Trump’s health and entitlement picks signal an intent to cut programs

President-elect Donald Trump's choices for health secretary and administrator of the government's largest health insurance programs have for years pursued a sharply conservative agenda that includes redefining Medicare, placing "personal responsibility" requirements on low-income recipients of Medicaid, and dismantling the Affordable Care Act.

If adopted, this agenda could dramatically alter access to insurance and medical services for more than 100 million Americans covered through the two entitlement programs and the ACA.

Trump has nominated Rep. Tom Price, R-Ga., to lead the Department of Health and Human Services and health consultant Seema Verma to run the HHS agency that oversees Medicare and Medicaid. The two are master tacticians of the right-leaning health-care vision Trump adopted as central campaign themes.

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Price, chairman of the House Budget Committee, is an orthopedic surgeon who was a state lawmaker before his election to Congress a dozen years ago to represent affluent Atlanta suburbs. He has four times introduced his own legislation to replace the polarizing 2010 health-care law, and he was part of a quartet of House committee chairmen who recently forged a GOP consensus document with 40 pages of proposed changes to the health-care system. Last year, he was chief sponsor of the only ACA-repeal bill that has ever reached the White House; President Obama vetoed it.

Verma is an Indianapolis-based health-care consultant who designed the most far-reaching Medicaid experiment under the Affordable Care Act that the Obama administration has allowed. It is based on the idea that beneficiaries should be required to take responsibility for their health and their finances. Even some of the poorest residents were required pay for part of their care. She has been advising other states with Republican governors on how to alter their Medicaid programs, as well.

Taken together, Trump's choices announced Tuesday morning demonstrate his seriousness about demolishing the Affordable Care Act and restructuring the two vast health-care entitlement programs that were pillars of the Great Society of the 1960s.

Price's and Verma's experience in conservative policymaking trenches immediately elated a variety of politicians and health-policy experts on the right, while worrying liberals.

Shortly after word of Price's selection surfaced Monday night, former House speaker Newt Gingrich tweeted:"He is the right leader to help Congress replace Obamacare."

In contrast, Ron Pollack, executive director of the liberal health-care lobby Families USA, said on Tuesday, "In contradiction to President-elect Trump's promise to protect the poor, both appointees have demonstrated an unusual insensitivity to the health-care needs of low-income families."

One of the central unknowns at the moment is whether Trump, in carrying out his pledge to repeal and replace the ACA, will adopt wholesale the relatively detailed set of ideas that Price, House Speaker Paul Ryan, R-Wis., and other House Republicans have forged – or whether the incoming president will want to place his own imprint on such policies.

For the most part, Trump's health-care positions, during his campaign and since the transition began, have been aligned with the House Republicans' thinking, though the president-elect's statements have been far less specific.

However, the most recent version of Price's bill to replace the ACA, called "Empowering Patients First," contains at least one important difference with Trump. It would reverse a requirement in the law that insurers may not refuse to cover customers with preexisting medical problems. During his campaign, Trump repeatedly said that he wanted to keep that facet of the law.

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In a conference call with reporters Tuesday morning to discuss Price's and Verma's selections, a Trump transition spokesman did not address that difference. The spokesman, Jason Miller, subtly signaled that the president-elect would look to the pair to chart the way forward on health-care policy. Miller noted that Trump has spoken of expanding the use of health-savings accounts, allowing insurers to sell policies in other states, and changing Medicaid from an entitlement program to block grants with fewer federal rules – ideas that all mesh with Price's thinking. "It's important to point out that Dr. Price and Ms. Verma will really be our point people who will be leading the charge on this front," Miller said.

At the White House, press secretary Josh Earnest gave a fresh defense of the ACA and said that whatever health plan Trump produces should be judged by the extent to which it expands insurance coverage, constrains health-care costs, and lengthens the financial life of Medicare, whose finances are fragile.

Price, a member of the House's tea party caucus, has been on the speaking circuit for years calling for limiting federal spending and lessening the government's role in health care. He tends to cloak his idea in gentle language, speaking often of "patient-centered health care where patients and families and doctors are making medical decisions."

Yet he is associated with the most conservative strain of thought in favor of eliminating the ACA and tilting the Medicaid and Medicare programs toward the private sector.

Early in the spring of 2010, two days after Obama signed into law the health-care bill that had passed without a single House GOP vote, Price pronounced it "the nail in the coffin for health care in the United States." A few months later, he signed a "Repeal-it!" pledge organized by the Club for Growth, a conservative, free-market group.

In 2009, one of the three times that Congress has renewed the Children's Health Insurance Program, created nearly two decades ago to help working-class families, Price voted against its extension. He also has worked to try to increase protection of his fellow physicians from malpractice lawsuits.

As for Verma, she redesigned Medicaid in Indiana, the home state of Vice President-elect Mike Pence, exercising the flexibility the ACA provides states. Under new rules, Indiana's beneficiaries pay for their insurance with help of savings accounts worth $2,500 each provided by the government. An intricate system of rules encourage Hoosiers on Medicaid to save money and get medical checkups. The program offers help in finding jobs but stops short of requiring people to work – a step the Obama administration opposes but that many conservatives favor.

Last year, a spending plan Price proposed as Budget Committee chair would have transformed Medicare, converting it from an entitlement to a system of "premium supports" – like vouchers – to help buy private insurance policies.

Last year, too, Price was asked in an NPR interview what it would take to get rid of the ACA. His reply was quick."It's going to take a different president."

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Abby Phillip, Max Ehrenfreund and Alice Crites contributed to this report.