The publication, Politico made news this week with a profile piece that reported that Speaker Paul Ryan (R-WS) will retire after this Congress.  There have been some denials although the profile painted a portrait of a Speaker who wants to exit politics soon.  If that is the case it is not expected that Ryan will slow down on his push to cut entitlements including Medicare, Medicaid and “welfare reform.”

Ryan did say that the cuts would be enacted through reconciliation legislation.  A question that might have to be decided is whether they try yet again to repeal the ACA.  With only 51 Republican votes starting in January 2018, it will make it more challenging to get the needed 50 votes.  Ryan did say in a local radio interview last week that health care entitlements including Medicare and Medicaid , “are the big drivers of debt….we spend more time on health-care entitlements, because that’s really where the problem lies, fiscally speaking.”

The irony is that Congressional leaders are talking about the need to address the annual deficit and the debt against the backdrop of a tax package that non-partisan economists in the CBO and Joint Committee on Taxation have said will increase the deficit by over $1 trillion.  That analysis stands even when increased economic growth is taken into account.

If the Speaker insists on cuts to Medicare it will be a challenge for a Ryan reform effort to see whether or not he can get his members and Republican Senators to join with him in cutting that untouchable entitlement—especially in the Senate.  But if cuts to Medicare are pulled it could be the ultimate compromise that then allows conservative members to reject Medicare cuts as a compromise and then go full force on other cuts including Medicaid.

What could these “welfare reforms” look like based on recent budget proposals and past proposals by the Speaker:

  • Advocates in Washington feel there will be strong focus on the SNAP (food stamps) programs focused on cuts, work requirements and drug testing;
  • Supplemental Security Income (SSI) for children which could be carved out from the larger program and converted into a fixed state block grant or perhaps cuts imposed in other ways;
  • Medicaid which could be subject to a re-visitation of the per capita cap block grant that was included in various ACA repeal bills, they may also tackle requirements for work;
  • ACA repeal, some members in the House would like to have another attempt to repeal the ACA even as the individual mandate is repealed as part of the tax cut package;
  • Medicare, if leadership is bold they may attempt to look at the earlier Ryan proposal that would raise the age of eligibility to 67 for future Medicare recipients and convert the rest of the program into a voucher or optional voucher that would give patients funds to buy their own insurance;
  • SSBG elimination, under Speaker Ryan’s leadership, previous votes have been cast to eliminate SSBG and the $1.7 billion;
  • TANF cuts, as included in the FY 2018 Administration budget, along with the elimination of SSBG—the Administration cut TANF by the amount states had transferred from TANF into SSBG, more than $1 billion;
  • Drug testing in many programs. This would be one of the greatest ironies for this Congress which has started to recognize that substance use is an addiction and needs to be treated as a disease.  This may not be as easy as it was in the 1980s and 1990s when drug testing—in the minds of some—was targeting urban populations impacted by crack-cocaine.  This drug opioid epidemic is effecting rural and suburban populations;
  • Child welfare optional block grant; by making it “optional” it makes the cuts sound less onerous. Many states would exchange the lack of future funding increases for the increased flexibility today and this may also be the Administration’s response to the various child welfare waivers that run out this year.