Rep. Paul Ryan of Wisconsin is like the dog that caught up to the car he was chasing. Now what?
The former Republican vice presidential candidate chairs the powerful House Ways and Means Committee in the new Congress, an ideal perch from which he can pursue his long-standing dream of transforming Medicare. The latest version of his premium-support plan—which Democrats dub vouchers—would give future seniors (anyone now 55 or under) the option of receiving federal subsidies to purchase private Medicare insurance plans instead of enrolling in the traditional program.
Ryan's blueprint also calls for raising the eligibility age from 65 to 67 and increasing premiums for wealthier beneficiaries—moves he says are necessary to keep Medicare affordable for the nation at large.
While Republicans describe the plan as a form of expanded Medicare Advantage, which has proven extremely popular with many seniors, Democrats charge a broad switch to private plans would allow Congress over time to cap or ratchet down the level of premium support. That, they say, would shift an unacceptable level of Medicare costs onto the elderly.
Stymied in previous efforts to advance premium support, which was first put forward by former Republican Sen. Pete Domenici and former Congressional Budget Office chief Alice Rivlin during the deficit reduction debates in the early part of this decade, the nine-term congressman is now ideally positioned to advance those ideas on Capitol Hill. But he faces a political conundrum.
While his agenda plays well in the House, where conservatives are firmly in control, the newly installed Republican majority in the Senate may not be willing to engage in a divisive battle over Medicare heading into the 2016 election, where Republicans will be defending 24 of the 34 seats up for grabs.
“I anticipate that those issues will be prominent again, at least in the House discussion,” said Julie Scott Allen, senior vice president at Drinker Biddle & Reath's District Policy Group. “The question I have is whether you have the appetite for that in the Senate?”
That's especially true in an environment where most political observers rank the possibility of enacting significant changes in Medicare as close to nonexistent. “It's a certainty that the president would never sign anything like that into law,” said Joseph Antos, a healthcare economist at the conservative American Enterprise Institute. “You go in with the knowledge that this would be purely a political exercise.”
So it's more likely that Ryan and his allies will use the next two years to create a political environment more hospitable to major changes to Medicare, never an easy sell to wary senior citizens or those getting close to being eligible for the program. That way, if Republicans are successful in capturing the White House and retaining their majorities in the House and Senate in 2016, they'll be positioned to advance changes that they argue are vital to maintaining the program's long-term financial viability.