HARI SREENIVASAN: As President-elect Trump’s pick to lead the Health and Human Services Department, Congressman Tom Price would oversee programs as wide-ranging as Medicare and Medicaid. But, first, he’d help lead efforts to carry out one of Mr. Trump’s signature campaign pledges: repeal and replace the Affordable Care Act, also known as Obamacare.
For more, we turn to Sarah Kliff. She has written extensively on the topic for the Web site Vox.
What do we know about Congressman Price and the plans that he has already had in mind?
SARAH KLIFF, Vox: So, he’s a congressman who has spent a lot of time thinking about repeal and replace of Obamacare. He’s the author of a 242-page replacement plan for Obamacare. He’s the guy you would pick if you’re quite serious about moving forward on Obamacare repeal.
HARI SREENIVASAN: Republicans have tried to do repeal and replace before. Even Speaker Ryan has a plan. What do these plans have in common?
SARAH KLIFF: So, they generally cover fewer people than Obamacare. They would leave a few million people uninsured. The exact number depends on the plan. They’re generally better for young, healthy people and worse for sick, older people.
HARI SREENIVASAN: How so?
SARAH KLIFF: They have a lot less protections for people with preexisting conditions.
They make it possible for insurance companies to charge more to those who are sick. That would be a really big change from Obamacare, which outlaws those provisions.
HARI SREENIVASAN: And then what does the pick say of Seema Verma, who is going to run Medicare and Medicaid, say about this new team that he’s putting in place? She’s worked on Medicaid expansion as a consultant for different states?
SARAH KLIFF: She’s incredibly experienced in Medicaid policy.
It suggests to me that the Trump administration is thinking about making some big changes to Medicaid, possibly adding premiums into the program, which serves low-income Americans.
HARI SREENIVASAN: And is there — when we talk about the changes that could affect millions of people — we know Obamacare gets this big umbrella thing, but really on brass tacks when it comes to specific policies that impact folks, so let’s, for example, take contraception coverage. How could that change?
SARAH KLIFF: That’s something that’s very easy for a Trump administration, for Congressman Price in office to really turn back on day one.
It’s something that the Obama administration did in regulations. It’s not in the law. They could rewrite those regulations to say that contraceptives are no longer covered under Obamacare.
HARI SREENIVASAN: And the congressman is against abortion, Congressman Price is, right? But it takes something else to try to get even your personal view put into legislation that gets passed by all of Congress.
SARAH KLIFF: Sure.
There is going to be a lot of back-and-forth, a lot of heated battles just like we had around Obamacare in 2010. There will be a lot of infighting and figuring out what does the Republican agenda on health care look like? What is one that Trump and senators and Representative Price at HHS now, what can they agree on?
HARI SREENIVASAN: What about Medicare? That affects a huge population also covered under this.
SARAH KLIFF: The Republicans have a pretty cohesive view for Medicare. They want to switch it to more of a voucher program, where seniors get a set amount of money, they shop for different plans. One of those plans might be a government-run Medicaid.
There would also be private competitors and they would kind of be using their set amount of money to pick whatever plan they could afford.
HARI SREENIVASAN: And how about the health — I guess the health insurance that most of us get through employer coverage?
SARAH KLIFF: There is a big change to that in Representative Price’s plan as well. He would cap the tax exclusion we right now for insurance, meaning that the cost of insurance that you get at work, that could go up pretty significantly under Representative Price’s plan.
HARI SREENIVASAN: And so all of these of course have political consequences. When you feel it in your personal pocketbook, you might choose to vote a different way.
SARAH KLIFF: Yes.
I think there will be things that Republican legislators like, that they like in policy and in theory, that are quite politically difficult to implement. The cap on employer-sponsored insurance is a great example of that.
Democrats wanted to make the same change in 2010, but they found it was politically impossible to do so. I think Republicans will face similar barriers.
HARI SREENIVASAN: All right, Sarah Kliff from Vox, thanks so much.
SARAH KLIFF: Thank you.
HARI SREENIVASAN: All right, let’s dig a little deeper now on the potential fallout for Obamacare and the people who use its benefits.
Sabrina Corlette specializes in health insurance markets, as a research professor at Georgetown University. And Bob Moffit is a senior fellow at the Heritage Foundation’s center for Health Policy Studies. The Trump team has been meeting with people at Heritage Foundation during this transition.
So, Bob Moffit, what does this appointment signal to you?
ROBERT MOFFIT, The Heritage Foundation: It signals that President-elect Trump is very serious about the promise to repeal and replace Obamacare.
The appointment of Congressman Price is the appointment of an individual who has a long experience in health policy in the House and has introduced legislation to repeal Obamacare and to replace it with provisions of his own.
So I think from the standpoint of the administration, this is a very serious appointment. It’s a very, very big signal to both the House and the Senate that the Trump administration is very serious about this issue.
HARI SREENIVASAN: Sabrina Corlette, he has had a 240-plus page plan already on the books. That’s in addition to all the other Republican plans that are out there to repeal and replace.
SABRINA CORLETTE, Georgetown University: Right.
I think one thing that Mr. Moffit and I would absolutely agree on is that the nomination of Mr. Price is a clear signal that the repeal of Obamacare is a top priority for this new president.
However, I don’t think that we can say anything that the Republicans have put forward, including Mr. Price, constitutes a replacement of the Affordable Care Act, because none of the proposals, including Mr. Price’s proposal, would cover nearly the same number of people that the Affordable Care Act covers, nor would it provide the same consumer protections for people with preexisting conditions.
HARI SREENIVASAN: Now, Robert Moffit, again, a plan does not exist. We’re talking about based on what he’s proposed before and what other Republicans have proposed before.
ROBERT MOFFIT: Right.
HARI SREENIVASAN: What’s the cost that maybe the new administration is willing to tolerate in the number of people that got…
ROBERT MOFFIT: Well, I think that the president-elect himself made a comment at the very beginning of this, and actually put it in print, that, in fact, nobody should fall through the cracks.
Remember that Tom Price is an orthopedic surgeon, so I think what we’re looking at is a surgical approach to the Affordable Care Act. I don’t think what you will see is any kind of massive disruption. I think the major concern right now for those of us in health policy is that we are already facing a massive instability in the insurance markets, particularly in the small group and the individual markets.
With premiums jumping 25 percent nationwide, average premiums in the exchanges, and then with these breathtaking deductibles — for a family with a bronze plan, you’re talking about a $12,000 deductible — health insurance is becoming less and less affordable for millions of Americans.
The people in the exchanges is only one part of this problem — or only one part of this problem. But you got about 10 million people in the individual market outside of the exchanges who do not get any subsidies at all who are being affected by this, and then you also have another 15 million people in the group market, so — small group market.
So this problem that we have right now with affordability and cost and the instability of the insurance market is affecting millions of people. What that means is, is that the administration cannot waste time on this. They have to come to the rescue of people to make sure that those who have coverage don’t actually lose it, and we have higher rates of uninsurance as a result of it.
HARI SREENIVASAN: Sabrina Corlette, how do you take a surgical approach, but also contain costs?
SABRINA CORLETTE: Well, I’m not sure how you take a surgical approach, based on what we have heard Mr. Price and other congressional leaders, as well as the president-elect, say.
They have called for a wholesale repeal of the Affordable Care Act. That would include expansion of Medicaid, which is the program that covers low-income people. That would include a repeal of the tax credits that help moderate-income people afford coverage, as well as the individual mandate, which is supposed to get healthy people into the pool and make coverage more affordable across the board.
Once you repeal all of that, that’s going to cause massive disruption in the market. So, that’s going to throw as many as 22 million people off of coverage. Now, Mr. Price has put forward a bill. However, the tax credits that it provides are a tiny fraction of what the Affordable Care Act provides to people.
They’re also not income-based, so they heavily favor higher-income people over lower-income people. And then if you have a preexisting condition and you have even a tiny lapse in coverage, you’re left out in the cold.
HARI SREENIVASAN: Mr. Moffit, this is also on the heels of President-elect Trump coming out and saying, listen, he’d like to preserve the clause that says you can’t discriminate on preexisting conditions.
That’s almost universally agreed. There is nobody that wants that.
ROBERT MOFFIT: There is nobody who is arguing that we should exclude individuals from health insurance coverage because they are sick or they have a preexisting condition. That’s nonsense.
That’s never been the debate. The question is, what is the best way to do it?
HARI SREENIVASAN: And how do you pay for that?
ROBERT MOFFIT: Well, you’re going to have to pay for it in any event, because we’re paying for it one way or another. If people do not get access to health insurance and they end up in the hospital emergency room, the most expensive place on the planet, tax players are stuck with the bill.
So, we have got to address this. Frankly, I think that a mainstream proposal right now that is circulating among House Republicans is to adopt one of the practices that we have in group insurance right now under the Health Insurance Affordability and Accountability Act, which is this, is that if you have credible coverage, creditable coverage, and you move from one job to another and join different types of groups, you cannot be rated up, regardless of any kind of preexisting condition.
HARI SREENIVASAN: Yes.
ROBERT MOFFIT: We do not have any kind of crisis of preexisting conditions in employment-based health insurance. The problem is in the individual market.
If you’re going to be personally responsible and buy insurance at an affordable rate, you can do that. Otherwise, you can be rated up. That puts the responsibility where it belongs, on the individual who is buying the insurance.
SABRINA CORLETTE: Well, for people who have come off an employer-based plan, that typically means they have come off because they have lost their job. It can be very difficult for those people to afford the premiums that you have to pay to maintain health insurance coverage, particularly given the fact that the tax credits that some of these Republican proposals are talking about are paltry.
So what would happen is, if you skip some time and go without coverage because you can’t afford it, you can’t afford the premium, what some of these proposals would do would effectively lock you out until you either get back into an employer-based plan or become eligible for Medicare.
HARI SREENIVASAN: All right, this is a conversation, and legislation will eventually make its way to Capitol Hill. We will have you back then.
Robert Moffit, Sabrina Corlette, thank you both.
ROBERT MOFFIT: Pleasure.
SABRINA CORLETTE: Thank you. It was a pleasure.
ROBERT MOFFIT: All right.