Rep. Tom Price, a fierce opponent of the Affordable Care Act, will become the next Health and Human Services secretary, if confirmed by the Senate.
President-elect Donald Trump announced the appointment Tuesday, saying Price "is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible health care to every American."
The Georgia Republican, an orthopedic surgeon and a leading conservative voice on health care issues, has repeatedly called for health care policy to be administered on a more local level.
"President Obama's health care law violates every principle of health care that Americans hold dear: accessibility, affordability, choices, innovation, quality and responsiveness," Price said in a statement last year.
Trump's choice to lead the health department stands in stark contrast to the two previous HHS secretaries under President Obama, who were tasked with implementing and defending the federal health care law.
Price has voted dozens of times to repeal Obamacare, and he played a key role in the bill Congress passed earlier this year that attempted to do so. The president vetoed the measure, and Republicans did not have enough votes to override it.
Legislation introduced by Price was among the first to offer a replacement for the Affordable Care Act. The "Empowering Patients First Act" offered tax credits for people to buy insurance and encouraged Americans to open health savings accounts, similar to the subsequent models proposed by House Speaker Paul Ryan.
This bill is one of several Republican plans likely to be debated in Congress, but it does represent a window into Price's philosophy on health care.
Instead of the Obamacare model, which mandates that most Americans get insured or face a tax penalty, Price's plan largely aimed to boost coverage by making it more affordable.
One component would have allowed patients to buy insurance across state lines — an idea that Trump repeatedly touted on the campaign trail as a solution to high health-care costs. And the health savings accounts that Price advocates allow patients to save money tax-free that can be used to pay for health care.
What Price's plan does not include is Medicaid expansion or an alternative. When it comes to Medicaid, Price has favored rolling back Medicaid expansion, which 32 states have adopted under the Affordable Care Act.
In a recent budget proposal, Price called Medicare, Medicaid and Social Security ineffective, advocating that the federal government change how Medicaid is funded entirely.
Instead of the federal government paying 57 cents of every state dollar spent on Medicaid, Price suggested the government issue block grants state that officials could determine how best to use. States would be responsible for any costs beyond the federal allotment, even if they incur unexpected costs from an economic downturn or population growth, for example.
"It's not a tweak," said Andrea Callow, a senior policy analyst at the nonprofit health care advocacy group Families USA. "It's a complete rupture of the Medicaid program as we know it."
Supporters of the proposal say market forces would reduce the price of premiums as companies compete for more customers, while critics say the plan would constitute a step backward from the system already in place.
"It would be hard to call it a comprehensive replacement," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. "It would not come anywhere near to covering the number of people the Affordable Care Act covers."
Corlette also worries that such a plan would allow insurance companies to move to states with fewer regulations. As a result, she said, healthy people would buy the cheaper plans, and sicker patients would be forced to pay exorbitant premiums for their coverage.
As for HSA's, she argued they do not benefit those who need health-care expansion the most.
"For people who are high income, it's a great tax shelter," Corlette said. "For those without a lot of disposable income it's not that useful."
Tevi Troy, the CEO of the American Health Policy Institute and the former deputy secretary of HHS under George W. Bush, said that view is too narrow. He said the government could also provide a financial incentive for poorer Americans to invest in HSAs.
Troy added that Price's proposals are part of a larger multi-pronged strategy.
"I don't think any one of these are a panacea, but in total, the proposals would reduce the cost of health care," Troy said.
In addition to his own proposals, Price would be tasked with incorporating plans from other Republicans as well as the president-elect himself.
Trump railed against the Affordable Care Act during his campaign, calling it a disaster, but after meeting with President Obama, Trump appeared to soften his position somewhat, saying he wants to keep one major component — the requirement that companies cannot refuse to sell a person insurance based on pre-existing conditions.
In a Price-led HHS, that would likely come in the form of preventing companies from denying coverage if a person has maintained health insurance for a set period of time.
Apart from his stance on health insurance, Price also has a conservative track record on abortion. The congressman received a 100 percent rating from the National Right to Life Committee and a 0-percent rating from the abortion rights group NARAL.
He has voted multiple times to cut off Planned Parenthood from federal funding and has opposed efforts to expand the State Children's Health Insurance Program to include higher income families.
"As a nation, we should promote the goal of reducing the number of Americans reliant upon government assistance and allow for personal choices in health care decisions," Price said in a column written for the conservative website, Townhall.
Price, who has served in the House of Representatives for 14 years, would also be the first doctor in the position since Louis Wade Sullivan led the department in the George H. W. Bush administration. Before entering politics, he practiced orthopedics for nearly 20 years.
He is currently the chair of the House Budget Committee.