Rising to the top
Industry groups quiet about Ryan’s effect on policies
Mitt Romney’s selection of Rep. Paul Ryan (R-Wis.) as his GOP vice presidential running mate raised Medicare and Medicaid as top campaign issues across the country, but healthcare industry groups were relatively mum last week about how Ryan’s addition to the Republican ticket will affect their policy agendas.
“I don’t think we’re changing our messaging, and I don’t think other folks are changing theirs,” said Shawn Gremminger, assistant vice president for legislative affairs at the National Association of Public Hospitals and Health Systems, which represents the nation’s safety-net providers.
“I think people are going back to the Ryan proposal,” he said, adding that entitlement reform will certainly be a discussion in 2013, and that Romney’s choice of Ryan “puts a finer point on where Romney will be if he’s elected.”
Marie Watteau, a spokeswoman with the American Hospital Association, said in an email that “clearly, the choice of Paul Ryan as VP candidate elevates the Medicare issue,” but that the organization would not be able to comment further for this story. A representative for the Federation of American Hospitals was not available for an interview last week, and a spokeswoman for America’s Health Insurance Plans said the group was not able to comment at this time.
As chairman of the powerful House Budget Committee, the 42-year-old Ryan made national headlines in April 2011 when his controversial fiscal 2012 budget—called the Path to Prosperity—proposed sweeping entitlement program changes that would offer a premium-support model for Medicare and transform Medicaid to a block grant program. His budget for fiscal 2013, which passed in the House but went nowhere in the Senate, called for similar reforms and was significant for mapping out the Republicans’ policy agenda for the coming year. Now the question is whether Ryan will push that agenda as an eight-term congressman (Wisconsin law allows him to run concurrently) or as the nation’s vice president.
Also, the healthcare industry should also prepare for another attempt to overturn the Patient Protection and Affordable Care Act if Romney and Ryan win in November. Romney has said that he would seek to restore the $716 billion spending reductions to Medicare embedded in the law, but he has not specified
how he would do that.
In response to a question for this story, Lanchee Chen, Romney’s policy director, sent a statement that said, “Mitt Romney and Paul Ryan have always been fully committed to repealing Obamacare, ending President Obama’s $716 billion raid on Medicare, and tackling the serious fiscal challenges our country faces. A Romney-Ryan administration will restore the funding to Medicare, ensure that no changes are made to the program for those 55 and or older, and implement the reforms that they have proposed to strengthen it for future generations.”
Among those reforms is a plan—which Ryan outlined in his budget—to transform Medicaid into a block-grant program for states. Edwin Park, vice president for health policy at the Center for Budget and Policy Priorities, said Ryan’s plan for block grants and cutting the program by $800 billion over 10 years will result in huge cuts to eligibility, benefits and provider rates.
“For hospitals in particular, not only would the House plan repeal the ACA but block grants would lead to more uninsured,” Park said. “These are real fundamental changes to the program, and that would ultimately have a caseload impact on providers.”
Anders Gilberg, senior vice president of the Medical Group Management Association government affairs staff, said the selection of Ryan will not change the group’s advocacy efforts, which will continue to focus on repealing the sustainable growth-rate formula that Medicare uses to pay physicians.
“You’ve got the short-term issue of the 27% cut on Jan. 1 and then the $300 billion to $400 billion cost to fully repeal (the SGR) as part of Medicare reform or deficit reduction or both,” Gilberg said. “It remains to be seen how much the administration affects those debates versus the Congress.”
During a normally quiet August recess, leaders of both political parties sent electronic messages and alerts last week that indicated they’re gearing up for an intense fight over Medicare in the months ahead. Democrats continue to assert that the Ryan budget will “end Medicare as we know it” and increase costs to seniors by about $6,400. Republicans say their plan will save the program for future generations, while the current administration cut Medicare payments by $716 billion over 10 years to fund the 2010 healthcare reform law.
“Ryan was certainly an interesting pick,” said the NAPH’s Gremminger. “In a lot of ways, it comes down to how good Paul Ryan is—and he’s very good; he’s very smart, a terrific speaker—versus his budget, which is unpopular among voters,” he added. “Can Paul Ryan’s skills as a candidate outweigh the drag that his budget is?”
Republicans say Ryan’s budget will keep Medicare running, while Democrats maintain the plan would end the program.