Medicare looms over Trump-Ryan alliance

Greg Nash

President-elect Donald Trump and Speaker Paul Ryan (R-Wis.) could be on a collision course over Medicare. 

Ryan is defending his long-standing proposal to make the program more reliant on private plans, arguing such a change is necessary to keep Medicare fiscally sustainable.

{mosads}But Trump said repeatedly during the campaign that he wanted to protect Medicare, not overhaul it. Vice President-elect Mike Pence reiterated that position on Sunday.

Given the possible resistance from Trump, and even from Senate Republicans, it is unclear how hard Ryan will push for Medicare changes next year, despite his clear desire to overhaul the program. 

“My guess is that Ryan’s going to put a lot of effort into trying to persuade Trump through Mike Pence and Reince Priebus and others,” said Peter Wehner, a senior fellow at the Ethics and Public Policy Center who has long been close to Ryan. Priebus is Trump’s incoming chief of staff.

“If that private effort doesn’t work, though, I can’t imagine Ryan would push it if the president were against it,” Wehner added. “I just don’t see how that works politically.”

In broad terms, Ryan has been making the case that changes to Medicare are urgent.

“We have to do things to fix this program so that we can guarantee that it’s there intact for current seniors, but also that there’s something there for us when we retire,” Ryan said last week. 

Remarks like that are in stark contrast with Trump’s during the campaign. 

“I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid,” Trump told conservative news website the Daily Signal last year. 

His campaign promoted the article’s headline — “Why Donald Trump Won’t Touch Your Entitlements” — on its website. 

Likewise, in a separate event last year, Trump said: “Every Republican wants to do a big number on Social Security, they want to do it on Medicare, they want to do it on Medicaid. And we can’t do that.”

Under Ryan’s plan, known as “premium support,” seniors would get a set amount of money from the government to help them buy health coverage from private insurance companies or traditional Medicare.

Democrats say that because the whole idea of premium support is to save the government money, the financial assistance would not keep up with rising healthcare costs over time, forcing more and more of the costs onto seniors. 

Since the election, there have been some questions as to whether Trump is changing his position on Medicare to move closer to Ryan’s.

The healthcare section of Trump’s official transition website includes a call to “Modernize Medicare, so that it will be ready for the challenges with the coming retirement of the Baby Boom generation — and beyond.” It does not provide any more details.

Trump’s pick for secretary of Health and Human Services, Rep. Tom Price (R-Ga.), is aligned with Ryan on Medicare, advocating for an overhaul.

But Pence, despite being close with Ryan, seemed to throw cold water on any talk of a change in Trump’s position on Sunday. 

“The people that are joining our administration are signing up for the president-elect’s agenda,” Pence said on ABC’s “This Week” when asked about Price’s views. 

“So no changes to Medicare?” host George Stephanopoulos asked. 

“Well, look, I think President-elect Trump made it very clear in the course of the campaign that, as president, we’re going to keep our promises in Social Security and Medicare,” Pence replied. 

Ryan, for his part, says he has not spoken with Trump yet about Medicare. 

In an interview with CBS’s “60 Minutes” that aired Sunday, host Scott Pelley posited to Ryan that he might “kick the can down the road” and not deal with Medicare for the next year or two. 

“This is not your top priority,” Pelley said. 

“It’s not our t—,” Ryan said before stopping himself. “I haven’t even discussed this with Donald Trump yet,” he continued. “But it is an issue that we have to tackle.”

Ryan told the Milwaukee Journal Sentinel on Monday that he has “no doubt” that Trump wants to “save Medicare for future seniors.”

Ryan and others say the premium support option is needed because Medicare is running out of money and going “bankrupt.”

Opponents respond that while Medicare has long-term challenges, it is not in a short-term crisis, and Medicare cost growth has slowed in recent years, which many experts attribute to changes made by ObamaCare. 

If ObamaCare were repealed, as Republicans have promised to do, it could shorten Medicare’s expected solvency. 

In addition to Trump’s views, one of the complications for Ryan is that Senate Republicans are less enthusiastic about his Medicare plan. Senate Democrats are already signaling they plan to put fighting changes to Medicare front and center in the 2018 battle for control of the chamber.

Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health Committee, said last week that a Medicare overhaul is “biting off more than you can chew.”

Sen. Susan Collins (R-Maine), a centrist, told the Portland Press Herald on Friday that she has “reservations” about a “complete upending” of the program.

House Ways and Means Committee Chairman Kevin Brady (R-Texas) told The Associated Press that changes could start slow. He said he sees 2017 as a time for “taking steps, small, in preparing for larger steps to save Medicare for the long term.”

An easier target for Republicans could be Medicaid, the government health insurance program for low-income people. 

Republicans are relatively united in calls to block grant Medicaid, meaning instead of an open-ended federal commitment, states would have a set amount of funding to draw from. 

Republicans say this would save money and give states more control. Democrats warn that it would lead to cuts in benefits or caps on enrollment. 

In the same interview on Sunday in which Pence pushed back on Medicare changes, he said there is a “real opportunity” to make changes to Medicaid.

Tags Donald Trump Kevin Brady Lamar Alexander Mike Pence Paul Ryan Susan Collins
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