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Opinion Get ready for a big, messy, explosive battle over Medicare’s future

(EPA/Mike Theiler)

As I noted this morning, Donald Trump’s choice of GOP Rep. Tom Price as Secretary of Health and Human Services clearly signals that he is deadly serious about repealing (and kinda sorta maybe replacing?) the Affordable Care Act. That’s a big deal, of course, and ensures a major political battle over the ACA’s fate.

But Price is also an ardent proponent of gutting traditional Medicare and converting it into a voucher scheme, along the lines of what Paul Ryan has proposed and turned into a kind of fiscal lodestar for the entire GOP. And that all but ensures an epic showdown over the fate of Medicare, which is a far more popular and established program than the ACA is, and has assumed a kind of hallowed, untouchable political status. That showdown will first unfold at the coming confirmation hearings for Price, which could have lasting political ramifications — if Democrats handle them correctly.

Tom Price, a vehement critic of the Affordable Care Act, is President Trump's secretary of the Department of Health and Human Services. (Video: Jenny Starrs/The Washington Post, Photo: Andrew Harrer/The Washington Post)

Here’s the Post’s description on where Price stands on the future of Medicare:

Price supports major changes to Medicaid and Medicare, health insurance pillars of the Great Society programs of the 1960s. Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies….
For Medicare, Price favors another idea long pushed by conservatives, switching it from a “defined benefit” to a “defined contribution.” With that, the government would give older or disabled Americans financial help for them to buy private insurance policies.

In other words, Price, like Ryan, favors ending the Medicare “guarantee.” Critics say this would result in higher costs for seniors over time, as their fixed payment from the government falls behind rising health care costs, potentially harming lower-income beneficiaries, and they argue that Medicare’s fiscal problems can be adequately addressed without such harmful outcomes.

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This presents Democrats with an early opening to drive home to voters that Trump — who promised not to touch entitlements and managed to fool a lot of pundits into treating him like a different kind of Republican — actually is likely to govern largely in sync with the unpopular fiscal and safety net priorities of congressional Republicans. Ryan himself recently confirmed that privatization of Medicare is very much on the table. As David Dayen explains, the choice of Price shows that the Trump administration will likely be firmly aligned with Ryanism. Also see Josh Marshall’s piece on why this whole battle is freighted with stakes that some Beltway reporters might not fully appreciate.

“The choice of Price confirms that one of the first items on the new agenda of Trump and Republicans will be destroying Medicare and social insurance,” Alex Lawson, the executive director of Social Security Works, argues to me. “Americans didn’t vote for this. Trump may have gotten through the GOP primaries and won older voters in the general election by promising not to touch Medicare and Social Security.”

Now, there is obviously so much Democrats can do here. If Republicans stay united, they probably can get Price through the confirmation battle, and they may well succeed in phasing out traditional Medicare. But as Nancy Pelosi pointed out in a recent interview with this blog, there is precedent for a different outcome. In 2005, after George W. Bush’s reelection, he tried to partially privatize Social Security, but after a long battle, that plan went down in flames because united Democratic opposition ended up fracturing Republicans. Pelosi is currently hoping Democrats remain equally united this time, in hopes of breaking off Republicans who are worried about the 2018 midterms.

In remarks at a Senate Democratic luncheon today, Dem Senate leader Chuck Schumer voiced similar sentiments.

“After the 2004 elections, Republicans tried to take the rug out from under our seniors to privatize Social Security. After the 2016 elections, it seems they’re intent on trying the same trick on Medicare,” Schumer said, according to his office. “Just as their efforts failed then, they will fail now.” Schumer added that Democrats would remain united against “privatizing Medicare.”

 It’s anyone’s guess whether this Dem effort will succeed — one can imagine Republicans might be under more pressure this time from the GOP base not to give ground — but regardless, some of the first major salvos in this battle will be fired at the confirmation hearings for Price.

The hearings could get pretty intense, too. That’s because on the Democratic side, the committee that Price’s nomination must pass through — the Health and Education committee — is likely to include senators like Patty Murray, Bernie Sanders, and Elizabeth Warren, who have the heft and ability to subject Price to tough and revealing lines of questioning. The challenge for them will be to drive home the true radicalism of the GOP agenda — of Trump’s agenda — when it comes to the future of social insurance for the elderly in America.

“They have to show Americans that the choice of Price shows that gutting Medicare and social insurance really is the Republican plan,” Lawson says. “They have to show that this is really happening.”