Congressional Democrats are warning that Speaker Paul Ryan and President-elect Donald Trump are gunning for Medicare — and they are rubbing their hands in glee at the prospect of an epic political battle over the government's flagship health program that covers 57 million Americans.
It turns out that Republicans, especially in the Senate, are not spoiling for a fight.
"We are not inclined to lead with our chin," said No. 2 Senate Republican John Cornyn of Texas. "And right now, we've got a lot on our plate."
Ryan, R-Wis., is the most powerful advocate in Washington for a premium-support approach that would, over time, remake Medicare into a voucher-like program that could force some seniors entering the program to buy health insurance on the open market instead of getting coverage through the traditional open-ended process. Critics say such coverage would take away a Medicare guarantee and give seniors subsidies whose value won't keep up with inflation.
Medicare covers 48 million seniors and nine million disabled people.
Ryan, just days after the election, said any legislation to replace President Barack Obama's signature Affordable Care Act law would necessarily include cuts to Medicare and Medicaid.
"Obamacare rewrote Medicare, rewrote Medicaid, so if you're going to repeal and replace Obamacare, you have to address those issues as well," Ryan told Fox News. "Those things are part of our plan to replace Obamacare."
Ryan's comments set off alarm bells, as did recent remarks by Rep. Tom Price, R-Ga. — made before becoming Trump's nominee to head the Department of Health and Human Services — suggesting that House Republicans are eyeing major Medicare cuts as early as the summer.
"Speaker Ryan has pushed to privatize Medicare for years and the President-elect has nominated a champion of that effort," said incoming Senate Democratic leader Charles Schumer of New York. "The people who are genuinely and rightly scared are millions of American seniors who don't believe privatization of Medicare will be in their interest."
Over the last couple of weeks, however, it's become clear that even House Republicans aren't gunning for a big fight on Medicare this year.
"I envision 2017 as taking steps, small, in preparing for larger steps to save Medicare for the long term," House Ways and Means Committee Chairman Kevin Brady, R-Texas, said in an interview with The Associated Press on Thursday.
Reaction among Senate Republicans at the prospect of major Medicare cuts, meanwhile, was almost one of bemusement.
"When you take a look at the menu, that's probably one of the last courses," said Sen. Ron Johnson, R-Wis.
Medicare is exceptionally popular, but faces major fiscal problems from an incoming wave of baby boomers. While there is widespread agreement that changes are needed to shore up the program, Medicare has an outsized reputation as a "third rail" political issue — touch it and you die.
Medicare cuts were used by Democrats to help finance the Affordable Care Act and they are a big part of GOP promises to balance the budget. But House Republicans have never pushed Medicare privatization beyond assuming it in their annual — but mostly symbolic — balanced budget plan. Senate Republicans have never shown much enthusiasm for the idea and it's not even clear that the House could actually pass it.
"Paul Ryan, who I admire tremendously, he's a big thinker. He's a big idea guy. I'm actually trying to figure out, 'How do we get it passed?' " added Cornyn, the top GOP vote counter. "The first test would be, 'Can it pass the House?' "
Ryan's post-election comments were especially striking because Trump made clear in the campaign that he wasn't interested in cutting Medicare. And Ryan said on Thursday that he hasn't discussed Medicare with Trump himself.
"As far as what our plans are with reforming and preserving (Medicare), that's just something we haven't discussed yet with the administration and we'll do it as the year goes on," Ryan told reporters.
"I think it would depend entirely on how committed the administration was to pushing some sort of reforms," added Thune. "I do think there are reforms that you could get north of 50 (votes) on here. But I don't know if what's being talked about (vouchers) is among those."