Calls by House Speaker Paul Ryan (R-WI) and other conservatives to overhaul Medicare next year as part of a major realignment of federal health care policy are encountering strong resistance from Senate Republicans, who argue that the GOP-controlled Congress already has its hands full attempting to repeal and replace the Affordable Care Act.
President-elect Donald Trump repeatedly vowed during the campaign that if elected, he would leave untouched Social Security and Medicare, the premier federal retirement and health care programs for seniors.
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But since the election, Trump has signaled support for “modernizing Medicare” to meet the budgetary challenges of caring for baby boomers. Ryan, meanwhile, has renewed his call for a “premium-support” approach. The Speaker’s plan would gradually transform Medicare from an entitlement to a voucher-type program in which seniors would be provided with a fixed amount to purchase coverage in the private market.
The highly popular Medicare program currently covers 57 million elderly and disabled Americans and is widely considered to be the most politically sacred federal program next to Social Security. While Ryan and other champions of reform say it’s essential to controlling the long term debt, many Senate Republicans concerned about preserving or expanding their majority consider an assault on Medicare next year borderline suicidal.
Over a dozen Senate GOP lawmakers indicated they were not planning or inclined to pursue substantial changes in Medicare, at least not during the first year of the new Trump administration, Politico reported on Friday. Other reports substantiated that Ryan and Trump’s calls for a fundamental revamping of the popular health care program for seniors had triggered a backlash in the upper chamber.
“We are not inclined to lead with our chin,” Senate Republican Majority Whip John Cornyn of Texas said, according to the Associated Press. “And right now, we’ve got a lot on our plate.”
Indeed, the Republicans’ post-election euphoria is giving way to more sobering and pragmatic calculations on how to best fulfill their campaign pledge to “repeal and replace” Obamacare without triggering a major upheaval in the insurance and health care industries and stripping 20 million Americans of their subsidized health care coverage.
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Ryan and Senate Majority Leader Mitch McConnell (R-KY) are currently plotting strategy to swiftly pass legislation to repeal major portions of the Affordable Care Act as early as mid-January, around the time that Trump is sworn in as the nation’s 45th president. However, GOP leaders in both chambers say it may take two or three years before they have a politically and economically feasible replacement for Obamacare.
If that proves to be the case, then the uncertainty caused by the long delay would likely accelerate the already troubling retreat of major insurers like UnitedHealthcare and Aetna from the Obamacare market and severely undercut the profits of hospitals and other health care providers. Congressional Republicans reportedly have begun talks with health insurers about possible new incentives that would keep them in the market following the repeal of the Obamacare legislation.
Both parties have used cuts in Medicare to offset the cost of their spending initiatives, as President Obama and the Democrats did in passing the Affordable Care Act in 2010 and the Republicans did in pursuing a balanced budget. Ryan said in an interview shortly after the Nov. 8 election that any legislation to replace Obamacare would necessarily require cuts in Medicare and Medicaid, the health insurance program for the poor and disabled.
But past efforts by Republicans to privatize Medicare for future beneficiaries have invariably failed. And Senate Minority Leader Chuck Schumer (D-NY) and House Minority Leader Nancy Pelosi (D-CA) almost gleefully are preparing to wage all-out warfare next year to block GOP attempts to revolutionize the program.
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“For the Democrats, Medicare is sacred,” Ross Baker, a political scientist with Rutgers University, said today. “It’s something they’re willing to die for. And for Republicans, I think, there is a concern . . . that people just don’t want it tampered with.”
“There is a lot of uncertainty right now over Obamacare,” he added in an interview. “The question is, how much more uncertainty do you want to introduce? I think people are fearful of losing those Medicare benefits . . . Even people who profess to want change, they don’t want that kind of change. It’s a non-starter as far as I can see.”
Or as Sen. Ron Johnson (R-WI) put it: “When you take a look at the menu, that’s probably one of the last courses,” according to the AP.