Republicans intent on making changes to the Affordable Care Act (ACA) will find it difficult to alter the way Medicare is delivered, according to experts watching closely what might happen with the new Trump administration.
House Speaker Paul Ryan, who will be hugely influential in constructing a replacement for Obamacare, has suggested changes to Medicare, allowing more seniors to choose a private insurance plan.
However, some critics argue the political pushback from seniors worried about facing the task of buying their own insurance might be too great as Republicans work to repeal large chunks of Obamacare.
“The Republicans will put a lot of energy into crafting a replacement for the ACA,” Michael Mandel, of the Progressive Policy Institute, told Patient Daily. “But privatizing Medicare will prove to be a very difficult task both technically and politically.”
But supporters of changes -- and Ryan himself -- reject the privatization label.
Under Ryan’s plan, private insurance companies would compete with traditional Medicare for customers. The plan, named “premium support,” would introduce competition, leading to lower costs and better coverage, supporters argue.
Under the plan, the subsidy would be tied to the price of a specific plan, and the payments income-linked to a recipient's income, so lower-income people would get a bigger subsidy.
The subsidy would rise as beneficiaries get sicker, but enrollees who choose plans that cost more than the government subsidy would have to pay the balance.
James Capretta, of the American Enterprise Institute, in a piece published by The New York Times, said Medicare Advantage is already tied to private insurance, and large numbers have chosen to enroll.
“More than 30 percent of all Medicare enrollees have voluntarily chosen to get their Medicare-covered benefits through these Medicare Advantage plans,” he said. “Premium support would make the implicit competition, which already exists among these plans and the traditional program, more explicit and transparent.”
Some critics have also described the payments as “Medicare vouchers,” which Capretta argued is the wrong way to characterize them. This implies the federal government would provide financial support for purchasing insurance to the beneficiaries -- and “do nothing else.”
The federal government would regulate the choices available to the beneficiaries and provide a structure for the beneficiaries to make their selections, according to Capretta.
“So far, president-elect Trump’s economic plan would widen those deficits rather than narrow them,” he said.
“It is not necessary to impose deep cuts in entitlements in the near term, but there is an urgent need to set in motion reforms that will ease budgetary pressures over the medium and long-term. Reforming Medicare is an essential step toward a sustainable fiscal policy.”
