Donald Trump told Americans that he would protect Medicare, promising to oppose cuts to benefits over and over again on the campaign trail.
“People have been paying in for years. They’re gonna cut Social Security. They’re gonna cut Medicare. They’re gonna cut Medicaid,” he told Fox News in April 2015, referring to the other candidates in the GOP presidential primary. “I’m the one saying that’s saying I’m not gonna do that!”
But his nominee to head the Department of Health and Human Services is a strong supporter of House Speaker Paul Ryan’s plan to raise the Medicare eligibility age and partially privatize the program — indicating either that Trump is walking back his campaign pledge or that there will soon be a conflict between Trump’s cabinet and his own stated views on the issue.
A little more than a week after the election, Trump’s pick for HHS secretary, Georgia Republican Congressman Tom Price, who now helms the House Budget Committee, told the press that he expected the House to push for Medicare privatization “within the first six to eight months” of the Trump administration — possibly by using the budget reconciliation process, which would allow the Senate to pass such a plan with a simple majority that could not be filibustered.
Two days after the election, Ryan had appeared on Fox News to urge changes to Medicare. “What people don’t realize is because of Obamacare, Medicare is going broke. Medicare is going to have price controls. Because of Obamacare, Medicaid is in fiscal straits,” Ryan said. “So you have to deal with those issues if you’re going to repeal and replace Obamacare. Medicare has got some serious problems because of Obamacare. So those things are part of our plan to replace Obamacare.”
As HHS secretary, Price would be in a powerful position to advocate for privatization as well as other changes to health care law that would undermine Medicaid and the Affordable Care Act (ACA). Seema Verma, who helped implement the Medicaid program in Indiana and other states, who Trump has tapped to head the Centers for Medicare and Medicaid Services, would report to Price.
Price has also sponsored budgets in Congress that would turn Medicaid into a block grant program. That would shift the federal government’s role from paying a fixed percentage of state Medicaid costs to paying a fixed dollar amount, giving the states the flexibility to cut back on eligibility. The block grant proposal floated by Ryan in the past would cut Medicaid funding by more than a quarter by 2024.
Price is also hostile to Obamacare. While Trump has in recent weeks indicated that he is in favor of maintaining provisions that ban insurance company discrimination against people with pre-existing conditions, Price’s proposal to replace the health care law would remove that ban. His plan would also replace the subsidies many Americans are now using to purchase health insurance with meager tax credits on a sliding scale based on age — with a maximum $3,000 credit for those 50 years old and older.
Dr. Zeke Emanuel, a health policy analyst who helped design the ACA, told MSNBC Tuesday afternoon that the details in Price’s replacement plan are thin, but that “the details we do have … suggest that many millions of Americans are likely to lose their coverage.”
The Georgia congressman also opposes Trump on a key campaign promise to decrease drug prices: Trump has supported allowing Medicare to negotiate for lower drug prices; Price opposes this reform, calling it a “solution in search of a problem.”
Top photo: Price at Trump Tower in New York City on Nov. 16.