With Donald Trump‘s victory, the possibility for sweeping right-wing policy changes, including a dismantling of the healthcare safety net, is real. Because Trump seems to have almost no interest or knowledge about policy, it’s a bit of a guessing game how all of this will play out — but the appointment of Tom Price as Secretary of Health and Human Services, reported late last night, is a strong signal. Medicaid expansion is in trouble. Funding for the traditional Medicaid program — which covers the elderly in nursing homes, low-income kids, the disabled, and other needy populations — is likely also on the chopping block. The privatization of Medicare, cutting benefits and pushing costs onto the elderly, will be on the table as well.

Price, a Georgia congressman, is a fierce opponent of Obamacare who authored a replacement bill. The first thing to know about Price’s bill is that it repeals Medicaid expansion altogether and replaces it with nothing, stripping health insurance from around 14 million Americans. That includes 300,000 low-income Arkansans currently on the private option. That coverage would be gone.


This is an important point: Republican backers of the private option (or its tweaked and re-named version, “Arkansas Works”) want to keep the coverage expansion but make more right-wing alterations, such as charging premiums to poor people, work requirements, etc. But Price’s bill (which is quite detailed) wouldn’t allow that. It would eliminate the funding and “Arkansas Works” would die.

Perhaps red-state leaders like Gov. Asa Hutchinson will push to keep the coverage expansion in place. One small sign in that direction: Trump’s appointment to head the Center for Medicare and Medicaid Services (CMS), Seema Verma, developed Republicanized changes in Indiana (which expanded Medicaid) of the kind Hutchinson likes. Verma would be a good administrator to implement a right-wing re-working of Medicaid that still kept the coverage expansion in place. But I wouldn’t bank on it. Price (and the House Speaker Paul Ryan) want to eliminate the Medicaid expansion altogether because it’s at the heart of their principled objection to Obamacare. If Congress passes a bill that does just that, and Trump signs it into law, millions of low-income Americans will lose their health insurance. The Price pick moves us a little further in that direction.


In addition to eliminating Medicaid expansion, Price’s plan would dismantle Obamacare’s protections for people with pre-existing conditions and make a variety of other changes to the individual health care market. The winners from these changes, like many Republican alternatives to Obamacare, are the healthy, wealthy, and the young; the losers are the sick, the poor, and the old.

Price also seeks to block grant the traditional Medicaid program, cutting federal funding by about $1 trillion over the next decade. In Arkansas, those cuts would hit 400,000 children in ARKids; home and community-based services for 11,000 elderly people and people with severe physical disabilities; medical care for the aged, disabled, and the blind, covering 142,000 people; medical services for 5,000 foster children; and many more of the state’s neediest patients.


Price, like Ryan, also backs a plan re-make Medicare into a voucher system that would offer less protection and impose more costs on beneficiaries. Price has said that Republicans plan to move on privatizing Medicare this year.

Trump said he would “repeal Obamacare” on the campaign trail and didn’t say much more than that. But here we are, and it’s looking more and more like Republicans aim to enact an overhaul of the health care system that will take health insurance away from millions of people, enact massive funding cuts to Medicaid, and end Medicare as we know it.