Tom Price’s appointment as secretary of Health and Human Services puts the Affordable Care Act in severe jeopardy.


NOVEMBER 29, 2016


With Donald Trump’s presidency on the horizon and majorities in both houses of Congress, Republicans leaders like Mitch McConnell and Paul Ryan, have practically been frothing at the mouth at the prospect of dismantling the Affordable Care Act. Given the president’s veto power, Barack Obama’s signature healthcare law has remained out of the G.O.P. reach for years, but with Trump in the Oval Office everything will change. And despite having seemingly walked back his campaign promise to repeal Obamacare in its entirety, President-elect Trump just appointed one of the harshest critics of the law in Congress to lead the Department of Health and Human Services—the strongest indication yet that the healthcare law could be targeted for erasure come January.

Amid the theatrics and showmanship that has defined Trump’s Cabinet selection process, the president-elect’s transition team announced on Tuesday morning that Tom Price, a Republican congressman from Georgia, has been appointed as secretary of Health and Human Services, putting the fierce Affordable Care Act critic in a key position to reform the $3 trillion U.S. healthcare system the G.O.P. has lambasted for years. “Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy, making him the ideal choice to serve in this capacity,” Trump said in a statement, adding, “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American.”

Unlike a number of his Republican peers, Price’s support of Trump’s candidacy throughout the election was unwavering, and—despite, as the Washington Post reports, the congressman’s lack of experience in running a major agency or business comparable to the $1 trillion Health and Human Services department—as a third generation physician, the orthopedic surgeon fits the ongoing trend of Trump feeding his reality-TV impulse to build a cabinet that could be right out of “central casting” while also rewarding loyalty. Price also has enjoyed Tea Party support and a congressional Web site that boasts his devotion to “limited government and lower spending.” He is, in other words, undeniably on board with Trump’s campaign promise to dismantle Obamacare.

But as even Obama warned, the political perils associated with reforming the already unstable healthcare industry are massive, and now the Republican Party will bear the burden of millions of Americans losing health insurance if the market is upended. Not to mention the logistics of actually appealing the sprawling healthcare law. Despite having secured a majority in the Senate, Republicans will still fall short of the 60 votes needed to overcome the Democratic filibuster, required to fully repeal the law. And as John McDonough, a professor at the Harvard T.H. Chan School of Public Health, told me in an interview earlier this month, “The notion of repealing the whole 950 pages of the law is a non starter. It won’t happen,” because “There is not a single Democrat of the 48 in there who would vote for that.”

As a result of this dynamic, House Republicans’s mostly likely strategy to circumvent the filibuster would be a complex process known as “budget reconciliation,” through which they can gut the most important aspects of the Affordable Care Act. With the maneuver, the G.O.P.—as House Speaker Paul Ryan demonstrated last year—can repeal all of the subsidies to help people buy health insurance, repeal the Medicaid expansion, and repeal all of the taxes used to pay for Obamacare with an omnibus bill that could be passed with a single party vote, which Trump would, presumably, sign into law.

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