Paul Ryan Champions Health Care Policy Reform, AI Amid Government Shutdown

Amid a government shutdown in nearby Washington, DC, Paul Ryan, former speaker of the House, told attendees at the Academy of Managed Care Pharmacy (AMCP) Nexus 2025 meeting in National Harbor, Maryland, that thoughtful policies and technological innovation can help build a more sustainable and effective health care system.1

In the midst of a government shutdown, Paul Ryan urges clear policies, AI innovation, and patient-focused solutions to build a sustainable US health care system. | Image Credit: Brooke McCormick

Adapting to an Unpredictable Policy Landscape

Moderated by Susan Cantrell, CEO of AMCP, the conversation began with Ryan’s take on Trump-era policies, particularly the “One Big Beautiful Bill.” While primarily a tax bill, Ryan explained that its Medicaid provisions, or “pay-fors,” will directly affect health care. The bill aims to address long-term pressures on entitlement programs from retiring boomers and a shrinking taxpayer base. Changes include restrictions for undocumented individuals and able-bodied, childless adults, which will affect states differently and reduce Medicaid reimbursements.

Cantrell noted that much of the health care policy during Trump’s second term so far stemmed from executive orders and asked Ryan for advice on how health care professionals can navigate this unpredictable landscape. He emphasized the importance of maintaining the proper roles of government branches. However, Ryan acknowledged that polarization and narrow party majorities have limited Congress’s ability to pass laws, leaving the executive branch to act through executive orders.

He also observed that Congress often drafts laws too vaguely, granting the executive branch wide discretion to interpret them. To address this, he argued that Congress must write clear, precise legislation to limit executive overreach.

Additionally, Ryan encouraged attendees to engage with their representatives to ensure their voices are heard.

“…it’s really important that you come through your trade associations and go explain to these policymakers…what the consequences of these decisions are; out of sight, out of mind,” he said. “If you’re not doing that, then policy will be written without your knowledge, consent, or input. It’s game time to make sure that your voices are heard.”

Navigating Political Polarization and the Strain on the Social Contract

Cantrell continued by acknowledging that the government shutdown had reached its 28th day. Given his experience with past shutdowns, she asked Ryan about the largest repercussions for health care nationwide.

He emphasized the human impact, noting that shutdowns primarily harm federal workers through furloughs and missed paychecks. They also disrupt the operations of government agencies and interfere with policy development.

“There's no upside, in my opinion, to these shutdowns,” Ryan said. “…I think it will end, hopefully, soon…it will probably be 5 Democrats in the Senate from purple states, where the cons outweigh the pros on the politics of the shutdown, to vote to reopen the government and go back to the table to negotiate.”

In the meantime, Ryan assured that entitlement programs continue, meaning Medicare and Social Security payments still occur. However, the status of agency workers’ jobs depends on who the executive branch deems essential.

Considering his 20-year career as an elected official, Cantrell asked Ryan to describe the evolution of policymaking. He said he considers the late 20th century to have been a peak period for the US as a republic, when elected officials were entrusted to make decisions. Currently, Ryan explained, the US government is more influenced by the “passions of the day,” reflected in the dominant “Make America Great Again” populism.

He added that social media has amplified this trend, increasing populism and subjecting politicians to constant, real-time scrutiny. In the late 20th century, Ryan noted, elected representatives could govern effectively without such immediate feedback and microanalysis. Now, every decision is closely examined, requiring politicians to grow a thicker skin.

Ryan emphasized that the system of checks and balances helps mitigate the effects of hyperpoliticization and populism, but he cautioned that “the interaction of social media between voters and politicians has definitely changed the way our politics function.”

Despite current polarization, Ryan described health care and retirement programs as the foundation of America’s social contract that all politicians can support. However, he warned that this system is becoming fiscally unsustainable as fewer workers support more retirees, driving up costs faster than the economy can sustain.

Although both parties agree on preserving these programs, Ryan said political gridlock has stalled needed reforms. Despite this dysfunction, he expressed optimism that the US will ultimately find practical solutions to modernize these systems.

Ryan argued that Medicare, specifically, must center on patient choice and competition to avoid the rationing or denial of care. He proposed a premium support model similar to Medicare Advantage, where seniors select from competing plans, with subsidies adjusted based on health and wealth. He also suggested tying retirement age to updated longevity tables to account for increasing life expectancy, which would encourage longer work lives and help sustain program finances.

Balancing Innovation, Cost, and Patient Access

Continuing the discussion on the future of health care, Cantrell highlighted various new treatment strategies, including cell and gene therapies, that have improved patient outcomes but come with high price tags. She asked Ryan for policy ideas that could expand access without “breaking the bank.”

Ryan explained that he supports state-based, federally financed risk pools to cover high-cost, medically complex patients, arguing that focusing resources on these individuals could make care more affordable and accessible for the remaining population. This approach, he claimed, would fund innovative treatments, incentivize pharmaceutical development, and over time, lower costs as new therapies move through the pipeline.

He also advocated for innovative solutions, including artificial intelligence (AI), to improve health care efficiency and outcomes.

“We all agree we want affordable health care,” Ryan said. “The question is, what can we do to make this all work without bankrupting ourselves?...I’m a big fan of AI and how this technology is going to help health care. The question is, can we do it in a way that it’s affordable, that we have the right incentive structures? I think the answer is yes, but that’s not the system we’ve got today.”

When Cantrell asked about AI risks, Ryan described himself as a “techno-optimist,” reiterating that AI could make care better, faster, and cheaper. He emphasized that the US is in a global AI race with China, and restrictive regulations would only slow down progress domestically, not worldwide. Ryan argued that the US, as a free society, should secure the first-mover advantage in shaping how AI operates globally rather than allowing a "tyrannical" regime to do so.

“[AI] is going to be the critical solution to our big problems: our demographic problems, our budget problems, our ability to actually make good on what we all want, which is universal care and coverage that's affordable and better, that makes our lives longer,” he said.

References

1. Cantrell S, Ryan P. General session featuring Paul Ryan; October 27-30, 2025; National Harbor, Maryland.