Health Care Heavy Hitters

Tom Price, the ACA’s Ardent Foe, Pushes For Repeal and Replace–With a Smile

Affable and engaging, the new HHS secretary is a staunch conservative who says ACA coverage is “useless” because of high deductibles and that the GOP has something better to offer.

Howard Wolinsky

As a congressman, Tom Price led the charge in Republican efforts to repeal the ACA. Year after year, Price introduced bills to undo the health care reform legislation. It seemed more like a bit of political theater than a real bid for change.

Now as HHS secretary, Price could be presiding over the reality of the less regulated, post-ACA health care system that he agitated for—if the GOP-dominated Senate and House make good on the party’s repeal-and-replace campaign promises.

Price, 62, with pure white hair, rimless glasses, and an easy, slightly cherubic smile, comes across like a friendly, family doctor, not the ambitious, politically-minded orthopedic surgeon that he is.

Congressional colleagues view him as a brainy mentor with the just-right blend of policy smarts and wisdom from decades of being a practicing physician. Rep. Diane Black, a registered nurse and fellow Republican who represents the suburbs east of Nashville, says Price is a “true policy wonk” but one who has a real-world perspective on health policy. She credits him with guiding her through the knotty details of legislation—and through the maze of tunnels under the Capitol complex that are “the bane of every freshman member of Congress’s existence.”

His affable manner belies Price’s staunch conservatism. Gail Wilensky, a Republican health economist who served in both the Bush 41 and Bush 43 administrations, describes Price as a “harder conservative” than her: “He is regarded as a conservative Republican from Georgia, and that is obviously different than being a Republican from other parts of the country.” The conservative Association of American Physicians and Surgeons, a physician group formed during World War II to oppose socialized medicine, gave Price its Shining Scalpel award in 2009 for “cutting through the rhetoric regarding ‘health care reform’ and fighting for patient- and physician-centered health care legislation.”

Price was a Daniel in the lion’s den in June when he was interviewed at the Aspen Institute’s Ideas Festival. Jeffrey Goldberg, editor in chief of the Atlantic, asked Price whether the House repeal-and-replace bill is, as his boss has described it, “mean.” Price adroitly deflected the question about a bill that is a direct legislative descendant of his anti-ACA legislation. “I think what’s mean is [a health system] that has 6.5 million Americans paying $3 billion in taxes or penalties so they have the right to purchase health coverage. That mean system might work for government, but it doesn’t work for patients.”

Third-generation physician

Price grew up in Dearborn, Mich. Both his grandfather and his father were doctors, which may explain some of his strong feelings about the patient-physician relationship. He has described seeing his father take care of all patients, insured or not, and how he likewise has cared for all comers. Price received his bachelor and medical degrees from the University of Michigan in Ann Arbor, completed his orthopedic surgery residency at Emory University, and then opened a solo medical practice. Eventually, he came to be a founding board member of Resurgens Orthopaedics. With almost 100 orthopedic surgeons and physiatrists, it claims to be the largest orthopedic practice in Georgia.

Price entered elective politics in 1996 when he was elected to the Georgia Senate. When he opposed tort reform legislation in 2003 because it didn’t put a cap on noneconomic damages in malpractice cases, Mark Taylor, then Georgia’s Democratic lieutenant governor, told the Washington Post that Price is a right-wing doctor before anything else. “Whether it be liability or any policy issues about how health care is delivered, how it is paid for, how it is accessed, it is doctors—all day, every day,” said Taylor.

A year later, Price was elected to Congress, representing Georgia’s 6th district, the suburban Atlanta district that sent Newt Gingrich to Congress. As a congressman, Price sponsored more than 70 pieces of legislation, but he was best known for his implacable opposition to the ACA.

Called for tax credits

He first introduced his alternative, Empowering Patients First Act, in 2009, a year before the ACA was signed into law. Price called for tax credits to offset the cost of individual health coverage based on age rather than income and premium price, expanding health savings accounts, and the sale of health insurance across state lines—all of which eventually made its way into the House and Senate bills now under consideration.

Price’s nomination to be HHS secretary got a mixed reception. The AMA gave its blessing, even though it has been a supporter of the ACA. The AMA has long encouraged physicians of all political stripes to participate in government; remarkably, Price is only the third physician to serve as HHS secretary. Patrice Harris, MD, the former chair of the AMA and a psychiatrist in Atlanta, sang his praises as a leader of patient-choice and market-based solutions and reducer of burdensome regulations. Daniel “Stormy” Johnson, MD, past president of the AMA, who has known Price since he was a Georgia delegate to the AMA’s policy-setting House of Delegates, was unstinting: “I can’t imagine a more qualified person to be in that job.”

But Price was also accused of buying and selling health care stocks when he was in Congress in a way that, at the very least, looked to be unethical because he was in a position to influence company profits. Price insisted he had done nothing improper and that virtually all of his health care trades were managed by his broker. The one exception was his investment in Innate Immunotherapeutics, an Australian company partly owned by Rep. Chris Collins, a New York Republican. Politico reported that Price sold his Innate shares for $250,000 earlier this year after an initial investment of $94,000.

The public face

As HHS secretary, Price has often been the public face of the anti-ACA effort, even though a single POTUS tweet or off-the-cuff remark completely overshadows anything Price might have said during the good-soldier hours he has logged testifying before Congress and talking at think tanks and events like the Aspen Ideas Festival. Price has also had to walk a fine line between criticizing the ACA while assuring the public—and insurers—that it won’t be undone recklessly.

“Nobody is interested in sabotaging the system,” said Price in testimony before Congress on June 8. Previously, Price said during a budget hearing in the House in March, “so long as the law is on the books, we at the department are obliged to uphold the law.” Still, as David Nather and Sam Baker at Axios pointed out last month, Price and others will have to switch gears from talking up the ACA’s failures to trying to make it work. Either that—or work to undermine it.

In late June, Price spoke at a roundtable about the Senate bill in Sandy, Utah, a suburb of Salt Lake City. The Deseret News covered the event.

“The bill itself that is now before the Senate, we believe is a step in the right direction,” Price said, noting that the bill’s Medicaid provisions offer “greater flexibility” and “more choice.” “You don’t want a system that works best for Florida. You want a system that works best for Utah,” Price said to the Utah audience. He defended the bill’s reduction in Medicaid spending, saying it will ensure that “small businesses once again are able to afford the ability to provide health coverage for their employees.” The ACA has led to more people being insured, but Price said the coverage is useless because of high deductibles.

Wilensky, the Republican health economist, said Price has some advantages that should help him be an effective HHS secretary. He has a good relationship with many members of Congress. His background as an orthopedic surgeon gives his views added credibility. It’s too soon to judge Price, she says. “The question of how effective will he be trying to manage a sprawling enterprise like HHS or thinking about the broader public health aspects involved in population health is something that we’ll have to wait and see. They will be new areas for him and so we’ll have to give him some time to see how he grows into those positions.”

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