Trump picks Rep. Tom Price for HHS secretary, Verma for CMS

By Modern Healthcare - November 28, 2016

Rep. Tom Price, poised to become the next HHS secretary, rips up a page of the Affordable Care Act ahead of Supreme Court arguments in a 2012 case challenging the law.

(Story updated at 11:04 a.m. ET)

U.S. Rep. Tom Price was nominated to be HHS secretary by President-elect Donald Trump, according to a person familiar with the decision. Seema Verma, who helped craft Indiana's conservative Medicaid expansion will lead CMS.

Price, an orthopedic surgeon from Georgia, would be a key part of Trump's promise to begin repeal and replacement of the Affordable Care Act immediately after inauguration in January.

Price currently has a powerful position as chairman of the House Budget Committee. The Republican is also on the Health Subcommittee of the House Ways and Means Committee.

Verma, a consultant, worked with Vice President-elect Mike Pence, the governor of Indiana, on Healthy Indiana 2.0, a Medicaid program that requires monthly contributions to health savings accounts.

"Together, Chairman Price and Seema Verma are the dream team that will transform our healthcare system for the benefit of all Americans," Trump said in a statement.

Democrats reacted with alarm, though they lack the power to block Price because of a change to filibuster rules they orchestrated when controlling the Senate.

"Congressman Price has proven to be far out of the mainstream of what Americans want when it comes to Medicare, the Affordable Care Act and Planned Parenthood," said incoming Senate Minority Leader Charles Schumer (D-N.Y.) "Thanks to those three programs, millions of American seniors, families, people with disabilities and women have access to quality, affordable health care. Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the hen house."

Price has been a staunch ACA critic and was one of the first to put forward his own replacement plan in the form of the Empowering Patients First Act.

It involves age-adjusted tax credits to help people buy insurance as well as increased reliance on health savings accounts and high-risk pools at the state level. It would allow people to opt out of Medicare, Medicaid or Veterans Affairs benefits and receive the tax credit to buy an individual plan. Critics say the plan would fail to keep pace with inflation and force higher out-of-pocket costs like deductibles and co-payments. The legislation has not been scored by the Congressional Budget Office.

Experts have also guessed he would concentrate on state reform efforts and noted he has worked across the aisle. Price has been a strong supporter of looking to state governments for proposals of how to spend their healthcare dollars, even if the ideas are more left-leaning than he might personally advocate.

He would likely encourage states to seek waivers for using Medicaid and Medicare money their own way.

Price has recently touted the healthcare plan spearheaded by House Speaker Paul Ryan, which has many of the same elements.

Another likely area of focus for Price at HHS would be rolling back abortion rights. He has previously called for defunding Planned Parenthood and has supported many pieces of anti-abortion legislation. In 2015, he co-sponsored a bill that would ban abortion after 20 weeks.

He has also opposed the ACA provision that requires plans to cover birth control as a no-cost preventive measure. Joe Antos, a health policy expert at the conservative-leaning American Enterprise Institute, said that Republican control of Congress and the White House could make abortion a more active issue than it has been before, although it would likely be decided in the courts.

Price appears to favor continuing bipartisan efforts to move away from fee-for-service reimbursement and focus on paying for the value and quality of care.

He voted for the Medicare Access and CHIP Reauthorization Act and put forward a path for value-based reimbursement methods in Medicare. Recently, however, he has criticized some aspects of the law's implementation. He has specifically said reporting requirements are a burden to physicians and should be streamlined.

Price has said the CMS Innovation Center, which develops and pilots value-based payment models and has been a frequent target for conservatives, has too much authority and should defer more to Congress.

Price joined Congress in 2004 after four terms in the Georgia state Senate. He worked in private practice for nearly 20 years and has taught residents at Emory School of Medicine and Grady Memorial Hospital in Atlanta.

Health professionals have been a major source of donations to Price throughout his political career. Individual and political action committees in the healthcare sector have donated more than $4.8 million to him. The American Association of Orthopaedic Surgeons is a top donor group.

Bruce Siegel, president and CEO of America's Essential Hospitals applauded the two top healthcare policy picks.

"Particularly noteworthy about both nominees is their experience caring for low-income and other vulnerable people, shaped by their work at hospitals with a safety net role— essential hospitals," Siegel said.

The last HHS secretary with a medical background was Dr. Louis Wade Sullivan, who served during President George H.W. Bush's administration and was founding dean of the Morehouse School of Medicine.

Other potential picks included Louisiana Gov. Bobby Jindal, who served in HHS in the George W. Bush administration.

Price would likely work closely with Paula Stannard, a former deputy general counsel and acting general counsel at HHS, who reportedly has been tapped by the Trump team to work more broadly on health reform initiatives. Stannard oversaw the food and drug, civil rights and legislation divisions of the 450-attorney HHS Office of the General Counsel. She also provided legal advice and counsel to senior HHS officials, including secretaries Tommy Thompson and Michael Leavitt.

Both Price's and Verma's nominations need to be confirmed by the Senate. The Trump administration also will need congressional approval to repeal and replace the ACA.