The Senate’s pre-dawn vote on Friday to confirm Rep. Tom Price of Georgia as the next secretary of health and human services was a pivotal moment in the Trump administration’s increasingly high stakes effort to repeal and replace the Affordable Care Act, and perhaps fundamentally change the nature of the federal health care system.
The Senate voted 52 to 47 along strict party lines to confirm Price, who was sworn in by Vice President Mike Pence at the White House later in the morning. His confirmation process was slowed by the Democrats due to a controversy over his dubious trading in medical and pharmaceutical company stocks while he helped write legislation affecting some of those companies.
Price will be under enormous pressure to reenergize the Republicans’ “repeal and replace” campaign that has stalled after encountering push back from insurers, health care providers, consumer advocates and even Republican governors and mayors.
That won’t be easy because many rank and file Republicans are being spooked by an intense backlash from liberal Democrats and progressive groups that are protesting efforts to dismantle Obamacare – including angry demonstrations at town hall meetings called by GOP lawmakers. In a few cases, Republicans skipped the meetings to avoid confrontation.
Price will also have to be careful in his dealings with House Speaker Paul Ryan (R-WI), Senate Majority Leader Mitch McConnell (R-KY) and a legion of committee chairs who have already begun discussing legislative options.
Yet his experience and depth of knowledge of complex health care issues undoubtedly will make him first among equals within the Trump administration in shaping policy on Obamacare as well as Medicare and Medicaid – two other programs that Price has long criticized as wasteful and ill-conceived.
“I think he’s going to have a major influence on White House thinking,” said Joseph Antos, a health care expert with the conservative-leaning American Enterprise Institute, “because he is clearly going to be the most senior and most knowledgeable person all the way around on health care financing.”
While Trump has shown little reluctance to speculate on the timing and scope of his ideas on replacing Obamacare – including his boast three weeks ago that a plan for providing insurance for “everyone” was imminent – Antos predicts that the president likely will take his cues from Price in the future. “I think that a lot of where the administration is going to come out on issues is going to originate with Tom Price, as opposed to it being top down, as it was in the Obama administration,” he said in an interview.
Price’s challenge in waging war on Obamacare is two-fold: One is to carry out Trump’s recent executive order that mandates agencies including the Department of Health and Human Services and the Internal Revenue Service to do whatever they can “within the law” to mitigate any adverse effects of the Affordable Care Act on the insurance industry, health care services or consumers. The order has been widely interpreted as Trump’s call to begin the demolition of Obamacare from within, before Congress finally gets around to passing legislation. Price reportedly will begin rolling out some policy changes shortly.
The other challenge is to take a leading role in designing or perfecting Obamacare replacement legislation. In recent weeks, a number of Republicans have begun promoting replacement plans of their own, including one by Sens. Susan Collins of Maine and Bill Cassidy of Louisiana that would essentially allow the states to decide whether to keep Obamacare or opt for some other health insurance system.
Sen. Rand Paul of Kentucky unveiled a more conservative system of tax credits and health savings accounts after privately conferring with Trump. And Rep. Greg Walden (R-OR), chair of the House Energy & Commerce Committee, Ways and Means Committee Chair Kevin Brady of Texas, and Ryan are all weighing in with proposals of their own.
For his part, Price has spent years working on replacement ideas, and most recently unveiled a 242-page bill detailing a new conservative approach. That legislation, called the Empowering Patients First Act, would use a handful of tax credits, savings incentives, state grants and other marketing incentives to spark greater competition within the insurance industry and provide consumers with more policy choices, ideally at a lower cost.
But Price’s proposals for weaning more than 20 million Americans away from Obamacare are highly controversial among Republicans as well as Democrats. And critics have warned that any radical alternative like this would result in millions of Americans losing coverage.
Price, a wealthy orthopedic surgeon from suburban Atlanta who has spent much of his political career as a state legislator and House member railing against government intervention, is unmatched in his disdain for Obamacare and government regulations that he says intrude on the relationship between doctors and their patients.
During his testimony before the Senate Finance Committee last month, Price declared that “we ought not go down the road” with anything that “gets in the way” of the patient, their families and physicians “making the decisions about what kind of health care they desire.”
The Tea Party conservative has embraced a number positions well outside of the mainstream of basic health care policy, as The Washington Post noted Thursday. Democrats say that they are even more alarmed that Price for years has advocated transforming Medicare from an open-ended entitlement for seniors to a fixed government contribution for beneficiaries to use to either purchase private insurance or continue with traditional Medicare.
Although Trump pledged during the campaign to leave Medicare and Social Security alone, liberal groups and advocates for seniors now worry that Medicare could become a bargaining chip later this year, as Republicans look for ways to finance their health care initiatives and help pay for a massive tax cut.
Senate Democratic Leader Chuck Schumer of New York charged that Price had “dedicated his life to destroying Medicare as we know it” and that Price’s premium support approach would result in millions of seniors losing their health care coverage.
McConnell vigorously defended Price and his views, saying at one point that Price “knows more about health care policy than just about anyone.”