Outgoing House Speaker Paul Ryan has been by far his party’s No. 1 champion for an aggressive overhaul of entitlement programs. He won’t accomplish that before retiring next year, but his impact on the GOP’s platform isn’t likely to fade in his absence.
Ryan forced the issue of entitlement cuts into a position of prominence within the Republican Party, largely through his earlier positions as chairman of the Budget Committee and then as Mitt Romney’s vice presidential candidate.
Medicaid: Ryan’s budget proposals called for converting federal Medicaid funding into a block grant to the states.
- That’s now one of the few pieces of health policy the GOP agrees on. Through all the hue and cry and competing ideas that ultimately sunk last year’s efforts to repeal the Affordable Care Act, steep Medicaid cuts — either through block grants or a system of spending caps — were a constant across almost every bill.
Medicare cuts have always been a harder sell politically, and none of Ryan’s potential successors have matched his energy on the issue.
- “He was a fabulous champion — maybe unequaled,” conservative economist Douglas Holtz-Eakin said.
- Ryan’s proposals would have converted Medicare from a single-payer program into a new system in which the government gave seniors a subsidy to purchase private coverage, similar to the basic structure of the ACA.
- That model, known as premium support, will still be a mainstay even without Ryan to press for it, Holtz-Eakin said.
- “Premium support can’t go away,” he said. “It solves too many of Medicare’s problems.”
The other side: Democrats would love for Holtz-Eakin to be right. Ryan's budgets never became the political poison that liberals (and some Republican strategists) had anticipated in 2012 and 2014, but you could make a strong case that they helped Democrats move back to playing offense on health care.