., has drafted the measure and taken to YouTube to promote it.
To get the proposal enacted, Ryan will have to get it through the Senate, which is controlled by the Democrats, and signed into law by President Obama.
If the measure is enacted as written and works as Ryan expects, it would keep Medicare the same for older workers.
For younger workers, the core Medicare program would become more like the Medicare Advantage program and similar in some respects to the exchange-based program that PPACA is supposed to create for younger workers in 2014.
Later-born workers who reach Medicare age would get a subsidy from the government and use that payment and private resources to choose from a menu that would include the traditional Medicare plan and private plans.
Like the new system PPACA is supposed to create for low-income and moderate-income working-age people in 2014. the Ryan Medicare system would provide extra assistance for lower-income enrollees and enrollees with more health risks.
The proposal also would increase the Medicare eligibility age to 67, from 65, starting in 2023.
After the committee approved the proposal, Ryan said in a statement that President Obama and Democrats in the Senate should do more to balance the federal budget.
"The Democrat-controlled Senate has failed to pass a budget in over 1,000 days, while the president still refuses to offer credible solutions to the most predictable economic crisis in our history," Ryan said in the statement.
Rep. Chris Van Hollen, D-Md., the highest ranking Democrat on the Budget Committee, said Congress should focus on getting people back to work, not changing Medicare.
"Putting Americans back to work is the fastest and most effective ways to reduce the short term deficit," Van Hollen said in a statement.
The Congressional Budget Office has estimated that the weak economy and under-employment will be responsible for about one-third of the projected 2012 budget deficit, Van Hollen said.
The Ryan proposal would be cruel to older, sicker Medicare enrollees, Van Hollen added.
"If your voucher amount is not sufficient to pay for the benefits you need, tough luck," Van Hollen said. "This Republican plan simply rations health care and choice of doctor by income. And despite the claims that market competition will curb the rising costs, the plan creates an artificial cap on the value of the voucher support."