Paul Ryan to Retire With Few Health Policy Wins (1)

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By Alex Ruoff

House Speaker Paul Ryan (R-Wis.) will retire at the end of this year likely without achieving his main health policy goals: repealing Obamacare and reforming Medicare.

Ryan announced April 11 he won’t seek re-election this year but will finish the year as the top Republican in the House. Brendan Buck, counselor to the speaker, said Ryan would “run through the tape” by fundraising for other conservatives and passing legislation.

House conservatives told reporters after Ryan’s announcement that they want him to be bold in his final year as a legislator by seeking the entitlement reforms and budget cuts he failed to achieve in the last spending bill passed by Congress.

“Sometimes when someone is leaving they become more bold and not less,” Rep. Mark Meadows (R-N.C.), head of the arch-conservative House Freedom Caucus, told reporters.

Rep. Mark Walker (R-N.C.), chairman of the conservative Republican Study Committee, told reporters he thinks Ryan may make a final push on entitlement reforms this year.

“I just think that’s been important to him for two decades,” Walker said.

Unlikely Changes

But Republican lobbyists told Bloomberg Law there’s little sign conservatives can actually pass the kind of entitlement reform Ryan has long sought: Medicare premium support, often called “voucherizing” of Medicare.

Ryan said in mid-December that Congress is “going to have to get back at entitlement reform” in 2018. He did not discuss any particular reform details, but the speaker said he discussed Medicare reform with President Donald Trump and has pushed to partially privatize Medicare.

There has been little substantial talk about reforming Medicare this year, however, largely out of fear it could cost Republicans in the upcoming midterm elections. With Ryan gone, there’s little sign Congress will take up the subject after the elections either.

“Losing Speaker Ryan’s leadership and passion for these issues will almost certainly make the road to these reforms longer and more difficult,” Dean Rosen, who works at the lobbying firm Mehlman, Castagnetti, Rosen & Thomas, told Bloomberg Law.

In 2012, Ryan, who then was chairman of the House Budget Committee, unveiled a plan with Sen. Ron Wyden (D-Ore.) to give seniors vouchers that could be used to purchase a private insurance plan or traditional Medicare.

Ryan’s Medicare plan has created a framework for Republicans looking to curb entitlement spending, particularly for the insurance program for the elderly, and gave the movement a prominent spokesman, Rep. Phil Roe (R-Tenn.) told Bloomberg Law.

Replacing him as the face of Medicare reform will be difficult, he said.

“He set the stage for us with his knowledge and his leadership,” Roe said.


Ryan has left his stamp on how congressional Republicans look at Medicaid, the public health insurance program for the poor.

When he led the Budget Committee, Ryan proposed adding work requirements to the Medicaid program. Work requirements are now a mainstay of conservative health policy. He also wanted to overhaul Medicaid and the Children’s Health Insurance Program, turning them into voucher programs largely run by the states.

In their failed effort to overhaul the Affordable Care Act in 2017 Republicans, led by Ryan in the House, set their sights on not just rolling back the health law’s expansion of Medicaid but also turning it into a block grant program.

—With assistance from Erik Wasson (Bloomberg News)

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Brian Broderick at

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