President-elect Donald Trump signaled his intent Tuesday to follow through on unraveling Obamacare, selecting an ardent foe of the law to be his health secretary and tapping a conservative policy guru from Indiana to oversee Medicare and Medicaid.
Conservatives cheered the picks of Rep. Tom Price to lead the Department of Health and Human Services, and of Seema Verma, president and CEO of a health consulting company, to serve as administrator of the Centers for Medicare and Medicaid Services, saying both nominees bring extensive expertise and a firm commitment to reform.
Mr. Trump also said he will nominate Elaine L. Chao, who ran the Labor Department under President George W. Bush, as his transportation secretary — a position that could be key to the president-elect’s plans for a massive infrastructure program that includes rebuilding roads and bridges throughout the country.
According to multiple reports, Mr. Trump also has chosen Steven Mnuchin to be Treasury secretary, a choice whose Wall Street ties Democrats quickly touted as a betrayal of Mr. Trump’s campaign promises to “drain the swamp” of special interests in Washington.
Although Democrats suggested an openness to Ms. Chao, who is the wife of Senate Majority Leader Mitch McConnell, they said they’ll also rally against Mr. Price, a staunch pro-life advocate and architect of House Republicans’ budgets the last two years — blueprints that envisioned major changes to Medicare and called for fast-track procedures to repeal the 2010 Affordable Care Act.
Republicans plan to rely on those same fast-track tools to attempt a repeal in 2017, when they’ll have GOP allies in the administration.
“We could not ask for a better partner to work with Congress to fix our nation’s health care challenges,” House Speaker Paul D. Ryan said.
Mr. Price offered his own legislative alternative to Obamacare for years, pushing for the repeal of heavy government mandates while maintaining some form of tax credits to help Americans to buy insurance, allowing insurers to sell their products across states lines and setting up high-risk pools in states — ideas that Mr. Ryan incorporated into his election-year outline for replacing Mr. Obama’s overhaul with a GOP president.
The incoming Republican president, Mr. Trump, said he’s counting on Mr. Price to manage the GOP’s tricky path ahead.
“He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare, and bring affordable and accessible health care to every American,” Mr. Trump said.
Democrats were spoiling for a fight.
“Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the hen house,” said incoming Senate Minority Leader Charles E. Schumer, New York Democrat.
Mr. Price succeeded Mr. Ryan as chairman of the Budget Committee in 2015, and adopted Mr. Ryan’s push to morph Medicare into a premium-support program. That idea is a political lightning rod that didn’t win over Mr. Trump on the campaign trail.
Mr. Price also has supported turning Medicaid coverage for the poor into a block grant to the states and stripping federal funding from Planned Parenthood, the nation’s largest abortion provider.
Democrats said as health secretary, Mr. Price would have control over funding and policies governing federal policies on abortion and contraceptives — areas where they said the pro-life congressman could undo Obama administration decisions.
Though a less prominent role than HHS secretary, Ms. Verma would have direct management over the Affordable Care Act’s twin pillars — web-based exchanges where consumers can shop for private coverage, often with the help of taxpayer-funded subsidies, and the state-by-state expansion of Medicaid, the government insurance program for the poor.
Ms. Verma rose to prominence by setting up the Healthy Indiana Plan, the state’s conservative twist on Medicaid expansion that started under former Gov. Mitch Daniels and was modified under Vice President-elect Mike Pence, the state’s current governor.
“She’s an outstanding choice. She’s the godmother of conservative thinking on how to make Medicaid more efficient and more effective,” said Robert Laszewski, a health care policy consultant in Alexandria, Virginia.
Analysts said Ms. Verma could serve as a powerful bridge for red states, using her waiver authority to grant them wide latitude in how they implement Medicaid until the GOP decides whether to overhaul the program.
For instance, Republican governors who’d fought with the Obama administration over work requirements or charging premiums on certain enrollees will now find a sympathetic ear in Ms. Verma.
“Before and after any legislative changes, she has the ability to let individual states make the kind of reforms they might be interested in,” said Caroline Pearson, a senior vice president at Avalere, a D.C.-based health consultancy.
Managing the exchanges could pose a tougher test, analysts said, if insurers flee a politically doomed program before Republicans figure out how to cover the millions of people who gained taxpayer-subsidized coverage through HealthCare.gov and state-run websites.
Republicans had hoped to have a replacement to go along with the repeal of Obamacare, but House Majority Leader Kevin McCarthy on Tuesday signaled their new strategy could involve a quick repeal, then a longer-term effort at replacement.
He said they would probably create a “transition” period to give stakeholders — including governors and state insurance commissioners — space to weigh in on what the replacement package would look like, though he didn’t provide a timeline.
Mr. McCarthy said the repeal can be done through fast-track procedures that only require a majority vote in the Senate, but any replacement plan would need 60 votes to overcome an expected Democratic filibuster. At best, Senate Republicans will hold 52 seats in the coming Congress.
Obamacare is already failing and cannot sustain itself, Mr. McCarthy argued, so Democrats will be under pressure to come to the table if the law is repealed and both sides have a deadline to move forward with something else.
“When that date came and you did nothing — if you want to play politics, I think blame would go to people who didn’t want to do anything,” he said.
Sen. Joe Manchin III, West Virginia Democrat, signaled Tuesday he’d be open to working with Republicans, but only if they show their cards from the start.
“I would like to see what they put forward,” he said. “I am amicable to anything, but [only] if it makes sense. I have always said this: If I can’t go home and explain it, I can’t vote for it.”
Rallying eight or so Democrats around a GOP replacement would be a tall order, analysts say, and could lead to a messy round of Capitol Hill finger-pointing if Republicans scrap the law and then nothing new is passed.
“It’s one thing to talk about repeal in the abstract, and it’s another thing to talk about repeal and replace, where you have a clear plan with winners and losers,” said Timothy Jost, a law professor at Washington and Lee University in Virginia who closely tracks the debate.
White House spokesman Josh Earnest said Obamacare set a “pretty high bar” by knocking down the uninsured rate and ushering in consumer protections, such as forbidding insurers from rejecting the sick or charging women more than men.
He also said the HHS nominee will need to take direction from Mr. Trump rather than devising his own plan to replace Obamacare.
“With all due respect to Congressman Price, it will be his job to implement the president’s plan, not his own,” Mr. Earnest said. “We’ll see if ‘Trumpcare’ measures up.”
⦁ Dave Boyer, Seth McLaughlin, S.A. Miller and David Sherfinski contributed to this report.