Price Backs Shifting Control of Health Funds to States

Price Backs Shifting Control of Health Funds to States

By Kerry Young, CQ Roll Call, January 24, 2017

Rep. Tom Price pushed at a hearing Tuesday for states to get more flexibility for Medicaid and said he favors a long-term renewal of the Children’s Health Insurance Program. Senate Democrats, meanwhile, continued to question the judgment of the Health and Human Services nominee for his active trading of health care stocks and views on entitlement programs.

The Georgia Republican appeared to move closer to confirmation at the Senate Finance Committee hearing, with Republicans strongly defending his nomination. Finance Chairman Orrin G. Hatch, R-Utah, said at the end of the hearing that he expected a committee vote on the nomination soon, without setting a specific time.

Price made multiple vague statements over the roughly four-hour hearing in support of helping people maintain their health insurance, but steered clear of offering many specifics.

He did speak in favor of renewing CHIP, which is due for reauthorization this fall. He said an eight-year extension would be better than a five-year one. Price, a physician, said he intended for future changes to the 2010 health care law (PL 111-148, PL 111-152) to increase and improve health coverage.

Democrats argued that Price's approach would result in many Americans losing their access to medical care. Lawmakers and Price tussled intensely over the future of Medicaid, which serves more than 70 million people, or more than one-fifth of the U.S. population. Sen. Maria Cantwell, D-Wash., said the Trump administration appears to be “creating a war on Medicaid,” referring to recent comments such as those from the president’s senior adviser Kellyanne Conway in favor of block grants.

Price took offense to that characterization. Yet Price has been a leader in House efforts to consider alternative ways to pay for Medicaid, including a move toward sending states set amounts of funding.

As House Budget Chairman, he put forward a draft fiscal 2017 budget resolution last year that the committee described as a bid to “transform Medicaid from an open ended entitlement back to a quality safety net” for the most vulnerable.

Under his plan, states would have two options. One would be to combine money for Medicaid and CHIP  into a single lump sum that could then be distributed by states. The other would be to use what the committee calls a per-capita-cap methodology, which would result in savings, according to the report.

The Democratic preference to expand the current health program for those living in or near poverty “traps increasing numbers of lower income people in Medicaid, where many sick individuals cannot get appointments, new beneficiaries cannot find doctors,” the committee report for the draft resolution said. “Medicaid cards are mere pieces of plastic.”

Price echoed this theme during the Finance hearing. He told the senators that about one of every three doctors who potentially could see Medicaid patients is not accepting this form of insurance.

“There's a reason for that,” he said. “If we're honest with ourselves, we'd be asking the question why?”

Price declined to give a direct response to Sen. Claire McCaskill, D-Mo., who repeatedly asked him to say whether he supported switching to Medicaid block grants. Price instead said he's interested in changing a "system that isn't working."

Several times during the hearing, he downplayed the importance of his past advocacy for changes in Medicaid to the role he intends to assume at HHS. As secretary, he said his job would be to implement what lawmakers decided, not to dictate it. Sen. Bob Casey, D-Pa., argued that Republican control of Congress and the White House gives added importance to his views on health programs.

"This is a live issue. This isn't theory or some policy" debate among House Republicans, he said. "This is the potential enactment of a law to block grant Medicaid."

Republicans including Sen. Bill Cassidy, R-La., welcomed Price’s willingness to consider new approaches, particularly on Medicaid. Sen. Rob Portman, R-Ohio, said the Centers for Medicare and Medicaid Services rejected a request from his state for a Medicaid waiver. Portman pressed Price to allow more flexibility. He also noted that President Donald Trump's pick to lead CMS is Seema Verma, a consultant who helped Indiana with its alternative Medicaid program.

"There have to be better ways to provide care to the Medicaid population because there are huge challenges right now," Price told Portman, adding that CMS needs to pay attention to governors and state insurance commissioners. "If we listen to them, I think they will guide us in the right direction."

However, Sen. Ron Wyden of Oregon, the ranking Democrat on Finance, told Price he may encounter GOP opposition as well to any effort to overhaul Medicaid. he predicted that Republican governors would prove among the toughest critics of a bid to change to block grants, seeing this as a bid to cut growth in federal funding for their states.

Democrats also sought to get Price to take stands on a number of issues. Sen. Robert Menendez of New Jersey pressed him on whether he believes as a doctor that there's a link between abortions and breast cancer.

"I think the science is relatively clear that's not the case," Price responded.

Menendez followed by asking what Price thought of claims that there's a link between vaccines and autism.

Wyden also at the start of the hearing raised questions about Price’s active trading of shares of health companies, while serving as a lawmaker active in this field. Price maintained throughout the hearing that his trading was ethical and fell within the rules for a member of the House.

“It’s hard to see how this can be anything but a conflict of interest," Wyden said.