Since the election, Paul Ryan has accommodated and deferred to Donald Trump on all sorts of issues they don’t see eye-to-eye on. But when it comes to Ryan’s career-defining cause — overhauling Medicare and other entitlements — the speaker has held his ground.

The clashing philosophies between the GOP's two top pols — Trump once called Ryan's doctrine "political suicide" — is about to come to a head. Left unresolved, it threatens to sink tax reform, a top priority for both men.


Reality will set in when House Republicans roll out their 2018 budget this spring. The blueprint would unlock a fast-track procedural tool that leadership wants to use to squeeze a tax bill through Congress on party lines.

But if Ryan sides with Trump and doesn’t include his proposal to turn Medicare into a voucher program in the budget, it may never pass. That’s because most House Republicans won’t vote for budget that doesn’t “balance” in 10 years — and Ryan can’t get there without taking on entitlements, including Medicare.

“There is no way to balance the budget without entitlement reform,” said House Budget Committee member Tom Cole, who expects Ryan to include his Medicare reform proposal in the budget this year. “It’s just simply mathematically impossible, and I think the most important thing for us is not to lose sight of that under pressure. We should write a budget that includes genuine entitlement reform.”

Republicans realize the dispute could make for real friction between the White House and GOP Congress early in Trump's administration. Rep. Chris Collins (R-N.Y.), a top ally of the president-elect, said he doesn’t envy Ryan’s task ahead.

“We have a Republican administration with their own opinion, and we don’t want to get crosswise with them, and Donald Trump is still the head of the Republican party. But we still have our Freedom Caucus," he said, referring to the group of fiscal hardliners. Collins added, seemingly in jest: "Who in the world would want to be speaker?”

It’s not just Freedom Caucus members whom leadership has to worry about. A host of more establishment Republicans told POLITICO they’re crossing their fingers that Ryan can get Trump to come around on entitlement reform — or at least get him to turn a blind eye to their upcoming budget. The main drivers of the nearly $19 trillion debt, they note, are these mandatory spending programs, not the annual discretionary spending they Congress directly controls .

“Because he’s a businessman, and he knows how to read a balance sheet, he’s going to be able to see what the problem is, long term, regarding our debt,” said Rep. Todd Rokita (R-Ind.), vice chairman of the Budget Committee. “So I’m going to rely on that acumen to be able to have a truthful conversation about it." Reducing the debt, he added, is "going to have to include entitlement programs: Medicare, Medicaid, Social Security.”

Ryan rolled out his Medicare proposal in 2008. It made him a hero of small-government conservatives and led to his choice as Mitt Romney's vice presidential pick at 42 years old, even as he was vilified by the left.

Trump, at the time, sided with Ryan's critics, calling the ex-Budget Committee chairman's plan “political suicide” because of its proposed changes to Medicare. The incoming president-elect hasn't changed his tune since.

Trump said on the campaign trail he had no interest in entitlement reform. And in an interview with CBS earlier this month, Trump’s incoming chief of staff, Reince Priebus, reiterated that the incoming commander-in-chief doesn’t want to “meddle” with entitlement reforms.

“He made a promise during the campaign that that was something he didn’t want to do. But what he wants to do is grow the economy, help shore up Medicare and Social Security for future generations,” said Priebus, a friend of Ryan and fellow Wisconsinite.

On Thursday, however, Ryan struck the opposite tone during a town hall. He delivered an impassioned defense of his Medicare reform plan.

“More than half of the money going to Medicare right now is the money we borrow; Medicare goes bankrupt in the next decade,” he said. “But if we want this program to succeed, we have to save it from the insolvency, the bankruptcy that's coming.”

Still, Ryan has deflected questions about whether he’ll push for entitlement reform this year as part of the budget.

"Right now we have [a fiscal 2017] budget with a tool for [Obamacare] repeal. The traditional budget will occur this spring,” Ryan told reporters when asked whether entitlement changes will be included in the fiscal 2018 budget. “We will get a new budget sent to us from the administration and the budget committee will dispose of it then. So we’re getting ahead of ourselves as to what the budget is going to look like.”

Last week, Congress passed a fiscal 2017 budget that didn't balance. Conservatives weren't pleased, but most of them went along because the legislation set in motion the party's plans to repeal Obamacare, and they didn't want to be blamed for holding up a top Trump priority.

But as they cast their “yea” votes, several GOP lawmakers vowed: It won’t be so easy next time.