Rep. Tom Price (R-GA), President Donald Trump’s nominee to lead the U.S. Department of Health and Human Services, was questioned about his position on the Trump Administration's plans to repeal and place the Affordable Care Act (ACA) during his second confirmation hearing, held by the U.S. Senate Finance Committee on Tuesday.
The Senate Finance committee will vote on advancing his nomination to the full Senate.
During the four-hour hearing, senators questioned Price about his positions on the future of the ACA, the scope of Medicare and Medicaid and the Trump’s Administrations plan to repeal and replace the ACA. In response to a question about what his goals for an Obamacare replacement plan, Price did not offer specifics but only said, “It’s imperative that we have a system that is accessible for every American, affordable for every American and incentivizes high quality healthcare and provides choices; it’s complicated to do.”
President Trump on Jan. 20 signed an executive order that could open the door for federal agencies to curtail some aspects of the ACA, and in particular, the order aims to reverse "unwarranted economic and regulatory burdens" resulting from the ACA.
Senator Mark Warner (D-VA) asked Price, “If you’re confirmed in this position, will you use this executive order in any way to try to cut back on implementation or following the individual mandate before there is a replacement plan in place?”
“If confirmed, I’m humble enough to know I don’t have the all the answers. The talented people at the Department have incredible knowledge and an expertise and my first action is to gain that insight and information so that whatever decisions we make with you and governors and others can be the most informed and intelligent as possible,” Price said.
Warner continued “One of the reasons so many of us are anxious to see your replacement plan is that the President [Trump] says he wants to have insurance for everybody and he wants to keep the prohibition on pre-existing conditions and keep people on policies until 26 and it seems there is, at the same time, a rush to eliminate all the things that pay for the ability for Americans to have those services. I want assurances that you wouldn’t use this executive order prior to a legal replacement to eliminate the individual mandate, which I would believe helps to shore up the cost coverage and the shifting of cost that is required in an insurance system.”
Price replied, “Any replacement or reform or improvement of the program is imperative to be instituted simultaneously.”
Price also was questioned about his current involvement with the Trump administration’s plans to repeal and replace the ACA. Senator Sherrod Brown (D-OH), said, “President Trump said he’s working with you on a replacement plan for the ACA, which is nearly finished and will be revealed after your confirmation. Is that true?”
“It’s true that he said that, yes,” Price said. And, he added, “I’ve had conversations with the president about health care, yes.”
Senator Pat Roberts (R-KS) asserted that even if Congress does nothing to repeal or amend the ACA, “the law is not working and the market is collapsing.” “When your confirmed, what tools will you have that can be utilized to provide stability and improve the individual insurance markets so insurance carriers will want to come back during this transition?,” he asked Price.
Price said, “We need to reconstitute the individual and small group market and provide stability in our conversation and our tone. We need to lower the temperature in this debate and say to those providing insurance products, we hear your challenges. They are exiting the market, but there is help on the way to allow us to reconstitute the individual and small group market, so people can gain coverage they want and purchase at a reasonable amount.”
Before he was questioned by Senators, Price, an orthopedic surgeon and Georgia Republican Congressman, discussed his experience as a practicing physician and said, “Our healthcare system is losing focus on our number one priority – the patient.” Price also outlined the six pillars of what he thinks make up an effective healthcare system: affordability; accessibility; quality; innovation; responsibility; and choices.
“Across the spectrum of issues the department [HHS] handles, we have to strengthen our resolve to keep our promise to those most in need of care and support and that means saving, strengthening and securing Medicare and that means ensuring the Medicaid population has access to quality of care and we need to expand our leading role in medical innovation,” Price said.
Senators questioned Price on his view of the Centers for Medicare & Medicaid Innovation (CMMI), as the center has been questioned in the past by House Republicans, including Price, for overstepping its definition in statutes. The CMMI was established as an added section under ACA. Price said that CMMI has “gotten off track."
“Innovation is so incredibly important to healthcare…innovation is in fact what leads quality healthcare and expands the ability of healthcare professionals to be able to treat patients. I’m a strong supporter of innovation and we need to incentivize innovation. CMMI is a vehicle that might do just that, however, it’s gotten off track into defined areas where it is mandatorially dictating to providers how they must practice.”
He continued, “So whether it’s a geographic area, such as 67 areas of our country that have to perform a certain procedure in a certain way, or whether 75 percent of the Medicare part D demonstration that dictates to providers what drugs they must use, that to me that is no longer a trial. I hope we can move CMMI in a direction that makes sense for patients.”
Later in the hearing, Senator Warren asked Price if he supported CMMI delivery system reform demonstrations, to which Price replied, “I support making certain that we deliver care in a cost effective manner, but not do things that harms the quality of care being provided.” Warner also asked Price about his position on bundled and episodic payment models. “For certain populations, bundled payments make a lot of sense,” Price said. Further, when asked if he would allow, as HHS Secretary, expansion of these models across the system, Price didn't address the question but replied, “What we ought to do is allow for all sorts of innovation, we ought to incentivize innovation.”
When Senators brought up the regulatory burdens facing rural and critical access hospitals, Price highlighted the role of health IT, specifically telemedicine. “There are areas from a technology standpoint where we are missing the boat, in rural areas and critical access hospitals. In every other industry out there, the information technology age has arrived and is moving with rapid speed and it seems in healthcare we have put roadblocks up with regard to the expansion of technology, and we need to incentivize that. It’s possible now, in my state, that if an individual is suspected of having a stroke they can go to a critical access hospital and, via telemedicine, providers can access specialists at the University Health Center. That’s improving the lives and care of patients across our state and there are so many things we can do to mirror that technological expansion.”
Senator Roberts also brought up health information technology as it relates to Meaningful Use and electronic health records and specifically asked Price how he will ensure, what Roberts referred to as, “an effective, but smarter and less burdensome rulemaking process.”
Price responded that physicians “are leaving the practice, not because they have grown tired of it but the onerous nature of the regulatory scheme coming out of Washington, D.C.” “Meaningful use has turned physicians into data entry clerks,” he said. Although Price did not specify how he would change Meaningful Use or offer any specific details about regulatory policies if he were to be confirmed as HHS Secretary.
Senator Pat Toomey (R-PA) pointed out that as healthcare becomes more consumer-driven, there should be more focus on offering transparency on healthcare outcomes, and Price agreed, saying “Outcomes are important and measuring what makes sense from a quality standpoint, and transparency in pricing as well. Right now, we don’t have that, and if you want to know what healthcare costs, it’s hard to find that. We should be honest with ourselves as policymakers and make it patient friendly, we need to make that a priority,” he said.
But, before Price was questioned about healthcare policies, he faced rigorous ethics questions from Democratic Senator Ron Wyden of Oregon regarding his investments in healthcare firms and his trading in health care stocks during his time in Congress. Among Price’s holdings are some in Innate Immunotherapeutics, Ltd., an Australian biomedical company in which another lawmaker, Rep. Chris Collins (R-N.Y.) is a major shareholder. As Healthcare Informatics previously reported, according to Price’s financial disclosure statements, on Aug. 31 he bought between $50,001 and $100,000 worth of stock in the firm, as noted in an article in the online publication STAT.
Wyden said he saw a conflict and said Price understated the value of his investments in Innate Immunotherapeutics. “It is hard to see this as anything but a conflict of interest and an abuse of position,” Wyden said.
“Everything I did was ethical, above board, legal and transparent, and he reason you know about these things is because we made that information available in real time as required by the House ethics committee,” Price responded.
Sens. Ron Wyden and Patty Murray, the top Democrats on the Finance and HELP committees respectively, wrote a letter to Price, which was released Monday, requesting his brokerage and equity holdings agreements in order to review his investment decisions.
Healthcare Informatics Editor-in-Chief Mark Hagland reported last week, during a courtesy confirmation hearing taking place in the Senate Health, Education, Labor and Pensions (HELP) Committee, Democratic senators questioned Price about his investment in Innate Immunotherapeutics as well his purchase of shares in medical device manufacturer Zimmer Biomet last year. A CNN report last week noted that “Price bought between $1,001 to $15,000 worth of shares last March in Zimmer Biomet, and “less than a week after the transaction,” Price introduced legislation “that would have delayed until 2018 a Centers for Medicare and Medicaid Services (CMS) regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.”
Eight Senate Democrats wrote a letter calling on the Securities and Exchange Commission to investigate Price's stock trading activities, saying they “raise serious questions about potential STOCK Act violations, illegal insider trading, and other conflicts of interest.”