The Republican war on Medicare raises the stakes in 2024

Nearly 670,000 Iowans rely on Medicare benefits—benefits they spent decades paying into, with the promise that the program would be there for them as they age.

And for decades, Medicare has done just that. Established in 1965 by Democratic President Lyndon B. Johnson, Medicare has helped protect countless seniors from potentially catastrophic health care costs and dramatically reduced poverty among older adults.

But from the early days of the program, Republicans have repeatedly tried  to cut and/or privatize Medicare. Although previous efforts have failed amid Democratic resistance, it hasn’t stopped Republicans from continuing to target the program that more than 65 million seniors rely on for health care.

This year, there are several new conservative proposals floating around that once again put Medicare in the crosshairs.

Here’s a look at the Republican party’s latest attacks on the program. 

The latest RSC budget

In March, the Republican Study Committee (RSC) released its latest budget proposal, which, in addition to calling for a raise to the Social Security retirement age and severely restricting reproductive freedom, calls for a restructuring of the Medicare program.

The RSC includes 80% of House Republican lawmakers, many of whom are allies of former president Donald Trump, the Republican nominee for this year’s November election.

In Iowa, Reps. Randy Feenstra, Ashley Hinson, and Zachary Nunn are part of the RSC.

The latest RSC budget proposes converting Medicare to a “premium support model,” a proposal that Republican Paul Ryan, former Speaker of the House, pushed while in power.

Under this model, seniors would receive a subsidy they could use on private plans competing against traditional Medicare. This could lead to thousands of dollars in additional out-of-pocket costs for American seniors across the United States, and would siphon Medicare funds to private insurance companies.

“Premium support ends the Medicare guarantee,” Social Security Works said in June. “Instead, seniors must fend for themselves on the open market with nothing but a coupon to offset as much of the cost of the insurance that they can find.” 

Medicare and Project 2025

The RSC document echoes many of the proposals included in Project 2025, an expansive blueprint drawn up by far-right organizations and Trump’s allies that would transform America into a far-right state.

Project 2025 has already gotten quite a bit of attention for its radically right-wing ideas, but one item, as Rolling Stone notes, would have a “monumental impact” on the health of American seniors and Medicare: a call to “make Medicare Advantage the default enrollment option” for newly eligible Medicare beneficiaries.

If this policy were to be implemented, it would end the traditional Medicare model, as well as its foundational promise that seniors can go to any doctor or provider who accepts Medicare, which is nearly all of them.

Medicare Advantage plans, on the other hand, often have limited networks of doctors for beneficiaries to choose from. Many health care providers have also stopped accepting private plans because they frequently deny the prior authorization requests doctors require before patients can receive care. This is especially problematic for sicker patients, who need care right away.

Implementing this policy would also contribute to the further corporatization of the US health care system, and generate massive profits for private health insurers at the expense of the federal government. Privatizing Medicare fully would also further threaten the program’s solvency, because for years, privatized health plans have overbilled the federal government, depicting their patients as being sicker than they are.

MedPAC, an independent congressional advisory agency, estimates that the federal government will already overpay Medicare Advantage plans by $88 billion this year alone.

The Biden administration has attempted to both recoup those past overpayments and prevent the problem from happening again, but health care industry lobbyists and lawmakers have aggressively fought these efforts.

Philip Verhoef, president of the health care advocacy group Physicians for a National Health Program, told Rolling Stone in February that it would be “disastrous” to make Medicare Advantage the default enrollment option.

“To do so would be really just a clear handout to the private insurance industry,” he said.

The GOP plan would also greatly accelerate the complete privatization of Medicare, according to David Lipschutz, associate director of the Center for Medicare Advocacy.

A slim majority of Medicare beneficiaries are already enrolled in Medicare Advantage, something Trump’s administration helped accomplish while he was president.

During Medicare’s open enrollment period in 2018, the Trump administration emailed millions of beneficiaries encouraging them to sign up for Medicare Advantage. His administration also tried to make Medicare Advantage seem more attractive to these beneficiaries by offering a range of perks for signing up for private plans. Some of these perks included getting rides to doctors’ appointments and having meals delivered. 

Medicare and the Inflation Reduction Act

If Trump is reelected in November, he could get his chance at brokering Medicare prices for drugs and potentially hinder efforts to lower drug costs for seniors.

President Biden’s Inflation Reduction Act (IRA) authorized Medicare to negotiate prices for expensive drugs with pharmaceutical companies for the first time. The first set of negotiations kicked off earlier this year, despite legal challenges from pharmaceutical companies.

The drug pricing law would require the GOP frontrunner to negotiate Medicare prices for some drugs if he wins a second term. But “Medicare has discretion in how it determines the negotiated price,” according to Axios. This means that Trump could scale back negotiating powers.

A Trump administration could loosen Medicare’s interpretation of whether a drug being negotiated has competition, Joe Grogan, who led Trump’s Domestic Policy Council, told Axios in February. This could result in more drugs being exempt from negotiations, Grogan said.

It’s not clear whether the former president would push Congress to change the rules of drug negotiations, but key Republican lawmakers have already said that’s on their agenda.

A Trump administration could, in theory, also decide to drop the federal government’s defense against the lawsuits from drug companies like Merck, if they’re not resolved by the end of Biden’s term. Doing so could effectively kill the drug negotiations program.

In stark contrast, President Biden has repeatedly vowed to defend and protect both Medicare and the Inflation Reduction Act.

At his third State of the Union address in March, President Biden urged lawmakers to “stand up for seniors.”

“If anyone here tries to cut Social Security or Medicare or raise the retirement age, I will stop them,” the president said.