The federal insurance program for older and disabled Americans is another enormous entitlement program whose future shape is now in question. Some Republicans, including Trump’s HHS nominee, have long favored changing Medicare from a system of “defined benefits” to a “defined contribution” in which the government would give beneficiaries a certain amount of money to help them buy private health plans.
Proponents argue that some people on Medicare already belong to a version called Medicare Advantage that is built around such private plans and that people who will be elderly in the future will be accustomed to picking health plans. Critics fear that, if the government no longer provides the insurance and sets benefits, coverage and older Americans’ ability to afford it could eventually erode.
During his campaign, Trump promised not to touch Medicare. More recently, he has said he favors “modernizing” he program but has not defined what he has in mind.