Trump taps Price to undo Oba­macare

Con­ser­va­tives cheer Cab­i­net picks while Democrats jeer ‘swamp’ crea­tures

The Washington Times Weekly - - Politics - BY TOM HOW­ELL JR.

Pres­i­dent-elect Don­ald Trump sig­naled his in­tent to fol­low through on un­rav­el­ing Oba­macare, se­lect­ing an ar­dent foe of the law to be his health sec­re­tary and tap­ping a con­ser­va­tive pol­icy guru from In­di­ana to over­see Medi­care and Med­i­caid.

Con­ser­va­tives cheered the picks of Rep. Tom Price to lead the De­part­ment of Health and Hu­man Ser­vices, and of Seema Verma, pres­i­dent and CEO of a health con­sult­ing com­pany, to serve as ad­min­is­tra­tor of the Cen­ters for Medi­care and Med­i­caid Ser­vices, say­ing both nom­i­nees bring ex­ten­sive ex­per­tise and a firm com­mit­ment to re­form.

Mr. Trump also said he will nom­i­nate Elaine L. Chao, who ran the La­bor De­part­ment un­der Pres­i­dent Ge­orge W. Bush, as his trans­porta­tion sec­re­tary — a po­si­tion that could be key to the pres­i­dent-elect’s plans for a mas­sive in­fra­struc­ture pro­gram that in­cludes re­build­ing roads and bridges through­out the coun­try.

Ac­cord­ing to mul­ti­ple re­ports, Mr. Trump also has cho­sen Steven Mnuchin to be Trea­sury sec­re­tary, a choice whose Wall Street ties Democrats quickly touted as a be­trayal of Mr. Trump’s cam­paign prom­ises to “drain the swamp” of spe­cial in­ter­ests in Wash­ing­ton.

Al­though Democrats sug­gested an open­ness to Ms. Chao, who is the wife of Se­nate Ma­jor­ity Leader Mitch McCon­nell, they said they’ll also rally against Mr. Price, a staunch pro-life ad­vo­cate and ar­chi­tect of House Repub­li­cans’ bud­gets the last two years — blue­prints that en­vi­sioned ma­jor changes to Medi­care and called for fasttrack pro­ce­dures to re­peal the 2010 Af­ford­able Care Act.

Repub­li­cans plan to rely on those same fast-track tools to at­tempt a re­peal in 2017, when they’ll have GOP al­lies in the ad­min­is­tra­tion.

“We could not ask for a bet­ter part­ner to work with Congress to fix our na­tion’s health care chal­lenges,” House Speaker Paul D. Ryan said.

Mr. Price of­fered his own leg­isla­tive al­ter­na­tive to Oba­macare for years, push­ing for the re­peal of heavy gov­ern­ment man­dates while main­tain­ing some form of tax cred­its to help Amer­i­cans to buy in­sur­ance, al­low­ing in­sur­ers to sell their prod­ucts across states lines and set­ting up high-risk pools in states — ideas that Mr. Ryan in­cor­po­rated into his elec­tion-year out­line for re­plac­ing Mr. Obama’s over­haul with a GOP pres­i­dent.

The in­com­ing Repub­li­can pres­i­dent, Mr. Trump, said he’s count­ing on Mr. Price to man­age the GOP’s tricky path ahead.

“He is ex­cep­tion­ally qual­i­fied to shep­herd our com­mit­ment to re­peal and re­place Oba­macare, and bring af­ford­able and ac­ces­si­ble health care to ev­ery Amer­i­can,” Mr. Trump said. Democrats were spoil­ing for a fight. “Nom­i­nat­ing Con­gress­man Price to be the HHS sec­re­tary is akin to ask­ing the fox to guard the hen house,” said in­com­ing Se­nate Mi­nor­ity Leader Charles E. Schumer, New York Demo­crat.

Mr. Price suc­ceeded Mr. Ryan as chair­man of the Bud­get Com­mit­tee in 2015, and adopted Mr. Ryan’s push to morph Medi­care into a pre­mium-sup­port pro­gram. That idea is a po­lit­i­cal light­ning rod that didn’t win over Mr. Trump on the cam­paign trail.

Mr. Price also has sup­ported turn­ing Med­i­caid coverage for the poor into a block grant to the states and strip­ping fed­eral fund­ing from Planned Par­ent­hood, the na­tion’s largest abor­tion provider.

Democrats said as health sec­re­tary, Mr. Price would have con­trol over fund­ing and poli­cies gov­ern­ing fed­eral poli­cies on abor­tion and con­tra­cep­tives — ar­eas where they said the pro-life con­gress­man could undo Obama ad­min­is­tra­tion de­ci­sions.

Though a less prom­i­nent role than HHS sec­re­tary, Ms. Verma would have di­rect man­age­ment over the Af­ford­able Care Act’s twin pil­lars — web-based ex­changes where con­sumers can shop for pri­vate coverage, of­ten with the help of tax­payer-funded sub­si­dies, and the state-by-state ex­pan­sion of Med­i­caid, the gov­ern­ment in­sur­ance pro­gram for the poor.

Ms. Verma rose to promi­nence by set­ting up the Healthy In­di­ana Plan, the state’s con­ser­va­tive twist on Med­i­caid ex­pan­sion that started un­der for­mer Gov. Mitch Daniels and was mod­i­fied un­der Vice Pres­i­dent-elect Mike Pence, the state’s cur­rent gover­nor.

“She’s an out­stand­ing choice. She’s the god­mother of con­ser­va­tive think­ing on how to make Med­i­caid more ef­fi­cient and more ef­fec­tive,” said Robert Laszewski, a health care pol­icy con­sul­tant in Alexan­dria, Vir­ginia.

An­a­lysts said Ms. Verma could serve as a pow­er­ful bridge for red states, us­ing her waiver au­thor­ity to grant them wide lat­i­tude in how they im­ple­ment Med­i­caid un­til the GOP de­cides whether to over­haul the pro­gram.

For in­stance, Repub­li­can gov­er­nors who’d fought with the Obama ad­min­is­tra­tion over work re­quire­ments or charg­ing pre­mi­ums on cer­tain en­rollees will now find a sym­pa­thetic ear in Ms. Verma.

“Be­fore and af­ter any leg­isla­tive changes, she has the abil­ity to let in­di­vid­ual states make the kind of re­forms they might be in­ter­ested in,” said Caro­line Pear­son, a se­nior vice pres­i­dent at Avalere, a D.C.-based health con­sul­tancy.

Manag­ing the ex­changes could pose a tougher test, an­a­lysts said, if in­sur­ers flee a po­lit­i­cally doomed pro­gram be­fore Repub­li­cans fig­ure out how to cover the mil­lions of peo­ple who gained tax­payer-sub­si­dized coverage through Health­ and state-run web­sites.

Repub­li­cans had hoped to have a re­place­ment to go along with the re­peal of Oba­macare, but House Ma­jor­ity Leader Kevin McCarthy sig­naled their new strat­egy could in­volve a quick re­peal, then a longer-term ef­fort at re­place­ment.

He said they would prob­a­bly cre­ate a “tran­si­tion” pe­riod to give stake­hold­ers — in­clud­ing gov­er­nors and state in­sur­ance com­mis­sion­ers — space to weigh in on what the re­place­ment pack­age would look like, though he didn’t pro­vide a timeline.

Mr. McCarthy said the re­peal can be done through fasttrack pro­ce­dures that only re­quire a ma­jor­ity vote in the Se­nate, but any re­place­ment plan would need 60 votes to over­come an ex­pected Demo­cratic fil­i­buster. At best, Se­nate Repub­li­cans will hold 52 seats in the com­ing Congress.

Oba­macare is al­ready fail­ing and can­not sus­tain it­self, Mr. McCarthy ar­gued, so Democrats will be un­der pres­sure to come to the ta­ble if the law is re­pealed and both sides have a dead­line to move for­ward with some­thing else.

“When that date came and you did noth­ing — if you want to play pol­i­tics, I think blame would go to peo­ple who didn’t want to do any­thing,” he said.

Sen. Joe Manchin III, West Vir­ginia Demo­crat, sig­naled he’d be open to work­ing with Repub­li­cans, but only if they show their cards from the start.

“I would like to see what they put for­ward,” he said. “I am am­i­ca­ble to any­thing, but [only] if it makes sense. I have al­ways said this: If I can’t go home and ex­plain it, I can’t vote for it.”

Ral­ly­ing eight or so Democrats around a GOP re­place­ment would be a tall or­der, an­a­lysts say, and could lead to a messy round of Capi­tol Hill fin­ger-point­ing if Repub­li­cans scrap the law and then noth­ing new is passed.


Pres­i­dent-elect Don­ald Trump chose Oba­macare foe Rep. Tom Price to run the De­part­ment of Health and Hu­man Ser­vices.

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