In Nominating Tom Price, Trump Insinuates Massive Health Care Cuts

Tom Price
Tom Price [CC BY-SA 2.0], via Wikimedia Commons

In the immediate aftermath of Donald Trump's stunning electoral triumph, many in the health care and HIV advocacy communities who had spent months preparing for an incoming Clinton administration found themselves scrambling to figure out what the new President-elect's health care policy will look like. When dealing with a man who displays rank contempt for the truth, it is almost always more fruitful to focus on the actions he takes rather than the statements he makes, and as of right now, the most telling action Trump has taken on health care policy is his nomination of Georgia Representative Tom Price as Secretary of the Department of Health and Human Services (HHS).

Unfortunately, as is the case with so many of Trump's policy positions, trying to determine with any certitude what stance a Trump administration will take on health care reform is a dubious exercise, and certainly not a cheery one. President-elect Trump has been reticent to release the concrete details of his health care plan and has made a habit of publicly contradicting himself on even the most basic matters.

One day, Trump could be proclaiming from his bully pulpit that he will fully repeal the Affordable Care Act (ACA, Obamacare) and replace it with "something terrific," and the next, he could be talking about how he wants to keep major portions of the ACA and is loath to throw the baby out with the bathwater.

How, then, are we supposed to divine what President-elect Trump's health care policies will be when the only consistent thread in his public statements on the matter is his inconsistency? Given a personality as mendacious and mercurial as Trump's, it is impossible to state with any certitude -- but the nomination of Price is certainly not encouraging news for those attuned to healthcare issues in the HIV community.

Unless you work inside the Beltway or live in suburbs of Atlanta, the name Tom Price probably doesn't ring a bell and there's not much reason why it should. A former orthopedic surgeon and six-time member of the House, Price is far more radical in his conservatism than his subdued demeanor would suggest.

Currently serving as the chairman of the House Budget Committee, Price has made a name for himself as an unwavering fiscal and social conservative and one of the foremost congressional critics of the ACA. In each of the last four congresses, Price has introduced a version of the Empowering Patients First Act, an evolving piece of legislation that would dismantle the ACA and replace it with a series of free-market-friendly policies that would be beneficial for the young, the healthy and the rich, and catastrophic for the old, the infirm and the poor.

If the content of the most recent iteration of the Empowering Patients First Act is any indication of the direction the Trump administration is going with its ACA replacement plan -- and there's plenty to indicate that it is -- all of the sickest and most vulnerable Americans that were helped by Obamacare are about to unceremoniously kicked to the curb. Under Price's plan, the individual mandate to purchase insurance would be removed, as would the government-run state marketplaces and the minimum essential coverage requirements that forced health insurers to meet certain quality standards in all of their plans. For instance, under the ACA, all insurers are required to cover certain treatments for substance use and mental health. Not so under Price's plan.

In lieu of the subsidies the ACA doles out to people based on their annual incomes, Price's plan would hand out a series of paltry tax credits adjusted by age, not income, meaning that a 55-year-old hedge-fund manager pulling down $3 million a year would receive the same $3,000 tax credit to purchase a private insurance plan as a 55-year-old Walmart cashier making a little over $18,000 a year. His plan would require insurers to offer coverage to anyone regardless of their heath, but would only prohibit insurers from raising rates on sick people if they maintained "continuous coverage". Essentially, what this means is that if, for any reason, someone lets their coverage lapse, insurance companies would be allowed to hike up their rates based on any pre-existing conditions.

But, the aspect of Price's plan that would be the most damaging to the poor and to many people living with HIV is that it would fully repeal the Medicaid expansion created by the ACA. Gone would be a world where the majority of states are able to provide Medicaid for anyone living at or below 138% of the federal poverty level, replaced by a return to the days when it was incumbent upon individuals to show that their particular illness constituted a disability that, in addition to their poverty, qualified them for Medicaid. Fourteen-million impoverished Americans would have their health insurance ripped away from them in an instant.

Add to all this the fact that Price supports major reforms to Medicare that would turn it into a voucher program that would force seniors to bear more of the insurance cost, and you're left with an HHS nominee who doesn't want just to get rid of Obamacare, but to eviscerate entitlement programs that have been the safety net for America's old and poor for over half a century. Price's legislative record, and the fact that such a record would convince Trump to nominate him to head the HHS, says far more about the nature of his administration's health care policies than any sound bite the President-elect could tweet.

Drew Gibson is a freelance writer and policy associate at AIDS United in Washington DC. You can follow him on Twitter at @SuppressThis. or visit his blog "Virally Suppressed," which covers a multitude of issues related to public health and social justice.