Price prom­ises ac­cess to health­care, but dodges ACA de­tails in first hear­ing

Modern Healthcare - - NEWS - By Shan­non Much­more

What would Rep. Tom Price do if con­firmed as the next HHS sec­re­tary? In a warm-up hear­ing be­fore a Se­nate com­mit­tee he at least af­firmed where he stands— even if he de­clined to clar­ify how the ad­min­is­tra­tion will pro­ceed on the Af­ford­able Care Act, Medi­care and Med­i­caid re­form and value-based pay.

Price, a con­ser­va­tive or­tho­pe­dic sur­geon from Ge­or­gia, said re­peat­edly that all Amer­i­cans should have ac­cess to health­care cov­er­age—but he stopped short of say­ing all Amer­i­cans should be cov­ered, de­spite Pres­i­dent Don­ald Trump’s re­cent state­ment that the re­place­ment for the Af­ford­able Care Act would in­clude “in­sur­ance for every­one.”

Price an­swered ques­tions for nearly four hours at a cour­tesy hear­ing be­fore the Se­nate Health, Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee. His of­fi­cial con­fir­ma­tion will be be­fore the Se­nate Fi­nance Com­mit­tee, which has sched­uled a hear­ing for Jan. 24.

Trump has said his team will have a plan ready to re­place the ACA when Congress moves to re­peal it, but Price of­fered no new de­tails.

But he em­pha­sized the im­por­tance of ac­cess to cov­er­age and the fi­nan­cial fea­si­bil­ity to buy it, dodg­ing a ques­tion from Sen. Bernie San­ders (I-Vt.) about whether health­care is a right. “It’s been al­ways my stated goal,” Price said. “That’s what I’ve worked on my en­tire ca­reer.”

The re­place­ment plans Price has en­dorsed, how­ever, would not main­tain cov­er­age for up to 30 mil­lion Amer­i­cans who ob­tained it un­der pro­vi­sions of the ACA. And it is un­likely the re­place­ment plans would pro­vide the fi­nan­cial as­sis­tance many Amer­i­cans would need to af­ford cov­er­age.

Karen Pol­litz, se­nior fel­low at the Kaiser Fam­ily Foun­da­tion, said whether the Em­pow­er­ing Pa­tients First Act, which Price in­tro­duced in 2015, would achieve the goals of ac­cess to af­ford­able cov­er­age for every­one

Dur­ing Wed­nes­day’s hear­ing, Price also in­sisted his ideas for ACA re­place­ment would put pa­tients at the cen­ter of their care by pro­vid­ing them with more choices and fewer man­dates.

de­pends on how cov­er­age is de­fined.

The plan pro­vides tax cred­its to help peo­ple pur­chase in­sur­ance, but they are based on age, not in­come. In­sur­ance com­pa­nies would likely pro­duce plans that could be af­forded with th­ese cred­its, but the cov­er­age would be far less com­pre­hen­sive than the min­i­mum ben­e­fits re­quired un­der the ACA, Pol­litz said. “The ba­sic frame­work is a re­turn to the way pri­vate mar­kets and Med­i­caid worked be­fore the ACA.”

Dur­ing Wed­nes­day’s hear­ing, Price also in­sisted his ideas for re­place­ment would put pa­tients at the cen­ter of their care by pro­vid­ing them with more choices and fewer man­dates.

Price also said the leg­is­la­tion to re­peal the ACA should not be a ve­hi­cle for changes to Medi­care. He said he un­der­stands that Trump has promised not to cut Medi­care, but he de­clined to make the same prom­ise.

Last week the Obama ad­min­is­tra­tion an­nounced that 359,000 clin­i­cians would par­tic­i­pate in the CMS’ sta­ble of val­ue­based pay­ment mod­els in 2017, many of them crafted and ad­min­is­tered by the CMS In­no­va­tion Cen­ter, which Price has crit­i­cized as over­step­ping its author­ity.

Price de­clined to com­mit to keep­ing or killing the In­no­va­tion Cen­ter. While say­ing it has “great pos­si­bil­ity and great prom­ise,” he re­it­er­ated his op­po­si­tion to pi­lots that re­quire providers to par­tic­i­pate. “I am a strong pro­po­nent and ad­vo­cate for in­no­va­tion, but I have seen in cer­tain in­stances what is com­ing out of CMMI is a de­sire to re­quire cer­tain kind of treat­ment for cer­tain dis­eases that may or may not be in the best in­ter­est of the pa­tient,” Price said. “I sim­ply re­ject that (Washington) is where those de­ci­sions ought to be made.”

The manda­tory Com­pre­hen­sive Care for Joint Re­place­ment model, he said, should have been a pilot that could be ex­panded if suc­cess­ful. CNN re­ported Price in­tro­duced leg­is­la­tion to de­lay that pro­gram after hav­ing pur­chased stock in Zim­mer Biomet, a lead­ing man­u­fac­turer of hip and knee im­plants.

Democrats on the panel re­peat­edly chal­lenged Price to ex­plain me­dia re­ports of in­vest­ments in health­care com­pa­nies that di­rectly ben­e­fited from leg­is­la­tion he helped en­act. He said he was “of­fended at the in­sin­u­a­tion.” Yet he said he plans to di­vest his hold­ings.

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