Secretary of Health and Human Services Dr. Tom Price joined me this morning:
HH: So pleased to welcome for the first time in his new position as Secretary of the Department of Health and Human Services Dr. Tom Price, an old friend of the show. Dr. Price, congratulations, it is a relief to have you at HHS.
TP: Oh, thanks so much, Hugh. It’s an incredible honor to serve here at HHS, and I’m just so privileged to have the President’s confidence in this role, and we look forward to moving things in a better direction.
HH: It’s been a long time since I saw you at the Docs 4 Patient Care conference, when you vowed to them and told me in the hallway Obamacare’s got to go, because we’ve got to restore the patient-doctor relationship. How soon does Obamacare get repealed?
TP: Well, I think it’s important for folks to appreciate why it needs to be repealed. And sometimes, that gets lost in all the muddle out there. But remember, and you know this well, that the costs are going up. People are paying more in the individual small group market for insurance. We’ve seen 25% increase in premiums over the last year, 99% over the last three to four years. Insurers are leaving the market. We’ve got a third of the counties in the country that only have one insurer offering coverage. Five states only have one insurer offering coverage. So things are not going well, and that’s what we need to do. We need to repeal it, because we need to put in place a patient-centered system, where patients and families and docs are making these decisions and not Washington, D.C. The timing, from the President’s standpoint, is as soon as possible. As he mentioned in his joint session last week to Congress, and to the nation, that he felt that it was imperative to repeal and replace Obamacare. He laid out priorities, and we’re hopeful that we can do that within the next number of weeks.
HH: There is a story by Jeremy Peters in the New York Times today about growing pressure to repeal. What about the repeal now and replace later strategy, Dr. Price, because if you give it a drop dead date, it’s all repealed jot and tittle by August of 2018, then it puts it on the Democrats to work with us. Otherwise, they’ll never work with us.
TP: Yeah, no, I think that the President has this exactly right, and that is that repeal and replace have to come essentially at the same time. And the reason for that is that with repeal, there are vulnerable populations out there. There are vulnerable folks that need to know and have the security that there will be an opportunity for them to gain coverage to the kind of health care and health coverage, health insurance coverage, that they want and not that the government forces them to buy. And so it’s absolutely, I think it’s imperative that we do these in concert with one another. Now there are things that you can’t do at the same time because of the vote margins in the Senate being necessary, but again, the reason to do this is because the individual small group market is collapsing in this country, and what we need to do is ensure that it remains in place and grows stronger and more vibrant so that it can be responsive to folks.
HH: Secretary Price, when a building burns down like Obamacare is burning down, you try and, the first thing you have to do is clear away the rubble, and you’re doing that. But then you remember what you liked the most about the old building. The three things that people seem to like about Obamacare – no exclusion for preexisting conditions, no lifetime cap on expenditures, and stay on your parent’s policy to age 26. Are those three features going to be features of any replacement?
TP: Yeah, the discussions are ongoing, but those are indeed the three things that folks mention most when they say what might work from the old construct. Certainly, having young folks stay on their parents’ plan, especially if they’re in school or not gainfully employed and don’t have coverage through their employer until 26, folks have really rallied around. Preexisting is really important. We don’t believe that anybody ought to be priced out of the market because they have a, they get a bad diagnosis or have a bad diagnosis. There are a number of ways to approach that, and we think one of those is to make certain that individuals, the onesies and twosies, the folks out there that are getting really squeezed right now because of the current law, that they have access to much larger pooling mechanisms so that they can join others solely for the purpose of purchasing coverage. And then they can get, at a reasonable price, what, the kind of coverage that they need and want for themselves and for their families.
HH: So what about the no lifetime cap?
TP: I think that again, that’s a work in progress, a discussion ongoing, and many individuals believe that that ought to remain in place.
HH: All right, now I want to talk to you from my experiences. I used to run the Federal Employee Health Benefits program back in the 80s.
HH: Adverse selection crippled it. Open seasons every year don’t make any sense unless you’ve had a triggering event like leaving your parents or getting married or something like that. When you look forward to replacement, is an open season every year actually possible? Otherwise, you’ll have adverse selection effects forever.
TP: Well, you can confine it, and that’s one of the things that we’ve done already. You know, there’s the law side, the legislative side that is working now to repeal and replace. There are also, as everybody knows, and especially in your audience, the rules and the regulations that the previous administration put into place. And we’re going to look at every single one of those that they put into place as it relates to the health care law, and say does it help patients or does it hurt patients. If it hurts patients, then we ought to remove it. One of the things that hurts the whole system is the adverse selection and the prolonged open enrollment. So we’ve already proposed a rule that would narrow the time window to be able to purchase coverage so that you don’t get that kind of adverse selection challenge.
HH: All right, now I want to talk a little bit about conscience issues, Secretary Price.
HH: Hobby Lobby won at the Supreme Court, and yet they never got relief. Little Sisters of the Poor was asking for the same relieve that was routinely granted to labor unions. Are you going to use your regulatory authority to extend conscience protections to people who do not want to participate in the purchase of abortifacients?
TP: This is really important, because this is fundamental to, we believe, the Constitution and individual rights. And as I said, we’re looking at all of the rules and regulations. The conscience provisions are ones that near and dear to my heart, and those of the President’s, and so the answer to your question is we will be addressing this, and we’re working through the legality of that and the rulemaking provision for that as we speak.
HH: All right, now Secretary Price, the, I think you’re lonely there in the building. I don’t know if any other HHS political appointee has been nominated, much less confirmed. Am I right about that?
TP: No one, none of the Senate-confirmed folks have been confirmed, yet. We hope to have Seema Verma on as director at CMS this week, I’m hopeful, through the Senate. But it’s, we’ve got a lot of good folks working here, but it’s been a slow, slow process. It’s a challenge right now. We’ve got, the people that are here are working 16, 18 hour days, and God bless them for it.
HH: Have you nominated, yet, a Food and Drug Administration director?
TP: We’ve got, I’ve got 18 Senate-approved, presidential-appointed, Senate-approved folks in my department, and we’ve got virtually all of them with names that we have sent to the White House. Most of them are, well, they’re all in various stages of being vetted and reviewed. Some, you know, they’ve got to go through an FBI background check and the whole financial vetting process that occurs. And so that’s where most of them are, and I think you’ll see some names being announced, I hope, this week, if not next.
HH: Now the President spoke in his address to the joint session about the need to expedite FDA approval.
TP: Yes. Yes.
HH: And it seems to me this is a national consensus on this. How do you move that up if everyone agrees that they’re too slow? How do you change that culture?
TP: At the FDA? It takes a leader, and I think that folks will be very, very pleased with the individual that we’ve identified and will hopefully work and get through the Senate confirmation process. It takes a leader who understands and respects the fact that getting, having a medication or a device come to market and having it take 10 to 14 years is simply too long. And we need to be responsive and accountable to our fellow citizens to make certain that we are on the cutting edge of innovation. Safety? Yes, it’s absolutely imperative that things that are on the market are proven to be safe by the FDA and other regulators, but we must not, we must not delay the length of time that it takes for things to get to market so that they can benefit individuals.
HH: Now if I can return to Obamacare, many of us have seen the town hall meetings, Secretary Price, where people have stood up and said I would be dead but for the Affordable Care Act. And those people aren’t made up. Those are real stories of folks who got access to the health care system. What do you say to them and to their elected leaders about the change that is coming?
TP: That we don’t believe that anybody ought to have the rug pulled out from under them. We firmly believe that every single American ought to have access to the kind of health coverage that they want for themselves and for their family, and the vision that we have is for lower costs, greater options, greater choices for folks, greater access to the kind of care that they desire, the kind of doctors, the doctors that they want to see and be treated where they want to be treated, not following the dictates of the federal government. So the goal is not to have people removed from their health coverage. The goal is to expand the choices and options and lower the costs for folks.
HH: Now the President, when he campaigned, Secretary Price, often spoke about erasing the lines. I always understood that to mean one market for one country, that if you’re going to offer a policy in New Mexico, even if nobody wants to buy it in Vermont, they ought to have the right to buy it. I mean, they won’t have the doctor network, they won’t have the hospitals. How do we get to a national exchange, to one market, not 50 two of them?
TP: Yeah, you know, folks mean different things when they say purchase across state lines. There are many number of bills in the Congress that have been introduced in past Congresses, and I expect they are this time as well. Some of them simply allow for insurers to sell insurance in another state. Sometimes, it’s an adjacent state. There’s some vision, some folks that have the vision that it ought to be through a state compact, that states agree with each other that insurers can sell in both states or a number of states. The national market that you describe is one that actually exists in the ERISA plans, in the self-insured plans. And so the Coca-Colas of the world, the Home Depots of the world, the Wal-Marts of the world, all those folks, they don’t, they don’t have one plan for every single state in which they’re domiciled and have facilities. They’ve got a single plan for the entire country, or plans that their employees can choose from. That’s the kind of vision that we believe is important especially for, again, those folks in the individual and small group market, the onesies and twosies out there that are just, just having huge challenges from a cost standpoint. We’re working through how that would work, and whether or not it’s possible to do that through the ERISA or the self-insured construct of the law.
HH: Interesting. Now I don’t want to get you in trouble with Leader McConnell. He loves his filibuster, and most of the Senators do, but we are talking about life and death legislation here. And the 60 vote rule, with an obstructionist Senate, is going to stop replacement. Ought the Senate to invoke the Reid Rule, which is that you can change the rules of the Senate with a simple majority in order to expedite health care reform and save lives?
TP: Well, I’ll leave the, as you might imagine, I’ll leave the Senate rules to the Senators. We’ve been talking and working with folks on both sides of the aisle. There are Democrats who are interested in making certain that their constituents have the opportunity to purchase the kind of coverage that they want, again, not that the government forces them to buy. So our goal is to do all that we can with every single member of the Senate, every single member of the House, to improve the health, safety and well-being of the American people, and we’re intent on doing that. To speak specifically to your issue, I think it’s important that folks realize that the reconciliation process of the budget authority that the House and the Senate have allows for many, many things to be done with just a simple majority in the United States Senate, and that’s the process that’s currently going to be going forward.
HH: Now the $64,000 dollar question, Secretary Price, is if you can’t get 60 votes in the Senate to replace, is the country better off with a simple repeal and no replacement, or by allowing the Obamacare house fire to continue to burn down to the foundation?
TP: Well, there are a number of things that can be done with a simple majority that would allow for appropriate construct or foundation for a replacement. And again, remember the hundreds of times that the previous administration, through this department right here, put forward rules and regulations and guidances for the nation that changed significantly how individuals are able to access health care, health coverage and their doctor. Because those were put forward in rules, they can be modified by rules or by guidances, and again, we’re looking through every single one of those to see whether or not they hurt patients or harm patients. And if they harm patients, then we believe that we ought to repeal them or remove them in a much better direction.
HH: Now I want to turn to the culture of the administration. How are you finding it, Secretary Price, to work with President Trump?
TP: Well, I just, I’m so incredibly honored to serve in his cabinet. This is a gentleman who is interested in getting things done, moving things in a positive direction for the nation. He knows that people are getting squeezed out there. He knows that people are being harmed in all sorts of ways. But from a health standpoint, he’s heard the stories. I was with the Vice President just this past week in Cincinnati with a small business group, and one fellow in Cincinnati had a business where he had 18 employees last year. This year, he has 15 employees, because he had to lay three of them off solely because he couldn’t afford the purchase of health coverage for them. This is just craziness where we are right now. So the President is just, he’s got a, really, a wonderful, warm heart for folks, and understands the challenges that they’re going through, and has challenged all of us to make certain that we move things in a much better direction as rapidly as possible.
HH: Now Secretary Price, I want to finish by talking about communications, and I’ve often faulted Republicans for not talking enough with the media. I also work for NBC. I would love for you to come and do a town hall with, say, Chuck Todd and Brian Williams and Rachel Maddow and myself and take questions from all over. Are you going to lean forward into these controversies and these conversations and then do events like that?
TP: Oh, we’ve got to. We simply must, because look, we’re not afraid of the solutions we’re putting forward. The solutions that we’re putting forward actually work. That’s why we’re excited about it, and that’s why I’m so incredibly enthusiastic about this position and the opportunity to serve in this position, because I believe that as we move forward, especially in the area of health coverage and health care, and put in place a system that allows patients and families and doctors to be making these decisions, that the American people are going to embrace that. They know that they don’t want the federal government in the exam room or in the operating room with them and their doctor. That’s not where they believe the role of government should be. So no, we’re excited about the opportunities that we have, and look forward to describing them and celebrating them with the American people.
HH: But selling these things really does take a lot of time.
HH: And I know that a cabinet secretary, I’ve worked for a few of them, you know, your day is already set. You’ve probably got a schedule in front of you that goes from sun up to sundown. And yet you’ve got to carve out coms time. And is that part of the strategic planning throughout the entire administration to persuade, not merely to roll over?
TP: Yeah, I think so, and I think that you’ve seen a commitment to communication from the administration. We’re working through that as this ties to the, to one of the questions that you asked earlier, and that is trying to fill all of the slots here in the department. And I think once we get, we get up and running with a full complement, that you’re absolutely spot on. The need for communication and relaying, laying out the challenges that exist right now for the American people, so they understand why things are being addressed and why they’re being done, they’re not being done for political reasons. The kinds of things that we’re working on in this department, we’re working on solely for the benefit of the American people. And we’ve got to be out there day after day after day and simply explaining that in all sorts of different venues, and trying to reach every single American so they understand and appreciate the concern that we have, but also the passion that we have for the solutions.
HH: And Secretary Price, my last two questions have to do with Social Security and Social Security Disability Insurance. That falls under your massive writ. I mean, you’ve got a huge department here. I talked to Mick Mulvaney about this last hour. It seems to me we have to both reform SSDI, because we’ve doubled from 7 million to 15 million the number of people who are receiving that monthly under the strangest of rules, and the retirement age is just not in keeping with modern actuarial tables. What do you have to say on both of those subjects?
TP: Yeah, the Social Security Administration is not under HHS, but…
HH: Oh, I’m sorry. I thought it was. It’s Labor?
TP: Yeah, that’s, well, I believe it’s Labor, yeah, though it’s maybe unto itself.
HH: Okay, well then, talk to me about disability insurance, though. You’ve got to know that from your budget days.
TP: Well, I’ll put that budget hat on, and you’re absolutely right. The challenges that we have from a fiscal standpoint for this nation are that the two-thirds of the budget is on autopilot, and from the mandatory spending side. And unless we as a nation address the fiscal challenges that we have, then we’re going to see much more difficult days, many more difficult days ahead, because we’re not going to be able to fulfill the promises that we’ve made to the American people for Social Security, for Medicare, for Medicaid. And so we believe that it’s important to save, strengthen and secure those programs as opposed to letting them simply go fallow because of inaction.
HH: Well then, I will go find whoever has SS and SSDI and ask them about that. Secretary Tom Price, it is great to talk to you, Doctor. Good luck in pushing forward, and I look forward to having you back soon here and on TV.
End of interview.