With Trump’s Health-Care Picks, Expect a Rocky Road Ahead on ACA Fight


Be prepared for some infighting as the Republican leadership looks to move the American health-care system away from Obamacare, analysts said after President-elect Donald Trump picked his nominees to head the HHS and CMS.

The appointments of Rep. Tom Price, a Georgia Republican and former orthopedic surgeon, to lead the Department of Health and Human Services, and Seema Verma, who previously worked on Medicaid state waivers in Indiana, to head the Centers for Medicare & Medicaid Services, spell an aggressive agenda for the administration, which campaigned on bold but broad promises of scrapping the Affordable Care Act while keeping the Medicare program intact for seniors.

“They sort of bring together a mix of health-care policy expertise and interests that sets the stage for a broad vision of reforming health care, Medicare, Medicaid and the ACA,” John Feore, a director with health-care consulting firm Avalere Health in Washington, told me.

Do the promises to completely scrap Obamacare while leaving Medicare alone sound at odds? Yes, said Lloyd Bookman, founding partner of health-care law firm Hooper, Lundy & Bookman in Los Angeles. But that’s because you likely wouldn’t find any candidate who would back both.

Given Price and Verma’s experience, experts told me they see a push away from ACA ideas toward a more flexible, market-driven system that could include health savings accounts, Medicare vouchers and Medicaid cost-sharing requirements. Hospitals in poor, rural areas may bear the brunt of the changes. And many Americans could lose coverage.

But with Verma’s involvement in Medicaid expansion and Price’s vocal support of a wholesale ACA repeal, their ideas might pit them against each other. And Price will be leaving public office behind to spearhead the agency.

“Going from a political position to running an agency will be different [for Price],” Judith Waltz, partner with Foley & Lardner in San Francisco, told my colleague, BNA legal editor Eric Topor. “He’ll have to take his direction from Congress. If the ACA goes, that comes from Congress. It’s not that easy to change course, and implement directives from the president and Congress.”

Pair these differences with Rep. Paul Ryan’s Better Way proposal, debate over the order of dismantling and replacing the controversial law, congressional Republicans committed to taking the lead on repeal, and “what that leads you toward is some sort of transition period so that you don’t immediately pull coverage expansions out from day one,” Feore said.

At least one Republican lawmaker, House Majority Leader Kevin McCarthy of California, told my colleague Alex Ruoff he’s sending out a letter to state governors and insurance commissioners for ideas. “Once [the ACA is] repealed, hopefully you’ll have fewer people playing politics and you’ll find the best policy.”

The “final straw may lie” somewhere in the middle of the conservative arguments, Feore added.

And across the aisle, Democrats are staunchly disavowing the nominees and their views, with some prepared to fight.

It’ll likely take years for the dust to settle on reforms—years that, given bipartisan support for some Obamacare provisions, could mean compromise along the way. In the meantime, it will be “a rocky road,” Bookman said.

Read my full BNA story on the impact of the new agency nominations here.

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