Giddy from his recent health care win, House Speaker Paul Ryan said he looks forward to tackling an overhaul of Medicare, which would leave many seniors without coverage or with higher premiums. On Friday, Speaker Ryan told the conservative radio host, Vicki McKenna, that he would like to see a plan for overhauling Medicare this year. He said the plan is part of an “ongoing conversation” with the Trump administration.
Last month, Office of Management and Budget Director Mick Mulvaney commented on a possible Medicare overhaul by saying the administration could “talk about it,” and that absolute resistance to the idea was “not a really conducive way to sort of maintain a relationship between the executive and the administrative branch.”
Speaker Ryan has been interested in making dramatic changes to Medicare for years. His 2015 budget plan, much like his previous budget plans, creates a voucher system for people to buy private insurance or traditional fee-for-service Medicare.
The original Medicare program is administered through the government and people pay a deductible when they get health care. If they have Medicare Part B, they pay a monthly premium. But Ryan’s plan would eliminate a guaranteed level of coverage under Medicare, raise the age of Medicare eligibility to 67 from 65, and hike income-related premiums.
That would mean that for many Americans who live in regions where traditional Medicare is more expensive than the voucher, they would have to pay higher premiums, according to a 2015 report from the Center for Budget and Policy Priorities. People enrolled in a private plan, using Medicare Advantage, would also be giving up the federally subsidized supplemental benefits they receive now.
Higher premiums could result in more people leaving the plans, thus reducing enrollment. This give providers less incentive to participate in the program, and results in people having both higher premiums and less provider options, according to the report. Raising the age of Medicare eligibility would also result in many 65 and 66 year-olds going without insurance. Ryan’s legislation also limited medical malpratice litigation and increased Medicare cost-sharing.
Henry Aaron, a health care economist at the Brookings Institution, told NPR that Ryan’s 2016 plan for Medicare, which makes traditional Medicare premiums so expensive that seniors have to move into more of a Medicare Advantage-type plan, is risky.
“The real question here is whether the requisite safeguards are in place to ensure that the elderly and people with disabilities would be able to maneuver in such a system,” Aaron said in the NPR interview.
Although Trump made positive comments about Medicare on the campaign trail, such as, “Abolishing Medicare, I don’t think you’ll get away with that one. It’s actually a program that’s worked,” Trump also vowed not to cut Medicaid in 2015, but pushed for health care legislation that converts Medicaid into an entitlement program and would cut Medicaid spending by $830 billion.
AARP, which opposed the House plan to repeal and replace Obamacare, was prepared to fight against changes to Medicare the moment Trump was sworn into office. In January, Eric Schneidewind, the president of AARP, tore apart the plan. He wrote in Time:
“While Speaker Ryan has dubbed his voucher-based approach ‘premium support,’ no one should be misled by the benign-sounding term,” Schneidewind wrote in Time Magazine. “This is a clear downgrade of the Medicare benefits people have earned throughout their working lives, and the use of buzzwords like ‘modernization’ and ‘choice’ cannot hide the fact that seniors will be asked to bear more risk at greater personal cost.”