For those who thought Donald Trump, someone who spent two years on the campaign trail promising to protect programs like Medicare, might consider keeping that promise, let today’s news disabuse you of that notion. The selection of Georgia Congressman Tom Price as Health and Human Services Secretary offers the clearest signal yet that Trump and House Speaker Paul Ryan are perfectly aligned, and ready to make Medicare phase-out the signature proposal of his presidency.
There’s not much daylight between Ryan’s and Price’s plans for the nation’s health system. Both want to repeal Obamacare; in fact, Price has issued a detailed replacement plan every year since 2009, before the ACA even passed. Price’s Empowering Patients First Act contains the usual features of conservative health-care plans—poorly funded high-risk pools for anyone rejected for a preexisting condition, letting insurers sell across state lines, health savings accounts, tort reform, and capping the tax exclusion for employer health coverage. Practically all of these ideas have been implemented either at the state level or during George W. Bush’s administration, and none succeeded in closing the uninsured gap or making health care cheaper. But Price’s major provision replaces the ACA with a meager tax credit to purchase private insurance on the individual market. It also allows people to opt out of Medicare or Medicaid and take the tax credit.
If that sounds familiar, it’s substantially the framework of Ryan’s premium-support plan to convert Medicare into a coupon for people to put toward insurance. Price has endorsed the Ryan plan: Earlier this month he said Congress would phase out Medicare in the first six to eight months of 2017. He even laid out how to get it done while avoiding the filibuster. Using budget reconciliation, fiscal items that don’t increase the deficit outside the 10-year budget window can get an up-or-down vote with limited debate.
Price succeeded Ryan as House Budget Committee chair, so he understands the mechanics of the process. And he would have to do something fast, because a full Obamacare repeal, including the Medicare provisions, would immediately reverse the ACA’s extension of the Medicare trust fund, triggering an inability to pay all benefits within the first year or two. So Price and Ryan would create an unnecessary crisis in Medicare to get to their favored solution of voucherizing it.
For good measure, Price’s last budget not only repealed Obamacare but turned Medicaid into a block-grant program for the states.