Acting CMS, HHS, FDA administrators hold significant agency experience

In the early days of the new presidential administration, interim and acting heads of HHS, CMS, and FDA hold the power pending the finalization of the new leaders. Norris Chochran, Dr. Patrick Conway, and Dr. Stephen Ostroff hold their positions after Secretary Burwell, Acting Administrator Andy Slavitt, and Commissioner Robert Califf, stepped down as President Obama handed over the reins to President Trump. These leadership positions are under extreme scrutiny as legislators push for repealing and replacing the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).

HHS

Acting HHS Secretary Norris Cochran has served the federal government for two decades, starting at the Centers for Disease Control and Prevention (CDC) in 1996. Cochran is currently the Director of the HHS Office of Budget, overseeing a large staff on budget formulation, execution, and policy, while supporting various budget and financial officials in their duties.

CMS

Dr. Patrick Conway is now the acting administrator of CMS, as well as the Deputy Administrator for Innovation and Quality. In these roles, he oversees Medicare, Medicaid, the Children’s Health Insurance Plan (CHIP), and the marketplaces, while also leading the Center for Clinical Standards and Quality (CCSQ) and the Center for Medicare and Medicaid Innovation (CMMI). Conway was previously Director of Hospital Medicine at Cincinnati Children’s Hospital and served as Chief Medical Officer at the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE).

FDA

Dr. Stephen Ostroff, is now serving his second stint as acting Commissioner of Food and Drugs. Before joining the FDA in 2013, in roles involving food safety, nutrition, and veterinary medicine, he served as Deputy Director of the National Center for Infectious Diseases at the CDC. In 2014, he served as the FDA’s Chief Scientist, then was the acting commissioner from April 2015 to February 2016, before serving as the Deputy Commissioner for Foods and Veterinary Medicine.

Is HHS Secretary too high for Price?

The presumptive nomination of Rep. Tom Price (R-Ga) to lead HHS as the agency’s Secretary was considered on January 18, 2017, by the Senate Committee on Health, Education, Labor and Pensions. The committee’s chair, Lamar Alexander (R-Tenn), praised the nomination of Price, calling him an “excellent nominee” and highlighting how he will “build a better bridge” to repeal and replace the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). The top Democrat in the committee, Senator Patty Murray (D-Wash) questioned Price on policy, conflicts of interest, and past statements, including one suggesting cost is not an issue for women buying birth control.

Opening statement

In his opening statement, Price talked about his passion for medicine, experience as a physician, and fascination with “fixing things.” He pointed to problems in the health care industry, recalling the point when he noticed “more individuals within our office who were dealing with paperwork, insurance filings, and government regulations than there were individuals actually seeing and treating patients.” He highlighted his goal of returning the focus of health care to the patient.

ACA

Price also noted his belief that the ACA should be repealed and replaced simultaneously and concurrently—a position that is consistent with the most recent stances of President-elect Trump (R) and House Speaker Paul Ryan (R-Wis). Price and Alexander both expressed a desire to avoid a “quick-fix” and to, instead, develop health care reform “that’s done in the right way, for the right reasons, in the right amount of time.”

Critique

Murray challenged Price’s qualifications and positions, including Price’s prior opposition to allowing Medicare to negotiate drug prices and plans to shift $1 trillion in Medicaid costs onto states. Additionally, Murray suggested that Price did not meet a basic, necessary qualification to lead HHS, namely the ability to put science before ideology. Finally, Murray condemned the Senate’s decision to move forward with Price’s confirmation hearings amidst an ongoing investigation into Price’s allegedly unethical medical stock trades during his time in the House.

HHS’ $83 billion budget proposal under spotlight at House hearing

The House Committee on Ways and Means held a hearing to evaluate HHS’ $82.8 billion discretionary budget request for Fiscal Year (FY) 2017. HHS Secretary Sylvia Mathews Burwell testified at the hearing in support of the agency’s request, noting that the funds are necessary to build on successes under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), advance medical research, and reform health care delivery.

Programs

Burwell testified that the budget would allow expanded access to health insurance coverage under the ACA by giving HHS another tool to encourage Medicaid expansion. Burwell explained that the budget would give three years of full federal support to any state that chooses to expand its Medicaid program, regardless of when the state elects to expand. The budget would also fund the Children’s Health Insurance Program (CHIP) through FY 2019. Burwell emphasized the importance of funding to advance the way providers are paid, how care is delivered, and the accessibility of quality care. She stressed the need to devote efforts to driving down prescription drug costs through innovative purchasing strategies and delivery system reforms that would be funded under the budget request.

Safety

Burwell testified in support of the $1.1 billion that HHS requested to combat opioid-related deaths. The funding would allow significant increases in access to treatment for individuals addicted to opioids, improve prescribing practices with enhanced prescribing guidelines, and provide preparation for communities and first responders. Her testimony highlighted other areas of funding need for HHS including efforts to increase access to behavioral and mental health care, combat antibiotic-resistant bacteria, and develop international and domestic preparedness.

Welfare

The testimony also noted the importance of supporting efforts related to early childcare, child welfare, and better targeting of funds under the Temporary Assistance for Needy Families (TANF) program. Burwell said that funding increases are necessary to support individuals at all stages of life. She justified budget requests for investments in the care of older adults by noting that the population age 65 and over is projected to more than double to 98 million in 2060.

Program Integrity

Burwell noted that combatting fraud and abuse in the Medicare and Medicaid programs was a top priority for HHS. In her testimony, Burwell explained that HHS hopes to continue efforts to cut fraud, waste, and abuse through the $199 million in new program integrity investments requested under the budget.

Response

Several members of the committee challenged the legitimacy of the budget proposal. For example, in his opening remarks, the Chairman of the House Committee on Ways and Means, Kevin Brady (R-Texas) noted his belief that the budget is “not rooted in reality.”