By Kerry Young, CQ Roll Call
November 30, 2016 -- Republicans do not yet have a united approach on whether to push to make significant changes in Medicare. But Democrats are already pouncing on the opportunity to portray themselves as defenders of seniors and people with disabilities against Republicans who want to gut the entitlement program.
"It's clear that Republicans are plotting a war on seniors next year," said Sen. Charles E. Schumer of New York, who will lead the chamber's Democrats next year, on Tuesday.
Lawmakers may turn to a debate about the future of Medicare after Republicans take steps to partially repeal the 2010 health care law, which President-elect Donald Trump has set as a priority. House GOP aides are already working on legislative language for repeal.
House Republicans have been pressing for years for a major shift in Medicare, with Speaker Paul D. Ryan, R-Wis., advocating for a move toward a defined contribution program. Under such a program, seniors would be given a set amount of money to shop for a Medicare plan. Critics say that if capped spending doesn't keep up with health care costs, seniors could suffer.
Under GOP proposals, insurers would play a larger role than they already do in managing Medicare. Already, private Medicare Advantage plans cover roughly one of every three people enrolled in Medicare, which serves people who are 65 and older or who have significant disabilities.
But some Senate Republicans don't appear as anxious as their House counterparts to jump into such a politically risky debate. Schumer already is predicting that GOP efforts to further privatize Medicare will falter, as did their plans for Social Security after their 2004 electoral victory.
Some Medicare changes may fall outside what can easily be handled through the fast-track legislative mechanism that House Republicans are eyeing to quickly undo parts of the 2010 health care law, said Joseph Antos, a researcher with the conservative American Enterprise Institute. The rules for using so-called budget reconciliation allow measures to proceed with simple majorities in the Senate and thus avoid filibusters, but the tool can only be used in limited circumstances. Rules named for the late Sen. Robert C. Byrd, D-W.Va., narrow the number of items to be included in a reconciliation bill to those with the clearest connection to changes in federal spending and revenue.
"All that is so complex and time-consuming that Medicare will have to wait, at least in terms of big decisions," Antos told CQ Roll Call. "The big push will probably not be in 2017 unless there is a grand package of reforms" that sweeps in Medicare and Medicaid, the joint federal–state health program for low-income people.
Senate Republicans Reluctant
Some Senate Republicans don't expect Congress to tackle a Medicare debate next year and say that it would not happen as part of the repeal of the 2010 health care law.
"My impression is that everyone would see [the health law] repeal as an issue in and of itself. It may have some Medicaid components, but I doubt that it has many Medicare components," Sen. Jerry Moran, R-Kan., told CQ Roll Call.
Moran also said he's concerned that House lawmakers will eye Medicare as a source of savings to be used for other purposes. "My view is that any changes in Medicare would be designed to strengthen and improve Medicare, and it should not be a source for funding other things," he said.
Sen. Lamar Alexander, chairman of the Health, Education, Labor, and Pensions Committee, said Tuesday he doesn't think that changes to Medicare should be part of next year's repeal effort.
"I think that falls under the rule of not biting off more than you can chew," the Tennessee Republican told reporters. "One of the Democrats' big problems with Obamacare was they tried to do too much, too fast. I think the problems about the solvency of Medicare should be left for another debate, another discussion."
Sen. Christopher S. Murphy of Connecticut is one of a handful of Democrats who say they would oppose Trump's nomination of House Budget Chairman Tom Price, R-Ga., as secretary of the Department of Health and Human Services due to his support for plans to alter Medicare.
"The nomination vote on Tom Price is the first test of whether Congress is prepared to stand up to the Republicans' clear desire to end Medicare as we know it," Murphy said in a statement.
Still, some Senate Republicans are anxious for a broad discussion of changes to the so-called entitlement programs that rest at the heart of the nation's budget woes.
"The big deal that we've got to do is going to have to include Medicare and Medicaid and Social Security," said Sen. Jeff Flake, R-Ariz.
Flake said he expected this work would have to wait until after completion of the effort to partially repeal the 2010 health care law.
"It's tough to see how it all fits in. It's a packed schedule, so I'd be surprised to see a serious discussion of Medicare in the months ahead," he said.
In contrast, Sen. Johnny Isakson, R-Ga., said it's possible that a broader conversation about changes to Medicare could emerge in the Obamacare repeal debate.
"It will be a part of the conversation," Isakson said. "Everything is going to be open for grabs."