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5 takeaways on replacing the ACA from Tom Price's Senate hearing

If you were hoping to get more clarity on plans for repealing and replacing Obamacare under the Trump administration, yesterday's confirmation hearing for Tom Price, the nominee for HHS Secretary, offered some assurances  but few specifics. 

Consisting of two lengthy rounds of wide-ranging questions about the nominee's policies and ethics, members of the Senate Finance Committee questioned the orthopedic surgeon and Republican representative from Georgia. But Price repeatedly refused to provide definitive answers to many of the members' questions. 

While many answers were vague, Price did provide some clarity about how he would lead the process of repealing or modifying the ACA. Here is what you need to know about Price's stances on healthcare reforms from changes to Medicaid to a potential loss of coverage for pre-existing conditions.  

1. Price promises to preserve Medicaid coverage — but it's unclear how

Despite previous support for proposals to block grant Medicaid, Price promised to allow patients who are currently in the program to keep their coverage. 

One of the most beneficial components of the ACA was the expansion of the Medicaid program, Sen. Bob Menendez (D-NJ) pointed out in the hearing, but that could change under the Trump administration.

Trump has said he would “maximize flexibility for states” with the goal of helping them “design innovative Medicaid programs that will better serve their low-income citizens,” The New York Times reported Kellyanne Conway, a counselor to Trump, recently told NBC News's Sunday Today Medicaid would become a block grant program after replacing the ACA. 

Eliminating Medicaid expansion would strip states from billions in federal funding and result in a “catastrophic loss,” according to Menendez. Some recent reports say the GOP is considering replacing the federal program with block grants to states, which would change the way Medicaid is funded and how states can spend such funds. 

Price did not answer whether he is in favor of this approach, but did say Medicaid isn't as responsive to the needs of beneficiaries is it should be. Medicaid faces "significant challenges," he said, adding that one out of three physicians who should be seeing Medicaid patients isn't doing so. 

When asked if he would support getting rid of the expansions, Price would only say that the administration does not support "a plan that would cause anybody to lose coverage."

"Any reform or improvement for the ACA would include an opportunity for individuals to gain the kind of coverage they want with the highest quality of healthcare, including those that are in the Medicaid population or close to it," he said. 

It remains to be seen whether this opportunity for coverage means he would support keeping the expansions in place. Approximately 11 million people could lose their Medicaid coverage if the expansions are repealed, according to the Kaiser Family Foundation

2. Price plans to ensure well-being of women and veterans

The ACA implemented regulations for improving care available to women and veterans.

Although Price has previously indicated he supports gutting Planned Parenthood's federal funding, he said he wants to have a system "in place ... that allows women to be able to purchase the kind of contraception that they desire."

Major provisions in the ACA allow veterans to obtain guaranteed coverage. "Sadly in many instances we're not doing this," Price said. He told committee members he looks forward to working with them to put in place a "better system" that ensures all veterans have access to affordable healthcare. 

However, he offered few specifics on the system he envisions and how it would improve women's and veterans' healthcare.

3. Price wants to get rid of the Cadillac Tax

The so-called "Cadillac Tax," a 40% excise tax on employer-sponsored plans that exceed $10,200 in premiums annually for individuals and $27,500 for families, has been a controversial component of the ACA from the beginning.

Price believes there may be better options than the "Cadillac Tax" for individuals to obtain the coverage they want through their employer. "There are other options that may work better," Price said.

Sen. Claire McCaskill (D-MO) questioned whether anyone with an income of less than $200,000 would benefit from the tax cuts that would come with repealing the ACA. "Nobody in America is going to enjoy a benefit from that," she said.

A recent Vox article suggested the reason why Republicans are in such a hurry to repeal the ACA is because it would repeal taxes for millionaires. Yet if the ACA's taxes are repealed, how affordable a replacement plan would be remains unknown. 

4. Price didn't promise an immediate ACA replacement

Sen. Ron Wyden (D-OR) expressed concerns over the possibility of Americans being "worse off" and losing their coverage under Trump's executive order. He asked Price to commit to prevent this from happening and refrain from implementing the ACA until a replacement plan is ready. But Price did not make this promise during the hearing. 

While the Trump has said the repeal and replace processes should happen "essentially simultaneously," senators questioned whether he was telling the truth about being close to finishing a replacement plan.

"President Trump said that he's working with you on a replacement plan for the ACA which is nearly finished and will be revealed after your confirmation, is that true?" asked Sen. Sherrod Brown (D-OH).

"It's true that he said that, yes," Price said. His response seemed to somewhat skirt the issue, and was followed by laughter in the audience. He later clarified: "I've had conversations with the president about healthcare."

If the ACA were to be repealed without a replacement plan in place, an estimated 20 million Americans would lose their coverage — potentially costing hospitals billions of dollars and result in massive job losses. 

5. Price wants to staying the course on preventive care services 

In 2012, Price said a ban on discrimination against people with pre-existing conditions is a "terrible idea," a position that was referenced by Sen. Bill Nelson (D-FL) at the hearing. Price denied the statement and instead showed support for protecting those with pre-existing conditions, who are typically the most costly patients.

Nobody with pre-existing conditions will lose their coverage, Price promised, adding that he also wants to keep coverage for preventive care services. 

"Nobody ought to lose their insurance because they get a bad diagnosis," he said. "I believe we need a system that recognizes that these conditions exist." 

The statement offered some assurances to those concerned about the loss of coverage for pre-existing conditions. But it remains unclear exactly how Price's ACA replacement plan would prevent those patients from losing access to coverage. 

Next steps

After the last two hearings for Price, it appears his nomination will likely be confirmed unless he stumbles in the next week or Democrats convert Republicans over to their side — both of which look unlikely at the moment.

The committee has yet to schedule a date to vote on Price's nomination, though "it will likely be next week or the following," Taylor Harvey, a Finance Committee Democratic aide, told Healthcare Dive.

Price must pass through the committee with a simple majority to be referred to the full Senate for a final vote. Harvey expects every Republican to support Price, which would result in his confirmation. 

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Filed Under: Health Law Policy & Regulation
Top image credit: Ana Mulero