Republicans are failing to move as quickly as promised to unwind the Affordable Care Act, and they’re looking to Rep. Tom Price’s confirmation as their chance to create some breathing space.
From cutting off free birth control for women to tightening the eligibility rules for midyear health insurance enrollees, Price – once confirmed as secretary of health and human services – will be able to tinker around the edges of the 2010 law. And that gives Republican lawmakers a bit more time to find consensus on their repeal-and-replace effort.
“I think we have to show measurable progress,” said Sen. John Thune, R-S.D. “And one of those really key things is getting Tom Price confirmed.”
Once confirmed, Tom Price also would be able to repeal one of the law’s most controversial initiatives: free birth control for women.
The Senate is expected to vote early Friday morning on Price’s confirmation despite calls by Senate Democrats to postpone the vote until questions about stock trades he made as a member of Congress are investigated.
Democrats planned to stage protests into the night, highlighting their request that the Securities and Exchange Commission look into whether the Georgia congressman had engaged in insider trading when he purchased stock in a company that stood to gain from legislation.
“What’s the Republican response?” asked Senate Minority Leader Chuck Schumer, D-N.Y. “Rush Price through. Don’t try to make sure that everything is totally on the up and up. . . . It’s like ethics is out the window.”
The conservative group America Rising Squared accused Democrats of looking to smear Price in an effort to stall a repeal of the Affordable Care Act. Senate Republicans showed little interest in slowing Price’s nomination.
Besieged by angry activists at town hall meetings in their districts and facing criticism from conservatives who want a speedy repeal, Republicans say that with Price at the helm of the department, they can proceed faster.
It’s incumbent upon Congress to act and say, ‘This is the plan,’ and then look at how a new HHS secretary might help with that process, not the other way around.
Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus
“Having a voice in the administration that’s on top of this issue every single day and talking about health care and what the administration’s position is on a consistent basis is critically important,” said Rep. Pat Tiberi, R-Ohio, the House Ways and Means Health Subcommittee chairman, who has been described by House Speaker Paul Ryan, R-Wis., as the chamber’s “quarterback” on efforts to repeal the law.
Republicans have been at a disadvantage without Price in place, Tiberi said.
“It’s hard to do the fine points on what the administration can do and what Congress can do,” Tiberi said. “He hasn’t been able to talk to us about it since he’s been nominated, so it makes it even more challenging. It will be helpful to know what they can and can’t do and what they are going to do, and then have a dialogue on what the administration’s position is.”
Yet Republicans who want Congress to move faster downplayed Price’s importance, saying lawmakers need to write the legislation.
“It’s incumbent upon Congress to act and say ‘This is the plan’ and then look at how a new HHS secretary might help with that process, not the other way around,” said Rep. Mark Meadows, R-N.C., the chairman of the conservative House Freedom Caucus, who has pressed his colleagues to move quickly and adopt a repeal bill that both chambers passed in 2015.
Putting the administration in the driver’s seat, Meadows cautioned, “really perverts our constitutional role.”
Still, lawmakers said they expect Price’s arrival to help them allay conservative fears that they’re not moving fast enough. Despite promising for seven years to repeal the sweeping health care law, Republicans find themselves without a ready alternative.
Republicans are also hoping that Price’s arrival clarifies the administration’s message. Trump’s proclamations on health care have complicated matters for Republicans – he’s pledged “insurance for everybody” – which conflicts with what some fiscal-minded Republicans want. And conservatives who want to move faster were disappointed with Trump’s suggestion over the weekend that the repeal could go into next year.
Meadows said he’d called the White House on Tuesday to get clarification on Trump’s remarks and that he was told the president was talking about how long it could take to transition into a different health care system.
“They were certainly supportive of moving quicker in the House and the Senate,” Meadows said of the White House.
Price as a member of Congress has championed his own health care plan, known as the Empowering Patients First Act, which would offer tax credits, encourage the use of health savings accounts and urge states to develop high-risk pools that would, at higher premiums, serve people more likely to need costly care.
Analysts say they expect Tom Price to look at quelling insurers’ fears.
But before Congress even acts, there are steps a new secretary of health and human services could take unilaterally.
Analysts say they expect Price to look at quelling insurers’ fears about the marketplaces for individual coverage.
That could mean writing rules to restrict who can participate in special enrollment periods during the calendar year, a move that could save insurers money. He also could tighten eligibility verification by writing rules that require people to prove they are eligible before being allowed into the program.
“What they will do first is what the insurers want,” said Timothy Jost, a former law professor at Washington and Lee University who backs the Affordable Care Act. “The insurers have said, ‘If we don’t get what we want, we’re out of here,’ and they don’t want that on their watch.”
Those steps could ease some Republican fears about yanking Obamacare without a replacement, said Heritage Foundation senior research fellow Edmund Haislmaier, who advised the Trump transition team.
“To the extent the administration can show they are working with insurers to stabilize the market, that’s going to make Republicans on the Hill a lot less nervous about moving forward on the legislative part of this,” Haislmaier said. “They’re very nervous about what happens when we do half of this. Do we get blamed for the other half that we can’t control?”
If Congress is able to reach a compromise and clear legislation, it’s likely to take as long as two years to implement.
But Price could give states greater flexibility to waive parts of the health care law, said Gail Wilensky, a senior fellow at global health organization Project HOPE, who ran the Medicaid program from 1990 to 1992 under President George H.W. Bush.
The Obama administration included an innovation waiver for states, but Wilensky said the guidelines were “written in a way that was narrowly defined, and that’s something the new administration could address.”
Price also would be able to repeal one of the law’s most controversial initiatives: free birth control for women.
The provision does not need congressional action because the Obama administration enacted it via a rule, not a law. The new administration would be required to follow a formal notice-and-comment period before it took effect. And health insurance plans can’t be changed outside the annual enrollment period, meaning any changes could be at least months away.