AUDIE CORNISH, HOST:
Repealing and replacing the Affordable Care Act, or Obamacare, is at the top of Republicans' to-do list. But if House Speaker Paul Ryan has his way, a much bigger federal health program will see major revisions as well - Medicare. And Ryan's solution looks, well, a lot like Obamacare, as NPR's Alison Kodjak reports.
ALISON KODJAK, BYLINE: Ryan has been making the argument that when Republicans repeal the Affordable Care Act and try to replace it with something else, they're going to have to overhaul Medicare at the same time. Here he is at his weekly press briefing last week.
(SOUNDBITE OF ARCHIVED RECORDING)
PAUL RYAN: Medicare itself is on a path to going bankrupt in 2028, I believe. So the trust fund gets exhausted next decade. So we are going to have to do things to preserve and shore up this program.
KODJAK: Ryan's pitching changes to the Medicare program that he says will save it money and could save senior citizens money as well. Just like Obamacare, Ryan's plan includes an exchange where people would go to shop for insurance. Companies would be required to offer a specific level of benefits, and the government would subsidize people's premiums. Avik Roy's a doctor and conservative policy analyst who founded the Foundation for Research on Equal Opportunity.
AVIK ROY: The Medicare reform proposal is pretty similar to the ACA exchanges in that it gives people a range of private insurance options and gives them a premium assistance payment to purchase those plans.
KODJAK: Or people could choose to stay on traditional Medicare. Medicare already offers private insurance policies known as Medicare Advantage plans. But Roy says they don't actually save money because the payments insurance companies receive are fixed by law. Ryan's plan would give seniors an incentive to choose cheaper insurance because they could keep the money they save.
ROY: So the idea would be both the Medicare program and the senior would share in the savings.
KODJAK: Roy says today, about half of Medicare's new enrollees choose Medicare Advantage plans. But a study from Brown University shows that as they get older and sicker, a lot of those seniors switch to traditional Medicare. That may be because picking private health insurance can be confusing, says Henry Aaron. He's an economist at the Brookings Institution. Aaron says when it comes to health care, it may not be a great idea to put Medicare's population in the hands of the free market.
HENRY AARON: The Medicare population, a lot of them consist of people who are really quite old, or who are really quite infirm, and in some cases have mental disabilities as well. That's a population that we really need to worry about.
KODJAK: He says even young working people get confused comparing insurance plans on the Obamacare exchanges.
AARON: How much more difficult will it be to make such a system work for a much more vulnerable and less capable population, which, not without exception, but on the average, the Medicare population is?
KODJAK: Speaker Ryan says his aim is to slow the growth of Medicare spending as millions of baby boomers age into the system. It's a tough goal because people just get sicker over time, says Tricia Neuman of the Kaiser Family Foundation.
TRICIA NEUMAN: You know, if they live long enough to be in their 80s and 90s, stuff starts to happen. And as people get sick and have multiple complicating conditions, it just gets expensive to treat them.
KODJAK: Which means trying to cut Medicare spending and keep a high level of health care benefits will require a very delicate balance. Alison Kodjak, NPR News, Washington.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.