Can The Senate Democrats Derail Tom Price?

How do Ryan and the congressional Republicans get away with all the twisted lies and deceptions about healthcare? Watch the Jimmy Kimmel video up top-- and remember, that's in Los Angeles! People are morons? I'm afraid so. Otherwise Friday would be a day we'd either be pissed off that another corporate Democrat was being inaugurated or we'd be rejoicing that Debbie Wasserman Schultz failed and we'd be inaugurating the first president dedicated to working families since FDR.

Did you watch the Price Senate hearings yesterday? How foolish and wasteful! Price said, with a straight face that he doesn't want to replace a "Democrat healthcare system with a Republican system. Instead he says he wants to replace "Democrat healthcare with American healthcare." No one called him an asshole, But, as Greg Sargent pointed out in his Washington Post column yesterday, Trump is already backtracking on his pledge that "everybody" will be covered. Sargent, unlike most mainstream journalists, called all the gobbledygook and misdirection what it is: a scam. "In recent days," he wrote, "Donald Trump and his advisers have gone to tremendous, extraordinary, terrific lengths to obscure a basic aspect of the replacement for the Affordable Care Act that he and congressional Republicans are likely to embrace after repeal: It will cover far fewer people."

Trump and his advisers have been saying that no one who currently has coverage under Obamacare will lose it under the GOP replacement. Trump himself recently said that under his replacement, “everybody” will have insurance, adding that “there was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” Top transition adviser Kellyanne Conway recently made similarly nice-sounding noises.

But today, Trump seemed to backtrack on this promise in interviews with Fox News and Axios. While he reiterated that people without money will get coverage, he clarified that he’s considering a mechanism to do this: Medicaid block grants. “We’ll probably have block grants of Medicaid back into the states,” Trump told Fox.

Progressives tend to oppose Medicaid block grants because they are all but certain to get cut, and because states would restrict eligibility requirements. As the Center on Budget and Policy Priorities recently put it, they “would likely eliminate the guarantee that everyone who’s eligible and applies for its benefits would receive them.”

Thus, this idea-- which seems likely to be at the center of the Trump/GOP replacement plan-- would dilute the guarantee of coverage that Obamacare is striving to make universal. The ACA does this through a combination of expanded Medicaid for everyone who is eligible (in states that participate) and subsidies that are doled out according to means to cap the percentage of income that other people pay for coverage. The GOP replacement would come up with a new subsidy scheme, perhaps tied to age but not income, but there’s no indication yet that it would accomplish that cap. That, combined with the likely Medicaid cuts, would add up to a scrapped guarantee.

Thus, the question of what the Trump/GOP replacement will actually look like turns on the question of what really counts as everybody having insurance. If the Republican plan does not strive for this type of guarantee but does try to make insurance more affordable, Republicans might still say this constitutes giving people access to insurance (if they’re willing to pay for it).

Today, Democrats have a chance to pin down Price on this. Harold Pollack, a health policy expert at the University of Chicago, suggests questions designed to clarify not just whether Trump envisions a replacement that covers “everybody,” but what this actually means:

“Should every American who has an income below the federal poverty line be guaranteed access to Medicaid? Should every other American be entitled to health insurance with out-of-pocket and premium costs limited to an affordable, capped fraction of their income?”

Then there’s also the question of what constitutes acceptable coverage. The ACA has basic regulatory standards that Republicans are going to want to repeal. That, too, is an area on which Price should be questioned.

“The real question is what counts as insurance,” Nicholas Bagley, a University of Michigan law professor who has written extensively on health reform, says. “Does Price support a replacement that would allow insurers to exclude mental-health services? Preventive services? What about annual or lifetime coverage limits? Or $10,000 deductibles?”

Now, for various reasons, Republicans just don’t believe health reform should guarantee coverage in the manner that the ACA does. And that’s fine-- that’s their philosophical view. But the point is that Trump and his advisers are trying to obscure this. Trump does not want to be the guy who kicked millions off insurance. But it appears congressional Republicans philosophically cannot support anything that does not do this.  This basic problem cannot be spun away forever. An actual comparison between the ACA and the GOP replacement cannot be dodged in perpetuity. Hopefully, today will begin to supply some clarity.

PolitiFact found that Schumer was being truthful when he said that "Trump campaigned on not cutting Medicare and Social Security, but his nominee for the Secretary of Health and Human Services, Tom Price, 'made his career on cutting Medicare and Medicaid.'" Price, wrote PolitiFact's Linda Qiu, "has introduced a plan to repeal and replace Obamacare every legislative session since 2009. Price’s Empowering Patients First Act instead provides tax credits to help pay for private insurance plans and expands health savings accounts. The Price plan also allows for people to opt out of Medicare and Medicaid (and other government-run health programs) and choose the tax credits to purchase private plans instead. It folds in his previous advocacy of private contracting between Medicare beneficiaries and doctors. Beyond his own proposals, Price supported Paul Ryan’s 2011 budget plan, which would have eventually moved Medicare toward private insurance by giving people under 55 voucher-like tax credits to purchase plans. This is also called premium support. When he became chairman of the House budget committee, Price was the primary author of a budget for fiscal year 2016  that included $900 billion in spending reductions to Medicaid (through block granting) and $148 billion to Medicare (by leaving the Obama administration’s cost-saving measures intact), according to the nonpartisan Committee for a Responsible Federal Budget. Price’s budget for fiscal year 2017 similarly sought: $1 trillion from Medicaid and $449 billion from Medicare. After Trump’s election, Price expressed optimism that lawmakers could overhaul Medicare in 2017."

The Center for Medicare Advocacy, a nonpartisan health care advocacy group, typically doesn’t weigh in on cabinet appointments but opposes Price’s nomination precisely because of his position on Medicare, said David Lipschutz, the group’s senior policy attorney.

"The policies he has advocated would significantly cut and alter Medicare," Lipschutz told us, listing Price’s support for a premium support model, opposition to allowing Medicare to negotiate prescription drug prices and advocating for private contracting between Medicare beneficiaries with physicians with Medicare footing the bill.

Gail Wilensky, the former director at the Centers for Medicare and Medicaid under President George H.W. Bush, called Price’s comment on Medicare as government intrusion a "gross exaggeration."

But Wilensky preferred to characterize Price as a supporter of Medicare reform. She added that like Price, she supports premium support as a model for Medicare reform, as do prominent Democrats Alice Rivlin, a health care policy expert who served under President Bill Clinton, and Bob Reischauer, a fellow at the left-leaning Urban Institute.

Our ruling

Schumer said, "Donald Trump said when he campaigned he wouldn't cut Medicare and Social Security" but his nominee for the Secretary of Health and Human Services "made his career on cutting Medicare and Medicaid."

Price, Trump’s HHS pick, has supported reducing the government’s role in Medicare and block granting Medicaid, which would amount to spending reductions to both programs. While it’s clear these proposals would reduce federal spending on the health safety nets, experts say it’s not the same thing as gutting the programs entirely.

Trump did pledge to leave Medicare and Social Security alone, and Price’s positions seem at odds with that. (It’s worth noting that Social Security isn’t administered by HHS).

We rate Schumer’s claim Mostly True.

Just as he started his confirmation hearing, the National Nurses United urged the Senate to reject Price as head of Health and Human Services. NNU Co-President Jean Ross, a registered nurse, pointed out that Price has also taken public positions that directly conflict with pledges made by Trump. She said that Price is against Trump's stated goals that include "a system that would assure healthcare coverage for everyone, lower healthcare premiums, deductibles and co-pays, high quality, a process to negotiate the high costs of prescription drugs, and has repeatedly opposed cuts to Medicare and Medicaid."

"There is only one plan that would achieve all of those goals, improving and expanding Medicare to cover all Americans," said Ross. "Medicare for all would mean universal, guaranteed access to care for all, guaranteed patient choice of provider, lower costs to families, strengthening Medicare through an expanded pool of healthier people, and the ability of the federal government to negotiate and demand fairer prices from the drug companies," Ross noted.

"That’s the health care plan President-elect Trump should support, and we should have an HHS Secretary who will protect the health and safety of Americans, not shred it," Ross said.

By contrast, Price supports the push by House Speaker Paul Ryan to privatize Medicare, a major cut in access and cost for seniors and the disabled and favors cuts to Medicaid by repealing the ACA expansion and replacing it with reduced block grants to states to make further cuts.

Price wants to repeal curbs on insurance abuses set by the ACA, notably the ban on pre-existing conditions exclusion, lifetime and annual payment limits.

The proposals by Price to replace subsidies for low income families to buy coverage with tax credits or health savings accounts, without any limits on industry price gouging, "would lead to additional disaster for millions of Americans already priced out of access to care, even if they have insurance," said Ross. "The last thing we need is a full return to a cutthroat healthcare system totally based on ability to pay."

..."As nurses know from the patients we care for every day, without health, there is no security. We cannot risk the very real consequences of Rep. Price’s reckless disregard for the health of our patients and our nation."