As the new head of the Department of Health and Human Services (HHS), Tom Price will have significant authority to rewrite the rules for the Patient Protection and Affordable Care Act (PPACA). But there is much more within his purview as head of an agency with a budget of more than $1 trillion for the current fiscal year, according to Kaiser Health News (KHN). He can interpret laws in different ways than his predecessors and rewrite regulations and guidance, which is how many important policies are actually carried out.
The responsibilities of the HHS include food and drug safety, biomedical research, and disease prevention and control, as well as oversight over everything from medical laboratories to nursing homes.
Price, who opposes the PPACA, abortion, and funding for Planned Parenthood, among other things, could have an immediate impact without waiting for a presidential order or an act of Congress. The KHN article lists five actions that he might take that would transform health policies currently in force.
Under the PPACA, most insurance plans must provide women with any form of contraception approved by the FDA at no additional cost. This has been controversial with regard to religious employers who object to artificial contraception. As secretary of the HHS, Price would have two main options: He could expand the “accommodation” that already exempts some houses of worship from the requirement. Or, because the specific inclusion of birth control came via a regulation rather than from the PPACA itself, he could simply eliminate no-copay birth control coverage from the benefits that insurance plans must offer.
The PPACA created an agency within Medicare––the Center for Medicare and Medicaid Innovation––that was tasked with investigating new ways to pay doctors and hospitals that would reduce costs while maintaining quality. The HHS secretary has the authority to require doctors and hospitals to participate in these experiments and new payment models. Some have proven unpopular with physician and hospital groups, particularly the idea of paying providers so-called bundled payments for packages of care, rather than allowing them to bill item-by-item. Price, as a former orthopedic surgeon, will likely act to scale back, delay, or cancel that project, since he has been a vocal critic in the past.
Republicans have been trying to separate Planned Parenthood from its federal funding for decades. Congress would have to change the Medicaid law to permanently defund the controversial women’s health group, which also performs abortions (with nonfederal funds) at many of its sites.
Price is expected to reinstate rules enacted during the Reagan and George D.W. Bush administrations––but repealed by President Clinton––that would ban staff in federally funded family-planning clinics from counseling or referring for abortion women with unintended pregnancies. He could also throw the weight of the HHS behind an investigation into Planned Parenthood’s ties to firms allegedly selling fetal tissue for profit, which has been investigated by a House committee.
In 2009, Congress gave the FDA limited authority to regulate tobacco products. Price voted against that regulation at the time. Now, as HHS secretary, he could weaken its enforcement, or he could rewrite and “water down” some rules, including recent ones affecting cigars and e-cigarettes.
At the end of the George W. Bush administration, the HHS issued rules intended to clarify that health care professionals did not have to participate in abortions, sterilizations, or other procedures that violated a “religious belief or moral conviction.” The Obama administration revised those rules dramatically, to the consternation of conservatives.
Before President Trump’s inauguration, his website stated: “The Administration will act to protect individual conscience in health care.” Price is expected to reinstate the rules in their original form.
Source: Kaiser Health News; February 10, 2017.