After a bruising confirmation process, the Senate confirmed Rep. Tom Price, R-Ga., to head up the Department of Health and Human Services, by a 52-to-47 vote.
As secretary, Price will have significant authority to rewrite the rules for the Affordable Care Act, some of which are to be issued.
But there is much more now within Price鈥檚 purview, as head of an agency with a budget of for the current fiscal year. 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.
鈥淰irtually everything people do every day is impacted by the way the Department of Health and Human Services is run,鈥� said Matt Myers, president of the Campaign for Tobacco-Free Kids. HHS responsibilities include food and drug safety, biomedical research, disease prevention and control, as well as oversight over everything from medical laboratories to nursing homes.
Price, a Georgia physician the Affordable Care Act, abortion and funding for Planned Parenthood, among other things, could have a rapid impact without even a presidential order or an act of Congress
Some advocates are excited by that possibility. 鈥淲ith Dr. Price taking the helm of American health policy, doctors and patients alike have sound reasons to hope for a welcome and long-overdue change,鈥� Robert Moffit, a senior fellow at the conservative Heritage Foundation, said in a statement when Price鈥檚 nomination was announced.
Others are less enthusiastic. Asked about what policies Price might enact, Topher Spiro of the liberal Center for American Progress said at that time: 鈥淚 don鈥檛 know if I want to brainstorm bad ideas for him to do.鈥�
Here are five actions the new HHS secretary might take, according to advocates on both sides, that would disrupt health policies currently in force:
Birth control coverage: Under the ACA, most insurance plans must provide women with any form of contraception approved by the Food and Drug Administration at . This has been particularly controversial in regards to religious employers who object to artificial contraception, leading to , and resulting in a two separate Supreme Court rulings, one about , and one about .
As secretary, Price would have two main options. He could expand the 鈥渁ccommodation鈥� that already exempts some houses of worship from the requirement to any employer with a religious objection. Or, because the specific inclusion of birth control came via a rather than the law itself, he could simply eliminate no-copay birth control coverage from the benefits insurance plans must offer. (This assumes continuing existence of the health law, at least for the short term.)
Medicare payment changes: The health law created an agency within Medicare, called , that was tasked with 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 the experiments and new payment models. Some have proved unpopular with physician and hospital groups, in particular the idea of paying providers so-called bundled payments for packages of care, rather than allowing them to bill item-by-item; one such package covers , from the time of surgery through post-surgical rehabilitation. Price, as a former orthopedic surgeon himself, would likely act to scale back, delay or cancel that project, since he 鈥渉as been a critic in the past,鈥� said Dan Mendelson, CEO of Avalere Health, a Washington-based consulting firm.
Planned Parenthood funding: Republicans have been agitating to separate Planned Parenthood from its federal funding . Congress would have to to permanently defund the women鈥檚聽health group, which also performs abortions (with non-federal funds) at many of its sites. But an HHS secretary has many tools at his disposal to make life miserable for the organization.
For example, during the Reagan and George H.W. Bush administrations, , and eventually , that would have banned staff in federally funded family planning clinics from counseling or referring for abortion women with unintended pregnancies. The subsequent Clinton administration repealed the rules, but they could make a comeback under the new secretary鈥檚 leadership.
Price could also throw the weight of the department into into Planned Parenthood鈥檚 ties to firms allegedly selling fetal tissue for profit, which has also been investigated by a House committee.
Tobacco regulation: After years of discord, Congress finally agreed to give the Food and Drug Administration (limited) authority to regulate tobacco products in . 鈥淭he core authority is statutory,鈥� said Matt Myers of the Campaign for Tobacco-Free Kids, who advocated for the law. That means Congress would have to act to eliminate many of its changes. But a secretary who opposes the law (Price at the time) could weaken enforcement, says Myers. Or he could rewrite and water down some rules, including recent ones affecting .
鈥淭he secretary has very broad discretionary authority not to vigorously enforce or implement the statute in an aggressive manner,鈥� Myers said.
Conscience protections: At the very end of the George W. Bush administration, HHS intended to clarify that health care professionals did not have to participate in performing abortions, sterilizations or other procedures that violated a 鈥渞eligious belief or moral conviction.鈥�
Opponents of the rules complained, however, that they were so vague and sweeping that they could apply not just to opponents of abortion, but also to those who don鈥檛 want to provide birth control to unmarried women, or HIV treatment to homosexuals.
The Obama administration dramatically, much to the continuing consternation of conservatives. They were among the few health-related items included in the health section of Trump鈥檚 website before he was inaugurated and the page was taken down. 鈥淭he Administration will act to protect individual conscience in health care,鈥� it said. Many expect the rules to be reinstated in their original form.
This is an updated version of a story that initially ran Dec. 9, 2016. It was updated Feb. 10, 2017 to reflect that Tom Price had been confirmed by the Senate.