PAUL RYAN’S LEGACY INCLUDES ‘BIG IDEAS’ SUCH AS A VOUCHER FOR INDIAN HEALTH

Mark Trahant*

Republished with author's permission from Trahant Reports / Indian Country Today, April 12, 2018, https://trahantreports.com.

Paul Ryan came to Washington to blow up Washington. He was first elected to represent his Wisconsin district at 28 years old. He campaigned over his career for a federal government that should shrink dramatically, spend far less, that taxes should be low, and the Republicans should be the party of big ideas.

Ryan announced Wednesday he will not run for re-election. He says he will complete his term as Speaker, but that’s not certain. He likely will face pressure to step down early, so another Republican can lead the party’s team into the November election. (More than forty Republicans have already announced their retirement contributing to the story about a coming Democratic wave.)

The Speaker leaves behind a different kind of legacy. He did get his tax cuts and substantial changes in the regulatory framework. But he also delivered more federal spending than ever. The deficit will hit $804 billion this year (a jump of 21 percent in a single year) and exceed $1 trillion by 2020. And, a new report by the Congressional Budget Office, says that a decade from now the total debt will be larger than the entire economy. “That amount is far greater than the debt in any year since just after World War II,” the CBO said Monday.

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The problem for Ryan, like Speaker John Boehner before him, is that the Republican majority is nearly ungovernable. The only way for Congress to function, to actually pass a budget, is to build a coalition that includes most Republicans, some Democrats, and work with a similar coalition in the Senate. That often means spending more money. That’s not the Congress — and the party of big ideas — that Ryan once had imagined.

And President Donald J. Trump has made that process worse. He caters to the bloc in Congress that cares little about actually governing. Chaos is fine. Big ideas, not so much.

Ryan proposed a major reform of government in 2010 long before he was elected Speaker of the House. It had his big ideas: Replace Medicare with direct payments to seniors who then could buy their own health insurance; turn Medicaid into a block grant to states; end employer-based health insurance; and dramatically cut government and taxes. There was no support for that plan.

Then two years ago, as a new speaker, Ryan unveiled another plan for reshaping government. “A Better Way” included a reform of the Indian Health Service by “giving choices to American Indians.” His big idea was to have the government issue vouchers for Indian health, outside the system. “Not only will this give American Indians more choice in where they receive care,” the Ryan plan promised. “It will challenge Indian health facilities to provide the best care possible to American Indians.”

And of course that voucher system would have cost less. The Ryan plan also included a provision for a Native American Health Savings Account so individual tribal members could buy their own health care services (Never mind a treaty sanctioned right.)

The basic premise of Ryan’s plan was that poverty is a problem because of government programs, thus, shrink the government, and poverty will go away. He told National Public Radio: “Let’s break up the welfare monopoly, instead of having just the welfare agency at the county level give people their benefits, which they basically rubber-stamp. … They don’t actually treat the person. Let other providers also provide these full-scale wraparound benefits. Let the Catholic Church do it. Let Lutheran social services. Let America Works, a for-profit agency that’s good at this.”

This is not a new idea; it was the same logic in the 1940s when Republican complained then that the Bureau of Indian Affairs was responsible for poverty, horrible living conditions, and general mismanagement. The solution over the next decade was the idea of “freeing the Indians” by terminating the federal responsibility, Termination. And a hundred and nine tribes were terminated, representing some 12,500 tribal members, and the end result was poverty conditions that were far worse.

That’s likely what would have happened again had Ryan’s “choice” approach to Indian health became law.

Ryan’s, “A Better Way,” once again called for turning Medicaid over to the states. “Instead of shackling states with more mandates, our plan empowers states to design Medicaid programs that best meet their needs, which will help reduce costs and improve care for our most vulnerable citizens.”

Medicaid has become a significant revenue source for the Indian health system. Under current law, Medicaid is a partnership between the federal and state governments. But states get a 100 percent federal match for patients within the Indian health system. Four-in-ten Native Americans are eligible for Medicaid insurance.

Rep. Tom Cole, a Republican from Oklahoma and a Chickasaw Nation citizen, said Ryan will be missed in Congress. “Paul Ryan is a visionary leader, a committed conservative and a master of the legislative process. His tenure as been marked by exceptional accomplishments – the largest tax cut and reform in a generation; the most regulatory reform for any Congress in the modern age; the most substantial defense buildup in 15 years; the end of the individual mandate in Obamacare – and a host of other important legislative accomplishments,” Cole said.

“He is not only the best Speaker I’ve had the opportunity to serve with, he’s also the finest person. Even Paul’s political opponents readily concede that he’s a person of absolute integrity, deep sincerity and of profound decency.”

*Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. On Twitter: @TrahantReports (This story is cross posted with Indian Country Today.)

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