Donald Trump made a lot of promises to the American people during the Presidential campaign. For seniors, who supported him overwhelmingly, none was more important that his promise "not to touch" middle-class benefits in Social Security and Medicare. There's no doubt his political calculus during this campaign accurately tapped in to a core middle-class value:
"As Republicans, if you think you are going to change very substantially for the worse Medicare, Medicaid and Social Security in any substantial way, and at the same time you think you are going to win elections, it just really is not going to happen."...Donald Trump, 2013 CPAC speech, Washington Times
The problem for President-elect Trump is that the American people fully expect his administration to now keep that campaign promise. Unfortunately, preserving Medicare and Social Security benefits could be among the first of his promises to go. Trump and Republican leaders in Congress have vowed the repeal of the Affordable Care Act will be one of their first acts. For seniors, that means billions in lost Medicare benefits, the return of the Part D prescription drug donut hole and years of solvency taken from Medicare. Millions of seniors will immediately feel the effects of these Medicare cuts which will weaken the program itself.
"The Affordable Care Act strengthens Medicare's financing by increasing efforts to reduce waste, fraud and abuse; slowing the rate of increase in payments to providers; improving quality of care and phasing out overpayments to private Medicare Advantage plans, plans that are continuing to increase their enrollments each year. The impact of these provisions has already resulted in extending the solvency of the Medicare Part A Trust Fund by more than a decade and lowering Part B out-of-pocket costs for beneficiaries.
In addition to Medicare beneficiaries, the Affordable Care Act is very important to millions of adults ages 50-64 who are uninsured because they do not have access to affordable private insurance. Many of these individuals are now able to purchase private insurance even if they have pre-existing medical conditions, and costs are more affordable due to the law's limits on age rating and the subsidies available for lower-income beneficiaries.
The number of uninsured "young seniors," aged 50-64, would increase, leaving them in poorer health by the time they are eligible for Medicare - thereby increasing Medicare's costs."...NCPSSM, 2015 ACA Repeal Letter to Congress
In addition to the immediate Medicare cuts that come with the repeal of Obamacare, the Republican Congress has made it clear another top priority is to turn Medicare into CouponCare. In fact, the Medicare Payment Advisory Commission (MedPac), has already announced it will include analysis of the GOP's Medicare privatization plan in its annual report next year. The Republican plans for Medicare, passed in GOP budgets over many years was most recently described in the "A Better Way" campaign led by House Speaker Paul Ryan. It has already been embraced by Vice President-elect Mike Pence:
"What's so inspiring to me is how much consistency there is between Donald Trump and the agenda House Republicans have put forward with a 'Better Way.'"...Vice President-elect Mike Pence.
Again, President-elect Trump won't be able to have it both ways on this issue. If he wants to preserve seniors' benefits in Medicare, as promised during the campaign, then adopting a voucher plan designed to shift costs to seniors fundamentally violates that pledge. Privatizing Medicare with a voucher plan, will leave seniors and people with disabilities - some of our most vulnerable Americans - hostage to the whims of private insurance companies and making it even harder for seniors to choose their own doctors. Beneficiaries will pay more money for less coverage because vouchers will not keep up with the increasing cost of health insurance. That is how the program saves money - at seniors' expense. In fact, the Congressional Budget Office predicted the CouponCare proposal in the GOP's 2011 budget would cost seniors $20,000 more each year. Over time, this proposal will create a death-spiral ending traditional Medicare. This scheme is, by definition, the antithesis of "not touching" seniors' benefits.
This conundrum for the Trump administration doesn't end there. On Social Security, the warning signs for seniors are just as alarming. Trump advisors and the Republican platform have made it clear that "entitlements" will very likely be on the agenda of a Trump presidency.
"After the administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare. We'll start taking a hard look at those to start seeing what we can do in a bipartisan way."
"...I think that whoever [is] the next president is going to have a horrible time in dealing with this, because those entitlements will race to the front of all the economic issues we have in this country." Sam Clovis, Trump campaign Chief Policy Advisor, May 2016
"I think you're going to see him do it across the board on entitlements."
"He's not making the case because it's a political suicide to make this case. If you go up and start saying I'm going to attack Social Security, I'm going to attack Medicaid...there goes those votes. So no smart politician is going to step into this milieu."
"At the end of the day, somebody's gotta say you've got to move the retirement age up two years."...Tom Barrack, Trump Economic Advisor, August 2016
The American people have spoken. They said they wanted change - they got it. And yet, they've also made it clear they don't support cutting middle-class benefits for millions of American families who depend on Social Security and Medicare. Time will tell whether President Trump will keep the promises candidate Trump has made and what this "change" election will actually mean to workers who've earned their Social Security and Medicare benefits and expect them to be protected, as promised.