What Happens to Medicare if Trump Supports Speaker Ryan?

During his presidential campaign, Donald Trump pledged not to touch Medicare. Now, it appears President-elect Trump is set to kill Medicare and, in the process, deny older adults and people with disabilities needed health care. House Speaker Paul Ryan plans for Congress to gut Medicare at the same time that Congress repeals the Affordable Care Act. And, there’s no doubt that Congressman Tom Price, whom Trump has just been picked to head the Department of Health and Human Services, is totally aligned with Ryan’s agenda.

To be clear, killing Medicare means destroying traditional Medicare. Of all the health care plans in America, traditional Medicare is most effective at ensuring people get needed care. Unlike private insurance, which increasingly rations care based on people’s ability to pay, traditional Medicare treats people equitably, regardless of health, geography or income and gives people a meaningful choice of doctors and hospitals throughout the country.

What is traditional Medicare? It is a public health insurance program providing medical and inpatient coverage, available to everyone with Medicare. About 70 percent of people with Medicare choose traditional Medicare because it gives them coverage from a wide range of doctors and hospitals. And, it allows them to budget for their care. As long as they have supplemental coverage that fills coverage gaps—retiree coverage from a former job, a Medicare supplemental insurance plan purchased in the individual market, Medicaid or a Medicare Savings Plan–virtually all their costs are covered. With traditional Medicare, unlike with a commercial Medicare Advantage health plan, there are no unexpected medical bills from out-of-network doctors.

How does traditional Medicare work? Traditional Medicare is designed to cover whatever care people need. Whether you need a lot of care or a little care, you can get it, from almost any doctor or hospital, and you are covered. And, you pay the same premium* and have the same out-of-pocket costs. (*Six percent of people with Medicare with incomes above $85,000 pay a higher premium than everyone else.) Medicare protects people with complex conditions from exorbitant costs; it ensures they can afford their care, so long as they have supplemental coverage. With traditional Medicare and supplemental coverage, unlike with a commercial Medicare Advantage plan, people do not pay more when they need more care. That’s why people in Medicare Advantage plans often switch to traditional Medicare when they need costly care.

How does traditional Medicare keep costs down? The government uses its negotiating leverage to set doctor and hospital rates for people with traditional Medicare. Commercial insurers that contract with Medicare to offer Medicare benefits, like United Health and Aetna—Medicare Advantage plans--are unable to exert the leverage Medicare does to keep rates down and therefore generally pay hospitals and doctors higher rates. That raises people’s premiums and health care costs. The commercial Medicare health plans and their enrollees currently benefit from traditional Medicare’s rates, which drive competition in the Medicare marketplace and help to keep costs down. But, these commercial health plans also have high administrative costs. Overall, Medicare is more efficient than commercial insurance.

How does traditional Medicare allow for innovation? Health policy researchers rely on traditional Medicare to understand what’s working and not working in our health care system. Without traditional Medicare, these researchers would be at a loss to understand our health care system as deeply or broadly as they do because Medicare’s data is publicly available to study. Commercial insurers treat their data as proprietary and usually are not willing to share it. They do not want to be accountable to anyone other than their shareholders and, for the most part, they are not obligated to be.

How does traditional Medicare improve our health care system? Traditional Medicare’s transparency and public accountability enable government to drive health care system improvements. Commercial insurers are financially incentivized to help themselves and their shareholders, not to serve the public good. They generally take advantage of traditional Medicare’s innovations.

If you do not want Congress to destroy traditional Medicare, sign this petition, call House Speaker Paul Ryan, and visit your Senators and let them know. Congressman Ryan and Republicans in Congress intend to weaken and destroy traditional Medicare. We don’t know exactly how, but here’s how it could happen:

The Republican Congress will pass a law that stops Medicare from paying for all the care older adults and people with disabilities need. Instead, the new “Medicare” will pay a limited amount of people’s health care costs, capping government spending.

Medicare will give older adults and people with disabilities a fixed amount toward the cost of their care—a voucher—driving up their costs and effectively denying them needed health care.

Traditional Medicare will attract people with the greatest health care needs, premiums will soar, and it will become unaffordable to all but the wealthiest Americans. Over time, it will be phased out.

To afford health insurance, most people will have no choice but to join a commercial Medicare Advantage plan with a narrow provider network, undermining their choice of doctors and hospitals, and threatening their continuity of care and access to specialty care. Commercial Medicare Advantage plans also will increasingly exclude from their formularies drugs that people with costly conditions need.

Once traditional Medicare is weakened, the commercial Medicare Advantage plans will lose their ability to use traditional Medicare rates as leverage to keep down the amounts they pay network doctors and hospitals; instead, Medicare Advantage plans will be forced to pay higher provider rates, driving up people’s health care costs further.

People in Medicare Advantage plans will struggle to afford the high deductibles and coinsurance for in-network care, let alone the even higher cost of out-of-network care.

If you want President-elect Trump, Speaker Paul Ryan, and other Republican leaders to keep their hands off Medicare, please sign this petition.