Paul Ryan has had three overarching goals during his political career: to cut taxes on the wealthy, to cut government spending on the poor and old, and to make the needy work if they want government help. Last year, the House Speaker finally checked the taxes bit off his Congressional bucket list. But his dreams of clipping the safety net have proven more elusive. The Obamacare repeal bill Ryan jammed through his chamber would have made the historic reductions to Medicaid that Republicans have been chasing for decades. But that effort died with a thumbs down from John McCain.