Senate Health, Education, Labor, and Pensions Committee
Nomination of Tom Price to Serve as Secretary of Health and Human Services
Wednesday, January 18, 2017 at 10:00am
Highlights from the Senate HELP Committee hearing are below.
The Senate Finance Committee – which primary jurisdiction over the HHS nominees –
is also scheduled to hold a hearing on Price’s nomination next Tuesday, January 24 at 10am.
Chairman Lamar Alexander (R-TN): What is our goal of repeal and replace? To lower the cost,
give people more choices, or put more decisions into hands of the states and the patients?
• Price: All of those issues are at the center of where we should be putting our attention. In
many instances, the closer you can hand decisions to the patient, the better. The states
know their patients better than we know them. The challenges that we should address
immediately deal with the individual market and the Medicaid market.
I know your plan won’t be presented until after your confirmation, however President-elect Trump
has signaled that repeal/replace will take place simultaneously.
• Price: No one is interested in pulling the rug out from anyone here.
I’ve been told by many that we basically need to have a rescue plan for the individual market by
March to avoid a collapse. Do you agree?
• Price: We’re clearly seeing changes in the individual and small group markets that are
adverse to the patient. It’s imperative for us to recognize and put in place solutions to
address it.
Ranking Member Patty Murray (D-WA): Recent press reports about your investments raise
serious questions about your judgement. I believe it is inappropriate and we need answers to this
regarding whether you and Rep. Collins used your access to nonpublic information.
• Price: I had no access to non-public information.
Do you share President-elect Trump’s goal of insurance for everyone?
• Price: The goal of the bills that I’ve worked on in Congress was to always make sure
individuals had the opportunity to gain access to coverage.
Sen. Michael Enzi (R-WY): Wyoming is the most rural state in the country. We need to make sure
people have access to care in these rural areas. It’s my understanding that the new administration
may have the ability to make some key policy changes immediately. Some of the most critical
changes for short-term stabilization of the markets might include reducing the number of special
enrollment periods and requiring upfront verification. My understanding from those in the
insurance business is that some targets actions by HHS could provide meaningful changes that
could impact premiums for the next year. Are those options that you might consider?
• Price: The insurers are deciding right now what the premium levels will be for CY 18. What
they need to hear from us is a level of support and stability in the market. You mentioned
that there are rural counties in your state with only one provider. As policymakers, we
must ask ourselves what the problems are out there. If we keep the patients at the center,
we’ll get to the answer.
Sen. Bernie Sanders (I-VT): President-elect Trump likely won election because he said he wasn’t
going to cut Medicare, Medicaid, and Social Security – is he going to follow through on that promise?
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Price: I haven’t had extensive conversations about those statements, but I have no reason to
believe that that position has changed.
Trump recently said pharma is “getting away with murder”. We’ve been working on legislation that
would allow the government to negotiate drug prices under Medicare program and another bill that
would allow drug importation. Will you join us in legislation that we are working on?
• Price: The issue of drug prices in this country is of great concern. If we get to the root cause
of what it is, I think we can solve this in a bipartisan way.
Other countries negotiate prices for drug prices. Will you work with us on this?
• Price: I will commit to ensure drug pricing is reasonable and that Americas have access to
the medications that they need.
That wasn’t the answer I was looking for.
•
Sen. Orrin Hatch (R-UT): There are members of this Committee who have traded health stocks
while serving on this Committee – this appears to be an attack on your character. The collapse of
the ACA has exacerbated the nation’s health care problems. What steps would improve the pipeline
for rare disease therapies to bring cures for those in need?
• Price: The Orphan Drug Act has revolutionized the ability for us to treat rare diseases.
There are things we can do in terms of patent protection, liability, etc.
Sen. Bob Casey (D-PA): Will you commit to maintaining protections to ensure that no child is
denied coverage because of a preexisting condition?
• Price: Absolutely – we need to make sure that every child has access to the care and the
coverage that they need. There are a number of ways to do this and I look forward to
working with you to make that happen. It’s imperative that we have a system in place that
works for patients.
Sen. Rand Paul (R-KY): (Referring to questions re: investments) To question whether you are being
honest is insulting. Now, I think we all want the most insurance for people at the least cost. What
are your ideas?
• Price: The principals that I think are imperative: affordability, access, quality,
responsiveness to patients, incentivizes innovation, and one that ensures that choices are
made by patients. If we have the principle of having patients have choice, then there ought
to be a full array of opportunities. HSAs make a whole lot of sense – they ought to have the
choice to select them. Association health plans would allow individuals who are
economically aligned – even though they don’t work together – to get insurance. This is not
a new idea. It makes a lot of sense. It spreads the risk and that way any one person’s
adverse health conditions do not affect as many other people because it’s spread out.
Sen. Al Franken (D-MN): As a physician, you may know that smoking kills approximately 480,000
Americans per year - $170 billion annually in health care costs. Yet between 1993 and 2012 you
were a shareholder of tobacco companies – meaning you personally benefited from tobacco sales.
Meanwhile, you voted against landmark legislation in 2009 that gave the FDA authority to regulate
tobacco. As a physician, how do you square reaping personal financial gain from the sales of an
addictive product that kills millions of Americans every decade?
• Price: It’s an interesting question and a curious observation. I have no idea what stocks in
held in the 90’s. All of these decisions for all of us I suspect are through mutual funds and
pension plans. I would bet in your pension plan that there are components of that that may
have something to do in some type of history.
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I find it hard to believe that you did not know you had tobacco stocks. Now, your bill – the
Empowering Patients First Act – will unravel something that has given a lot of Americans peace of
mind. This is what this hearing should be about. You are a smart man. (Time expired but Price was
able to respond)
• Price: This is one of the things that makes it hard to reach a solution in Washington. The
Senator’s concerns are valid, but the conclusions that he’s driven from my policies are not. I
hope that we are able to work together – if I’m given the privilege to lead – to try solve these
difficult problems.
Sen. Michael Bennet (D-CO): Do you support the budget that was passed by Senate Republicans to
repeal the ACA and adds to the budget deficit. Can you commit that any replacement plan will not
contribute to our debt?
• Price: The conclusions that the CBO recently reached are looking at it without taking a
replacement plan into account. We will make certain that the replacement plan addresses
the health care challenges and we look forward to making sure we are as fiscally
responsible that we can be.
Almost the entire theory from Republicans has been that the ACA has increased our deficit. I would
hope that nothing that you would advocate for
• Price: I certainly hope that’s the case and I look forward to working with you to ensure that
it is.
Sen. Susan Collins (R-ME): Could you explain what would happen to the individual market if
nothing is replaced after we repeal?
• Price: I have people that tell me they cannot get the care they need because they can’t
afford the deductible under the ACA. Those are the kinds of things that we need to be
addressing.
I think that’s important to clarify. I think most people reject the idea of repealing the ACA without
replacing it. Another group has advocated repeal with a two or three year delay – that approach
also doesn’t work because it creates confusion. It’s my understanding that your goal is to quickly
pass reform package to provide access to affordable coverage for all Americans with more choices
than we have now.
• Price: Absolutely And we also don’t talk about the people that still can’t afford the coverage
now. It’s incumbent on us to step back and ask why that is. I would suggest that it’s because
of the structure that makes it impossible for those people to gain coverage.
I’m baffled by what CMS reimburses for and what it doesn’t. Will you pledge to look at those polices
and reevaluate what we do pay for?
• Price: Absolutely – it’s imperative for us to continue reevaluate our processes.
If we invest in biomedical research, we have the ability to improve American lives, but also lower
health care costs. Do you support NIH increases?
• Price: One of the core avenues to be able to do that is through NIH. NIH is a treasure for our
country.
Sen. Sheldon Whitehouse (D-RI): Republicans have a responsibility to put a replacement plan
together. The American people are entitled to know what they are going to be offered as a
replacement. It’s really hard to negotiate with nothing. You would want to keep the Medicare Part
D donut hole closed for seniors?
• Price: It’s important that the re-opening of the donut hole would be a legislative, not
administrative activity.
But would you propose something on that?
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• Price: I’m not aware of any discussions to do that.
In one of your budget proposals, there was a proposal to throw “able bodied people” off of Medicaid
unless they were working or looking for work or in job training. Are people who have addiction,
mental health, issues, etc. “able-bodied” by your definition?
• Price: We weren’t as specific as the definition was. The fact is there are many people who
believe that providing for an opportunity for individuals who are able-bodied without
children to seek or gain employment – that’s what would be defined in the regulation itself.
So “able-bodied” does not include those who have mental health and substance use disorders, etc.?
• Price: Again – that’s the work that would be done to develop the regulation. I think people
that demonstrated that they were in fact having challenges that would preclude them from
being able to seek work or employment or education, etc. – they should be attended to.
Sen. Tammy Baldwin (D-WI): Do you think the drug price increases are a problem – such as the
EpiPen?
• Price: There are certain areas where drug price increases seem to have little basis in
rational findings. But it’s important to appreciate that we’ve done some good things in this
area (generic drugs).
Trump supports Medicare drug price negotiation. Will you work to repeal the prohibition on this?
• Price: We need to find solutions to challenges of people gaining access to medication – it
may be changing the way people negotiate…
Would you support drug price transparency?
• Price: I would look forward to exploring ways to make that work if I am confirmed.
We talked about the opioid epidemic – one of the major issues is access to treatment. If the ACA is
repealed, there will not be a mandate for substance abuse treatment.
• Price: The opioid abuse epidemic is rampant. In terms of the mandate, that’s a legislative
issue, but I think it’s absolutely vital that substance abuse and other kinds of things are able
to be treated.
Sen. Todd Young (R-IN): One area of the ACA that members of the Republican party have indicated
their desire to repeal is the CMMI. You’ve already indicated that you opposed the mandatory
nature of those innovation projects. I think CMMI can continue to be a helpful lab for
experimentation. For me, this makes sense - this is the way scientists operate. Do you intend to
keep this innovation center?
• Price: As I mentioned, I’m a strong supporter of innovation at every level. CMMI I believe
has great promise to do things that would allow us to change the payment model, and I
strongly support that. I had adamantly opposed the mandatory nature of which CMMI has
approached things like the Joint Hip/Knee Replacement Model and the Medicare Part B
Demonstration Model. The problem that I have with the Part B Model – that really is an
experiment – in every experiment that deals with people, we demand that there be
informed consent for the participants. If either of these were in a pilot project and they
worked, then we should scale them up.
Sen. Chris Murphy (D-CT): I hope you can understand the nature of our frustration about this ACA
repeal/replacement plan. How are you going to measure your replacement plan’s success?
• Price: After replacement, I would ask ‘is the OOP cost for individuals higher or lower than it
was before?’ I hope that we’re able to increase choice and access, decrease costs vs what’s
been happening over the past few years under the ACA.
I would just like to point out that having coverage and having access to coverage are two different
things.
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Sen. Lisa Murkowski (R-AK): Alaska moved forward with Medicaid expansion a few years ago,
many have obtained coverage that weren’t able to beforehand. Recognizing that there were certain
exemptions as part of the ACA, there has been extraordinary collaboration between our tribal
health organizations that have allowed for increased efficiency, increased health access. What will
happen to those who have gained coverage via Medicaid expansion and what can we do to ensure
options for those people? And should a block grant approach be considered?
• Price: Medicaid is imperative and vital for members of our population. It’s a federal-state
partnership that we must ensure individuals don’t fall through the cracks. Whether it’s
retaining the same level of Medicaid participation or providing another option for
something else that allows them coverage that suits their needs, we are committed that that
coverage is able to be continued.
What about the concerns expressed by the tribal health organizations, that a block grant approach
could impact some of the assurances and benefits that these organizations have seen?
• Price: This is an early stage and it’s a legislative decision, but we would look forward to
working with you on these issues. The 1332 Waiver program is just beginning, but it’s one
that holds significant promise in making certain that we’re able to ensure that things like
reinsurance, high risk pools, etc. make it so that individuals do not lose their opportunity to
have access to high quality care.
The level of regulatory burden our small hospitals are faced with – you can do things
administratively early on if you are confirmed. Have you looked into what regulatory issues could
be addressed early on that could help reduce some of the regulatory burden – particularly for some
of these smaller hospitals?
• Price: Not specifically, but I share with you the concern about regulatory guidelines, etc. –
especially from the rural areas (doctors, etc. included).
Sen. Elizabeth Warren (D-MA): I want to understand the changes to Medicare and Medicaid that
you have already proposed – the budget that you recently authored as Chairman of the House
Budget Committee would have cut Medicare spending by $449 billion over the next decade. You’re
budget also would have cut Medicaid funding that goes to the states by more than $1 trillion.
• Price: What we believe is appropriate is to make sure the individuals who are receiving the
care actually are receiving the care.
President-elect Trump was very clear on the campaign trail that he would not cut Medicare and
Medicaid. Do you believe he was telling the truth?
• Price: I believe so, yes.
Given your record of opposing cuts to these programs, I sent the President a letter in December
asking for clarification. So I’ll ask you – can you guarantee that you will safeguard President-elect
Trump’s promise?
• Price: What the question presumes is that money is the metric.
The President-elect said he would not cut money for these programs. That’s the simple question I
am asking you.
Sen. Johnny Isakson (R-GA): I just want to make one point – I respect everyone on this Committee,
but it’s important for us to understand the disclosure rules and the way they operate. It’s entirely
possible for any of us to have someone else make an investment on our behalf and not know where
that person invested it.
Sen. Maggie Hassan (D-NH): The opioid epidemic in the United States – under Medicaid
expansion, thousands of NH citizens were able to get treatment for substance use disorders. You
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have proposed repealing Medicaid expansion. So can you guarantee that those with substance use
disorders who have gotten insurance through expansion will not lose health insurance?
• Price: I think it’s absolutely imperative that we as a nation make certain that everyone has
access to the kind of mental health and substance abuse challenges that they have.
So is that a guarantee that you will find funds to actually provide the treatment?
• Price: It’s a guarantee that I’m committed to making certain that we address that need that
is so vital and important to address that.
I’m concerned that you’re not committed to that if the ACA is repealed and I’m concerned about the
impact that might have on the states. I also want to ask whether you think that people with health
insurance should have some very basic essential coverages (checkups, etc.).
• Price: Allowing patients to have choices to select the kind of coverage that they want
instead of someone else deciding for them.
But an essential benefit under the ACA requires private insurers to cover private substance use
treatment. They also have stopped covering a lot of things until required by law. So yes or no – the
Empowering Patients First Act would repeal the requirements that insurance companies cover
substance use disorders?
• Price: It’s important that we remember the patients is at the center of all of this. As an
administrator – if I am so privileged to do so – I would follow the policies that are adopted
by Congress and signed by the president. We look forward to working with you to make
certain that those things are covered and that those patients receive they care they need.
I look forward to working with you too, but I’m concerned about your unwillingness to commit to
making sure that insurance companies cover this as an essential benefit.
Sen. Bill Cassidy (R-LA): Did the Empowering Patients First Act explicitly repeal mental health
parity laws?
• Price: I don’t believe so.
I don’t think so either. So mental health parity would still apply – that does cover substance
abuse. The issue of whether this should be an essential health benefit – you’re a big believer in
Health Savings Accounts (HSAs). I gather an HSA could be used for doctor visits, essential medical
services, etc. so I just want to point that out as well. When we give the patient the power over their
health care / to allow them to choose, they become a more active, informed consumer. I applaud
you for that. Turning to Electronic Health Records (EHRs) – your Department would be in charge of
meaningful use, etc. What thoughts do you have on this?
• Price: EHRs are so important because it allows the patient to have their history to access
their information at any time. The federal government’s role should be with regard to
interoperability – to make sure these different systems can talk to one another. It’s
imperative that the metrics actually correlate with the quality of care being provided vs
what is happening right now where providers are wasting time documenting these things.
Sen. Tim Kaine (D-VA): You’ve proposed turning Medicaid into a block grant program, you’ve
repeatedly vote against CHIP, and you’ve proposed a restricting of Medicare that would increase
costs for seniors. These programs are critical to Virginians.
• Price: I think it’s important to recognize that there are challenges in these programs right
now. We need to step back and say ‘what are we doing wrong?’
I am all with you on fixing challenges, but we shouldn’t create anxiety for people.
• Price: One of my goals is to provide stability to folks.
Sen. Tim Scott (R-SC): What role do you think community health centers can play – particularly in
rural and underserved areas?
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Price: Community health centers are vital to our health care delivery system. They fill a
void across the country and we need to do everything to strengthen them.
What do you see as the future of telemedicine?
• Price: Telemedicine is going to allow those in rural and underserved areas the access to
intellectual capital and resources from a clinical standpoint. I think we need to accentuate
the ability to use telemedicine.
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