DW blog: The First 100 Days

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Trump pick for FDA confirmed

May 10, 2017
Scott Gottlieb, MD, has been confirmed by the U.S. Senate to serve as the commissioner of the U.S. Food and Drug Administration. The Senate voted 57-42 in favor of confirmation. Dr. Gottlieb, an internist, served as deputy commissioner of the FDA under President George W. Bush.


Pick for FDA moves forward

April 27, 2017

The Senate HELP Committee has voted 14-9 to advance Scott Gottlieb, MD ― President Trump’s nomination for commissioner of the U.S. Food and Drug Administration (FDA).

Dr. Gottlieb, an internist, served as deputy commissioner of the FDA under President George W. Bush. The full Senate will now vote on Dr. Gottlieb’s nomination. However, a date has not been set for the vote yet.


AADA meets with Tom Price to discuss regulatory relief

April 17, 2017
American Academy of Dermatology Association (AADA) staff met with Tom Price, MD, secretary of the U.S. Department of Health and Human Services (HHS), to discuss reducing the regulatory burden on physicians. The Secretary of HHS has the authority over the Medicare Physician Fee Schedule (MPFS) and has also been granted authority by President Trump, via Executive Order, to take steps to minimize the fiscal and regulatory burden of the Affordable Care Act (ACA). The AADA ― along with staff from six other specialties ― requested that Sec. Price propose ACA regulatory relief within the proposed 2018 MFPS ― expected to be released by the Centers for Medicare and Medicaid Services (CMS) in July.

Tom Price MeetingSpecifically, the coalition expressed concerns that the methodology used to calculate the Value Based Modifier (VBM) is flawed, and, therefore, requested that the fee schedule establish a Value Based Modifier (VBM) of zero for 2018. CMS has estimated that more than 60 percent of practices (mostly small and solo) and 36 percent of physicians will incur penalties of either 2 or 4 percent in 2017. 

The coalition also requested that the agency adopt broader hardship exemptions for the Meaningful Use program. Additionally, the group called on HHS to adjust the requirements under the Physician Quality Reporting System (PQRS), specifically by reducing the number of measures that physicians must report.

Dr. Price and his staff were very receptive to the coalition’s requests and stated that they would share the information with CMS. In the past, Dr. Price has also expressed concerns over the administrative load placed on physicians, and stated that he is committed to decreasing over-burdensome regulations.


White House names HHS deputy secretary

April 11, 2017
The Trump Administration has nominated Stephen Parente to serve as the assistant secretary of planning and evaluation at the U.S. Department of Health and Human Services (HHS). He will be the principal advisor to HHS Secretary Tom Price, MD. Parente is a health care economist and currently works as a professor at the University of Minnesota.


Pick for FDA faces Senate committee

April 6, 2017
Scott Gottlieb, MD ― President Trump’s pick for commissioner of the U.S. Food and Drug Administration (FDA) ― faced the Senate Health, Education, Labor, and Pensions Committee at a confirmation hearing this week and discussed his thoughts about the drug-approval process. Specifically, Dr. Gottlieb indicated that the current process slows down the rate of drug approvals and can be improved without sacrificing safety. Dr. Gottlieb also stated that his first priority as commissioner of the FDA would be to address the U.S. opioid epidemic.

During the hearing, Dr. Gottlieb also answered questions about his financial and advisory ties ― which were listed in Dr. Gottlieb’s conflict of interest notice ― with about 30 medical companies. Dr. Gottlieb indicated that he would work “…with the ethics officials at HHS and FDA to have continued discussions on what additional steps I should take to make sure I’m fully complying with the law if I’m confirmed into this role.”

Dr. Gottlieb, an internist, served as deputy commissioner of the FDA under President George W. Bush. The Committee is expected to vote on Dr. Gottlieb’s appointment after congressional recess.


HHS gets new health IT coordinator

March 31, 2017
Donald Rucker, MD, will head up the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for Health Information Technology. The health IT ONC helps guide health information technology initiatives, such as the CMS EHR Incentive Program. Dr. Rucker was an emergency physician before serving as chief medical officer of Siemens. He currently works at Ohio State University as an adjunct professor in the biomedical informatics department.


HHS hires health IT lead

March 22, 2017
Former U.S. Rep. John Fleming, MD, (R-La.) has been hired to serve under HHS Secretary Tom Price, MD, as deputy assistant secretary for health technology. According to news reports, Dr. Fleming supports the widespread use of health information technology and says he will work to improve health IT interoperability. During his time on Capitol Hill, he spoke out against the Medicare Access and CHIP Reauthorization Act (MACRA), citing concerns about the administrative burden that the law would have on physicians.


President Trump picks HHS deputy secretary

March 15, 2017
President Trump has announced his intent to nominate Eric D. Hargan, JD, to serve as deputy secretary of the U.S. Department of Health and Human Services (HHS). Hargan is a shareholder of Greenberg Traurig, LLP, in its Health and FDA Business practice. He previously served as deputy general counsel, principal associate deputy secretary, and acting deputy secretary of HHS under the George W. Bush Administration. Hargan’s nomination will require a Senate confirmation.


Senate confirms White House pick for CMS lead

March 13, 2017
The Senate has voted 55 to 43 to confirm Seema Verma as administrator of the Centers for Medicare and Medicaid Services.


White House picks lead for FDA

March 10, 2017
President Trump has nominated Scott Gottlieb, MD, to lead the U.S. Food and Drug Administration (FDA).  In the past, Dr. Gottlieb has stated that administrative red tape is preventing competition in the drug manufacturing industry, and if confirmed, he would likely have an integral role in President Trump’s efforts to speed up the drug-approval process.

Dr. Gottlieb has a medical degree from Mount Sinai School of Medicine and did his residency in internal medicine at the Mount Sinai Medical Center. Dr. Gottlieb previously served as a deputy commissioner of the FDA under President George W. Bush.


President Trump pick for CMS administrator moves forward

March 2, 2017
The Senate Finance Committee has voted 13-12 to approve Seema Verma as the next CMS administrator. Verma’s nomination will now go to the full Senate for a vote.


Senate Finance Committee postpones vote on CMS administrator

March 1, 2017
The Senate Finance Committee has postponed a vote on President Trump's pick for CMS administrator. The Committee took a preliminary vote of 15-11 with proxy votes to approve Seema Verma. However, because the vote was only 9-9 without proxy votes, the Committee will have to vote again. Per the Committee's rules, proxy votes do not count.

Verma helped create and update the Healthy Indiana Plan ― Indiana's consumer-directed Medicaid program ― under Gov. Mitch Daniels and Vice President Mike Pence when he served as governor of Indiana. Prior to her role at SVC, Verma served as vice president of planning for the Health and Hospital Corporation of Marion County in Indiana and director for the Association of State and Territorial Health Officials in Washington, D.C.


OMB director confirmed

Feb. 16, 2017
The Senate has voted 51 to 49 to confirm Rep. Mick Mulvaney (R-S.C.) for director of the Office of Management and Budget. In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. As director, Mulvaney will likely be involved with repeal and replacement efforts on the Affordable Care Act.

The Senate Finance Committee will hold a hearing on Seema Verma today ― President Trump’s pick for CMS administrator. AADA staff will be attending the hearing.


Senate confirms Trump pick for VA secretary

Feb. 14, 2017
The Senate unanimously confirmed David Shulkin, MD, to serve as secretary of the Department of Veterans Affairs. Dr. Shulkin ― trained in internal medicine ― was nominated by President Barack Obama in 2015 to serve as the undersecretary of the U.S Department of Health and Human Services.

In previous media interviews, Dr. Shulkin has indicated that he is in favor of offering a mixed care model for veterans ― where the VA would provide services such as treatment for post-traumatic stress disorder and the private sector would offer veterans other services such as obstetrics and gynecology.


Senate confirms Tom Price for HHS Secretary

Feb. 10, 2017
The U.S. Senate has voted (52-47) to confirm Dr. Tom Price as Secretary of the U.S. Department of Health and Human Services (HHS) under President Donald Trump. Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years. Dr. Price has worked on issues affecting dermatology, such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties. Dr. Price has also demonstrated a commitment to decreasing over-burdensome regulations associated with EHR, MACRA, and quality reporting.

In other confirmation news, the Senate Finance Committee will hold a confirmation hearing for Seema Verma, President Trump's pick for CMS administrator, next week.


Senate Committee approves Dr. Price

Feb. 1, 2017
The Senate Finance Committee has approved the nomination of Tom Price, MD, to serve as secretary of HHS. Dr. Price's nomination will now go to the full Senate for a vote.

A vote on Dr. Price's approval was delayed yesterday in the Senate Finance Committee after committee Democrats boycotted the vote. The Committee rules require that at least one Democratic member must be present for the Committee to proceed. However, today Committee Republicans agreed by unanimous consent to temporarily change the committee’s rules, thereby allowing the committee to vote in favor of approving Dr. Price.


Committee approval of Dr. Price nomination delayed

Jan. 31, 2017
Democratic members of the Senate Finance Committee have boycotted a Committee vote on the approval of Tom Price, MD, as secretary of the Department of Health and Human Services (HHS). The vote, which was scheduled for Jan. 31, has been postponed due to the boycott. The Committee rules require that at least one Democratic member must be present for the Committee to proceed.

Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years.

The American Academy of Dermatology Association (AADA) understands and appreciates that not all of its members are supportive of Dr. Price’s nomination. However, after thoughtful discussion, and prior to the delay of the committee vote, the AADA Board of Directors determined that it was in the best interest of the AADA and its members to send a letter of support for Dr. Price. The AADA has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. Dr. Price has been a staunch supporter of several issues that impact dermatology. Specifically, Dr. Price has worked on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties. Dr. Price has also demonstrated a commitment to decreasing over-burdensome regulations associated with EHR, MACRA, and quality reporting. 

The AADA’s support at this critical point in the nomination process will help keep dermatology at the forefront of discussion as the new Administration works to address issues of concern. Read more from the AADA letter. For questions or concerns, contact president@aad.org.


Senate Finance Committee schedules vote on Dr. Price nomination

Jan. 30, 2017
The Senate Finance Committee has scheduled an Open Executive Session for Tuesday, Jan. 31 at 10:00 a.m. eastern to discuss and potentially vote on the nomination of Dr. Tom Price as secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, previously served as congressman for Georgia’s 6th district and as House Budget Committee chair and would be the first physician to serve as secretary of HHS in nearly 25 years.


Dr. Price discusses ACA, regulatory burdens, transparency, and drug prices in nomination hearing

Jan. 24, 2017
Rep. Tom Price, MD (R-Ga.) ― President Trump’s pick for secretary of the Department of Health and Human Services (HHS) ― sat before the Senate Finance Committee, which will determine if his nomination proceeds to a confirmation vote, and answered questions about several health care issues.

Affordable Care Act
Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, referenced President Trump’s executive order that directs the secretary of HHS to work toward the swift repeal of the ACA. Sen. Wyden asked Dr. Price if he could assure that no one citizen will be worse off if the ACA is repealed? Dr. Price committed to working with Congress to ensure access to high-quality care. Piggybacking off of Sen. Wyden’s question, Sen. Sherrod Brown (D-Ohio) asked if Dr. Price would enforce the ACA’s ban on discriminating against patients with pre-existing conditions or patients with illnesses that are expensive to treat. Dr. Price responded, “Nobody ought to lose their insurance because they get a bad diagnosis.”

Sen. Pat Roberts (R-Kan.) asked what tools Dr. Price will utilize to provide stability and improve the individual insurance markets to make them more appealing so that insurance carriers will want to come back? Dr. Price stated, “This law isn’t working. It’s not working for patients. One of the goals I have is to lower the temperature in this debate.” He indicated that government should assure carriers that the replacement plan will be more attractive to insurers.

When asked by Sen. Richard Burr (R-N.C.) what his overall goals are for an ACA replacement plan, Dr. Price reiterated his desire to provide accessible and affordable coverage for high quality care while offering patients choices.

CMMI
Sen. Orrin Hatch (R-Utah), chair of the Senate Finance Committee, asked Dr. Price about his thoughts on the Center for Medicare and Medicaid Innovation (CMMI) ― the agency under CMS that develops and tests value-based payment models. “Innovation is so incredibly important to health care and the vibrant quality of health care that we need to be able to provide to our citizens,” Dr. Price said. “One of the roles that we as policymakers have is to incentivize innovation. The Center for Medicare and Medicaid Innovation is a vehicle that might do just that. I think, however, that CMMI has gotten off track a bit. I think that what it has done is defined areas where it has mandatorily dictated to physicians and other providers in this country in certain areas how they must practice. I’m a strong supporter of innovation but I hope that we can move CMMI in a direction that actually makes sense for patients.”

Regulatory burdens
Sen. Roberts referenced various regulations, such as meaningful use, that have caused undue burdens on providers and asked Dr. Price how he will work to alleviate the burden. In response, Dr. Price agreed stating that, “The regulatory scheme that we’ve put in place is choking the individuals that are actually trying to provide care. So much so that you have physicians and other providers who are leaving the practice. The meaningful use project makes it that much more difficult. We’ve turned physicians into data entry clerks.” Dr. Price went on to say that recognizing the problem is the first step and then government must take a second look at the consequences of what it has done.

Transparency: Quality and cost
Sen. Pat Toomey (R-Pa.) asked Dr. Price about his opinions on transparency in health care, to which Dr. Price stated firmly that quality and cost information regarding care should be available to patients. “Outcomes are important and we need to be measuring what makes sense from a quality standpoint and allow patients and others to see what those outcomes are,” Dr. Price said. “But it’s transparency in pricing as well. If you’re an individual and want to know what something costs, it’s virtually impossible to find out what that is. If we want to make the system patient-friendly, not insurance-friendly or government-friendly, then we would make that a priority.”

Drug pricing
With regard to access to medications, Sen. Wyden asked Dr. Price if he would be willing to follow President Trump’s recommendation and allow federal health care plans the authority to negotiate drug prices. In response, Dr. Price said, “Right now the PBMs [pharmacy benefits managers] are doing that negotiation. It’s important to have the conversation and look at whether or not there’s a better way to do that. If there is, then I’m certainly open to it.”

In addition to a litany of questions on various health care related issues, several members of the committee reiterated concerns about the ethics of Dr. Price’s investments in various health-related companies while supporting bills that could have benefited these companies. The Senate Finance Committee will vote on Dr. Price’s nomination within the next several weeks.


NIH director to stay put

Jan. 20, 2017
Francis Collins, MD, PhD, will remain as the director of the National Institutes of Health (NIH) under the Trump Administration. However, it is unclear if Dr. Collins will remain in the position permanently. About 50 Obama appointees will remain under the Trump Administration to maintain continuity until President-elect Trump’s nominees are confirmed. Dr. Collins is a is a physician-geneticist and has served as the director of the NIH since 2009. He has garnered bipartisan support in Congress.


Dr. Price faces Senate HELP committee in nomination hearing

Jan. 18, 2017
The Senate Health, Education, Labor and Pensions (HELP) Committee held a nomination hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for secretary of the Department of Health and Human Services. The American Academy of Dermatology Association attended the hearing. Among several health care related issues that were addressed during the hearing, most notably Dr. Price was asked about his thoughts on a replacement for the Affordable Care Act (ACA), access to drugs, and regulatory burdens on physicians. Additionally, Dr. Price addressed concerns about his financial ties to a medical device company.

ACA replacement
When asked by Committee Chair Sen. Lamar Alexander (R-Tenn.) about Dr. Price’s goal for an ACA replacement plan, Dr. Price stated that health care needs to be affordable, accessible, high quality, and responsive to patients, offer incentives for innovation, and ensure choices are made by and preserved for patients. When asked about the timing of repeal and replace, he stated, “I think that one of the important things that we need to convey to the American people is that nobody is interested in pulling the rug out from anybody.” Dr. Price also expressed an interest in implementing high-risk pools and expanding the use of health savings accounts in a replacement plan to cover general health services.

Medicare drug price negotiations
Sen. Bernie Sanders (I-Vt.) asked Dr. Price if he would join him and Democrats in efforts to allow Medicare to negotiate drug prices and allows drugs to be imported from Canada. Without confirming his position on government price negotiations or importation, Dr. Price stated that the cost of drugs is a high priority for all Americans and he committed to working with Congress in addressing the drug pricing issue.

Regulatory burdens
Sen. Bill Cassidy (R-La.) asked Dr. Price for his thoughts on what the government can do to address the regulatory burden that physicians are experiencing with electronic health record (EHR) requirements, such as Meaningful Use. Dr. Price said that EHRs are important from an innovative standpoint because they allow patients access to their medical history. However, he said that the federal government’s role is to ensure interoperability between EHR systems. Additionally, he indicated that the government should work more closely with providers in determining the metrics that should be measured through these systems to improve quality. “If we truly worked with the providers and asked them what we should measure, I suspect that there are some very specific things we could use.”

Government authority in health care
Sen. Pat Roberts (R-Kan.) expressed his concerns about the increased authority of the Independent Payment Advisory Board (IPAB), the Centers for Medicare and Medicaid Innovation (CMMI), the U.S. Preventative Services Task Force (USPSTF), and the Patient-Centered Outcomes Research Institute (PCORI). Dr. Price stated his concerns about CMMI, indicating that the patient should be at the center of care and that health care treatments should not be dictated by government.

Questions on ethics
Committee Ranking Member Sen. Patty Murray (D-Wash.) and Sen. Elizabeth Warren (D-Mass.) questioned the ethics of Dr. Price’s ties to a medical device company. Recently, information has been released about Dr. Price’s personal investments and potential ties to his legislative actions. According to House records, in 2016 Dr. Price bought between $1,001 to $15,000 worth of shares in Zimmer Biomet ― a knee and hip implant manufacturer. Shortly after the purchase, Dr. Price introduced the HIP Act that would have delayed a CMS regulation that would hurt Zimmer Biomet financially. Zimmer Biomet's PAC also donated to Dr. Price's reelection campaign.

When questioned at the hearing, Dr. Price indicated that the trade in Zimmer Biomet shares in his broker-direct account was handled by a broker and also denied knowledge of nonpublic information when trading certain stocks. Sen. Orrin Hatch (R-Utah) asked, “Can you confirm that you have always followed the law relating to trading in stocks while serving as a member of Congress?” Dr. Price responded, “Everything that we have done has been above board, transparent, ethical, and legal. The Office of Government Ethics has looked at our holdings and given advice on what needs to be done in terms of divesting from certain stock holdings to make certain that there are no conflicts of interest. We have read those, agreed to those, and signed those. That document is online for everybody to see.” View Dr. Price’s public financial disclosure report and his ethics agreement.

The HELP Committee hearing is considered a courtesy hearing. A formal hearing before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is scheduled for Jan. 24.


Nomination hearing scheduled for OMB pick

Jan. 18, 2017
The Senate Budget Committee has announced that it will hold a hearing on the nomination of Rep. Mick Mulvaney (R-S.C.) ― President-elect Donald Trump’s pick for director of the Office of Management and Budget ― on Jan. 24. A formal hearing for Dr. Tom Price's nomination as HHS secretary before the Senate Finance Committee ― the committee that will vote on Dr. Price’s nomination ― is also scheduled for Jan. 24.

In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. If confirmed, Mulvaney would be involved with expected efforts to roll back the Affordable Care Act (ACA) and other reforms implemented by the Obama Administration.


President-elect Trump addresses ACA, drug prices in first press conference

Jan. 11, 2017

In his first press conference as President-elect, Donald Trump has restated his position that the Affordable Care Act (ACA) should be repealed and replaced as soon as possible. He stated, “We're going to be submitting, as soon as our secretary [Dr. Tom Price] is approved, almost simultaneously ― shortly thereafter ― a plan. It will be repeal and replace. It will be, essentially simultaneously.”

Additionally, President-elect Trump reiterated his position that Medicare should be allowed to negotiate drug prices. “We’re the largest buyer of drugs in the world, and yet we don't bid properly…were going to start bidding and were going to save billions of dollars over a period of time,” the President-elect said.

Click here to read a transcript of the press conference.


President-elect Trump picks VA lead

Jan. 11, 2017
President-elect Donald Trump has selected David Shulkin, MD, to serve as secretary of the Department of Veterans Affairs. Dr. Shulkin ― trained in internal medicine ― was nominated by President Barack Obama in 2015 to serve as the undersecretary of the U.S Department of Health and Human Services.

In previous media interviews, Dr. Shulkin has indicated that he is in favor of offering a mixed care model for veterans ― where the VA would provide services such as treatment for post-traumatic stress disorder and the private sector would offer veterans other services such as obstetrics and gynecology.


Congress appoints new E&C Health Subcommittee leader

Jan. 6, 2017
House Energy and Commerce Committee Chair Rep. Greg Walden (R-Ore.) has announced that Rep. Michael Burgess, MD (R-Texas) will serve as the leader of the House Energy and Commerce Health Subcommittee. The Health Subcommittee will play a large role in repealing and replacing the Affordable Care Act (ACA). The subcommittee also manages issues related to the CHIP program and FDA user fees.

Read more about Rep. Burgess’s thoughts on the ACA in the October issue of Dermatology World.


Rep. Black steps in for Dr. Price at House Budget Committee

Jan. 4, 2017
House Speaker Paul D. Ryan (R-Wis.) has announced that Rep. Diane Black (R-Tenn.) will serve as interim chair for the House Budget Committee ― stepping in for Rep. Tom Price, MD (R-Ga.) as he goes through the confirmation process for Secretary of the U.S. Department of Health and Human Services. If Dr. Price is confirmed, the House GOP Steering Committee would name a permanent chair ― a position that, as interim chair, Rep. Black would likely assume. If Dr. Price is not confirmed, he could return as chair.

The House Budget Committee would be heavily involved in the repeal of various pieces of the Affordable Care Act through the budget reconciliation process. “As interim Chairman for the House Budget Committee, I am ready to work with my colleagues on both sides of the aisle to repeal this law that has burdened families and businesses and turn the page to a new healthcare system that lowers costs, spurs free market competition, and ultimately empowers patients — not Washington bureaucrats,” Rep. Black said.


Tentative hearing scheduled for Dr. Price nomination

Jan. 3, 2017
The Senate Health, Education, Labor and Pensions Committee has set a tentative date for a hearing for Rep. Tom Price, MD (R-Ga.) ― President-elect Donald Trump’s pick for Secretary of the U.S. Department of Health and Human Services ― on Jan. 18. However, the hearing date will not be officially announced until one week before it is definitively scheduled to occur. This is would be a courtesy hearing, as it is the Senate Finance Committee that will ultimately vote on the nomination.

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

Similarly, Seema Verma, President-elect Trump’s choice for CMS administrator, can anticipate a confirmation hearing in the near future. Although a date for her hearing has not been publicly floated, the Senate Finance Committee indicates that it has received three years of tax returns and completed questionnaires from both Dr. Price and Verma.


President-elect Trump picks budget director

Dec. 21, 2016
President-elect Donald Trump recently nominated Rep. Mick Mulvaney (R-S.C.) to serve as director of the influential Office of Management and Budget (OMB). In addition to helping prepare and administer the federal budget, OMB measures the performance of federal agencies, supervises and coordinates procurement, financial management, and information policies, and plays a role in the approval of major regulations that could significantly impact the economy. If confirmed, Mulvaney would be involved with expected efforts to roll back the Affordable Care Act (ACA) and other reforms implemented by the Obama Administration. He also would be tasked with helping the President-elect keep his promise to maintain a moratorium on new federal regulations.
Before entering politics, Mulvaney was a private-practice lawyer and a businessman. He was elected to the South Carolina House in 2006, and to the U.S. House of Representatives in 2010.

President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January. 


Cures, drug pricing, and the next Administration

Dec. 14, 2016
Yesterday afternoon at the White House, joined by Vice President Joe Biden and key lawmakers from both parties, President Obama signed into law the 21st Century Cures Act, which makes new advancements in medical research and seeks to accelerate the approval of new drugs and treatments for patients. “It is wonderful to see how well Democrats and Republicans in the closing days of this Congress came together around a common cause,” said the President at the official signing ceremony. “I think it indicates the power of this issue and how deeply it touches every family across America.”

Among the federal agencies tasked with implementing the 21st Century Cures Act is the National Institutes of Health (NIH), which will see an increase in funding. Francis Collins, MD, PhD, a physician-geneticist, currently heads up the medical research agency. While President-elect Trump has yet to announce his picks of whom he wants to lead the Food and Drug Administration and the NIH, several key Republicans have expressed their support for keeping Collins on board.

The 21st Century Cures Act was applauded by many as it made its way through Congress and to the President’s desk for signature. However, additional actions are expected in the coming months in order to help address escalating drug prices. Barbara Greenan, senior director of Advocacy and Policy at the AADA, said the AADA “…looks forward to working with the new Administration and Congress on addressing this highly impactful issue in the context of other health system reforms.”


Trump picks Cleveland Clinic CEO for advisory panel

Dec. 7, 2016 

President-elect Donald Trump has selected a panel of private-sector leaders to help guide his economic and business policy choices. The President's Strategic and Policy Forum will include 16 noted business leaders, including the CEOs of Disney, General Motors, JP Morgan Chase, and Walmart. Of interest to medicine, Cleveland Clinic CEO Toby Cosgrove, MD, has been selected as a member of the panel. A cardiovascular surgeon by training, Dr. Cosgrove has led Cleveland Clinic's quality improvement efforts, including making same-day appointments available throughout the system. Under his leadership the system has been regularly named one of the top hospitals in the United States.


Congress names top Democrat for House W&M Committee

Dec. 6, 2016

Rep. Richard Neal (D-Mass.) has been selected as Ranking Member on the House Ways and Means Committee, which has jurisdiction over tax- and revenue-related issues. Specific to dermatology, the Committee would be responsible for addressing a repeal of the 10 percent indoor tanning tax, and would likely play a role in any efforts to reform Medicare and/or repeal and replace the Affordable Care Act.


Congress appoints new E&C chair

Dec. 1, 2016
While President-elect Donald Trump’s transition team is vetting members of the new Administration’s cabinet, on Capitol Hill, Rep. Greg Walden (R-Ore.) has been selected as the chair of the U.S. House Energy and Commerce Committee which has jurisdiction over issues concerning health care, and is the primary committee for addressing the Affordable Care Act, the Medicare Access and Chip Reauthorization Act (MACRA), compounding, drug pricing, and the 21st Century Cures bill that, if passed, would provide medical research funding. Rep. Walden will replace Rep. Fred Upton (R-Mich.), who has served in the role since 2010. Rep. Walden is the outgoing National Republican Congressional Committee chairman. According to his congressional website, he is in favor of repealing and replacing the Affordable Care Act and he also supported the 21st Century Cures Act.


President-elect Trump picks CMS administrator

Dec. 1, 2016
President-elect Donald Trump has nominated Seema Verma, president, CEO, and founder of SVC, Inc., a health policy consulting group, to serve as CMS administrator.

Verma helped create and update the Healthy Indiana Plan ― Indiana's consumer-directed Medicaid program ― under Gov. Mitch Daniels and Vice President-elect Gov. Mike Pence. Prior to her role at SVC, Verma served as vice president of planning for the Health and Hospital Corporation of Marion County in Indiana and director for the Association of State and Territorial Health Officials in Washington, D.C.

President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January.


President-elect Trump picks Dr. Price for HHS

Nov. 30, 2016
President-elect Donald Trump has nominated House Budget Committee Chair, Rep. Tom Price, MD (R-Ga.), to serve as Secretary of the U.S. Department of Health and Human Services.

Dr. Price, an orthopedic surgeon, has been a staunch supporter of the full repeal of the Affordable Care Act (ACA) ― he introduced the Empowering Patients First Act in 2015 which would fully repeal and replace the ACA with a system that includes individual health pools and expanded health savings accounts, and would have given physician groups control over performance-based quality measures. As a physician, Dr. Price has indicated that he understands the administrative burdens placed on the physician community and has expressed concerns over the burdens of electronic health records and Meaningful Use ― indeed, he was instrumental in the passage of a blanket hardship exemption from MU requirements in 2015. He also supports allowing physicians to balance bill their Medicare patients, repealing the Independent Payment Advisory Board (IPAB), allowing the use of in-office compounded drugs, preserving the In-Office Ancillary Services Exception to the Stark Law, and ensuring that step therapy protocols do not impede patient access to necessary treatment. 

The American Academy of Dermatology Association (AADA) has had a long-standing relationship with Dr. Price, who was a featured speaker at the AADA's 2012 Legislative Conference. The AADA has worked with him on issues such as Medicare payment reform, shortening EHR reporting periods, and ensuring that the MACRA transition included opportunities for physicians to avoid penalties.

President-elect Trump’s nominations will require a simple majority vote in the Senate. Hearings on his nominations will likely take place in early January. The AMA and other medical organizations have announced their strong support for Dr. Price's nomination.


The fate of Obamacare

Nov. 28, 2016
The debate about repealing and replacing the Affordable Care Act (ACA), also commonly known as Obamacare, has raged since the controversial legislation was signed into law in 2010. Since then Republicans in Congress have voted to repeal all or parts of the law more than 60 times ― efforts that have died in the Senate or been vetoed by President Obama. “After nearly a decade of premium increases, Obamacare is sending premiums to new heights and despite all of the efforts folks must endure to obtain coverage, they often face further obstacles to gain access to care,” said Rep. Tom Price, MD (R-Ga.) — who will be nominated Secretary of the U.S. Department of Health and Human Services in the new Administration — in an interview with the Academy’s Dermatology World magazine. “Obamacare can’t be fixed; we must fully repeal it so we can start over with a new approach.”

However, now that Republican President-elect Donald Trump is headed to the White House, the controversial piece of legislation could be on its way out. Throughout his campaign, President-elect Trump has vowed to sign legislation that would fully repeal the ACA, and just recently, Vice President-elect Mike Pence has confirmed that full repeal will be one of the Administration’s top priorities, stating, “Decisions have been made by the president-elect that he wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free-market solutions that he campaigned on.”

In terms of replacement options, “Republicans would preserve some insurance market protections,” said Eric Cragun, senior director of The Advisory Board’s health care policy division, in a recent webinar. “They would likely cap tax exclusions for employers and expand HSAs.” Indeed, in a recent interview with the Wall Street Journal, the President-elect indicated that he would be open to keeping two provisions of the current law: the provision that would not allow insurance companies to deny coverage to patients with pre-existing conditions, and the provision that allows children to remain on their parents’ health plans through age 26.

Yet, repealing the law will require 60 votes in favor of repeal in the Senate and Republicans currently hold only 51 seats. Congress could remove certain provisions under the ACA through a process called budget reconciliation, however, “It’s a classic example of: it’s much easier said than done,” said Piper Su, vice president at McDermott Consulting, in a recent Advisory Board webinar. According to Su, the ACA provisions that could be repealed through the budget process would have to be significantly tied to federal fiscal policy. “The provision would have to have a big budget impact. It’s a fairly complicated maneuver, but they’d have to try because it’s hard to envision a world where they would get 60 votes to do an overall repeal.”

Read more about how the new Congress and Administration are likely to address these issues in the October issue of Dermatology World.