On Jan. 3, 2017, members of the House of Representatives gathered in their chambers on Capitol Hill to be officially sworn into office as duly elected representatives of their constituents. Shortly after the pomp and circumstances concluded in the House Chamber, the leadership of the House of Representatives and the Chairmen of the House committees were elected. The outcomes of these elections, and the three House leaders profiled here, will ultimately have a dramatic effect on the efforts of the Trump administration to repeal the Affordable Care Act and to revolutionize the funding of federal health care programs. This week, we are profiling the three most prominent Republicans who will oversee health care legislation in the House of Representatives during the 115th Congress. In the coming weeks, we will be developing similar profiles for the Democratic leadership in the House and the leadership of the United States Senate.
Speaker of the House Paul Ryan of Wisconsin
Speaker Paul Ryan has retained his powerful Constitutional office, in which he is second in line of Presidential succession. First elected to represent Wisconsin’s First Congressional District in the House of Representatives in 1998, Speaker Ryan gained recognition and notoriety as the chairman of the House Budget Committee by working to reign in federal spending and increase accountability to taxpayers. In addition to serving on the House Budget Committee, he served on the House Ways and Means Committee, focusing on simplifying the tax code and making health care more affordable and accessible.
In January 2010, Speaker Ryan unveiled the “Roadmap for America’s Future,” a proposal to eliminate the federal deficit, reform the tax code, and preserve entitlements for future generations. In addition to utilizing across- the-board tax cuts to stimulate the economy, his proposal would have privatized a portion of Social Security and privatized Medicare. While the “Roadmap for America’s Future” failed to achieve congressional passage, the bill did become the foundation for House Republicans’ efforts to create an alternative to the Affordable Care Act (ACA), better known as Obamacare.
Shortly after his unsuccessful campaign as Governor Mitt Romney’s vice-presidential candidate during the 2012 election, Speaker Ryan reintroduced a modified version of the “Roadmap for America’s Future,” which sought to balance the budget within 10 years by cutting spending, reforming poverty programs, and importantly, reforming the health care entitlements—the largest drivers of deficit spending and debt. Regarding specifics on health care reform, the “Path to Prosperity” proposal addressed Medicare and Medicaid reform by converting the federal share of Medicaid spending into a block grant indexed for inflation and population growth. While this new version also failed to receive passage, it documents Speaker Ryan’s health care reform ideas, which likely will be thoroughly considered in the coming weeks.
Upon his assumption of the Speaker’s Office in August 2015, Speaker Ryan vigorously supported the Empowering Patients First Act (EPFA), legislation originally sponsored by Representative Tom Price, who is President-elect Trump’s designee for the position of secretary of Health and Human Services (HHS). A potential roadmap for replacing the ACA, EPFA would create and expand tax deductions and credits to aid in the purchasing of health insurance, promote state-based high-risk insurance pools, create individual and small employer membership associations and association health plans, allow for interstate insurance markets, and would reform malpractice lawsuits.
Representative Ken Brady of Texas, Chairman, House Committee on Ways and Means
As chairman of the House Committee on Ways and Means, which has jurisdiction over Medicare, Rep. Ken Brady will yield tremendous influence on shaping any health care legislation debated in the 115th Congress. First elected to the House in 1996, Rep. Brady succeeded Speaker Ryan as chairman of the Ways and Means Committee. He has advocated for lower taxes, deficit reduction and free trade, and he called for replacing the income tax with a national sales tax. In 2016, shortly after he became the chairman of the committee, Rep. Brady also became chairman of the health sub-committee, which places him in the center of congressional debate on Medicare and health care law. Regarding health care, he has firmly advocated for the immediate repeal of the ACA. In its place, he believes increased competition and elimination of unnecessary overhead costs on the system will make health care more accessible and affordable, as opposed to a government takeover of the health care system.
In recent months, Rep. Brady has expressed concern about the potential insolvency of Medicare within the next 20 years. As chairman of the Ways and Means Subcommittee on Health, he unveiled a three step process to make Medicare sustainable for the long-term. In 2015, Congress acted successfully to achieve the first important step in saving Medicare, changing the way Medicare pays local doctors by passing the Medicare and CHIP Reauthorization Act (MACRA), which eliminated the Sustainable Growth Rate formula. Rep. Brady has stated that his intent during the 115th Congress is to take step two by improving the way Medicare pays hospitals, nursing homes, rehabilitation hospitals and other post-acute services for seniors. His third step to save Medicare would create better and smarter personalized Medicare options for seniors.
Representative Greg Walden of Oregon, Chairman, House Committee on Energy and Commerce
As chairman of the House Committee on Energy and Commerce, which has jurisdiction over the Department of Health and Human Services, Rep. Greg Walden will be charged with guiding any significant changes to the ACA through his committee. As the representative for rural eastern Oregon’s 2nd District since his election in 1998, Rep. Walden has consistently advocated for affordable health care, especially in rural communities. He became the co-chair of the Rural Health Care Coalition. In 2009, the National Rural Health Association applauded Rep. Walden as a “Rural Champion” for his effort to attach an amendment to HR 3200, America's Affordable Health Choices Act of 2009, which would ensure proportional representation for rural America on the committee that advises on Medicare policy. Rep. Walden has continued to be a strong voice for the underserved rural health care community.
Recently Rep. Walden has expressed concern with the impact of the ACA on Oregon residents. In his literature, he describes how the ACA has driven up insurance costs while reducing choices for Oregonians. He specifically discusses how the law set up two new health “co-ops,” which folded within 3 years. In response, Rep. Walden has joined Speaker Ryan and Rep. Brady in advocating for the Republican alternative to the ACA based upon the Empowering Patients First Act (EPFA). As chairman of one of the committees to be tasked with the passage of a replacement for the ACA, Rep. Walden will seek to ensure representation for the rural communities around the country in the final version.
As the debate on the next phase of federal health care programs commences in the coming weeks, these three men will yield tremendous influence on the final health care proposal. While they have each supported the general Republican health care platform, they also have unique perspectives that will shape their advocacy: Speaker Ryan’s focus on cost efficiency, Rep. Brady’s emphasis on Medicare solvency, and Rep. Walden’s championing of rural health care.