House Speaker Paul Ryan has long been eying a chance to make dramatic changes to Medicare.

But former Gov. Tommy Thompson says that’s not likely to happen anytime soon, given the list of big issues Congress and President Trump are looking to tackle.

“You can only gore so many cows and still remain standing,” Thompson told a luncheon in Madison this week, noting the 2018 election year looms large. “You’ve gotta pick your fights.”

Ryan has been looking to get private plans to compete along the traditional Medicare program and giving recipients premium support payments. But critics like the AARP call it a voucher system that will cost seniors and shortchange Americans currently paying to participate in Medicaid later on.

Trump has been cool to that proposal, with White House Chief of Staff Reince Priebus telling CBS last month Trump isn’t looking to “meddle” with Medicare or Social Security.

Thompson predicted Trump would win the fight, though he said Ryan has “hit his place in history” and called him “extremely bright.” But he said the list of big issues such as tax reform, cybersecurity and infrastructure is daunting and will take priority over Medicare.

Congress, he added, really only has this year to tackle those issues before the 2018 election season starts and lawmakers start “getting skittish.” Thompson said figuring out those solutions will be tough but he’s “got a lot of confidence and faith in Paul.”

“I think they can get it done, but it’s not gonna be easy,” he said. “They thought it would be easy to just repeal Obamacare and then three months later come back in and replace it. Not gonna happen.”

Ryan and other Republicans, he said, will be busy in the coming months trying to figure out what to do with Obamacare. Thompson, the former secretary of the U.S. Department of Health and Human Services, said “nobody seems to know exactly” when a repeal will happen or what will take its place.

“Every day, it’s a new fight and a new problem,” he said.

Thompson did predict Republicans will turn Medicaid funding into block grants so states can have more flexibility, which Wisconsin GOP leaders have asked for. He also said Republicans will ensure that people can buy insurance across state lines, though he noted a difficulty would be figuring out which state or states regulate the insurers.

But there are several other points of disagreement among Republicans, chief among them how to establish the level of block grant funding for each state. Another major sticking point is whether to get rid of Obamacare’s Medicaid expansion, as some GOP leaders in states that took the expansion press to keep those expanded coverage levels.

Ultimately, Thompson said he expects a “piecemeal” approach to replacing Obamacare, which will include keeping some of its more popular aspects.

But any plan, he said, will not just have to get enough Democratic votes in the Senate but also has to unite Republicans.

“Getting Republicans together is going to be a bigger problem than finding the eight Democratic senators,” he said.

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