The coming reported battle over Medicare

President-elect Donald Trump's move to tap Georgia Rep. Tom Price to lead the Department of Health and Human Services signals that his administration could be moving far to the right on programs such as Medicare and Medicaid.

The president-elect won praise from conservatives for his pick of Price to serve as health and human services secretary.

The staunchly conservative lawmaker will be leading an agency with a $1 trillion budget and overseeing Medicare and Medicaid programs which affect more than 100 million Americans.

A six-term congressman and orthopedic surgeon, Price has been a vehement critic of President Barack Obama's Affordable Care Act. If confirmed by the Senate, he'll be a leading figure in Republican efforts to repeal the health care law.

Incoming Senate Democratic leader Chuck Schumer said Price "has proven to be far out of the mainstream of what Americans want" for programs that help seniors, women, families and those with disabilities. His nomination, Schumer said, is "akin to asking the fox to guard the hen house."

Schumer appears to be right.

Like many Republicans, Price is an advocate for repealing and replacing the Affordable Care Act. But he is also a leading proponent of overhauling entitlement programs such as Medicare.

The Washington Post reports that Price is "One of the 18 members of the House GOP Doctors Caucus." Price supports major changes to Medicaid and Medicare, health insurance pillars of the Great Society programs of the 1960s. Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies. Instead, like many Republicans, he wants to covert Medicaid into block grants to states - which would give them more latitude from federal requirements about eligibility rules and the medical services that must be covered for low-income Americans. This plan would also require "able-bodied" applicants to meet work requirements to receive health care benefits - an idea that the Obama administration has consistently rebuffed."

The Republican proposals are likely to lead deep cuts for those who use the program. The nonpartisan Congressional Budget Office has estimated that at least 14 million people would lose coverage if Congress revokes the Medicaid expansion that has occurred under the Affordable Care Act.

On Medicare, Price has proposed switching it from a "defined benefit" to a "defined contribution." This means the government-run health insurance plan for the elderly and disabled will shift from a guaranteed government program to a risky and skimpy voucher program.

"Beneficiaries would have to pay much more to stay in traditional fee-for-service Medicare," John K. Gorman, a former Medicare official who is now an insurance consultant, said to the New York Times. "Regular Medicare would become the province of affluent beneficiaries who can buy their way out of" private plans.

During his election campaign, Trump promised to protect Medicare. In fact he said substantial changes to the popular program would be a political death wish. But the president-elect's selection of Price would indicate that despite his populist message and promises, the incoming Trump administration would face internal and external pressure to change Medicare.

House Speaker Paul Ryan (Wis.) and other Republican leaders in congress have long championed changes in entitlement programs including deep cuts and a move toward privatization.

With Price in his cabinet and with Republicans controlling the House and the Senate, Trump could be pushed toward changing Medicare even if that is not his political inclination.

Democrats and moderate Republicans must oppose and defeat these proposals similar to what was done when President George W. Bush proposed efforts to drastically change Social Security after his re-election in 2004.

(Reprinted from the Philadelphia Tribune)