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By choosing Wisconsin Rep. Paul Ryan to be his running mate, presumptive GOP presidential nominee Mitt Romney put Medicare on the table as a major 2012 campaign issue.
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Ryan, who has served as House Budget Committee chairman since the Republicans took control of the House of Representatives in 2011, has advanced plans to control federal spending by restructuring both Medicare, the health insurance program for the elderly, and Medicaid, the federal-state health insurance program for low-income and disabled people.
But during his seven terms in Congress, Ryan has amassed a portfolio of health policy positions beyond these plans, which have won widespread support from Republicans and equally widespread denunciations from Democrats. Kaiser Health News has assembled this guide to his positions.
On reform philosophy, Ryan:
- Supports repeal of much of the 2010 health law, including the Independent Payment Advisory Board, Medicaid expansion, subsidies and the individual mandate. However, his House-passed budget plan included many of the Medicare trims that are now hot-button items in the campaign. Ryan has said that those Medicare cuts, totaling $716 billion, are included in his budget because they are part of the budgetary baseline.
- Throughout his career and most recently in the Roadmap for America’s Future, supported market-based reforms such as interstate insurance purchasing and the creation of association health plans, as well as efforts to decouple health coverage from the workplace, including removing tax incentives for employer-sponsored insurance and providing tax credits to individuals to purchase their own insurance.
- Backed a 2009 proposal – the Patients’ Choice Act – which emphasized proposals such as health promotion and disease prevention and included, among other provisions, state-based health exchanges, protections against pre-existing condition exclusions as well as insurance denials based on age or health status, and expanded health savings accounts.
In the health care marketplace, Ryan:
- Supports medical liability reforms that cap non-economic damages and assisting states in establishing “solutions to medical tort litigation.”
- Consistently supported proposals to allow the reimportation of prescription drugs.
On Medicare and aging, Ryan:
- Proposed revamping Medicare to, among other things, change it from a defined benefit to a premium-support program. Starting in 2023, Ryan’s budget would give future Medicare beneficiaries (those currently younger than 55) a set amount – a voucher — to purchase either a private health plan or the traditional government-administered program. His proposal also would increase the eligibility age from 65 to 67.
- In 2011, teamed up with Sen. Ron Wyden, D-Ore., for Medicare overhaul plan: Guaranteed Choices To Strengthen Medicare And Health Security For All.
- In 2003, voted in favor of Medicare Part D (Medicare Prescription Drug and Modernization Act of
On Medicaid, Ryan:
- Backs the idea of replacing current Medicaid program with a block grant plan in which states would receive a set amount of money to use for Medicaid programs.
- Opposed various expansions of the Children’s Health Insurance Program, arguing that the proposals expanded “bureaucracy-driven health care” and increased entitlement spending.
On abortion and contraception issues, Ryan:
- Opposed abortion rights provisions in an estimated 59 votes during his tenure in the House of Representatives – both on legislative proposals and procedural motions. He’s a member of the House Pro-Life Caucus and has a 100 percent rating from the National Right to Life Committee. He opposes all abortions, even in the cases of rape or incest, unless the mother’s life is at stake.
- Voted for an amendment to the 2011 continuing resolution that would have stopped federal support for Planned Parenthood.
Kaiser Health News has extensive coverage of Ryan’s record on health policy — a sample of which you will find below.
FAQ: Ryan’s Plan Would Make Key Changes In Medicaid, Too
Aug. 14, 2012 — How would Paul Ryan’s plan to reduce federal spending, which has been approved twice by the GOP-controlled House, change Medicaid?
FAQ: How Paul Ryan Proposes To Change Medicare
Aug. 13, 2012 — Mitt Romney’s choice for vice president has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare.
FAQ: Obama v. Ryan On Controlling Federal Medicare Spending
May 3, 2012 — Here are some questions and answers about the Democratic and Republican approaches to moderating spending on the popular program, which covers 47 million seniors and disabled people.
New Ryan Budget Would Transform Medicare And Medicaid
March 20, 2012 — The Republican chairman of the House Budget Committee surprised no one when he released a spending blueprint that would drastically reshape the Medicare and Medicaid programs for the elderly and poor in an attempt to rein in their soaring costs.
Video: Ryan On ‘Moral And Legal Obligation’ To Fix Entitlements
March 20, 2012 — House Budget Committee Chairman Paul Ryan, R-Wis., as well as Rep. Tom Price, R-Ga., said that the sweeping changes proposed to Medicare in the GOP 2013 budget would protect the program for seniors and the disabled.
Can GOP Deliver On Its Promise To Preserve Traditional Medicare?
March 8, 2012 — Proponents see the new proposal as more politically palatable than last year’s House budget that would have eliminated traditional Medicare. But critics argue it would change the current program so fundamentally that it might no longer be a desirable – or affordable — option.
House GOP 2013 Budget Proposal — Health Programs
Selections from “The Path To Prosperity,” the House Budget Committee’s 2013 budget outline (PDF).
Analysis: Wyden-Ryan Plan Could Neutralize Medicare In 2012 Election
Dec. 15, 2011 — Even with just two congressional supporters, a new Medicare overhaul plan could have big implications for next year’s congressional election.
A proposal for Medicare “premium support” by Rep. Ryan and Sen. Ron Wyden, D-Ore., released in December 2011 (PDF).
Understanding Rep. Ryan’s Plan For Medicare
April 4, 2011 — Ryan lays out a plan to convert Medicare into a premium support program for which the government will spend a specific amount for beneficiaries’ care, a fundamental shift from the current fee-for-service program.
Republican’s Controversial Proposal To Mend Medicare
Nov 2, 2010 — Ryan wrote the book, “Young Guns: A New Generation of Conservative Leaders,” with fellow House Republicans Eric Cantor of Virginia and Kevin McCarthy of California. Because the GOP is taking control of the House, they will be in position to advance their ideas.
A proposal by Ryan and Clinton OMB director Alice Rivlin, released in November 2010.
Resources And Proposals On Curbing Medicare Cost Growth
A Kaiser Health News resource with details on the competing proposals.
Ankita Rao contributed.