Paul Ryan on Health Care
Republican nominee for Vice President; U.S. Rep. (WI-1)
RYAN: All Republicans want to repeal and replace ObamaCare. We're having a debate about the best strategy for achieving that goal. And with the government shutdown, we're talking about discretionary spending, just government agency budgets, but it doesn't affect entitlements. ObamaCare is an entitlement like Medicare and Social Security is, and so the entitlement carries on even under a government shutdown scenario. So it's just not that simple and easy. You know, rather than sort of swinging for the fences and trying to take this entire law out with discretionary spending, I think there are more effective ways of achieving that goal. We think that we can do better by delaying this law. We've already had votes to delay; Democrats have supported us in that. There's going to be a better strategy to actually achieve our goal of ultimately replacing ObamaCare.
RYAN: Well, look, our budget is a vision document, encapsulating what we think is the right way to go-- fundamental tax reform, patient-centered health care replacing ObamaCare, getting our budget balanced. We've been criticized for repealing ObamaCare in our budget. It's not as if we woke up the day after the election and said let's change our principles.
Q: But the votes are simply not there to repeal ObamaCare. And if somehow or another Congress did repeal it, the president would almost certainly veto it, and there are certainly not enough votes for a veto override. So aren't you just kind of wasting time by saying repealing ObamaCare is how you really save money?
RYAN: Two points: #1, that just goes to show that ObamaCare is a massive budget buster. And #2, I really believe it's going to destroy the health care system in America.
RYAN: What we propose is flexible grants that go back to the states. We get rid of the bureaucracy in Washington. We think the ObamaCare expansion of Medicare is reckless. We are pushing 20 million people, into a program that's failing. More and more doctors and hospitals don't even take the program. And we want to reform Medicaid by giving states the ability to customize the Medicaid program.
Q: Can you honestly say by turning Medicaid into a block grant and giving it to the states that you can cut $770 billion out of that program, over the next 10 years, and that's going to have no impact on legitimate recipients?
RYAN: Yes. These are increases that have not come yet. By repealing ObamaCare, and the Medicaid expansions which haven't occurred yet, we are basically preventing an explosion of a program that is already failing. Prevent that growth from going because it's not going to work
RYAN: Well, first of all, it's not a voucher. It's premium support. Those are very different. A voucher is you go to your mailbox, you get a check and you go buy something. That's not what we are saying. We are saying, let's convert Medicare into a system that works like the one I have as a congressman, as federal employees. You have a list of guaranteed coverage options, including traditional Medicare. Medicare subsidizes your plan based on who you are, total subsidy for the poor and the sick, less of a subsidy for wealthy seniors. Doing it this way, harnessing the power of competition, is the best way to save Medicare for future generations. This guarantees that Medicare does not change for people in or near retirement. The problem is, Medicare is going broke.
RYAN: Absolutely. Medicare is going bankrupt. Medicare was there for my grandmother, just like it's there for my mom right now who's a Florida senior. We will honor this promise. And the best way to do it is reform it for my generation. You see, if you reform these programs for my generation, people 54 and below, you can guarantee they don't change for people in or near retirement. Here's what we're saying: Give younger people, when they become Medicare-eligible, guaranteed coverage options that you can't be denied, including traditional Medicare. Choose your plan, and then Medicare subsidizes your premiums.
BIDEN: It's a voucher. Now they got a new plan: "Trust me, it's not going to cost you any more." Folks, follow your instincts on this one.
RYAN: A hundred percent coverage for them.
Q: How do you pay for it?
RYAN: The premium support payments? By taking down the subsidies for wealthy people.
BIDEN: We will not be part of any voucher [that says] when you're 65, go out there, shop for the best insurance you can get; you're out of Medicare. You can buy back in, if you want, with this voucher, which will not keep pace with health care costs, because if it did keep pace with health care costs, there would be no savings. We will be no part of a voucher program or the privatization of Social Security.
RYAN: A voucher is you go to your mailbox, get a check and buy something. Nobody's proposing that.
If we renew the contract, we will get the same deal--with only one difference: In a 2nd term, he will never answer to you again.
In so many ways, starting with ObamaCare, re-electing this president would set in motion things that can never be called back. It would be a choice to give up so many other choices. When all the new mandates of government-run healthcare come down, the last thing the regulators will want to hear is your opinion. When the Obama tax increases start coming, nobody in Washington is going to ask whether you can afford them or not. But we the people need to think ahead, even if our current president will not, to avoid that crisis while there is still time.
ObamaCare comes to more than 2,000 pages of rules, mandates, taxes, fees and fines that have no place in a free country. You know what? The president has declared that the debate over government controlled health care is over. That will come as news to the millions of American who will elect Mitt Romney so we can repeal Obama Care.
An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn't even ask for. The greatest threat to Medicare is Obama Care and we're going to stop it.
Medicare is a promise and we will honor it. A Romney-Ryan Administration with protect and strengthen Medicare for my mom's generation, for my generation and for my kids and yours.
I will continue my efforts to keep the government out of the doctor's office and allow seniors and their doctors the freedom to decide what is best.
Unfortunately, the President's new open ended health care entitlement will exacerbate the current problems in health care. His plan has already forced people to lose their current coverage, increased premiums and will take away Medicare Advantage plans from millions of seniors.
Claims that the new entitlement will lower the federal deficit fly in the face of the facts. Adding tens of millions of new beneficiaries, who will be subsidized by the federal government, will drive up health care costs, and fees will force employers to reduce their workforces. We need to fix what is broken in health care without breaking what is working. That's why I voted to repeal this law. We need to replace it with patient centered reforms. I don't believe a bureaucrat should be in charge of your health care decisions--you should be in charge.
A month later, shortly before passage of the Affordable Health Care Act, Ryan showed his gratitude toward Obama during a health care summit by assailing the bill to the president's face as "full of gimmicks and smoke and mirrors," ticking off its quantitative errors and then characterizing it with the Frank Luntz-tested phrase "government takeover health care." Obama stared icily at the Budgeteer throughout his harangue.
Ryan sat and tried not to explode. The attack felt both gratuitous and personal to him. As he would later say, "'Autism,' 'kids with Down's syndrome,' 'maybe your grandparents' -- that's demagoguery. That's rank demagoguery, and it's beneath the office."
The Ryan proposal would convert the current Medicare program to a system under which beneficiaries received premium support payments--payments that would be used to help pay the premiums for a private health insurance policy and would grow over time with overall consumer prices. Additionally, the proposal would convert the matching payments that the federal government makes to states for Medicaid costs under current law into block grants of fixed dollar amounts beginning in 2013, and [would repeal ObamaCare]. Under the Ryan proposal, mandatory spending for health care would be about 6% of GDP in 2030 and about 5% in 2050, CBO estimates.
Paying more for health care would be particularly challenging for elderly people with less savings and lower income. However, the proposal specifies that people with sufficiently low income would receive an additional federal contribution to a medical savings account that would help them pay for their premiums and out-of-pocket medical spending. The analysis here for a typical 65-year-old does not address the impact of those accounts on the financial burden facing low-income beneficiaries.
[In the 2012 election] Americans deserve a choice--a choice between two dramatically different visions for our country's future. As conservatives, we owe Americans that choice. Look, I know there are people who are terrified at the prospect of an election with real alternative visions at stake: "Just oppose--we can win that way. Don't propose bold ideas--that's too risky." I'll admit, the easy way is always tempting. But my friends, if that's all we stand for, then what are we doing at here CPAC?
It will not be enough to repeal the President's disastrous health-care law. We must solve the problem in health care by curbing out-of-control costs that erode paychecks for working families and push quality coverage out of reach for millions of Americans.
Health care spending overall is expected to rise a bit--by less than 1% over a decade. That's because about 34 million more Americans will gain coverage. As for "millions" losin their current coverage, there's truth to that, but context is required. about 8 million low-income workers will get subsidies to go buy their own insurance in state-based exchanges.
Ryan backed his claim about stifling job creation with a CBO report. CBO said the law would have a small impact on the labor supply, and that would be mostly due to workers retiring early or working less because they would have more secure health care options.
The law is actually expected to reduce the deficit, according to the CBO, over the next two decade and beyond. It remains to be seen whether all of the cost-cutting measures will be fully implemented. But we went through various Republican claims about the supposed flaws in CBO's analysis and found the GOP assertions to be mostly bogus.
Businesses and unions from around the country are asking the Obama Administration for waivers from the mandates. Washington should not be in the business of picking winner and losers. The President mentioned the need for regulatory reform to ease the burden on American businesses. We agree--and we think his health care law would be a great place to start.
Last week, House Republicans voted for a full repeal of this law, as we pledged to do, and we will work to replace it with fiscally responsible, patient-centered reforms that actually reduce costs and expand coverage. The President's law is accelerating our country toward bankruptcy.
In the Senate, that meant employing the "nuclear option". This process known as budget reconciliation, requires only a simple majority of 51 votes to pass a bill. It had never been used--never--to push through a $1,000,000,000,000 expansion of government and to seize control of one-sixth of the economy. In the House, a process called "deem and pass" was essentially the same thing.
The ugly health-care debacle finally came to an end with final passage of the overhaul in the House on March 21, 2010. 219 House Democrats voted for the bill, 34 opposed it. No Republican, in the House or the Senate, voted for the bill. For the first time since before the Civil War, the minority party was so completely excluded from the shaping of major reform legislation that it voted unanimously against the final bill.
Through a combination of tax credits, high-risk pools, transparency, regulatory reform, and information technology, patient-centered reforms would foster a vibrant health-care marketplace. In stark contrast to Obamacare, my plan unapologetically seeks to apply our nation's timeless principles--our Founders' commitment to individual liberty, limited government and free enterprise--to today's challenges.
Rep. RYAN: No.
Pres. OBAMA: No?
Rep. RYAN: People 55 and above are grandfathered in.
Pres. OBAMA: But just for future beneficiaries, the basic idea would be that at some point we hold Medicare cost per recipient constant as a way of making sure that that doesn't go way out of whack, right?
Rep. RYAN: We drew it as a blend of inflation and health inflation. Medicare is a $38 trillion unfunded liability-- it has to be reformed for younger generations because it's going bankrupt. And the premise of our idea is, why not give people the same kind of health care plan we here have in Congress?
Employers would offer portable health insurance plans employees can keep when they change jobs (you get the $5,000 even when you are unemployed). Individuals who work for companies not offering health plans can shop for their own insurance. States could partner with the federal government to ensure high-risk individuals have access to affordable insurance.
This plan includes a provision that would allow individuals to buy health insurance from any state in the country. Currently individuals can only buy plans certified in their state. This limits competition and increases prices.
In short, the defining feature of the new Washington Way is that it strips the power of making law away from the people. This new Washington Way is designed to transfer lawmaking to a small elite group who know what is best for us. And from start to finish, the way President Obama and the Democratic majority went about supposedly fixing our health-care system has been conducted in the new Washington Way.
[Sen. DeMint, R-SC]: The Democrats have Medicare on a course of bankruptcy. Republicans are trying to save Medicare & make sure there are options for seniors in the future. Medicare will not be there 5 or 10 years from now. Doctors will not see Medicare patients at the rate [Congress will] pay.
[Sen. Ayotte, R-NH]: We have 3 choices when it comes to addressing rising health care costs in Medicare. We can do nothing & watch the program go bankrupt in 2024. We can go forward with the President's proposal to ration care through an unelected board of 15 bureaucrats. Or we can show real leadership & strengthen the program to make it solvent for current beneficiaries, and allow future beneficiaries to make choices.
Opponent's Arguments for voting No:
[Sen. Conrad, D-ND]: In the House Republican budget plan, the first thing they do is cut $4 trillion in revenue over the next 10 years. For the wealthiest among us, they give them an additional $1 trillion in tax reductions. To offset these massive new tax cuts, they have decided to shred the social safety net. They have decided to shred Medicare. They have decided to shred program after program so they can give more tax cuts to those who are the wealthiest among us.
[Sen. Merkley, D-OR]: The Republicans chose to end Medicare as we know it. The Republican plan reopens the doughnut hole. That is the hole into which seniors fall when, after they have some assistance with the first drugs they need, they get no assistance until they reach a catastrophic level. It is in that hole that seniors have had their finances devastated. We fixed it. Republicans want to unfix it and throw seniors back into the abyss. Then, instead of guaranteeing Medicare coverage for a fixed set of benefits for every senior--as Medicare does now--the Republican plan gives seniors a coupon and says: Good luck. Go buy your insurance. If the insurance goes up, too bad.
Proponent's Argument for voting Yes:
[Rep. Pitts, R-PA]: Section 4002 of PPACA establishes a Prevention and Public Health Fund, which my bill, H.R. 1217, would repeal. The PPACA section authorizes the appropriation of and appropriates to the fund from the Treasury the following amounts:
Opponent's Argument for voting No:
[Rep. Waxman, D-CA]: This bill represents the Republicans' newest line of attack to disrupt, dismantle, and to ultimately destroy the Affordable Care Act. For many years, Republicans have joined with Democrats in supporting programs to prevent disease, to promote health and, in turn, to cut health care costs. But today, the House will vote to end funding for the first and only Federal program with dedicated, ongoing resources designed to make us a healthier Nation.
Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.
Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.
Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.
Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.
Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.
Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.
SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. PALLONE. This is a comprehensive bill which will establish full mental health and addiction care parity. The Mental Health Parity Act of 1996 authorized for 5 years partial parity by mandating that the annual and lifetime dollar limit for mental health treatment under group health plans offering mental health coverage be no less than that for physical illnesses. This bill requires full parity and also protects against discrimination by diagnosis.
OPPONENT'S ARGUMENT FOR VOTING NO:Rep. DEAL of Georgia: I am a supporter of the concept of mental health parity, but this bill before us today is not the correct approach. This path will raise the price of health insurance, and would cause some to lose their health insurance benefits and some employers to terminate mental health benefits altogether.
The bill's focus is also overly broad. Our legislation should focus on serious biologically-based mental disorders like schizophrenia and bipolar disorder, not on jet lag and caffeine addiction, as this bill would include. There are no criteria for judicial review, required notice and comment, or congressional review of future decisions.
I would ask my colleagues to vote "no" today so that we can take up the Senate bill and avoid a possible stalemate in a House-Senate conference on an issue that should be signed into law this Congress.
LEGISLATIVE OUTCOME:Bill passed House, 268-148
CONGRESSIONAL SUMMARY: This Act would enroll all 6 million uninsured children who are eligible, but not enrolled, for coverage under existing programs.
PRESIDENT'S VETO MESSAGE: Our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. My Administration strongly supports reauthorization of SCHIP. [But this bill, even with changes, does not meet the requirements I outlined].
It would still shift SCHIP away from its original purpose by covering adults. It would still include coverage of many individuals with incomes higher than the median income. It would still result in government health care for approximately 2 million children who already have private health care coverage.
SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill protects health insurance coverage for some 6 million children who now depend on SCHIP. It provides health coverage for 3.9 million children who are eligible, yet remain uninsured. Together, this is a total of better than 10 million young Americans who, without this legislation, would not have health insurance.
The bill makes changes to accommodate the President's stated concerns.
Proponents support voting YES because:
Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:
Opponents recommend voting NO because:
Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:
Veto message from President Bush:
Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.
Proponents support voting YES because:
This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.
It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses. HR4 does not require using the Department of Veterans Affairs' price schedule.
Opponents support voting NO because:
Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.
Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.
The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.
Repeals the Patient Protection and Affordable Care Act, effective as of its enactment. Restores provisions of law amended by such Act.
Repeals the health care provisions of the Health Care and Education and Reconciliation Act of 2010, effective as of the Act's enactment. Restores provisions of law amended by the Act's health care provisions.
|2012 Governor, House and Senate candidates on Health Care:||Paul Ryan on other issues:|
Newly-elected Democrats taking office Jan.2015:
AZ-7: Rep.-Elect Ruben Gallego
CA-11:Rep.-Elect Mark DeSaulnier
CA-31:Rep.-Elect Pete Aguilar(R⇒D)
CA-33:Rep.-Elect Ted Lieu
CA-35:Rep.-Elect Norma Torres
FL-2: Rep.-Elect Gwen Graham(R⇒D)
HI-1: Rep.-Elect Mark Takai
MA-6: Rep.-Elect Seth Moulton
MI-12:Rep.-Elect Debbie Dingell
MI-14:Rep.-Elect Brenda Lawrence
NE-2: Rep.-Elect Brad Ashford(R⇒D)
NJ-12:Rep.-Elect Bonnie Coleman
NY-4: Rep.-Elect Kathleen Rice
PA-13:Rep.-Elect Brendan Boyle
VA-8: Rep.-Elect Donald Beyer
Seated in special elections 2013-2014:
AL-1: Bradley Byrne(R)
IL-2: Robin Kelly(D)
LA-5: Vance McAllister(R)
MA-5: Katherine Clark(D)
MO-8: Jason Smith(R)
NJ-1: Donald Norcross(D)
SC-1: Mark Sanford(R)
VA-7: Dave Brat(R)
Newly-elected Republicans taking office Jan.2015:
AR-2: Rep.-Elect French Hill
AR-4: Rep.-Elect Bruce Westerman
AL-6: Rep.-Elect Gary Palmer
CA-25:Rep.-Elect Steve Knight
CA-45:Rep.-Elect Mimi Walters
CO-4: Rep.-Elect Ken Buck
FL-26:Rep.-Elect Carlos Curbelo(D⇒R)
GA-1: Rep.-Elect Buddy Carter
GA-10:Rep.-Elect Jody Hice
GA-11:Rep.-Elect Barry Loudermilk
GA-12:Rep.-Elect Rick Allen(D⇒R)
IA-1: Rep.-Elect Rod Blum(D⇒R)
IA-3: Rep.-Elect David Young
IL-10:Rep.-Elect Robert Dold(D⇒R)
IL-12:Rep.-Elect Mike Bost(D⇒R)
More newly-elected Republicans taking office Jan.2015:
LA-5: Rep.-Elect Ralph Abraham
LA-6: Rep.-Elect Garret Graves
ME-2: Rep.-Elect Bruce Poliquin(D⇒R)
MI-4: Rep.-Elect John Moolenaar
MI-8: Rep.-Elect Mike Bishop
MI-11:Rep.-Elect Dave Trott
MN-6: Rep.-Elect Tom Emmer
MT-0: Rep.-Elect Ryan Zinke
NC-6: Rep.-Elect Mark Walker
NC-7: Rep.-Elect David Rouzer(D⇒R)
NH-1: Rep.-Elect Frank Guinta(D⇒R)
NJ-3: Rep.-Elect Tom MacArthur
NV-4: Rep.-Elect Cresent Hardy(D⇒R)
NY-1: Rep.-Elect Lee Zeldin(D⇒R)
NY-21:Rep.-Elect Elise Stefanik(D⇒R)
NY-24:Rep.-Elect John Katko
OK-5: Rep.-Elect Steve Russell
PA-6: Rep.-Elect Ryan Costello
TX-4: Rep.-Elect John Ratcliffe
TX-23:Rep.-Elect Will Hurd
TX-36:Rep.-Elect Brian Babin
UT-4: Rep.-Elect Mia Love(D⇒R)
VA-10:Rep.-Elect Barbara Comstock
WA-4: Rep.-Elect Dan Newhouse
WI-6: Rep.-Elect Glenn Grothman
WV-2: Rep.-Elect Alex Mooney
WV-3: Rep.-Elect Evan Jenkins(D⇒R)
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