On his website in an article entitled, “Healthcare Reform to Make America Great Again,” President Donald Trump stated, “On day one of the Trump administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” In fact, both houses of Congress had voted for a repeal before the inauguration had taken place. In the Senate, the vote was 51 to 48. The House of Representatives followed suit and voted 227-198 to instruct committees to draft legislation that would repeal the 2010 Affordable Care Act (ACA).

With these actions and the nomination of orthopedist and Representative Tom Price (R, Georgia), an ardent opponent of the ACA, as the proposed Secretary of Health and Human Services, it is likely that the administration is on a path to dismantle President Obama’s signature healthcare plan—one that covers 20 million Americans. The healthcare community is deeply divided on the future of the ACA and what reforms will mean to patients. While no formal replacement plan has been proposed, an examination of Price’s legislative record, as well as some of the proposals that he and others have put forth, may provide a glimpse into the future.

Under the current plan, individuals cannot be denied coverage or charged higher premiums due to preexisting conditions. Insurance companies are required to provide free preventive care and extend coverage for young adults on their parents’ plans through age 26. Medicaid has been expanded via federal matching funds for states that extend coverage for low-income, uninsured individuals. Tax credits are provided to small businesses and individuals to help finance their health insurance plans. Some of the more contested aspects of the ACA include women’s health care (including abortion and contraception), and the requirement that nearly all have health insurance or pay a fine. There has been opposition to what some perceive as an excessively complex system with too many regulations.

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At his confirmation hearings, Price faced tough questioning and strong opposition by several members of the committee. If confirmed by the Senate, he would oversee Medicare, Medicaid, the NIH, FDA, and CDC. His alternative to the ACA, called the “Empowering Patient First Act,” states that there should not be “a government takeover of health care.” Price vowed in his hearing that he would not “pull the rug out” from under those covered by the ACA. He favors returning control to individual states, such as providing them with block grants for Medicaid funding and creating state-run “high risk pools.” Under his plan, people would not be compelled to purchase health insurance. His plan would provide tax credits (based on age, not income) and allow individuals to opt out of Medicare, Medicaid, and veterans’ coverage to purchase private insurance, which, in theory, provides greater choice. Unlike some other proposed Republican alternatives, Price’s plan would not guarantee coverage for preexisting conditions unless the patient has maintained continuous coverage in the past.

Price would expand health savings accounts and permit the sale of insurance across state lines, as well as make pharmaceuticals available from outside the United States at a lower cost. It is likely that Price’s vision of health coverage would not continue to support women’s health services, as his plan does not guarantee prenatal care and he is opposed to abortion and funding for contraception. He supports allowing physicians to charge fee-for-service and balance-bill patients for services not fully covered by their insurance, rather than the value-based model of the ACA. Price believes that this will assist physicians who are not being adequately compensated for their services by Medicare. He has voted against tighter regulations on tobacco, enhanced coverage of mental health and addiction issues, and expansion of the Children’s Health Insurance Program.

Although the American Medical Association has “strongly” supported Price, “for his service as a physician, state legislator, and member of the US Congress” and has called him a “leader in … policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens,” this organization only represents approximately 25% of all physicians, and his nomination has spurred strong reaction among many clinicians. An online open letter entitled, “The AMA Does Not Speak for Us” that gathered more than 5,500 signatures stated, “Dr. Price’s proposed policies threaten to harm our most vulnerable patients and limit their access to health care.” The American Academy of Family Physicians has endorsed Price, while members of the American Congress of Obstetricians and Gynecologists are concerned about his lack of support for abortion and Planned Parenthood.

National Nurses United, representing 185,000 members, stated, “If confirmed, it is clear that Rep. Price will pursue policies that substantially erode our nation’s health and security … throwing our most sick and vulnerable fellow Americans at the mercy of the healthcare industry.” They fear that replacing the ACA would “endanger the health of tens of millions of Americans and serve to weaken if not demolish the nation’s healthcare safety net.” In the past, organizations that Price aligns himself with have supported restricting the role of nurse practitioners.