When Donald Trump chose conservative Georgia Congressman and former orthopedic surgeon Tom Price as his nominee for Secretary of Health and Human Services, he showed the world he is completely serious about repealing the Affordable Care Act. Throughout his campaign, he promised over and over to replace Obamacare with "something better." Commentators (Inc. included) questioned whether it would be easy--or even possible--to repeal a law that survived a Supreme Court challenge and dismantle a program that provides health insurance to 22 million Americans. Well, if it can be done, Tom Price is the man to do it.

Since Trump and many of his advisors have never held elected office, it can be often be challenging to guess exactly what President Trump's policies will be once he takes office. Not so with health care. Every year since Obamacare was born, Price has introduced his own counter-proposal called the Empowering Patients First Act. Unless Democrats in the Senate block either Price's confirmation or Obamacare's repeal with a filibuster (which, of course, they could), odds are ACA will be repealed. Then Secretary Price will get the chance to put some of his proposals into law.

Here's what that might look like:

1. Exchanges will go away.

The state-based exchanges, marketplaces where Americans can shop for insurance under the ACA have proved fairly unpopular. Price will likely dismantle them.

2. Age-based incentives will replace penalties and subsidies.

One problem with Obamacare that even those on the left acknowledge is that too few young healthy people have signed up for health insurance they're likely not to need. It's easy to see why: When my husband and I moved two years ago we had one uninsured month and were penalized $60 as a result. With average subsidies, the cheapest available insurance plan would have cost us $500 to $600.

Price would likely replace the subsidies and penalties system with age-based tax credits that will make insurance much more affordable for younger people, especially those with decent incomes. Prices will rise for the poor and for older Americans, however.

3. Insurers will be allowed to sell insurance across state lines.

This is almost guaranteed to happen, as Trump made this campaign promise frequently while running for president. The idea is that allowing consumers to buy insurance from states without laws that, say, require insurance to cover chiropractic would increase competition and give consumers a wider range of affordable options. But some observers question how many insurers would actually take advantage of this opportunity, given all the complexities of negotiating contracts with providers in a new market. Stay tuned.

4. The employer mandate will vanish.

Some small (but not that small) businesses have chafed at the requirement to offer an insurance benefit if they have 50 employees or more. With a pro-small-business, anti-regulation president, this rule is bound to disappear.

5. Employers may have to pay taxes on the health insurance they offer employees.

To discourage employers from offering employees (usually top execs) overly generous health plans, Obamacare includes a 40 percent "Cadillac tax" on high-cost employer plans. That provision was set to go into effect in three years. Price will likely junk it and replace it with his plan to disallow tax deductions for employee plans costing more than $8,000 per year for an individual or $20,000 per year for a family. It may seem odd that a conservative is proposing a tax increase. The explanation is that the tax credits in Price's plan will reduce tax revenues which the government will need to make up somehow.

6. Sick people who let their insurance lapse may be in real trouble.

One of Obamacare's most popular provisions is that it forbids insurance companies from denying coverage to people with existing medical conditions. Under Price that will only remain true for those who have maintained continuous coverage for at least 18 months. Otherwise, insurers will be entitled to deny coverage for those conditions for up to 18 months.

7. Mandated coverage for birth control may go away.

This is a provision that conservative and religious groups have been fighting against from the beginning and Price is likely to give them what they want.

8. So much for results-based health care.

One philosophy behind Obamacare is that insurers and patients should pay in relation to how healthy they get as opposed to paying for individual medical procedures. Anyone who's ever had a completely unnecessary just-to-be-sure medical procedure will appreciate why. But Price is a former doctor and grew up in a pay-for-procedure world. He's likely to go back to that format.

9. It will be much tougher to sue your doctor.

Speaking of Price's former profession, he is likely to introduce provisions that protect doctors from malpractice suits, including state-level malpractice tribunals and limits on the evidence patients can use in such cases. That led one law professor to quip that his bill: "Should probably be called 'Empowering Doctors First.'"

10. We aren't going back to 2009.

It's interesting to note that choosing Price means we likely aren't going back to a pre-Obamacare world. Republicans argued back then that the ACA was unneeded because Americans were perfectly happy with the plans they could get from their employers or buy as individuals from insurers.

No one seems to be arguing that anymore. Some of the changes Trump and Price will likely sadden Obamacare supporters. But the idea that we need to make health insurance more available to all seems to have taken root.

Published on: Nov 30, 2016
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