The guessing game begins over Trump’s health care picks
A Donald Trump administration is likely to prove as unorthodox as his campaign — and that extends to the health care realm. The presumptive GOP nominee has not named any advisers with notable health care policy experience, and few names have emerged as possible picks for top administration jobs — and some wouldn’t want to serve aPresident Trump.
But a few names are being floated as potential HHS secretary — particularly Ben Carson, given his medical pedigree and strong support for Trump. The other names in the ether: Florida Gov. Rick Scott, who rose to prominence as CEO of hospital chain Columbia/HCA, and former Louisiana Gov. Bobby Jindal, who held a top HHS post in the administration of George W. Bush and who was a sworn enemy of Obamacare while he was governor. All three have expressed support for Trump now that he’s the presumptive nominee.
Those three names are just speculation at this point. Health care policy wonks are pretty much unanimous in saying they’ve had no interactions with the Trump campaign and don’t have a credible clue who he might turn to orchestrate his health care policy.
“Who the hell knows?” said Thomas Scully, who served as CMS administrator under President George W. Bush. “Unpredictable is the most you can say.”
Trump has backed some unorthodox ideas for a Republican — promising to provide health care to everyone, supporting negotiations over what Medicare pays for prescription drugs and simultaneously vowing to repeal Obamacare — leading some to suggest his picks for top jobs could also be surprising.
“His philosophy on most things is pretty moderate,” Scully said. “You’d probably find he’d surprise a lot of people by picking a lot of moderates and maybe even Democrats.”
Trump’s incendiary rhetoric and lack of governing experience leads many to believe he’ll have trouble attracting the best and brightest to his administration. And some high-profile conservative thinkers are already ruling out a post in the Trump administration.
“I’d never consider doing it because I think the person at the top of the government would be really unfit for the job,” said James Capretta, who oversaw health care programs at OMB during George W. Bush’s first term.
But Dan Mendelson, president of Avalere Health, thinks that will change if Trump actually is in line for the presidency. In particular, Mendelson thinks jobs running agencies such as CMS or FDA could be attractive if Trump picks someone with little governing experience to oversee HHS.
“I would expect those picks to be very functional and people who know how to do their jobs,” said Mendelson, who served in the Clinton administration. “In a world where the HHS secretary is more a visionary, or more of a political pick, the operating division heads get more authority and are able to operate more autonomously, and that would be my expectation for a Trump administration.”
Several health care policy wonks suggested Trump might look to the private sector for top posts given his business background and disdain for the Washington establishment. But Tom Miller, of the right-leaning American Enterprise Institute, pointed out there would also need to be a trove of mid-level officials who actually know how the giant bureaucracy works, which could present an opportunity for ambitious GOP congressional staffers.
“Punch their ticket for a couple of years in the executive branch and then they come back out on K Street,” Miller predicted. “That’s the food chain of health policy.”
Many conservative health care policy experts, who overwhelmingly supported other candidates in the primary contest, are still processing the reality that Trump will be the nominee. The Manhattan Institute’s Avik Roy, who advised the campaigns of former Texas Gov. Rick Perry and Sen. Marco Rubio, said he doesn’t plan to vote for Trump in November.
“I honestly don’t know what to do,” Roy said. “I’m not a fan of Hillary either.”
That doesn’t mean, however, that he’s ruled out serving in a Trump administration if that comes to pass.
“If the president asks you to serve, I don’t think you just dismiss it out of hand,” Roy said. “I think you have to take it seriously and consider it.”