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Robbing the Poor to Pay Paul Ryan’s Pals

Speaker may have powerful ally for assault on Medicaid

House Speaker Paul D. Ryan says pieces of a health care law replacement plan could be included in the current budget reconciliation measure. (Bill Clark/CQ Roll Call)
House Speaker Paul D. Ryan says pieces of a health care law replacement plan could be included in the current budget reconciliation measure. (Bill Clark/CQ Roll Call)

House Speaker Paul D. Ryan wants you to know that he cares about the poor. He wants you to know that his deeply held Catholic convictions drive him to seek opportunity for those in poverty, particularly people of color.

He speaks in the compassionate tones of someone who means to help not harm, and I believe that these are his real values, even if I often don’t agree with his policy prescriptions.

That’s why it’s so curious that the Wisconsin Republican has fetishized destroying Medicaid, the federal-state health insurance program for the destitute and disabled. House Republicans are moving forward with a plan that would reportedly slash Medicaid funding to help finance tax cuts for drug, insurance and medical device companies as part of a stalled effort to repeal and replace Obamacare.

Targeting the poor

But while the specific contours of the policy may still be under discussion, Ryan has been targeting health insurance subsidies for the poorest Americans ever since Republicans won control of the House in the 2010 midterm elections.

In early 2011, when he was writing his first blueprint as chairman of the House Budget Committee, Ryan developed a plan to gut Medicaid by cutting $1 trillion over 10 years. Ryan’s favored approach, which appears to be in play again, is to stop providing health insurance for the poor based on eligibility and need. He prefers a modified voucher system in which states are given a limited amount of money for each person eligible for the program, regardless of their individual needs.

There are two basic justifications for Ryan’s assault on entitlements: First, he has argued, the federal government needs to drive down the costs of programs that contribute to the debt; and second, he says, giving too much assistance to the impoverished encourages them to stay poor. These seem like compelling frames for entitlement reform. After all, reducing debt seems like a good thing. And why would anyone want to oppress the poor more?

But Ryan’s plans are neither a serious answer to rising debt nor a means to creating opportunities for the least among us. Contrary to his self-styled mission for justice, and his expert way of talking about his care for those in need, his approach to Medicaid is a stealth attack on those who have neither power nor money in service of those who have both.

A half-dozen years ago, Ryan wanted to go after the big entitlements — Medicare and Social Security — but settled for trying to destroy Medicaid. Why? Because middle-class people, who have more political clout, wouldn’t stand for major changes to programs that benefit them. That’s why, during his campaign for the presidency, Donald Trump promised to protect Medicare and Social Security.

The Congressional Budget Office projects that fiscal 2017 spending on Medicare will net at $592 billion, while Medicaid will account for $389 billion. It doesn’t take a green eyeshade to see that there’s a lot more money in Medicare — or that the kind of cuts for Medicaid that Ryan has flirted with in the past ($100 billion a year) would debilitate that program.

A third-rail topic

The real money — more than $1 trillion a year — is in Social Security. But Republicans’ fingers got burned on the hot stove of an angry electorate — particularly lower-income voters in ruby red states — when they tried to make relatively minor adjustments to that program after George W. Bush was re-elected.

So, eager to put a budgetary scalp on the wall, it looks like Ryan is targeting the poor again. How this could possibly fit into creating opportunities for the poor is completely beyond me. Eating up more of their paychecks with out-of-pocket health care costs, or simply increasing the odds that they won’t get preventive care or treatment seems like a pretty sharp detour away from economic empowerment.

Ryan failed the last time he tried to overhaul Medicaid. But now, with longtime ally Tom Price running the Department of Health and Human Services, he’s got another shot at passing his punitive revamp into law. Instead of making a play to simply reduce the debt with it, though, he’s looking at using the found money to finance tax cuts for corporations. That’s just morally bankrupt.

I like Ryan, and I have long believed he was the singular person who could lead House Republicans, in part because he was willing to contrast his ideas against those of his political rivals. But this is just a recipe for balancing tax cuts for the business community on the backs of those who need federal assistance most.

More broadly, if Ryan really wanted to help the poor, he wouldn’t victimize them. And if he wanted to be honest, he wouldn’t blame them for his own perfidy with patronizing, moralistic rhetoric about how federal assistance condemns them to a lifetime in poverty. Mr. Speaker, you have bold ideas and a good heart; you’re better than this.