What leadership changes mean for orthopaedic surgeons

The resignation of Rep. John A. Boehner (R-Ohio) as Speaker of the House kicked off a series of changes in the Republican leadership. As new leaders take their positions, the American Association of Orthopaedic Surgeons (AAOS) and the Orthopaedic Political Action Committee (Orthopaedic PAC) will continue to bring issues to the forefront and to advocate for legislation that benefits orthopaedic patients and providers.

Out with the old
On Friday, Sept. 25, 2015, in an emotional meeting with fellow Republicans, Speaker of the House Boehner announced that he would step down from his position and resign from Congress. In the 25 years since his election in 1990, Rep. Boehner had held several leadership positions, including House Republican Conference Chairman, House Minority Leader, and House Majority Leader.

Although a wave of far-right candidates elected to the House in 2010 propelled Rep. Boehner into the Speaker's seat, they were also responsible for limiting his accomplishments. His surprising announcement underscored the increasingly frustrating and precarious nature of a leadership position that had been constantly criticized by both Democrats and Republicans.

"My first job as Speaker is to protect the institution," Mr. Boehner said. "It became clear to me that this prolonged leadership turmoil would do irreparable harm to the institution." He is the first House Speaker to resign willingly since Democrat Thomas P. (Tip) O'Neill Jr in 1986. 

Initially, Majority Leader Rep. Kevin McCarthy (R-Calif.) was projected to replace Rep. Boehner as Speaker. Rep. McCarthy moved into leadership in July 2014, when Virginia Rep. Eric Cantor, the previous House Majority Leader, lost his re-election primary to a Tea Party-backed challenger.

But when Rep. McCarthy announced that he was dropping out of the race for Speaker, the Republican Party was shocked again. "If we are going to unite and be strong, we need a new face to help do that," Rep. McCarthy said about his decision. "I feel good about the decision. I think we're only going to be stronger." Rep. McCarthy will remain in his current position as House Majority Leader.

The decision sidetracked plans by several Congressmen, including Rep. Tom Price, MD, of Georgia and Rep. Steve Scalise of Louisiana, who were interested in vying for the position of Majority Leader.

In with the new
Rep. Paul D. Ryan (R-Wisc.) was the party's second choice for Speaker, but he initially declined to run. "It is important that we, as a Conference, take time to deliberate and seek new candidates for the Speakership," he said in a statement. "While I am grateful for the encouragement I've received, I will not be a candidate. I continue to believe I can best serve the country and this conference as chairman of the Ways and Means Committee."

That changed on Oct. 20, when Rep. Ryan had a change of heart and announced that he would pursue the bid for Speaker, provided that his party unite behind him and met several conditions. "If you can agree to these requests, and I can truly be a unifying figure, then I will gladly serve," he stated.

In addition to a clear message of support from Republicans, Rep. Ryan wanted a House rules change that would prohibit any member of the chamber from seeking a vote to eject the Speaker. He also made it clear that he will prioritize family time with his three young children. After receiving support from 70 percent of the House Freedom Caucus, Rep. Ryan decided to move forward with his bid. On Oct. 29, 2015, he was officially elected as the 54th Speaker of the House of Representatives, with 236 votes.

Who is the new Speaker?
Speaker Ryan is a fifth-generation Wisconsin native and the youngest of four children. He earned bachelor's degrees in economics and political science from Miami University in Oxford, Ohio. During college, he completed a foreign affairs internship in Washington, D.C., working with Wisconsin Sen. Bob Kasten. He also spent a semester at American University in Washington, D.C. Married for 15 years, Rep. Ryan has three children.

After graduation, he accepted a position as a congressional aide in Sen. Kasten's office and supplemented his income with part-time jobs. In 1995, he became the legislative director for Sen. Sam Brownback of Kansas, but returned to Wisconsin in 1997.

Rep. Ryan was first elected to the House in 1998 and is currently serving his ninth term. He was the ranking member of the House Budget Committee in 2007 and became chair in 2011 when Republicans took control of the House. A fiscally conservative voice, he put forward specific plans to tackle the financial crisis. These plans, known as "The Path to Prosperity," were designed to help spur job creation, curb government spending, and lift the crushing burden of debt. He also helped negotiate the Bipartisan Budget Act of 2013 with Sen. Patty Murray (D-Wash.).

Under Wisconsin law, Rep. Ryan was allowed to run concurrently for the House and as Mitt Romney's running mate in the 2012 presidential election. He won the House race, but lost the presidential campaign.

In January 2015, Rep. Ryan was named chair of the House Committee on Ways and Means. Although his term as chair was short, the committee made significant strides on health issues under his leadership. The most notable action was passage of the bill permanently repealing the sustainable growth rate formula." The bill, the Medicare Access and CHIP Reauthorization Act, was signed into law in April.

Other important healthcare issues included committee passage of a bill to repeal the Independent Payment Advisory Board and legislation which would repeal the excise tax on medical devices. Rep. Ryan believes that taxing medical devices stifles innovation, threatens American jobs, drives up heat care costs, and makes treatments less accessible for those who need them.

Brady's ways
Taking Rep. Ryan's place as chair of the House Committee on Ways and Means is Rep. Kevin Brady (R-Texas). In a statement, Rep. Brady said he would use the position to advance "a pro-growth agenda to get this country back on track. This includes taking real steps toward fixing this broken tax code, reforming welfare, saving Social Security and Medicare for the long term, and enlarging America's economic freedom to trade." He also told reporters, "We're going to play a crucial role in moving the big issues forward."

Rep. Brady is currently in his 10th term. He graduated from the University of South Dakota with a degree in mass communications and resides in Montgomery County, Texas, with his wife and two sons. His political career began with election to the Texas House of Representatives in 1990, where he served for 6 years. First elected to Congress in 1996, he has been a reliable conservative voice, a champion of free enterprise and American-made energy with a focus on creating jobs, reducing Washington spending, and sunsetting obsolete federal agencies.

Until 2013, Rep. Brady chaired the Trade Subcommittee of Ways and Means, where he led the successful effort to pass new sales agreements with Panama, South Korea, and Colombia. He was the White House liaison on the successful passage of the Central American Free Trade Agreement. He currently serves as the Deputy Whip and Vice Chairman of the Joint Economic Committee, where he has led opposition to the president's stimulus package and fought efforts to raise taxes on families, small businesses, and American energy producers.

Rep. Brady has sponsored more than 160 bills or amendments and cosponsored almost 1,800 bills or amendments. He is a member of several Congressional Caucuses including the Congressional Army Caucus, the Congressional Fitness Caucus, the House Rural Health Care Coalition, and the Republican Study Committee, among others. The American Conservative Union gave him a lifetime rating of 94.5/100.

Stephanie Hazlett is a government relations specialist in the AAOS office of government relations. She can be reached at hazlett@aaos.org