Democrats spoiling for a new fight after Donald Trump’s shocking presidential victory last month may have found the one they wanted.
With Trump’s inauguration still six weeks away, Republicans already are promising to use their total control of Congress and the presidency to make major changes to Medicare, which for more than 50 years has paid health care costs for millions of seniors — Democrats and Republicans alike.
Democrats are convinced that fighting against changes in the iconic insurance program would put them on the side of the angels with many of the nation’s aging voters.
On Wednesday, former presidential candidate and Vermont Sen. Bernie Sanders; House Minority Leader Nancy Pelosi of San Francisco; Sen. Chuck Schumer, D-N.Y., and other Democrats appeared in Washington with what they said were 1 million signatures collected by various advocacy groups and unions demanding that Republicans not touch Medicare benefits.
Sanders referenced Trump’s statements from the campaign — “He said, ‘I am not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid,’” — then added, “Mr. Trump, we are going to hold you accountable.”
“The people have paid into the systems and they should get their money back,” Pelosi said. “Hands off Medicare.”
Within days of Trump’s Nov. 8 victory, House Speaker Paul Ryan, R-Wis., and Georgia Rep. Tom Price, Trump’s pick to run the Department of Health and Human Services, said Medicare reform is a priority that will be taken up sometime next year.
In the past, both GOP leaders have called for cutting the cost of Medicare by moving more seniors from the current government-paid insurance plan to private plans, paid for by federal payments to seniors that would be used for health insurance costs.
“We are going to have to do things to preserve and shore up the program,” Ryan said in a recent news conference, adding that the changes he’s calling for are “reforms that we’ve been talking about here in the House … for many years.”
They also are changes Democrats have fought successfully for many years, and after the bruising presidential defeat, they’re looking forward to another go-around.
Medicare, and health care in general, is a much easier issue for Democrats than many of the party’s other concerns, said Barbara O’Connor, a retired professor of political communications at Sacramento State University.
“Global warming is too esoteric a topic for many people,” she said. “But health care is something everyone deals with. … It’s a rallying cry for seniors that cuts across parties.”
After half a century, Medicare is part of the country’s landscape, a program that even its critics admit has worked well in keeping the nation’s elderly healthy and out of poverty.
In the Bay Area, On Lok — Cantonese for “peaceful, happy home” — has been serving the elderly for more than 45 years, with much of its funding coming from Medicare and Medicaid.
“On Lok served as one of the original Medicare demonstration projects in the late 1970s to better serve seniors in need of long-term care services,” Grace Li, the nonprofit’s CEO, said in a statement. “Today, Medicare is a critical program. … Any new proposal that significantly changes the Medicare program would require … a great deal of discussion in Congress before moving forward.”
For 73-year-old Olinda Marti-Volkoff, who spends time at On Lok’s 30th Street Senior Center in Noe Valley, Medicare has been an important part of her life and a program that works well for her.
“When you get as old as we have here, the last thing you need is worries about how to pay for doctors,” the Mission Terrace resident said. “I honestly wouldn’t be able to pay for my expenses otherwise.”
For Democrats, Medicare can be the path back to the middle-class voters, particularly in the Midwest and the Rust Belt, who abandoned them to support Trump for president. While many of these voters were pushing for change, it likely was for change that didn’t directly hit them.
“Medicare is hallowed ground among both Democrats and Republicans, people who vote a lot,” said David McCuan, a political science professor at Sonoma State University. Democrats “can try to carve out success not only among the people on Medicare, but also from those supporting parents and grandparents,” younger people who would be on the hook if Medicare changes left seniors — or their relatives — with higher medical bills.
While Republicans argue that drastic changes are needed to keep Medicare solvent, they deny that the fixes will either raise costs or trim services for the elderly.
“I think what’s happening is you’re getting the latest wave of Democrat talking points to try and play ‘Medi-scare’ politics,” Ryan said at his news conference. “We have to do things to fix this program so we can guarantee that it’s there intact for current seniors, but also that there’s something there for us when we retire.”
Any proposed changes would be phased in over a number of years, and most would not affect people who are retired or nearing retirement age, Ryan has said. His latest plan, proposed in 2015, would allow people to continue to choose a traditional Medicare plan while providing — and encouraging — more options to use private insurance.
But the purpose of making changes is to cut the current costs of the Medicare program, and those cost savings have to come from somewhere. Suggestions include raising the eligibility age, now 65, to 67, and increasing costs or cutting benefits for wealthier recipients.
There are concerns, though, that “premium support,” a voucher-like program for private insurance favored by both Ryan and Trump nominee Price as a replacement for traditional Medicare, would not keep up with fast-growing health care costs, leaving an ever-widening gap between what the government pays and what seniors are charged.
A 2011 study by the Kaiser Family Foundation Program on Medicare Policy found that under an earlier reform plan proposed by Ryan, someone retiring at age 65 in 2022 would have out-of-pocket health care expenses equal to nearly half of their Social Security income, more than twice as much as under traditional Medicare.
While Ryan has revised his plan since then, “the proposed changes would be a major shift for Medicare,” said Tricia Neuman, director of Kaiser’s Medicare policy program. “There are many big questions.”
Republicans know that passing a Medicare reform plan won’t be easy, and some are concerned that Ryan may want to move too far, too fast.
While GOP Rep. Kevin Brady of Texas, chairman of the House Ways and Means Committee, has vowed that Republicans won’t be deterred by the politics of a Medicare battle, he also suggested the party will move slowly on the reforms, starting out next year with small changes that may or may not include the game-changing premium support.
The bigger question, though, is how much stomach Trump has for a fight over Medicare.
During the GOP primary, the president-elect vowed not to cut Medicare or Social Security and ridiculed Ryan for supporting Medicare changes when he ran as Mitt Romney’s vice presidential candidate in 2012.
But on his transition website, Trump promises to “modernize Medicare, so that it will be ready for the challenges with the coming retirement of the Baby Boom generation — and beyond.” That revised vow, while lacking any details, combines with his planned appointment of Price, a hard-core warrior for trimming back government spending on health care, to convince Democrats that it’s time to prepare for battle.
“Every single day that goes by, the Republicans are making more inroads into undermining Medicare. Their budget calls for it,” Pelosi said in a news conference last week.
The lines already are forming behind the Democrats.
Health Access California is a consumer health care advocacy coalition, pushing for affordable health care for all the state’s residents.
“Medicare is so popular because if you’re not on it, you know someone who is,” said Executive Director Anthony Wright. The Republican plan to revise it “would shift the program to a voucher system and … end Medicare as we know it.”
If that doesn’t get the 57 million people in the program — and their families — upset, he said, “We’ll do everything in our power to make those changes controversial.”