Medicare, like Medicaid, has long been a reform target of congressional Republicans who seek to bend the cost curve for the program that provides coverage for more than 50 million seniors at a cost of more than $500 billion per year. Last year, Speaker Paul Ryan (R-WI) unveiled his proposal to convert Medicare to what is known as a "premium support" program in which the federal government would provide a payment on behalf of each Medicare recipient toward the purchase of a health insurance plan – either a private plan, a similar Medicare Advantage plan or traditional Medicare. This transition of Medicare from an open-ended entitlement program to a premium support program has drawn the ire both of congressional Democrats and advocates for elderly Americans.

As part of his Better Way agenda, Speaker Ryan also proposes to raise the Medicare eligibility age to 67, repeal the Independent Payment Advisory Board, and make additional reforms aimed at lowering costs to the federal government and placing Medicare on stronger financial footing.

Takeaway: Speaker Ryan has ambitions plans for Medicare aimed at transforming the program to a "premium support" program. The change would be the most significant change to the system since Medicare's passage in 1965. However, chances are not great that the reforms will move forward, as President Trump has expressly ruled out changes to the Medicare system, and, given the slim majority for Senate Republicans, it is uncertain any measure would be able to pass the Senate.