November 30, 2016; U.S. News & World Report

Donald Trump is in the midst of his presidential transition, naming the people he wants to be cabinet members and senior administration leaders. He has selected six-term Rep. Tom Price (R-GA) to become the next Secretary of Health and Human Services (HHS). In addition to his political credentials for the position, Price is a medical doctor who practiced as an orthopedic surgeon and taught orthopedic surgery at Emory University. He will enter the position primed to make major changes.

Price, 62, currently chairs the House Budget Committee and is known to be a strong critic of three key federal programs HHS administers: the Affordable Care Act (ACA), also known as Obamacare; Medicare; and Medicaid. While the ACA is still relatively new, Medicare and Medicaid were established in the mid-1960s. These three large and complex programs defy simple explanation, but, simply speaking, they are the core of federal and federal/state collaborative health care delivery. Similarly, assigning exact cost figures isn’t easy, but the three programs represent nearly $1 trillion in annual federal spending alone. Medicare covers about 57 million Americans and Medicaid covers roughly 77 million (figures include some “dual eligible” recipients receiving support from both programs).

An early and persistent critic of the ACA, he has been a consistent supporter of the “repeal and replace” sentiment expressed by President-elect Trump during the campaign and by Congressional leaders from the day the measure was passed in 2010. He has also supported GOP efforts to privatize Medicare and Medicaid, providing vouchers to allow Medicare recipients to purchase private insurance and giving greater flexibility to states in how (and to whom) Medicaid services are delivered and how Medicaid reimbursements are handled.

The stated rationale behind these moves is that a more free, market-based solution to healthcare payments would reduce bureaucracy, increase competition, and facilitate direct patient-provider communication about care decisions. Medicare and Medicaid payments to doctors and other providers are also, on average, significantly lower than private insurance payments for the same procedures and treatments, which critics assert is part of the “cost-shift” that increases uncompensated care costs and stresses hospital and clinic budgets.

Supporters of the current and emerging system, of course, have a different view. They believe that the federal government’s buying power, regulation, and lack of a profit motive keeps costs lower for both patients and taxpayers. The ACA’s design includes a move away from procedure-based reimbursement and towards a population health model that is believed to reduce costs by incentivizing providers to keep patients healthier and in less need of fewer expensive acute surgeries and chronic disease management programs. Moreover, supporters are concerned that privatizing healthcare programs and services will either cause the federal government’s costs to increase to cover the same number of people, or require cuts in services to maintain funding levels.

At the very least, nonprofits must be prepared for actions at the federal and state levels that will greatly complicate, change the terms of, or even eliminate funding streams on core safety net programs.

The next Senate Minority Leader, Sen. Chuck Schumer (D-NY), is a harsh critic of Price. “Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the henhouse,” Schumer said in a statement. He has not indicated that he will oppose Price’s confirmation by the Senate, but he has given early, vehement notice that he’ll fight any attempts to materially change any existing health programs or deny federal funds to Planned Parenthood, another move championed by many Republicans.

“The Republicans’ ideological and visceral hatred of government could deny millions of senior citizens across the country the care they need and deserve,” he said in a statement. “To our Republican colleagues considering this path, Democrats say: make our day. Your effort will fail, and this attack on our seniors will not stand.”

—Michael Wyland