5 things to know on deregulation, Medicaid from HHS Secretary's CNN event

HHS Secretary Tom Price, MD, weighed in on a number of healthcare issues during a March 15 CNN town hall-style event, focusing mainly on defending the Republican-sponsored replacement for the Affordable Care Act (ACA).

That bill, the American Health Care Act (AHCA), takes many cues from ACA alternatives Price had sponsored during his time in Congress, including provisions like age-based tax credits and incentives for continuous coverage. To Price, it’s the better option than the ACA, despite the recent report from the Congressional Budget Office (CBO) saying it would lead to 24 million more people being uninsured by 2026.

Here are five of the most important responses Price gave during the event:

1. HHS deregulation would follow the AHCA

In criticizing the CBO’s report on the AHCA, Price said its assessment covered only “one-third” of the Trump administration’s healthcare plans. The second piece would be cutting rules, regulations and guidance letters issued by HHS under President Barack Obama.

“And we're going to look at every single one of those to see whether or not they help patients or hurt patients,” Price said. “If they hurt patients, they need to go away. If they drive up costs, then they need to go away.”

The third phase, Price said, would be more legislation, such as medical malpractice reform (Price once proposed physician tribunals to decide malpractice cases outside of the court system) and allowing insurers to sell plans across state lines.

Passing the AHCA, however, is far from guaranteed. Three Republicans on the House Budget Committee voted against the bill as it advanced out of the committee on March 16.

2. Rolling back Medicaid eligibility

The first audience question came from Brian Kline, a cancer patient from Pennsylvania who credited the expanded Medicaid eligibility with saving him from “medical bankruptcy.” He asked why Price favors rolling back the Medicaid expansion when it’s helped people like him.

Price suggested Kline’s satisfaction with Medicaid isn’t typical.

“It's wonderful that you have received the care that you've received, and it's because of the incredible innovations and great doctors across this land. But that's not necessarily true for everybody,” Price said.

Kline followed up by saying he didn’t feel Price answered his question.

3. Challenges facing rural populations

Following Kline’s question was one from Mitch Jacques, MD, a family physician from West Virginia. He said he sees patients “almost every day” who used to work in the coal industry and are now covered by Medicaid. Jacques asked Price whether Congress understands what will happen to those types of patients if the Medicaid expansion is rolled back.

Price responded by saying only one-third of doctors will take Medicaid patients and throwing more funding into the program won’t improve care.

“[The] Medicaid population, as you know—and the good doctor knows—is four different groups of Americans,” Price said. “It's elderly. It's disabled. It's, by and large, healthy moms and kids. And we, the federal government, tell them, the states, you've got to treat every one of those exactly the same from an insurance standpoint. That doesn't make any sense.”

4. Immunizations should be decided by state governments

Price has emphasized the AHCA would allow greater choices for patients in managing their healthcare. He didn’t directly answer a question about whether that flexibility would extend to a patient who doesn’t want vaccinations or blood transfusions for religious or ethical reasons, but he did respond to the CNN moderators’ follow-up on whether immunizations should be required for measles, mumps or polio.

“I believe it's a perfectly appropriate role for the government. This happens, by and large, at the state government level, because they're the ones that have the public health responsibility to determine whether or not immunizations are required for a community population, whether it's growing kids or the like, or if there's an outbreak of a particular infectious disease, whether or not an immunization ought to be required or be able to be utilized,” Price said.

Price has been criticized for being a member of a medical group called the American Association of Physicians and Surgeons (AAPS), which has claimed mandated vaccines can cause “death or serious long-term adverse effects,” along with promoting debunked theories like HIV doesn’t lead to AIDS and abortions cause breast cancer through its medical journal.

5. AHCA’s tax break for insurer execs

The AHCA would repeal the ACA’s limit on tax deductions for health insurance executives’ compensation over $500,000. When asked why that provision was necessary, Price said it reverses the Obama administration’s policy that highly paid executives in healthcare “ought to be punished.”

“This is the federal government before saying to a certain sector of society, a certain individual, you can't make what that company is willing to pay you for your services. That doesn't sound like America to me,” Price said. “What we're saying is that we ought not single out certain individuals in this nation and have the federal government have the power to be able to say you're going to be treated differently than that individual, even though you make the same amount of money.”