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How HHS secretary contender Tom Price might replace the ACA

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Politico and other news organizations in Washington are reporting that Rep. Tom Price, R-Ga., could be Donald Trump’s pick for secretary of Health and Human Services.

Related: View: A conservative Obamacare replacement could work

If those stories are correct, many obstacles stand between Price being a top candidate for that post and him getting that post. Under current procedural rules, the next president would need to round up at least 60 votes, including some Democrats, to get an HHS nomination to the floor of the Senate.

Some liberal groups are arguing that Price is too hostile toward gay and lesbian rights and too strongly opposed to abortion to be a good HHS secretary nominee.

Even if someone else ends up leading HHS, Price will still be the chairman of the House Budget Committee, and any conversations he’s had with Trump, and with Trump transition team members, about the Affordable Care Act could affect how the next administration approaches efforts to repeal and replace the ACA.

Here’s a look at some of Price has said about repealing and replacing the ACA over the past few years.

1. Reconciliation

Price has supported efforts to prune away as much as of the ACA possible by using a budget reconciliation bill.

The budget reconciliation bill consideration process lets a budget reconciliation bill get to the floor of the Senate with just 51 votes.

A budget reconciliation bill must focus solely on budget matters. Some Republicans have argued that a reconciliation-process-based ACA attack could leave some of the worst parts of the law in place and make the current health insurance market problems even worse.

Price conceded, in a 2015 interview with a Bloomberg reporter, that “reconciliation cannot be used for everything.”

Related: Republicans committed to repealing PPACA, budget chief says

But “reconciliation is a powerful tool,” Price said.

2. Defined contribution health plans

In 2005, Price had 24 cosponsors on his side when he introduced House Resolution 215. The bill would have expressed the view of the House that the country should move the U.S. health coverage system away from depending on employer-sponsored group health plans, and toward defined contribution health plan programs that would let consumers choose and own their own health coverage.

3. Health reform pilot programs

In 2007, Price worked with Rep. Tammy Baldwin, D-Wis., on H.R. 506, a bill that could have created a bipartisan State Health Innovation Commission.

The commission would have provided grants that a state could use to test a wide variety of health reform ideas, such as creating new tax credits, expanding health savings account options, or setting up government-run “single-payer” health care finance systems.

4. Tax credits

Drafters of the Affordable Care Act established the ACA public exchange system partly to create a vehicle for administering the advanced premium tax credit subsidy program.

Most exchange plan users use estimates of what their income and household size will be in the coming year to qualify for the tax credit. The government pays the tax credit subsidy money to the exchange plan issuers while the coverage year is under way, to cut the amount of cash the exchange plan users have to pay out of their own pockets for premiums.

Most of the consumers are at least a little bit wrong about how much subsidy help they should get. About half get money back from the premium tax credit subsidy program when they file their tax returns for the coverage year, and many of the others have to pay money back to the government.

The Internal Revenue Service has developed elaborate rules for premium tax credit administration.

In 2015, Price proposed eliminating the income-based ACA tax credit, and the exchange programs that administer the tax credit.

In place of the ACA tax credit, he would offer an age-based tax credit that would be available to all taxpayers.

Each U.S. resident age 35 to 50 would get $2,100 per year.

The tax credit users could then use their tax credits to buy policies that would be much less tightly regulated than the current ACA individual major medical policies.

5. Health problems

One criticism of many efforts to repeal and replace the Affordable Care Act is that they would leave people with diabetes, cancer, or other serious health problems with no coverage options, or unappealing options.

Price proposed retaining the current ban on medical underwriting, but only for people who keep health coverage in place.

Supporters of that approach say it would protect people with health problems without encouraging people to skip making premium payments when they feel healthy.

6. Benefits mandates

When Price developed the 2015 ACA replacer proposal, he tried to reduce the cost of coverage and simplify health market compliance and oversight by eliminating many ACA benefits mandates.

He would eliminate the requirements that a major medical plan cover a standard package of essential health benefits.

He would let coverage issuers and buyers decide, for example, whether a policy should cover emergency care, or mental health care.

7. Skin in the game

In the 2015 proposal, Price would have tried to bring cost pressures to bear on patients by eliminating the current ACA limits on health plan enrollees’ annual spending on out-of-pocket costs.


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