Under the bright studio lights and a red, white and blue set, moderators and audience members at a recent CNN town hall event took turns grilling Health and Human Services Secretary Tom Price about the way the GOP health care bill treats the sick, the vulnerable and the elderly.
Questions oscillated from the personal to the emotional to the fiscal.
A since-recovered cancer patient spoke of how Obamacare’s Medicaid expansion saved his life and prevented financial ruin. “Why do you want to take away my Medicaid expansion?” Brian Kline asked.
A Planned Parenthood supporter pressed Price on his stance related to the woman’s health care provider given its role of treating the poor. And co-host Wolf Blitzer also pushed the former Georgia congressman on the bill’s estimated $880 billion cut to Medicaid.
No matter what was thrown at him, Price was unflappable. His answers were chipper, polished and empathetic — to a point. But he also used every opportunity to spin tough questions into a chance to spread the White House message.
“Thank goodness that things are going well from your health care standpoint,” Price told Kline. “I practiced medicine over 20 years and took care of a lot of patients with cancer. And it was one of those challenges that, when it faces you as an individual or someone in your family, you want to make certain that you’ve got access to the highest quality care that you can receive.”
The hourlong town hall came at a critical moment for the embattled health care bill and one of the top men tasked with selling it.
Republican moderates, unsettled by the number of people projected to lose their coverage, were beginning to announce their opposition. Earlier that day, conservative grass-roots activists had flooded Capitol Hill to rally against the legislation, and House Speaker Paul Ryan conceded for the first time that he would need to make changes in order for it to pass.
None of that was apparent as Price made his case before the cameras. The bill, dubbed the American Health Care Act, might as well have been a bouquet of daisies.
“Wolf, you’re falling into the same old trap of individuals who are measuring the success of Medicaid by how much money we put into it,” he told Blitzer when pressed about the funding cuts.
Price's town hall performance offers a glimpse into why the former orthopedic surgeon landed the job he did in the Trump administration. It also provides clues about how the deeply private man from Roswell will use his new role to remake a sector that drives one-sixth of the economy.
Price, 62, is firmly rooted in his conviction that health care decision making should be shifted away from Washington’s corridors of power and toward states and doctors’ offices. He has entered his second month as health chief seemingly well aware of his position’s unparalleled power to help determine how care gets delivered in America.
Public salesman
As a member of Congress, the guarded Price was never one to go out of his way to talk to the press.
But in the two weeks since the American Health Care Act was introduced, Price has made cable news appearances on a near-nightly basis.
The media blitz has given many people outside metro Atlanta their first glimpse of Price’s doctorly bedside manner.
The man is pretty much the same behind closed doors, several of his former colleagues say. They have been seeing a lot more of Price recently as he’s made the sales pitch to wary lawmakers on behalf of the Trump White House.
“It’s all about business,” Georgia U.S. Sen. David Perdue said of a recent presentation Price gave to Senate Republicans. He said Price explained to the group: “ ‘Here are the things we’ve already done. Here are the things we’re about to do, and these are the impacts.’ ”
Price was never a social butterfly during his 12 years in the House of Representatives, nor did the Michigan native fit in with the Georgia delegation’s good ol’ boy ethos. But his policy credentials, particularly on health care, were broadly respected among his GOP colleagues.
He was among the first and only House Republicans to offer a comprehensive alternative to Obamacare as early as 2009. The Empowering Patients First Act later became the starter dough for the current GOP replacement bill, but it was stricter in some aspects, including in its immediate repeal of the Affordable Care Act’s Medicaid expansion.
Price would tutor fellow Republicans on how to talk about health care and other policy issues on the campaign trail, and lawmakers would sometimes approach him on the House floor to seek medical advice only half-jokingly.
“Tom’s a smart guy,” said U.S. Rep. Mike Simpson, R-Idaho, a longtime colleague who’s still undecided on the GOP health care bill. “If there’s one guy that can convince me to vote for this, it might be Tom Price.”
But Price’s relationships on Capitol Hill may only go so far. Internal differences over health care may be too deep-rooted to win enough consensus to pass the American Health Care Act or any other GOP plan.
“I’ve always admired Tom Price,” said U.S. Rep. Raul Labrador, R-Idaho, a member of the conservative House Freedom Caucus, one of the holdouts on the plan. “I just think he’s got a problem that he’s got a product that’s not that good. All that respect that I have, I can’t set aside my concerns about the bill.”
Price's role as top salesman hasn't been without its hiccups. He had a major unforced error last weekend when he said that "nobody will be worse off financially" under the GOP bill. Critics compared the comment to President Barack Obama's notorious "if you like your health care plan, you can keep it" pledge during the previous health care debate, and Price later backed away from the remark at the CNN town hall.
“Markets are constantly changing. Providers are coming in and out of networks,” said U.S. Sen. Ron Wyden of Oregon, the top Democrat on the Senate Finance Committee who was heavily critical of Price during his confirmation process. “So when I saw him on Sunday saying nobody’s going to get hurt, I said ‘that movie is not going to end well.’ ”
The stakes could not be higher.
President Donald Trump and the GOP have gambled their political futures on tearing down and replacing the Affordable Care Act. If they are ultimately unable to follow through, it could have real consequences at the ballot box in 2018 and beyond.
For Price, the stakes are more personal. He no longer has to worry about re-election every two years, but he’s built his political career on marketing his own vision for health care. It would be a major disappointment if the long promised repeal-and-replace bill fails.
Price declined an interview, but his spokesman, Ryan Murphy, said the secretary is “working tirelessly to make certain patients’ interests are represented at every step in the process.”
“Having served as a doctor, as a member of Congress and now as the head of HHS, Secretary Price understands this issue from every angle — from the perspective of ensuring patients are at the center of these solutions, that the legislative process is respected, and that there is appropriate regulatory relief to address the harm Obamacare is doing to the American people,” Murphy said in a statement.
Regulatory master
Price’s biggest chance to make his mark on the health care system could come administratively, regardless of whether the Republican replacement bill passes.
Through special rule makings, guidance and regulatory tweaks at HHS, Price can make what are essentially unilateral changes to loosen the grip of the Affordable Care Act or tweak aspects of Medicare that could have a major impact on doctors and patients.
More than most other health secretaries in recent memory, Price is viewed by many observers as a master of such minutiae.
He has “a lot of room to actually change how we’re seeing health care right now without making legislative changes,” said Kristi Martin, a former senior adviser at HHS who helped implement Obamacare.
Using those powers is built into what Trump has described as “phase two” of the Republican health care plan.
Price has already begun doing some behind-the-scenes tinkering to clear a path for the White House-backed bill, recently writing a letter to states that some said opened the door for adding work requirements to Medicaid, long a priority of conservatives.
The White House has been vague about other specific changes that Price may seek, but some experts interviewed by The Atlanta Journal-Constitution said Price could look to water down what are known as “essential health benefits.”
Under the Affordable Care Act, insurance plans on the individual market have to cover nearly a dozen such benefits, but “the outlines of that in the law were very vague,” said Thomas Scully, who led HHS’ Centers for Medicare and Medicaid Services during the George W. Bush administration. “So the details about how those are designed and what are in those packages are basically all administrative.”
Up to Price’s interpretation, Scully said, are how such plans cover issues like mental health.
It’s a similar story for the types of birth control that insurers must offer free of charge under the Affordable Care Act, Martin said. The Obama administration told insurers they had to cover all approved methods of birth control, she said, but Price could change those requirements.
Another powerful lever available to Price is through HHS’ Center for Medicare and Medicaid Innovation. The program, which was once on the GOP’s hit list, allows Price to test out on a pilot scale different ideas for altering how such entitlement programs deliver their services.
“Based on their chief actuary’s analysis, if it saves Medicare money, they can just enact it programwide,” said Kenneth Thorpe, a professor of health policy at Emory University. “It’s a very, very powerful rule-making authority that he has.”
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