Does Republican Carlos Curbelo support ending the Medicare guarantee?

U.S. Rep. Joe Garcia, D-Miami, portrays his Republican challenger Carlos Curbelo as out of touch with middle-class residents in his South Florida district when it comes to issues such as Medicare benefits.

A Web ad repeatedly shows Curbelo in a TV interview saying "if anybody has a complaint, file it," while the ad lists a litany of attacks on Curbelo. (That quote is unrelated to Medicare and relates to a situation involving Curbelo’s work as a lobbyist.)

Narrator: "When Curbelo supported ending the Medicare guarantee?

Curbelo: "If anyone has a complaint, file it."

Here we will fact-check whether Curbelo "supported ending the Medicare guarantee" -- an attack that could draw the attention of senior voters in the district that spans Miami to Key West.

Paul Ryan’s proposals for Medicare

The ad provides no explanation about what it would mean to end the Medicare guarantee or why Garcia claims that is Curbelo’s view. Curbelo is a Miami-Dade school board member who has never served in Congress so he hasn’t voted on any Medicare plan.

Garcia’s attack relates to Curbelo’s statement in April 2014 about a GOP budget plan by U.S. Rep. Paul Ryan, R-Wis. Ryan, the House budget chairman, has included proposals to overhaul Medicare in his past few budget proposals with some changes along the way.

When the Miami Herald asked Curbelo in April about whether he supported Ryan’s plan in response to a Democratic Congressional Campaign Committee attack, Curbelo said, "I would vote for any budget that helps create jobs and rewards hard work, protects Medicare for seniors, and stops immorally piling debt on my generation and on my daughters' generation. While I have not fully reviewed this budget I'm inclined to support it."

So what did the DCCC mean about ending the Medicare "guarantee"?

The clearest -- and least controversial -- explanation of how Medicare is a guarantee is that once you turn 65, you get Medicare, no questions asked. That’s been the case since Medicare was established in 1965.

Medicare is structured as a defined-benefit plan rather than a defined-contribution plan. That means it specifies the benefits provided, rather than letting benefits depend on the amount of money paid into the system.

But the federal government doesn’t guarantee that it will pay for every possible service or treatment -- Medigap insurance plans have emerged to pay for the procedures that Medicare doesn’t cover. And Congress and the president can change what is covered under Medicare. The Affordable Care Act makes changes to Medicare to reduce future growth of the program.

Ryan has released multiple versions of his Medicare plan the past few years.

The plan Ryan released this year advocates reforming Medicare into a "premium support" program in which, starting in 2024, every new beneficiary would go into the premium-support system, but they will be able to choose whether their premium-support payment goes to help pay for a private plan or a traditional fee-for-service plan. (Critics refer to this as a voucher plan, and it does have some similarities.)

A spokesman for Ryan said the premium support payment would be pegged to the average bid. For those who were 55 or older in 2013, they would remain in the traditional Medicare system. Ryan also raises the eligibility from age 65 to 67.

Ryan’s proposal to overhaul Medicare has not gone far because it lacks support in the Democratic-controlled Senate.  

The ‘guarantee’ of Medicare

Simply saying that Ryan’s plan is "ending the Medicare guarantee" is a misleading overstatement.

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If we talk about the "Medicare guarantee" simply as seniors getting Medicare when they hit a certain age, they are still guaranteed to get it.

"It is a fundamental change to Medicare, but saying that it ends the guarantee is too far, because everyone would still get some kind of insurance," said Massachusetts Institute of Technology economist Jonathan Gruber, who has advised Republican Mitt Romney and President Barack Obama on health care matters.

Michael Tanner, a health care expert at the libertarian Cato Institute, said that under Ryan’s plan Medicare "is liable to be a smaller benefit, but it still is going to be a universal benefit. While it's going to be a smaller benefit, so is President Obama’s."

Some Medicare experts we interviewed argued that it is unclear what types of services would remain guaranteed.

"The Ryan plan keeps changing, lacks key details, and has multiple dimensions, making it hard to evaluate," said Jonathan Oberlander, a health policy professor at the University of North Carolina.

Today, Medicare has a host of services that are covered including a number of days in the hospital or nursing home and covers specified tests and procedures.

"These are ‘guaranteed.’ What would be covered under an insurance plan that people might buy with a voucher is not specified in law," said Henry J. Aaron, a senior fellow at Brookings Institute. "Benefits could erode over time if the voucher was not increased as fast as medical costs rise, a standard feature of many voucher plans, unless people ponied up additional premium payments that might rise rapidly if they want to maintain breadth of coverage."

At this point, Ryan’s plan leaves advocates with questions.  

"I don’t know for certain if there would be guaranteed core benefits or if the benefits that are guaranteed now would have to be in those plans," said Judith Stein, executive director of the Center for Medicare Advocacy. "It would be substantially different."

What Curbelo says

Curbelo told PolitiFact Florida that he is against a voucher or premium-support plan for Medicare.

"I’ve never supported the voucher concept," Curbelo said. "I don’t think we need to do that. I think we can preserve Medicare as it exists today through other reforms."

Curbelo calls for "eliminating the rampant fraud in fee-for-service, adjusting the eligibility age to account for longer lifespan, and potentially, means testing," his campaign spokesman Wadi Gaitan told PolitiFact Florida.

Curbelo, however, doesn’t deny that he said he supported Ryan’s overall budget proposal, though he told PolitiFact Florida he disagrees with the premium-support plan within it.

"Given a choice between the GOP budget and the Democrats’ budget, he would have supported the GOP budget," Gaitan said.

Accusing a Republican of wanting to get rid of the "Medicare guarantee" is a common Democratic tactic this year -- in fact, Garcia’s attack on Curbelo is similar to one in April by the Democratic Congressional Campaign Committee. (The DCCC has used a similar attack on U.S. Rep Steve Southerland, R-Fla., and the Senate Democratic Campaign Committee has used it against GOP Senate candidate Joni Ernst in Iowa.) This Democratic talking point is the latest variation on the Democratic line that "Republicans voted to end Medicare," which PolitiFact rated Lie of the Year in 2011.

Our ruling

Garcia said "Curbelo supported ending the Medicare guarantee."

The Democrats are hanging this claim on a very weak thread: when asked about Ryan’s budget proposal which includes a Medicare overhaul Curbelo said, "While I have not fully reviewed this budget I'm inclined to support it." That statement sheds no light on Curbelo’s views on changing Medicare.

Ryan’s plan would change Medicare but it wouldn’t end the guarantee that seniors get it when they hit a certain age. And Curbelo says he wants to reform Medicare in other ways that don’t involve Ryan’s premium-support plan.

We rate this claim False.