Gutting Obamacare might be the least controversial part of Tom Price’s health care agenda.

By tapping the tea party Republican as his top health care official, President-elect Donald Trump sends a strong signal he may look beyond repealing and replacing Obamacare to try to scale back Medicare and Medicaid, popular entitlements that cover roughly 130 million people, many of whom are sick, poor and vulnerable. And that’s a turnabout from Trump’s campaign pledge — still on his campaign website — that he would leave Medicare untouched.


Price, a former orthopedic surgeon and six-term House member from suburban Atlanta, has proposed policies that are more conservative than those of many House Republican colleagues. His vision for health reform hinges on eliminating much of the federal government's role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code. The vast majority of the 20 million people now covered under Obamacare would have far less robust coverage — if they got anything at all.

“Young, healthy and wealthy people may do quite well under this vision of health care reform,” said Larry Levitt, a senior vice president at the nonpartisan Kaiser Family Foundation. “But the people who are older and poorer and sicker could do a lot worse.”

A close ally of Speaker Paul Ryan and his successor as House Budget Committee chairman, Price also supports privatizing Medicare so that seniors would receive fixed dollar amounts to buy coverage — an approach that Democrats lambaste as a voucher system that would gut a 50-year-old social contract and shift a growing share of health care costs onto seniors. Republicans argue the changes are needed to keep Medicare from going bankrupt. Trump’s transition spokesman did not return calls Tuesday about whether the president-elect now shares his nominee’s views on Medicare.

Price also wants to limit federal Medicaid spending to give states a lump sum, or block grant, and more control over how they could use it — a dream of conservative Republicans for years and a nightmare for advocates for the poor who fear many would lose coverage. Trump has endorsed block grants.

“When it comes to issues like Medicare, the Affordable Care Act and Planned Parenthood, Congressman Price and the average American couldn’t be further apart,” said New York Sen. Chuck Schumer, who will be minority leader in the Senate next year. “Between this nomination of an avowed Medicare opponent to serve as HHS secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”

Price’s partner at Health and Human Services will be Seema Verma, whom Trump picked to run the Center for Medicare & Medicaid Services, the agency in HHS that would actually dismantle Obamacare and set up whatever slimmed down system succeeds it. She’s a health care consultant who worked with several states that put a conservative stamp on their Medicaid program — including one under Indiana Gov. Mike Pence that booted participants who failed to pay small monthly premiums.

Price is close to Ryan, who will lead congressional Republicans' efforts to repeal and replace Obamacare starting in January. The GOP is expected to roll back much of the sweeping health care law early on in Trump's presidency through a complicated budget process called reconciliation — one of only two opportunities in 2017 to pass legislation without Democrats' cooperation.

Republicans could then set their sights on Medicaid and Medicare, assuming they have the appetite for an even bigger health care fight with Democrats who will fiercely defend the programs.

“They will … not just roll back five or 10 years of progress — but 50.” said Anthony Wright, executive director of Health Access California, a consumer advocacy group that supports Obamacare.

The administration also has multiple other priorities — tax reform, infrastructure investment, filling the Supreme Court vacancy — and it’s not yet clear how Trump’s White House will order them.



Senate Majority Leader Mitch McConnell dodged a question Tuesday about whether he expects to take up a Medicare overhaul next year. “I am not going to speculate on what the agenda may be on a variety of issues,” he said.

Democrats pounced on Price's nomination as a bad sign for the future of Obamacare and Medicare, but they don’t have the numbers to block his confirmation.

"Given Chairman Price’s past health proposals, I have grave concerns with what his policies would do to Americans,” said Sen. Ron Wyden, the top Democrat on the Senate Finance Committee, which would have to approve Price's nomination.

Price's selection also raised concerns among women's rights groups, who pointed to his past support for defunding Planned Parenthood and scaling back access to birth control. He’s also a strong opponent of abortion.

"Price could take women back decades," Planned Parenthood President Cecile Richards said.

Still others questioned whether he possessed the experience to run an organization as large and complicated as HHS. Price ran an orthopedic clinic prior to running for Congress, and would be the first physician to head the agency since 1993.

"To put in charge of the nation's health care system and a trillion-dollar budget someone who has never overseen anything larger than a congressional committee ought to raise eyebrows when this position has historically been reserved for an individual with significant administrative experience," said Rep. Steny Hoyer.

But many Republicans praised Price’s choice — and if they remain united, they may not need any Democratic support to get him confirmed.

As HHS secretary, several said they expect Price to serve as the conduit between the administration and congressional Republicans on the overhaul effort. Price's 2015 Obamacare replacement plan largely dovetails with Ryan's own ideas and could serve as a rough blueprint.

The legislation promotes the use of health savings accounts and selling insurance across state lines, but does away with requirements that insurers offer comprehensive benefits as well as constraints on what they can charge older enrollees.

Tax credits meant to help individuals afford insurance would be determined based on age rather than income, with those older than 55 receiving the maximum $3,000. That’s not enough to buy a comprehensive policy in most places today — but the GOP says they’ll make the market more competitive and let consumers buy policies that may be skimpier but cheaper.

Price’s plan would offer less protection for people with pre-existing conditions — individuals would need to maintain continuous insurance coverage, or risk running into problems getting covered.

“In general they’re trying to shift risk from the government to individuals, and particularly to low-income individuals," said Topher Spiro, who heads health policy at the left-leaning Center for American Progress. "It’s hard to see how that’s giving them a leg up, and how that’s improving the quality of their lives.”

How much of that vision makes it into legislation likely depends on whether Republicans can first successfully — and quickly — come together on a broad Obamacare replacement package. Price's nomination positions him to play a key role in that process, and in shaping the GOP's ambitious vision for health care.

"Dr. Tom Price will bring practical knowledge as a doctor and a legislator to an agency that needs it now more than ever," McConnell said. "Obamacare has failed the American people who have been let down by years of broken promises. Americans deserve better and Dr. Price is the right person to lead the charge."

Victoria Colliver contributed to this report.