Donald Trump’s recent announcement of Rep. Tom Price (R-GA) as his nominee for Secretary of Health and Human Services doesn’t just represent an attack on the Affordable Care Act — in fact, it’s an attack on the last half-century of health care reform in America.
Naturally, much of the initial media coverage of Price’s nomination has focused on the implications for efforts to repeal the ACA. Yet his addition to the Trump administration also lays the groundwork for efforts to gut Medicare, Medicaid, and the Children’s Health Insurance Program, which together provide coverage for one-third of all Americans.
In other words, Donald Trump’s administration appears to be ready and willing to undermine every pillar of the American health care system. And the health coverage of millions of seniors, low-income families, and children hangs in the balance.
Donald Trump’s administration appears to be ready and willing to undermine every pillar of the American health care system.
In an ideal world, Price’s background as a doctor would have driven him to focus on the needs and fears of uninsured patients. But we don’t live in that world. Instead, Price’s driving motivation seems to be an extreme anti-government ideology, regardless of whether government is working to improve patient’s lives, health, and financial security.
First of all, Price wants to privatize Medicare, shifting it to a premium support model where seniors receive a capped voucher to purchase coverage on their own. The value of this voucher would decline over time, leaving seniors to cover an increasing share of the costs in later years. Instead of working holistically to reduce overall health care costs, this approach would just shift them onto seniors. What’s more, Price supports Speaker Paul Ryan’s proposal to raise the Medicare eligibility age from 65 to 67. Only two weeks ago, Price told reporters that Congress would attempt to pass a Medicare premium support proposal “within the first six to eight months” of Trump’s presidency.
Medicare is an incredibly popular program among seniors and the general public, but Price’s opinions of it are extreme, even by conservative standards. Tom Price isn’t merely echoing Speaker Ryan’s Medicare proposals — he’s a true believer in the idea that actually, Medicare is bad.
Writing in Politico back in 2009, Price argued on Medicare’s 44th anniversary that “Nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.” And bizarrely, at a time when patient advocates have increasingly focused on the problem of surprise medical bills, Price actually introduced legislation to make it easier for doctors to charge Medicare beneficiaries higher prices than the program normally pays for services, with patients having to cover the extra costs themselves.
Tom Price’s plans for Medicaid aren’t any better. His latest budget proposal would have repealed Medicaid expansion entirely, without replacing it. More ambitiously, it would also have block granted Medicaid, changing it to a system where federal spending is capped and massively reduced. Together, these two proposals would slash Medicaid funding by $2.1 trillion over 10 years — reducing the program’s funding by one-third by the tenth year.
As the Urban Institute found when analyzing an earlier version of the Ryan budget, block granting Medicaid would result in 14 to 20 million low-income people losing their health coverage. This would come on top of the millions losing coverage with the repeal of Medicaid expansion.
In addition to huge cuts to Medicaid, the incoming administration appears poised to make significant changes to the program’s benefits and cost-sharing. Medicaid, like Medicare, is run by the Centers for Medicare and Medicaid Services within HHS. Trump’s choice of nominee to head CMS, Seema Verma, is a health care consultant who helped Indiana and Kentucky design proposals for Medicaid waivers that focused on raising costs for beneficiaries and setting up a variety of hoops for them to jump through in order to access care. While the Obama administration has rejected the most harmful state proposals, CMS under Verma appears poised to drive many of these changes in Medicaid — encouraging states to impose work requirements, charge premiums and higher cost-sharing, and reduce benefits. Trump’s selection of Verma indicates a plan to shrink Medicaid into a program that not only covers fewer people, but that charges them more for worse coverage.
Compounding the effects of such a Medicaid rollback is the fact that Tom Price has long been one of Planned Parenthood’s most fervent critics in Congress. At the same time that he guts Medicaid, his proposed defunding of Planned Parenthood would further reduce health care options for the low-income women who would lose coverage.
It doesn’t end there. The Children’s Health Insurance Program, or CHIP, covers about 8 million low-income kids and has generally received broad bipartisan support since its creation in 1997. Yet one of the exceptions to its long list of bipartisan supporters is — you guessed it — Tom Price, who has repeatedly voted against CHIP during his Congressional career. What makes Price’s opposition to CHIP so scary is that CHIP needs to be re-authorized next year or millions of kids will lose their coverage.
The stakes could not be clearer. If Tom Price has his way, we won’t just go back to where we were before the ACA, when 48 million Americans were uninsured — 20 million more than today. We will go back even further, rolling back much of the progress we have made since the creation of Medicare and Medicaid in the 1960s and adding millions more to the number of uninsured.
President-elect Trump hasn’t talked much about health policy since the election. During the campaign, he often claimed to be a different kind of Republican, one who had no intention of cutting Medicare and Medicaid.
It’s too early to know if all of that was empty talk. But the only clues we have now of Trump’s intentions are the people he is empowering to shape the future of America’s health care. And unfortunately, those people know exactly what their agenda is.
Thomas Huelskoetter is the Research Associate for Health Policy at the Center for American Progress. ThinkProgress is an editorially independent site housed at the Center for American Progress.