Medicare, like Medicaid, has long been a reform target of congressional Republicans who seek to bend the cost curve for the program that provides coverage for more than 50 million seniors at a cost of more than $500 billion per year. Last year, Speaker Paul Ryan unveiled his proposal to convert Medicare to what is known as a “premium support” program in which the federal government would provide a payment on behalf of each Medicare recipient toward the purchase of a health insurance plan either a private plan, a similar Medicare Advantage plan or traditional Medicare.