[W]ASHINGTON — The first day of confirmation hearings for the secretary of the U.S. Department of Health and Human Services felt more like a proxy war about the future of the Affordable Care Act than the vetting of a Cabinet member.
Rep. Tom Price, R-Ga., has been a leading House critic of the ACA, also known as Obamacare. Shortly after the law passed, Price said the law is “a costly and misguided encroachment of government that will destroy jobs and drive our nation further toward a fiscal crisis.”
President-elect Donald Trump’s decision to tap Price for HHS sends a clear signal that he will try to repeal the law as president. Both the House and Senate have initiated the budget reconciliation process directing congressional committees to draft repeal legislation.
In Price’s Wednesday hearing before the Senate Health, Education, Labor and Pensions Committee, Democrats vigorously defended Obamacare, citing the 20 million people the law has covered.
“My constituents are coming up to me with tears in their eyes, wondering what the future holds for their health care given the chaos Republican efforts could cause,” said the committee’s ranking member Sen. Patty Murray, D-Wash.
In his opening remarks, committee chairman Lamar Alexander, R-Tenn., painted a starkly different picture, likening the law to “a collapsing bridge in your hometown.”
“Across the country, premiums and copays are up, employers have cut jobs in order to be able to afford the mandates of Obamacare, Medicaid mandates are consuming state budgets,” Lamar continued. “In one third of America’s counties, citizens with federal subsidies have only a single choice of a company to buy insurance from on the Obamacare exchanges.”
Price struck a conciliatory tone, promising that “nobody’s interested in pulling the rug out from anybody.”
“We all want a health care system that’s affordable, that’s accessible to all, of the highest quality, with the greatest number of choices, driven by world-leading innovations, and responsive to the needs of the individual patient,” Price said.
U.S. Sen. Bernie Sanders, I-Vt., was skeptical of Price’s remarks and relentlessly prodded him, demanding clear pledges on health care policy.
Vermont’s junior senator began by quoting various Trump pronouncements promising to protect federal safety net programs, including the following tweet:
I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid. Huckabee copied me.
— Donald J. Trump (@realDonaldTrump) May 7, 2015
“I think it is likely [Trump] won the election because millions of working class people and senior citizens heard him say he was not going to cut Social Security, Medicare and Medicaid,” Sanders said. “Congressman Price, a very simple question: Is the president-elect, Mr. Trump, going to keep his word to the American people and not cut Social Security, Medicare and Medicaid, or did he lie to the American people?”
Price kept his response short: “I have no reason to believe he’s changed his position.”
Sanders then quoted Trump again, this time from a press conference the president-elect held this month in which he pledged to negotiate for lower drug prices.
“Pharma is getting away with murder,” Trump said at the time.
Sanders asked Price to pledge to work with Democrats to allow for the importation of cheaper prescription drugs from Canada and other countries — a longtime Sanders policy goal.
Sanders also asked Price whether, if confirmed, he would use the vast bargaining power of Medicare, a program that purchases drugs for millions of Americans annually, to negotiate for lower prescription prices.
Price said “there are a lot of reasons” for high costs.
“Do you believe that health care is a right of all Americans, whether they are rich or they are poor?” Sanders asked next.
“We are a compassionate society,” Price began, only to be interrupted by Sanders.
“No, we are not a compassionate society,” the Vermont senator snapped back. “In terms of our relationship to poor and working people our record is worse than virtually any other country on Earth. We have the highest rate of childhood poverty of any other major country on Earth, and half of our senior, older workers have nothing set aside for retirement.”
While Trump promised over the weekend to ensure “insurance for everybody” in his replacement plan, Republicans have tried to walk back that rhetoric.
Sanders asked Price to define what an ideal system would look like. Price promised to “make sure that every single American has access to the highest quality care and coverage that is possible.”
“‘Has access to’ does not mean they are guaranteed health care,” Sanders shot back. “I have access to buying a $10 million home. I don’t have the money to do that.”
Price, an orthopedic surgeon and Tea Party caucus member, has repeatedly introduced legislation in the House to replace the ACA.
His 2015 bill — The Empowering Patients First Act — is being eyed as a possible skeleton for Republicans as they draft comprehensive replacement legislation.
Price’s replacement bill would, among other things, expand the contribution caps allowed for health savings accounts. Deposits to HSAs are not subject to the federal income tax and may be used to cover certain health care costs for people with high-deductible health plans. The bill would also expand the number of services HSA savings could pay for, including some primary care costs.
Price’s plan offers federal tax credits to help consumers pay for health care. But unlike the tax credits offered through the ACA — which are calculated on an income scale — Price’s plan would calculate credits based on age.
The proposal would allow Americans to opt out of government-run health plans — including Medicare, Medicaid and plans offered through the Department of Veterans Affairs. In exchange, consumers would receive vouchers to purchase health care through a private insurance provider.
Price’s bill would also offer incentives for states to set up so-called high-risk pools, which, before the ACA was passed, offered care for people with pre-existing conditions, such as cancer, who found it hard to find coverage. The pre-existing condition protections mandated in the ACA would be weakened significantly.
The plan would also fully repeal the Medicaid expansion offered under the ACA, which has resulted in roughly 10 million more low-income Americans receiving health coverage. (In Vermont, Medicaid expansion allowed the state to cut the number of people without insurance in half between 2009 and 2014, though costs hurt last year’s state budget. Medicaid costs have declined in fiscal year 2016.)
Price, the House Budget chairman, has proposed draconian cuts to entitlement programs, including reductions over a 10-year period of $449 billion to Medicaid and more than $1 trillion to Medicare.
Consumers would be able to buy out-of-state health insurance policies, under the Price proposal, an idea championed in Vermont by Gov. Phil Scott.
Scott and other Republicans believe the move would foster more competition and lower prices as health care companies jockey for customers. But differences in regulations and requirements by state could be difficult to maneuver.
In his testimony Wednesday, Price offered no hint of what exactly the replacement plan will look like, or how many of his past proposals will be embraced. He instead offered broad assurances to the public.
“I think there’s been a lot of talk about individuals losing health coverage,” Price said. “That is not our goal or our desire, nor is it our plan.”
Sen. Sheldon Whitehouse, D-R.I., said Obamacare is flawed but the law has slowed the rise in health care costs nationwide. (Vermont’s health care premiums are among the highest in the country, though they have risen at much lower rates that the national average.)
Whitehouse chastised Price and Republicans for criticizing Obamacare without offering any improvements to the law.
“We throw this thing out at our peril,” he said. “And we throw it out with nothing to replace it. It’s like being asked to jump out of an airplane without a parachute and saying, ‘Trust us, we will build a parachute.’”
In addition to policy quarrels, Democrats also raised ethical and legal questions about investments Price has made in health care companies.
Price’s nomination is not subject to approval from the Senate HELP committee, and instead will be voted on by members of the Senate Finance Committee, which will hold a hearing with Price on Jan. 24.
