President-Elect Trump Taps Rep. Tom Price For Secretary Of Health And Human Services

Politico: “Rep. Tom Price Is President-Elect Donald Trump’s Choice.” Politico reported that President-elect Donald Trump chose Rep. Tom Price “to serve as the next secretary of Health and Human Services,” and noted that Price has a background as “an orthopedic surgeon and has been a longtime opponent of the Affordable Care Act.” From the November 29 article:

Rep. Tom Price is President-elect Donald Trump’s choice to serve as the next secretary of Health and Human Services, the real estate mogul’s transition team announced in an email early Tuesday morning.

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy, making him the ideal choice to serve in this capacity,” Trump said in a statement. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American. I am proud to nominate him as Secretary of Health and Human Services.”

Price (R-Ga.) is an orthopedic surgeon and has been a longtime opponent of the Affordable Care Act, which the president-elect has pledged to repeal and replace. The Georgia congressman was an early supporter of Trump’s and endorsed him for president last May. [Politico, 11/29/16]

Major Newspapers Failed To Note The Impact of Price’s Proposed Health Care Policies

NY Times: Trump “Could Not Have Found Anyone More Prepared Than Representative Tom Price” To “Dismantle And Replace” The ACA. The New York Times failed to include any discussion of the tangible impact of Price’s proposed changes to the ACA, Medicare, or Medicaid in its glowing review of his selection to lead HHS. A November 28 article, claimed Trump “could not have found anyone more prepared” than Price to “dismantle and replace President Obama’s health care law.” The article called Price’s proposed legislation a “detailed, comprehensive replacement plan,” noting that it would “offer age-adjusted tax credits,” health-savings accounts, and “grants to states to subsidize insurance for ‘high-risk’ populations, but largely avoided any discussion of the effect those policies would have on the level and quality of coverage in the U.S. The article also claimed that Price has “intimate knowledge of Medicare” while neglecting to explain how previous budget proposals he has supported would fundamentally alter a health insurance system used by tens of millions of persons with disabilities and retirees:

While some Republicans have attacked the Affordable Care Act without proposing an alternative, Mr. Price has introduced bills offering a detailed, comprehensive replacement plan in every Congress since 2009, when Democrats started work on the legislation. Many of his ideas are included in the “Better Way” agenda issued several months ago by House Republicans.

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The legislation Mr. Price has proposed, the Empowering Patients First Act, would repeal the Affordable Care Act and offer age-adjusted tax credits for the purchase of individual and family health insurance policies.

The bill would create incentives for people to contribute to health savings accounts; offer grants to states to subsidize insurance for “high-risk populations”; allow insurers licensed in one state to sell policies to residents of others; and authorize business and professional groups to provide coverage to members through “association health plans.”

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He has introduced legislation that would make it easier for doctors to defend themselves against medical malpractice lawsuits and to enter into private contracts with Medicare beneficiaries. Under such contracts, doctors can, in effect, opt out of Medicare and charge more than the amounts normally allowed by the program’s rules.

He also supported legislation to bar federal funds for Planned Parenthood, saying some of its clinics had been involved in what he called “barbaric” abortion practices.

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Mr. Price’s intimate knowledge of Medicare could serve him well. The secretary of health and human services sets Medicare payment policies for doctors, updates the physician fee schedule each year and issues rules that can have a huge influence on the practice of medicine. The government is carrying out a law that changes how doctors are paid under Medicare, and Medicare often serves as a model for private insurers. [The New York Times, 11/28/16]

Wash. Post: Price Is “A Fierce Critic Of The Affordable Care Act And A Proponent Of Overhauling The Nation’s Entitlement Programs.” The Washington Post reported on Trump’s selection of Price, describing him as a “fierce critic” of the ACA and a “proponent of overhauling the nation’s entitlement programs,” but barely described the potential effect of the implementation of his policies. The article claimed “Price already is familiar with the budget process, the federal bureaucracy, and the costs and mechanics of changing the Affordable Care” and described his proposed reforms as “major changes to Medicaid and Medicare.” The only mention of the impact of Price’s proposals focused exclusively on his Medicaid agenda, noting that “outside groups and watchdogs have warned that such proposals probably would lead to deep cuts for those who use the program.” On Medicare, the article misleadingly claimed Price’s proposed changes “would give older or disabled Americans financial help” to buy private insurance, neglecting to mention that such a change amounts to privatization of the program. From the November 29 article:

President-elect Donald Trump has chosen Rep. Tom Price (R-Ga.), a fierce critic of the Affordable Care Act and a proponent of overhauling the nation’s entitlement programs, to lead the Department of Health and Human Services.

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One of the 18 members of the House GOP Doctors Caucus, Price supports major changes to Medicaid and Medicare, health insurance pillars of the Great Society programs of the 1960s. Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies. Instead, like many House Republicans, he wants to convert Medicaid into block grants to states — which would give them more latitude from federal requirements about eligibility rules and the medical services that must be covered for low-income Americans. This plan would also require “able-bodied” applicants to meet work requirements to receive health-care benefits — an idea that the Obama administration has consistently rebuffed.

Some outside groups and watchdogs have warned that such proposals probably would lead to deep cuts for those who use the program. The nonpartisan Congressional Budget Office has estimated that at least 14 million people would lose coverage if Congress revokes the Medicaid expansion that has occurred under the ACA.

For Medicare, Price favors another idea long pushed by conservatives, switching it from a “defined benefit” to a “defined contribution.” With that, the government would give older or disabled Americans financial help for them to buy private insurance policies.

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In choosing Price to fill a key Cabinet position, Trump will add to his team a staunchly conservative lawmaker close to the House speaker. Price already is familiar with the budget process, the federal bureaucracy, and the costs and mechanics of changing the Affordable Care Act as well as revamping the Medicare entitlement program. [The Washington Post, 11/29/16]

WSJ: Rep. Price “Carve[d] Out A Leading Role In Shaping The [Republican] Party’s Health Policy” And “The Party’s Alternative Vision To Democrats’ Affordable Care Act.” The Wall Street Journal failed to note the effect Price’s potential policies would have on the number of uninsured Americans. The article outlined the provisions of Price’s legislation, the Empowering Patients First Act, which “includes refundable, age-adjusted tax credits for people to buy insurance if they don’t have access to coverage through an employer or government program,” a mechanism for opting out of government-run programs like Medicare, and a provision to aid “individuals with pre-existing medical conditions by helping states set up new ‘high-risk’ pools.” From the November 29 article:

President-elect Donald Trump has chosen top officials for health-care policy, picking House Budget Committee Chairman Tom Price (R., Ga.) as secretary of the Health and Human Services Department, the sprawling agency that will likely dismantle Democrats’ 2010 health-care overhaul.

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Mr. Price, a 62-year-old former orthopedic surgeon, is one of several GOP physicians who sought to carve out a leading role in shaping the party’s health policy and, in particular, the party’s alternative vision to Democrats’ Affordable Care Act.

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Mr. Price has championed his own legislation, the Empowering Patients First Act, since 2009, taking a position on a number of hot-button issues for conservative health policy thinkers. In its latest iteration, the proposal includes refundable, age-adjusted tax credits for people to buy insurance if they don’t have access to coverage through an employer or government program. People in a government program, such as Medicare, Medicaid or Tricare, would also be allowed to opt out of it and get tax credits toward the cost of private coverage instead.

Mr. Price had previously included tax deductions in his plans, a tool typically favored by harder-line conservative health-policy thinkers, but said he had “moved towards credits because we felt it was cleaner.”

The plan offers a one-time credit aimed at boosting health-savings accounts, long described by supporters as a way of bringing down medical spending, and derives part of its funding from capping how much employers can spend on providing employee health care before being taxed. The plan seeks to make health insurance available to individuals with pre-existing medical conditions by helping states set up new “high-risk” pools or other programs for such enrollees, and sets new rules allowing insurers to sell policies across state lines. [The Wall Street Journal, 11/29/16]

Experts Explain That Price’s Proposed Reforms Would Gut Access To Health Care And Significantly Curtail Reproductive Rights

Slate’s Jordan Weissmann: Price’s Health Care Plan Model On Paul Ryan’s Medicare Privatization Scheme That Turns Program “Into A Voucher System.” Slate business and economics correspondent Jordan Weissmann pointed to Price’s previous proposal to turn Medicare “into a voucher system” similar to the a privatization scheme supported by Speaker of the House Paul Ryan as one of the many reasons his nomination as HHS secretary would be “horrible news for Obamacare and Medicare.” From the November 29 article:

Donald Trump’s transition team announced on Tuesday morning that the president-elect has selected Georgia Rep. Tom Price as secretary of health and human services. The move sends at least two very loud messages. First, the incoming White House is dead serious about scrapping the Affordable Care Act. Second, it may well be open to ending Medicare as we know it.

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Price is similarly keen on [Speaker of the House Paul] Ryan’s plan to transform Medicare by turning it into a voucher system, where the government would give seniors money that they could use to purchase private insurance. He included those changes in his 2015 budget, and recently told reporters that he expected Republicans to tackle Medicare “reform” some time in 2017, echoing Ryan’s own post-election comments.

As health and human services secretary, Price would ultimately be in charge of administering programs like Medicare, Medicaid, and the Affordable Care Act—and presumably serve as Trump’s point man on health policy. Given that the president-elect is by all accounts a deeply impressionable man with little to no policy expertise, Price is almost certainly set to play an extremely influential role in any negotiations over health-care legislation. [Slate, 11/29/16; Media Matters, 11/28/16]

Vox’s Sarah Kliff: Price’s Bill Will “Benefit The Young, Healthy, And Rich,” Disadvantage “The Sick, Old, And Poor.” Vox’s health care reporter Sarah Kliff extensively outlined the impact of Price’s proposed legislation, the Empowering Patients First Act, noting that it replaces the ACA “with a plan that does more to benefit the young, healthy, and rich — and disadvantages the sick, old, and poor.” Price’s plan “would allow insurers to cut whatever benefits they no longer want to cover” which would “likely benefit healthy people,” but would “send the cost of more comprehensive plans — the plans sicker people need — skyrocketing.” From the November 28 article:

Empowering Patients makes the individual market more advantageous for healthier people. It eliminates the essential health benefits package, which mandated that all insurers cover a set of 10 different types of care including maternity services and pediatric care. Empowering Patients would allow insurers to cut whatever benefits they no longer want to cover — they could stop covering maternity benefits, for example, to make their plans less attractive to women who plan to become pregnant. This would likely benefit healthy people, who generally want less robust coverage at a cheaper price. But it’ll send the cost of more comprehensive plans — the plans sicker people need — skyrocketing. And it could leave someone who, say, wants health insurance to cover her maternity costs completely out of luck.

There are other ways Empowering Patients makes insurance better for young people too: by letting insurance plans charge them lower rates.

It does this by allowing insurers to charge their oldest enrollees as much as they want. Right now, insurers can only charge the oldest enrollees three times as much as the youngest — that constrains prices for patients in their 50s and 60s.

Eliminating this regulation would increase “increases the overall number of people with coverage, but older people end up falling out of the market as premiums rise,” says Christine Eibner, an economist with RAND Corporation who has modeled similar changes to Obamacare’s age-rating provisions.

And while young people might have cheaper premiums and an easier ability to enroll, older Americans could struggle to purchase coverage in this market, where their costs would rise. These are people who tend to have more urgent health care needs and could be in a worse position without health care than a young adult might be. [Vox, 11/28/16]

Vox’s Sarah Kliff: “Price’s Plan Provides Significantly Less Help To Those With Pre-Existing Conditions.” Kliff also explained how the Empowering Patients plan “provides significantly less help to those with pre-existing conditions than other Republican proposals.” Price’s “continuous coverage” requirement still “requires insurance plans to offer coverage to any patient regardless of how sick they are” but it “would let insurers charge sick people more if they did not maintain ‘continuous coverage.’” Kliff added that Price’s plan has “a much weaker safety net” than other options. From the November 28 article:

Price’s plan provides significantly less help to those with pre-existing conditions than other Republican proposals, particularly the replacement plan offered by House Speaker Paul Ryan (R-WI).

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Prices’ Empowering Patients plan, like Obamacare, requires insurance plans to offer coverage to any patient regardless of how sick they are. But the Empowering Patients plan, unlike Obamacare, would let insurers charge sick people more if they did not maintain “continuous coverage.”

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Empowering Patients does have a safety net for people like this: It would invest $3 billion over three years in a high-risk pool to cover those with preexisting conditions who are unable to afford coverage on the marketplace. This is significantly less generous than other Republican proposals for high risk pools. Ryan’s Better Way plan, for example, would put $25 billion towards the high-risk pools over a decade ($2.5 billion per year) and keep them running indefinitely. In that way, Price’s bill has a much weaker safety net than his House colleagues envision. [Vox, 11/28/16]

Huff. Post’s Jonathan Cohn: Price’s Plan Would “Rescind Entirely” ACA’s Medicaid Expansion “For The Poorest Americans.” According to Huffington Post national correspondent Jonathan Cohn, Price’s proposed health care overhaul would “rescind entirely [the Affordable Care Act’s] expansion of Medicaid for the poorest Americans.” When combined with the removal of coverage guarantees for people with pre-existing conditions and the removal of quality control regulations for insurance plans, Price’s agenda would mean “fewer people are covered” and “people with the worst medical conditions” would be more economically insecure. From the November 29 article.:

The “Empowering Patients First Act,” as it is known, would gut Obamacare’s regulation of insurance plans, reduce the total financial assistance going to people buying private coverage and rescind entirely the law’s expansion of Medicaid for the poorest Americans.

Insurers could resume some of the practices that Obamacare now prohibits ― like selling bare-bones plans and, in some cases, denying coverage to people with pre-existing conditions. Price’s proposal would offer people tax credits, but there’d be no guarantee the credits could actually pay for comprehensive coverage.

The result, according to one analysis, would be less government spending and regulation ― as well as lower taxes on the rich. Many younger and healthier people would get access to cheaper insurance, particularly if they were comfortable with plans that had minimal coverage or gaps in benefits.

But a scheme like Price’s would also mean fewer people covered and, almost certainly, less financial protection for people with the worst medical conditions. [The Huffington Post, 11/29/16]

CBPP’s Edwin Park: “Proposed Medicaid Block Ground Would Add Millions To Uninsured And Underinsured.” Edwin Park, the vice president for health policy at the Center on Budget and Policy Priorities (CBPP), criticized Price’s plan, noting that “the combined Medicaid cut” would add “tens of millions of Americans to the ranks of the uninsured and underinsured.” Park underlined that repealing the Medicaid expansion “means that at least 14 million people would lose their Medicaid coverage.” From the March 2015 report:

House Budget Committee Chairman Tom Price’s budget plan proposes to radically restructure Medicaid by converting it to a block grant and cutting federal funding for it steeply, by $913 billion over the next decade. It would also repeal health reform’s Medicaid expansion. The combined Medicaid cut would reach $1.8 trillion over ten years, relative to current law, adding tens of millions of Americans to the ranks of the uninsured and underinsured.

Repealing health reform’s Medicaid expansion means that at least 14 million people would lose their Medicaid coverage or no longer gain coverage in the future. (That’s the number of people who the Congressional Budget Office [CBO] estimates would eventually gain coverage under the Medicaid expansion, though it could reach 17 million if all states adopt the expansion.) In addition, the large and growing cut in federal Medicaid funding from the block grant would almost certainly force states to sharply scale back or eliminate Medicaid coverage for millions of low-income people who have it today. All told, after accounting for the plan’s proposed repeal of health reform’s marketplace subsidies, tens of millions of people would likely become uninsured under Chairman Price’s plan.

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The Urban Institute estimated that former Chairman Ryan’s similar block grant proposal in 2012 would lead states to drop between 14.3 million and 20.5 million people from Medicaid by the tenth year (outside of the effects of repealing health reform’s Medicaid expansion). That would cause a drop in enrollment of between 25 percent and 35 percent. The Urban Institute also estimated that the block grant likely would have caused cuts in reimbursements to health care providers of more than 30 percent by the tenth year. Chairman Price’s Medicaid block grant proposal likely would mean similarly draconian cuts. [Center on Budget and Policy Priorities, 3/17/15]

Rewire: “Price Could Lead The Charge In Rolling Back The ACA’s Birth Control Benefit.” Rewire political and campaigns editor Ally Boguhn detailed the impact Price could have on reproductive rights if confirmed as HHS secretary, writing that “Price could lead the charge in rolling back the ACA’s birth control benefit.” The article emphasized how Price has long been “an opponent of the benefit and dismissed those who could not otherwise afford contraception”:

That direction includes repealing the Affordable Care Act (ACA). Price cited the importance of the issue while campaigning for Trump, claiming that the Republican presidential ticket was a way to “make sure we put in place a real health solution.”

If he were to become HHS secretary, Price could lead the charge in rolling back the ACA’s birth control benefit, which requires employer-sponsored health insurance plans to cover contraception as preventive care with no cost to the consumer. Price has long been an opponent of the benefit and dismissed those who could not otherwise afford contraception in a 2012 interview with ThinkProgress.

“Bring me one woman who has been left behind. Bring me one,” Price said, referring to women who cannot afford contraception. “There’s not one. The fact of the matter is, this is a trampling of religious freedom and religious liberty in this country.” [Rewire, 11/21/16]

Dean Clancy: The Empowering Patients First Act Is “A Jekyll-And-Hyde Combination Of Market-Oriented Reforms And Special Interest Provisions.” Dean Clancy, a former senior official in the White House and Congress and contributor to U.S. News & World Report, wrote an article critiquing Price’s health care legislation as a “generous helping of cronyism.” Clancy described the legislation as “a Jekyll-and-Hyde combination of market-oriented reforms and special-interest provisions, with the latter benefiting mostly Price's fellow physicians.” From the May 2015 article:

The bad news is that some of them also come with a generous helping of cronyism.

Priceless. Take, for example, the new bill by Rep.Tom Price, a medical doctor from Georgia and chairman of the House Committee on the Budget. Price is a rising star in the House Republican leadership and a true health reform expert. Friendly and well-spoken, he's a natural to lead his party on health care issues, and it's a mantle he's cheerfully shouldered.

But his bill, the “Empowering Patients First Act,” reveals what can happen when an all-too-human lawmaker undertakes to write laws with huge financial impacts for his own profession. Price's bill is schizophrenic, a Jekyll-and-Hyde combination of market-oriented reforms and special-interest provisions, with the latter benefiting mostly Price's fellow physicians. One almost imagines the bill having been written by two separate personalities: “Noble Reformer Tom Price” and “Water-Carrier Tom Price.”

Noble Reformer Price's handiwork, found mostly in title I of the bill, is truly admirable. It reveals deep insight into what plagues our health system and prescribes sensible remedies. In addition to fully repealing Obamacare, this part of the bill includes bold, well-thought-out reforms to facilitate greater access to tax-free Health Savings Accounts and to equalize the tax treatment of individually purchased and employer-sponsored insurance. Such reforms would, as the bill's title suggests, empower patients by promoting consumer choice and competitive markets.

Noble Reformer Price also proposes to repeal Medicare's individual mandate and thus liberate older Americans to escape Medicare's price controls and bureaucratic rationing. Bravo! [U.S. News & World Report, 5/22/15]