Tom Price took the helm of the Department of Health and Human Services on Friday, capping a lengthy confirmation process that ended in the wee hours of the morning.

Now, as the health and human services chief, Price can begin fulfilling a yearslong goal of unwinding Obamacare. But instead of dismantling the health care law from the halls of Congress, he’ll be acting from inside the agency that oversaw its implementation.

The Senate confirmed Price 52-47, and the former House Budget Committee chairman is taking over the Department of Health and Human Services as the White House and Congress prepare to follow through on their campaign promises to repeal Obamacare.

An orthopedic surgeon who served more than a decade in the House, Price has spent the last seven years in Congress opposing the Affordable Care Act. The new HHS secretary introduced his own health care plan in 2009—he’s reintroduced that same proposal, the Empowering Patients First Act, in every Congress since then.

The Georgia Republican will take the helm of the agency at a crucial time. GOP lawmakers are debating how to dismantle the law, with a vote to repeal the Affordable Care Act expected to take place by March or April.

Unwinding Obamacare

But even as congressional Republicans finalize their course for unwinding the law, Price can now use his executive power to begin chipping away at Obamacare’s framework.

The Affordable Care Act gave the federal government the power to write and implement many of the law’s regulations through the federal rule-making process—like the exemptions from the individual mandate that are available to consumers who encounter hardships and the mandate that requires insurance plans to cover contraception and abortifacients.

And already, President Donald Trump is using that authority to make changes to the law.

“You live by the administrative state, you die by the administrative state,” Ed Haislmaier, a senior fellow at The Heritage Foundation who worked on health policy for Trump’s transition team, told The Daily Signal.

During a confirmation hearing in January, Price told a Senate committee he believed insurers needed some assistance from the Trump administration before 2018.

“What they need to hear from all of us, I believe, is a level of support and stability in the market,” the Georgia Republican said.

And as the new health and human services secretary, Price can begin providing them with that relief by tightening the monitoring of consumers purchasing coverage on Obamacare’s exchanges—changes insurers asked the Obama administration to make long before Trump took office.

That includes making changes to special enrollment periods, or the time outside the standard enrollment window a person can purchase health insurance, and verifying the eligibility of consumers purchasing coverage during open enrollment and special enrollment periods.

The Obama administration created several special enrollment periods, which a consumer can qualify for if they lose their health insurance, get married, or move to a new state.

But insurance companies warned last year that Americans were taking advantage of the special enrollment periods and purchasing coverage only when it was needed.

That led to an increase in costs for plans and higher costs for consumers, insurers said.

“The Trump administration you would expect to go in and say, ‘We’re going to prioritize minimizing costs and disruption, and we’re not going to let people enroll at the drop of a hat,’” Haislmaier said.

The new health and human services secretary can also eliminate federal regulations that already exist at the state level, such as oversight over proposed rate increases and network adequacy.

Under the current system, insurance companies looking to raise their rates must receive approval from state regulators and the federal government, which review the plans insurers want to sell for the upcoming benefit year.

“If you’re approaching it from the Obamacare mindset, then you make insurers go through all of that at the federal level after they’ve done it at the state level,” Haislmaier said. “If you come in at the Trump administration, they’re saying, ‘We’re not interested in nationalizing insurance. If it’s OK with the state, it’s OK with us.’”

According to draft documents obtained by Politico, the Trump administration is also weighing whether to make changes to a provision of Obamacare that dictates how much more insurers can charge older Americans than younger Americans.

The provision prohibits insurance companies from charging their older customers more than three times what they charge younger customers. According to the documents, the Trump administration proposes changing the ratio to 3.49-to-1.

Health policy experts, though, worry that such a change may not be legal, since the Affordable Care Act specifically set the ratio for insurance companies. Changing the ratio from 3 to 3.49 would require action from Congress.

Still, Trump administration officials believe that since 3.49 “rounds down” to 3, the changes can be made without a change in statute, according to The Huffington Post.

Eliminating Mandates

In addition to enhancing the monitoring of consumers who sign up for coverage, Price can take aim at one of Obamacare’s most controversial provisions: the contraception mandate, which requires plans to cover contraceptives and abortifacients without cost-sharing.

Price, an opponent of abortion, has criticized the contraception mandate in the past for infringing on religious liberty.

As the leader of the Department of Health and Human Services, the Georgia Republican could have his agency rewrite the regulations tied to the mandate or choose not to enforce it.

Price could also revise the list of services insurers are required to cover—called the essential health benefits requirement—to amend or exclude preventive health.

The White House set the stage for the new Health and Human Services secretary to begin making changes to Obamacare just hours after the president took the oath of office.

On Inauguration Day, Trump signed an executive order to “ease the burden of Obamacare as we transition to repeal and replace.”

The order was light on specifics, but health policy experts said it gave the executive branch the authority to begin addressing the thousands of regulations tied to Obamacare.

And some wondered if the individual mandate was on the chopping block.

Price could decide not to enforce the individual mandate, the part of Obamacare that requires consumers purchase insurance or face a fine, or extend hardship exemptions to all enrollees.

But Haislmaier said that for Price, the decision regarding enforcement of the mandate would need to involve the White House, since such a move would require coordination between multiple agencies.

For the executive branch, deciding whether to enforce the individual mandate also is a game of timing.

Republicans are considering passing a repeal bill that gets rid of the individual mandate, among other major provisions of Obamacare.

Turning to Congress

Haislmaier questioned whether it would be necessary for the Trump administration to take action on a part of the law Congress may get rid of on its own.

“If the mandate is going to be repealed in repeal legislation, is it worth the bother of the administration doing it?” Haislmaier asked.

Like with the executive order on Obamacare, the White House began the process for making changes to the health care law through the rule-making procedure before the Senate confirmed Price.

Last week, the Trump administration submitted a proposed rule to the Office of Management and Budget. The details haven’t yet been released to the public, but the rule aims to stabilize the Obamacare markets, likely through the changes reference above.

Once the details are released, it’s Price who will oversee the efforts to provide relief for insurers. (For more from the author of “How Trump’s Executive Orders Line up With Past Presidents” please click HERE)

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President Donald Trump will use his business skills to negotiate lower prices and foster more competition in the health care market—but he doesn’t want to rush things, White House press secretary Sean Spicer said Tuesday.

Spicer declined to give a specific timeline for seeing Congress repeal and replace the law, saying that Democrats rushed the passing of Obamacare and Republicans should not rush the replacement.

“I think we can have this done legislatively sooner rather than later. But I think the implementation is going to be a little bit longer. It was a big, big bill that the Democrats had,” Spicer told reporters during a press briefing Tuesday. “As you recall, they told us they could read it after they passed it. We are now going through this to make sure we can do this in a very responsible way.”

The Daily Signal asked if the president agreed with House Speaker Paul Ryan, R-Wis., that the Obamacare law cannot be tinkered with or repaired but must be scrapped for something fundamentally different.

“What we’re focused on is the end solution,” Spicer told The Daily Signal. “We’ve been very clear over and over again that the president is going to repeal and replace [Obamacare], and that what Americans will get at the end of this is a health care solution, as I’ve said before over and over again, is going to give them a lower cost solution with more options.”

Spicer said that Trump’s vision is what was “promised in the first place,” but not delivered by Obamacare.

“The president being able to approach this in the businesslike manner that he’s done so successfully in the past is going to ensure that he negotiates prices and that we look at those businesslike practices, force competition among and other things that will help lower costs,” Spicer continued.

Ryan has previously said Congress can repeal and replace Obamacare in March or April. However, during an interview on Fox News with Bill O’Reilly aired before the Super Bowl, Trump said, “I would like to say, by the end of the year, at least the rudiments, but we should have something within the year and the following year.”

And Ryan on Tuesday talked about repealing the law this year.

Other reporters Tuesday pressed Spicer on the timeline for Congress repealing and replacing the law.

Spicer said the president and Republican congressional leaders are on the same page. But he stressed it would be a mistake to rush a repeal bill, as Democrats did in passing the Affordable Care Act in 2010.

“It’s a mammoth bill what they passed,” Spicer said. “We’ve got to make sure we do this right. We don’t want to end up with the same results the Democrats did. They rushed it through, no one was able to read the bill, premiums have skyrocketed, access and options have gone down. We need to make sure we understand we don’t do this in a way that ends up with the same result.” (For more from the author of “White House Says Trump Won’t Rush Obamacare Replacement” please click HERE)

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A new report shows that Obamacare enrollees could pay more money and end up with fewer options in 2017.

The study from Avalere Health, a health care consulting firm, showed rising premiums, deductibles, and out-of-pocket costs for many customers, a shrinking amount of insurance options in the exchange market, and a drastically lower number of Obamacare enrollees than projected.

Premiums for the silver-level plan, Obamacare’s most popular option, increased by an average of 12 percent in 2017. Specifically, the Avalere report showed that 71 percent of Obamacare enrollees covered under the silver plan have seen their average costs rise from $496 per month last year to $554 per month this year. The average cost for the first and second cheapest silver-level plans have also gone up by 25 percent.

Even for Obamacare’s bronze-level plan—the cheapest, lowest quality option—the monthly, average premiums rose from $408 in 2016 to $475 this year.

“Part of the reason why these premiums are rising is because there are fewer people enrolled than I expected, and the people who are enrolled are sicker than expected,” said Chris Sloan, a senior manager at Avalere, in a phone interview with The Daily Signal.

However, according to Sloan, with government subsidies and tax credits, lower-income earners enrolled in Obamacare may not be affected by the rising costs of these cheaper plans.

“While many consumers will experience significant premium increases this year, most will receive subsidies to help offset the costs of the increases and make premiums more affordable,” Sloan said in a statement.

Obamacare premiums are going up, but due to government financial assistance, real costs for many enrollees are remaining relatively the same. These costs will fall on taxpayers, according to a health care expert.

“If subsidies are going up through premium tax credits and cautionary reduction subsidies, the federal taxpayer ends up paying for that increase, so the burden of that is on all us federal taxpayers,” said Alyene Senger, a health care policy analyst at The Heritage Foundation.

Senger added, “When supporters of the [Affordable Care Act] say, ‘Well, these figures don’t really matter, because we’re subsidizing [Obamacare enrollees] so they aren’t feeling the brunt of their premium increases because the federal taxpayer is picking up the tab,’ that doesn’t apply to all the people who are purchasing in the individual market that get no subsidy.”

However, even with many Obamacare enrollees being assisted by subsidies or tax credits, they may still find themselves paying more out of pocket for their health care, as deductibles for services and drugs jumped by about 20 percent for silver-level plans in 2017. The number of silver-level plans charging coinsurance—an out-of-pocket payment charged after a consumer’s deductible is paid—for specialty drugs went up by 10 percent.

Issuer participation is also a problem highlighted by the Avalere report, as approximately 1 in 3 regions in America now only have one health insurance issuer. In 2016, just 4 percent of the country was limited to one issuer in their region. After several national and regional insurers exited the exchange markets, 36 percent of the country is now stuck with one issuer in their region.

“What this means is that people who have purchased insurance for 2017 have a lot less choice, so if there’s only one issuer offering health plans in your area and their network doesn’t include your doctor, then that’s it, you don’t really have another option,” Sloan told The Daily Signal.

“People in this market just won’t have as much choice as they had in 2016, or 2015, or 2014,” Sloan said.

This Avalere report, titled “2017 Health Insurance Exchange Snapshot,” was published on Jan 18. (For more from the author of “New Obamacare Report Shows Rising Costs and Fewer Options for 2017” please click HERE)

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Several Republican congressmen from the House Freedom Caucus say they want a full repeal and replacement of Obamacare, despite private talk from some GOP lawmakers about a partial repeal.

Reps. Mario Diaz-Balart, R-Fla.; Mark Meadows, R-N.C.; Raul Labrador, R-Idaho; Scott Perry, R-Pa.; Mark Sanford, R-S.C.; and Jim Jordan, R-Ohio; were all present at the January meeting of Conversations with Conservatives, a monthly press Q&A hosted by conservative lawmakers and The Heritage Foundation.

When Jordan was asked how he felt about the progress Republican lawmakers had made on Obamacare, he said, “I’d like to see an acceleration of the front-end repeal side … let’s get rid of [Obamacare], that’s what we told the voters that we were going to do. Let’s repeal it as quickly as we can and let’s have the effective day be not three and four years down the road.”

The congressman from Ohio added, “health care will be better and cost less when Obamacare is gone.”

“Let’s get after it as soon as we can and repeal everything: every tax, every mandate, and most importantly, every single regulation because I believe that’s [what will be] driving down premiums and deductible costs,” concluded Jordan on the issue of an Obamacare repeal.

Perry went on to stress the importance of having an alternative health care plan at or soon after the time of repeal, saying, “I do think that the repeal and the alternative needs to happen at the same [time], or …. with[in] a week or two or something like that.”

Labrador, Perry, Sanford, and Jordan all agreed that Obamacare must be repealed, with Sanford saying, “Just in terms of the political realm, I think as a vote for conservatives, it would be very difficult for any of us, at the end of the day, to not vote yes on repeal, whether it’s concurrent or not with regard to replace.”

Talking about a replacement for Obamacare, Labrador said, “I want to make sure that we’re gonna move to a free-market plan. And I’m encouraging our leadership to take a bold position on this and move as far away from Obamacare and government-centered health care as possible.”

Jordan agreed, saying, “Ideally, we’d like a plan that’s free market-oriented, patient-oriented, doctor-oriented, community-oriented; not [as] Washington-focused as Obamacare.” (For more from the author of “Former House Freedom Caucus Chairman on Obamacare: ‘Let’s Repeal It as Quickly as We Can'” please click HERE)

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Some Republican lawmakers are beginning to have doubts about the GOP’s plans to repeal and replace Obamacare, they revealed in a closed-door gathering Thursday in Philadelphia.

But those lawmakers find themselves at odds with conservatives who have for years pushed for repeal of the Affordable Care Act—as well as the top Republican in the House.

“We have to repeal it,” Rep. Jim Jordan, R-Ohio, said of Obamacare in an interview with The Daily Signal. “That’s what we told voters we’re going to do, and we have to repeal all of it. Every mandate. Every regulation.”

The Washington Post reported Friday that some Republicans appeared to be wavering over how to follow through on their long-held promise to repeal and replace Obamacare.

The Post obtained a recording of a session on health care held Thursday at House and Senate Republicans’ joint retreat at the Loews Philadelphia Hotel.

Some lawmakers in the meeting expressed concerns over tackling major issues accompanying repeal of the health care law, including how to craft a replacement plan in a timely manner and whether to include a measure to defund Planned Parenthood in the repeal legislation.

Reps. Tom McClintock of California, John Faso of New York, and Tom MacArthur of New Jersey were among those The Post identified on the recording.

Despite their hesitations, however, House Speaker Paul Ryan reaffirmed the GOP’s commitment to rolling back the health care law this year.

“We have to move quickly because we’re in the midst of collapse [of the health care law],” Ryan said during an event Friday organized by Politico.

“We have a moral obligation to fix this problem. Period,” he said.

#Obamacare has been a spectacular failure. We're going to replace it with a more affordable, patient-centered system. pic.twitter.com/HBiMeAucBj

— Paul Ryan (@SpeakerRyan) January 27, 2017

In a meeting with fellow Republicans in Philadelphia, Ryan mapped out a timeline for repealing and replacing the health care law. He told lawmakers that Congress would pass the bill repealing Obamacare by March or April.

Republicans initially planned to pass a repeal bill shortly after President Donald Trump’s Jan. 20 inauguration.

That legislation—passed through a budget tool called reconciliation—also would include parts of a replacement.

For years, conservatives such as Jordan, who previously chaired the roughly 40-member House Freedom Caucus, have made a target of Obamacare—which Congress passed in 2010 without a single Republican vote.

Now that Republicans have the numbers to successfully repeal the health care law, Jordan is calling for Congress to move quickly.

“I want to do it as soon as we possibly can, because I start from the very fundamental premise that health care will be better and cost less when Obamacare is gone,” the Ohio Republican said. “So let’s get rid of it as quickly as we can.”

Despite a commitment to repealing Obamacare in coming weeks, some Republicans are skeptical that ending taxpayer funding of Planned Parenthood, the nation’s largest abortion provider, should be included in that action.

That provision was part of the bill Republicans sent to President Barack Obama’s desk early last year to roll back major provisions of Obamacare.

Obama vetoed that bill. But with Republican control of both chambers of Congress and the White House, conservatives are pushing for the new repeal bill to at a minimum mirror the legislation passed last year.

#Obamacare is collapsing. We've got to step in and provide relief to Americans suffering under this law. pic.twitter.com/pLoBvawuTc

— Paul Ryan (@SpeakerRyan) January 27, 2017

Ryan said earlier this month that the House will include Planned Parenthood’s defunding in the budget reconciliation bill the chamber takes up this year.

And conservative lawmakers are urging the House speaker to follow through on that pledge.

“The repeal should include the Planned Parenthood defund language as well because, for goodness sake, that was in the bill we put on President Obama’s desk,” Jordan told The Daily Signal. “Are we going to put something less on President Trump’s desk than what we put on President Obama’s desk?”

“Of course the Planned Parenthood funding should be dealt with in that bill,” he said. (For more from the author of “Republicans Express Doubts over Obamacare ‘Repeal and Replace’ Plan” please click HERE)

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