The only big Medicare reform idea that's been pitched in public is called 'premium support,' championed by Rep. Paul Ryan (R). Here's how it would work, and here's why Democrats deride it as a 'voucher.'
J. Scott Applewhite/AP/File
In part, that's a reference to one fundamental rift: He has demanded that any entitlement overhaul be accompanied by new tax revenue, and Republicans have said "no" with equal firmness.
For now, the big reform idea that's been pitched in public is called "premium support," championed by Rep. Paul Ryan (R) of Wisconsin.
It's a free-market approach to reform. Enrollees who reach Medicare age in 2024, or later, would receive a government "premium-support payment" that they could use to buy health coverage. Insurers would compete for their business, with benefit packages that would have to be equivalent to today's Medicare, or better.
The annual growth of the government aid – Democrats deride it as a voucher – would be capped using a process of competitive bidding by insurers.