Pulse Check: Does Trump need a health care czar?
Rep. Tom Price, President-elect Donald Trump’s pick to run HHS, is facing an early test: How to repeal and replace Obamacare when congressional Republicans and Trump aren’t necessarily on the same page.
“It’s going to be very difficult,” former Democratic Senate Majority Leader Tom Daschle told POLITICO’s “Pulse Check” podcast. For instance, Trump’s pledge to keep Obamacare’s consumer protections raises complicated questions around how to pay for those provisions — “and that’s just for starters.”
Republicans’ plans to immediately strike down Obamacare have sparked a complicated intra-party debate about how to replace the law without disrupting coverage for millions. And it’s also raised questions about Price’s role. If confirmed as HHS secretary, should Price be the visionary policy wonk, driving Obamacare repeal? Or will another figure be tapped to lead Republicans’ reforms, with Price focused more on day-to-day implementation of the White House’s strategy?
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Daschle knows something about bridging that gap. Eight years ago, Barack Obama — then the president-elect — tapped Daschle to simultaneously lead HHS and the White House’s health reform efforts, only to have Daschle withdraw the nomination because of tax-related issues. And like Price, Daschle had experience crafting legislation in Congress and even mapped out his own proposal for how national health reform should look.
Still, Daschle got a front-row seat to the early discussions around what would become Obamacare and — despite fiercely disagreeing with Trump’s goal — highlighted what he thinks the incoming administration will need to succeed when crafting policies to roll the law back. For starters: Pick a health reform czar.
“It’s an over-used term,” he acknowledged, but a White House intent on crafting heath reform needs “somebody who can really coordinate the entire effort.” After Daschle withdrew his nomination, the job of health reform czar went to Nancy-Ann DeParle, and Kathleen Sebelius became HHS secretary.
Having witnessed Democrats’ own battle for health reform drag on for more than a year, the job of health reform czar “can’t be bifurcated, it can’t be divided up with a number of people involved, or you lose a lot of the ability to move the process forward,” he added.
Daschle and others also detailed what a HHS secretary needs to succeed, particularly while trying to play a role in steering major reforms.
“The most important skill of all is not a skill per se, but a relationship with the president,” Daschle said. “You’ve got to have [that] trust, that ability to walk into the Oval Office. And most Cabinet secretaries today don’t have that.”
But that shouldn’t be a problem for Price, who was one of Trump’s earliest endorsers, Daschle pointed out.
A secretary also must be willing to relinquish his or her own policy preferences. Doug Holtz-Eakin, who was the policy director for Sen. John McCain‘s 2008 presidential campaign, said he vetted potential HHS secretaries with that expectation in mind. “I expected them to adopt McCain’s policy,” Holtz-Eakin told POLITICO’s podcast last month. “That was not optional.”
Working with Obama, Daschle discovered that balancing act. “I had very strong ideas, a lot of ideas, about how we might proceed,” he said. But those were subordinate to Obama’s own priorities. “It’s always the president’s decision,” Daschle said.
And after Obama’s long campaign, by late 2008 the president-elect had developed strong thoughts about the best strategy for health reform. “We had big discussions about whether we should do single-payer and start out with that” as a negotiating tactic, Daschle said. “Ironically, [Obama] said no, I want to take something that has broad Republican support. Let’s start with the Heritage Foundation plan.”
That decision points up one more challenge for a HHS secretary: When to disagree with the president. Beginning with a more conservative approach to health reform in 2009 boxed Democrats in and gave them fewer options when bargaining with Republicans, Daschle said he worried at the time. “Where do you negotiate if you start where you want to end up?” he said.
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