When Tom Price served in the Georgia Senate, he often carried with him a legal folder, about a foot thick, crammed with legislative proposals. The joke among his colleagues was that he was the only one under the Gold Dome who actually read all of them.
He had a similar reputation even before he entered elected politics. As a young doctor leading an executive committee at North Fulton Hospital, Price was known for running meetings with the organization’s bylaws in hand.
That 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. But it was health care policy that truly defined his career.
It was the reason he traveled the state in the 1990s to rail against Hillary Clinton’s health care proposal during her husband’s presidency, a prelude to his first run for office. It was the centerpiece of his rise from Roswell surgeon to political power broker in the Georgia Senate.
And his former campaign manager swears the chance to lead the federal government’s health care system was on his mind shortly after he won his U.S. House seat in 2004.
“This is something he was made for,” Jared Thomas said. “I remember clear as a bell, in August 2004 right after he won the seat, he said that he thought he had a good dozen years in the House but he wanted to be considered for health secretary or surgeon general.”
That timetable proved remarkably prescient, as President-elect Donald Trump tapped him last week to run the Health and Human Services Department. His 20 years in medical practice and two decades in public office made him a natural to carry out Trump’s goal of dismantling President Barack Obama’s health care overhaul.
Price, who has long shirked the press, has declined to give interviews in the days since his nomination, including with The Atlanta Journal-Constitution.
The ‘bad cop’
Price has not divulged his specific plans for the Department of Health and Human Services, with a roughly $1 trillion annual budget and 80,000 employees.
“The reason I got into the public service arena initially was because of concerns about health care, so it’s a great honor to be considered,” Price said Nov. 30 after a vote on Capitol Hill.
But his formative years in statehouse politics and medical practice provide clues to how he’ll run a sprawling bureaucracy.
Current and former colleagues describe Price as more of a workhorse than a back-slapper, someone who’s calculated, unquestionably knowledgeable and unafraid to go into the weeds on policy.
“A lot of nights we’d be going to dinner, the lights would be on in his office and he’d be in there working,” said U.S. Rep. Lynn Westmoreland, who served with Price on Capitol Hill and in the state Legislature. “I think that’s the reason that people may view him as not as sociable or whatever. His work ethic is just something I don’t think anybody could compete with.”
A Michigan native, Price ended up in Georgia partially to flee the cold. After studying medicine at Emory University — he’s a third-generation doctor — he helped build Resurgens Orthopaedics into a nationwide firm. In his free time, he roamed the sidelines of local high school football games, volunteering as a medic.
He earned his first political experience raveling to living rooms and conference halls as vice president of the Medical Association of Georgia, a role that helped him win an open state Senate seat. The trade group, which is often more conservative than national medical lobbies, continues to be fiercely loyal to him.
“Even though he’s been at the state Capitol, in Washington, D.C., he’s kept in touch with the doctors and patients and is very aware of what our daily issues are,” said Dr. Steven Walsh, the group’s president. “That awareness, his open-mindedness and his vision is going to create so much opportunity in the position he’s been offered.”
Price was ambitious from the start, and he soon won a role in the GOP’s small but growing caucus. Price and fellow Republicans squirreled away in basement rooms under the Gold Dome plotting a course to power. They recruited candidates, raised money and dreamed up policy.
Price was the movement’s no-nonsense drill sergeant who carved his niche as a wonkish majority leader — the first Republican in that role in Georgia history — when the GOP flipped the Senate after the 2002 election. The Republicans’ most immediate task was keeping together a fractious group of ideologues, newcomers and party-switchers, many getting their first taste of political power.
“What we both learned is how to herd cats,” said Eric Johnson, who was then the top Republican official in the Senate. “Everyone wanted to be a big dog, and he was so good at holding the stick sometimes. Sometimes the caucus needed to see the stick. And he’ll probably have to use that skill often: ‘You’re going to help me or you’re going to find another job.’ ”
He wielded his newfound power with brutal efficiency, sometimes exacting revenge on Democrats who had for generations controlled state government. He brought a Newt Gingrich-style sense of Republican partisanship to a party long in exile.
Price personally wrote the rules that sidelined Democratic Lt. Gov. Mark Taylor and was the quiet force behind “tort reform” — new limits on medical malpractice complaints long sought by the medical lobby and spurned by trial lawyers.
“There was no better tactical politician than Tom Price at the Capitol,” said Chuck McMullen, who was Price’s chief of staff in the Senate.
His statehouse inner circle was tight, revolving around his wife, Betty, an anesthesiologist who is now a state legislator, and a few close aides. He quickly established a reputation for a prickly personality and a sharper tongue. He was respected but never loved by many of his fellow politicians, and some privately poked fun at his high-pitched voice and brusque manner.
He never seemed to mind the talk. Johnson called him the “bad cop to my good cop.” And Thomas put it this way: “Tom has never viewed politics as a charm contest. He’s there to get stuff done. And occasionally you have to break some eggs to make an omelet.”
‘The wrong side’
To Democrats, he could be insufferable. Other Republican leaders would flirt with supporting Democratic proposals or compromise. Price struck a hard line.
“He was hard to deal with,” said Bobby Kahn, the top aide to Democratic Gov. Roy Barnes, who was in office from 1998 to 2002. “He didn’t tell you what you wanted to hear like some of the others. He either wouldn’t respond or would just tell you no.”
Tom Bordeaux, then a Democratic lawmaker from Savannah, remembers trekking to Price’s office for a sit-down on the flaws of a tort reform measure.
“He was polite. He was cordial and kind to talk about it. But he was totally inflexible,” said Bordeaux, who was recently elected to a probate judgeship. “That came from seeing a totally different side of everything than I do.”
Price’s solidly conservative voting record included hard-right stances on some of the state’s biggest debates. He backed Georgia’s constitutional amendment banning same-sex marriage and opposed Barnes’ plan to shrink the size of the Confederate emblem on the state flag. The latter vote, in particular, still infuriates Georgia Democrats.
"He's an intelligent guy. That's why I was really disappointed when he voted against changing the flag," said state Sen. Vincent Fort, an Atlanta Democrat elected to the state Senate the same year as Price. "It was a vote that history would remember, and he was on the wrong side of it."
Climbing the ladder
When Johnny Isakson announced he would leave his U.S. House seat to run for the U.S. Senate in 2003, Price decided to join the crowded field to replace him. The odds were against him.
The seat stretching across Atlanta’s affluent northern suburbs had been represented by a Cobb County Republican since it was created by the Legislature in 1991, and the geography favored state Sen. Robert Lamutt, a venture capitalist from Cobb who pumped more than $1.5 million of his own fortune into the campaign.
But Price closed the gap in Cobb — he even told a reporter in the heat of the race that he would move there, though he never did — and ran up the score so much in north Fulton in an August 2004 runoff that he won.
In Washington, Price made clear he had higher ambitions. He methodically, yet cautiously, positioned himself for top posts in the House, Senate and Georgia’s Governor’s Mansion, but he only rose as high as the No. 5 leadership job in the House.
“There’s a hunger for some new thinking, critical thinking, creative thinking, more energy,” Price said in September 2015 after launching a short-lived bid for House majority leader, running as a consensus-builder. “We don’t need more division. We’ve had way too much division.”
Upon first arriving in Congress, Price aligned himself with the chamber’s most conservative members, eventually rising to become chairman of the influential Republican Study Committee. Inspired by Gingrich, he took to the House floor weekly in the late 2000s to rail against the Democrats in charge, leading what he called the “official truth squad” that evangelized to the C-SPAN cameras and a mostly empty chamber.
Price’s buttoned-up Midwestern sensibility at times didn’t fit in with the good ol’ boy manner of many of his fellow Georgians in Congress.
“Price is that kid in class who always raises his hand,” said Brian Robinson, a Republican operative and former aide to Westmoreland and Gov. Nathan Deal who praised Price’s selection as health secretary. “He knows every answer and volunteers for every assignment.”
That friction boiled over during the 2010 governor’s race, when Price was the only GOP member of the delegation to back family friend Karen Handel over Deal, a former colleague. That slight was not forgotten in the governor’s office, and Price was largely left out of the redistricting process that year.
“In this business you have things that you disagree with people on and then you’re going to have things that you agree with them, and 95 percent of the time I would say that the delegation was in agreement with what Tom did,” Westmoreland said. “We don’t harbor a lot of bad feelings.” He also said Price was an ideal pick for health secretary.
‘He knows who he is’
Over the years, Price has built a sterling reputation among Republicans on health care issues. He was also known for relentlessly sticking to a message.
His circle of confidants in Washington remained small, but he became fast friends with Paul Ryan, a fellow policy geek who shared breakfast with him weekly as part of a small group that sometimes included Mike Pence.
“He knows who he is,” Ryan told The Atlanta Journal-Constitution in 2015. “He knows what he’s trying to get done and he knows how to work with people who do not necessarily agree with him, which makes him, in my opinion, a very effective conservative.”
Price in 2015 inherited the House Budget Committee chairmanship from Ryan. In that role he was able to achieve what Ryan never could thanks to a newly minted Republican Senate: an agreement to balance the budget for the first time in 14 years.
Price’s fiscal blueprint also proposed massive changes to Medicaid and the food stamp program in order to produce a surplus within 10 years. An offshoot bill repealing the Affordable Care Act and defunding Planned Parenthood was later vetoed by Obama.
Where Price truly separated himself from his colleagues was by offering one of the GOP’s only detailed replacement plans for the Affordable Care Act. The plan aimed to provide health care for all Americans without Obamacare’s mandate, but it never received a vote even after Republicans won control of the House.
Many of the proposals in Price’s plan are expected to see new life in 2017 now that Republicans control the White House and Congress, a prospect that worries left-leaning Obamacare backers.
“In Georgia, over 500,000 people have gained insurance through the Affordable Care Act, so we’re definitely concerned about what a repeal would mean for the people that gained coverage,” said Laura Harker, a health analyst at the Georgia Budget and Policy Institute.
Republicans on Capitol Hill will be able to avoid a Democratic filibuster and tear down large swaths of the law using a special budgetary process. They will also be able to use that same procedure to build portions of a replacement plan, but not all of it — the GOP will need some support from across the aisle for that.
What is clear is that after his Senate confirmation hearings — he's expected to be cleared with ease — Price is poised to play a leading role in what will surely be of the most divisive debates on Capitol Hill.
“He wants to win. He will want to accomplish this more than Trump wants to accomplish this. He does not like to lose,” said Johnson, his former Gold Dome colleague. “And he’ll use everything — sugar and spice — to win the battle for a new health care plan.”