Health and Human Secretary Tom Price, on Wednesday night, spent an uncomfortable hour in a CNN-hosted town hall Wednesday night, answering questions from stony-faced cancer patients, medical professionals and others demanding an explanation of how Americans -- particularly poor and low-income Americans -- will be able to afford health care coverage under the Republicans’ proposed replacement for the Affordable Care Act.
His appearance was largely overwhelmed by the furor over massive budget cuts proposed by the Trump administration and a federal court ruling that struck down the president’s second attempt to institute a ban on people from six majority-Muslim countries entering the United States. And that’s a shame because the difficulty he had offering clear answers to the concerns his questioners raised suggests future struggles as the GOP tries to sell the bill to the American people.
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Price, a physician himself who Represented Georgia in Congress before accepting a spot in the Trump cabinet, sat down with hosts Wolf Blitzer and Dana Bash just days after the Congressional Budget Office released its estimate predicting that 24 million fewer Americans would have health insurance coverage by 2026 if the AHCA becomes law.
Bash brought up the agency’s finding and asked how the GOP could claim that its proposal increases access to health coverage in the face of a number like that.
“This is very interesting and it's an important question,” Price acknowledged, before going on to largely avoid answering it. The HHS secretary fell back, as other supporters of the bill have done in recent days, on claiming that additional regulatory changes and further legislation removing restrictions on the health insurance markets will generate so much choice and competition that the markets will drive costs down to make insurance affordable for everyone.
However, he didn’t specify a single regulation that he would do away with, and the only legislative priorities he identified were removing barriers to the sale of insurance across state lines and reform of the medical malpractice laws, neither of which, according to experts, would have a large impact on the price of coverage.
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Price then faced a question from Brian Kline, a Pennsylvania man in recovery from colon cancer, whose care was paid for by the Medicaid expansion that the Affordable Care Act created.
“Medicaid expansion saved my life and saved me from medical bankruptcy,” Kline said. “Now, I earn $11.66 an hour at my retail job. And obviously, I cannot afford to pay for my cancer care out of pocket. My life really depends on having access to my doctors and medical care.
“Getting a cancer diagnosis is bad enough. But Medicaid expansion gives me the economic security in knowing that funding is always going to be there for my cancer care. So my question for you, Secretary Price, is pretty straightforward. Why do you want to take -- why do you want to take away my Medicaid expansion?”
“The fact of the matter is that we don't,” Price replied. “We don't want to take care away from anybody. What we want to make certain, though, is that every single American has access to the kind of coverage and care that they want for themselves.”
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Kline indicated that he was unsatisfied by Price’s answer, but the discussion eventually moved on.
A West Virginia physician, after pointing out that the AHCA would throw one in five of his low-income patients off the Medicaid rolls, asked, “Do you think the members of Congress really understand the hardship that patients will have, particularly those on the edge if they lose their health insurance? And how can we help those patients who don't have health insurance?”
“Yeah, we're not interested in having anybody lose health insurance,” Price said. But instead of addressing the people who would lose insurance under the GOP plan, he pointed out that there are 20 million Americans who chose to pay a penalty rather than comply with the ACA’s individual mandate.
Bash then pointed out that the AHCA would massively cut Medicaid spending, lopping about 25 percent. How, she asked, can he promise “that these people can continue to get the care that they got under Obamacare?”
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“The premise of that question is that the way that you measure the success of Medicaid is by how much money goes into it,” he said. “We believe the way that you measure the success of a program is whether or not it takes care of the individuals, the beneficiaries that are actually needing that program.”
He continued, “The fact of the matter is that we believe there's a better way to provide the kind of care and services for Medicaid patients” and said that is “the states, not Washington, D.C.” are allowed to design the programs, the levels of care will be improved despite the hundreds of billions of dollars in funding the system would lose over the next ten years if the AHCA were approved.
Price faced a question from a former US Marine, now in recovery from opioid addiction, who worried that the AHCA eliminated the requirement that Medicaid provides care to addicts.
Price insisted that care would still be available, though not necessarily through Medicaid, and returned to the idea that returning authority for designing treatment to the states will work wonders on the system.
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“Many of them have been hamstrung by the federal government, not being able to do what they believe is most helpful for their vulnerable population,” he said. “So there are wonderful ways I believe in addressing this in a positive way if we keep our focus on the patient -- not on government, but on the patient.”
One of the more dramatic moments of the night came when Price was confronted Karen Santana, of Brooklyn, who was diagnosed with breast cancer at age 30.
Pointing out that the Republican plan would eliminate the individual mandate, allowing young and healthy people not to purchase health insurance if they are willing to risk a temporary 30 percent surcharge if they get sick and decide they need coverage.
“If the mandate is removed, how will insurance companies be able to afford to pay for people with pre-existing conditions, just like me?”
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Price answered with a litany of complaints about the Affordable Care Act and repetition of the promise that prices will come down so dramatically under AHCA that even a cancer survivor would be able to afford good coverage with the relatively small tax subsidies available under the plan.
Blitzer pushed back, pointing out the reason insurance works is that people who buy it and don’t wind up needing coverage subsidize those who do.
“So I think what you just said is that you want to force young individuals to purchase coverage so that they can participate in a government program.”
Price was falling back on the “freedom” argument that House Speaker Paul Ryan has used to defend the AHCA, insisting again that unspecified future changes to the system would create so many great plans that young and healthy consumers will happily purchase coverage.
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But Santana pushed back, saying that most young people really don’t feel that they need coverage. “I want to say that when I was diagnosed, I was 30 years old, and, you know, in the prime of my life, and I had a 9-month-old son. You know, I never thought -- I was very young. I never thought I was going to be diagnosed with this, especially at such a young age. And I know people that are in their 20s and are diagnosed with very severe diseases.”
“And we want them all to have health coverage,” Price insisted. “Every single one of them.”
How that’s going to happen, though, was still a mystery at the end of the night.
