Paul Ryan on Health Care

Last Updated : Aug 28, 2012

Summary

Congressman Ryan has been a long time advocate for reforming the health care system, Medicare, and Medicaid. While he has offered a number of his own solutions, he opposed the 2010 reform package known as Obamacare. His solutions for the two programs in the Path to Prosperity have been a large topic of conversation since he was selected for the Vice Presidential candidate in 2012.

Medicare Part D

Congressman Ryan supported the Medicare Part D prescription drug bill. In touting the bill's passage out of committee and its final passage, he stated that Medicare is an outdated program and that this addition would provide seniors with access to prescription drugs and extend the solvency of the program. He criticized the Democratic led plan as pushing private providers out of business and forcing everyone onto the government prescription drug plan. 

Health Care for the Uninsured Act of 2005

In 2005, Congressman Ryan put forth a plan called the Health Care for the Uninsured Act of 2005. This legislation had three main components consisting of tax deductions and tax credits. The first of these was allowing an individual who purchases a high-deductible health plan combined with an HSA and does not receive health insurance through their employer to deduct from his or her taxable income the amount of the premium. The second component was a small business tax credit that allowed small businesses to receive a refundable tax credit for contributions they make to their employees’ health savings accounts (up to $200 for a contribution into an individual HSA or $500 for a family HSA.) The final component was a subsidy of up to $1,000 for an individual or $3,000 for a family that was to go directly to the insurer.

Health Care Records

Among the changes Congressman Ryan has proposed includes plans to reduce costs by addressing health care records. These efforts include the Independent Health Record Bank Act in 2006, the Better Health Information System Act in 2006, and the Independent Health Record Trust Act in 2007. Among these pieces of legislation, the Independent Health Record Act would allow the Federal Reserve to create those individual health records and hold them. It could make money from the sell of that information as long as those funds were shared with the owners.

Medicare

Few in Congress have been sounding the alarm on the need to reform the Medicare system as long or as loud as Congressman Ryan. These calls for reform began in 2003 with the Part D implementation and continued into 2004 when Medicare trustees reports showed that Medicare was in financial trouble. Several times over many years, Congressman Ryan was critical of the failure to address the Medicare trigger. Under the requirements of the Medicare Modernization Act of 2003, if the Medicare Trustees determine the program faces a significant funding shortfall, a fast-track procedure is set in motion, requiring the President to submit a proposal that addresses Medicare’s imbalance within 15 days of the date upon which he submits his budget. Congressional Democrats turned off this “Medicare Trigger” in the 110th Congress and again in the 111th Congress. It was not waived in the 112th Congress and Congressman Ryan called out the Obama administration when that time passed and no action was taken.

The primary changes to the Medicare that were proposed by Congressman Ryan were part of the Path to Prosperity, also known as the Paul Ryan plan. When the plan was originally proposed, it was a voucher type system in which seniors were given a set amount (around $8,000) and allowed to purchase insurance from a set of private providers. The amount that each person would receive was means tested with beneficiaries with incomes below $80,000 ($160,000 for couples) receiving the full standard payment amount; beneficiaries with annual incomes between $80,000 and $200,000 ($160,000 to $400,000 for couples) receiving 50 percent of the standard amount; beneficiaries with incomes above $200,000 ($400,000 for couples) receiving 30 percent.

When this plan was originally proposed, it would involve all citizens. The current incarnation of the plan allows anyone over the age of 55 to remain within the current Medicare system. It also allows lower income people to remain on Medicaid if they quality for both.

Medicaid

The primary model for changes to Medicaid also comes from the Paul Ryan Plan. In that plan, Congressman Ryan proposes changing Medicaid to a system where people recieve a debit card that allows them to purchase health care and supplement the funds provided on that card with their own funds. 

SCHIP

Congressman Ryan opposed the reathorization and expansion of the SCHIP program in 2009. He noted that the legislation goes beyond extending SCHIP and instead expands eligibility to include families making more than $80,000 a year, loosens citizenship verification standards, and moves millions of children who already have private insurance onto government-run health care. He asserts tha the legislation attempts to pay for itself through a tax on tobacco and by attacking physician-owned hospitals. He states that the true cost of this entitlement expansion is deceptively hidden in that after five years of attracting new SCHIP enrollees, the bill abruptly cuts SCHIP funding by 65% in 2014. 

Obamacare

When the Obamacare package was originally proposed, Congressman Ryan criticized the legislation in three areas. First, he said that it was a government takeover of health care and called it a one-size fits all program that provides power for government rationing and price setting. Second, he said that it was simply another unsustainable health care entitlement with a $3 trillion cost that drives states deeper in the red and a shell game doc-fix. Finally, he stated that the bill put heavy taxes and fees on small businesses and individuals. 

As the final pieces of legislation passed the House and Senate, Congressman Ryan stated that it would exacerbate our fiscal crisis by adding trillions of dollars to our debt burden, raise taxes on families and small businesses by more than $500 billion, and dramatically expand the federal government's role in personal health care decisions.

In March of 2008, Congressman Ryan supported legislation to repeal the Independent Payment Advisory Boards in the health care law. He stated that repealing the IPAB is critical to ensuring that seniors never have to face the waiting lists and rationed care that have affected other nations who have gone down the misguided path of bureaucratic medicine.

Overall Health Care Reform

As part of the Paul Ryan plan, Congressman Ryan proposed large changes to the overall health care in the US. It created state based health care exchanges that were certified by the federal government. A tax credit is provided to assist in the purchasing of these plans, which facilitate the purchasing of insurance across state lines, and changes insurance from an employer provided system to one that is portable from job to job. The new health care exchange would prohibit exclusion for pre-existing conditions, prevent exorbitant fees, and have high risk pools.

 

Medicare Part D

On June 19, 2002 Congressman Ryan spoke on the House floor in support of the committee passage of the Medicare part D Prescription Drug plan. On June 25, he spoke again on the House floor in opposition to the Democratic version of that bill and in support of a Republican led version. On the 27th, he again spoke on the House floor in support of the final passage of the Republican version.

 

 

 

Medicare Reform Necessary

In March of 2004, Congressman Ryan issued a press statement noting a recent Medicare report showing that reform to the system was necessary to prevent the system from becomign insolvent.

 

Health Care for the Uninsured Act of 2005

In April of 2005, Congressman Ryan issued a press statement noting his support for legislation called the Health Care for the Uninsured Act of 2005.

 

Small Business Health Savings Accounts

In July of 2005, Congressman Ryan issued a press statement noting his support for legislation that would allow small businesses to have health savings accounts.

 

Independent Health Record Bank Act

In June of 2006, Congressman Ryan introduced the Independent Health Record Bank Act. This legislation created a nation wide health record system.

 

Better Health Information System Act of 2006

The Better Health Information System Act of 2006 was put forth in July of 2006 and was intended to remove barriers to creating a system to hold medical records.

 

Independent Health Record Trust Act

In July of 2007, Congressman Ryan released a press statement noting legislation that he was introducing called the Independent Health Record Trust Act. The legislation was intended to allow each person to maintain control of their own medical records.

 

Opposition to SCHIP

In August of 2007, Congressman Ryan issued a press statement noting his opposition to the planned reauthorization of the SCHIP legislation. Within the statement, Congressman Ryan notes a number of items that he opposed about the bill including cutting Medicare funds and using budget gimmicks.

 

Medicare Quality Enhancement Act

In August of 2007, Congressman Ryan introduced the Medicare Quality Enhancement Act to require Medicare to share data with outside providors to ensure that quality metrics are being met.

 

Opposition to SCHIP Veto Override

In October of 2007, Congressman Ryan issued a press statement noting his opposition to a recent vote to override a veto by President Bush on the SCHIP Reauthorization bill. He notes in the press statement a number of items within the legislation that he opposes. In a later press release, he refered to the legislation as a bait and swith.

 

 

The Need for Reform

In March of 2008, Congressman Ryan issued a press statement noting a recent report on the financial status of social security and the need to reform social security and Medicare before it is too late.

 

Statement On Medicare Trigger

In February of 2008, Congressmen Ryan issued a press statement noting that the recent report on the state of Medicare had created a trigger requiring the administration is put forth a plan to address the instability of the program.

 

Opposition to SCHIP Reauhorization

In January of 2009, Congressman Ryan issued a press statement noting his opposition to the expansion and reauthorization of the SCHIP legislaiton.

 

Early Opposition to Obamacare

In June of 2009, Congressman Ryan issued a statement noting his opposition to the Democratic plans for health care reform and his view that real reform was the Patient's Choice Act. In September of 2009, he released another statement noting what he had heard in town halls that people did not want to change what was working, but rather to fix what wasn't working. When the legislation passed the House, another statement was released noting that passage and claiming that the legislation was not about health care but rather ideology.

 

Reactions to Senate and Final Passages

In December of 2009, Congressman Ryan released a press statement noting the passage of the health care reform legislation through the Senate. When the reconciliation package passed the Congress again, he released another statement noting his opposition.

 

What Real Reform Looks Like

In March of 2010, Congressman Ryan issued a press statement noting what reforms that he would like to see made in Congress. Chief among these was Patient's Choice Act. In April of 2010, he released a press statement noting a recent CBO report that the health care reform would not meet financial promises.

 

Failure to Act on Trigger

In March of 2011, Congressman Ryan issued a press statement noting that a Medicare trigger had been initiated requiring the President to file a proposal to deal with Medicare financial shortfalls and that the Obama administration was not acting on that trigger.

 

The Class Act

In October of 2011, Congressman Ryan issued a press statement noting the administration's admition that the CLASS Act was not financially soluble.

 

Support for Repealing IPAB

In March of 2012 Congressman Ryan issued a press statement noting his support for legislation to end the Independent Payment Advisory Board.

 

Reaction to Supreme Court Ruling

In June of 2012, Congressman Ryan issued a press statement noting his reaction to the supreme court ruling on Obamacare and his view that the legislation needs to be repealed and replaced.

 

Official Website Statements

 

Campaign Website Statements

 

Voting Record

Tort Reform

In March of 2012, the House voted on HR 5, also know as the Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011. This legislation would have set a statute of limitations of three years after the date of manifestation of an injury or one year after the claimant discovers the injury for a lawsuit, made each party liable only for the amount of damages directly proportional to such party's percentage of responsibility, allowed the court to restrict the payment of attorney contingency fees, authorized punitive damages only where there is clear and convincing evidence that a person acted with malicious intent to injure the claimant, limited punitive damages to $500,000, limited noneconomic damages to $250,000, and denied punitive damages in the case of products approved, cleared, or licensed by the Food and Drug Administration (FDA), or otherwise considered in compliance with FDA standards. Paul Ryan voted in favor of the HEALTH Act.

Paul Ryan voted in favor of the HEALTH Act.

Repeal of Health Care Reform

In early 2011, the House voted on repealing the 2009-2010 health care reform legislation, called "Obamacare" by its opponents. Paul Ryan voted in favor of repealing the health care legislation.

Paul Ryan voted in favor of repealing the health care legislation.

2009-2010 Health Care Reform - Amendments

There were three significant votes on the health care reform legislation in the house. The first passed the house version, the second passed the reconciliation bill, and the third passed a bill to address "problems" in the original bills. This vote passed amendments to address the problems with the reconciliation bill. Paul Ryan voted against the health care amendments for the House and Senate bills.

Paul Ryan voted against the health care amendments for the House and Senate bills.

Health Care and Education Reconciliation Act of 2010

In March of 2010 the House voted on the Health Care and Education Reconciliation Act of 2010. The legislation was to pass the health care reform through the reconciliation process. No Republicans voted for the legislation and 22 Democrats voted against the bill. The bill passed 220-207. Paul Ryan voted against the Health Care and Education Reconciliation Act of 2010.

Paul Ryan voted against the Health Care and Education Reconciliation Act of 2010.

2009-2010 Health Care Reform - Reconciliation

After a separate version of health care reform passed in the Senate, the Democrats lost the 60 seats they needed to break a Republican filibuster. To pass the reform bill, the House passed a reconciliation bill that would allow the House and Senate versions to be combined without a separate verion passing the Senate. Paul Ryan voted against the health care reconciliation bill.

Paul Ryan voted against the health care reconciliation bill.

2009-2010 Health Care Reform Bill

The Affordable Health Care for America Act (HR 3962) was the version that passed the House. It was supported by most Democrats and only 1 Republican. Paul Ryan voted against the original health care reform bill.

Paul Ryan voted against the original health care reform bill.

Family Smoking Prevention and Tobacco Control Act

The Family Smoking Prevention and Tobacco Control Act sets up health requirements for tobacco products, sets labeling guidelines, requires tobacco companies to report the content of their products, and prescribes punishements for violating any rules. The measure passed the House 298-112. Paul Ryan voted against the Family Smoking Prevention and Tobacco Control Act.

Paul Ryan voted against the Family Smoking Prevention and Tobacco Control Act.

SCHIP

In addition to attempting overall health care reform, congress re-authorized SCHIP in 2009. SCHIP is a program to provide children with health care and fund it through tobacco taxes. The program passed with the full support of Democrats and roughly 1/4 of the Republicans. Paul Ryan voted against SCHIP.

Paul Ryan voted against SCHIP.

Medicare Part D - Final Vote

After the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 passed the Senate, it came back for a final vote in the House. It passed the House in final form 220-215. Paul Ryan voted in favor of Medicare Part D when it passed the House in final form.

Paul Ryan voted in favor of Medicare Part D when it passed the House in final form.

Medicare Part D

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is sometimes called Medicare Part D. It was a sweeping reform that created plans for the senior citizens to purchase prescription drugs. The bill iniitially passed the House 216-215. Paul Ryan voted against Medicare Part D.

Paul Ryan voted against Medicare Part D.

 

Sponsored and Cosponsored Legislation

Session-112; Bill Number-H R 2; Repealing the Job-Killing Health Care Law Act - Cosponsor

Repeals the Patient Protection and Affordable Care Act, effective as of its enactment. Restores provisions of law amended by such Act. Repeals the health care provisions of the Health Care and Education and Reconciliation Act of 2010, effective as of the Act's enactment. Restores provisions of law amended by the Act's health care provisions.

Session-112; Bill Number-H R 144; Small Business Paperwork Mandate Elimination Act of 2011 - Cosponsor

Amends the Internal Revenue Code to repeal a provision (added by the Patient Protection and Affordable Care Act) that extends to corporations that are not tax-exempt the requirement to report payments of $600 or more.

Session-111; Bill Number-H R 5141; Small Business Paperwork Mandate Elimination Act - Cosponsor

Amends the Internal Revenue Code to repeal a provision (added by the Patient Protection and Affordable Care Act) that extends to corporations that are not tax-exempt the requirement to report payments of $600 or more.

Session-111; Bill Number-H R 5111; To amend the Patient Protection and Affordable Care Act to modify special rules relating to coverage of abortion services under such Act. - Cosponsor

Amends the Patient Protection and Affordable Care Act to prohibit federal funds from being to used to cover any part of the costs of any health plan that includes coverage of abortion services. (Currently, federal funds cannot be used for abortion services and plans receiving federal funds must keep federal funds segregated from any funds for abortion services.) Requires any qualified health benefit plan offered through an Exchange that includes coverage for abortions to also offer a qualified health benefit plan through the Exchange that is identical in every respect except that it does not cover abortions.

Session-110; Bill Number-H R 3234; HSA Improvement and Expansion Act of 2007 - Cosponsor

Amends Internal Revenue Code provisions relating to health savings accounts (HSAs) to: (1) allow HSAs to incorporate flexible spending and health reimbursement arrangements; (2) increase the annual HSA contribution limitation; (3) permit the use of HSAs to purchase health insurance; (4) allow the payment of certain medical expenses incurred before the establishment of an HSA; (5) allow veterans eligible for service-connected disability benefits to establish an HSA; and (6) allow spouses to make increased catch-up contributions to a single HSA.

Session-109; Bill Number-H R 5743; HSA Improvement and Expansion Act of 2006 - Prime Sponsor

Amends Internal Revenue Code provisions relating to health savings accounts (HSAs) to: (1) allow a one-time, tax-free transfer of balances in employer flexible spending arrangements, health reimbursement arrangements, and individual retirement accounts to HSAs; (2) revise HSA eligibility criteria for spouses covered by flexible spending arrangements, individuals over age 65 automatically enrolled in Medicare part A, and veterans receiving medical benefits; (3) increase contribution limits for HSAs; (4) allow payment of high deductible health insurance premiums from HSAs; and (5) allow payment from an HSA of certain medical expenses incurred before the establishment of such HSA.

Session-109; Bill Number-H R 5559; Independent Health Record Bank Act of 2006 - Prime Sponsor

Requires the Board of Governors of the Federal Reserve System to prescribe standards for the establishment and certification of independent health record banks to store individual electronic health records. Gives an individual ownership over his/her entire health record with the right to review its contents at any time during normal business hours. Allows a bank to generate revenue through the sale of nonidentifiable and partially identifiable health information contained in the bank for research purposes, but requires that such revenue be shared with account holders and allows such revenue to be shared with health care providers and payers. Excludes any such revenue from the gross income of the bank, account holder, or health care provider or payer. Requires prior authorization by an individual before access can be given to his/her electronic health record. Permits access to a limited, authenticated information set concerning an individual for emergency response purposes without the individual's prior consent. Requires the Board of Governors, acting through the Under Secretary for Technology or other appropriate official, to: (1) develop a program to certify entities to operate independent health record banks; and (2) establish an interagency council to develop standards for federal security auditing for entities operating banks. Imposes fines and/or imprisonment for the wrongful disclosure of information collected, maintained, or made available by a record bank. Amends the Internal Revenue Code to allow a tax deduction for the cost paid by a taxpayer to maintain an independent health record bank account.

Session-109; Bill Number-H R 4157; Health Information Technology Promotion Act of 2006 - Cosponsor

Amends the Public Health Service Act to add a new title II part D (Health Information Technology). Establishes within the Department of Health and Human Services (HHS) an Office of the National Coordinator for Health Information Technology. Directs the National Coordinator to: (1) provide for a strategic plan for nationwide implementation of interoperable health information technology in both the public and private health care sectors; (2) serve as the principal advisor to the Secretary regarding such technology, and coordinate HHS policies and programs for promoting its use; (3) ensure that such policies and programs are coordinated with those of relevant federal agencies and departments; (4) identify funding sources to promote and support information technology planning and adoption in medically underserved communities; and (5) collaborate with the Agency for Healthcare Research and Quality and the Health Services Resources Administration and other federal agencies to support technical assistance and resource development for such medically underserved communities, particularly those seeking to establish electronic health information networks across providers. Declares that Executive Order 13335 shall not have any force or effect after the enactment of this Act. Requires the National Coordinator to study and report to the Congress on the development and implementation of health information technology in medically underserved communities.

Session-109; Bill Number-H R 2177; Healthcare Enhancement for Local Public Safety Retirees Act of 2005 or the HELPS Retirees Act of 2005 - Cosponsor

Amends the Internal Revenue Code to allow retired public safety officers to elect an annual exclusion from gross income up to $5,000 for distributions from governmental retirement plans for the payment of accident or health insurance or long-term care insurance.

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