Medicare as we know it in jeopardy if Trump supports Paul Ryan's reforms

House Speaker Paul Ryan's plan to phase out Medicare is nothing new. But now, under a Trump presidency and with both houses of Congress in Republican hands, it looks like he could hypothetically be able to make it happen.

Back in 2011, as a U.S. representative for Wisconsin's 1st Congressional District, Ryan floated a plan to turn Medicare into a "premium support" program. The "premium support" would be a payment that would let you buy insurance from private insurers. But you won't get full coverage.

As Josh Marshall acidly noted Sunday in a blog for TPM, "In any case, rather than Medicare you'll have insurance from an insurance company, which everybody should love because haven't you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

"You'll hear lots of people calling this 'reform' and other catchwords. But Medicare is a single payer, universal health care system. Replacing it with private insurance means getting rid of it. Even calling it 'privatization' masks what is really afoot."

On Fox News Special Report on Thursday, Ryan was asked about entitlement reform. His answer:

"You have to remember, when Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid. If you are going to repeal and replace Obamacare, you have to address those issues as well. What a lot of folks don't realize is this 21-person board called the IPAP is about to kick in with price controls on Medicare. What people don't realize is because of Obamacare, Medicare is going broke, Medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits. You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare. Those are part of our plan."

Marshall says that's false, and Ryan knows it. Instead of putting Medicare under deeper financial stress, the Affordable Care Act has had the opposite effect and actually extended Medicare's solvency by over 10 years, he says.

According to Medicare's trustees, the "Part A" trust fund — the costliest component of Medicare, covering hospitalization — is set to become insolvent in 2028. In 2009, before the passage of the Affordable Care Act, it was projected that fund would go broke in 2017.

Ryan's plan to end Medicare as we know it can be found on his website.

Under the plan, current beneficiaries won't be affected, but if you are one of the millions of Baby Boomers about to retire and were counting on Medicare to cover your health care costs in your golden years, forget about it. Instead you'll get a voucher — a government subsidy that you can use toward private insurance that will cover a portion of those costs. The rest will come out of your pocket.

And given the always rising expense of health care, that could be a big chunk of change.