We posted a long item about Tom Price’s biography, and an overview of some of the issues that may come up during his confirmation as HHS secretary.
Joyce Frieden, news editor of MedPage Today, did a series of interviews with top academic health policy experts about what Price brings to the table, and we asked her to sum up the high points for you here, including some aspects that directly affect physicians and payment reform.
David Howard, Ph.D., associate professor of health policy and management, Emory University:
He says Price’s top priority will be replacing the ACA – one plan that Price has discussed involves the use of tax credits. According to Howard, Price has also talked about setting up a health care marketplace similar to the ACA’s exchanges, in which insurers would be required to accept people with preexisting conditions, although how they would handle people who haven’t maintained continuous coverage is yet to be worked out. [Note: the exchanges wouldn’t have the same subsidies or regulatory structure as the ACA, but they would be online markets.]
Price also favors high-risk pools but the funding mentioned in his plan is not very generous – $1 billion to $2 billion a year.
Another Price priority, Howard says, would be easing quality reporting requirements for physicians in Medicare.
Michael Sparer, Ph.D., J.D., chair of health policy and management, Columbia University:
He says Price would give states expanded discretion to run their Medicaid programs; that could include block grants, per-capita caps, or waivers so they can impose co-pays and do other things they weren’t previously allowed to do.
Price also could impact reproductive rights. He and others have long discussed defunding Planned Parenthood, Sparer said. The ACA’s coverage of birth control at no cost to the beneficiary could also be at risk.
Mark McClellan, M.D., Ph.D., director of the Margolis Center for Health Policy at Duke University in Durham, N.C., and former CMS administrator:
In terms of Medicare payment reform, Price may put more emphasis on programs that work for smaller providers, as opposed to large, mandatory programs like the Part B demonstration project, unless they have been shown to work, McClellan said.
Programs such as the oncology care model – payment reforms that can help specialists move in a new direction – are likely to be favored, McClellan said. “It’s really about less regulation and more reliance on private-sector innovation.”
Price also has supported more significant changes to Medicare, including a premium support model, but those reforms are probably farther down on the list, he added.