It is often said that the first casualty of war is the truth. In the coming war on health security for the American people, one question is whether Donald Trump was sincere when he said he would not cut Medicare, a claim he made repeatedly throughout the campaign. Unfortunately, his selection of Tom Price as head of HHS raises a bright red flag as to whether Medicare is truly safe. 

Price is on record not only supporting Medicare vouchers but also for allowing doctors to balance bill Medicare patients – as if people in this country didn’t already have big enough problems with out-of-pocket medical bills. Based on his history, it is hard not to believe that older Americans and people with disabilities will be right up there with low-income people and people with pre-existing conditions at the head of the line to receive a cut in their health care benefits from the president and congressional Republicans.

And while we’re at it, I wouldn’t take too much comfort from stories suggesting that Senate Republicans are cool to a Medicare voucher or premiums support plan (there is no effective difference between the two, it is just a matter of whether the fixed dollar subsidy goes to the beneficiary or directly to the insurer). It’s the timing of the attack, not its substance that seems to concern them most.

Meanwhile, at least some Congressional Republicans are realizing that calling for a repeal that has no chance of actually happening is a much easier exercise than actually crafting a workable alternative. Perhaps it has something to do with the fact that – despite continued division over ACA – the public is deeply skeptical of any moves to repeal it without having some clarity on the alternative. Only about one in four voters support ACA repeal, fewer than the 30 percent who want to expand the law. Roughly equal numbers support implementing the law as is and scaling it back. Even those who favor repeal want to see the alternative first.

Voters are right to be concerned. The lengthy time gap that Republican leaders are envisioning between repeal and replace would be a “slow motion disaster” for health insurance. Moreover, deep divisions over what direction to move in underscore the possibility that the party could be unable to come to any agreement on a new plan (just as they haven’t for the past six years). The Senate Republican Policy Committee unveiled their plan to begin repealing what they call “the most harmful provisions of the ACA.” Apparently tax credits and Medicaid expansion that make health insurance affordable for 22 million people qualify as “harmful.” That’s probably a surprise to the people who are getting those benefits.