Ryan said that he believes he has begun convincing President Trump in their private conversations about the need to rein in Medicare, the federal health program that primarily insures the elderly. As a candidate, Trump vowed not to cut spending on Social Security, Medicare, or Medicaid. (Ryan also suggested congressional Republicans were unlikely to try changing Social Security, because the rules of the Senate forbid changes to the program through reconciliation — the procedure the Senate can use to pass legislation with only 50 votes.)
“I think the president is understanding that choice and competition works everywhere in health care, especially in Medicare,” Ryan said. "...This has been my big thing for many, many years. I think it's the biggest entitlement we've got to reform.”
Ryan's remarks add to the growing signs that top Republicans aim to cut government spending next year. Republicans are close to passing a tax bill nonpartisan analysts say would increase the deficit by at least $1 trillion over a decade. Trump recently called on Congress to move to cut welfare spending after the tax bill, and Senate Republicans have cited the need to reduce the national deficit while growing the economy.
“You also have to bring spending under control. And not discretionary spending. That isn't the driver of our debt. The driver of our debt is the structure of Social Security and Medicare for future beneficiaries,” Sen. Marco Rubio (R-Fla.) said last week.
While whipping votes for the tax bill, Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) attacked “liberal programs” for the poor and said Congress needed to stop wasting Americans' money.
“We're spending ourselves into bankruptcy,” Hatch said. “Now, let's just be honest about it: We're in trouble. This country is in deep debt. You don't help the poor by not solving the problems of debt, and you don't help the poor by continually pushing more and more liberal programs through.”
Trump has not clarified which specific programs would be affected by the proposed “welfare reform,” though congressional Republicans are signaling that they aim to impose work requirements on food stamps and direct cash assistance for the poor.
“We have a welfare system that's trapping people in poverty and effectively paying people not to work,” Ryan told Kaminsky on Wednesday. “We've got to work on that.”
Liberals have alleged that the GOP will use higher deficits — in part caused by their tax bill — as a pretext to accomplish the long-held conservative policy objective of cutting government health-care and social-service spending, which the left believes would hit the poor the hardest.
“What’s coming next is all too predictable: The deficit hawks will come flying back after this bill becomes law,” said Sen. Ron Wyden (D-Ore.), the ranking Democrat on the finance committee, during a speech on the tax debate. “Republicans are already saying 'entitlement reform' and 'welfare reform' are next up on the docket. But nobody should be fooled — that’s just code for attacks on Medicaid, on Medicare, on Social Security, on anti-hunger programs.”
On the Senate floor during the tax debate, Sen. Bernie Sanders (I-Vt.) asked Rubio and Sen. Patrick J. Toomey (R-Pa.) to promise that Republicans would not advance cuts to Medicare and Social Security after their tax bill. Toomey said that there was “no secret plan” to do so, while Rubio said he opposed cuts to either program for current beneficiaries. However, neither closed the door to changing the programs for future beneficiaries.
“I am not going to support any cuts to people who are on the program and need those benefits. But I want this program to survive,” Toomey said. To which Sanders responded: “He just told you he's going to cut Social Security.”
Many conservatives have long argued for cutting and changing social safety net programs, arguing that anti-poverty programs have failed and that Social Security spending is growing at an unsustainable rate.
Still, members of both parties have long been reluctant to cut benefits, especially for seniors, due in part to the potential political cost of doing so. In discussing changes, Republicans, including Rubio, have largely confined their ideas to plans that would affect new beneficiaries, rather than current ones.
But it may be particularly difficult for Republicans to push those measures ahead of the 2018 midterm elections, in which many in swing states and districts face well-funded Democratic challengers hoping to ride an anti-Trump wave into office.
Ryan said he's optimistic, adding that Republicans could target the Affordable Care Act and Medicaid next year in addition to Medicare, despite their failure to repeal the health care law in 2017.
“What it is we really need to convert our health care system to a patient-centered system, so we have more choices and more competition. Choice and competition brings down prices and improves quality; government-run health care is the opposite of that,” Ryan said. “So I think these reforms that we've been talking about, that we're still going to keep pushing, that will help not just make Medicaid less expensive ... but it will help Medicare as well.”