Rep. Tom Price, R-Ga., President-elect Donald Trump's choice to head the Department of Health and Human Services and one of Congress's most vehement critics of the Affordable Care Act, told senators on Wednesday that 'it is absolutely imperative" for the government to ensure that all Americans "have the opportunity to gain access" to insurance coverage - a more modest goal than the incoming president has set forth in recent days.
In a hearing before the Senate Health, Education, Labor and Pensions (HELP) Committee committee, Price laid out the central elements of his years-long attempt to replace the ACA along conservative lines. His statement about access to coverage was in sync with widespread GOP thought about promising consumers a chance to get insurance, but it stopped short of Trump's comments last weekend that he was seeking "insurance for everybody" in a nearly finished plan.
The nominee indicated that the plan would likely be ready by March but did not elaborate on its content.
And while Trump has vowed this past weekend to curb drug prices in Medicare and Medicaid by negotiating directly with pharmaceutical firms, Price shied away from pledging to do that. Under questioning from Sen. Bernie Sanders, I-Vt., who argued that the United States has the world's highest drug costs specifically because it does not negotiate with the industry, the congressman replied "there are a lot of reasons for that" and said he wanted to "get to the root causes of that."
Price said he would work to ensure "that the drug prices are reasonable and individuals across the country have access" to needed prescriptions.
The courtesy hearing before the Senate panel marks the first time Price has appeared before lawmakers since being nominated; his formal confirmation hearing, before the Senate Finance Committee, is set for Jan. 24. This initial encounter gave the six-term congressman his first opportunity to make a public case for his selection, while allowing Democrats to argue their case for why the incoming administration should preserve - not jettison - the 2010 health-care law, also known as Obamacare.
Both the committee's chair, Lamar Alexander, R-Tenn., and top Democrat, Patty Murray, Wash., made it clear they were searching for more specific details on the president-elect's plans to replace the ACA.
Alexander began the hearing by reading conflicting comments by Trump, House Speaker Paul Ryan, R-Wis., and Senate Majority Leader Mitch McConnell, R-Ky., about how they planned to replace the existing law "simultaneously," "concurrently" and "in manageable pieces."
The law should only be repealed, the chairman argued, "when there are concrete practical reforms in place that give Americans affordable access to health care. It's not about developing a quick fix."
Murray criticized Republicans for "rushing" the confirmation process and told the nominee that she had "serious concerns about your qualifications and plans for the department you hope to lead."
"Just last week, you voted to begin the process of ripping apart our health-care system without any plan to replace it," Murray said. "My constituents are coming up to me with tears in their eyes, wondering what the future holds for their health care given the chaos Republican efforts could cause."
Sen. Sheldon Whitehouse, D-R.I., continued that theme later while pointing out that the ACA has slowed the rise in U.S. health-care spending.
"So we throw this thing out at our peril," he told Price. "And we throw it out with nothing to replace it. It's like being asked to jump out of an airplane without a parachute and saying, 'Trust us, we will build a parachute.'"
Said Whitehouse: "I think the American people are entitled to know what they are going to be offered as an alternative."
Price, who practiced as an orthopedic surgeon for nearly two decades before entering politics, emphasized how his first professional calling - "to care for patients" - convinced him the current health-care system needed to be overhauled.
The congressman recounted how at one point while he was practicing medicine, he noticed "that there were more individuals within our office who were dealing with paperwork, insurance filings and government regulations than there were individuals actually seeing and treating patients. It was in those moments that it became crystal clear that our health-care system was losing focus on the number one priority - the individual patient."
But Price's conservative vision is under fire from Democrats.
During questioning, he reiterated his support for what would be a fundamental change to Medicaid by requiring "able-bodied" people to be in work activities in order to qualify for benefits. Whitehouse pressed him repeatedly on whether people with addictions or mental health problems would be required to work.
After dodging the question a few times, the nominee responded, "I think people have an understanding of what able-bodied is, and it doesn't [involve] the things you described."
Also under fire is Price's practice of continuing to invest in the health sector while in office. Democrats have called for ethics investigations, while Trump transition officials have demanded apologies from at least one news organization over a story about Price's investments.
On Tuesday, Democrats highlighted some of Price's financial investments that have raised questions about potential conflicts of interest and focused on uncertainty about Republicans' plans for replacing the health-care law they are vowing to repeal. And Democrats on the HELP Committee demanded a delay in the hearing - a demand the committee's Republican majority ignored.
Price told the committee Wednesday that he has had "no conversations with my broker about any of my political activity at all, except for her congratulating me on my election."
Republicans have acknowledged that many constituents are anxious about what will happen once President Barack Obama's signature health law is repealed, but they said that did not justify a delay in either overturning the ACA or acting on Price's nomination.
In an interview Wednesday morning on Fox News, Trump sought to reassure the public about the direction he intends to move the health-care system. "Nobody is going to be dying on the streets with a President Trump," he said.
His remarks in the interview were similar in tone to an interview he gave The Washington Post over the weekend, but he added one more detail. "And we'll probably have block grants of Medicaid back into the states," he told Fox, referring to a fundamental change many Republicans have favored for years to the state-federal insurance program for lower-income Americans.
In a separate interview published Wednesday in the online publication Axios, Trump said he wanted to have more Americans insured - potentially through Medicaid block grants - but hinted that his plan might not translate into universal coverage. "You know there are many people talking about many forms of health care where people with no money aren't covered," he said. "We can't have that."
The department Price would run is one of the government's largest, with a $1 trillion budget. It would place Price at the fulcrum of some of the most incendiary domestic issues facing the incoming administration. Beyond the future of the Affordable Care Act, the HHS secretary has a role in setting policy for reproductive health, major entitlement programs, vaccines and other public health matters.
A Michigan native who went to medical school at Emory University in Atlanta, Price, 62, left his practice to serve in the Georgia state Senate. He became the first GOP majority leader in the chamber's history. While serving in the state Senate, he advocated for reducing jury awards for fellow physicians found guilty of malpractice.
Price, a former chairman of the conservative Republican Study Committee who has belonged to the House tea party caucus, took the helm of the House Budget Committee in 2015.
While many Republicans shied away from Trump during the 2016 campaign, Price was an early and loyal foot soldier. Last May, he organized a joint statement of loyalty to Trump by nine GOP House committee chairs, calling on "all Americans to support him."
His ideas for changing the health-care system reach farther than those advocated by the president-elect. And he has wanted to make fundamental changes since before the Affordable Care Act came into existence.
Starting early in his tenure on Capitol Hill, Price wrote a series of commentaries lambasting the popular Medicare program and exhorting changes along more conservative lines. "Its flawed structure increasingly fails our seniors on all counts - responsiveness, innovation, access, cost and quality," he wrote in 2008 in the Washington Times. He has repeatedly introduced legislation that would have converted Medicare from the entitlement program it has been since its origins in the 1960s to a system of "defined contribution," with the government giving older Americans fixed sums to help them purchase private health plans.
His views on Medicare appear to go beyond those of the president-elect, who vowed during his campaign to protect the program and, since his election, has spoken only in vague terms about "modernizing" it.
Like many Republicans, he contends that Medicaid, the joint state-federal program for lower-income Americans, should cease to be an entitlement covering everyone who is eligible. Instead, he favors giving each state a lump sum, or block grant, and freeing states from many federal rules, including ones that require certain health services to be covered. States would be allowed to compel "able-bodied" Medicaid applicants to meet work requirements - a requirement that the Obama administration has opposed.
Price also had long advocated a major change in the way the U.S. tax system treats health insurance, extending to individuals the kind of tax breaks that have been provided for many decades to employers for the health benefits they offer their workers. In another Washington Times op-ed, from 2009, he argued for "patient-owned coverage" and criticized the fact that "currently, most Americans get health insurance through a third-party - either their employer of the government."
He has drafted nearly half-a-dozen bills aimed at rolling back the Affordable Care Act, in favor of an approach that would redirect power from the federal government to the states and the private sector. But in recent weeks, his own financial dealings have attracted as much attention as his policy positions.
In December, the Wall Street Journal reported that Price had traded more than $300,000 in shares in about 40 health, biomedical and pharmaceutical companies over a four-year period starting in 2012, while he was involved with legislation that might affect those firms' stocks.
Price said that he had already agreed to divest of any holdings that the Office of Government Ethics recommended he sell.
On Tuesday, however, Sen. Kirsten Gillibrand, D-N.Y., called on the Securities and Exchange Commission to investigate whether Price had violated any ethics law, including a statute that Gillibrand sponsored, which outlaws insider trading by members of Congress.
Separately, CNN reported Monday that Price bought shares of stock in a medical device manufacturer, Zimmer Biomet, shortly before he introduced legislation that would have helped the company. And a Kaiser Health News story said that the chief executive of a company, MiMiex, in the congressman's district - a top campaign donor to Price - wrote an email to company managers, directing them to "IMMEDIATELY" contribute to a political action committee that supports Republicans.
Senate Minority Leader Charles Schumer, D-N.Y., has asked the Office of Congressional Ethics to investigate the Zimmer Biomet trade, which he called possibly "illegal."
The transition team, who noted that the Zimmer Biomet purchase was made by a broker and the congressman learned of the trade after introducing the bill that would have affected the firm, has demanded CNN retract the story.
Both Murray and Sen. Al Franken, D-Minn., sharply questioned Price on the fact that Rep. Chris Collins, R-N.Y., suggested he invest in Zimmer Biomet and last year purchased the stock at a discount rate in a private offering.
Murray noted that Collins had been overheard recently boasting that he had helped other lawmakers make money by giving them stock tips. "Is that a stock tip?" she asked.
"That's not what happened," Price replied. "I had no access to non-public information."
Price noted that his initial purchase of the company in 2015 was through the stock exchange, while a subsequent trade in 2016 were through a "private placement offering." Initially he said of the later trade, "I don't know that it was" at a discount rate, but later appeared to accept Franken's conclusion that a lower price is "the definition of a private placement offer."
"It really begs credulity, sir, when you say that you did not know that you got a discount price," Franken said, noting that "about 20 people" were able to participate in the private placement offer. "These sound like sweetheart deals."
"What I don't understand that once you found out your broker bought it, you kept the stock," Franken said of the Zimmer Biomet purchase.
Throughout the hearing Price--who said he was not aware of what precise stocks he held in the past, or at present--said he had not sought to take advantage of his public position. "Everything that we have done has been above board, ethical, transparent and legal," he said.
Price was introduced by a committee member and fellow Georgia Republican, Sen. Johnny Isakson, who praised the nominee's acumen and began the GOP effort to insulate him from Democratic lines of attack.
"Sometime he's boring, but he's always knowledgeable," Isakson said, drawing a chuckle from committee members." Isakson also tried to tamp down concerns about the ethics of Price's investment, and he rebutted critiques that Price has not always supported the Social Security system.
Isakson called Schumer's allegations "patently wrong," adding that he backed Price's nomination "because I know he's the right man, for the right job, at the right time, for America."
Blando also noted that HELP Committee member Sheldon Whitehouse, D-R.I., and Senate Finance Committee members Mark Warner, D-Va., and Thomas Carper, D-Del., have traded in health-care stocks as well. He said that Schumer has acknowledged owning bonds from Fannie Mae and Freddie Mac at the time of the federal takeover of the two major mortgage insurers. All four senators have said in the past that they did not take any legislative action aimed at boosting their portfolios.
Democrats - including White House press secretary Josh Earnest, in his last-ever press briefing Tuesday - argue that Trump's nominees have a particular obligation to explain their actions given the president-elect's pledge to clean up corruption in Washington.
"It seems like exactly the kind of financial entanglement that's left a lot of people feeling alienated from Washington, D.C., that's left a lot of people questioning the motives of members of Congress," Earnest said of Price's investment in Zimmer Biomet. "Was he sponsoring that legislation because of his own personal motive - personal financial interest? Was he sponsoring that legislation because he knew it was likely to lead to a political contribution? Or was he sponsoring that bill because he thought it was good policy? It's hard to know. It's an open question."
"And I suspect this is going to be an issue that's going to receive careful scrutiny - hopefully not just on the part of Democrats, but also on the part of Republicans who are interested in making sure that the incoming president's Cabinet nominees are looking to do the job for the right reasons," Earnest added.
The Washington Post's Sean Sullivan contributed to this report.