ROSWELL, GEORGIA - Carla Dent is a restaurant owner who steers her employees to federal health insurance exchanges. Eden Purdy helps poor and working-class Georgians navigate the health care marketplace. Bryson Boech is a grocery cashier recently diagnosed with multiple sclerosis, what the insurance industry calls a pre-existing condition.
None of the three claims to be intensely political, but all say they are concerned their congressman, Tom Price, will rip up President Barack Obama's 2010 health care law if the Senate confirms the Georgia Republican to be Donald Trump's health secretary. Price's Senate confirmation hearing is scheduled for Wednesday.
"I just can't imagine they would throw out the whole thing and upset the market like that," said Dent, whose Pastis restaurant sits in the historic district of Price's hometown of Roswell.
A few miles away, Purdy, program director at North Fulton Community Charities, said she was "kind of in a holding pattern." She is finishing the latest open-enrollment period for insurance exchanges established under the Affordable Care Act. "But we have this big caveat hanging out there — big caveat," she said.
The questions are all the more searing because of apparent differences between Trump and his nominee to lead the Department of Health and Human Services: Both men promise to "repeal and replace Obamacare," but their replacement priorities may not dovetail.
An orthopedic surgeon elected in 2004, Price has long been a conservative critic of Obamacare, arguing instead for as little government involvement as possible. He applies the same idea to criticisms of Medicare, the government insurance programs for older Americans, and Medicaid, government insurance for the poor and disabled.
Trump, meanwhile, called the 2010 law "a disaster" on the campaign trail, but recently said he wants "insurance for everybody," seemingly advocating universal coverage sought for generations by Democrats, not a small-government fix preferred by Republicans like Price.
The president-elect promises a detailed plan in the coming days. Price, meanwhile, already is sponsor of an existing 200-page-plus health insurance overhaul he says is rooted in GOP priorities — tax credits for coverage, encouraging health savings accounts. But as HHS secretary, his job would be to sell whatever Trump wants and implement whatever the president signs.
The realities of Price's district explain his approach in Congress. The district comprises Republican-leaning suburbs along the northern ring of metro Atlanta, dynamics that leave Price invulnerable to any Democratic Party challenger. The district has a median household income of more than $83,000 — about $30,000 more than the national mark and $34,000 higher than the Georgia as a whole. The poverty rate is 8.6 percent, compared with 17 in Georgia and 13.5 nationally.
Insured through employers
That affluence means that about 650,000 out of 730,000 people in Price's district have health insurance, according to the Census Bureau. About 575,000 have private insurance policies. That number includes 40,600 consumers who bought individual policies in ACA exchanges.
That's comparable to 41,500 in a neighboring district that includes the city of Atlanta and less affluent suburbs. And it means that Price serves many constituents like Jonathan Junkins, an IT manager who says he's always had "good insurance" from his employer. Junkins, 36, says he pays about $150 out of pocket each month for premiums, with his employer paying the rest. Asked whether he saw the health insurance debate affecting him, he said, "Not really. My company is pretty good."
Still, the district has almost 80,000 people without health insurance of any kind. Most of those, according to Purdy, are the working poor who "fall through the cracks" because Georgia chose not to expand Medicaid as part of the Affordable Care Act. They make too much to qualify for the existing Medicaid program, but not enough to qualify for the subsidies to buy private insurance on the exchanges.
Dent, the restaurant owner, acknowledges that high costs in the overall market prevent her from offering a small-group plan to her employees, many of whom have bought subsidized ACA policies. Yet she says she prizes the known quantity of the law above Trump's "complete unpredictability."
Boech, who has an individual policy he bought before ACA became law, said he wants the security of the law's requirement that insurers sell policies to anyone regardless of medical histories. "Multiple sclerosis is expensive," he said. "I know that. If I lose insurance and don't have that protection, well ... ," he said, his voice trailing off.
Purdy, meanwhile, bemoaned Georgia's decision not to expand Medicaid, but noted that some of her better-paid clients still can't afford policies on the exchanges, even if they qualify. They opt to pay a tax penalty for forgoing coverage.
"I assume that any changes would mean some people will benefit and some people will suffer more," she said. "We just don't know."