Lawmakers should give more consideration to whether federal healthcare programs are effective than how much they cost, Department of Health and Human Services Secretary Tom Price, M.D., told lawmakers on Thursday. 

Price, speaking during a Senate Committee on Finance hearing on President Trump’s fiscal year 2018 budget, used Medicaid as an example to urge lawmakers to look beyond a program’s costs to see “whether the program actually works.”

“If how much money the government spends on a program were truly a measure of success, Medicaid would be hailed as one of the most successful in history,” Price said. He noted that Medicaid spending is forecasted to pass $1 trillion within the next decade, compared to the $200 billion the government spent annually on the program 20 years ago.

“This mixed impact of Medicaid coverage on health outcomes suggests we need structural reforms that equip states with the resources and flexibility they need to serve their unique Medicaid populations in a way that is as compassionate and as cost-effective as possible,” Price said.

Trump’s budget, Price said, would “unleash” state lawmakers to reform the Medicaid program to “meet the unique needs of their citizens” by allowing states to prioritize how federal Medicaid funds are used. Those reforms could cut $610 billion from the program, he predicted.

Reforms in the FY 2018 budget “will go a long way” to improve healthcare access, but more needs to be done “to transition from the failures of Obamacare to a patient-centered system,” he added.

Meanwhile, Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-WV) have floated the idea of phasing out federal funding for the Affordable Care Act’s Medicaid expansion over a period of seven years, starting in 2020, The Hill reported. Senate Majority leader Mitch McConnell (R-KY) proposed a three-year transition that would end funding in 2023 at a Senate lunch on Tuesday. 

Some have speculated that the Senate’s version of the ACA repeal bill could ultimately preserve some Medicaid provisions, such as expansion.