THE VILLAGES, Florida (AP) — Vice presidential candidate Paul Ryan introduced his 78-year-old mother to voters Saturday as he defended the Republican ticket from withering criticism from President Barack Obama for proposals to overhaul the government's popular Medicare program that provides health care coverage to seniors.
In the week since Republican presidential candidate Mitt Romney announced Ryan as his running mate, Medicare has become the latest flashpoint in an increasingly contentious presidential campaign.
Ryan, a deficit hawk and the House Republicans' chief budget writer, has stood out in Washington for laying out tough spending choices that many lawmakers in both parties avoid. So it was almost inevitable that his selection as running mate would vault Medicare to the top of the campaign debate.
Democrats say it's a debate they are glad to have because voters tend to trust them more than Republicans on the big social entitlements. But Obama has vulnerabilities, too, given the Medicare cuts he pushed to expand health insurance for Americans and to keep the costs of doing so in line.
The issue could determine the outcome in several critical battleground states. Florida, Pennsylvania and Iowa are among the top five states in the percentage of people 65 and over, and all three are closely contested.
Medicare is a dicey issue for both sides: Obama is steering billions from the entitlement to help pay for the expansion of coverage under his health care law; Ryan is a champion of overhauling Medicare to make the traditional program no longer the mainstay for tomorrow's seniors — just one of many old-age health insurance choices.
On a day Republican presidential candidate Mitt Romney devoted to raising campaign cash in Massachusetts, Ryan accused Obama of raiding the Medicare "piggybank" to pay for his health care overhaul and he warned starkly that hospitals and nursing homes may close as a result.
The Wisconsin congressman introduced his mother to an audience of seniors at The Villages, a sprawling retirement community in central Florida, and passionately defended a program that has provided old-age security for two generations of his own family.
"She planned her retirement around this promise," Ryan said as Betty Ryan Douglas looked on. "That's a promise we have to keep."
Campaigning in New Hampshire, Obama said it's a promise that the Republican ticket would tear up.
Seeking to drive older voters away from Romney, Obama has seized on Ryan's plan to shift future retirees into a system dominated by private insurance plans, saying seniors would have to pay thousands of dollars more out of their pocket for their health care coverage.
"You would think they would avoid talking about Medicare, given the fact that both of them have proposed to voucherize the Medicare system," he said in Windham. "But I guess they figure the best defense is to try to go on offense.
"So, New Hampshire, here is what you need to know: Since I have been in office, I have strengthened Medicare."
He made a similar point later in the day while campaigning in Rochester, New Hampshire.
Ryan's proposal in Congress would encourage future retirees to consider private coverage that the government would help pay for through a voucher-like system, while keeping the traditional program as an option.
According to the nonpartisan Congressional Budget Office, Medicare over time would spend thousands less per senior under the Ryan plan than under current policy. Critics say that would shift heavy costs to individual retirees.
Older Americans have often resisted changes in Medicare, the federal health care insurance program for people 65 and older, and for the disabled. Polls show the public generally opposes plans to replace the current program which pays doctors, hospitals and other medical providers directly for their services.
The Romney-Ryan ticket is betting that voters' worries about federal deficits and the Democrats' health care overhaul have opened the door for a robust debate on the solvency of Medicare, one of the government's most popular and costliest programs.
In Florida, Ryan said that Medicare officials themselves have predicted that one out of six hospitals and nursing homes will go out of business as a result of Obama's Medicare cuts.
That was a far from an exact reference to a 2010 analysis by Medicare chief actuary Richard Foster. He said then that roughly 15 percent of hospitals and nursing homes that provide Medicare services could "become unprofitable" over a decade — not necessarily go out of business — thanks to cuts in payments from the government under the health care law.
But Foster's analysis also said the law would improve key Medicare benefits, solve gaps in prescription drug coverage for seniors, provide free preventative services such as cancer screenings, expand health insurance to millions more people, reduce the federal budget deficit and extend the solvency of the government's hospital insurance trust fund by up to 12 years. Hospitals remain largely on board with the health care law, without apparent fear of closing.
The Obama campaign recognizes that Romney and Ryan have tried to neutralize the usual Democratic advantage on Medicare by striking first with a Medicare ad and with their criticism of Obama's health law for reducing Medicare spending by $700 billion over 10 years.
"They are being dishonest about my plan because they can't sell their plan," the president said. The cuts in Obama's plan come from health care providers, not from benefits to seniors.
In New Hampshire, Obama cast the choice on Election Day in November as one between two fundamentally different approaches to the government's responsibility to its citizens. His approach of portraying Romney's tax and economic plans as a giveaway to the rich was familiar, but seemed to have a particularly sharp bite.
"They've been trying to sell this trickle-down snake oil before," he told his audience in Windham. "It did not work then. It will not work now. It will not reduce the deficit, it will not create jobs. It's the wrong direction for America."
Florida has the highest concentration of voters over 65 in the U.S. Some 17 percent of Floridians fall into that group.
New Hampshire, where Obama campaigned Saturday, has 14 percent of its residents over 65.
Associated Press writers Philip Elliott in The Villages, Florida, Jim Kuhnhenn in Rochester, New Hampshire, Charles Babington in West Tisbury, Massachusetts, and Calvin Woodward in Washington contributed to this report.