Tom Price spent years railing against Obamacare. Now he’ll finally have sweeping power to do something about it.
The Georgia Republican congressman is on the verge of becoming the Trump administration’s top health care official, armed with broad authority to begin unwinding Obamacare by using as much executive power as possible, even as Congress struggles to find consensus on a plan to repeal and replace the health care law. First, he could ax Obamacare’s mandate ensuring coverage for contraception and give insurers more latitude to determine which health benefits they will — and won’t — pay for. Those changes will likely be paired with stricter monitoring of Obamacare enrollees, as the administration aims to win over jittery health plan executives with policies that prioritize insurance market predictability and profitability.
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Conservatives who railed against Barack Obama’s vast powers to build up the Affordable Care Act declared vindication Saturday with President Donald Trump’s executive order to tear it apart.
“For me, it’s a mix of irony and schadenfreude,” says Josh Blackman, a law professor who’s written two books that criticized the Obama administration’s implementation of the law. “I’ve warned for years that, with a new president in the White House, the exact same powers could be used for different purposes. That’s what we’re seeing now, to a T.”
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President-elect Donald Trump says the program he plans to institute as a replacement for the Affordable Care Act will “get private insurance companies to take care of a lot of the people that can afford it.”
“We’re going to have a plan that’s going to be great for people. And it’s going to be much less expensive. And you will be able to actually have something to say about who your doctor is and your plan,” Trump told Fox News’ “Fox & Friends” in an interview that was taped Tuesday and aired Wednesday morning. “We have to cover people that can’t afford it. And that’s what I’m talking about. And we’ll probably have block grants of Medicaid back into the states. … Nobody is going to be dying on the streets with a President Trump.”
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While the budget passed early this morning won’t be signed into law, it must be approved by both chambers for committees to begin drafting reconciliation legislation. Reconciliation is one of the most powerful weapons in the majority’s procedural arsenal. Under reconciliation, bills are protected from the 60-vote filibuster so they can be passed through the Senate and House by a simple majority. Democrats used it to finish passing the ACA seven years ago, and now Republicans intend to return the favor to dismantle the law. There’s a hitch, though: Under budget reconciliation, only provisions that affect federal spending or taxes can be targeted. That means Republicans cannot completely eliminate or replace the law in one fell swoop. The final call on what can or cannot be addressed in a reconciliation bill will be made by the Senate parliamentarian. The GOP did a dry-run in the last Congress, passing a reconciliation bill that killed key parts of the ACA, including the individual mandate, insurance subsidies for consumers and the Medicaid expansion. President Obama vetoed the legislation, but that won’t be an issue this time around with Trump in the White House.
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Republicans have been winning elections for years by promising to repeal and replace the Affordable Care Act. Now that the dog has caught the car, we have to know what to do with it. Republicans have captured the White House, and kept the House, Senate and a majority of the governors’ offices. There are no more excuses, and voters are rightfully expecting quick and bold action.
Already, though, the media is beginning to highlight or perhaps even create differences among the Republican victors, with stories about some in the party wanting a quicker timeline for repeal than others. Before we get bogged down by a debate about whether Obamacare should be repealed within two or three years (and I am for sooner than later), it would be helpful to remember why conservatives have opposed Barack Obama’s health law so vehemently. And no, despite the president’s protests, it is not simply because of the name. Articulating our principled objections will help inform how Republicans should replace this flawed legislation.
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House and Senate Republican leaders are forging ahead with plans to repeal Obamacare then replace it later — dismissing mounting pressure from their own party to delay the repeal vote until they have a fully formed alternative.
But they’re hoping to ease internal concerns that Republicans will be attacked for acting hastily — worries that accelerated after libertarian-leaning Sen. Rand Paul (R-Ky.) bucked party leadership on the matter last week and received a blessing from President-elect Donald Trump. Speaker Paul Ryan (R-Wis.), Senate Majority Leader Mitch McConnell (R-Ky.) and their top lieutenants in both chambers are now considering a strategy that includes adding some replacement provisions to the repeal bill, according to lawmakers and aides.
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Official Washington still is struggling to understand and adapt to the populist wave that carried Donald Trump to the White House. Anger and denial linger still, emotions rooted in the social and economic chasm between Trump voters and the political class.
What does this mean for health? The first fight is already shaping up, of course, over Obamacare. The way forward falls on President-Elect Trump, his presumptive HHS Secretary Tom Price (R-GA) and the GOP-controlled Congress to make good on his campaign promise of replacing Obamacare with “something terrific.” This won’t be easy, and the latest reports are that the can might be kicked down the road a few years.
Responding to populist frustrations will require policymakers to recognize that long-held policy assumptions may no longer apply in a rapidly changing economy. These include:
- The link between jobs and coverage. How workers – and seniors — get coverage will evolve.
- The broken link between “health” and health insurance. Regulators will at some point give insurers room to innovate, permitting new forms of coverage that promote health and offer new ways to finance care for chronic conditions.
- The broken link between premium and risk. A health promotion approach will require restoring this link, allowing insurers to encourage and reward healthy behaviors.
- New technology. Technology will one day penetrate the health care regulatory encrustation and dispel the lingering paternalism that regards consumers as incapable of making informed choices about their medical care.
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Brandishing a new slogan, “Make America Sick Again” adapted from President-elect Donald Trump’s campaign, Democrats are holding rallies in Ohio, Pennsylvania, and West Virginia, featuring the stories of thousands of the red-state Americans who have benefited from Obamacare. Those rallies will culminate in several nationwide events beginning Jan. 15 where they will warn of the chaos to ensue if the health law is repealed without a replacement plan. They’re also urging followers to bombard lawmakers’ district offices and phone lines with calls against repeal.
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Vice President-elect Mike Pence will rally House Republicans Wednesday morning on a plan to repeal Obamacare, POLITICO has learned — a counter-punch to President Barack Obama’s visit to the Hill the same day.
Pence will meet with the full House Republican Conference to talk about the party’s plan to dismantle Obama’s signature health care law, according to a House Republican leadership aide. The meeting is House Republicans’ first of the new Congress, which kicks off Tuesday.
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President Barack Obama will head to Capitol Hill Wednesday to meet with congressional Democrats about how to shield Obamacare from Republican efforts to dismantle it, a Capitol Hill source told POLITICO.
The meeting is at 9 a.m. in the Congressional Visitors Center auditorium and is for both House and Senate Democrats, according to a notice sent to members Friday morning.
With Republican vowing to begin repealing Obamacare almost immediately when the 115th Congress convenes next week, Democratic lawmakers are immersed in strategy sessions on how to protect the nearly seven-year-old health care law.