3 health­care poli­cies Paul Ryan ul­ti­mately couldn’t sell

Modern Healthcare - - Politics - By Su­san­nah Luthi

House Speaker Paul Ryan’s sur­prise—but not sur­pris­ing— an­nounce­ment that he will re­tire from Congress at the end of this term leaves the uni­fied Repub­li­can gov­ern­ment with lit­tle to tout in terms of health­care leg­isla­tive vic­to­ries.

Dur­ing his two decades in Congress, Ryan fought to bring con­ser­va­tive ideas to the health­care de­bate. Many were de­tailed in his 2016 “A Bet­ter Way” blueprint, which laid the ground­work for the at­tempted re­peal of the Af­ford­able Care Act and many of the Trump ad­min­is­tra­tion’s reg­u­la­tory ef­forts to curb Med­i­caid growth and over­haul in­surance ex­changes.

Here are three poli­cies cham­pi­oned by Ryan, but ul­ti­mately re­jected by the pub­lic.

1 Re­peal-and-re­place

Ryan and the rest of the GOP hoped to cap­i­tal­ize on Don­ald Trump’s victory in Novem­ber 2016 and fi­nally ful­fill a seven-year pledge to cast aside Oba­macare. Yet the depth of the cuts to Med­i­caid and pro­jected loss of health cov­er­age for mil­lions of Amer­i­cans ul­ti­mately sank the ef­fort.

One ob­server noted that Ryan’s ex­pe­ri­ence as chair­man of the House Bud­get Com­mit­tee fu­eled his de­sire to cur­tail federal spend­ing, in­clud­ing Medi­care and Med­i­caid, all the while ad­vo­cat­ing tax cuts.

In years past, Ryan pro­posed cap­ping Med­i­caid fund­ing and grant­ing states more flex­i­bil­ity in set­ting cov­er­age eli­gi­bil­ity, in­clud­ing adding work re­quire­ments. While some states have added these pro­vi­sions through CMS waivers, no na­tional pol­icy has made it through Congress.

2 Medi­care premium support

Health pol­icy wonks in Wash­ing­ton, D.C., still talk about the Democrats’ cam­paign com­mer­cial blast­ing Ryan’s push for Medi­care premium support, where a dark-haired Ryan body-dou­ble pushes “Granny” off a cliff in her wheel­chair.

Yet be­fore those ad­ver­tise­ments, Ryan worked with Sen. Ron Wy­den (D-Ore.) on a premium support pro­posal lay­ing out a choice of pri­vate plans or tra­di­tional fee-forser­vice on a Medi­care ex­change.

Wy­den walked away from the idea, but Ryan kept it alive in his bud­gets and in his “Bet­ter Way” out­line. While Congress isn’t likely to take it up any­time soon, Medi­care premium support as a pol­icy re­mains closely as­so­ci­ated with Ryan.

3 De­fund­ing Planned Par­ent­hood

Ryan in his bud­gets also cham­pi­oned the idea of cut­ting Planned Par­ent­hood out of the Med­i­caid pro­gram de­spite the idea’s wide­spread un­pop­u­lar­ity.

Un­der the uni­fied Repub­li­can Congress, Ryan kept push­ing to de­fund Planned Par­ent­hood, even as op­po­si­tion from GOP Sens. Su­san Collins of Maine and Lisa Murkowski of Alaska guar­an­teed such a mea­sure wouldn’t pass in the Se­nate.

Ryan ar­gued that com­mu­nity health cen­ters could take their place in man­ag­ing poor women’s re­pro­duc­tive health.

“By putting these dol­lars in the federal com­mu­nity health cen­ters— for every Planned Par­ent­hood, there are 20 federal com­mu­nity health cen­ters—they pro­vide these kinds of ser­vices with­out all of the con­tro­versy sur­round­ing this (abor­tion) is­sue,” Ryan said dur­ing a CNN town hall last year.

AP PHOTO

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