When it comes to claims about Medicare, some political talking points just never die.
In Iowa and Virginia, Republicans have accused Democrats of cutting Medicare to pay for Obamacare. In Florida, a Republican was slammed for ending the Medicare "guarantee." Other Medicare-related attacks have been deployed in Arkansas and Kentucky Senate races. The point of all the attacks is to convince midterm voters that one side or the other won't protect the program.
Take this one, used in a recent ad aired by the National Republican Senatorial Committee in the hotly contested Iowa Senate race between Democratic Rep. Bruce Braley and Republican state Sen. Joni Ernst:
"Bruce Braley voted to cut $700 billion from Medicare to support Obamacare," the ad says. "That's just not fair. We paid in. We paid for it. That should be there for us."
It's correct that Braley, as a House member, voted for the Affordable Care Act in 2010. However, PolitiFact has been skeptical of numerous previous claims that Obamacare cuts Medicare, rating them either Half True or Mostly False, depending on how they are worded. Other fact-checkers have concluded similarly. The claim is too sweeping and doesn't convey fully what the law is doing.
As Congress was debating President Barack Obama's health care law in 2010, its backers acted to fend off one line of criticism — that the bill was a budget-buster — by making sure the bill didn't add to the deficit. So lawmakers wrote in new taxes and new savings.
Among the spending cuts were reductions in future Medicare costs. When the law was passed, the reductions amounted to $500 billion over 10 years; eventually, as the 10-year budget window shifted into the future, the cost of these reductions rose to more than $700 billion over 10 years.
The combined reductions are estimated to be $415 billion for traditional Medicare, $156 billion for the managed-care option known as Medicare Advantage, $56 billion in payments to teaching hospitals that serve low-income populations, and $114 billion in other categories, according to a Congressional Budget Office estimate.
The cuts are not aimed at beneficiaries. Hospitals, for example, will be paid less if they have too many readmissions, or if they fail to meet other new benchmarks for patient care.
It's possible that some beneficiaries, including Medicare Advantage participants, could see additional costs passed along to them, experience reductions in services, or find fewer doctors willing to treat them. But seniors also benefit from the health care law — for instance, there's new spending of $48 billion over 10 years for Medicare Part D prescription coverage to target the so-called "doughnut hole." The law also expands preventive care benefits.
The other claim — that current seniors have already fully paid for benefits — is also misleading, generally earning a Mostly False.
Yes, Americans 65 and over have "paid in" through payroll taxes they've paid throughout their working lives. But today's beneficiaries have gotten far more back in Medicare spending than what they put into the system through their tax payments.
Researchers with the nonpartisan Urban Institute figured out what people turning 65 in various years have "paid in" to the system and what they can expect to "take out" after they reach age 65.
Overall, for today's typical Medicare beneficiary, what they paid into the system represents just 13 percent to 41 percent of what they can expect to get out of it. The rest is funded by younger Americans' payroll taxes. That's what makes the claim inaccurate.
Meanwhile, Democrats continue to insist that Republicans intend to roll back the Medicare "guarantee" saying that's what a GOP budget plan from U.S. Rep. Paul Ryan, R-Wis., would do.
Ryan, the House budget chairman, has included proposals to overhaul Medicare in his past few budget proposals. Would his plan end the Medicare "guarantee"? PolitiFact has rated claims on that point all the way from Half True to False, depending on the specifics.
The clearest — and least controversial — explanation of how Medicare works is a guarantee that once you turn 65, you get Medicare, no questions asked.
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 plan Ryan released this year advocates turning 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.)
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.
But simply saying that Ryan's plan is "ending the Medicare guarantee" is a misleading overstatement.
"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 Obama on health care matters.
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.
In some cases, Democrats have leveled the attacked against Republicans who have said they don't fully support Ryan's plans for Medicare. In Miami, U.S. Rep. Joe Garcia, D-Miami, recently made the accusation against Republican challenger Carlos Curbelo.
Though Curbelo has said he's inclined to support the Ryan plan, he has also said he's against the way it proposes changing 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 supports "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.
PolitiFact Florida rated the attack on Curbelo False.
PolitiFact Florida reporter Amy Sherman contributed to this report. Edited for print. Read the full versions at PolitiFact.com.