As President-elect Donald Trump continues to fill out his cabinet, the key position of HHS secretary is still open. Insiders expect an announcement soon, and have their eyes on Georgia Rep. Tom Price, who is expected to concentrate on state reform efforts and is known for working across the aisle.
Price, an orthopedic surgeon from Georgia who is used to having considerable influence on health policy, was quick to support Trump's bid for the White House. He spoke on Trump's behalf at rallies, often focusing on complaints about the Affordable Care Act.
He was seen entering Trump Tower in Manhattan last week where the presidential elect was hosting multiple potential cabinet picks. His office said there is no comment on his potential position. Others being mentioned for the top healthcare policy post include Louisiana Gov. Bobby Jindal, who served in HHS in the George W. Bush administration. Former neurosurgeon Dr. Ben Carson, who ran as a presidential candidate in the primaries, declined the position.
He would be a key part of Trump's promise to begin repeal and replace of the ACA immediately after inauguration. Price currently has a powerful position as chairman of the House Budget Committee. He is also on the health subcommittee of the House Ways and Means Committee. He has always been a staunch critic of the law, and was one of the first to put forward his own replacement plan in the form of the Empowering Patients First Act.
It involves age-adjusted tax credits to help people buy insurance as well as increased reliance on health savings accounts and high-risk pools at the state level. It would allow people to opt out of Medicare, Medicaid or Veterans Affairs benefits and receive the tax credit to buy an individual plan. The legislation has not been scored by the Congressional Budget Office.
He has recently touted the healthcare plan spearheaded by House Speaker Paul Ryan, which has many of the same elements.
Stuart Butler, a senior fellow at the Brookings Institution, said Price has supported the several health policy changes Republicans are now proposing, including block grants for Medicaid, changing Medicare into a premium support system and allowing insurance to be sold across state lines.
Price and Ryan could potentially conflict with Trump's campaign promise not to touch Medicare, however.
Butler and American Enterprise Institute fellow Joe Antos both said Price has some history of working with Democrats and has shown a willingness to talk about policy ideas with people of all political views.
“One of the hallmarks of his time in Congress has been that he does collaborate with people to the extent that they want to collaborate,” Antos said.
Butler said a key area where Price would be likely to focus if he gets the job is working with states on their ideas for healthcare reform. He has been a strong supporter of looking to state governments for proposals of how to spend their healthcare dollars, even if the ideas are more left-leaning than he might personally advocate.
He would likely encourage states to seek waivers for using Medicaid and Medicare money their own way, Butler said.
“I think that's going to be a piece that you should look for in a Price HHS in the Trump administration,” he said. “You've got 33 Republican governors who think they can do things better.”
Another likely area of focus for Price at HHS would be rolling back abortion rights. He has previously called for defunding Planned Parenthood and has supported many pieces of anti-abortion legislation. In 2015, he co-sponsored a bill that would ban abortion after 20 weeks.
He has also opposed the ACA provision that requires plans to cover birth control as a no-cost preventive measure. Antos said that Republican control of Congress and the White House could make abortion a more active issue than it has been before, although it would likely be decided in the courts.
Price appears favorable to continuing bipartisan efforts to move away from fee-for-service reimbursement and focus on paying for the value and quality of care.
He voted for the Medicare Access and CHIP Reauthorization Act and put forward a path for value-based reimbursement methods in Medicare. He has recently, however, criticized some aspects of the law's implementation. He has specifically said reporting requirements are a burden to physicians and should be streamlined.
Butler said he doesn't think Price would try to impede value-based purchasing methods because “that's a trend that is so profound.”
Antos said Price would likely continue delays of MACRA implementation to be sure physicians are prepared. Price has proposed legislation that would exempt pathologists from electronic health record meaningful use requirements under the ACA.
“Physicians and other medical practitioners should not be penalized when the law is inflexible or inapplicable,” he said in a news release announcing the legislation. “Washington must recognize the real world impact of many of these regulations and the real-life danger of a one-size-fits-all approach.”
Antos said the CMS Innovation Center, which has been a frequent target for conservatives, could also see major changes. Price has often said the center, which develops and pilots value-based payment models, has too much authority and should defer more to Congress.
“I don't see him as supporting eliminating all research into new payment mechanisms and new delivery systems,” Antos said. “He knows that you have to do research there, but he's very leery, for example, of mandatory participation.”
Price joined Congress in 2004 after four terms in the Georgia state Senate. He worked in private practice for nearly 20 years and has taught residents at Emory School of Medicine and Grady Memorial Hospital in Atlanta.
Health professionals have been a major donor to Price throughout his career. Individual and political action committees in the healthcare sector have donated more than $4.8 million to him. The American Association of Orthopaedic Surgeons is a top donor group.
Antos said he would expect a Price pick to be viewed favorable by many in Congress because Price is a seasoned legislator with a medical background.
“Nobody can argue that he's unfamiliar or he doesn't deal deeply with the kinds of issues at hand,” he said.
The last HHS secretary with a medical background was Louis Wade Sullivan who served during President George H. W. Bush's administration and was Founding Dean of the Morehouse School of Medicine.