A small but vocal minority of doctors have cited the “fundamental pledge” they made to protect their patients as reason to oppose Rep. Tom Price (R-Ga.), President-elect Donald Trump’s pick to run the Department of Health and Human Services.
Price has mounting conflict of interests allegations, and has also endorsed policies that threaten the most vulnerable populations and innovations to improve health care, according to letters to the Senate signed by more than 8,000 doctors and medical students supporting the Clinician Action Network or the National Physicians Alliance.
“As we have previously expressed, we are deeply concerned about the effect Dr. Price’s policies will have on our patients and the progress made under the [Affordable Care Act],” CAN, an organization formed in the wake of Trump’s election to publicly advocate for vulnerable patients, told The Huffington Post in a statement.
These 8,000 opponents make up a small percentage of the more than 916,200 physicians in the country, but they are illustrative of a medical community that’s becoming more politically engaged ― and increasingly polarized.
“[Doctors] are becoming activists in different ways,” said Thomas D’Aunno, director of the health policy and management program at New York University’s Robert F. Wagner Graduate School of Public Service. “Physicians not only want to know about the system but they want to have more of a seat at the table in leading the changes.”
Price vs. Obamacare
Price, a former orthopedic surgeon, is an outspoken opponent of the Affordable Care Act. Trump has made it clear that he plans to repeal the health care law as soon as possible and replace it as soon as his HHS secretary is confirmed.
“We’re going to be submitting, as soon as our secretary is approved ― almost simultaneously, shortly thereafter ― a plan,” Trump said this week during his first post-election press conference. “It’ll be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day ― could be the same hour.”
Republicans in Congress have neither agreed upon nor put forth a replacement plan, so this is likely impossible. Still, Senate Republicans pressed forward on Thursday, passing a budget resolution to strip the ACA of its funding and spending provisions. The resolution still needs to be voted on by both chambers, but doesn’t require a presidential signature.
“Many of the provisions that have radically improved care ... do not exist in Tom Price’s vision for health care in America.”- Manik Chhabara, co-founder of the Clinician Action Network
Reports show that the ACA has brought preventive services to 71 million Americans without cost-sharing, Manik Chhabara, an internal medicine physician and co-founder of the CAN, said Thursday during a press conference. That includes screenings for breast and colon cancer, immunizations, annual checkups and contraception.
Trump’s eagerness to replace Obamacare implies that he could be considering Price’s previous repeal proposal to be a blueprint for a new plan, Manan Trivedi, an internal medicine physician and president of the NPA, said at the press conference.
That plan would “essentially erode the health insurance market,” he said, by eliminating Medicaid expansion, instituting regressive subsidies and getting rid of consumer protections.
“Many of the provisions that have radically improved the care that Americans have access to as part of the Affordable Care Act do not exist in Tom Price’s vision for health care in America,” Chhabra said. “And that has us extremely concerned.”
Potential harm for vulnerable groups
The letter also says physicians oppose Price because he supports privatizing Medicare.
Phil Blando, a Trump transition spokesman speaking on behalf of Price’s team, dismissed this concern as a “Democratic talking point,” but didn’t elaborate.
However, there is evidence that Price advocates for at least some privatization of Medicare. Namely, he has supported the idea of the government giving qualifying individuals specific sums of money to pay for private health plans. Doing so would shift a big portion of the financial risk to seniors ― and critics worry that the guarantee of coverage provided by traditional Medicare wouldn’t survive in such an environment.
The primary goal of those plans is to limit how much the government spends on health care for seniors. Critics of such plans concede that would happen, but worry the policies would leave vulnerable Americans more exposed to higher medical bills.
“His support of the Ryan voucher plan for Medicare would be devastating to millions of American seniors,” Trivedi said.
Price’s opponents have also called out the nominee for having repeatedly fought against reproductive rights; taking policy positions against the LGBT community; endorsing legislation that would weaken gun violence protection; supporting less regulation of tobacco; opposing mental health parity laws; and being against funding for AIDS and malaria research and the Children’s Health Insurance Program.
Growing concern over conflicts of interest
The NPA and other public watchdog groups have called for a congressional ethics committee to investigate allegations of serious conflicts of interests and potential ethics violations. This would be in addition to the Office of Government Ethics background check required for all Cabinet nominees.
Price traded health industry company stocks worth over $300,000 while also working to sponsor or co-sponsor dozens of pieces of legislation regarding the health industry, Trivedi said.
“We are not certain that he broke the law, but clearly serious enough questions have been raised to warrant an inquiry,” he said. “Especially in his position as HHS secretary, we need to know that he has no other conflicts of interests.”
Additionally, Price may have benefited from a sweetheart deal from an Australian biotech firm, Kaiser Health News reported Friday.
A medical community divided
The American Medical Association, the country’s largest physicians group with 250,000 members, doesn’t seem as concerned as the CAN or NPA. Instead, it endorsed Price, who is a member, almost immediately.
In a statement issued on Nov. 29, board of trustees chair Dr. Patrice Harris urged the Senate to “promptly consider and confirm Dr. Price for this important role.” She explained in a follow-up letter that Price’s physician background would provide Trump’s Cabinet with a crucial perspective.
The endorsement surprised many physicians, especially considering the AMA supported the passage of the ACA. However, that position has shifted slightly. As CEO and executive vice president Dr. James Madara wrote in a letter to Congress earlier this month, “Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time.”
Madara also said policymakers should lay out a detailed replacement plan before altering health care coverage.
CAN’s founding members told HuffPost in December that they were critical of the AMA’s endorsement of Price. The AMA declined to comment on the CAN-NPA joint press conference against Price.
In addition to the AMA, Price has received endorsement from the American College of Emergency Physicians, the American Hospital Association, the Association of American Medical Colleges and the American Dental Association.
Still, the 8,000 detractors who wrote to lawmakers indicate that the medical community is becoming increasingly splintered.
“Fifty years ago, the American Medical Association was not only the voice of the whole medical community but it was among the most powerful lobbying groups in the United States,” said Michael Sparer, chair and professor of health policy and management at Columbia University’s Mailman School of Public Health.
“As the physician community has become more fragmented, it has lost the single voice that represents it,” he added. “In part, that’s what you’re seeing right now.”
Those divisions have a political element. The New York Times reported in October that two-thirds of surgeons, anesthesiologists and urologists are registered Republicans, but the majority of infectious disease specialists, psychiatrists and pediatricians are Democrats.
While a newly politicized medical community might be outspoken regardless of the candidate being considered for health secretary, Price is an especially polarizing choice. In addition to earning a zero rating from Planned Parenthood and co-sponsoring two anti-choice abortion bills, Price has spoken out against value-based care that would pay doctors based on the quality of their work, a measure Republicans like House Speaker Paul Ryan (R-Wis.) have consistently supported.
“His positions are actually fairly extreme,” D’Aunno said.