Recently I was talking with a small business owner about the privately purchased health care policy that covered the owner and spouse. They pay about $12,000 a year for a policy with a $6,000 deductible each. Preventative health maintenance with a medical professional is something that they just can’t afford. Their insurance is only to prevent financial disaster if they develop a catastrophic illness. The discussion concluded with the statement, “I can’t wait until we qualify for Medicare.”

When the Affordable Care Act (ACA) was being developed there were signs at many town hall meetings saying “Keep Your Government Hands Off My Medicare.” While some laughed because Medicare is a government program, the underlying message was clear. Medicare was a government program that seniors currently value even while aware of its flaws.

Medicare is the type of program that Republicans fear most – a government program that in general works well. Their greatest fear is that the public will say: “If Medicare works so well for the elderly, why don’t we expand it to cover younger individuals?” Medicare presents a threat to the current mantra that private is better.

Thus it was not by chance that on Feb. 16, when House Speaker Paul Ryan unveiled the outlines of Republican “repeal and replace” legislation, the outline focused on cutting back Medicaid and restructuring both private and employer-based insurance to a system that expects citizens to put money into health savings accounts to pay for premiums and deductibles and suggests that tax credits will help you save. If you don’t, or can’t save enough, that is your problem. Interestingly, Medicare is not mentioned.

But if you read the June 2016, GOP “A Better Way Healthcare Task Force” report, it becomes clear that this current legislation is the first step in eventually bringing such changes to Medicare.

A cornerstone of the Better Way proposal is to switch Medicare to a premium support program. Medicare recipients would choose a private insurance program that would provide benefits. The federal government would give that company a fixed premium support payment directly (thus the Republicans insist it is not a voucher given to the member).

Regardless of the semantics, the bottom line is that if the support doesn’t cover the cost of the selected plan, the Medicare member must pay the rest and then follow the insurance company’s particular rules regarding accessing services. Thus the quality of medical services you will receive will depend largely on what you can afford. Proponents are very unclear on how low-income seniors will receive assistance with out-of-pocket costs when they want to markedly reduce the Medicaid programs that fulfill this role.

The Republican Medicare reform plan would go into effect in 2024. If you have enrolled in Medicare before then, you won’t have to switch to the new system. The problem is that in their full health care task force report, the Republicans indicate they would like seniors to “enjoy the benefits of employment in later life.” Thus in 2020 they would raise the age at which one would qualify for Medicare to correspond with full retirement in Social Security – age 67.

I am a physician who will qualify for Medicare as it is now just before the 2020 deadline if the Republican plan is passed. I currently have private health insurance. I can assure you that I will not take this private insurance premium support option if it is offered. I’ll prefer to stick with the traditional Medicare program and purchase private supplemental insurance.

Thus if you are currently 61 or younger, you need to seriously consider if the Republican premium support/private conversion plan will work to your benefit. If the answer is no, you need to be making your opinion known to your representatives and senators as well as President Trump now.

Dr. Stephen Soltys is a retired professor emeritus who still teaches at SIU School of Medicine on a volunteer basis.