On the campaign trail, President Donald Trump promised to repeal Obamacare while simultaneously pledging that he wouldn’t make cuts to Medicaid and Medicare. His nomination of Georgia Rep. Tom Price to be the secretary of Health and Human Services suggests that Trump was more serious about killing the Affordable Care Act than he was about preserving federally funded health care.
During two Senate hearings totaling eight hours, Price answered questions about how he would run the department, calmly repeating his mantra of providing “access” to the kind of insurance plans people want to buy while fielding criticisms from Democrats about owning stock in health-care-related companies. A so-called courtesy hearing last week with the Senate Committee on Health, Education, Labor and Pensions was the warm-up act before Tuesday’s big show with the Committee on Finance, which will decide whether to pass his nomination to the full Senate for a confirmation vote.
As was pointed out several times at both hearings, if confirmed, Price will be in charge of about $1.1 trillion in annual spending. Here’s what we learned from the hearings about Price’s views on major health care issues:
On Trump’s executive order regarding the ACA: Price was asked how he would implement an executive order Trump issued Friday that made it clear that the president expects the department to start making changes to ACA policies before a replacement plan for the law is in place. “Our commitment is to carry out the law of the land,” Price said when Democratic Sen. Mark Warner of Virginia asked Price whether he would use the order to start undermining the ACA. He mostly didn’t say how he’d act on the order, though he hinted at giving insurance companies more leeway on the kinds of plans they can sell.
On metrics: Access will be the word of the year, if Price’s testimony before these two committees is any indication. While the metric most frequently used to defend the Affordable Care Act has been increased insurance coverage, Price and other Republicans are angling to make access to coverage the metric du jour. Still, coverage is the data point Republicans will have to reckon with as they build a replacement plan because, popular or not, the Affordable Care Act shifted the public’s expectations. As Vermont Sen. Bernie Sanders pointed out during the health committee hearing, having access to insurance isn’t the same as having coverage (“I have access to buying a $10 million home; I don’t have the money to do that,” Sanders quipped).
On his stocks: There was a clear party breakdown in whether senators felt that Price’s ownership of health care stocks — including stocks that would be affected by legislation he worked or voted on — represented a conflict of interest. Democrats criticized him and openly questioned his ethics while Republicans stuck by his side, pointing out that the information was made public in congressional disclosure forms. Price denied any wrongdoing and said he’d comply with all of the recommendations from the Office of Government Ethics on how to divest in order to avoid the appearance of a conflict.
On substance abuse and “essential benefits”: Both committees brought up opioid addiction, which illustrates the challenges Republicans will face in trying to replace Obamacare. Under the ACA, insurance companies are required to cover treatment for addiction and substance abuse, and several Democratic senators wanted to know whether Price thought that should continue. Though they were asking specifically about substance abuse, the question touched on the broader issue of guaranteed benefits — insurers are currently required to cover a broad range of “essential health benefits” including checkups, screenings and mental health care — which will be one of the biggest issues for any plan meant to replace the ACA. Historically, when insurance companies weren’t required to cover all of these services, they didn’t do so, so these rules meant some people got a broader range of coverage, but they also led to higher insurance premiums.
Price said he thought treatment for addiction should continue but didn’t say how that might happen if the ACA is repealed (his proposed replacement bill cuts all guaranteed benefits).
Price was also asked to clarify whether someone with an addiction problem is considered “able-bodied.” Like many Republicans, Price is a fan of work requirements for entitlement programs such as Medicaid, the federal health care program for low-income people and families, which he’d like to see applied to able-bodied people. After much prodding, Price allowed, “I think people have an understanding of what able-bodied is, and that’s somebody who doesn’t have the kinds of things that you’ve described.”
On insurance coverage regulations: Essential health benefits aren’t the only insurance-industry regulation that Price doesn’t like. He also opposes ACA provisions that mandate what types of insurance plans can be sold. For example, current rules ban high-deductible catastrophic plans for most people, but Price said he believes this type of plan works for many Americans. These plans illustrate the balancing act Republicans face in crafting a replacement for the ACA: Republicans blame rising deductibles on the ACA (although there’s evidence that deductibles were increasing independently of the law), and yet Republican plans that have surfaced to date rely heavily on high-deductible catastrophic plans to ensure that people have access (there’s that word again) to coverage. It’s easy to rally the populace against rising deductibles, but it could be far less popular to suggest that people switch to plans that provide little health care coverage except in the case of a catastrophic event.
On Medicare: Last week’s hearing began with committee Chairman Lamar Alexander, a Republican senator from Tennessee, asking Price whether a replacement for the ACA would also reform Medicare, the federal health care program for people 65 or older. “Absolutely not,” he replied. But Price has made it clear that he’d like to see Medicare turned into a voucher system, which would provide limited dollars to seniors to buy private health insurance. The hearings did little to clarify whether he’d push that agenda.
On vaccines: New Jersey Sen. Bob Menendez, a Democrat, questioned Price on whether he shares Trump’s skepticism about vaccine safety. After saying the science is pretty clear on the fact that vaccines don’t cause autism, Price started to add, “There are individuals across our country …,” but Menendez cut him off, saying, “I’m not asking about individuals; I’m talking about science.”
On prescription drugs: Trump recently called for the federal government to set up a bidding system for prescription drugs to curb headline–grabbing increases in costs. When questioned about the president’s stance, Price took an ambiguous position, saying that a lack of transparency may be affecting the price of some drugs. When pushed repeatedly by Democrats on the health committee, he acknowledged that as secretary, he’d have to answer to Trump and would do as his boss directed.
Price mentioned the Orphan Drug Act, a bill signed into law by President Ronald Reagan and meant to provide financial incentives for drug companies to develop drugs for diseases that affect only a small number of people. He neglected to mention, however, that the law has been abused by drug companies to win federal dollars for blockbuster drugs. He also praised the increasing sale of generics, which save Americans millions of dollars each year, though he didn’t mention Trump’s recent call to cut pharmaceutical imports, many of which are generics.
On women’s health: Price has backed measures that limit abortion throughout his time in office, and he proposed legislation in 2015 that would have defunded Planned Parenthood. In a terse exchange with Sen. Ron Wyden, a Democrat from Oregon, Price said he didn’t think that defunding the health care provider would hurt women’s access to care, despite a report from the nonpartisan Congressional Budget Office finding that women would lose access to some services. After much prodding from Wyden on the findings of the report, Price said: “I respectfully disagree.”
On how Republicans will replace the ACA: File this under “things we still don’t know.” Price declined to say whether a replacement plan would be ready by March 1, when insurance plans will have to start putting together offerings for 2018, though several Republican committee members pushed him to do so. When Ohio Sen. Sherrod Brown, a Democrat, asked whether Trump’s statement that he was working with Price to develop a replacement plan for the ACA was true, Price gave a careful response: “It’s true that he said that, yes.”
Read more about Trump’s Cabinet appointments here.