5 Things To Know About Rep. Tom Price's Health Care Ideas

Nov 29, 2016
Originally published on November 29, 2016 6:23 pm

Georgia Rep. Tom Price has been a fierce critic of the Affordable Care Act and a leading advocate of repealing and replacing the 2010 health care law.

Price, an orthopedic surgeon from the suburbs of Atlanta, introduced his own legislation to repeal and replace Obamacare in the current Congress and the three previous sessions. Price's plan, known as the Empowering Patients First Act, was the basis for a subsequent health care proposal unveiled by House Speaker Paul Ryan, with Price's endorsement, in June.

Price's major complaint about the ACA is that it puts the government in the middle of the doctor-patient relationship.

"They believe the government ought to be in control of health care," Price said in June at the American Enterprise Institute event where Ryan unveiled the Republican proposal to replace Obamacare. "We believe that patients and doctors should be in control of health care," Price continued. "People have coverage, but they don't have care."

Now that President-elect Donald Trump has tapped Price to lead the Department of Health and Human Services, here are five key planks in his own health care proposal.

  1. Price's plan offers fixed tax credits so people can buy their own insurance on the private market. The credit starts at $1,200 a year and rises with age, but isn't adjusted for income. Everyone receives the same credit whether they are rich or poor. People on Medicaid, Medicare, the military health plan known as Tricare, or the Veterans Affairs' health plan could opt instead for the tax credit to buy private insurance.
  2. Price advocates for expansion of health savings accounts, which allow people to save money before taxes to pay for health care. This includes allowing people who are covered by government health programs including Medicare and the VA to contribute to health savings accounts to pay for premiums and copayments. These proposals are included in Ryan's plan.
  3. People with existing medical conditions couldn't be denied coverage under Price's plan as long as they had continuous insurance for 18 months prior to selecting a new policy. If they didn't, then they could be denied coverage for that condition for up to 18 months after buying a new plan.
  4. The Price proposal limits the amount of money companies can deduct from their taxes for employee health insurance expenses. Companies can deduct up to $20,000 for a family health insurance plan and $8,000 for an individual. The goal is to discourage companies from offering overly generous insurance benefits to their workers. Ryan's plan proposes a cap on the employer tax deduction but doesn't specify the level of the cap.
  5. States would get federal money to create so-called high-risk pools under Price's plan. These are government-run health plans for people with existing medical conditions who can't get affordable health insurance on the private market. Critics say high-risk pools have been tried in as many as 34 states and largely failed because they were routinely underfunded.

Price has said he's not wedded to his own ideas and is open to compromise, so the final proposal to replace Obamacare is likely to be a hybrid of his ideas and those hammered out with other Republican House members and presented as Ryan's plan.

Still, with Price on track to be at the helm of HHS, he would be the one writing the rules to implement whatever legislation is eventually passed.

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President-elect Donald Trump has named more Cabinet officials. And now we're going to hear about two nominations to his health care team. Georgia Congressman Tom Price, an orthopedic surgeon, is his choice to lead the Department of Health and Human Services. And a private health care consultant named Seema Verma is his nominee to run the Medicare and Medicaid programs. Joining us is NPR health policy correspondent Alison Kodjak to discuss these appointments. Hi. Thanks for being here.

ALISON KODJAK, BYLINE: Hey. Thank you, Ari.

SHAPIRO: Tell us a little bit about Congressman Tom Price.

KODJAK: Well, as you said, he is a doctor. He's an orthopedic surgeon from outside Atlanta. He's been in Congress for six terms and has risen to become the House Budget Committee chairman, which is a really powerful position. It's what Paul Ryan was before he became speaker.

As head of HHS, he'd oversee an agency with a trillion-dollar budget, which is twice the budget of the Defense Department, and two of the biggest federal programs - Medicare and Medicaid. A little bit about him - he's a big opponent of abortion rights. He's an opponent of gay rights. And he's been a real critic of Obamacare right from the start.

SHAPIRO: So if President Trump goes forward with his promise to repeal and replace Obamacare, does that suggest that Price will be leading this repeal effort?

KODJAK: Well, he won't be leading it in the sense that he won't be in Congress working on the legislation. Although over the last few years, he has introduced many times bills to repeal and replace Obamacare that have great detail. And many of those proposals have been adopted by Speaker Ryan in the proposal he's laid out, which we think is probably the best roadmap to what may happen.

In addition, as head of HHS, if and when any repeal and replacement goes through, his agency will be writing the regulations on how it's implemented.

SHAPIRO: What does Price's version of a replacement to Obamacare look like?

KODJAK: Well, he does call for full repeal of Obamacare, which means no more health insurance exchanges, no more Medicaid expansion. Instead, what he proposes is giving people a fixed, refundable tax credit. For somebody who's about, 30 it would be about $1,200 a year to go out on the private market and buy their own health insurance.

That amount would go up with age because as you age, you use more health care, and your insurance is more expensive. But it wouldn't be adjusted for income, which is one of the main things that Obamacare does - which is give more support to lower-income people.

SHAPIRO: Do they have any way of guaranteeing that people with pre-existing conditions will still get coverage, which is one of the most popular parts of the Affordable Care Act, Obamacare?

KODJAK: There is a - you know, some protections in Price's plan - not as much as in Obamacare - in that if you keep your insurance and don't let it lapse, then you cannot be excluded for having a pre-existing condition, and an insurer must cover that.

But if you do let your insurer - insurance lapse, then an insurance company can charge you more and can refuse to cover that condition for up to 18 months.

SHAPIRO: Tell us about Seema Verma, who President Trump has chosen to lead the Centers for Medicare and Medicaid.

KODJAK: Well, she's been a pretty private figure, working behind the scenes on Medicaid programs around the country. She's a private consultant, and her company and she specifically worked with Indiana, with Mike Pence and his predecessor on their Medicaid expansion.

One of the hallmarks of that program has been that it requires low-income people to pay a premium to get their Medicaid. They also were trying very hard to get a work requirement to go with that plan. That was rejected by the Obama administration. But those are some hints at what she may be looking for if she looks to change Medicaid as the head of CMS.

SHAPIRO: That's NPR's Alison Kodjak, our health policy correspondent. Thanks a lot.

KODJAK: Thank you. Transcript provided by NPR, Copyright NPR.