On Tuesday, President-elect Donald J. Trump announced his nomination of six-term Republican Congress member Tom Price of Georgia to be the secretary of health and human services.
Like many of his Republican colleagues, Price has been a vocal and long-standing critic of the Affordable Care Act, aka Obamacare. But Price, a former orthopedic surgeon, stands apart. While other Republicans have expressed their desire take a hatchet to the landmark healthcare law, he has taken up a scalpel and carved out the most detailed plan yet to repeal and replace the ACA.
“Repeal and replace” was a mantra of Trump’s campaign, yet the president-elect provided no specifics on how to do it or what might replace the ACA. Price’s plan could fill that void. But uncertainty still prevails over any prognosis for the country’s healthcare system. Up for speculation is everything from the political maneuvers necessary to repeal the ACA to the Republican establishment’s acceptance of Price’s replacement plan, some aspects of which are at odds with other Republican plans.
Still, one thing seems certain following the nomination: Trump is dead set on his plan to kill the ACA—despite previous inklings of softening. In a statement released Tuesday, Trump said of Price: “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American."
And with the ACA effectively on death row, healthcare experts are worried.
The man
While political pundits and journalists can only speculate on Price’s strategy come January 20, his long tenure in Congress offers a clear look at his positions and values.
Price, a US representative of the northern suburbs of Atlanta since 2005, holds staunch conservative values and identifies as a member of the Tea Party caucus. As chairman of the House Budget Committee and a member of the House Ways and Means Committee, including the Subcommittee on Health, he has worked to promote those conservative values.
Moreover, Price has voted against federal funding for abortions and Planned Parenthood, which provides critical medical services to women, particularly those of low income. He voted against paid parental leave for federal employees. He didn’t support a measure that would prevent LGBTQ discrimination or another that would expand protections for victims of domestic violence and intimate partner abuse, a major public health issue. Price has supported legislation that would bar the Environmental Protection Agency from regulating greenhouse gases. He voted against a current law that allows the Food and Drug Administration to regulate tobacco, even though cigarette smoking is the leading preventable cause of death in the US. He also voted against expanding the Children’s Health Insurance Program and a measure that required negotiating prescription medication prices for Medicare Part D.
Like many of his fellow Republicans, Price repeatedly voted against Obamacare. In 2010, shortly after President Obama signed the ACA into law, Price said: “Congressional Democrats and the Obama administration blatantly ignored the voices of the American people and rammed through a hyper-partisan piece of legislation that will have a disastrous effect on our nation’s health care system.” (An equal number of Americans support the ACA as oppose it.)
In 2013, Price said in a statement: “Under Obamacare, the American people are paying more for health care and getting less—less access, less quality, and fewer choices.” (However, the Department for Health and Human Services, which Price is set to head, reported that 20 million Americans gained access to health insurance because of the ACA. And the law made health plans more comprehensive.)
Regardless of the ACA’s strengths and weaknesses, Price has introduced a plan—the Empowering Patients First Act—that would scrap the ACA in its entirety and set up a new system, which Price says will get the federal government out of doctors’ offices.
“The Empowering Patients First Act puts patients, families and doctors in charge by focusing on the principles of affordability, accessibility, quality, innovation, choices, and responsiveness,” he said in a statement last year.
The plan
The main features of Price’s plan (PDF) include:
- incentives for people to contribute to health savings accounts
- age-based tax credits for health insurance coverage
- federal grants to help states subsidize insurance for “high risk” populations
- a provision to allow insurance providers to sell plans across state lines easily
- reforms that make bringing lawsuits against doctors harder, which is intended to “reduce the costly practice of defensive medicine.”
Critics of the plan have pointed out and Vox explained that many features will benefit the rich and healthy at the expense of the poor and sick.
For instance, the age-based tax credits get bigger as a person ages—and likely sees increases in their income. Under the plan, Americans would get incentives of:
- $900 when they’re under age 18
- $1,200 between 18 to 35 years of age
- $2,100 between 35 and 50 years of age
- $3,000 at 50 years and older
If you’re middle-aged, middle-class, and in good health, you might be fine under the Empowering Patients First Act and able to afford health insurance regardless. But if you’re, say, a college graduate who’s just starting a career and has a serious medical condition, insurance may not be affordable.
Under the ACA, tax credits are based on income, not age, allowing those with low incomes to get more help.
Price’s plan also eliminates the ACA’s mandates for large, comprehensive coverage plans. Erin Trish, a researcher at the USC Schaeffer Center for Health Policy and Economics, told Ars that Republicans have long grumbled about this feature of the ACA. “One of the criticisms is that the premiums are high because policies are required to cover a lot,” she explained. But, she added, “it’s a trade-off.”
Insurance companies may be able to offer lower prices for more meager plans. And that could attract more young and/or low-income healthy people to sign up for coverage. But offering cheap, bare-bones plans to young, healthy people would likely drive up the prices of large, comprehensive plans that sick and older people need. This is because the affordability of those comprehensive plans is buoyed by healthy people buying into them and not needing all of their coverage.
The Empowering Patients First Act, like other Republican plans, also muddies one of the ACA’s more popular features: preventing insurance companies from denying coverage or discriminating based on a pre-existing condition. Price’s plan would uphold this feature only for people who have continuous coverage. If, however, someone with a pre-existing condition went for a period without health coverage—like if they lost their job and couldn’t pay for insurance during their employment gap—insurance companies could deny them coverage or dramatically raise their prices.
Unlike other Republicans’ plans, Price’s says nothing about the ACA’s Medicaid expansion, which could leave the more than 15 million Americans who gained coverage this way scrambling to find affordable coverage.
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