The Administration

Trump’s healthcare nominees are just what the doctor ordered


It has been widely reported that President-elect Trump’s nomination of Rep. Tom Price, an orthopedic surgeon, to be the next secretary of Health and Human Services (HHS), and Seema Verma to be the next administrator of the Centers for Medicare and Medicaid Services (CMS), has drawn many cheers from Republicans eager to repeal and replace the Affordable Care Act.

To be sure, replacing Obamacare would be a huge victory for conservatives, and Price has proved he is more than qualified to take on the task by authoring a comprehensive replacement plan in every Congress since 2011.

{mosads}But all of the focus on Obamacare overlooks the real reason Price’s nomination is just what the doctor ordered: He will take over the reins of HHS just in time to begin implementation of the biggest change to Medicare physician payment in generations, the “Medicare Access and CHIP Reauthorization Act” (MACRA).


MACRA finally repealed the unworkable Sustainable Growth Rate (SGR) formula that dictated Medicare payments to physicians, and averted what would have been a 21-percent payment cut in 2015.

Under the new payment structure, physicians who provide care to the 56 million people enrolled in Medicare will be rewarded for providing value over volume, and have the option to either join newly created “alternative payment models” or remain in a revised version of fee-for-service.

Keep in mind that Price would be only the third physician to fill the top spot in the 63-year history of HHS — if there were ever a time for a doctor to lead the agency, this is it.

As House Budget Committee Chairman and a member of the powerful Ways and Means Committee, Price was actively involved in the drafting of MACRA. If confirmed as HHS secretary, Price can ensure MACRA’s implementation aligns with congressional intent.

In October of this year, Price and his 17 colleagues on the “GOP Doctors Caucus” wrote a letter to CMS calling on the agency to simplify MACRA’s requirements, alleviate the reporting burden for submitting quality measures, help small and rural practices comply with law, and make cost reporting optional until measures are refined and properly tested.

As HHS secretary, Price would have the power to put his words into action, and ultimately put thousands of nervous physicians at ease.  

Besides having the right résumé for the job, Price fits into the president-elect’s pattern of nominating critics to lead the very agencies they have vocally opposed.   

Trump’s pick to run the Environmental Protection Agency, Oklahoma Attorney General Scott Pruitt, has sued the agency over recent methane emission regulations.

Education Secretary nominee Betsy DeVos supports charter schools and vouchers for private schools.

Ben Carson, picked to run the Department of Housing and Urban Development (HUD), has expressed deep skepticism towards HUD’s fair housing initiatives.

In Price, Trump’s has chosen to lead HHS a man who has championed efforts to rein in the authority of one of the powerful entities he may soon oversee — the Center for Medicare and Medicaid Innovation (CMMI).

CMMI was established by the ACA to test new payment models designed to lower costs and improve quality. To carry this out, the ACA granted CMMI the power to waive requirements of the Medicare and Medicaid statutes, and to compel provider and patient participation in its experimental models.

A few such models were promulgated in direct conflict with provider rates or provisions made as specific by Congress as the CMMI’s own mandate; and CMMI did not seek congressional consent.

Price declared CMMI has “effectively assumed the authority to rewrite current law” and is “a bipartisan concern that goes to the heart of our constitutional system” in a September op-ed.

Price also led two congressional sign-on letters this year calling for an end to all current and future CMMI initiatives that mandate participation.   

At the helm of HHS, Price could tame CMMI’s power and bring autonomy back to providers and patients. Physicians, not bureaucrats, will decide how to best structure their practices.

Price’s viewpoint as a surgeon, combined with the cost-saving eye of a Budget Committee chairman, is just what this administration needs to take on the tough issues facing our health system and implement a massive overhaul to the way Medicare pays physicians.

After tapping a Medicare expert and physician to lead HHS, President-elect Trump wisely balanced out his health care roster by nominating Medicaid tactician Seema Verma to run CMS.

Verma has decades of health policy experience and is best known for her work on complex Medicaid issues.

She was the architect of Indiana’s Medicaid expansion model, “Healthy Indiana Plan 2.0,” which requires monthly contributions to health savings accounts. Additionally, Verma has assisted numerous other states with Medicaid implementation and waiver development, including Iowa, Ohio, Kentucky, Tennessee, Michigan and Maine.

But, it comes as no surprise that Democrats have equated the nominations of two highly qualified individuals with doomsday for America’s seniors.

Incoming Senate Minority Leader Chuck Schumer said:

“Between this nomination of an avowed Medicare opponent to serve as HHS Secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”  

This hyperbolic backlash against the president-elect’s nominees is reminiscent of the infamous 2012 presidential campaign ad that showed a man perceived to be then-vice presidential candidate Paul Ryan pushing grandma off a cliff as “America The Beautiful” played in the background.

While it may make for good political theater, these attacks aren’t rooted in fact. As Senate Finance Committee Chairman Orrin Hatch (R-Utah) said:

“It’s clear Tom is a bright and capable lawmaker whose personal experience as a doctor and public servant has allowed him to develop an encyclopedic understanding of the challenges plaguing the nation’s health care system.”

With Price’s experience as a fiscal-hawk physician, and Verma’s deep understanding of the challenges faced by states, Trump picked the right team to usher in a new era for health care reform and Medicare physician payments.

Marc Samuels is the CEO of ADVI and former health care policy advisor to Presidents George H.W. Bush and George W. Bush.

The views expressed by Contributors are their own and are not the views of The Hill.

Tags Chuck Schumer Orrin Hatch Paul Ryan

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