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Trump chooses Obamacare opponent to lead Health and Human Services

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6469 (Published 30 November 2016) Cite this as: BMJ 2016;355:i6469
  1. Michael McCarthy
  1. Seattle

US President-elect Donald Trump has nominated Representative Tom Price, a conservative Republican from Georgia, to be his secretary of Health and Human Services (HHS). Price, 62, a former orthopedic surgeon, has sought to repeal or defund President Obama’s Affordable Care Act since its passage in 2010.

The nomination suggests that Trump intends to pursue his campaign pledge to repeal and replace the health reform law, as well as proceed with major overhauls of Medicaid, the state-federal insurance plan for people who are poor or have a disability, and Medicare, the federal insurance plan for elderly people, sought by Republican congressional leaders.

Price has also attempted to end federal funding for abortion; the women’s health service organization and abortion advocacy group, Planned Parenthood; and human embryonic stem cell research.

In a statement, Trump said: “Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy, making him the ideal choice to serve in this capacity.”

HHS, which has a budget of more than $1.1 trillion (£883 billion; €1 trillion), oversees most federal health agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, and the Centers for Medicaid and Medicare Services.

Democrats criticized the choice. Senator Chuck Schumer, a New York Democrat and the incoming Senate minority leader, said that Price’s views were “not what Americans want when it comes to Medicare, the Affordable Care Act, and Planned Parenthood.” He said that nominating Price to be the HHS secretary was “akin to asking the fox to guard the hen house.” The appointment needs Senate confirmation, and Schumer warned that Price would face tough confirmation hearings.

As a legislator, Price has advocated for less government regulation of healthcare and a return to market based policies to be determined by individual states and not the federal government. Last year he introduced a bill to repeal and replace the Affordable Care Act, including the Act’s Medicaid expansion program, which has provided insurance coverage to 15 million people.

The bill would also have eliminated many of the regulations imposed on the insurance industry by the health reform law—such as requiring them to give coverage for maternity care—and allowed the sale of low priced policies, which critics say often give inadequate coverage.

The bill would have allowed people of opt out of Medicare, Medicaid, and other group plans, and receive tax credits to help buy personal plans. Tax credits would help cover the cost of premiums and people would have tax free health savings accounts to cover out-of-pocket costs. These accounts, proponents say, would let people buy lower cost, high deductible plans to cover major medical expenses while drawing upon their savings to pay for routine care. Such reforms, advocates say, would make people more cost conscious, leading them to shop for cheaper plans and care. This, in turn, would spur innovation in the healthcare industry, leading to lower prices and improved services.

Price’s proposals are more radical than those of other Republicans. Some want to keep the Medicaid expansion program, which has provided insurance for millions of residents in their home states, and many are chary of any effort to alter Medicare, one of the most popular federal programs.

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