VP-elect Mike Pence dampens Paul Ryan's call for Medicare overhaul, affirms Trump promises

Vice President-elect Mike Pence on Sunday dampened speculation that Republicans would turn their attention to a major overhaul of the Medicare program for seniors next year after repealing the Affordable Care Act. He insisted that President-elect Donald Trump would honor his campaign commitment to leave Medicare and Social Security unscathed.

In an appearance on the ABC News' This Week with George Stephanopoulos, Pence indicated that Trump was sticking to his pledge first made in April 2015 to prevent congressional Republicans "from doing a big number" on Social Security and Medicare. Trump at that time insisted that such a move would be unfair to the millions of Americans who regularly pay into the retirement and health care systems assuming that they would receive full benefits when they finally retire.

"We can't do that," Trump said at that time.

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Asked today about renewed calls from House Speaker Paul Ryan (R-WI), House Budget Committee Chair Tom Price (R-GA) and others to privatize Medicare into a voucher-style system, Pence replied that Trump hasn't changed his position and that a Medicare overhaul is not on the table.

"Well, look. I think President-elect Trump made it very clear in the course of the campaign that as president, we're going to keep our promises in Social Security and Medicare," he said.

But Pence indicated that Trump's pledge wouldn't necessarily extend to the Medicaid program for 65 million low-income and disabled Americans. He said that "there's a real opportunity" for major savings by converting Medicaid from an entitlement to block grants to the states – a move that would give state officials far more latitude to set eligibility requirements and impose cost-saving measures.

Pence, the governor of Indiana, touted changes that were made in his own state since the advent of the 2010 Affordable Care Act. For example, Indiana obtained a waiver from the federal government to require beneficiaries to make a monthly contribution to health savings accounts equal to two percent of their income in order to continue to receive full benefits. Other states have initiated reforms including stricter work requirements for able-bodied beneficiaries.

"We want to give states even greater flexibility in innovating and creating the kind of health care solutions that work for their population," he said.

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Pence said that Trump and congressional Republicans would make good on their long-standing promise to repeal much of the Affordable Care Act "right out of the gate" after Trump is sworn in as the 45th president January 20. House and Senate GOP leaders are hard at work planning to dismantle Obamacare under arcane budget "reconciliation" rules that will enable the Senate to block a Democratic filibuster and approve the legislation with a simple majority.

The Republican-controlled Congress approved similar legislation last January but it was vetoed by President Obama. With Trump in the White House, the legislation is certain to be enacted within weeks of Trump taking office.

However, Pence was vague on the crucial question of how long it would take the new administration and GOP-controlled Congress to devise a replacement for Obamacare without stripping tens of millions of Americans of their health care coverage. Some senior Republicans in the House and Senate have predicted that it could take as long a two to three years to enact replacement legislation that reflects the GOP's free-market ideas.

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Trump said recently during an interview with CBS's "60 Minutes" program that the repeal and replacement of Obamacare would be done seamlessly and "simultaneously". While that clearly will not be possible, Pence insisted that there would be no change in the president-elect's stated approach

"There will be an orderly transition away from this disastrous policy," Pence said. "But the first thing we have to do is pry the enormous weight of Obamacare off the national economy. We think that will create tremendous economic growth in businesses large and small, and then setting an orderly transition process in place to capture the power of the free market."

"The president-elect has been very clear – we want to give the American people more choices, the ability to buy health insurance across state lines, these health savings accounts, but doing that in a way that doesn't upset the apple cart or create anxiety among Americans about their health care."

Pence's insistence that Medicare reform will not be part of Trump's ambitious legislative agenda heading into the new year, his statement by no means will be the final word on the matter.

Ryan had tenuous relations with Trump throughout the campaign but fully embraced the billionaire businessman after his surprise victory over Democrat Hillary Clinton Nov. 8. The House speaker described the election as a "mandate" to enact sweeping changes, even though Trump trailed Clinton in the popular vote by more than two million.

Last week Ryan told reporters he is determined to pursue major changes in Medicare next year, regardless of warnings from senior Senate Republicans that he and others might be biting off more than they can chew.

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Ryan contends that reforming Medicare and Medicaid to assure the programs' long-term financial viability must be made part of any move to replace the Affordable Care Act, which has provided health insurance coverage for more than 20 million Americans. For years, Ryan has promoted plans to convert Medicare to a premium-support system in which seniors are provided with fixed amounts of money or vouchers to purchase coverage in the private market.

Ryan included variations of this approach in past GOP budget plans when he was chair of the House Budget Committee, and then this year he highlighted that approach in his "Better Way" proposals for revamping federal health care and insurance programs. The House speaker stresses that his voucher-style approach would not impact current retirees or people nearing the retirement age, but is designed to steer future retirees into less expensive private health insurance.

"We are going to have to do things to preserve and shore up this program," he said Thursday, according to the Washington Post. "The reforms that we've been talking about here ... for many years are reforms that do not affect the benefits for anyone in or near retirement. But for those of us who are in the younger generations, the X generation on down, it won't be there for us if we stay on the current course."

Senate and House Democratic leaders already are bracing for a possible political showdown on Medicare next year, and have warned Ryan and other GOP leaders that they would be courting political disaster if they follow through with their threat. While both parties have sought to cut spending on Medicare in the past to offset the cost of other programs, efforts to make fundamental changes to the system have been met with staunch opposition from Democrats, seniors' advocates such as AARP and liberal activists.

"We say to our Republicans that want to privatize Medicare: Go try it. Make our day," Senate Minority Leader Chuck Schumer of New York said last week.

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