Disclosures suggest rebates and insurers responsible for rising out-of-pocket drug costs
Price was a disaster for HHS — Time for an administrator, not an ideologue
Last Friday's resignation of Health and Human Services Secretary Tom Price was big news. Almost unnoticed was the fact that Sunday marked the expiration of the Children's Health Insurance Program, which serves 9 million kids. Similarly, Congress failed to meet its Sunday deadline to reauthorize federal funding for 1,400 community health centers, which are on the front-lines of caring for 27 million - and can be an underserved area's only primary care option.
These are shocking failures - with dire human consequences should they continue to go unaddressed - and illustrative of the challenges facing the next HHS secretary.
As Price recently acknowledged, whoever runs HHS is "the head of the largest organization in federal government." This role - overseeing care for America's most vulnerable citizens - requires accountability. That clearly didn't fit Price.
Beyond the travel scandal that brought him down, he was admonished by fellow Republicans for preventing HHS staff from communicating with Congress. Nor did Price, a former congressman, communicate much with Congress himself, having famously been spotted in a Capitol Hill bar during vote-wrangling for the House's Affordable Care Act repeal effort.
It's obvious that President Trump has no grasp of health care policy, beyond Twitter exhortations. That makes it even more important that the next HHS secretary be a subject-matter expert.
Price's lack of a personal relationship with Trump was not dissimilar to the dynamic that existed between President Obama and his first HHS secretary, Kathleen Sebelius. Sebelius, the governor of Kansas, was selected only after Obama's first choice, former South Dakota Sen. Tom Daschle, withdrew from consideration. Sebelius had no real input into the ACA's shaping, and was frequently in an unflattering spotlight during its implementation.
Sebelius's successor, Sylvia Burwell, was a trusted bureaucrat, and former nonprofit executive, confirmed by a Republican Senate on a 78-17 vote. Prior secretaries, including the two former governors - Tommy Thompson of Wisconsin and Mike Leavitt of Utah - nominated by President George W. Bush, were confirmed unanimously or with near-unanimity.
Washington, D.C. gets to play one of its favorite parlor games in guessing who replaces the disgraced Price. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has responsibility for a great deal of what HHS does, but a professional background confined to being a consultant. And her past professional efforts had, at best, mixed results - Iowa's Medicaid privatization is a disaster.
A governor would bring to the role the gravitas it requires, although the Attorney General Jeff Sessions is a cautionary tale for those contemplating giving up a political sinecure to serve a temperamental president. Florida's Rick Scott has perhaps the best relationship with Trump, but made a fortune running a company that paid a $1.7 billion fine for Medicare fraud. Bad optics. Moderate Massachusetts Gov. Charlie Baker is a former health care executive, but has joined other Republican governors in opposing the ACA repeal, and replacement, bills. The best bet might be a lateral move - having Veterans Affairs Secretary David Shulkin, a doctor, run HHS.
Elections have consequences, and it's unremarkable that Republicans, with control of the federal government, focus on repealing the ACA - which they have long-demonized. But those repeal efforts have failed without a credible alternative. Administrative sabotage, Price's approach, is no substitute for legislative action. A responsible HHS secretary would now promote the dialogue between Senate Health, Education, Labor, and Pensions Committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) to shore up the ACA individual market component, at least in the near-term.
Further, there is much more to our health care system than the ACA. The next HHS secretary will be the steward of both Medicare and a traditional Medicaid program that dates to 1965. The proliferation of privatization within Medicare - so-called Medicare Advantage plans - drive costs, with improper payments perhaps $16 billion annually.
Both Medicare and Medicaid are beset with rising drug prices. In our aging U.S., there will be an estimated 3 million more 85-and-older residents in 2030 than there were in 2012. We are not ready for this age wave, as we are neglecting the long-term care system we currently have. A predominantly-Medicaid population places nursing home care at the edge of insolvency, with poor Medicaid rates depressing caregiver wages, while home-and-community-based Medicaid options similarly struggle.
The next HHS secretary must be an administrator, not an ideologue, capable of meeting the moral responsibilities of his or her vital role. Millions of American lives hang in the balance.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association, which represents 90 long-term care facilities. Williams is also an attorney, former Washington state deputy insurance commissioner and former Washington state representative.