WASHINGTON — During a Jan. 18 Senate hearing on his nomination for secretary of the Department of Health and Human Services, Rep. Tom Price, R-Ga., faced hostile questions about his plans for the repeal and replacement of the Affordable Care Act (ACA), including the fate of the HHS contraceptive mandate.

“I have serious concerns about your understanding of women’s needs for basic health care like birth control, given your expressed doubts on this topic,” Sen. Patty Murray, D-Wash., the ranking Democrat on the Health, Education, Labor & Pensions Committee, told Price, in comments that referenced the mandate, which required most employers to provide cost-free birth control, abortion and sterilization in their health insurance policies.

During the tense, four-hour hearing, Murray raised objections to what she characterized as Price's “proposals to make women pay extra, out-of-pocket for birth control, and your repeated efforts to defund our nation’s largest provider of women’s health care, Planned Parenthood.”

Price’s low-key response was polite, but offered no pledge to protect the HHS mandate, which has spawned an explosion of lawsuits over the past five years, including a legal challenge by the Little Sisters of the Poor and the Eternal Word Television Network, the Register’s parent company.

But when senators peppered the congressman with questions about his plan to replace the Affordable Care Act, also known as Obamacare, Price repeatedly vowed to protect health care access for millions of Americans who have come to depend on the ACA, despite its well-publicized troubles.

“We must absolutely ensure that individuals do not fall through the cracks in whatever transition occurs,” said Price, reacting to a question about the changes ahead for low-income patients, who have joined the expanded rolls of Medicaid in 32 states and now fear an ACA repeal could threaten those benefits.

The high-profile hearing served as a reminder that Price, if confirmed, would play an outsized role in President Donald Trump’s administration. The president has staked much of his political capital on a successful transition from the ACA to a market-based framework that would retain access for patients with pre-existing conditions, but would be less costly, more flexible and provide a greater role for individual states to craft their own approach.

 

Equipped for the Job

Price’s many allies view the six-term pro-life congressman — a former orthopedic surgeon — as an excellent choice to lead the HHS, given his deep practical knowledge of the U.S. health care system and his role as chair of the House Budget Committee.

“He’s the best-equipped (in terms of understanding the complexities of health financing) person who has ever been named for HHS secretary,” Joseph Antos, an expert on health care policy at the American Enterprise Institute, told the Register.

“Of course, that doesn’t mean the job will be easy, but his Hill experience gives him an edge in what will be tough sledding.”

Sally Pipes, president and CEO of the Pacific Research Institute and an advocate for free-market solutions who knows Price well, said he possesses the right mix of skills and character to navigate the tough road ahead.

“I don’t think Trump could have made a better nomination,” Pipes told the Register, noting that Price released his own replacement plan, “Empowering Patients First Act,” two years ago and will seek to incorporate those ideas into the Republican Party’s blueprint.

“He is an orthopedic surgeon, so he understands the problems with the health care system, and he is an honorable man,” Pipes added.

Pro-life activists, for their part, are heartened by the nominee’s strong record on life issues. They expect him to quickly roll back federal rules that provide tax-payer subsidies for abortion and weaken conscience rights for those who oppose the practice.

“We are very optimistic that the health care plan coming forward will be strongly pro-life. We didn’t have that hope under Obama,” the National Right to Life’s Committee Carol Tobias told the Register.

Her organization has publicly endorsed Price’s nomination and stated its expectation that he would “empower the Department of Health and Human Services to protect the most vulnerable members of our society: the unborn and their mothers, the elderly, and the medically dependent and disabled.”

Price, a Presbyterian, has co-sponsored the Pain-Capable Unborn Child Protection Act and the Health Care Conscience Rights Act. And the National Right to Life Committee praised his past proposals to “dismantle Obamacare’s disastrous rationing mechanisms.”

 

Confirmation Challenges

If confirmed, Price will lead a sprawling agency with a $1-trillion budget and bear responsibility for vital social entitlements, like Medicare. He would also oversee the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Institutes of Health.

Further, Price would review FDA regulations that decide the fate of promising new medical devices and drugs. And at the Jan. 18 hearing, Democrats pounced on media reports that Price had traded stocks in companies that would directly benefit from legislation he proposed or endorsed.

“Do you believe it is appropriate for a senior member of Congress, actively involved in policymaking in the health center, to repeatedly personally invest in a drug company that could benefit from those actions?” Murray asked Price, who insisted that he had little input in decisions made by broker and mutual funds.

Earlier in the week, CNN reported that Price had bought shares in a medical device company and then later proposed a bill that would have helped the company. And while Price noted that he had already submitted all his financial dealings for ethical review, Democrats are expected to raise this matter again at the formal hearing for his nomination next week.

The chief priority for Price, however, will be to reassure U.S. lawmakers and the American public that a GOP-led repeal and replacement of Obamacare will not inject further instability into the state health exchanges that already face a host of challenges.  

“My concern is with Republicans repealing without a clear plan to replace,” said AEI’s Antos.

Confusion over the specifics of a GOP plan, combined with a lengthy delay in implementation of a new framework — a goal that Democrats and some Republicans favor — could make things tough for insurance carriers who have stuck with state exchanges, despite financial losses.

Yet Antos also acknowledged that a comprehensive replacement plan “inevitably would take several years to implement.”  Thus, until all the provisions are in place, “insurers need concrete assurance that the individual market can become a reasonable business proposition.”

‘Adequate Health Care’

As the nation prepares for a new approach to federal health care policy, the U.S. bishops have warned against the repeal of key ACA provisions “without the concurrent passage of a replacement plan that ensures access to adequate health care for the millions of people who now rely upon it for their well-being,” according to a Jan. 18 letter from the U.S. bishops to Congress..

“We recognize that the law has brought about important gains in coverage, and those gains should be protected,” Bishop Frank Dewane of Venice, Florida, chair of the USCCB Committee on Domestic Justice and Human Development, said in the letter. 

Bishop Dewane emphasized that health care reform “should be truly universal, and it should be genuinely affordable.”

 Congress has already taken its first steps toward dismantling the ACA, as U.S. lawmakers voted along party lines in the House and Senate this month to approve a budget resolution that will serve as the vehicle to repeal Obamacare.

“Reconciliation is the only legislative vehicle that will move fast enough to allow insurers to meet the late-spring deadlines to file rate applications for 2018,” explained Antos, in a reference to the legislative mechanism a GOP-led Congress will use to unwind Obama’s signature policy achievement.

President Trump has said that he will soon present a plan to replace the ACA with the goal of “insurance for everybody.”

 

Defining the GOP’s Plan

Trump has yet to offer specifics on his plan. But the GOP’s approach will likely be defined by policies that Price has already developed.

“Paramount among them is a system of age-based refundable tax credits designed to subsidize the purchase of individual coverage,” explained Sally Pipes in a recent post for the Washington Examiner.

“These tax credits are a vast improvement over Obamacare’s complicated scheme of income-based premium subsidies.”

Pipes hopes that Democrats will also approve of Price’s solution for a critical problem on the state exchanges — consumers who enter the system and receive costly medical treatments, but then drop their coverage after urgent health issues are resolved.  

Price would provide a stronger incentive to stay in the market, she said, by offering “coverage to people with pre-existing conditions as long as they maintain continuous coverage from year to year.”

“This would create a strong incentive for healthy people to stay insured,” Pipes said.

Price also supports high-risk pools for consumers with serious medical conditions who can’t get adequate or affordable coverage.

"These programs would protect the sickest patients without raising premiums for everyone else in the conventional market,” Pipes explained.

Before the ACA’s passage, individual states offered high-risk insurance plans with mixed results, as some programs were poorly funded. 

More questions still remain about Price’s views on a host of related matters, including his plans for reforming Medicare. 

But during his first hearing, Price was very clear about the GOP’s larger message to the American public.

Said Price: “We think it’s absolutely imperative that individuals that have health coverage be able to keep health coverage and move, hopefully, to greater choices and options for them to gain the kind of coverage they want for themselves and their families.” 

Joan Frawley Desmond is a Register senior editor.