Georgia congressman Tom Price, the nominee to be secretary of the Department of Health and Human Services told lawmakers Wednesday that if confirmed he would aim to have some form of Obamacare replacement in effect by early March so that insurers could have time to adjust their 2018 offerings accordingly.
"Insurers are deciding right now, as they come forward in March and April, what the premium levels will be for 2018. What they need to hear from all of us is a level of support and stability in the market, the kinds of things that make it so that they're able to provide to patients," Price said at a confirmation hearing before the Senate Health, Education, Labor and Pensions Committee. Price will have another confirmation hearing next week before the Senate Finance Committee, the panel that will actually vote on recommending his confirmation by the full Senate.
Price stressed that despite Republican lawmakers' plan to repeal Obamacare, those now covered by insurance obtained under the Affordable Care Act will see the changes implemented incrementally.
"So I think there's been a lot of talk about—about individuals losing health coverage," Price said under questioning from committee chairman Lamar Alexander, R-Tenn. "That is not our goal nor is it our desire, nor is it our plan."
"Nobody's interested in pulling the rug out from under anybody," Price said. "We believe that it's absolutely imperative that individuals that have health coverage be able to keep health coverage and move hopefully to greater choices and opportunities for them to gain the kind of coverage that they want for themselves and for their families."
Nevertheless, the incoming Trump Administration should make reform of the individual market, the most affected by the ACA, a top priority.
Prompted by Alexander's comments about the dire condition of Tennessee's ACA exchange, Price said "it's imperative" that the Trump Administration come up with a solution to address the situation there and in other states. "We're clearly seeing changes in the individual and small group market that are adverse to the patient, whether it's decreasing access to coverage, whether it's increasing premiums, whether it's higher deductibles, something is going badly wrong out there."
Price noted that there are five states with only one insurance provider and that one-third of U.S. counties have only one insurance provider.
Price didn't go into much detail about what the Trump Administration is likely to put forward, although as a congressman he has proposed his own plan to repeal and replace Obamacare. His legislation, like one offered by House Speaker Paul Ryan, R-Wis., provide people without employer coverage tax credits for buying health insurance on their own and those who don't earn enough to pay taxes could apply the credit directly to premiums.
Democrats on the committee took aim at Price's plan, which they say is a poor substitute for the comprehensive coverage available under the ACA, which bars insurers from excluding people with pre-existing conditions.
Under Price's bill, people with pre-existing conditions could not be denied coverage but insurers would not have to cover treatment for those conditions for 18 months after purchase of coverage (this provision is meant to discourage people from waiting until they're sick to buy coverage and replaces the 'individual mandate' that Obamacare relies on to make sure the pool of insured has enough healthy people for the insurance program to pay for itself).
Sen. Patty Murray of Washington, the committee's ranking Democrat roasted Price for the provision, which she said would hurt "millions of Americans with pre-existing health conditions [who] lack insurance for short periods of time."
Price countered that those with pre-existing conditions not covered by private insurance would be put in high risk pools and individual health pools "that would allow every single person in the individual small group market . . . to be able to gain access, again, to the coverage that they want."
Murray, bound by limitation on the time allowed for questions, cut off the conversation. "We disagree on the consequences of that," she said.
Moving on, she also criticized his bill for eliminating ACA mandates on coverage for prescription drugs, mental health and substance use disorders, maternity coverage and lifetime coverage that helps people with cancer and chronic illness.
Price insisted that how those areas would be covered under ACA replacement is a larger question because "we would put a different construct in place that would allow for every single person to gain access to the coverage that they want and have nobody fall through the cracks."
As her time ended, Murray summed up her reaction: "I am very concerned that your vision for a health care system is very different than one that I think millions of Americans are counting on."
Sen. Al Franken, D-Minn., picked up the ball by criticizing the plan for tax credits, which he said will leave lower income people in the lurch. "It's no different for someone who's poor, someone who makes $20,000, $30,000 than to Bill Gates," he said. "It is an incredibly regressive system. You have talked about ending the—you guys want to end the expansion of Medicaid. That has people in Minnesota scared out of their mind."
For all of the criticism of Obamacare, Franken said it has "bent the cost curve" and cut the increase in healthcare costs below what it was in the previous 10 years and provided coverage for 20 million more people. "But forget them," he said, noting that during 2008 campaign in which Barack Obama was elected, "I was going around the state of Minnesota. In every VFW hall, in every cafe, I would see a bulletin board where it would have a burger bash or spaghetti dinner for someone who had gone bankrupt because they had gone through their annual cap or their lifetime cap. I am very frightened about what you are going to do and so are millions of Americans."