House Speaker Paul Ryan has pushed to transform Medicare from a program that directly pays medical bills for the elderly into a voucher-like system where future seniors receive a limited subsidy to buy private insurance. He told Fox News on Nov. 10 that “Medicare has got some serious problems because of Obamacare, so those things are part of our plan to replace Obamacare.”

Alexander’s remarks reflect hesitation among numerous Republican senators with the idea, now that they will have control of both chambers and the White House.

Broad hesitation

Republican Senators Ron Johnson of Wisconsin, Pat Toomey of Pennsylvania, Johnny Isakson of Georgia, Richard Shelby of Alabama and Chuck Grassley of Iowa all stopped short of endorsing the idea Tuesday, when asked if they want to turn Medicare into a "premium support" system in 2017.

The proposal is also giving a shell-shocked Democratic Party a rallying cry, uniting them in opposition to a plan they believe is a losing issue for the GOP. Many Senate Democrats quickly came out against Trump’s plan to nominate Price, citing his support for voucherizing Medicare.

“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,” said Senator Chuck Schumer of New York, the incoming Democratic leader. “Just as their efforts failed then, they will fail now.”

Two red-state Democrats facing tough re-election races in 2018, Indiana’s Joe Donnelly and West Virginia’s Joe Manchin, have come out against such a Medicare overhaul, signaling that Republicans won’t be able to rely on bipartisan cooperation on the idea.

“They’re talking about that. This whole thing about privatization and all that -- I’m not in that camp,” Manchin told reporters Tuesday. “I’m just not there.”

Trump’s promises

An additional complication is the president-elect’s position. Since 2015, Trump promised to be a different kind of Republican -- by protecting Medicare.

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid. Every other Republican is going to cut,” he said in an article posted on his campaign website.

Four weeks before the election, he told a Florida crowd that Clinton “wants to cut your Medicare,” citing stolen e-mails showing her privately endorsing a bipartisan proposal that would have included long-term cuts such as raising the eligibility age.

But since his victory, Trump may be opening the door to the idea, between the Price choice and new language on his transition website that echoes proponents of privatizing Medicare. The website says Trump wants to “modernize” Medicare “so that it will be ready for the challenges with the coming retirement of the Baby Boom generation -- and beyond.”

A Trump transition-team spokesman didn’t return a request for comment.

‘Radical departure’

Pursuing such a Medicare transformation would be “a radical departure” and “a direct violation of what Trump said” in the campaign, said Senator Sherrod Brown, an Ohio Democrat. “He’s breaking his promise. He’ll also lose.”

Republicans may end up putting off Medicare changes and focus more narrowly on the Affordable Care Act, said Rodney Whitlock, a former health policy adviser to Grassley.

“Republicans want to repeal and replace the ACA and enact major Medicare and Medicaid reforms. Doing all three at the same time is challenging, bordering on impossible. Two is very possible. They are certain to tackle the ACA. Medicaid reforms fit more logically with the ACA. A major Medicare restructuring conversation at the same time will be much harder,” Whitlock said.

An added complication would arise if Republicans succeed at repealing Obamacare, which could mean restoring the law’s $700 billion in reimbursement cuts to Medicare providers and thereby shortening its solvency, which currently extends to 2024.

Wait for replace

It’s that sort of conundrum that prompted Alexander to call for enacting an Obamacare replacement together with repeal, contrary to some Republicans who want to repeal it immediately and worry about replacing it later.

“I agree with President-elect Trump, who said those things should be done simultaneously,” Alexander said. “And I think if you replace and repeal Obamacare simultaneously, then you have to figure out how you’re going to replace it before you repeal it.”

Senate Majority Leader Mitch McConnell was mum when asked twice Tuesday whether Americans should expect a Medicare overhaul effort in 2017.

“I’m not going to speculate on what the agenda may be on a variety of different issues next year,” he told reporters. “I can tell you where we’re going to start: with a process to repeal and replace Obamacare.”

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