Conservatives put Gottlieb, Jindal at top of list to head HHS

Exactly how long Dr. Don Wright occupies the top spot at HHS is anyone's guess, but conservative policy insiders have wasted little time in compiling a wish list of candidates to become the department's next permanent secretary.

Wright was temporarily anointed to the post when Dr. Tom Price abruptly resigned late last week. As Congress struggled to repeal the Affordable Care Act, hope has fallen on HHS as the avenue from which conservative healthcare reform will take place. Besides overseeing a department that accounts for nearly one-quarter of all federal spending, the secretary has tremendous latitude in shaping program under the ACA. There are 1,442 instances in which the law states: "the Secretary may..."

To that end, conservative policy insiders are highlighting a group of individuals including former Louisiana Gov. Bobby Jindal and current Food and Drug Administration Commissioner Dr. Scott Gottlieb.

"They are all committed to real healthcare reform," said Sally Pipes, president Pacific Research Institute, a conservative think tank. "They have been supporters of repeal and replacement of Obamacare and understand that the law is flawed."

She also expressed support for Dr. John Calvin Fleming Jr., who was appointed in March to be deputy assistant secretary for health information technology reform at the ONC.

Most of the conservative policy experts reached by Modern Healthcare cited Jindal as the front runner. He has both the political and healthcare chops for the role and has experience overseeing a large bureaucracy, something Price, a former orthopedic surgeon and Georgia congressman, lacked according to Gail Wilensky, who headed the predecessor to the CMS in the George H.W. Bush administration.

Jindal was assistant secretary for planning and evaluation at HHS during the first term of George W. Bush. While governor of Louisiana he gained praise in Republican circles for declining to expand Medicaid under the ACA.

Possibly undermining his chances though is the fact that he was critical of President Donald Trump during the primaries.

Some think Gottlieb has a real shot at getting the job since he is good at selling policy ideas to stakeholders and seems to have support in Congress.

It will be critical that the next person not only understand healthcare matters but be able to effectively sell it outside of the Beltway, according to Joseph Antos, senior healthcare policy expert at the conservative American Enterprise Institute.

"They need someone who has a greater ability to show empathy," Antos said. "I don't think that was one of Price's strengths."

Others are not so sure Price will be easily replaced. As a surgeon and a legislator, he devoted his career to finding ways to improve access to healthcare while lowering costs, and there are few people with his credentials or integrity, according to Dr. Hal Scherz, who started the group Docs4PatientCare to lobby against the ACA.

"Price was the best person to fix the healthcare mess," Scherz said. "The conservative agenda is greatly crippled with him gone."

Given Trump's penchant for firing those who disappoint him after only a few months, or even days, on the job, and his administration's apparent shift in focus away from healthcare to tax reform, it's unclear if the post will be filled quickly.

"Why would anyone want the job?" Mark Pauly, an economics and health care management professor at the Wharton Business School at the University of Pennsylvania said. "It doesn't pay much and it's nothing but grief."