Senate and House Republicans appear to be heading toward a confrontation over whether or not to dive into Medicare reform under President-elect Donald Trump.
The unknown factor in the debate is Trump, himself. His campaign pledge was not to cut Medicare, Medicaid, or Social Security. However, his Cabinet picks cast doubt on that promise.
House Budget Committee Chairman Tom Price, tapped by the president-elect to serve as secretary of Health and Human Services, is a vocal advocate of Medicare reform. The same holds true for Rep. Mick Mulvaney, Trump’s choice to head the White House budget office.
There is also Speaker Paul Ryan who, shortly after the election, said Medicare and Medicaid would have to be reformed when reforming ObamaCare.
“ObamaCare rewrote Medicare, rewrote Medicaid, so if you’re going to repeal and replace ObamaCare, you have to address those issues as well,” Ryan told Fox News.
Republicans who will spearhead the plan to take action now on Medicare say it’s the best time to conduct the overhaul. They point to Medicare’s funding shortfall which is set to hit hard in 2028.
While House Republicans are more ambitious, Senate Republicans prefer to address an ObamaCare replacement bill that does not contain changes to Medicare – a timid approach reflecting their slim majority.
They will be met with the argument that newly-elected government majorities will allow for the reforms they’ve wanted for years. To bolster this argument, the reform bill would have the advantage of special budgetary protections known as ‘reconciliation’ that prevent Senate filibusters.
“It’s inextricably linked from the textbook standpoint. It’s something that ought to be done,” Rep. Mark Sanford (R-SC) of the Budget Committee says about replacing ObamaCare and reforming Medicare.
Sanford also acknowledges the political risk that comes with changing Medicare. “From a political standpoint, it probably won’t be [linked] because it involves hard lifting that brings with it real pain that’s not politically popular.”
Senate Republican Policy Committee Chairman John Barrasso, a doctor and the leadership’s expert on healthcare issues, said the inevitable funding shortfall Medicare faces is a “tidal wave” staring policy makers in the face as “10,000 Baby Boomers turn Medicare-age every day.”
But, he too recommends waiting. “We need to have the discussion, but I don’t think that it should be part of the repeal and replacement of ObamaCare.” Senate Health Committee Chairman Lamar Alexander (R-TN) shares Barrasso’s view.
What many Republicans would like is to transform Medicare from a fee-for-service program that provides virtually unlimited coverage to a program in which the government’s contribution per patient is much more static. Under this type of system, it is thought that beneficiaries will have greater incentive to control their personal medical costs.
Other avenues of reform the GOP could pursue include raising the Medicare retirement age and implementing means testing, possibly limiting benefits for wealthier people or charging them additional fees.
The answer to this debate facing Congressional Republicans will be interesting. Will they opt to create a new system to replace ObamaCare without addressing Medicare, or will they aim for an all inclusive re-structuring?
“There’s tension on both sides of the answer,” said Rep. Michael Conaway (R-TX). “The things we will do in lieu of ObamaCare will be difficult.
“Do you bite off too much trying to tackle both at the same time?” he asked, conveying doubt that Congress could accomplish both tasks simultaneously.
At the same time, Conaway noted, “We have to renegotiate Medicare. If we can do them both at the same time that would be great because the sooner we get Medicare done, the less draconian the changes will have to be.”
Congress convenes on Capitol Hill Jan. 3rd, 2017.
H/T: The Hill
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