In a contentious hearing Wednesday on Capitol Hill, Democratic members of Congress tried to pin down Health and Human Services Secretary Tom Price on whether he will try to gut the Affordable Care Act. Coming less than a week after the GOP’s seven-year quest to repeal the law came to a crashing halt, the Price hearing offered an early window into whether the Trump administration will try to undermine the law administratively after failing to unwind it legislatively.

Democratic lawmakers asked Price again and again whether he will simply “follow the policies” of Obamacare, as he promised in his confirmation hearing, or if he will use the powers of his office to take apart the law. Price, dodging many of the questions aimed his way, gave few assurances he will administer all of Obamacare’s regulations and programs going forward.

Following the sudden demise of the GOP bill to repeal the ACA, President Trump predicted that Obamacare would “explode” on its own, sparking fears the administration would work behind the scenes to make that happen. As Health and Human Services Secretary, Price controls many levers of the nation’s health care system, and his answers before the committee will do little to assuage the fears of administrative sabotage.

Here are the pillars of the ACA Price suggested he may not uphold going forward:

Individual Mandate

The top Democrat on the House subcommittee, Rep. Rosa DeLauro (D-CT), asked Price Wednesday if he would enforce Obamacare’s individual mandate, the law that eligible Americans must buy health insurance or pay a penalty. Asked for a simple yes-or-no answer Price said: “So long as the law is on the books, we at the department are obliged to uphold the law.”

He went on to criticize the mandate, which ensures a mix of healthy and sick individuals in the insurance pool, saying that the Congressional Budget Office “puts a whole lot of stock in the individual mandate and we would suggest that the proof isn’t there.”



An executive order Trump signed in January suggested the administration may opt not to enforce the tax penalty on people who don’t purchase health insurance, but there has been little clarity on what exactly they will do going forward. A full refusal to enforce the individual mandate would essentially gut the ACA, creating the very “death spiral” Republicans claim is already happening.



Essential Health Benefits

Several Democrats on this committee grilled Price about his commitment to upholding Obamacare’s provision that all insurance plans cover 10 essential health benefits, including prescription drugs, hospitalization, maternity care, mental health, and addiction treatment. Republicans had planned to gut these rules in their failed repeal bill, and Price repeatedly dodged questions Wednesday about future enforcement of the law.

“Does the Trump administration believe maternity care should be a covered benefit under federal law?” asked Rep. Nita Lowey (D-NY), the ranking member of the full House Appropriations Committee. Price replied: “Individuals ought to be able to select the kind of coverage they want, not that the government forces them to buy.”

He repeated this talking point when questioned by Rep. Katherine Clark (D-MA) on upholding coverage for substance abuse and addiction treatment, which insurers currently have to cover under the ACA.

“Do you support a mandate for insurance coverage for treatment?” she asked.

“What I believe and what we believe is that every single American needs access to the kind of coverage that they want for themselves,” answered Price, suggesting that he supports gutting the Essential Health Benefits rule in favor of a system where people choose health coverage à la carte based on their individual needs.

Some Republicans argue that doing this would dramatically bring down premiums, allowing insurers to sell cheap, bare-bones plans to healthier people who prefer them. But Democrats and many moderate Republicans warn doing this would make coverage for things like maternity care and opioid addiction treatment astronomically expensive.

Rep. Barbara Lee (D-CA) asked Price directly if he is “planning to narrow the essential benefits that insurers are required to cover,” to which he responded that his “goal and mission is to make certain that every American has access to affordable coverage. Whatever we can do to make that happen, we think is vital.”

Outreach

One way the Trump administration has already impeded the functioning of the ACA is by scrapping planned advertisements and outreach during the last open enrollment period.

“We aren’t going to continue spending millions of taxpayers’ dollars promoting a failed government program,” HHS told TPM in January. The move made a difference: signups were down significantly compared to the same time in 2016.

On Wednesday, under intense questioning by DeLauro, Price refused to commit to funding these ads and outreach in the future.

DeLauro: Do you intend to halt advertising again this year, yes or no?

Price: I haven’t had any discussions about that. That was done prior to my arrival.

DeLauro: Will you maintain or expand the level of funding provided during the 2017 open enrollment?

Price: We’re committed to making certain that the American people have access to affordable coverage.