The medical community’s better-paid specialists have poured at least $3.1 million over the past 13 years into the political committees of the orthopedist-turned-congressman who is charged with dismantling the Affordable Care Act.
Republican Rep. Tom Price of Georgia, President-elect Donald Trump’s choice to lead the U.S. Department of Health and Human Services, has long been an advocate for medical specialists, promoting a traditional, market-based health care system that critics say pays little heed to the nation’s soaring medical costs.
With Republicans controlling Congress and the White House, Price will be set up for success in pushing major changes to President Barack Obama’s signature health care plan along with changes to Medicare and Medicaid, programs that together cover about 140 million Americans.
Senate Democrats have said they will object to Price’s confirmation, both to protect the Affordable Care Act, which provides coverage for the uninsured, and also because Price favors privatizing and shrinking the Medicare program for the elderly.
The specialists’ donations to Price represent more than 20 percent of his congressional campaign funding, a McClatchy analysis found, demonstrating the depth of support he has received from fellow doctors.
The reports – dating to 2004, when he won his first House election representing suburban Atlanta – showed that his benefactors include other institutions in the health care industry. More than a third of his total of $15 million in campaign donations have come from health care interests, which he would be responsible for regulating.
Price’s fellow orthopedic surgeons, who earn an average annual income of $497,000, accounted for more than $900,000 of his donations, McClatchy found in its analysis of Federal Election Commission records and data from the nonpartisan Center for Responsive Politics. Other groups of specialists across the country, from urologists and neurosurgeons to skin and eye doctors, have made donations.
Spokespeople for the American Association of Orthopaedic Surgeons and Trump’s transition team, which is handling Price’s nomination, did not respond to requests for comment.
In Congress, Price has championed the causes of doctors. For example:
▪ He succeeded in limiting cuts in Medicare reimbursements to physicians.
▪ He tried but failed to block reductions in Medicare and Medicaid payments to physicians for expensive hip and knee replacements.
▪ On the thorny issue of whether laws should limit how much patients can recover in damages if they are harmed by physician errors, he has proposed to end “civil justice abuse” by removing those cases from the hands of juries and shifting them to administrative tribunals.
In 2009, with Congress nearing approval of the ACA, also known as Obamacare, Price argued in a nationally broadcast response to an Obama radio address that the program’s “one-size-fits-all approach” would make it impossible to provide affordable care “without impairing the quality, innovation and choices that define American medicine.”
Republicans’ market-driven alternative to Obamacare, Price contends, would increase coverage and lower costs “without putting a bureaucrat between you and your doctor.”
The ACA now insures an estimated 20 million Americans, many of whom previously lacked health coverage. Two of the more popular parts of the ACA include guarantees that insurers will cover patients regardless of pre-existing conditions and a provision that allows parents to keep children on their insurance plans until they turn 26. President-elect Donald Trump has endorsed keeping both of those provisions.
Some doctors strongly disagree with Price. At least 5,500 physicians, both family doctors and specialists, have signed a petition challenging his nomination because his approach “threatens to harm our most vulnerable patients and limit their access to health care.”
The higher-earning specialists have issues beyond Obamacare that are driving their interests.
Officials at the Department of Health and Human Services are trying to rein in what they consider to be excesses in the U.S. health care system, the world’s costliest. They have been pursuing changes to the department’s longstanding payment policies in Obama’s ACA program and Medicare to focus more on the quality of care while reducing costs. Those changes can squeeze doctors’ incomes.
Price has resisted this push for what’s called “value-based” medicine. It generally calls for hospitals and doctors to form integrated care networks that are compensated more on patient outcomes rather than sheer volume of services. This effort would pressure private physicians to abandon practices that depend on a high number of consultations and procedures, said Donald Berwick, who headed the Centers for Medicare and Medicaid Services in 2010 and 2011.
“This is threatening to specialists, especially the procedural specialists that Dr. Price represents,” Berwick said in a phone interview. “This is a threat to people that are used to incomes and the status quo.”
A recent survey of hospitals employing medical specialists by the consulting firm of Merritt Hawkins put neurosurgeons’ average salaries of $553,000 at the top, followed by heart surgeons ($525,000), orthopedic surgeons ($497,000), gastroenterologists ($455,000) and urologists ($412,000).
Upon accepting Trump’s selection of him on Nov. 29, Price said he not only would seek to redesign the health care system so that it “works for patients, families and doctors” and “leads the world in the cure and prevention of illness,” but also so that it’s based on “sensible rules.”
Berwick said he assumes from Price’s statement that the congressman sympathizes with doctors, especially specialists, who “are feeling over-measured” by electronic reporting requirements in an era of heavy government surveillance. Berwick said he agrees the government needs to pare the requirements to a smaller number of “meaningful metrics.”
In addition to removing malpractice cases from the courts, Price’s legislation to replace the ACA proposes to free physicians of any legal liability if they follow prescribed guidelines for medical procedures. That approach was attempted in Maine without success, and several other states studied it before backing away, said Max Mehlman, who wrote a book on medical malpractices and is a law professor at Case Western University in Cleveland.
“The secretary of Health and Human Services is supposed to be a secretary for all of the people, and I think Price is going to be a secretary for the medical profession,” said Mehlman, who has accepted research grants from the American Association of Justice, the trade association for plaintiffs’ attorneys.
The American Medical Association endorsed Obama’s program, which created state insurance pools to make coverage more affordable for sick people, as well as expanding Medicaid in many states. Specialists opposed the legislation.
But both groups cheered Price’s nomination since he would be the first physician in nearly a quarter century to serve as health secretary.
Cindy Moran, executive vice president for government relations for the American College of Radiology, said the group likes Price “mainly because he was a physician, and a specialist, which was an added bonus.”
“He’s been an ally on a number of issues for a long, long time,” she said.
Moran said radiologists were burned when the Obama administration cut increases in Medicare reimbursement rates to doctors to save $500 billion – money that was used to cover Obamacare costs.
Now, she said, Price “will have potentially a disproportionate share of the policy-making voice.”
Cathy Grealy Cohen, vice president of government affairs at the American Academy of Ophthalmology, whose political action committee has donated $57,500 to Price’s campaigns, credited Price with legislation “that prevented all the doctors in the country from getting a 2 percent cut” in Medicare payments.
“There will be somebody in the secretary’s job who understands the practice of medicine for a change,” she said.
A tea party Republican who heads a conservative caucus study committee, Price succeeded House Speaker Paul Ryan of Wisconsin last year as chairman of the powerful House Budget Committee. Some of his views on health care, especially on scaling back Medicare and the federal Medicaid program for the poor, mirror Ryan’s.
Price also has been a member of the Association of American Physicians and Surgeons, an obscure medical group with unconventional views. Critics say the group promotes scientifically discredited theories, including that abortion causes breast cancer and that vaccines can cause serious disabilities.
Price’s financial disclosure statement for 2004, the year he won his congressional seat, showed a net worth between $7.9 million and $14.9 million (the reports list assets assets and liabilities only in broad ranges). It’s unclear whether his wealth emanated from his 20-year orthopedic practice or another source, but it enabled him to lend $499,000 to his first campaign.
Sophie Ota and Jessica Campisi contributed to this report.
Greg Gordon: 202-383-6152, @greggordon2
Lesley Clark: 202-383-6054, @lesleyclark
David Goldstein: 202-383-6105, @GoldsteinDavidJ