Expect tough questioning from Senate Democrats when Congressman Tom Price appears before two of their committees in his bid to become the next secretary of the Department of Health and Human Services.
His confirmation journey continues Jan. 18 with a hearing before the Senate HELP (Health, Education, Labor and Pensions) Committee. Then it’s on to the Senate Finance Committee (no date set as of this writing, but it’s expected to come after Donald Trump’s Jan. 20 inauguration).
Price, a conservative Republican orthopedic surgeon from Atlanta, was elected to Congress in 2004. In addition to his opposition to the Affordable Care Act, Price has pressed for significant policy changes in Medicare, Medicaid, the Children’s Health Insurance Program and other Democratic-favored programs. On the personal side, there’s been renewed scrutiny of past campaign contributions from the health care industry and Price’s history of investing in health care stocks. A controversial CNN piece earlier this week on the latter issue earned a sharp rebuke from the Trump transition team.
The HELP committee won’t take a confirmation vote on the nomination. That will be left to Finance, which oversees Medicare and Medicaid and thus most federal health care spending. However, HELP does have jurisdiction over many HHS programs and agencies including the FDA, CDC, NIH, as well as many aging and mental health programs. Plus – given that its members include Bernie Sanders and Elizabeth Warren – expect a lively hearing with some sharp exchanges about drug costs, and overall HHS priorities.
So who is Price?
Interestingly, because he talks frequently about the challenges facing small practice and independent physicians, it’s commonly assumed that he came from such a professional background himself. (I even repeated this assertion at a panel discussion soon after his nomination because I had heard it so often from reputable people). My Politico colleague David Pittman, who has family in the area where Price practiced and did some good old-fashioned reporting, learned that Price was the first board chairman at Resurgens Orthopedics, a merger of seven surgical practices. The group has about 100 physicians, mostly orthopedic surgeons, and is the largest orthopedic practice in Georgia (with 21 locations alone in the Atlanta area). It’s also among the 10 largest practice groups of its type in the United States. So, not a small practice.
Price’s politics are on the conservative side of the spectrum, even for the House. He has been involved in its Tea Party caucus, though not the even more conservative Freedom Caucus that played a key role in John Boehner’s 2015 ouster as speaker.
Price, 62, studied at the University of Michigan but settled in Atlanta following his medical training at Emory University. He became politically activate through his deep opposition to the Clinton health plan of 1993-94, which he saw as a government intrusion in medicine. He became more active and influential within the Georgia branch of the American Medical Association and successful ran for the state legislature. In 2004 he was elected to the U.S. House of Representatives to represent a district that by then overlapped Newt Gingrich’s old stomping grounds. Once in the House, he made his name as a conservative doc and fiscal hawk, rising to the powerful chairmanship of the House Budget Committee.
He is the author of one of several potential replacement plans for Obamacare. It’s not the most conservative plan out there, but is to the right in most respects from Paul Ryan’s plan (though Price also has endorsed Ryan’s approach). Price is a strong advocate of Ryan’s “premium support” plan for Medicare, and wants its consideration to be a House priority following ACA repeal and replacement. Price has strong anti-abortion views, is opposed to expansion of the Children’s Health Insurance Program and has made capping malpractice awards one of his signature issues.
Price is a critic of the Center for Medicare and Medicaid Innovation (CMMI), which was created through the ACA to test new payment and delivery models. He hasn’t called for its abolition – some of its work on payment reform has bipartisan support and the GOP leadership seems to realize it can also use the agency to advance some of their policy agenda. Price has criticized CMMI for overreaching, particularly regarding any mandatory bundling projects. Like most Republicans (and a not insignificant number of Democrats), he opposed CMMI’s proposal to launch a large-scale test of new payment models for Medicare Part B drugs, a proposal which the outgoing administration ended up putting on ice. He and some colleagues outlined their views on CMMI in this letter.
Below is a sampling of the reporting about Price’s background, his ACA replacement proposal and the controversy over his stock ownership practices.
Profiles
In his hometown paper, The Atlanta Journal Constitution, Greg Bluestein and Tamar Hallerman report that a “no-nonsense work ethic, attention to detail and an unquenchable thirst to be at the center of weighty decisions — particularly involving medical policy — has driven Price, 62, throughout his life. He ran for office as a tax-hating fiscal conservative. However, it was health care policy that has truly defined his career. ”
Robert Pear in The New York Times reviews the anti-regulatory zeal that has marked Price’s career. “A review of Mr. Price’s record in Congress, including his speeches and legislative proposals, suggests that he would try to reduce the burden of federal regulations on health care providers, especially doctors.”
Health Policy
Here is Price’s press release describing his repeal and replace plan in 2015, and here’s a summary. And here’s a critique of it in the New England Journal of Medicine.
Stock Ownership & Campaign Contributions
As best as I can tell, Stat’s Sheila Kaplan was the first to write about his stock portfolio – rich in pharmaceutical and medical companies. The Wall Street Journal a few weeks later dug into that more deeply. Kaiser Health News then explored one stock he got on a preferential basis – which exploded in value. Public Citizen also issued this statement and a letter about his stock trade history.
Three McClatchy reporters, Greg Gordon, Lesley Clark and David Goldstein, took an early look at campaign donations from medical groups favoring Price, who has “has long been an advocate for medical specialists, promoting a traditional, market-based health care system that critics say pays little heed to the nation’s soaring medical costs.” Roll Call dove into his donor base and how he has defended some of their interests.
CNN reported that Price purchased shares $1,001 to $15,000 worth of shares last year in Zimmer Biomet, one of the world’s leading manufacturers of knee and hip implants. Soon after Price introduced legislation that would have directly benefited that company. It’s important to note that the bill he introduced aimed to eliminate the entire CMMI hip and knee bundling mandatory demonstration – and while Biomet would have been affected, so would huge swathes of the health industry. Price had long opposed massive mandatory CMMI experiments; it’s a defining issue for him.
It is important to note that the Trump transition team in that Jan. 16 email to reporters points out that Price’s policy positions on these issues have been clear for years. They also assert that since a broker manages Price’s portfolio, the congressman has not directly made some of the more controversial investment decisions ascribed to him.
Endorsements
The American Medical Association has endorsed Price to become HHS secretary, and that has weight on the Capitol Hill. Here’s Patrice A. Harris, M.D., the AMA’s board chairperson, explaining the reasons in this post at the Kevin MD site:
“Over these years, there have been significant policy issues on which we agreed (medical liability reform) and others on which we disagreed (passage of the Affordable Care Act),” Harris wrote. “Two things that have been consistent are his understanding of the many challenges facing patients and physicians today, and his willingness to listen directly to concerns expressed by the AMA and other physician organizations.”
The endorsement was not popular with a lot of the AMA’s members, as this petition illustrates.
I’m writing this post just before the first hearing, and while Price’s confirmation still appears likely, Democrats do plan a tough fight. You never know what surprises can come up in the course of a confirmation, as one past HHS nominee – former House Speaker Tom Daschle – can testify.
