House Budget Chairman's Track Record on Medicare Belies His Rhetoric

Margot Sanger-Katz
National Journal

On Medicare, Rep. Paul Ryan, R-Wis., positions himself as sharply different from President Obama, saying the president has made cuts that would harm seniors who are at or near retirement while Ryan would do no such thing.

But rhetoric aside, the House Budget Committee chairman's budget—expected to be released next week—will almost certainly rely on all the same Medicare cuts he’s decrying. The best evidence for that? He’s used them in his last two budget proposals.

The part of Ryan’s upcoming budget that has received the most attention recently is his proposal for what will happen to those not yet eligible for Medicare benefits. Ryan’s recent plans have meant that future beneficiaries will have their public Medicare benefits replaced by a fixed payment they can use to buy government or private health plans.

But in defending his plan against White House criticism, he is also fond of saying that while his budget will change the program for future seniors, it will not touch benefits for those who are already enrolled. “His reforms ensure no changes for those in or near retirement, a sharp contrast to the real harm inflicted on seniors by the president’s health care law,” said Ryan spokesman Will Allison this week.

In fact, the contrast is not very sharp. The president’s health reform law included significant reductions in Medicare spending. The bill slowed the growth of future payments to hospitals and reduced subsidies to insurance companies that cover some Medicare beneficiaries. Ryan has criticized those cuts, but when he’s written his budgets, he has not proposed reversing them. In his budgets, he has assumed that other parts of the health law—those that cost the government money—would be repealed. That is clearly not going to happen now.

Last year’s budget kept the same $716 billion in Medicare cuts made by the health reform law, and then added an additional $150 billion in reductions.

It’s possible that Ryan would achieve those savings differently from the president’s health law; last year’s budget resolution and accompanying memo do not provide any such policy details. But cuts of that size could only be achieved by either reducing benefits to seniors—which would run counter to the “no harm” assurance—or through the type of pay cuts to providers and insurance carriers that the new health care law already includes, and which his office described as the “real harm inflicted on seniors.”

Ryan’s budget memos have also said that he would eliminate the health law’s Independent Payment Advisory Board, one of its cost-cutting mechanisms. That means he would need to make up the savings somewhere else to hit identical budget numbers.

Asked to clarify the statement, Allison told National Journal Daily, “Chairman Ryan’s previous budgets have always ended Obamacare’s raid on Medicare.” He did not explain how the budget could have identical Medicare program savings while eliminating the health law’s “raid.”