President-elect Donald Trump's selection of Tom Price to head the U.S. Department of Health and Human Services, and Seema Verma to helm the Centers for Medicare and Medicaid services, has caused some buzz among news outlets, bloggers and opinion writers. Most interpret the picks as a move by the incoming administration to target the Affordable Care Act, and potentially replace it with its own alternative.
Price, an orthopedic surgeon and Republican Representative from Georgia, has long been a critic of the ACA, even penning his own alternative to the law in 2009 entitled the Empowering Patients First Act. Verma is the CEO of SVC Inc., a healthcare consulting firm, and an ally of Vice President-elect Mike Pence. Verma worked with Kentucky Gov. Matt Bevin to design his alternative to Medicaid expansion, a provision of which is that beneficiaries must hold a job to be eligible.
That's got the internet chattering.
Contributor Bruce Japsen, writing for Forbes, argued that Price's selection could slow the industry-wide shift from volume to value. Price has been a critic of that shift, bemoaning certain features such as mandatory moves to put hospitals and doctors at risk for Medicare spending for hip and knee replacements.
Price has also been a vocal opponent of MACRA, which ties doctor Medicare payments to quality and outcomes. When the final rule was released last month, Price said he was "deeply concerned about how this rule could affect the patient-doctor relationship."
Louise Radnofsky and Peter Nicholas' piece in the Wall Street Journal reiterated Price's hardline conservative views, but suggested that he may be more open to compromise than people think -- assuming that the people with whom he's compromising are fellow Republicans. Working alongside three other House Republicans this year, Price had already given his approval to a unified proposal called "A Better Way."
"I wouldn't draw any lines in the sand other than that the path that we're on doesn't work," said Price in June.
WSJ also touted Verma's conservative credentials, noting that she helped Indiana win major conservative concessions in exchange for agreeing to Medicaid expansion, and has helped other so-called "red" states seek similar arrangements with Washington.
WSJ's Greg Sargent, in his opinion piece, said that Price's plan to roll back Medicare would harm the very poor, working class voters who came out for Trump in droves at the polls.
The Indy Star, meanwhile, painted a portrait of Verma as a quiet but influential consultant. She's made millions helping Indiana shape its public healthcare policy, the Healthy Indiana Plan, a consumer-driven insurance program for low-income residents touted by Republicans as a model for a potential national alternative.
But The Star raises the spectre of a possible conflict of interest. At the same time she was helping to craft the Indiana plan, she worked for a large Medicaid vendor in the state, division of Hewlett-Packard, which paid Verma more than $1 million and has landed in excess of $500 million in state contracts during her tenure.
Verma has publically stated that she has played no role in HP's contracts with the state.
Steve Benen, writing for MSNBC, called the Price appointment "scary." He pointed to Price's far-right conservatism, saying that while most House Republicans have endorsed the ACA provision requiring insurers to accept all applicants, regardless of pre-existing conditions, Price has stated that it's a "terrible idea."
Benen also criticized the Empowering Patients First Act, which would have fully rescinded Medicaid expansion and allow insurers to resume practices now forbidden under the ACA, such as selling bare-bones plans and denying coverage to those with pre-existing conditions.
Also cause for worry, according to Benen, is the possibility that Republicans may now move forward with a proposal to privatize Medicare.
Vox's Sarah Kliff contended that Price's nomination means Trump is serious about dismantling the ACA. Despite the criticism it has garnered, Price's plan is the only conservative plan with fully fleshed-out details; all of the other proposals are mere white papers.
Among Kliff's concerns are that while Price's plan would make insurance better for younger, healthier people, it would make it worse for those who are old and sick.