Senate Democrats, GOP at loggerheads over ACA repeal, HHS nominee

Senate Democrats on Tuesday grilled Rep. Tom Price, MD (R-Ga.), President Donald Trump’s pick to head the Department of Health and Human Services, on a host of healthcare issues, but most prominently regarding Republican intentions to repeal the Affordable Care Act.

Price was on the hot seat for four hours during a Senate Finance Committee hearing considering his nomination for HHS Secretary. Similar to last week’s “courtesy” hearing before the Senate health Committee, Tuesday’s questioning of Price was divided down partisan lines and was particularly contentious regarding the uncertain future of the ACA.

“The American public has heard many promises about healthcare from the new administration—no cuts to Medicare or Medicaid, nobody hurt by ACA repeal, insurance for everybody, much less expensive and much better,” said Ranking Member Sen. Ron Wyden (D-Ore.). However, he charged that “Congressman Price’s own record undercuts these promises.”

While congressional Republicans have yet to offer a replacement plan for Obamacare, Wyden noted that the Trump administration is plowing ahead with a “broad executive order that endangers Americans’ health” and that, as chairman of the House Budget Committee, Price is the “architect” of what Wyden called a “repeal and run” scheme.

According to Wyden, if Price’s repeal bill becomes law, 18 million Americans would lose their healthcare plans in less than two years.

“In one decade, you’d go from 26 million uninsured to 59 million,” he said. “Repeal and run raises premiums 50 percent in less than two years. Costs skyrocket from there. The market for individuals to buy health insurance collapses. No-cost contraceptive coverage for millions of women—gone. By defunding Planned Parenthood, nearly 400,000 women would lose access to care almost immediately. Hundreds of thousands more would lose their opportunity to see the doctors they trust.”

Overall, Wyden warned that Price’s plan “takes America back to the dark days when healthcare was for the healthy and the wealthy.” At the same time, he made the point that there’s a major gap between what President Trump has pledged to provide—“insurance for everybody” and “great healthcare…much less expensive and much better”—compared with the congressman’s own proposals.

Specifically, Wyden charged that the Empowering Patients First Act (H.R. 2300) sponsored by Price would fully repeal Obamacare and bring back discrimination against people with pre-existing conditions, such as pregnancy or heart disease. Under the provisions of the legislation, he said “insurers get the power to deny care and raise costs on those with pre-existing conditions if they didn’t maintain coverage.”

Nonetheless, in his testimony before the Senate committee, Price emphasized that his has been a “lifetime of commitment to improving the health and well-being of the American people.”

If confirmed as HHS Secretary, Price said he intends to fulfill the “promises our society has made to senior citizens and to those most in need of care and support by saving, strengthening, and securing Medicare for today’s beneficiaries and future generations while ensuring that our nation’s Medicaid population has access to quality care.”

Representative Thomas "Tom" Price, a Republican from Georgia and secretary of Health and Human Services (HHS) nominee for U.S. President-elect Donald Trump, left, speaks with Senator John "Johnny" Isakson, a Republican from Georgia, before a Senate Health, Education, Labor and Pensions Committee confirmation hearing in Washington, D.C., U.S., on Wednesday, Jan. 18, 2017. Price will be a key player in the GOP's efforts to dismantle the Affordable Care Act, the outgoing president's signature law. Photographer: Andrew Harrer/Bloomberg

On the topic of repealing Obamacare, Price contends that the ACA “isn’t working for folks in the individual and small group market.” He charges that, “premiums are up significantly” and high deductibles have grown, while problems persist in some areas of the country where there is only one health insurer offering coverage.

Price indicated that, if he is confirmed as HHS Secretary, he would be committed to working with Congress to “make certain that we have the highest quality healthcare and that every single American has access to affordable coverage,” adding that the goal is to “make sure people have better healthcare, not less healthcare.”

As far as discriminating against people with pre-existing conditions, Price argued that “in a system that pays attention to patients, nobody ought to be priced out of the market for having a bad diagnosis…what we need is a system that recognizes that pre-existing conditions do indeed exist, and we need to accommodate it and make certain that nobody loses their insurance or is unable to gain insurance because of a pre-existing condition.”

Asked by Wyden if some Americans will be worse off if the ACA is repealed, Price replied that the Trump administration will guarantee that individuals who lose coverage because of the repeal of Obamacare will be covered under whatever replacement plan emerges.

Given that scenario, Wyden told the Senate committee that he worries that repealing the ACA with only the promise to produce a replacement plan later is very troubling. “Independent experts say that this is going to destroy the market on which millions of working families buy health coverage,” according to Wyden.

Also See: Price contends Obamacare repeal isn’t intended to yank coverage from millions

Senate Finance Committee Chairman Orrin Hatch (R-Utah) noted that the next HHS Secretary will play a “pivotal role” as Republicans in Congress and the Trump administration work to repeal Obamacare and replace it with “patient-centered reforms that will actually address cost.” However, he challenged what he characterized as unfair attacks and "distorted" representations of Price’s legislative record.

“With regard to Dr. Price’s views and voting record, I’ll simply say that virtually all the attempts I’ve witnessed to characterize Dr. Price’s views as being ‘outside of the mainstream’ have been absurd, unless, of course, the only ideas that are in the ‘mainstream’ are those that endorse the status quo on healthcare and our entitlement programs,” Hatch said.

At the same time, Hatch emphasized that while repealing the ACA is an important endeavor for the Trump administration “it should not be the sole focus of the next HHS Secretary,” who will manage an annual department budget of more than $1 trillion.

“It is no exaggeration to say that HHS touches more of the U.S. economy and affects the daily lives of more Americans than any other part of the U.S. government,” Hatch said about the department, which includes the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology.

“I firmly believe that Dr. Price has the experience and qualifications necessary to effectively lead this large and diverse set of agencies, and many people share that view,” added Hatch.

Also See: Trump’s pick for HHS Secretary has health IT chops

As a member of Congress, Price introduced the Meaningful Use Hardship Relief Act of 2015 (H.R. 3940) and was an early co-sponsor of the FLEX-IT Act (H.R. 5001) to ease the burdens on providers in adopting health IT so that they can better focus on patient care.

At Tuesday’s Senate hearing, Price said that regulations like Meaningful Use are “choking” providers with burdensome requirements, so much so he argued that physicians are leaving their medical practices.

“We’ve turned physicians into data entry clerks,” Price added. “If you talk to patients, what they recognize is that when they go in to see their doctor they see the top of his or her head as they punch the data into a computer, as opposed to that sharing of information that’s so vital and necessary between the physician and patient for quality healthcare.”

Nonetheless, Price testified that he is a strong supporter of innovation, which is critical to providing quality healthcare. Still, he told the senators that the Center for Medicare and Medicaid Innovation (CMMI), which was created by the ACA to test innovative payment and service delivery models to reduce program expenditures while preserving and enhancing the quality of care, has “gotten off track” by dictating to physicians and other providers how they must practice.

“That’s changing the way that American medicine is practiced by folks making decisions here in Washington, as opposed to patients and families and doctors making those decisions,” commented Price. “I hope that we can move CMMI in a direction that actually makes sense for patients.”

The ACA appropriated $10 billion to support CMMI activities between fiscal years 2011 to 2019. However, what happens to CMMI should Obamacare be repealed remains an open question.

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