Replacing the Affordable Care Act (ACA), Medicare reform, malpractice lawsuits and differing definitions of “coverage” versus “access” were all discussed in the first Senate hearing of President-elect Donald Trump’s nominee to run HHS, U.S. Rep. Tom Price, MD, R-Georgia.

Before being questioned by the Senate Health, Labor, Education and Pensions (HELP) Committee, Price tried to explain his healthcare philosophy and how it was shaped by his experience as both a surgeon and a founder of an orthopedic practice. It included some subtle digs at the Obama Administration’s healthcare policies.

“Many of my patients were never more irritated or angry when they recognized that there was somebody else in the exam room—not physically, but figuratively—who was getting between the doctor and the patient in making decisions,” Price said, “whether it was the insurance company or government.”

Here are some of the policies discussed as Price was grilled about his vision government’s role in healthcare.

Rolling back insurance coverage ‘not our goal’ with ACA repeal

The top Democrat on the committee, Washington Sen. Patty Murray, led off by saying Price’s previous ACA alternatives, like the Empowering Patients First Act (EPFA), would lead to millions of people losing health coverage, increased insurance premiums and lowered standards of coverage.

Price later responded by saying the plans he and the Trump administration have in mind are not aiming to “pull out the rug…from anybody.”

“I think there’s been a lot of talk about individuals losing their health coverage. That is not our goal, nor it is our desire, nor is it our plans,” Price said.

When pressed about Trump’s promise of “insurance for everybody,” he said that’s “been always my stated goal.”

Access vs. coverage

While Price admitted the ACA has led to greater insurance coverage, he repeatedly said during the hearing there is a difference between coverage and access to care—which he feels is limited by the ACA.

“I get calls almost weekly from my former fellow physicians who tell me that their patients are making decisions about not getting the kind of care that they need because they can’t afford the deductible,” Price said. “If you’re an individual making 30, 40, 50 thousand bucks a year, and your deductible is now $6,000 or $12,000 for a family—which is not unusual on the exchange—you may have an insurance card, it may have the name of a wonderful insurance company on there, but you don’t have any care because you can’t afford the deductible.”

That definition of “access” led to a testy exchange with U.S. Sen. Bernie Sanders, I-Vermont. When Price was pressed by Sanders on whether he feels healthcare is “a right,” Price didn’t directly answer, instead saying he wants to work on ensuring “the highest quality care and coverage possible.”

Sanders replied, “Access to does not mean that they are guaranteed healthcare. I have access to a $10 million home, I don’t have the money to do that.”

What is and isn’t part of ACA repeal?

With Trump promising his ACA replacement proposal would come after Price is confirmed, members of both parties wanted to know exactly what would be included in the package.

Some of those questions were meant with definitive responses. Price said the repeal bill will “absolutely not” be the vehicle for make changes to Medicare. What would be included are some provisions to “rescue” the individual market before insurers have to submit rates for 2018.

“What they need to hear from all of us, I believe, is a level of support and stability in the market,” he said.

In other areas, Price wouldn’t commit to a position, like whether the replacement would keep the provision allowing kids to stay on their parents’ health plans until the age of 26.

Malpractice

U.S. Sen. Orrin Hatch, R-Utah, asked about Price’s plans for changes to medical liability. He didn’t offer a concrete proposal, but said both the malpractice insurance rates paid by doctors and hospitals and the effects on care delivery worries him.

“So if we look at that in that light and try to focus on decreasing the practice of defensive medicine to the benefit of patients, then I think we can get to the right answer and there are some exciting opportunities out there that have been bipartisan in the past,” Price said.

Price offered a radical change to handling malpractice lawsuits in the EPFA. The bill would’ve moved those cases from courts to medical tribunals made up mostly of physicians and healthcare professionals.

Too doctor-friendly?

Stances like medical tribunals have given Price a reputation of being very friendly to physicians’ interests. U.S. Sen. Al Franken, D-Minnesota, came to a similar conclusion during the hearing.

“I know that you do things that physician groups (support),” Franken said, when talking about provisions in the EPFA proposal. “I see you as someone who is there for the doctor.”

Price said those kinds of accusations are “what makes it difficult to reach a solution in Washington.”

“The concerns expressed by the Senator are valid concerns," he said. "The conclusions that he drew on the policies I promoted and will continue to promote are absolutely incorrect.”

Ethics and the next steps

Outside of debates about policy, Price was repeatedly questioned about reports his legislative activity was tied to his stock holdings in medical companies. CNN has reported Price bought shares in knee and hip implant maker Zimmer Biomet just before proposing a bill to delay CMS’ mandatory joint replacement bundled payment model. Price denied knowledge of the trade beforehand and said all his financial dealings were legal.

The HELP committee didn’t take a vote on Price’s confirmation. That will be left up to the Senate Finance Committee, which is tentatively scheduled to question Price on Jan. 24. If approved by the committee, the last step in his confirmation would be approval by the full Senate. HELP Committee Chair Lamar Alexander, R-Tennessee, said he expected the process for Price to be wrapped by early February.