Paul Ryan’s cruel vision for American health care will haunt Congress after his retirement

Amanda Michelle Gomez

Amanda Michelle Gomez Health Reporter, Think Progress

House Speaker Paul Ryan (R-WI) is on his way out the door.

But while he’s largely failed to implement his vision before retirement — that is, to repeal Obamacare and privatize every safety-net program there is — Republicans aren’t going to stop trying to do so anytime soon. In fact, they’ll likely take cues from his record.

Throughout his time in Washington, Ryan built a career on portraying himself as a deficit hawk, somehow convincing people he’s some great wonk. In 2012, The New York Times’s James Stewart praised Ryan, calling his approach to tax reform “eminently sensible.”  Former Clinton administration budget chief, Alice Rivlin, called Ryan “smart and knowledgeable” and decided to partner with him on his quest to privatize Medicare, which failed.

But in reality, there’s nothing genius about a career spent trying to cut “entitlement reforms” — code for popular health programs like Medicare and Medicaid — to validate the notion that you’re a deficit hawk. Ryan has worked to scrap nearly every safety net program in existence, while ignoring the deficit.

His most ambitious proposal — to privatize Social Security — demonstrated he was too radical for even the Bush administration.

But that didn’t stop him. While you can’t call Ryan a moderate, you can call him ambitious, even tenacious.

When midterms gave Republicans control of the House, he released in 2012 a budget proposal, the “Path to Prosperity” — in which he called for more state flexibility and “entitlement” cuts. The Director of the Office of Management and Budget under President Ronald Reagan, David Stockman, called it a “fairy-tale budget plan” and it ultimately never did pass Congress.

Finally, in 2017, with Republicans leading all three branches of government, Ryan had the power to do something. He managed to get the House to pass the most unpopular health bill in three decades. The American Health Care Act would have repealed and replaced the Affordable Care Act (ACA), left 23 million more people uninsured, created more expensive health plans, and massively cut Medicaid.

The bill’s ultimate failure in the Senate is Ryan’s biggest regret. But he takes comfort in knowing he got the ball rolling.

“It did pass the House and I’m proud of that fact,” Ryan told CNN’s Jake Tapper on Wednesday, after he announced his retirement. “So yeah, we got a lot of work to do, but I do really feel that I’ve helped contribute to advancing the cause of dealing with entitlement and I think we could make it better.” 

He’s right. He got the ball rolling for a lot of things, including Medicaid cuts.

Ryan — who said he’s been dreaming of cutting safety-net programs for the country’s most vulnerable since he was “drinking at a keg” in college — has laid much of the groundwork for the rollbacks in Medicaid we’re seeing under the Trump administration. As Vox’s Dylan Scott argued, “Trump is carrying on Ryan’s Medicaid-gutting agenda.”

Ryan initially suggested adding work requirements to Medicaid in his 2012 budget proposal. While he wasn’t able to change Medicaid’s funding structure recently, the Trump administration is now undermining the integrity of Medicaid by allowing states to add their own work rules. Already the White House has given the green-light to three states — with Arkansas rolling out its work rule as soon as June.

Ryan’s not just leaving a path forward on Medicaid. Conservatives are also continuing to promise constituents that they’ll repeal the Affordable Care Act. Sen. Dean Heller (R-NV) promised his base this just last week.

And even though Republicans haven’t been able to repeal it yet, they’ve been actively working to undermine the health care law in other ways. Over the course of his presidency so far, Trump has drastically cut outreach and advertisements, repealed the individual mandate, and used his bully pulpit only to say the ACA is repealed or imploding. This all led to 400,000 less people signing up for the ACA marketplace this year. On Monday, the Trump administration issued a new regulation, signalling his administration is trying to create a health care marketplace parallel to the Obamacare marketplace, with fewer consumer protections.

Ryan’s reach has even extended into food stamps. While Ryan wasn’t able to cut the Supplemental Nutrition Assistance Program by billions as he suggested in his 2012 proposal — his repeated calls to address fraud have stuck. The Trump administration is now considering allowing states to drug test SNAP applicants.

It would be one thing if Ryan actually was a deficit hawk. But instead, he’s leaving office — and a leadership position in a Republican-led government — with the deficit on its way to balloon to more than $1 trillion in 2020, two years earlier than previous estimates. The Congressional Budget Office specifically pointed to the tax bill that Ryan considers a major accomplishment as the reason why.

“My dad died when I was 16, the age my daughter is, and I just don’t want to be one of those people looking back at my life thinking I wish I’d spent more time with my kids,” Ryan said Wednesday, to explain his retirement. “If I spend another term they will only know me as a weekend father.”

Thing is, Ryan has spent his career actively making it harder for low-income parents to do just this — asking them to work more so they can move off public programs. Perhaps he’ll think about this when he’s unemployed and signs up for an ACA health plan.

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Reposted from Think Progress

Posted In: Allied Approaches

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