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Paul Ryan on Health Care

Republican nominee for Vice President; U.S. Rep. (WI-1)


Honor our Medicare promise by reforming system for young

Q: Will benefits for Americans under Medicare have to change for the program to survive?

RYAN: Absolutely. Medicare is going bankrupt. Medicare was there for my grandmother, just like it's there for my mom right now who's a Florida senior. We will honor this promise. And the best way to do it is reform it for my generation. You see, if you reform these programs for my generation, people 54 and below, you can guarantee they don't change for people in or near retirement. Here's what we're saying: Give younger people, when they become Medicare-eligible, guaranteed coverage options that you can't be denied, including traditional Medicare. Choose your plan, and then Medicare subsidizes your premiums.

BIDEN: It's a voucher. Now they got a new plan: "Trust me, it's not going to cost you any more." Folks, follow your instincts on this one.

Source: 2012 Vice Presidential debate , Oct 11, 2012

Nobody is proposing vouchers; it's a check in the mailbox

Q: What is your specific plan for seniors who really can't afford to make up the difference in the value of what you call a premium support plan and others call a voucher?

RYAN: A hundred percent coverage for them.

Q: How do you pay for it?

RYAN: The premium support payments? By taking down the subsidies for wealthy people.

BIDEN: We will not be part of any voucher [that says] when you're 65, go out there, shop for the best insurance you can get; you're out of Medicare. You can buy back in, if you want, with this voucher, which will not keep pace with health care costs, because if it did keep pace with health care costs, there would be no savings. We will be no part of a voucher program or the privatization of Social Security.

RYAN: A voucher is you go to your mailbox, get a check and buy something. Nobody's proposing that.

Source: 2012 Vice Presidential debate , Oct 11, 2012

Regulators don't want your opinion on ObamaCare mandates

Obama's whole case these days is basically asking us to forget what he promised four years ago, and focus instead on his new promises. He made those ringing promises to get elected. Without them, he wouldn't be president. But here's the question: If Barack Obama's promises weren't good then, what good are they now?

If we renew the contract, we will get the same deal--with only one difference: In a 2nd term, he will never answer to you again.

In so many ways, starting with ObamaCare, re-electing this president would set in motion things that can never be called back. It would be a choice to give up so many other choices. When all the new mandates of government-run healthcare come down, the last thing the regulators will want to hear is your opinion. When the Obama tax increases start coming, nobody in Washington is going to ask whether you can afford them or not. But we the people need to think ahead, even if our current president will not, to avoid that crisis while there is still time.

Source: Speech at 2012 Values Voters Summit , Sep 14, 2012

ObamaCare's mandates & fines have no place in a free country

Here we were faced with a massive job crisis so deep that if everyone out of work stood in single file, that unemployment line would stretch the length of the entire American continent. You would think that any president, whatever his party, would make job creation and nothing else his first order of economic business, but this president didn't do that. Instead, we got a long, divisive, all or nothing attempt to put the federal government in charge of health care.

ObamaCare comes to more than 2,000 pages of rules, mandates, taxes, fees and fines that have no place in a free country. You know what? The president has declared that the debate over government controlled health care is over. That will come as news to the millions of American who will elect Mitt Romney so we can repeal Obama Care.

Source: 2012 Republican National Convention speech , Aug 29, 2012

Protect Medicare as an obligation to grandparents

The biggest, coldest power play of all in ObamaCare came at the expense of the elderly. You see, even with all the hidden taxes to pay for the health care takeover, even with the new law and new taxes on nearly a million small businesses, the planners in Washington still didn't have enough money; they needed more. They needed hundreds of billions more. So they just took it all away from Medicare, $716 billion funneled out of Medicare by President Obama.

An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn't even ask for. The greatest threat to Medicare is Obama Care and we're going to stop it.

Medicare is a promise and we will honor it. A Romney-Ryan Administration with protect and strengthen Medicare for my mom's generation, for my generation and for my kids and yours.

Source: 2012 Republican National Convention speech , Aug 29, 2012

Choice of Medicare or certified plan, starting in 2022

I have introduced comprehensive health care reform legislation that redesigns Medicare for those 55 and younger, protects access to health care services for beneficiaries, and restores the fundamental relationship between doctors and patients. I preserve the current Medicare system for those in or near retirement. For those who will reach retirement age in 2022, my proposals will give individuals the opportunity to either stay in the traditional Medicare program or purchase a Medicare-certified plan of their choosing. Medicare will provide a premium-support payment to individuals and those who are sicker will receive greater assistance. It is also adjusted for income, so that low-income seniors will also receive additional assistance to cover their out out-of-pocket costs.

I will continue my efforts to keep the government out of the doctor's office and allow seniors and their doctors the freedom to decide what is best.

Source: 2012 House campaign website, ryanforcongress.com, "Issues" , Aug 11, 2012

Replace ObamaCare with patient-centered reforms

No one should face bankruptcy because of a catastrophic illness; no one should be denied health coverage because they are considered "uninsurable."

Unfortunately, the President's new open ended health care entitlement will exacerbate the current problems in health care. His plan has already forced people to lose their current coverage, increased premiums and will take away Medicare Advantage plans from millions of seniors.

Claims that the new entitlement will lower the federal deficit fly in the face of the facts. Adding tens of millions of new beneficiaries, who will be subsidized by the federal government, will drive up health care costs, and fees will force employers to reduce their workforces. We need to fix what is broken in health care without breaking what is working. That's why I voted to repeal this law. We need to replace it with patient centered reforms. I don't believe a bureaucrat should be in charge of your health care decisions--you should be in charge.

Source: 2012 House campaign website, ryanforcongress.com, "Issues" , Aug 11, 2012

Patients' Choice Act: untie health coverage from employment

To tackle our health care crisis, I have introduced legislation--The Patients' Choice Act --that equalizes the discriminating tax treatment of health care so that you are not tied to your employer for coverage. My proposal provides all Americans with an advanceable, refundable tax credit. My proposal gives workers and families the freedom to acquire a plan that best suits their needs, and people will no longer live in fear of losing their health care if they lose their job. My proposal gives portability to individuals and greater flexibility to small businesses to help their employees purchase health insurance through the establishment of association health plans.My comprehensive proposal also includes:
Source: 2012 House campaign website, ryanforcongress.com, "Issues" , Aug 11, 2012

Under age 54, provided with subsidy for private insurance

Ryan's Path to Prosperity would "save Medicare" by providing those under the age of 54 with a subsidy known as "premium support" -- he assiduously avoided the politically toxic term "voucher" -- to help purchase a coverage option from a private insurer. It would also "repair a broken Medicaid system" by shifting the federal burden over to the states and compensating them with block grants. The Cato Institute labeled the budget "a huge opportunity to improve health care."
Source: Do Not Ask What Good We Do, by Robert Draper, p.140 , Apr 24, 2012

2008 signature plank: reconfigure Medicare & Medicaid

As the new Budget Committee ranking member in 2007, Paul Ryan earned the right to produce the GOP's budgetary alternative to that of the Democratic majority. Strikingly, 40 Republicans -- 20% of the entire conference -- found his budget too austere and sided with the Democrats in defeating it. Undaunted, the Budget Committee ranking member went at it again in 2008 -- this time with a budget that featured what would become, for better or worse, Ryan's signature planks: reconfiguring Medicare and Medicaid. Again, 20% of the Republicans voted against their own budget. A month later, Ryan refined and repackaged his budget, dubbing it a "Road Map for America's Future." By the time it went to the House floor on April 2, 2009, Ryan was calling his budget "The Path to American Prosperity." Notwithstanding the new label, precisely the same number of Republicans voted against it as they had the previous year.
Source: Do Not Ask What Good We Do, by Robert Draper, p.137 , Apr 24, 2012

ObamaCare is government takeover of healthcare

The only public official in Washington who seemed willing to publicly give Ryan his props was Barack Obama. While visiting a Republican conference in January 2010, the president waved a copy of the Road Map over his head and said, "I think Paul, for example, head of the Budget Committee, has looked at the budget and has made a serious proposal. I've read it. I can tell you what's in it. And there are some ideas in there that I would agree with, but there are some ideas that we should have a healthy debate about, because I don't agree with them."

A month later, shortly before passage of the Affordable Health Care Act, Ryan showed his gratitude toward Obama during a health care summit by assailing the bill to the president's face as "full of gimmicks and smoke and mirrors," ticking off its quantitative errors and then characterizing it with the Frank Luntz-tested phrase "government takeover health care." Obama stared icily at the Budgeteer throughout his harangue.

Source: Do Not Ask What Good We Do, by Robert Draper, p.138 , Apr 24, 2012

Obama: Ryan's budget plan ends Medicare as we know it

A senior White House official would later claim that the president and his speechwriters had been unaware that Ryan had been invited to the event. Obama's speech that afternoon amounted to a stern rebuke of the Path to Prosperity. "It's a vision that says America can't afford to keep the promise we've made to care for our seniors. Put simply, it ends Medicare as we know it. Many are someone's grandparents who wouldn't be able to afford nursing home care without Medicaid. Some are middle-class families who have children with autism or Down's syndrome.These are the Americans we'd be telling to fend for themselves."

Ryan sat and tried not to explode. The attack felt both gratuitous and personal to him. As he would later say, "'Autism,' 'kids with Down's syndrome,' 'maybe your grandparents' -- that's demagoguery. That's rank demagoguery, and it's beneath the office."

Source: Do Not Ask What Good We Do, by Robert Draper, p.142-143 , Apr 24, 2012

Seniors are threatened with denied access to care

Over the past century, the American people have sought to furnish a strong and stable base of health and retirement security for working families. In a free society built on entrepreneurial risk-taking and hard work, such protection provides insurance against the vagaries of life. But when government mismanagement and political cowardice turn this element of the social contract into an empty promise, seniors are threatened with denied access to care and the next generation is threatened with a debt that destroys its hard-earned prosperity. Both consequences would violate President Lyndon B. Johnson's pledge upon signing the Medicare law: No longer will older Americans be denied the healing miracle of modern medicine; no longer will young families see their own incomes eaten away because they are carrying out their obligations to their parents. To fulfill Johnson's pledge in the 21st century, America's generations-old health and retirement security programs must be saved and strengthened.
Source: The Path to Prosperity, by Paul Ryan, p. 7 , Apr 5, 2012

Younger workers choose from subsidized coverage options

Medicare is facing an unprecedented fiscal challenge. This budget saves Medicare by fixing flaws in its structure so it will be there for future generations. By putting these solutions in place now, this budget ensures that changes will not affect those in and near retirement in any way. When younger workers become eligible for Medicare a decade or more from today, they will be able to choose from a list of guaranteed coverage options, including a traditional Medicare fee-for-service plan. This flexibility will allow seniors to enjoy the same kind of choices in their plans that members of Congress enjoy. Medicare will provide a payment to subsidize the cost of the plan, and forcing plans to compete against each other to serve the patient will help ensure guaranteed affordability. In addition, Medicare will provide increased assistance for lower-income beneficiaries and those with greater health risks.
Source: The Path to Prosperity, by Paul Ryan, p. 14 , Apr 5, 2012

CBO: Ryan cuts mandatory health costs from 15% to 6% of GDP

Under CBO's most recent long-term projections, based on the assumption that then-current law [including ObamaCare] would generally remain in place, spending on the government's major mandatory health care programs will increase from roughly 10% of GDP today to about 15% in 2030.

The Ryan proposal would convert the current Medicare program to a system under which beneficiaries received premium support payments--payments that would be used to help pay the premiums for a private health insurance policy and would grow over time with overall consumer prices. Additionally, the proposal would convert the matching payments that the federal government makes to states for Medicaid costs under current law into block grants of fixed dollar amounts beginning in 2013, and [would repeal ObamaCare]. Under the Ryan proposal, mandatory spending for health care would be about 6% of GDP in 2030 and about 5% in 2050, CBO estimates.

Source: CBO Analysis of Path to Prosperity by Paul Ryan, p. 2 , Apr 5, 2012

CBO: Elderly pay more for Medicare under Ryan plan

A typical beneficiary would spend more for health care under the Ryan proposal than under CBO's [previous] long-term scenarios for several reasons. First, private plans would cost more than traditional Medicare because of the net effect of differences in payment rates for providers, administrative costs, and utilization of health care services. Second, the government's contribution would grow more slowly than health care costs, leaving more for beneficiaries to pay.

Paying more for health care would be particularly challenging for elderly people with less savings and lower income. However, the proposal specifies that people with sufficiently low income would receive an additional federal contribution to a medical savings account that would help them pay for their premiums and out-of-pocket medical spending. The analysis here for a typical 65-year-old does not address the impact of those accounts on the financial burden facing low-income beneficiaries.

Source: CBO Analysis of Path to Prosperity by Paul Ryan, p. 23-24 , Apr 5, 2012

CBO: States pay more for Medicaid under Ryan plan

Under the Ryan proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system. Debt would eventually shrink relative to the size of the economy--but the gradually increasing number of Medicare beneficiaries participating in the new premium support program would bear a much larger share of their health care costs than they would under the current program; payments to physicians and other providers for services provided under the traditional Medicare program would be restrained; states would have to pay substantially more for their Medicaid programs or tightly constrain spending for those programs; and spending for federal programs other than Social Security and the major health care programs would be reduced far below historical levels relative to GDP. It is unclear whether and how future lawmakers would address the pressures resulting from the long-term scenarios or the proposal analyzed here.
Source: CBO Analysis of Path to Prosperity by Paul Ryan, p. 4 , Apr 5, 2012

FactCheck: No, Medicare cost doesn't exceed national defense

Paul Ryan writes, "Medicare & Medicaid together consume 22% of the federal budget--more than national defense, including the costs of the two wars." That statement is only true if one defines "national defense" strictly as the budget for the Department of Defense (totaling $664B, or 20% of the 2010 budget, compared to $793B for Medicare/Medicaid, or 23% of the 2010 budget). Ryan adds the "two wars" clause to imply a more general definition of "defense," but just adding the two wars excludes several very large defense expenditures in departments other than DoD: These are the low-end estimates for the 2010-2012 budget; see our "Background on Homeland Security" page for more details.
Source: OnTheIssues FactCheck on Young Guns, p.116 , May 2, 2011

FactCheck: costs go up just a bit; jobs go down just a bit

Ryan made several criticisms of the health care law, saying, "Costs are going up, premiums are rising, and millions of people will lose the coverage they currently have. Job creation is being stifled by all of its taxes, penalties, mandates and fees." The long list includes false, misleading and not entirely true statements.

Health care spending overall is expected to rise a bit--by less than 1% over a decade. That's because about 34 million more Americans will gain coverage. As for "millions" losin their current coverage, there's truth to that, but context is required. about 8 million low-income workers will get subsidies to go buy their own insurance in state-based exchanges.

Ryan backed his claim about stifling job creation with a CBO report. CBO said the law would have a small impact on the labor supply, and that would be mostly due to workers retiring early or working less because they would have more secure health care options.

Source: FactCheck.org on 2011 State of the Union GOP response , Jan 26, 2011

FactCheck: No evidence that healthcare reform explodes debt

Ryan claimed: "Health care spending is driving the explosive growth of our debt. And the president's law is accelerating our country toward bankruptcy."

The law is actually expected to reduce the deficit, according to the CBO, over the next two decade and beyond. It remains to be seen whether all of the cost-cutting measures will be fully implemented. But we went through various Republican claims about the supposed flaws in CBO's analysis and found the GOP assertions to be mostly bogus.

Source: FactCheck.org on 2011 State of the Union GOP response , Jan 26, 2011

Open-ended healthcare entitlement moves US toward bankruptcy

The President and his party created a new open-ended health care entitlement. What we already know about the President's health care law is this: Costs are going up, premiums are rising, and millions of people will lose the coverage they currently have. Job creation is being stifled by all of its taxes, penalties, mandates and fees.

Businesses and unions from around the country are asking the Obama Administration for waivers from the mandates. Washington should not be in the business of picking winner and losers. The President mentioned the need for regulatory reform to ease the burden on American businesses. We agree--and we think his health care law would be a great place to start.

Last week, House Republicans voted for a full repeal of this law, as we pledged to do, and we will work to replace it with fiscally responsible, patient-centered reforms that actually reduce costs and expand coverage. The President's law is accelerating our country toward bankruptcy.

Source: 2011 State of the Union: Republican Response , Jan 25, 2011

ObamaCare passed with no GOP support & split Democrats

If supporters of government health care couldn't summon the votes necessary to pass health-care reform through the democratic process, they would just bypass the democratic process.

In the Senate, that meant employing the "nuclear option". This process known as budget reconciliation, requires only a simple majority of 51 votes to pass a bill. It had never been used--never--to push through a $1,000,000,000,000 expansion of government and to seize control of one-sixth of the economy. In the House, a process called "deem and pass" was essentially the same thing.

The ugly health-care debacle finally came to an end with final passage of the overhaul in the House on March 21, 2010. 219 House Democrats voted for the bill, 34 opposed it. No Republican, in the House or the Senate, voted for the bill. For the first time since before the Civil War, the minority party was so completely excluded from the shaping of major reform legislation that it voted unanimously against the final bill.

Source: Young Guns, by Reps. Ryan, Cantor & McCarthy, p. 97-99 , Sep 14, 2010

For tax credits; high-risk pools; & regulatory reform

At the onset of the debate, I joined with several colleagues in the House and Senate in offering The Patients' Choice Act--a comprehensive reform proposal that provide access to quality, affordable coverage for all Americans. It starts by ending the tax discrimination against people who don't get health insurance from their employer. The Patients' Choice Act replaces the bias in the tax code with universal tax credits so that all Americans have the resources to purchase portable, affordable coverage tha best suits their needs, with additional support provided for those with lower incomes.

Through a combination of tax credits, high-risk pools, transparency, regulatory reform, and information technology, patient-centered reforms would foster a vibrant health-care marketplace. In stark contrast to Obamacare, my plan unapologetically seeks to apply our nation's timeless principles--our Founders' commitment to individual liberty, limited government and free enterprise--to today's challenges.

Source: Young Guns, by Reps. Ryan, Cantor & McCarthy, p.104-105 , Sep 14, 2010

Medicare is a $38 trillion unfunded liability--add vouchers

Pres. OBAMA: The major driver of our long-term liabilities, is Medicare and Medicaid and our health care spending. That's going to be what our children have to worry about. Now, [Rep. Paul Ryan's] approach--if I understand it correctly, would say we're going to provide vouchers of some sort for current Medicare recipients at the current level.

Rep. RYAN: No.

Pres. OBAMA: No?

Rep. RYAN: People 55 and above are grandfathered in.

Pres. OBAMA: But just for future beneficiaries, the basic idea would be that at some point we hold Medicare cost per recipient constant as a way of making sure that that doesn't go way out of whack, right?

Rep. RYAN: We drew it as a blend of inflation and health inflation. Medicare is a $38 trillion unfunded liability-- it has to be reformed for younger generations because it's going bankrupt. And the premise of our idea is, why not give people the same kind of health care plan we here have in Congress?

Source: Obama Q&A at 2010 House Republican retreat in Baltimore , Jan 29, 2010

Road Map: buy health insurance from any state in the country

If the total value of the employer tax "exclusion" was added up and shared equally among all Americans, every family in America could receive $5,000 to buy their own health insurance. This is the Road Map proposal for health insurance. Employers could continue to receive health insurance through their employer, and the employer could still deduct the cost of health insurance from their taxes if they so choose.

Employers would offer portable health insurance plans employees can keep when they change jobs (you get the $5,000 even when you are unemployed). Individuals who work for companies not offering health plans can shop for their own insurance. States could partner with the federal government to ensure high-risk individuals have access to affordable insurance.

This plan includes a provision that would allow individuals to buy health insurance from any state in the country. Currently individuals can only buy plans certified in their state. This limits competition and increases prices.

Source: Saving Freedom, by Jim DeMint, p.245 , Jul 4, 2009

Replace Medicare with $9500/year private insurance payment

Under the Road Map plan for Medicare, there would be no changes for current retirees and those who are fifty-five and older. Those younger than 55, upon reaching the age of 65, would receive a standard payment of $9,500 a year to pay for their private health insurance plan. This is the average amount Medicare currently spends per beneficiary. The amount would be inflation adjusted, and high-risk seniors could apply for additional risk-adjusted payments. Low-income seniors can also establish a Medical Savings Account to pay for other medical expenses. This is a freedom solution because future retirees would be free to own and control their health insurance.
Source: Saving Freedom, by Jim DeMint, p.246 , Jul 4, 2009


Paul Ryan on Voting Record

Washington Way: closed-door deals & one-party votes

Business in Washington these days isn't being conducted the way our Founders envisioned--and certainly not in a manner that respects the consent of the governed. We have seen over the past two years a new Washington Way: [instead of] open debate broadcas on C-SPAN, it's closed-door, backroom deals. The Washington Way doesn't seek input from both sides of the issue; it muscles through bills on strict one-party votes. And the Washington Way isn't interested in honest up-or-down votes on transformational programs. It rigs the process to produce the outcome it desires through any means necessary.

In short, the defining feature of the new Washington Way is that it strips the power of making law away from the people. This new Washington Way is designed to transfer lawmaking to a small elite group who know what is best for us. And from start to finish, the way President Obama and the Democratic majority went about supposedly fixing our health-care system has been conducted in the new Washington Way.

Source: Young Guns, by Reps. Ryan, Cantor & McCarthy, p. 94-95 , Sep 14, 2010

Voted YES on the Ryan Budget: Medicare choice, tax & spending cuts.

Proponent's Arguments for voting Yes:

[Sen. DeMint, R-SC]: The Democrats have Medicare on a course of bankruptcy. Republicans are trying to save Medicare & make sure there are options for seniors in the future. Medicare will not be there 5 or 10 years from now. Doctors will not see Medicare patients at the rate [Congress will] pay.

[Sen. Ayotte, R-NH]: We have 3 choices when it comes to addressing rising health care costs in Medicare. We can do nothing & watch the program go bankrupt in 2024. We can go forward with the President's proposal to ration care through an unelected board of 15 bureaucrats. Or we can show real leadership & strengthen the program to make it solvent for current beneficiaries, and allow future beneficiaries to make choices.

Opponent's Arguments for voting No:

[Sen. Conrad, D-ND]: In the House Republican budget plan, the first thing they do is cut $4 trillion in revenue over the next 10 years. For the wealthiest among us, they give them an additional $1 trillion in tax reductions. To offset these massive new tax cuts, they have decided to shred the social safety net. They have decided to shred Medicare. They have decided to shred program after program so they can give more tax cuts to those who are the wealthiest among us.

[Sen. Merkley, D-TK]: The Republicans chose to end Medicare as we know it. The Republican plan reopens the doughnut hole. That is the hole into which seniors fall when, after they have some assistance with the first drugs they need, they get no assistance until they reach a catastrophic level. It is in that hole that seniors have had their finances devastated. We fixed it. Republicans want to unfix it and throw seniors back into the abyss. Then, instead of guaranteeing Medicare coverage for a fixed set of benefits for every senior--as Medicare does now--the Republican plan gives seniors a coupon and says: Good luck. Go buy your insurance. If the insurance goes up, too bad.

Reference: Ryan Budget Plan; Bill HCR34&SCR21 ; vote number 11-HV277 on Apr 15, 2011

Voted YES on repealing the "Prevention and Public Health" slush fund.

Congressional Summary:Amends the Patient Protection and Affordable Care Act (PPACA) to repeal provisions establishing and appropriating funds to the Prevention and Public Health Fund (a Fund to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs). Rescinds any unobligated balanced appropriated to such Fund.

Proponent's Argument for voting Yes:
[Rep. Pitts, R-PA]: Section 4002 of PPACA establishes a Prevention and Public Health Fund, which my bill, H.R. 1217, would repeal. The PPACA section authorizes the appropriation of and appropriates to the fund from the Treasury the following amounts:

We have created a slush fund from which the Secretary of HHS can spend without any congressional oversight or approval. I would suggest to my colleagues that, if you wanted more funding to go towards smoking cessation or to any other program, the health care law should have contained an explicit authorization. By eliminating this fund, we are not cutting any specific program. This is about reclaiming our oversight role of how Federal tax dollars should be used.

Opponent's Argument for voting No:
[Rep. Waxman, D-CA]: This bill represents the Republicans' newest line of attack to disrupt, dismantle, and to ultimately destroy the Affordable Care Act. For many years, Republicans have joined with Democrats in supporting programs to prevent disease, to promote health and, in turn, to cut health care costs. But today, the House will vote to end funding for the first and only Federal program with dedicated, ongoing resources designed to make us a healthier Nation.

Reference: To repeal the Prevention and Public Health Fund; Bill H.1217 ; vote number 11-HV264 on Apr 13, 2011

Voted NO on regulating tobacco as a drug.

Congressional Summary:Amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to provide for the regulation of tobacco products by the Secretary of Health and Human Services through the Food and Drug Administration (FDA). Defines a tobacco product as any product made or derived from tobacco that is intended for human consumption. Excludes from FDA authority the tobacco leaf and tobacco farms.

Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

Reference: Family Smoking Prevention and Tobacco Control Act; Bill HR1256&S982 ; vote number 2009-H187 on Apr 2, 2009

Voted NO on expanding the Children's Health Insurance Program.

Congressional Summary:

Proponent's argument to vote Yes:

Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.

Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.

Reference: SCHIP Reauthorization Act; Bill H.R.2 ; vote number 2009-H016 on Jan 14, 2009

Voted YES on overriding veto on expansion of Medicare.

Congressional Summary:Pres. GEORGE W. BUSH's veto message (argument to vote No):In addition, H.R. 6331 would delay important reforms like the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. Changing policy in mid-stream is also confusing to beneficiaries who are receiving services from quality suppliers at lower prices. In order to slow the growth in Medicare spending, competition within the program should be expanded, not diminished.

Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.

Reference: Medicare Improvements for Patients and Providers Act; Bill HR.6331 ; vote number 2008-H491 on Jul 15, 2008

Voted NO on giving mental health full equity with physical health.

CONGRESSIONAL SUMMARY:

SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. PALLONE. This is a comprehensive bill which will establish full mental health and addiction care parity. The Mental Health Parity Act of 1996 authorized for 5 years partial parity by mandating that the annual and lifetime dollar limit for mental health treatment under group health plans offering mental health coverage be no less than that for physical illnesses. This bill requires full parity and also protects against discrimination by diagnosis.

OPPONENT'S ARGUMENT FOR VOTING NO:Rep. DEAL of Georgia: I am a supporter of the concept of mental health parity, but this bill before us today is not the correct approach. This path will raise the price of health insurance, and would cause some to lose their health insurance benefits and some employers to terminate mental health benefits altogether.

The bill's focus is also overly broad. Our legislation should focus on serious biologically-based mental disorders like schizophrenia and bipolar disorder, not on jet lag and caffeine addiction, as this bill would include. There are no criteria for judicial review, required notice and comment, or congressional review of future decisions.

I would ask my colleagues to vote "no" today so that we can take up the Senate bill and avoid a possible stalemate in a House-Senate conference on an issue that should be signed into law this Congress.

LEGISLATIVE OUTCOME:Bill passed House, 268-148

Reference: Mental Health and Addiction Equity Act; Bill H.R.1424 ; vote number 08-HR1424 on Mar 5, 2008

Voted NO on Veto override: Extend SCHIP to cover 6M more kids.

OnTheIssues Explanation: This vote is a veto override of the SCHIP extension (State Children's Health Insurance Program). The bill passed the House 265-142 on 10/25/07, and was vetoed by Pres. Bush on 12/12/07.

CONGRESSIONAL SUMMARY: This Act would enroll all 6 million uninsured children who are eligible, but not enrolled, for coverage under existing programs.

PRESIDENT'S VETO MESSAGE: Our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. My Administration strongly supports reauthorization of SCHIP. [But this bill, even with changes, does not meet the requirements I outlined].

It would still shift SCHIP away from its original purpose by covering adults. It would still include coverage of many individuals with incomes higher than the median income. It would still result in government health care for approximately 2 million children who already have private health care coverage.

SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill protects health insurance coverage for some 6 million children who now depend on SCHIP. It provides health coverage for 3.9 million children who are eligible, yet remain uninsured. Together, this is a total of better than 10 million young Americans who, without this legislation, would not have health insurance.

The bill makes changes to accommodate the President's stated concerns.

  1. It terminates the coverage of childless adults in 1 year.
  2. It prohibits States from covering children in families with incomes above $51,000.
  3. It contains adequate enforcement to ensure that only US citizens are covered.
  4. It encourages securing health insurance provided through private employer.
LEGISLATIVE OUTCOME:Veto override failed, 260-152 (2/3rds required)
Reference: SCHIP Extension; Bill Veto override on H.R.3963 ; vote number 08-HR3963 on Jan 23, 2008

Voted NO on adding 2 to 4 million children to SCHIP eligibility.

Allows State Children's Health Insurance Programs (SCHIP), that require state legislation to meet additional requirements imposed by this Act, additional time to make required plan changes. Pres. Bush vetoed this bill on Dec. 12, 2007, as well as a version (HR976) from Feb. 2007.

Proponents support voting YES because:

Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:

  1. It terminates the coverage of childless adults.
  2. It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
  3. It contains adequate enforcement to ensure that only US citizens are covered.

Opponents recommend voting NO because:

Rep. DEAL: This bill [fails to] fix the previous legislation that has been vetoed:

Veto message from President Bush:

Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.

Reference: Children's Health Insurance Program Reauthorization Act; Bill H.R. 3963 ; vote number 2007-1009 on Oct 25, 2007

Voted NO on requiring negotiated Rx prices for Medicare part D.

Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.

Proponents support voting YES because:

This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.

It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses. HR4 does not require using the Department of Veterans Affairs' price schedule.

Opponents support voting NO because:

Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.

Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.

Reference: Medicare Prescription Drug Price Negotiation Act; Bill HR 4 ("First 100 hours") ; vote number 2007-023 on Jan 12, 2007

Voted YES on denying non-emergency treatment for lack of Medicare co-pay.

Vote to pass a resolution, agreeing to S. AMDT. 2691 that removes the following provisions from S 1932:
Reference: Reconciliation resolution on the FY06 budget; Bill H Res 653 on S. AMDT. 2691 ; vote number 2006-004 on Feb 1, 2006

Voted YES on limiting medical malpractice lawsuits to $250,000 damages.

Vote to pass a bill that would limit the awards that plaintiffs and their attorneys could be given in medical malpractice cases. The bill would limit non-economic damages, including physical and emotional pain to $250,000. The bill would also limit punitive damages to $250,000 or double economic damages, whichever amount is greater. Punitive damages would be banned against makers and distributors of medical products if the Food and Drug Administration approved those products. The bill would call for all states to set damage caps but would not block existing state statutory limits. The bill would cap attorneys' contingency fees to 40% of the first $50,000 in damages; 33.3% of the next $50,000; 25% of the next $500,000; and 15% of any amount in excess of $600,000.
Reference: Medical Malpractice Liability Limitation bill; Bill HR 4280 ; vote number 2004-166 on May 12, 2004

Voted YES on limited prescription drug benefit for Medicare recipients.

Medicare Prescription Drug and Modernization Act of 2003: Vote to adopt the conference report on the bill that would create a prescription drug benefit for Medicare recipients. Starting in 2006, prescription coverage would be made available through private insurers to seniors. Seniors would pay a monthly premium of an estimated $35 in 2006. Individuals enrolled in the plan would cover the first $250 of annual drug costs themselves, and 25 percent of all drug costs up to $2,250. The government would offer a fallback prescription drug plan in regions were no private plans had made a bid.Over a 10 year time period medicare payments to managed care plans would increase by $14.2 billion. A pilot project would begin in 2010 in which Medicare would compete with private insurers to provide coverage for doctors and hospitals costs in six metropolitan areas for six years. The importation of drugs from Canada would be approved only if HHS determines there is no safety risks and that consumers would be saving money.
Reference: Bill sponsored by Hastert, R-IL; Bill HR.1 ; vote number 2003-669 on Nov 22, 2003

Voted YES on allowing reimportation of prescription drugs.

Pharmaceutical Market Access Act of 2003: Vote to pass a bill that would call for the Food and Drug Administration to begin a program that would permit the importation of FDA-approved prescription drugs from Australia, Canada, the European Union, Iceland, Israel, Japan, Lichtenstein, New Zealand, Norway, Switzerland and South Africa.
Reference: Bill sponsored by Gutknecht, R-MN; Bill HR.2427 ; vote number 2003-445 on Jul 24, 2003

Voted YES on small business associations for buying health insurance.

Vote to pass a bill that would permit the creation of association health plans through which small companies could group together to buy insurance for their employees. Association health plans that cover employees in several states would be excused from many individual state insurance regulations but would be regulated by the Labor Department.
Reference: Small Business Health Fairness Act; Bill HR 660 ; vote number 2003-296 on Jun 19, 2003

Voted YES on capping damages & setting time limits in medical lawsuits.

Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2003: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. Limits the availability of punitive damages, and sets a 3-year limit for suing.
Reference: Bill sponsored by Greenwood, R-PA; Bill HR 5 ; vote number 2003-64 on Mar 13, 2003

Voted YES on allowing suing HMOs, but under federal rules & limited award.

Vote to adopt an amendment that would limit liability and damage awards when a patient is harmed by a denial of health care. It would allow a patient to sue a health maintenance organization in state court but federal, not state, law would govern.
Bill HR 2563 ; vote number 2001-329 on Aug 2, 2001

Voted YES on subsidizing private insurance for Medicare Rx drug coverage.

HR 4680, the Medicare Rx 2000 Act, would institute a new program to provide voluntary prescription drug coverage for Medicare beneficiaries through subsidies to private plans. The program would cost an estimated $40 billion over five years and would go into effect in fiscal 2003.
Reference: Bill sponsored by Thomas, R-CA; Bill HR 4680 ; vote number 2000-357 on Jun 28, 2000

Voted YES on banning physician-assisted suicide.

Vote on HR 2260, the Pain Relief Promotion Act of 1999, would ban the use of drugs for physician-assisted suicide. The bill would not allow doctors to give lethal prescriptions to terminally ill patients, and instead promotes "palliative care," or aggressive pain relief techniques.
Reference: Bill sponsored by Hyde, R-IL; Bill HR 2260 ; vote number 1999-544 on Oct 27, 1999

Voted YES on establishing tax-exempt Medical Savings Accounts.

The bill allows all taxpayers to create a tax-exempt account for paying medical expenses called a Medical Savings Account [MSA]. Also, the measure would allow the full cost of health care premiums to be taken as a tax deduction for the self-employed and taxpayers who are paying for their own insurance. The bill would also allow the establishment of "HealthMarts," regional groups of insurers, health care providers and employers who could work together to develop packages for uninsured employees. Another provision of the bill would establish "association health plan," in which organizations could combine resources to purchase health insurance at better rates than they could separately.
Reference: Bill sponsored by Talent, R-MO; Bill HR 2990 ; vote number 1999-485 on Oct 6, 1999

Rated 11% by APHA, indicating a anti-public health voting record.

Ryan scores 11% by APHA on health issues

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.

Source: APHA website 03n-APHA on Dec 31, 2003

Repeal the Job-Killing Health Care Law.

Ryan co-sponsored Repealing the Job-Killing Health Care Law Act

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.

Source: H.R.2 11-HR002 on Jan 5, 2011

2012 Governor, House and Senate candidates on Health Care: Paul Ryan on other issues:
WI Gubernatorial:
Scott Walker
WI Senatorial:
Ron Johnson
Tammy Baldwin



Lame-duck session 2012:
KY-4: Thomas Massie(R)
MI-11:Dave Curson(D)
NJ-9: Donald Payne Jr.(D)
WA-1: Suzan DelBene(D)

Re-seated Former Reps:
AZ-1: Ann Kirkpatrick(D)
AZ-5: Matt Salmon(R)
FL-8: Alan Grayson(D)
IL-11:Bill Foster(D)
NH-1: Carol Shea-Porter(D)
NV-3: Dina Titus(D)
NY-24:Dan Maffei(D)
TX-36:Steve Stockman(R)

2013 Resignations and Replacements:
AL-1:Jo Bonner(R,resigned)
IL-2:Jesse Louis Jackson(D,resigned)
IL-2:Robin Kelly(D)
MA-5:Ed Markey(D,to Senate)
MA-8:Stephen Lynch(D)
MO-8:Jo Ann Emerson(R,resigned)
MO-8:Jason Smith(R,elected June 2013)
SC-1:Tim Scott(R,resigned)
SC-1:Mark Sanford(R)
SC-1:Elizabeth Colbert-Busch(D)
Newly-elected Democrats:
AZ-9: Kyrsten Sinema
CA-2: Jared Huffman
CA-7: Ami Bera
CA-15:Eric Swalwell
CA-24:Julia Brownley
CA-29:Tony Cardenas
CA-35:Gloria Negrete McLeod
CA-36:Raul Ruiz
CA-41:Mark Takano
CA-47:Alan Lowenthal
CA-51:Juan Vargas
CA-52:Scott Peters
CT-5: Elizabeth Esty
FL-18:Patrick Murphy
FL-22:Lois Frankel
FL-26:Joe Garcia
HI-2: Tulsi Gabbard
IL-8: Tammy Duckworth
IL-10:Brad Schneider
IL-12:Bill Enyart
IL-17:Cheri Bustos
MD-6: John Delaney
MA-4: Joe Kennedy III
MI-5: Dan Kildee
MN-8: Rick Nolan
NV-4: Steven Horsford
NH-2: Annie Kuster
NM-1: Michelle Lujan-Grisham
NY-5: Grace Meng
NY-10:Hakeem Jeffries
NY-18:Sean Maloney
OH-10:Joyce Beatty
PA-17:Matt Cartwright
TX-16:Beto O`Rourke
TX-20:Joaquin Castro
TX-23:Pete Gallego
TX-33:Marc Veasey
TX-34:Filemon Vela
WA-6: Derek Kilmer
WA-10:Denny Heck
WI-2: Mark Pocan
Newly-elected Republicans:
AR-4: Tom Cotton
CA-1: Doug LaMalfa
CA-21:David Valadao
CA-41:Paul Cook
FL-3: Ted Yoho
FL-6: Ron DeSantis
FL-19:Trey Radel
GA-9: Doug Collins
IL-15:Rodney Davis
IN-2: Jackie Walorski
IN-5: Susan Brooks
IN-6: Luke Messer
KY-6: Andy Barr
MI-11:Kerry Bentivolio
MO-2: Ann Wagner
MT-0: Steve Daines
NY-26:Chris Collins
NC-8: Richard Hudson
NC-9: Robert Pittenger
NC-11:Mark Meadows
NC-13:George Holding
ND-0: Kevin Cramer
OH-2: Brad Wenstrup
OH-14:Dave Joyce
OK-1: Jim Bridenstine
OK-2: Markwayne Mullin
PA-4: Scott Perry
PA-12:Keith Rothfus
SC-7: Tom Rice
TX-14:Randy Weber
TX-25:Roger Williams
UT-2: Chris Stewart
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