President-elect Donald Trump’s pick to run the Health and Human Services Department enters his first confirmation hearing Wednesday with an Obamacare-sized target on his back and a host of ethical questions swirling around him.
Rep. Tom Price, a six-term congressman from a wealthy Atlanta suburb, will face off against Senate Democrats intent on derailing his nomination to lead the department that will play a central role in the GOP’s plans to dismantle Obamacare. And Republicans will be searching for guidance on how the incoming Trump administration plans to make good on the party’s pledge to replace Obamacare without harming those now covered by it.
Price’s path to HHS was never going to be easy, given the partisan battle over the federal health care law covering 20 million Americans and Price’s support for a Medicare overhaul strongly opposed by Democrats. And Price has increasingly faced ethical questions about more than $300,000 in health care-related stock trades he made while writing legislation affecting those companies. Senate Democrats have asked for an investigation into the investments, and on Tuesday they called on the HELP Committee to delay its hearing on Price’s nomination.
The Senate HELP Committee won’t vote on the nomination, making this just a so-called courtesy hearing, but that won’t prevent sparks from flying. Wednesday’s session offers Democrats their first opportunity to pressure Price over his investments, replacing Obamacare, drug prices, and how his vision for health care contrasts with Trump’s.
Here’s POLITICO’s guide to Price’s confirmation hearing:
Repealing and replacing Obamacare
Price’s top priority at HHS would be guiding the repeal and replacement of Obamacare. For that, he’s particularly well-equipped — Price is a former orthopedic surgeon who’s developed one of the more detailed replacement proposals out there, and Trump said he will unveil his own replacement plan once Price is installed at HHS.
Price’s 2015 replacement bill follows traditional GOP thinking on health care. It would provide tax credits for insurance and expand the use of health savings accounts, eliminate Obamacare’s benefit requirements and coverage mandates, and provide insurance protections for people with pre-existing conditions who’ve remained continuously covered.
But Trump didn’t do Price any favors this weekend when he pledged “insurance for everybody.” Not even Obamacare came close to that goal, and GOP health care plans have never aimed for universal coverage.
Democrats are likely to press Price on his own priorities for replacing Obamacare and whether he can deliver on Trump’s promises. Republicans, facing a tight timeline to repeal and replace Obamacare, may try to gather clues on how they should proceed.
Price’s health care investments
Price is sure to face pointed questions about his personal investments in health care companies during his time in Congress. Democrats have called on government ethics officials to investigate Price’s health care stock trades, following reports that he got a sweetheart deal from a biotech company and invested in Zimmer Biomet, a medical device-maker, just days before writing legislation that would have eased regulations on the sector.
Senate Minority Leader Chuck Schumer suggested Tuesday that investment may have even violated a 2012 law banning lawmakers from making trades based on inside information. HELP Committee Democrats Al Franken (Minn.), Elizabeth Warren (Mass.) and Tammy Baldwin (Wis.) on Tuesday called on the panel to delay Price’s hearing until an ethics investigation is completed, saying the trades raise questions about Price’s conduct while in Congress.
Price has committed to divesting his holdings in 43 stocks, including Zimmer Biomet, if confirmed as HHS secretary, and Trump’s transition team maintains Price has followed legal and ethical guidelines.
Yet, the stock trades have provided Democrats with a clear line of attack they hope will string out Price’s nomination and play into broader criticisms that Trump’s Cabinet could be rife with conflicts of interest.
Overhauling Medicare and Medicaid
Price has advocated for radical overhauls of both Medicare and Medicaid, entitlement programs that currently cover roughly 130 million Americans. He’s called for moving Medicare toward privatization by giving seniors a fixed amount to spend on health insurance, and he wants to limit federal spending on Medicaid by giving states a lump sum — or block grant — and more flexibility for how to use that money.
Those ideas are fiercely opposed by Democrats and even clash with Trump’s campaign promises not to cut entitlements. Democrats, who are already sounding the alarm on the GOP’s plans for Medicare, will try to pin down Price on whether he wants to pursue a major overhaul during the Trump administration.
Price may also be tested on the future of Medicaid, which was expanded under Obamacare and could be sharply cut back in a replacement plan. The GOP faces internal opposition from several governors who took the optional Medicaid expansion.
Prescription drug pricing
Democrats are bound to grill Price on his view of drug prices, given how outspoken committee members like Sens. Bernie Sanders (I-Vt.) and Warren are on the issue. Trump has signaled a crackdown on drug prices, saying last week that the pharmaceutical industry is “getting away with murder.” He’s repeatedly called on Medicare to negotiate prices with drug companies — a policy long supported by Democrats but deeply opposed by Republicans and the industry’s powerful lobby.
Price has historically opposed allowing Medicare to directly negotiate drug prices, saying in 2007 that it was “a solution in search of a problem.”
Democrats looking to exploit divisions between Price and Trump may also tackle whether the United States should allow the importation of cheaper drugs from other countries. Trump campaigned on opening up the flow of drugs from Canada as a way to lower prices, something that Price could unilaterally accomplish as HHS secretary through new regulation. But Price has been on the record opposing that policy, citing concerns about the safety of drugs not regulated in the United States.
Women’s health issues
Price could also draw fire from Democrats for his rigid conservative views on abortion, birth control and defunding Planned Parenthood.
In 2005, he co-sponsored a bill that would’ve defined life as beginning at the moment of conception, which opponents say could outlaw abortion in nearly all instances. More recently, Price voted for a House amendment that would’ve allowed health insurers to eliminate preventive reproductive health care benefits due to religious objections.
Those positions garnered Price a zero percent rating from Planned Parenthood on its most recent congressional scorecard, and promise to be a major sticking point for Democrats like Washington Sen. Patty Murray, who has called the GOP’s Planned Parenthood defunding effort “shameful.”
But perhaps more intriguing will be whether Sen. Susan Collins (R-Maine) chooses to wade into the issue. Collins has opposed plans to defund Planned Parenthood as part of an Obamacare repeal bill.
The future of health care delivery
The incoming Trump administration is likely to continue the shift toward paying health care providers based on quality, rather than how many services they provide, in a bid to lower costs.
It’s a goal that’s largely bipartisan, but Price has strong views on how to implement a major overhaul that Congress enacted almost two years ago. Price wants to ease expectations on doctors and give them more time to adapt new payment rules.
Price has been sharply critical of Medicare’s new innovation center, particularly for requiring hospitals and physicians to participate in programs that make them more accountable for spending on hip and knee replacements. Republicans, including Price, last year called for shutting down the innovation center, but Price’s views may change now that he stands to control the department and determine what programs it should pursue.