It’s not just Obamacare that will be under assault in 2017. Medicare may also get a makeover when the new Republican-controlled Congress convenes Tuesday.
While on the campaign trail President-elect Donald Trump promised to leave retirement programs alone, but senior advocates and political pundits alike say House Republicans have long wanted to change the national insurance program that provides healthcare to more than 55 million Americans who are 65 or older and younger people with disabilities.
House Speaker Paul Ryan (R., Wis) has long wanted to replace traditional Medicare with a federal voucher system that would help beneficiaries pay premiums to commercial insurance plans. Ryan calls this system "premium support."
"Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well," Ryan said in an interview with Fox News Channel days after the election.
What’s more, some of Trump’s advisers have previously called for changes to Medicare, as well as Social Security and Medicaid. Tom Leppert, the former mayor of Dallas who is on his transition team, once released a plan calling for the privatization of Social Security and Medicare. In a policy paper titled "An American Opportunity," Leppert urged the government "to provide Medicare subsidies for the purchase of certified private plans" while maintaining the current system for those 55 and older.
The makeover will likely begin on the first day the 115th Congress meets, which is when the House of Representatives typically votes on the rules that determine how bills are handled on the House floor for the next two years.
“In the past," writes Charles Tiefer, a professor at the University of Baltimore School of Law and expert on government contracting and Congressional legislating, "Congress had procedurally shielded Medicare and Medicaid from the most alarming kinds of meddling and slashing. Other kinds of spending, like defense and farm subsidies, occur only by annual appropriations. They compete afresh, each and every year, with the rest of the appropriated spending, known as ‘discretionary spending.’"
In other words, Medicare is considered "mandatory spending" and therefore do not have to compete with the general pool of discretionary spending. Changes to these programs can only be made by some "affirmative new legislation." This Congress, Tiefer maintains, will likely change the rules by switching these programs from "mandatory funding" to "discretionary appropriations."
With Medicare competing for long-term funding, Republicans hope to "voucherize" the program by giving Medicare beneficiaries a fixed (and limited) amount to buy insurance policies. Currently, Medicare beneficiaries are enrolled in a full fee-for-care program.
Democrats have vowed to fight the privatizing of the program. Last month , House Minority Leader Nancy Pelosi (D., Calif.) joined forces with Sens. Chuck Schumer (D., N.Y.), the incoming Senate Democratic leader, and Bernie Sanders (I., Vt.) to warn their Republican counterparts that they would stand against the proposed changes.
"We’re going to need everyone to stand together next year to fight back any attempts to privatize or weaken Medicare," Schumer said in December. "All signs suggest a fight is coming."
And Sanders reminded Trump of his campaign promises. "You said you would not cut Social Security, you would not cut Medicare, you would not cut Medicaid. You know what? Millions of us are going to demand that you keep your promise."
Trump, however, hasn’t talked about Medicare since his election, focusing on his cabinet picks and other government matters instead.