Jan. 5, 2017
WASHINGTON — When President-elect Trump chose Rep. Tom Price (R-Ga.) to be Secretary of Health and Human Services, he poked an already buzzing hornet’s nest.
Like the rest of the country, doctors, nurses, and medical students have very divided opinions about the government’s role in healthcare. Price’s nomination amplifies that division.
The American Medical Association (AMA) voiced immediate support for Price, while the American Medical Students Association (AMSA), Physicians for a National Health Program (PNHP), and National Nurses United (NNU) roundly condemned the nominee. Most other physician and nurse organizations voiced something between concern and resignation.
MedPage Today spoke with the leadership of several physician and nursing groups to understand their concerns and in some cases highlight areas of agreement.
Line In the Sand
On Nov. 29, the AMA backed Price, a member of the association’s House of Delegates, in a press statement: “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” wrote Patrice Harris, MD, a psychiatrist from Atlanta and chair of the AMA Board of Trustees.
That statement infuriated many physicians, including AMA members and nonmembers alike.
For example, the Clinician Action Network, led by Manik Chhabra, MD, Navin Vij, MD, and Jane Zhu, MD, MPP, posted a letter that has since gathered 5,000 signatures from clinicians across the country: “We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients.”
The letter criticized Price’s record and presumed agenda, such as “the dismantling of Medicaid” and “proposals to reduce funding” for the Children’s Health Insurance Program. The group also worried that essential benefits such as opioid use disorder treatment, prenatal care, and access to contraception would be threatened.
Harris explained that the AMA’s support should not be viewed as a blanket endorsement for every one of Price’s positions. She also recalled the “flurry of objections” that targeted another physician nominee, C. Everett Koop, MD, who served as surgeon general under President Ronald Reagan. Koop is now remembered for his efforts to prevent tobacco use and to promote safe sex for AIDS prevention.
Initially, many physicians were alarmed by Koop’s anti-abortion stance, Harris noted. But “Dr. Koop’s one-time opponents later cited him as a role model for how the U.S. surgeon general can help the nation face serious health care challenges.”
Some Docs Enthusiastic
Others, like Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, who practices in Tucson, Ariz., offered unqualified support for Price’s nomination.
Orient said she shares Price’s views on reproductive rights and does not believe taxpayers should pay for another person’s abortion or birth control, which she said “is quite reasonably priced.”
She said she considers Price’s critics’ concerns for health equity “laughable.”
“Instead of trying to have the optimal medical care for everybody and [giving] people the right to choose their own medical care and the right to control of their own money, they want to take these resources out of the hands of people making decisions for themselves and put it in the hands of bureaucrats who have this whole formula to decide what they think is equitable. And they don’t think it’s equitable for people to spend their own money for their own medical care,” Orient said.
“Tom Price has been in favor of allowing people to do this, even if they’re on Medicare,” she said, referring to Price’s support for Medicare privatization.
Red Flags for Others
While PNHP has been critical of the Affordable Care Act, wholesale repeal is not the solution the group has in mind — that is, unless the ACA were replaced with a single-payer system, Robert Zarr, MD, a pediatrician based here and a past PNHP president, said in a phone interview with MedPage Today.
Instead, Zarr anticipates an acceleration of healthcare privatization: “We’ll see it go a lot faster now that we have a House and a Senate and a White House presumably agreeing on this one premise — which is ‘private is good, public is bad.'”
“People who have HIV, who have advanced kidney disease … people who are living in devastated communities economically … If access to healthcare is made harder and harder, then they’re going to have a shorter lifespan, and they’re going to suffer more before they die.”
Many nurses also oppose Price’s nomination, Deborah Burger, RN, of Santa Rosa, Calif., and co-president of National Nurses United, the largest nurses union in the country, told MedPage Today in a phone interview.
If the ACA is repealed, one of the first steps in that repeal will likely involve a reversal of the tax increases that fund subsidies that help people afford their premiums.
And the revenue for Republicans’ proposed block grants for Medicaid won’t be there, she continued.
Seeking Common Ground
As more people declare their gender identity and sexual identity, they have been ostracized and stigmatized by clinicians, said Cipriano: “The healthcare community really needs to step up to make sure that these [LGBTQ] individuals … are being adequately cared for, and if there’s an inherent bias in the leaders of our Health and Human Services [Department], that doesn’t bode well for the healthcare community really embracing their needs.”
Price will very likely be confirmed, said Cipriano. She hopes that he will listen to nursing groups. In addition to supporting continued federal funding for nursing education, Cipriano hopes Price will set partisanship aside and embrace the “triple aim” — improving access, quality, and affordability of healthcare — and continue to advance value-based payment.
The American Congress of Obstetricians and Gynecologists (ACOG), in a letter to Price concerning his opposition to federal funding for abortion and for Planned Parenthood, sounded a warning: “Planned Parenthood clinics provide critical preventative healthcare services to women and men. Abortion is healthcare. ACOG remains committed to protecting each of these critical aspects of women’s health.”
The group also acknowledged areas where Price’s views aligned with its own: Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and medical liability reform.
“Your consistent efforts to find common ground and work together on shared goals are laudable, and your commitment to accomplishments, rather than talking points, is unfortunately all too rare in Washington. We hope that you will use your new role as an opportunity to expand on these collaborative practices,” ACOG wrote.
Laura Wooster, MPH, executive vice president of public policy for the American Osteopathic Association, also sounded a cautious tone in a phone call with MedPage Today. “Other than stating our priorities, it seems premature to really start getting vocal,” she said, explaining that the group doesn’t normally endorse or oppose nominees.
She noted, though, that many of the group’s members have echoed one of Price’s talking points, the “administrative burden” that government involvement in healthcare can sometimes bring.
Senate Opposition Brewing?
Even though confirmation seems assured, Price still must face grilling and probable opposition from Senate Democrats.
On Thursday, Democrats in Congress called for an ethics probe into Price’s financial holdings and investments. Price traded $300,000 worth of shares in health-related companies while in the House, according to The Wall Street Journal.
“There’s enough evidence here that cries out for an investigation. Whether the law was actually broken, whether there [were] quid pro quos or inside information is the better way to put it — we don’t know,” said Senate Minority Leader Chuck Schumer (D-N.Y.) at a news conference, as reported by CNN.