Republicans have called for major Medicare changes for years, but now thatthey may be in a position to push something through, some partyleaders are wary of sparking a fight over a popular program thatPresident-elect Donald Trump promised he’d protect.

“That falls under the rule of not biting off more than you canchew,” Senator Lamar Alexander of Tennessee, who chairs the Health,Education, Labor and Pensions Committee, said in an interview. “Theproblems about the solvency of Medicare should be left for anotherdebate, another discussion, and not be part of the replace andrepeal” effort on Obamacare.

Trump’s selection of House Budget Chairman Tom Price of Georgiato lead the Health and Human Services Department provokedDemocratic concerns that Republicans will try to privatize Medicarewhen they go after Obamacare.

After Trump’s victory, Price told reporters that Congress willseek to pass a Medicare overhaul as early as the fall of2017.

House Speaker Paul Ryan has pushed to transform Medicare from a program that directlypays medical bills for the elderly into a voucher-like system wherefuture seniors receive a limited subsidy to buy private insurance.He told Fox News on Nov. 10 that “Medicare has got some seriousproblems because of Obamacare, so those things are part of our planto replace Obamacare.”

Alexander’s remarks reflect hesitation among numerous Republicansenators with the idea, now that they will have control of bothchambers and the White House.

Broad hesitation

Republican Senators Ron Johnson of Wisconsin, Pat Toomey ofPennsylvania, Johnny Isakson of Georgia, Richard Shelby of Alabamaand Chuck Grassley of Iowa all stopped short of endorsing the ideaTuesday, when asked if they want to turn Medicare into a "premiumsupport" system in 2017.

The proposal is also giving a shell-shocked Democratic Party arallying cry, uniting them in opposition to a plan they believe isa losing issue for the GOP. Many Senate Democrats quickly came outagainst Trump’s plan to nominate Price, citing his support forvoucherizing Medicare.

“After the 2004 elections, Republicans tried to take the rug outfrom under our seniors to privatize Social Security. After the 2016elections, it seems they’re intent on trying the same trick onMedicare,” said Senator Chuck Schumer of New York, the incomingDemocratic leader. “Just as their efforts failed then, they willfail now.”

Two red-state Democrats facing tough re-election races in 2018,Indiana’s Joe Donnelly and West Virginia’s Joe Manchin, have comeout against such a Medicare overhaul, signaling that Republicanswon’t be able to rely on bipartisan cooperation on the idea.

“They’re talking about that. This whole thing aboutprivatization and all that -- I’m not in that camp,” Manchin toldreporters Tuesday. “I’m just not there.”

Trump’s promises

An additional complication is the president-elect’s position.Since 2015, Trump promised to be a different kind of Republican --by protecting Medicare.

“I’m not going to cut Social Security like every otherRepublican and I’m not going to cut Medicare or Medicaid. Everyother Republican is going to cut,” he said in an article posted onhis campaign website.

Four weeks before the election, he told a Florida crowd thatClinton “wants to cut your Medicare,” citing stolen e-mails showingher privately endorsing a bipartisan proposal that would haveincluded long-term cuts such as raising the eligibility age.

But since his victory, Trump may be opening the door to theidea, between the Price choice and new language on his transitionwebsite that echoes proponents of privatizing Medicare. The websitesays Trump wants to “modernize” Medicare “so that it will be readyfor the challenges with the coming retirement of the Baby Boomgeneration -- and beyond.”

A Trump transition-team spokesman didn’t return a request forcomment.

‘Radical departure’

Pursuing such a Medicare transformation would be “a radicaldeparture” and “a direct violation of what Trump said” in thecampaign, said Senator Sherrod Brown, an Ohio Democrat. “He’sbreaking his promise. He’ll also lose.”

Republicans may end up putting off Medicare changes and focusmore narrowly on the Affordable Care Act, said Rodney Whitlock, aformer health policy adviser to Grassley.

“Republicans want to repeal and replace the ACA and enact majorMedicare and Medicaid reforms. Doing all three at the same time ischallenging, bordering on impossible. Two is very possible. Theyare certain to tackle the ACA. Medicaid reforms fit more logicallywith the ACA. A major Medicare restructuring conversation at thesame time will be much harder,” Whitlock said.

An added complication would arise if Republicans succeed atrepealing Obamacare, which could mean restoring the law’s $700billion in reimbursement cuts to Medicare providers and therebyshortening its solvency, which currently extends to 2024.

Wait for replace

It’s that sort of conundrum that prompted Alexander to call forenacting an Obamacare replacement together with repeal, contrary tosome Republicans who want to repeal it immediately and worry aboutreplacing it later.

“I agree with President-elect Trump, who said those thingsshould be done simultaneously,” Alexander said. “And I think if youreplace and repeal Obamacare simultaneously, then you have tofigure out how you’re going to replace it before you repealit.”

Senate Majority Leader Mitch McConnell was mum when asked twiceTuesday whether Americans should expect a Medicare overhaul effort in 2017.

“I’m not going to speculate on what the agenda may be on avariety of different issues next year,” he told reporters. “I cantell you where we’re going to start: with a process to repeal andreplace Obamacare.”

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