- After Tom Price's resignation as HHS Secretary on Friday in the wake of criticism of excessive taxpayer spending on private plane travel, the focus in Washington, D.C., has shifted to his potential replacements.
- According to pundits and media outlets, names being circulated include members of President Donald Trump's cabinet like FDA Commissioner Scott Gottlieb and Veterans Affairs Secretary David Shulkin; others in HHS like CMS Administrator Seema Verma and acting director Don Wright; and public officials like former Louisiana Gov. Bobby Jindal and Florida Gov. Rick Scott.
- Whoever takes the role at HHS will have immediate issues to deal with, including open enrollment for Affordable Care Act (ACA) as well as complaints the department has deliberately sabotaged the law by gutting funds to promote enrollment and undermining the exchange markets.
Guessing games like these are a staple of Washington, D.C., but it would be folly to make assumptions about how Trump will decide. The first nine months of his administration have featured many departures, and nominations for agency officials have been varied in terms of predictability.
Price's signature at HHS — deregulation — is unlikely to change much. It is a theme important to Trump and the Republican Party, which controls cabinet confirmations with its majority status in Congress.
By most accounts, the leading candidate is Seema Verma. Some of her actions at the CMS have alarmed the healthcare industry, including the decision to eliminate and scale back some mandatory bundled payment programs and her plan to seek a "new direction" for the CMS innovation center.
However, she also has a history of designing ways to expand Medicaid. An expansion plan she helped develop in Indiana included many conservative policies that helped convince officials in the red state to eventually approve it. She spent some of that time working with Mike Pence, then the Indiana governor and now the vice president. That relationship will come in handy for Verma if she wants the promotion.
Price's downfall was rapid. Politico first reported the unusual travel activity less than two weeks ago. It comes as a surprise to think that the ACA outlasted Trump’s HHS secretary, but the failure to execute ACA repeal is a part of why Trump was already frustrated with Price before the charter jet scandal broke.
Trump reportedly fumed that Price was out of town for key votes on repeal bills and absent from many strategy discussions. But Price took more behind-the-scenes approach to changing the ACA. Throughout the repeal debate, HHS has slashed funds to advertise and promote ACA open enrollment. The department has barred regional directors from participating in enrollment events and gutted both the overall advertising budget and the funding for community-level groups that help people enroll. The enrollment website is also scheduled to be down for 12 hours of all but one Sunday during the open enrollment period.
Democrats in Congress have said they will not support a nominee for secretary who plans to continue undercutting the ACA. But they didn't support Price, either, and he was confirmed on a strict party-line vote.
Private travel wasn't the outgoing secretary's only scandal. One of the major issues during Price's confirmation process was his investment in healthcare companies that he was also regulating as a member of Congress. But that didn't stop his confirmation to head HHS.
The healthcare industry has been concerned about slow hiring at HHS in the new administration. Of the 17 health posts that require Senate confirmation, three still have no nominee and seven are awaiting confirmation.
The White House has not revealed any timeline for replacing Price, and may not feel particularly rushed with ACA repeal sidelined for now. HHS is a massive department with crucial tasks, however, so there will be pressure to get a new leader in place quickly.