Trump picks healthcare “dream team;” or is it something else?

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President-elect Donald Trump has assembled his healthcare “dream team.” Rep. Tom Price (R-GA), a longtime critic of the Affordable Care Act but champion of health IT legislation that reduces the burden on physicians, is his pick to lead the Department of Health and Human Services. And he chose Seema Verma, founder and CEO of consulting firm SVC Inc., to serve as administrator of the Centers for Medicare & Medicaid Services (CMS).

@realDonaldTrump nominates @RepTomPrice to lead @HHSgov & Seema Verma for @CMSgov Click To Tweet

Price, a representative from Georgia’s 6th Congressional District and chairman of the House Budget Committee, supported Trump throughout his candidacy, arguing that the healthcare reform law had “destroyed” the healthcare system. Indeed, The Washington Post notes that he was a leader in Republican opposition to the ACA and worked on several comprehensive bills to replace it.

“Chairman Price, a renowned physician, has earned a reputation for being a tireless problem solver and the go-to expert on healthcare policy, making him the ideal choice to serve in this capacity,” said President-elect Trump in a statement. “He is exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible healthcare to every American. I am proud to nominate him as Secretary of Health and Human Services.”

Trump said Verma is his choice for CMS administrator because she has “decades of experience advising on Medicare and Medicaid policy and helping states navigate our complicated systems,” according to FiercePharma. If both positions are confirmed, Trump said, Price and Verma would be “the dream team that will transform our healthcare system for the benefit of all Americans.”

Price said in a statement that he was “humbled” by the nomination and the challenges ahead. “There is much work to be done to ensure we have a healthcare system that works for patients, families, and doctors; that leads the world in the cure and prevention of illness; and that is based on sensible rules to protect the well-being of the country while embracing its innovative spirit,” he said.

Unsurprisingly, reaction to Trump’s choice for the next HHS secretary split along party lines. While House Speaker Paul D. Ryan (R-WI) said in a Twitter post that Price is the “absolute perfect choice for HHS secretary,” incoming Senate Minority Leader Charles Schumer (D-NY) said in a statement to media outlets that Price doesn’t represent what Americans want when it comes to Medicare, the ACA and Planned Parenthood.

“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,” Schumer said.

In addition to dismantling President Barack Obama’s signature legislation, Forbes reports that Price could slow the healthcare industry’s transition to value-based care. The 62-year-old orthopedic surgeon has opposed Medicare’s mandatory bundled payment initiatives for hip and knee replacements. He has also criticized the implementation of the Medicare Access and CHIP Reauthorization Act.

However, Price has also been vocal on health IT issues in Congress, according to Politico, which noted that he pushed for a doctor-friendly version of the law regulating the use of electronic health records. The American Medical Association issued a supporting his nomination.

“Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” the AMA stated.

Price also filed unsuccessful legislation to prevent HHS from forcing physicians to use ICD-10 codes prior to the new code set’s implementation last year, according to Medscape.

Verma said she was honored by the nomination and looks forward “to helping him tackle our nation’s daunting healthcare problems in a responsible and sustainable way.”

The Indiana resident has close ties to Vice President-elect Mike Pence, according to her bio, and designed Pence’s Medicaid expansion plan, known as Healthy Indiana Plan 2.0, and also worked with other states including Kentucky, Iowa, and Ohio on their Medicaid expansion proposals.

Before she became a consultant, Verma worked as vice president of planning for the Health & Hospital Corporation of Marion County, Indiana, and as the director of the Association of State and Territorial Health Officials in the District of Columbia.

Steve’s Take:

In choosing Rep. Tom Price, Donald Trump has picked as his secretary of health and human services a man intent on systematically weakening, if not annihilating, the nation’s healthcare safety net. He’s been extremely outspoken about that, so let’s start with such assumption.

Dr. Price, a Republican from Georgia, is a fierce opponent of the Affordable Care Act, the 2010 health reform law, and beyond that, supports plans to rip Medicare and Medicaid, which cover tens of millions of elderly, disabled and low-income Americans. He is against a woman’s right to choose and has backed legislation to strip Planned Parenthood of federal funding.

Mr. Trump and many Republicans have talked vaguely about plans to repeal the health reform law but suggest they might keep some popular parts of it, says The New York Times. Dr. Price makes no such pretenses. The detailed legislation he introduced most recently in 2015 would destroy the reform law and is a good indication of his philosophy in managing the nation’s largest health programs: cut benefits and leave millions with no health care whatsoever.

So, to repeat, Dr. Price has remained steady for many years in his calls to see the ACA repealed, Forbes points out.

His bill would, among other things, roll back the federally financed expansion of Medicaid in 31 states and the District of Columbia, taking coverage away from 14 million poor. It would also severely cut federal subsidies that help individuals and families buy policies on government-run health exchanges.

The reduced subsidies would make it hard, if not impossible, for millions to afford the coverage they have gotten since the Affordable Care Act went into effect. And the bill would no longer require insurers to cover addiction treatment, birth control, maternity care, prescription drugs and other essential medical services.

As for coverage of pre-existing medical conditions–a key element of the current law, requiring insurers to sell plans to those with health problems–Dr. Price’s bill has that protection only for those who maintained continuous health coverage with any insurer for the previous 18 months. This means that insurers would not be required to sell an affordable plan to anyone who did not have coverage for, say, a month while he or she was between jobs.

Before being elected to Congress, Price was a successful orthopedic surgeon for two decades, an assistant professor at Emory University School of Medicine and medical director of the Orthopedic Clinic at Grady Memorial Hospital in Atlanta.

As for Medicare, Price said after Mr. Trump’s election that he planned to fast-track privatization, a long-held Republican idea in which seniors would be provided vouchers to buy whatever insurance they choose. But those subsidies would also grow more slowly than medical inflation, leaving seniors to pick up more of the cost or to forego adequate care.

Mr. Ryan’s latest iteration works a lot like the Obamacare exchanges–private insurers and the government would offer plans from which seniors could choose, and if they pick one that costs more than their subsidy, they pick up the tab. Dr. Price has also supported raising the eligibility age from 65 to 67, says the Baltimore Sun.

All this would cut costs for the federal government–the Congressional Budget Office estimated that Dr. Price’s Medicaid proposal would reduce federal spending by $1 trillion over a decade, effectively reducing the program’s budget by a third in the final year of that period. The savings from the latest privatization program for Medicare aren’t clear, but Mr. Ryan has couched his proposals in terms of reducing the entitlement’s long-term costs–which is ironic in that Obamacare actually extended the solvency of the program by 11 years.

But it wouldn’t necessarily cut costs for the healthcare system, and in fact, Dr. Price has been hostile to the federal government’s efforts to shift away from fee-for-service models of payment toward ones that focus on quality and outcomes–perhaps the most far reaching of which is Maryland’s Medicare waiver.

That experiment has held hospital spending growth in Maryland to a cumulative 4.2% since January of 2014, saving Medicare nearly $420 million. Meanwhile, the hospital readmission rate for Medicare patients there during that time dropped nearly 6% compared to the national average, and the rate at which patients acquire infections in the hospital has dropped by a third.

Beyond his commitment to eviscerate Obamacare, Dr. Price, who leads the House Budget Committee, published a budget proposal (pdf) last year that would convert Medicaid into a block grant to state governments. This would reduce federal spending on the program by 34% by 2025, according to the Center on Budget and Policy Priorities. Such a cut would inevitably cause states to offer fewer benefits and reduce the number of people covered, far beyond the 14 million who would lose their coverage if Medicaid expansion is rolled back.

It is impossible to know which parts of Dr. Price’s agenda will become priorities for the new administration. But we do know that he will now have a very powerful pulpit from which to advocate his radical positions.

Meanwhile, Seema Verma, who has a master’s in public health from Johns Hopkins University, has been chosen to head CMS. She has a strong background in health policy and is not new to either state- or federal-level health programs, particularly Medicaid. She will do well to serve as a strong voice for community and public health, having overseen many initiatives in her home state of Indiana. Her selection might also suggest that Medicaid reform is in discussion.

Although HHS Secretary Sylvia Burwell contends that Obamacare is “now woven into the fabric of our nation,” it will certainly not exist in its current form much longer. While most estimate that a full repeal will not happen, it is certain that major changes are coming. And the ACA is not alone. It is reported that a major overhaul of the FDA will occur early in the new administration, and that some transformations will take place in the Centers for Medicare & Medicaid Services (CMS).

So what’s the bottom line on these nominations’ effect on our healthcare system–assuming they will be confirmed–and, of course, they will.

Dr. Price and Ms. Verna offer the prospect of a healthcare system transformed far more radically than President Barack Obama ever attempted. That’s not what Mr. Trump campaigned on, but it may be what we Americans are in store for.

Steve's Take: @RepTomPrice & Seema Verma will change healthcare more than @BarackObama Click To Tweet

If nothing else, it should be an exciting time for HHS personnel there on Independence Avenue in DC following the inauguration. But it’s not just federal government types, it’s all of us who will be morphing from the Obamacare era to this upcoming one. Buckle your seat belts!