system. Republican House Speaker Paul Ryan has long wanted to
reform Medicare by turning it into a premium support model in which
individuals receive vouchers to buy coverage from private payers. "It's
a bit of an irony: eliminating exchanges in one market and creating
them in another," says legislative and health policy strategist Piper Su,
vice president of McDermott+Consulting in Washington, D.C. Mr.
Ryan also wants to increase the qualifying age from 65 to 67. Mr.
Trump has expressed interest in "modernizing" Medicare, but has pro-
vided little detail.
Mr. Trump and Mr. Ryan also want to cut Medicaid by establishing
block grants to states that would provide local governments with
annual funds to allocate as they see fit or a per capita allotment that
would provide states a flat amount for each enrollee.
With Republicans in control of Congress and Mr. Trump in the White
House, Mr. Ryan has the chance to push though the Medicare and
Medicaid reforms he's been touting for years.
No more excuses
Mr. Strazzella says Republicans are already developing an aggressive
repeal-and-replace strategy so there will be achievable action points
on Mr. Trump's desk as soon as he takes office next month. The GOP
is firmly in control of Washington, providing it with the opportunity to
fulfill the promise of healthcare reform that has energized its base.
That opportunity also comes with immense pressure.
"The Republican dog has finally caught the car it's been chasing,"
says Dr. McDonough. "There's so much at stake. It's entirely possible
they'll be able to complete the repeal, but unable to pull off the
replace. That would be a train wreck, especially because they have all
3 branches of government and the whole country will be watching."
OSM
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