Donald Trump’s plan to repeal and replace Obamacare began in earnest on Tuesday with the selection of House Budget Committee Chairman and six-term Georgia Representative Tom Price as the next secretary of Health and Human Services. Price has been one of the most consistent opponents of the Affordable Care Act in Congress, and has written perhaps the most comprehensive Republican alternative to the bill. That pick, along with the selection of the Indiana health-policy consultant Seema Verma to run the Centers for Medicare and Medicaid Services, appears to signal that Trump is making his vision of healthcare reform a top priority. But what will Price actually be able to do at his new position?
Both Price and Verma know healthcare well. Price, a physician, is not a neophyte in the vein of Ben Carson at Housing and Urban Development, but a seasoned health-policy thinker who knows the minutiae of the major public-insurance programs and reforms. Verma, whose CMS will administer those programs, has previously worked closely with the agency as one of the architects of Mike Pence’s market-based Medicaid expansion in Indiana and of much of Indiana’s state health policy.
Although Price’s selection is the clearest signal yet of the direction Trump intends for his replacement of Obamacare—defunding Obamacare subsidies, cuts to Medicaid, expanded high-risk pools, health savings accounts tax breaks, and continuous coverage requirements for pre-existing conditions waivers—now that he’ll be outside of Congress, Price won’t have the authority to simply end Obamacare on his own. Enacting his apparent preferences for diminishing public insurance for children and denying care for elderly people who can’t afford co-pays requires legislative authority. Until a bill comes along that changes the structure of the Affordable Care Act or dismantles it, Price cannot act unilaterally on his stated desires to end it.