You don’t have to go back too far to find out what U.S. Rep. Tom Price, MD, R-Georgia, may favor as a replacement to the Affordable Care Act (ACA) if he’s confirmed as HHS Secretary under President-elect Donald Trump.
His path to confirmation begins Jan. 18 when he’s due to be questioned by the Senate Health, Education, Labor and Pensions Committee. Democrats have warned his nomination process could last into March.
Once he’s in at HHS, he’s likely to be leading the charge on Trump’s ACA replacement plan. He has no shortage of ideas in that department, having sponsored four different versions of his alternative plan called the Empowering Patients First Act (EPFA). Here are some policies from Price’s past bills that could see new life in the Trump administration:
1. Changes to buying and selling insurance
The EPFA’s version of health insurance reform isn’t like the ACA’s subsidized coverage through exchanges. Tax credits would still be involved, but instead of the ACA income-based subsides, Price’s plan awards money based on age: 18- to 34-year-olds would receive $1,200, 35- to 54-year-olds would get $2,100, and those from ages 55 to 64 would get $3,000. The credit would automatically be given when a consumer buys coverage.
It would also allowed insurers to sell the same plans across state lines, an idea Trump has advocated but is already possible for states to allow, with insurers showing little interest.
2. Goodbye individual, employer mandates and Medicaid expansion
The first provision of the EPFA is repealing the ACA, and with it, the tax penalties for individuals not buying coverage or employers not offering it would disappear. The expansion of Medicaid in 31 states and the District of Columbia would also be rolled back, potentially leading to more than half a million healthcare jobs being lost and putting extra pressure on revenue-strapped rural hospitals.
The 2011 version of his bill, however, had similar provisions to the ACA regarding Medicare Disproportionate Share Hospital (DSH) payments, recommending those be cut as the uninsured rate declined.
3. What about pre-existing conditions?
The ACA’s ban on insurers denying coverage based on pre-existing conditions is one provision Trump has said he’d like to keep in its replacement, despite past examples showing the ban doesn’t work without a mandate to buy insurance. Price’s plan, however, has a modified version, where insurers can’t take pre-existing conditions into account as long as a patient hasn’t had a lapse in coverage.
If they did lose their insurance for a period of time, they would be moved into high-risk pools, which had been used in 35 states to cover high-cost patients prior to the ACA. A similar proposal was included in the “Better Way” healthcare plan released by House Republicans in 2016.
4. Malpractice changes
Being an orthopedic surgeon, Price is considered to be an ally to physicians. Among his more doctor-friendly proposals were changes to medical malpractice lawsuits within the EPFA.
The bill would move malpractice cases away from jury trials to be heard by a state administrative tribunal. Judging based on standards created by a “qualified physician consensus-building organization,” the tribunal—at least half of which has to be made up of doctors or healthcare professionals—would make a recommendation on liability and compensation. Only after a tribunal decision could a patient or physician request a traditional jury trial.
The changes would have also prevent apologies from physicians from being used as evidence in malpractice cases, and any damage awarded over $50,000 would be paid periodically, rather than in a lump sum.
5. Banning use of comparative effectiveness research
One of the lesser-known proposals in Price’s bill would prevent HHS from using research based on comparative effectiveness or patient-centered outcomes. That kind of research directly compares healthcare interventions, rather than judging a new treatment to a placebo.
Those projects were given $1.1 billion in funding in the early days of President Barack Obama’s first term, despite Price’s objections. According to a 2009 Health Affairs article, he claimed such research would “strip doctors and patients of the right to make healthcare decisions, creating a permanent government rationing board that would prescribe care."
Within the EPFA, Price would prohibit HHS from using those studies when making decisions on covering a treatment in a federal healthcare program. Findings from the federal commission on comparative effectiveness research would be withheld until they were examined and approved for release by “relevant physician specialty groups” outside of government.