Day One: Trump Begins ACA Take Down

MedPage Today

Jan. 21, 2017

WASHINGTON — Just hours after his inauguration, President Donald Trump enabled a federal agency to pull back on critical provisions of the Affordable Care Act (ACA).

Trump signed an executive order on Friday pressing government departments to “change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states, according to the New York Times. The move will essentially allow the U.S. Department of Health and Human Services (HHS) to begin unraveling the law before Congress can repeal it.

Rep. Ralph Abraham, MD, (R-La.) told MedPage Today in a phone interview on Friday that Trump was “going to work, right after he finishes lunch,” although he did not specify if orders related to the ACA would be enacted.

The order outlines its aim “to minimize the unwarranted economic and regulatory burdens of the [Affordable Care] Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market,” according to CNN. This includes the potential weakening of the “individual mandate,” which requires most Americans to have health insurance or pay a tax penalty.

Abraham noted that Rep. Tom Price, MD, (R-Ga.), currently Trump’s nominee for HHS secretary, would have the authority to change and undo many key regulations.

Asked whether such changes could hurt patients if a replacement plan has not been implemented, Abraham said he was optimistic. “[Price is] a very logical, measured man. He will make decision that are best for the patient,” he stated.

In a press release, Sen. Lamar Alexander (R-Tenn.), chair of the Senate Committee on Health, Education, Labor and Pensions, stated that “President Trump is right to make the urgent work of rescuing Americans trapped in a collapsing Obamacare system a top priority on his first day in office.”

Alexander noted that he was looking forward to repealing the law but also to “replacing it simultaneously with concrete, practical reforms that give Americans access to truly affordable health care.”

Optimism, Excitement, and Protest: An Inauguration Day Snapshot

WASHINGTON — Before and during Friday’s inauguration of Donald J. Trump as the 45th president, MedPage Today reporters were on the phone and on the scene to talk to healthcare providers — those taking care of the inauguration crowd as well as physician members of the audience — and members of Congress who are health professionals and had their own take on the day. We also were present for one of the more offbeat protest actions at the inauguration.

Rep. Eddie Bernice Johnson (D-Texas), a former psychiatric nurse, was at the inauguration. “I really don’t know Trump, but I’m going to do my best to make the best use of my working with him for the betterment of my constituents,” she said in an interview Thursday. “I just can’t sit back and say, ‘Mine didn’t win and there’s nothing I can do.’ … I just believe that if I work hard there’ll be something I can do that will represent the people of [my] district.”

At the inauguration, Lou Provost, a member of a two-person roving medical team from the U.S. Public Health Service that was on the lookout for inauguration-goers who experienced health problems, said that things had been slow so far, “which is just the way we like it.” Any minor injuries the two had seen came from people who had tripped or fallen on the soft ground near the Capitol.

Bijender Kumar, MD, medical director of Hancock Regional Hospital in Indianapolis, Ind., said in a phone interview from the inauguration that he was excited about Trump’s presidency because “we definitely need some changes in the Affordable Care Act (ACA).” Kumar said he was “proud” of Rep. Tom Price, MD (R-Ga.), President Trump’s nominee for Secretary of Health and Human Services, and that Price and Seema Verma, Trump’s pick to run the Medicare and Medicaid programs, “might make great changes” by working together.

However, Kumar said he was not in favor of completely repealing the ACA. “Twenty million people are already on it, so completely repealing it is not a good idea,” he said.

Good Ideas for Replacement

Another supporter, Anne Galante, MD, an ob.gyn who volunteers at the Open Door Clinic of Middlebury, Vt., also did not support full repeal; however, she’s still critical of the law.

“The spirit of covering everybody is good, but in reality it wasn’t good for everybody … People technically have insurance, but they can’t use it.”

Trump has good ideas for replacing the ACA, she said — i.e., including health savings accounts and allowing health insurance companies to sell plans across state lines — and she believes that he won’t let people “die in the streets,” as he’s promised.

She admits, she is “nervous” — “I really hope the new administration doesn’t drop the ball.”

Meanwhile, a few hundred people gathered downtown Friday morning to call for President Trump to end federal cannabis prohibition. Congregating on the sidewalk just to the west of Dupont Circle in Northwest Washington, a group of event organizers with the group DCMJ handed out small joints to anyone who could show proof of being at least 21.

About 11:30 a.m., the protesters marched down 19th Street towards the National Mall. They played music as they walked, arriving peacefully in between the Washington Monument and World War II Memorial.

Several protesters headed for a nearby security checkpoint to get into the Mall, while others stayed outside and listened to the inauguration festivities via a portable speaker organizers brought. Four minutes, 20 seconds into Trump’s speech, most among that crowd of about 100 sparked their lighters and indulged.

Helping the Uninsured

Sen. Bill Cassidy (R-La.) sounded positive about Trump’s inauguration speech, in which he talked about solving the problems of the poor.

Cassidy said he wasn’t disappointed that new president hadn’t mentioned healthcare.

“If you combine his previous statements regarding the need to cover all and take care of those with pre-existing conditions with [today’s speech] about those who have not done well over the past 8 years and you put them together … it shows that I think he’s going to be where most physicians are,” he said in a phone interview. “We want patients to have coverage, and we want it to be meaningful.”

Rep. Andy Harris, MD, (R- Md.) said Trump’s speech was non-partisan. “It was an America-first speech. He was unabashedly America-first on the campaign and I think it struck a chord in the Midwest.”

Harris was also unfazed by the absence of healthcare in Trump’s speech.

“I think he’s going to to roll up his sleeves and begin to take the steps to make sure that American healthcare and health insurance becomes affordable … He’s sent clear signals in the last week that this is one of his top priorities.”

Harris characterized healthcare changes as “reform and replace” rather than repeal-and-replace, noting that Republicans can’t do everything they’d like through the budget reconciliation process.

“Without 60 votes in the Senate you really can’t repeal it… I’m just being a little more technically correct.. The end goal is to put in something that works, so I don’t think that the semantics of it matter.”

‘Repair’ Rather Than ‘Replace’

Harris’s colleague, Rep. Ralph Abraham, MD, (R- La.) took a similar view.

“I would prefer to use the word ‘repair’ rather than ‘replace,’ because we’re going to keep some things. It’s not going to be a complete replacement, but it’s going to be a pretty good overhaul,” he told MedPage Today in a phone interview, noting that preserving access for those with pre-existing conditions and allowing people under 26 to stay on their parents’ insurance plans were two of the “good things.”

Anish Koka, MD, a Philadelphia cardiologist who supported Obama prior to voting for Donald Trump, said he was optimistic about Trump’s healthcare plans. “My general feeling was we were headed on a path that’s going to make it more and more challenging for physicians — especially independent physicians — to survive, since [things like] bundled payment and large integrated care networks have a lot of [requirements] that a lot of solo or small practices don’t have,” he said in a phone interview.

“It is somewhat of a relief to feel that, based on some of the early comments Tom Price has made — certainly at his hearing — there may be relief coming for independent physicians in terms of onerous regulations that are tough to manage.”

As for the ACA, “Whether you call it repeal, or fixing it, something that allows us as physicians to take on patients in a way that’s not untenable; that’s what I’d like,” Koka said. “The vast majority of us want expanded access for patients … the question is, how do we get that? It became increasingly obvious that the ACA and the way they were going about it is not necessarily the best way to go about it.”

Senators Grill Price, but He Stands His Ground

WASHINGTON — Repeal of the Affordable Care Act and its consequences were on the hot seat as senators questioned Rep. Tom Price, MD (R-Ga.) Wednesday about his fitness to serve as Secretary of Health and Human Services.

“I have serious concerns about your qualifications for the department you hope to lead,” said Sen. Patty Murray (D-Wash.), ranking member of the Health, Education, Labor, & Pensions (HELP) Committee, at a hearing on the nomination. “Just last week you voted to begin the process of ripping apart our healthcare system without any plan to replace it, even though [it’s estimated that] 30 million people will lose their coverage.”

Wednesday’s hearing was a “courtesy” hearing before the committee, which is not tasked with sending Price’s nomination to the Senate floor for a vote. That responsibility falls to the Senate Finance Committee, which is scheduled to hold a formal confirmation hearing and vote on the Price nomination next Tuesday.

Healthcare for All

Price maintained that if he is confirmed, he will fulfill president-elect Donald Trump’s promise of healthcare for everyone. “The principles that I think are absolutely imperative for the healthcare system is one that’s affordable for everybody, one that provides access to health coverage and care for everybody, one that’s of highest quality, that’s responsive to patients … one that incentivizes innovation, and that insures choices are made and preserved by patients,” he said.

Access was a word that Price returned to frequently when he was asked if he would guarantee that certain groups would not lose healthcare coverage under a replacement for the ACA. “It’s incredibly important that we have a system for every single American to have access to the kind of coverage they need and desire,” he said in answer to another question.

Access to health insurance is not an exact match for President-elect Donald J. Trump’s promise of health insurance for all, a point hammered home by Vermont Sen. Bernie Sanders, the independent who challenged Hillary Clinton for the Democratic nomination. “I have access to buying a $10 million home. I don’t have the money to do that,” Sanders said.

Democratic senators also pressed Price on potential conflicts of interest, specifically his healthcare stock trades, several of which been the subject of media coverage. Price maintained that many of his stock trades are done through a broker so he is not always aware of them, and that he has disclosed any relevant trades as required by the House Office of Government Ethics.

In response to questions about his purchase of stock in six pharmaceutical companies shortly before introducing a bill blocking a regulation that would likely have hurt those same companies, he noted that “My opposition to having the federal government dictate what drugs are available to patients is longstanding.”

Contraception Coverage

Murray also asked Price about his views on paying for contraceptive coverage. “You have said you don’t think cost is an issue for women in buying birth control and stated, ‘Bring me one woman who has been left behind … there is not one,’ correct?” she said.

“I think what I said and what I meant was that when I had patients in my office who were unable to afford medication, we did everything we could to make certain they got that medication. What I meant to capture in that conversation was that if there are individuals who are unable to afford that med, or any med, that there are avenues within the healthcare system physicians and others take to make sure individuals receive medication that they need.”

Murray related the example of a constituent diagnosed with endometriosis who takes contraceptives for chronic pain and who told Murray that “No copay birth control is an essential tool for helping women like me with endometriosis who otherwise would have to live with chronic pain.”

“Women are deeply concerned about the impact this election could have on access to healthcare they need; I’ve heard from many of them,” said Murray. “Will you commit to ensuring all 18 FDA-approved methods of contraception continue to be covered so women don’t have to go back to paying extra costs for birth control?”

“What I will commit to … is that we believe strongly that every single American ought to have access to the kind of coverage and care they desire and want,” said Price. “That’s our commitment and it runs across the board.”

“Birth control is an essential part of women’s healthcare and if you are confirmed I will be holding you accountable for that,” Murray responded.

As was expected, Price received friendlier queries from Republicans on the HELP Committee. “You are clearly one of premier people in all of Congress to understand the problems of healthcare, and have the background … to solve the problems we have,” Sen. Orrin Hatch (R-Utah) said to Price, an orthopedic surgeon.

Sen. Rand Paul, MD (R-Ky.), also spoke favorably of Price. “I think what I regret about this kind of hearing is sort of the vitriol, the rancor and partisanship that should go into something; we want the same things. To question your motives is insulting; To question whether you’re honest is insulting … I think we all want the most amount of insurance for people, and the least amount of cost.”

Paul and Price discussed ideas that might be included in a Republican replacement for the ACA, including health savings accounts and high-deductible catastrophic coverage. “I think health savings accounts and high-deductible catastrophic coverage make a whole lot of sense for many individuals; they ought to have the choice,” said Price.

He also said a replacement plan could include high-risk pools to insure people who might otherwise have trouble getting coverage. Sen. Al Franken (D-Minn.) who was called on next to question Price had his own comment on the risk pool idea: “I’ll tell you how to get a really big risk pool — it’s called Medicare for everyone,” he said.

Price also discussed the Meaningful Use regulations for physicians’ use of electronic health records. “Electronic medical records and electronic health records (EHRs) are so important because … they allow the patient the opportunity to have their health history with them at all times, and allow the provider access to that,” he said. “We in the federal government have a role [in EHRs], but that role ought to be interoperability, to make certain that different systems can talk to each other so it inures to the benefit of the patient.”

But the Meaningful Use rules have really been burdensome for doctors, Price added. “I have had more than one physician tell me that the final regulations and rules related to Meaningful Use were the final straw for them … and they quit.”

“I think the thing that’s absolutely imperative, is to find out what things ought to be determined and checked … that the metrics used actually correlate with what’s being provided … so if we truly worked with those providing the care, saying, ‘What is it that we could ask you to measure that would really correlate with the outcome and quality of care provided,’ I suspect there’s some really specific things we could use.”

“Hope those watching are reassured by what they heard from you,” committee chairman Sen. Lamar Alexander (R-Tenn.) said as the hearing concluded. “While we intend to repair damage from Obamacare and that would mean repealing major parts of it, that won’t become effective until alternatives are in place … we don’t want to pull the rug out from everybody.”

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Volunteers deliver petitions to the Senate HELP Committee with more than 510,000 signatures from people opposing the nomination of Rep. Tom Price, MD, as Health and Human Services secretary. (Photo by Shannon Firth)

Voices Opposed

Just before the hearing began Wednesday morning, representatives of Planned Parenthood, the National Physicians Alliance, Physicians for a National Health Program, and Public Citizen, hand-delivered stacks of boxes containing various anti-Price petitions that they report include 500,000 signatures.

“As a physician, it just doesn’t look like he puts the interests of patients first,” said Susan Molchan, MD, a psychiatrist, nuclear medicine physician, and member of the board of directors for the National Physicians Alliance, told MedPage Today.

Molchan cited his stock buys in tobacco companies as evidence that Price has put corporate interests ahead of patients. Price opposed regulating nicotine as a drug, but Molchan said “nicotine has clearly been accepted as a drug, a very addictive drug for years.”

Price’s support for privatizing Medicare, by transitioning to a voucher-like program for future beneficiaries, also worried Molchan.

“To throw Medicare, which has much lower overhead than private insurance … into the grinder of private health would be terrible.” While she acknowledged that Medicare has its flaws, “it works better than the private health industry, which is out for big corporate entities,” she said.

If his nomination is confirmed, Price’s leadership, “will further erode standards for the approval of medical devices and the approval of drugs,” said Sammy Almashat, MD, MPH a research associate for Public Citizen’s Health Research Group based here.

“We’re very concerned that his presence [at HHS] will send a message to the FDA that the standards should be lowered even further than they already have been.”

His support for repealing the Affordable Care makes him “very dangerous” particularly for Americans with life-threatening diseases such as cancer and HIV and other chronic diseases, he said.

“[G]utting the minimal safety nets that still exist in the form of Medicare, in the form of the Affordable Care Act, would be disastrous for those patients. As a physician, I don’t see how another physician could support such policies.”

Med Students Assail Proposed ACA Repeal at D.C. Event

WASHINGTON — Medical students descended on the nation’s capital on Monday to protest the proposed repeal of the Affordable Care Act (ACA).

Hailing from all over the country, including as far away as Los Angeles, more than 50 medical trainees met with dozens of senators and legislative assistants, delivering petitions and hoping to dissuade Congress from doing away with the ACA. Medical students at over 30 other academic institutions in others states gathered to protest locally.

Also, around 25 members of #ProtectOurPatients participated in a FacebookLive Chat organized by Sen. Chuck Schumer (D-N.Y.) where they discussed the consequences of repeal with dozens of Senate Democrats in an online forum.

“Our main ask for today is for bipartisan work to be done on opposing repeal and working together to improve the existing ACA,” Sidra Bonner, a medical student at the University of San Francisco and lead organizer of the protest, told MedPage Today.

The grass-roots campaign #ProtectOurPatients, represents 4,000 medical students, including nursing students and other allied health professionals, Bonner explained.

While the group fundamentally opposes repeal, if it does happen, Bonner said, “there needs to be an immediate and better plan in place … [one that’s] better than the existing ACA in terms of access, quality, and cost,” she said.

The medical students may get their wishes granted to some extent — on Jan. 10, 2017, a group of Republican lawmakers introduced an amendment to extend the deadline for budget reconciliation, the promised “repeal bill,” from Jan. 27 to March 3, 2017.

“By providing more time to come up with legislative solutions, we have a better opportunity to produce a thoughtful, workable replacement that ensures Americans have access to affordable, diverse insurance plans that meet their needs,” Sen. Susan Collins (R-Maine) said in a press release.

The Senate is expected to vote on the preceding step in the repeal process, approving a budget resolution this week that would serve as a blueprint for repeal.

Lukewarm Republicans

Only two Republican senators met with protesters directly: Collins and Sen. Jeff Flake (R-Ariz.).

Protester Margaret Hayden, a second-year medical student at Harvard Medical School in Boston, grew up in Brunswick, Maine, and described her encounter with Collins, who is considered a more moderate Republican.

“I told her how I talked to the hospital CEO from Brunswick; talked to the chairman of the Maine Lobstermen’s [Community] Alliance and both said the same thing: That the Affordable Care Act isn’t perfect, but it’s providing essential services and protections for the people they care for and work on behalf of,” Hayden stated.

Hayden said she asked Collins to vote against repeal unless an immediate replacement offering “the same or better coverage” can be implemented.

Hayden described Collins as “responsive and understanding” especially regarding access to coverage for those with pre-existing conditions. “She’s committed to working on a replacement plan that will offer that for [Maine residents].”

As for the request to vote against repeal without a replacement, Collins said “she’s taking it under consideration,” Hayden reported.

A meeting between Flake and Kyle Ragins, MD, MBA, an emergency medicine resident at the University of California Los Angeles, had a less positive encounter.

Ragins wrote in a follow-up email on Tuesday that Flake was “evasive” and “noncommittal” regarding the request to vote “no” to a repeal without a simultaneous replacement.

Students also met with Republican staffers from the offices of Sen. Lamar Alexander (R-Tenn.), Sen. Roy Blunt (R-Mo.), Sen. Tom Cotton (R-Ark.), Sen. Rob Portman (R-Ohio), Sen. Marco Rubio (R-Fla.), and Sen. Pat Toomey (R-Pa.).

Democrats Engage

During the Facebook Live Chat, protester Maria Phillis, JD, a fourth-year medical student at Johns Hopkins University in Baltimore reported speaking with Sen. Elizabeth Warren (D-Mass.).

Phillis, who plans to specialize in obstetrics and gynecology, expressed concern to Warren that if the ACA is repealed, requirements to cover maternity care for women would disappear.

“[I]t’s really important to have that prenatal care,” Phillis said, noting that it’s not uncommon for life-threatening conditions to emerge during pregnancy. One example is pre-eclampsia, she said, noting that when it is caught early, clinicians can decide how to proceed to protect the mother and her baby.

“If we don’t have those people coming in and getting care, we may have them coming into deliver and having a seizure, and possibly even dying,” Phillis emphasized.

Following his Live Chat, MedPage Today asked Sen. Cory Booker (D-N.J.) if he was hopeful about saving Obamacare.

He said that he hoped warnings against repeal without replacement from groups such as the American Medical Association and the American Enterprise Institute (a conservative think tank) would prevail.

“Any action related to repeal is going to produce a lot of uncertainty that could destabilize markets and really cause a healthcare crisis in our country,” he said.

Sen. Ron Wyden (D-Ore.) and Sen. Amy Klobuchar (D-Minn.) were more cautious.

“Those who are saying they’re for repeal are saying ‘Nobody’s going to get hurt. Nobody’s going to lose any services.’ Tell that to the hundreds and thousands of women who depend on Planned Parenthood and depend on it for vital and preventive services,” Wyden told MedPage Today.

Klobuchar added that Republicans “just want to say ‘repeal.’ That sounds good on a bumper sticker, but you’re basically threatening the healthcare of millions of people.”

Sen. Kamala Harris (D-Calif.) made a pocketbook argument against repeal, saying that financially ACA repeal affects “all of us.” If “people are going to emergency rooms as the first place they seek medical care. It’s about all that we will benefit from in terms of having a healthy society and a productive society.”

Some medical students also participated in #ProtectOurPatients events at their own schools elsewhere in the country. Following are photos submitted to MedPage Today from Oregon Health & Science University, Yale University, Stanford University, and University of California branches in San Francisco, Los Angeles, Irvine, and Davis.

Doctors, Nurses Still Divided on Tom Price

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

Other nurses like Pamela Cipriano, PhD, RN, president of the American Nurses Association, also criticized Price’s record on diversity and inclusion, as well as his opposition to gay marriage.

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.

RNC: Young Internist Rallies Docs Against Trump

No matter what Trump says or does, he still manages to maintain 38% support in voter opinion surveys, Bryan Hambley, MD, co-founder of Stand Together Against Trump (STAT) told MedPage Today. Hambley completed his internal medicine residency at University Hospitals and is now a fellow in critical care medicine.

In this interview he tells Shannon Firth, MedPage Today’s Washington Correspondent, that he was spurred to action by Trump’s call to ban Muslim refugees, noting that he works daily side-by-side with Muslim doctors.

Protesters will convene Thursday afternoon for a march and later that evening for a rally in Public Square.

Click here for video.

RNC: Docs Protest as Trump Takes Stage

CLEVELAND — In the semi-darkness of Cleveland’s Public Square, activists Thursday night held signs glowing with tiny fluorescent bulbs that read S-T-A-T for “Stand Together Against Trump.”

It was nearly 10 p.m. and the group was just a few minutes walk from the stage where Donald Trump would formally accept the nomination at the Republican National Convention. They sang and chanted and waved and gave speeches, determined not to leave until he did.

STAT, a group of physicians, nurses and other professionals, first began publicly protesting the Trump campaign in March ahead of the Ohio primaries. It does not endorse a candidate and does not represent a single party.

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Aside from voting, Fatima Fadlalla, MD, a resident in internal medicine in Cleveland, said she’s never been active politically, but this time was different. She stepped away from the 30 or 40 people chanting on the marble steps in a grassy corner of the square — home to the iconic Cuyahoga County Soldiers and Sailors Monument.

“When the language that you hear in the election … when the leader of an entire party is, you know, spouting such language and using such divisive words and framing things in such a way that is so skewed and so against what you inherently believe, it is absolutely your responsibility to say something and to stand out, because you don’t want to look back in time and look back in history and think I had a moment and I didn’t seize it, and I didn’t say what I should have.”

As a physician, Fadlalla is concerned about Trump’s impact on her patients and the state of healthcare in the country. “It’s amazing how far he’s managed to come without actually making any specific policy remarks. But when you have somebody who frames certain arguments in such a way that is so narrow and so alienating, it’s hard to imagine that that type of individual will then be able to see some of the greater issues that are surrounding our patients and the population that we deal with, whether they’re inner-city or rural people.”

She said she worries about the social determinants of health — poverty, violence, lack of education — and thinks Trump is someone who won’t understand “that there are broader things going on that impact health. That in itself is going to have a negative impact on any sort of positive policies that would help my patients,” she said.

“I worry what a Donald Trump presidency would look like for myself as someone who is muslim and has lived here all of her life. … I worry what that looks like for my parents who immigrated here, and my friends and I worry about what that looks like for minorities.”

But she was clear about her purpose. “I’m here more than just as, like, a Muslim or just as a black person or as a woman. I’m here because I grew up believing in what I was taught about America, and about the values that we have as a country about equality, about justice, and I think that we seem to be getting further and further away from where we started in 1776, and that’s sad and that’s terrifying.”

“I just hope that people, you know, who are claiming to want to ‘make America great again’,” she said, steadying her voice, “will just take a moment and really look at what the founding fathers were talking about. I mean they weren’t perfect, but what they aspired or what they dreamed was far bigger and far better.”

Fadlalla’s sister Sara came with her to the protest. Sara Fadlalla is a post-baccalaureate student at Cleveland State University. She is applying to dental schools.

“She’s younger, I think, more energetic and very hopeful,” said Fatima Fadlalla of her sister. “I think having somebody that you’re used to taking care of, part of you wants to reassure them that things will be okay and that the future is better than the days before. And so that’s kind of what we’re holding to. … ” she said, her brown eyes starting to glisten. She apologized as she wiped at the corners of her eyes with her headscarf.

“I just hope that that’s actually the truth.”

RNC: Former CBO Director on Trump-Pence

CLEVELAND — MedPage Today caught up with Douglas “Doug” Holtz-Eakin, PhD, president of the American Action Forum, a center-right Washington-based think tank and a former director of the Congressional Budget Office, about his views on the Trump-Pence ticket, and whether Donald Trump would adopt Paul Ryan’s blueprint for health reform.

“When Ryan started the task force projects. I thought he would fail,” Holtz-Eakin said. Holtz-Eakin expected that, because it’s an election year, [House] members would be skittish about laying out too many specifics in policy areas, including healthcare, that a presidential nominee could then ignore.

“I’m not so sure now,” he said.

“You could easily see Trump as president saying, ‘Okay, see what kind of a deal you can get out of the House and Senate. We’ll work on the deal.’ And that’s what he likes. Cutting the deal. I don’t think he cares about the substance and the starting points.”

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