Signaling that he is serious about rolling back the ACA, President-elect Donald Trump has chosen Rep. Tom Price (R-Ga.), one of Capitol Hill's fiercest critics of President Obama's health care law, to be Secretary of Health and Human Services. Price, an orthopedic surgeon and Chair of the House Budget Committee, is the author of one of the Republican ACA replacement plans, Empowering Patients First, which you can read about here.
Employers should be aware that Price calls for capping the tax exclusion. According to the article, “Price’s bill proposes limiting the employer-tax exclusion for insurance to $8,000 for individual policies and $20,000 for families... As popular as this provision will be with economists, you can bet that the public will hate it, as it would make some health plans significantly more expensive -- and face similar pushback to Obamacare’s Cadillac tax.”
It’s not a slam-dunk that his plan will be the replacement plan, but it does provide insights to what his preferences are. (Other Republican replacement plans that include a tax exclusion cap set a higher threshold -- $12,000 for individuals and $30,000 for families). As with the ACA’s excise tax, a cap on the tax exclusion would be a major focus of lobbying efforts for employers and advocacy groups like ABC, ERIC, and Fight the 40.
While Price’s replacement plan calls for eliminating Medicaid expansion, Trump selected Indiana health policy consultant Seema Verma to run the Centers for Medicare and Medicaid Services. Veerma has worked on redesigning Medicaid programs in states that have chosen to expand the program. She also spearheaded Indiana's healthcare reform efforts after the ACA passed to help health agencies prep for its implementation. So there could be some push and pull there.
There are significant differences between Price’s plan and those of other Hill Republicans. As HHS Secretary, Price won’t have the authority to replace the ACA himself. But he’ll be a key player in negotiations with Congress over which parts of which replacement plans they will choose, and he’ll control the replacement’s implementation. With this appointment, it seems the question now isn’t whether Republicans will move to repeal and replace the ACA -- it’s how quickly will they be able to coalesce around one option.