“I never thought I’d be speaker,” Paul Ryan wrote in a letter to colleagues. “But I pledged to you that if I could be a unifying figure, then I would serve – I would go all in.”

On October 29, Ryan won the election with an overwhelming majority (236 votes in favor, only nine against) to become the youngest Speaker of the House since 1869.

There’s been a lot of talk since then about what he plans to do and how he intends to make peace between the factions that be. But unification isn’t the only topic on the table.

The 2016 election means high stakes for Medicare

“It’s now conventional wisdom in the Republican Party that Medicare should be converted into a defined-contribution program to prod seniors into private Medicare plans and cap spending,” said Harris Meyer at Modern Healthcare. That being the case, there’s a good chance that Republicans will strike out in that direction, especially if next November puts the GOP at the helm of Congress and the White House.

What, specifically, might the move entail? Both Jeb Bush and Marco Rubio support a plan to convert Medicare into a voucher program, in which the federal government would make a fixed monthly contribution that beneficiaries could use either to pay for Medicare or to purchase the private plan of their choice.

Pros and cons? On one hand, the voucher program could keep Medicare spending in check by introducing private competition to the game. On the other, it could inadvertently bring costs down upon beneficiaries, especially those already struggling with hardship or illness.

Bush and Rubio aren’t the only ones brainstorming changes to Medicare. Governor Chris Christie is pushing to raise the age of eligibility. Ryan, too, has proposed his own plans to restructure the program, similar to the voucher model.

Since Ryan’s ascent to Speaker, the unknowns take on new urgency. Will Republicans move to restructure Medicare immediately as a symbolic gesture, a foreshadowing of the changes that the party would like to make to Obamacare? Or will the GOP take a more conservative stance?

Oddly enough, in this case Donald Trump is a more moderate voice, questioning whether Medicare reform is really what we need at this moment. Both he and Mike Huckabee have argued for other ways to bring Medicare costs down; for example, reducing expenses by treating chronic disease more effectively.

In any case, questions are brewing around Ryan’s new position. Will he succeed in uniting a GOP that’s currently fractured in several directions? Will his first moves earn bipartisan support? More importantly, how will Medicare change over the next several months and years in response to Ryan’s influence?

His first steps will set the tone. Subscribe to our blog to get the latest on Medicare reform, and be the first to know how changes in the program are likely to impact your business.

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