With President-elect Donald Trump slated to nominate Georgia Republican Rep. Tom Price as his secretary of Health and Human Services, the incoming president shows he is serious about following up his campaign promise to repeal the Affordable Care Act.
As chairman of the House Budget Committee, Price has been one of the most vociferous critics of the 2010 health care reform law. The 2015 budget that passed out of his committee in his first year as chairman proposed repealing the Affordable Care Act entirely as well as its Independent Payment Advisory Board, which is used to curb costs of Medicare.
In addition, the budget proposed getting rid of Medicaid expansion, which a number of states with Republican governors had already rejected. Interestingly enough, incoming Vice President Mike Pence allowed a version of Medicaid expansion in his state. Republicans frequently talk about plans to "repeal and replace" Obamacare, but most are slim on details.
But Price's proposed Empowering Patients First Act of 2015, of which he has introduced variations throughout the years, has detailed plans. Under Price's proposal, the Affordable Care Act would be repealed effective immediately upon enactment.
In its place, the bill would create refundable tax credits for health savings accounts. In addition, the proposal would require the Department of Health and Human Services to give a grant to each state to create high-risk insurance pools or reinsurance pools. One of the more popular provisions of the Affordable Care Act is prohibiting people from being denied coverage because of a preexisting condition.
Price has proposed as a replacement that individuals in small group markets would be allowed to pool together into groups of hundreds of thousands or a million to make it so those with preexisting condition look similar to other healthier individuals. Another part of the replacement would be what is called continuous coverage, which means people can't be denied coverage if they switch insurance from one insurer to another.
The bill has never gone to vote in the committees to which it has been referred. Price stated recently that it is possible that Republicans can use budget reconciliation to repeal the law in 2017.
But House Majority Leader Kevin McCarthy shot down the idea in a news conference on Tuesday. Asked to clarify a statement that he would work with Rep. Tom Price to replace and then repeal the Affordable Care Act, Republican Sen. Lamar Alexander told reporters, "Well I agree with President-elect Trump who said those things should be done simultaneously. And I think if you replace and repeal Obamacare simultaneously you have to figure out how you're going to replace it before you repeal it."
Asked how Medicare fit into the discussion, Alexander said, "I think that falls under the rule of not biting off more than you can chew."