On the campaign trail, both former President Donald Trump and Vice President Kamala Harris are eager to portray themselves as guardians of Medicare. Each presidential candidate accuses the other of backing spending cuts and other policies that would damage the health insurance program for older Americans. But the election's outcome could alter the very nature of the nearly 60-year-old federal program.
More than half of Medicare beneficiaries are already enrolled in plans, called Medicare Advantage, run by commercial insurers, and if Trump wins, that proportion is expected to grow — perhaps dramatically. Trump and many congressional Republicans have already taken steps to aggressively promote Medicare Advantage. And Project 2025, a political wish list produced by the conservative Heritage Foundation for the next presidency, calls for making insurer-run plans the default enrollment option for Medicare.
Such a change would effectively privatize the program, because people tend to stick with the plans they're initially enrolled in, health analysts say. Trump has repeatedly tried to distance himself from Project 2025, though the document's authors include numerous people who worked in his first administration. Conservatives say Medicare beneficiaries are better off in the popular Advantage plans, which offer more benefits than the traditional, government-run program.
Critics say increasing insurers' control of the program would trap consumers in health plans that are costlier to.