Major points and what they mean
Week 5 - Medicare reforms
Republican legislators are heavily focused on "repeal and replace." But there is also an opportunity to advance Medicare reform.
House Speaker Paul Ryan (R-WI) is leading the push for reform. He argues that Medicare, funded by two major sources, cannot survive. Starting in 2028, current data predict that the "Hospital Insurance Trust Fund" (from Medicare payroll taxes) will run out of reserve funds. It is currently spending more money than it takes in, paying for hospital care, skilled nursing, and other Medicare Part A services.
In 2028, payments will continue, but it will only be spending as much money as it takes in - 87% of current costs (a 13% drop).
Ryan's plan is called A Better Way. Critically, it is not an actual bill. Rather, it is a "blueprint," meant to shape discussions about future legislation. Thus, it focuses on major goals, but not the details about how they would come into being.
One of those major goals is privatizing Medicare. This would give people money ("premium support," sometimes called "vouchers") to help them buy private insurance on a "Medicare exchange." Changes wouldn't start until 2024, grandfathering in current and impending Medicare beneficiaries. But Medicare doesn't just serve seniors. In 2016, it covered 9.1 million people with disabilities.
Any policy affecting those people - including our community - would be a major concern. A Better Way talks about Medicare almost exclusively as a program for senior citizens. Until an actual bill is created, we can't tell if reforms will include people with disabilities. And we can't tell if they would be partially or fully protected from privatization with grandfathering provisions.
There is also the challenge posed by President Trump. He promised not to touch Medicare, which puts him at odds with reformers. His chief of staff, Reince Priebus, has repeated that promise. So has Tom Price, Trump's pick to lead the Department of Health and Human Services.
Turning Medicare into private insurance subsidies would totally change the relationship between people and their services. We must know if Medicare reforms include or exclude people with disabilities. For now, the biggest Medicare proposal being discussed, Paul Ryan's A Better Way, doesn't say.