Tom Price spent years railing against Obamacare. Now he’ll finally have sweeping power to do something about it.

The Georgia Republican congressman is on the verge of becoming the Trump administration’s top health care official, armed with broad authority to begin unwinding Obamacare by using as much executive power as possible, even as Congress struggles to find consensus on a plan to repeal and replace the health care law. First, he could ax Obamacare's mandate ensuring coverage for contraception and give insurers more latitude to determine which health benefits they will — and won’t — pay for. Those changes will likely be paired with stricter monitoring of Obamacare enrollees, as the administration aims to win over jittery health plan executives with policies that prioritize insurance market predictability and profitability.


If he really wants to test the limits of executive authority, he could stop enforcing the individual mandate that Americans buy health insurance — a foundation of the law.

While the goal is to use the existing powers given to the Health and Human Services secretary to lower costs and loosen oversight of health insurers, hospitals and doctors, Price has promised to try to calm an anxious health industry.

“What they need to hear from all of us, I believe, is a level of support and stability in the market,” Price said during a January Senate confirmation hearing.

Price’s installation as Health and Human Services secretary — which could happen as early as this week — would come not a moment too soon for Republicans struggling to follow through on their long-sought goal of dismantling the health care law. Congressional Republicans are deeply divided over how to eliminate large parts of Obamacare and when to do it, fearing they could spook insurers who have little incentive to wait without knowing what to expect at the end of the transition. That could prove chaotic for millions of consumers.

The indecision has already laid waste to Trump’s blustery vow to dismantle the law on his first day in office. And there’s just as much confusion over what to put in its place. Lawmakers for months have swiveled between replacing Obamacare wholesale and simply repairing and rebranding it through smaller fixes. The only consensus among them seems to be the lack of one.

“We’re in the information-gathering mode right now,” said Rep. Mark Meadows, who heads the hard-line conservative House Freedom Caucus and has called for repealing and replacing Obamacare as early as March. “It’s not like it’s rocket science in terms of what you have to address, but it is rocket science in terms of figuring out the right mix.”

But even as Congress spins its wheels, Price can push forward by using his discretion to undo crucial elements of Obamacare. That’s largely thanks to the Obama administration, which granted its health officials authority to write and implement hundreds of rules tied the law. The Trump administration now plans to use that same license to undo as much of Obamacare as it can.

“The statute itself gave [HHS] a lot of discretion,” said Edmund Haislmaier, a senior research fellow at the Heritage Foundation, who worked on health policy for the Trump transition team. “Live by the administrative state, die by the administrative state.”

Price’s earliest moves are expected to target parts of Obamacare that he’s condemned for the better part of a decade. The seven-term lawmaker, who was an orthopedic surgeon in the Atlanta area before running for public office, has been sharply critical of provisions that require insurers to offer customers a minimum set of benefits, as well as an Obama-era standard mandating contraceptive coverage as a preventive health benefit.

Rep. Louie Gohmert, R-Texas, right, and Rep. Tom Price, R-Ga., arrive with copies of the Patient Protection and Affordable Care Act during a news conference on Capitol Hill on March 21, 2012, to express their anger about the legislation on the second anniversary of its passage. | AP Photo

“The entire law is predicated upon the assumption that a person’s individual choice — and in this case one’s religious freedoms — are to take a back seat to the wishes and the will of Washington bureaucrats,” Price said in 2012, at the height of the contraceptive coverage debate.

Weakening — or simply opting not to enforce — those regulations would pave the way for insurers to restrict benefits, making it harder for people to get coverage for services like maternity or mental health care. Price could also abdicate some of the federal government's oversight role, leaving it to individual states to monitor such questions as whether insurers are meeting so-called network adequacy standards that ensure enrollees have access to close-by hospitals and doctors.

Price could go as far as halting enforcement of the law's individual mandate. But that might topple the entire law, and such a dramatic step could alienate insurers the Trump administration needs to ensure the success of any Obamacare replacement. Already some companies have warned Republicans they’re worried about keeping the market upright.

The administration has prepared a yet-to-be issued directive that could give insurers more certainty by, for example, tightening the rules around special enrollment periods and making it harder for people to continue receiving coverage after they’ve stopped making premium payments.

“It doesn’t matter whether your plan is the Obama plan and the ACA or whatever Republicans are doing. You need the insurance industry to participate,” said Bill Pierce, a senior director at communications consultancy APCO Worldwide and former Republican HHS senior staffer. “If they don’t, I don’t know what you do.”

Still, Price will have plenty of room to singlehandedly shift health care toward a free-market system, from loosening insurance regulations to easing care requirements for doctors and hospitals. Doing that could give stymied congressional Republicans more clarity about what to do next.

“I think it will relieve worries on Capitol Hill among Republicans that somehow they’ll be left holding the bag,” Haislmaier said. “Right now, part of what you’re seeing on the Hill is the fear of the unknown.”