New Ryan plan sticks to familiar themes: ACA repeal, Medicare premium support

Offering a sneak preview of the 2014 budget he will propose this week, House Budget Committee Chairman Paul Ryan (R-Wis.) said on the TV program Fox News Sunday that his fiscal plan—similar to his fiscal 2012 and 2013 blueprints—will promote repealing the 2010 healthcare law and transforming Medicare into a premium-support system.

After Fox News Sunday host Chris Wallace confirmed with Ryan that the House GOP plan again assumes overturning the Patient Protection and Affordable Care Act, Wallace told Ryan: "That's not going to happen." Ryan didn't flinch when he replied that House Republicans think that it should.

"We believe Obamacare will actually lead to hospitals and doctors and healthcare providers turning people away," Ryan said. "It's a program that basically puts Medicare under the control of 15 people on a board that will determine what kind of benefits people get. That's a rationing board however you slice it," he continued, referring to the law's Independent Payment Advisory Board, which the law created as a backstop measure to control the per-capita growth rate in Medicare.

"We don't think healthcare is going to be improved in this country. We think it's going to look very ugly over the next couple of years and that's why we're going to propose replacing Obamacare with patient-centered healthcare with a better healthcare system for everybody: for the poor, for people in the states, for Medicare, so that we can actually have affordable health insurance for everybody, including people with pre-existing conditions, without costly government takeovers, which is what Obamcare represents. And yes, our budget does promote repealing Obamacare and replacing it with a better system."

As he did last year, Ryan will again propose reforming Medicare by offering a premium-support model that allows seniors to choose from a list of guaranteed coverage options, including traditional Medicare, for their future healthcare needs.

"Doing it this way—harnessing the power of choice and competition, where the senior gets to choose her benefit that's comprehensive—is the best way to save Medicare for future generations," Ryan said. "This guarantees that Medicare does not change for people in or near retirement, and it also guarantees for those of us who are under the age of 55, that we actually have a Medicare program when we retire."

With regard to Medicaid, Ryan said his party believes the Affordable Care Act's expansion of the program is "reckless" because it pushes millions of people into a program that is failing. Wallace challenged Ryan, asking how the Wisconsin Republican thought shifting Medicaid to a state block grant program and cutting $770 billion from Medicaid over 10 years—which was included in Ryan's budget last year—would not affect legitimate recipients.

"These are increases that have not come yet," Ryan said. "So by repealing Obamacare and the Medicaid expansions, which haven't occurred yet, we are basically preventing an explosion of a program that is already failing. So we're saying: Don't grow this program through Obamacare because it doesn't work."

Ryan is expected to release his budget proposal on Tuesday.