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House Speaker Paul Ryan’s dream of turning Medicaid into a block grant to the states with capped funding went up in smoke on Friday when he had to pull his bill to repeal and replace the Affordable Care Act because of a lack of votes. In drafting the bill, Ryan was enthusiastically touting it to conservative groups as an historic bill that would end a major federal entitlement program. After he passed the legislation, he was set to go after Medicare and turn it into a voucher program, which would also have ended its entitlement status. Now, it seems like Ryan’s future as House Speaker is more in doubt than Medicaid and Medicare remaining as entitlement programs.
It is also doubtful that House Republicans will want to follow Ryan with another controversial health care proposal, this one targeting seniors and the disabled. Turning Medicare into a voucher would be even harder because he does not have the support of President Donald Trump who has refused to change his campaign position of opposing cuts to Medicare and Social Security. Ryan could still try to damage Medicare in the budget process and go against Trump and Democrats there too. Perhaps a majority of the Republicans in the House are looking to cut entitlements in order to finance tax cuts and not have to cut other discretionary programs as much. Again, if more than twenty four of them are not in agreement though they will have trouble passing anything big, on the budget, tax cuts or infrastructure spending.
In fact, we may be seeing more splits between conservative and moderate Republicans. Media reports suggest that Ryan will remain as Speaker because no one else wants the job or has the votes to defeat him. What is clear though is that, for now, he is a much weakened figure. The plan he drafted to repeal and replace the Affordable Care Act was defeated for two main reasons: the large outcry from the public at town hall meetings and through other communications with members of Congress and secondly, because the bill was punitive and made life worse by taking away health care from millions of people who needed it.
Paul Ryan pursued this repeal legislation and his Medicare voucher plan as an ideological dream to reduce the role of the federal government and end entitlements. According to one recent poll, only 17% favored the bill Ryan drafted that he had to pull back in defeat. I suspect that support to turn Medicare into a voucher has about the same level of support That is why a lot of members of Congress will not be following Paul Ryan’s Medicare crusade.