HHS Secretary Tom Price, MD, testified before the Senate Finance Committee and Ways and Means Committee Thursday on President Donald Trump's budget as it relates to HHS and the House-passed American Health Care Act.
Here are the key takeaways.
1. Medicaid. Dr. Price defended President Trump's budget cuts from the Medicaid program. At the finance hearing he indicated there is likely some overlap between $610 billion in cuts included in the president's budget and the $834 billion in cuts included in the AHCA.
"The constellation of programs we would envision would provide for greater opportunity for individuals to get coverage, as opposed to less right now. I would remind folks again there are 20 million Americans without health coverage. What we would envision is a system that actually responds to those folks and individuals who find that it's better for them not to be covered on the Medicaid system, but on a system that is more responsive to them," Dr. Price said, alluding to previous comments on Medicaid waivers that would allow states to focus resources on specific populations.
2. Opioids. In both hearings, he listed the opioid epidemic as one of the top three health challenges currently facing the nation and discussed a five-part strategy and budget increase of $50 million to fight it. However, Sen. Sherrod Brown, D-Ohio, challenged Dr. Price's commitment to fight the opioid epidemic as conflicting with Medicaid cuts. Ohio spent $939 million on fighting the opioid epidemic in 2016, $650 million of which came from Medicaid, Mr. Brown said. "How do you plan to increase access to treatment when you cut the single biggest source of funding for treatment by $600 billion," Mr. Brown asked.
Dr. Price said, "If we are going to be married to a system that has resulted in 52,000 overdose deaths in 2015, that's not a system I want to be married to." He added, "What I commit to you and what I look forward to working with you on is a system that actually works for the parents who are suffering today because they lost a loved one."
3. Stabilizing ACA marketplaces. Several Democrats challenged Dr. Price on the administration's commitment to current law and maintaining the ACA marketplaces until a new plan is in place, citing reduced time to sign up for coverage, reduced outreach and uncertainty about the future of cost-sharing subsidies, among other issues. "Nobody is interested in sabotaging the system," Dr. Price said. He noted the market stabilization rule released in April as evidence the administration was committed to a stable transition.
4. Cost-sharing reduction subsidies. Senators grilled Dr. Price on the future of the cost-sharing reduction subsidies, which were authorized by the Obama administration to help offset the cost of providing discounted deductibles to low-income marketplace enrollees. They are also the subject of a lawsuit challenging the constitutionality of the payments. Dr. Price cited this lawsuit as a reason why he could not provide more information on the future of these payments. "The current court case is now House v. Price. What I can tell you is that the budget reflects the payment of the CSR payments through 2018," he said.
5. Contraceptive coverage. When asked to discuss a rule that would allow employers not to include birth control in basic health coverage, Dr. Price did not provide a direct answer. He instead repeated, "I believe women that desire to have access to birth control ought to have access to birth control."
6. Zika. The budget cuts funding for the National Institutes of Health from about $31.8 billion to $26 billion, and the administration followed this with additional proposed cuts to NIH of $1.2 billion in fiscal 2017. When asked how these cuts position the agency to prevent and control outbreaks like Zika, Dr. Price said, "We believe the budget accommodates for handling any challenge that may exist from the Zika threat. The proposed budget identifies reductions we believe can be accomplished at NIH … by increasing efficiencies and making certain we have the core mission of NIH accomplished through the resources that are made available."
7. GOP approach to healthcare bill. Democrats voiced concern about the Senate version of the healthcare bill intended to repeal and replace the ACA. "We have no idea what's being proposed. There's a group of guys in a back room somewhere making these decisions. This is hard to take," said Democratic Sen. Claire McCaskill of Missouri. In an aside to Finance Committee Chairman Orrin Hatch, R-Utah, she asked if there would be a hearing for the healthcare proposal. Mr. Hatch indicated there will likely not be a hearing for the proposal.
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