Paul Ryan's view on Health Care

House Republicans have taken the first steps to control Washington’s reckless spending spree by rolling back the President’s fiscally irresponsible health care law.  Businesses, policy experts, and government actuaries have confirmed what the country already knew: this law spends trillions of dollars that we don’t have, raises taxes on workers, businesses and families, and puts the federal government squarely in the middle of health-care decisions. 

Budgetary smoke and mirrors were used to claim this plan would reduce the deficit. The law relies on 10 years of tax increases and 10 years of Medicare cuts to pay for six years of new spending.  The bill raids more than $700 billion from Medicare to fuel a new $1.7 trillion open ended entitlement and ignores the $298 billion needed to avert cuts to Medicare physicians.  Even the implementation costs are hidden behind budgetary gimmicks and Washington-style accounting rules.

In addition to its impact on the deficit, the health care law is damaging to job creation and economic growth. Its dizzying maze of mandates and thousands of new regulations threaten to cripple businesses both large and small. The bill also hurts workers by encouraging employers to drop coverage and dump employees into a government-controlled exchange rather than pay the increased rates associated with new mandates in the bill.

With the recent Supreme Court ruling, 21 tax increases remain in the law, a dozen of which target Americans earning less than $200,000 per year for singles and $250,000 per year for married couples. With the national unemployment rate hovering at over 8%, keeping a job-destroying, spend-and-tax policy on the books would be irresponsible and would further diminish the prospects of a robust economic recovery. 

I raised these concerns with the President at the 2009 Blair House Summit and again when Congress took up the bill.  Since then, the Administration’s own Chief Actuary, along with a host of other independent studies, have raised many of the same concerns.

But as the House stands ready to undo this damage, some are crying foul claiming that repeal will in fact raise the deficit.  Only in Washington can repealing a massive new government-spending program be seen as adding to our fiscal problems. To be clear, the same budgetary gimmicks that were used to enact the health care law last year are still there. Nothing has changed.

All of this belies the point that our nation’s health care system is fundamentally broken. We spend more per capita on health care than any other developed nation, yet our health outcomes are worse. Republicans and Democrats both agree that the status quo in health care is unacceptable.  Congress must work diligently to improve the quality of care, lower costs, and slow the spiraling growth of programs already on the books. These are not new ideas, and I have been advocating for comprehensive patient-centered health care reform since before the health care debate began in earnest. 

We cannot afford to tinker around the edges of this fundamentally flawed law. Full repeal is a critical step towards true health care reform. 

Supreme Court Decision

On June 28, 2012, the Supreme Court affirmed that the federal mandate to purchase government-approved health insurance imposes a tax on the American people. Despite the disappointing decision on the law’s constitutionality, there is no question that the law remains terrible policy.

I remain committed to advancing reforms that realign incentives so that individuals and their doctors – not government bureaucrats or insurance company bureaucrats – are the nucleus of our health care system. This requires reforms to equalize the tax treatment of health insurance, invite true choice and competition, and ensure critical programs like Medicare and Medicaid can deliver on their promise in the 21st century.

Path to Prosperity

Our government has a spending problem—a problem so large that it is driving up our debt, hurting our nation’s ability to create jobs, and threatening our future. In the past, Washington has not been truthful about the magnitude of these problems facing our country, but we can no longer afford to put off an honest, fact-based conversation on how to solve them. Unless we act soon, government spending on health and retirement programs will crowd out spending on all other government programs, including national security, and, eventually, will consume every cent of every federal tax dollar. 

No one person or party is responsible for the looming crisis. Yet the facts are clear: major spending increases have failed to deliver promised jobs. The safety net for the poor is coming apart at the seams. Government health and retirement programs are growing at unsustainable rates. The new health care law has created a tremendous fiscal burden, and a complex, inefficient tax code is holding back American families and businesses.

The House-passed budget repeals the President’s disastrous new health care law and protects the health and retirement security of those who need it. With the creation of Medicare in 1965, the United States made a commitment to help fund the medical care of elderly Americans to ensure that a serious illness would not exhaust their life savings or the assets and incomes of their working children and younger relatives. 

Medicare’s structural imbalance threatens beneficiaries’ access to quality, affordable care. A flaw in the structure of the program is driving up health care costs, which are, in turn, threatening to bankrupt the system – and ultimately the nation. Unless Congress fixes what’s broken in Medicare, without breaking what’s working, the program will end up causing exactly what it was created to avoid – millions of American seniors without adequate health security and a younger working generation saddled with enormous debts to pay for spending levels that cannot be sustained.

It is morally unconscionable for elected leaders to cling to an unsustainable status quo with respect to America’s health and retirement security programs. Current seniors and future generations deserve better than empty promises and a diminished country. Current retirees deserve the benefits around which they organized their lives. Future generations deserve health and retirement security they can count on. By making gradual structural improvements, Congress can preserve America’s social contract with retired workers.

Recognizing the problems facing Medicare, the House Budget Proposal:

Strengthens health and retirement security by taking power away from government bureaucrats and empowering patients with control over their care.

Repeals the new health care law’s unaccountable board of bureaucrats empowered to cut Medicare in ways that would jeopardize seniors’ access to care.

Saves Medicare for current and future generations, with no disruptions for those in and near retirement.

For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.

Program growth would be determined by a competitive-bidding process – with choice and competition forcing providers to reduce costs and improve quality for seniors.

Premium support, competitive bidding, and more assistance for those with lower incomes or greater health care needs will ensure guaranteed affordability for all seniors. 

Allowing the federal government to break its promises to current seniors and to future generations is unacceptable. The reforms outlined in the budget passed by the House protect and preserve Medicare for those in and near retirement, while saving and strengthening this critical program so that future generations can count on it to be there when they retire.

Reforming Medicaid in the Path to Prosperity

The Congressional Budget Office estimates that federal spending on Medicaid, a program which provides medical care for the poor, will grow from $276 billion in 2013 to $622 billion by 2022.  This translates into an annual growth rate of 9 percent.  Should this problem continue to be ignored, Medicaid will continue to overwhelm state and federal budgets and fail the vulnerable people who need it most.

Specifically, the Path to Prosperity:

Secures the Medicaid benefit by converting the federal share of Medicaid spending into a block grant tailored to meet each state’s needs, indexed for inflation and population growth. This reform ends the misguided one-size-fits-all approach that has tied the hands of so many state governments. States will no longer be shackled by federally determined program requirements and enrollment criteria. Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations.

Improves the health-care safety net for low-income Americans by giving states the ability to offer their Medicaid populations more options and better access to care. Medicaid recipients, like all Americans, deserve to choose their own doctors and make their own health care decisions, instead of having Washington dictate those decisions for them.

Saves $810 billion over ten years, contributing to the long-term stabilization of the federal government’s fiscal path and encouraging fiscal responsibility at the state level.

All Americans will pay more because of this broken Medicaid system – and not just in higher taxes. Because Medicaid’s reimbursement rates have been ratcheted down to below-market levels, the care that Medicaid patients receive is often substandard. Offering states more flexibility for their Medicaid beneficiaries will remove the stigma Medicaid recipients face, and allow them to take advantage of a range of options available. Several of the nation’s governors have made innovative proposals to fix Medicaid. This budget encourages further efforts in this direction.