Rep. Ryan as VP nominee and health policy

Rep. Ryan has focused a good deal on health policy during his career as a legislator. However, he has not used his power as Chair of the Budget Committee in the House of Representatives to push ahead into the nitty gritty of passing health reform legislation.

One of the highlights of the 2012 FY House budget passed during Spring 2011 was a general outline of Rep. Ryan’s proposal to eventually replace traditional Medicare with a voucher provided to Seniors with which to purchase private health insurance. In December of 2011, he modified his proposal, joining Democratic Sen. Ron Wyden in issuing a proposal that would allow Seniors a choice between traditional Medicare and purchasing private insurance coverage with a voucher provided by the federal government, whose amount was to be set by competitive bidding.

Putting the outline of this Medicare proposal into the budget resolution in 2011 turned out to be mostly for show; the nitty gritty of such a complicated proposal would have to be authorized by detailed legislation, and could not be done in a Budget resolution. House Republicans could have started the hard work of hammering out the details of this Medicare proposal, holding hearings, committee mark ups, CBO scores and eventually votes during the 19 months they have controlled the House of Representatives. Instead, they did nothing. For all the hubub of the 2011 budget resolution, neither the Commerce Committee nor the Ways and Means Committee–where the heavy legislative lifting will have to be done– ever took up the Medicare premium support idea at all. Not in its original, or the modified form Rep. Ryan espoused in December 2011.

Rep. Ryan also co-sponsored the Patients’ Choice Act (PCA, introduced May 20, 2009) that focuses on setting up insurance exchanges with soft individual mandates for the under 65 age group–what I called in July 2009 the most comprehensive Republican health reform alternative introduced into the last Congress. I have blogged a great deal about Rep. Ryan’s bill (co-sponsored by Nunes in House, and Burr and Coburn in Senate) (here, here, here, herehere, herehere, here) and it is a serious proposal.

However, the most important thing to know about the Patients’ Choice Act is that it has never been marked up by a House Committee or scored by the CBO. This was understandable during 2009-10 when the Democratic party controlled the House, but during the past 19 months that Republicans have controlled the House, not committing to the details of “replace” was a choice. And given the clarity with which House Republicans knew what they were against, what does it mean that none of the relevant committees (Ways and Means, Commerce, Ryan’s own Budget) even gave Ryan’s bill a hearing?

I suspect that it means that none of the committees (much less the entire House) could have passed any proposal to alter Medicare in the way envisioned by Rep. Ryan, and that a mark up of the Patients’ Choice Act would have highlighted the similarities between what Ryan was for one month before the first version of the ACA was reported by a committee in June 2009, and what became law in the ACA.

My book has a detailed comparison of the Patients’ Choice Act and the ACA that identifies what I claim in to be a bipartisan way ahead on health reform based on my reading of the ACA and Ryan’s PCA. In policy terms, a deal has always been available, and if President Obama is re-elected, I suspect a health reform deal of some sort will be cut in the next Congress, as a part of a larger deal on taxes, etc.

If Gov. Romney and Rep. Ryan win, then I assume that means Republicans will keep the House and retake the Senate. I fully expect under those circumstances that the ACA will be repealed. Lots of my friends are worried about what the Republicans will then put in place of the ACA. I am actually more worried that they would do what they have done the past 19 months in the House on replace: nothing.

update: a few tweaks for clarity; fixed a date error

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

5 Responses to Rep. Ryan as VP nominee and health policy

  1. steve2 says:

    Catching up after vacation. You probably saw this before, but I didnt realize the PCA was scored by HSI. Just in case you didnt know, link below.

    Click to access HSI_Report_on_PCHOICE_07-21-2009.pdf


    • Don Taylor says:

      Steve Parente sent it to me back in summer of 2009 and I blogged about it.
      The most interesting thing about their private scoring was that it generally showed much more insurance uptake, and in some of the initial June 2009 CBO scores that said only +16 Million with deficit increased that sent Dems back to drawing board, Steve and HSI said +40 million. Steve told me his model better at small market/individual uptake than CBO at a conference and thats why he always over predicted CBO on insurance expansions.

      • steve2 says:

        Thanks Don. TBH, I keep getting Ryan’s different plans mixed up. Now, throwing in the nonexistent Romney “plans”, it is getting worse. Hmm, maybe that is on purpose?


  2. Pingback: Health reform prospects if Gov. Romney wins « freeforall

  3. Pingback: ACA redistribution via Medicaid: what it means for future reform | freeforall

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