THE PROGNOSIS

For a while after President Trump was elected, I thought I should watch a few episodes of “The Apprentice” if only to hear him utter the infamous phrase, “You're fired.” Turns out I didn't need to.

Tom Price — who led the Department of Health and Human Services for a mere eight months — is packing up his desk at the Humphrey building, announcing Friday that he's resigning from the sprawling federal agency that oversees not only the government's big Medicare and Medicaid health insurance programs, but also the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health.

Even before the news broke that Price had spent hundreds of thousands of taxpayer dollars on private jet flights, Trump had been increasingly dissatisfied with the Georgia doctor and his ineffectiveness in selling various health-care plans to former congressional colleagues. The president had even joked back in July about firing Price, telling a group of Boy Scouts that he'd say, “Tom, you're fired” if Price didn't get the votes for a bill repealing Obamacare.

Even so, Price's fall was swift — he resigned 11 days after the first of several reports by Politico about his use of private planes to conduct official business. And it comes at a less-than-optimal time for HHS, just a month before the Affordable Care Act marketplaces open for business.

Whoever Trump appoints to replace Price will inherit many messy questions. He had invited governors to propose more conservative changes to their Medicaid programs and marketplaces, taken steps to reverse Obama-era rules implementing the ACA and pulled back on experimenting with new ways of paying Medicare providers. In short, Trump can still make a big mark on HHS even after the dramatic failure of ACA rollback efforts in Congress.

Trump has picked Don Wright, who has been director of the Office of Disease Prevention and Health Promotion, as acting secretary in the interim. But Trump has several options for replacing Price. Trump might go with a governor, since they're used to running large health-care programs. Or he might promote someone within HHS -- most likely Seema Verma -- or someone elsewhere in his administration. A few senators' names have surfaced as possible picks, too.

Here's a list of the top names being circulated:

Seema Verma, administrator of the Centers for Medicare and Medicaid Services:

Pros: Verma is a favorite of Vice President Pence; she helped him reshape Indiana's Medicaid program while he was governor. She has already been confirmed by the Senate. She knows a lot about Medicaid.

Cons: Like Price, Verma has been viewed as ineffective on Capitol Hill in advocating for Trump's priorities (such as repealing the ACA).

 

Scott Gottlieb, commissioner of the Food and Drug Administration:

Pros: Gottlieb is a physician, like Price. He has garnered some bipartisan support; a few Senate Democrats voted for his confirmation. He's well-known in Washington policy, government and industry circles.

Cons: Gottlieb doesn't have the executive experience a governor could bring to the table.

Rick Scott, governor of Florida:

Pros: He's a former hospital executive. He's from a state that Trump would need to win in 2020.

Cons: Scott is still in the middle of hurricane response efforts, so he might not want to head to Washington. Also, he's from a state Trump would need to win in 2020, meaning the president might not want to remove a key ally from a critical post.

David Shulkin, secretary of Veterans Affairs:

Pros: Shulkin is also a doctor. He's the only Obama-era secretary that Trump kept on and the only Cabinet member to be confirmed unanimously. He's a Trump favorite.

Cons: The Washington Post recently reported that Shulkin combined some official travel with leisure travel a la Price. This summer, he attended Wimbledon and took a cruise on the Thames while meeting with European officials.

Bobby Jindal, former Louisiana governor:

Pros: Known as a top conservative thinker on health-care policy, Jindal has proposed his own Obamacare replacement plans. Jindal was originally viewed as a top contender along with Price for the role HHS secretary. He worked at the agency under President George W. Bush.

Cons: He and Trump criticized each other as they were running in the 2016 GOP primary. He's extremely conservative, advocating for health-care ideas that are even more conservative than what many Republicans would back.

Charlie Baker, governor of Massachusetts:

Pros: A former health-care executive. Previously his state's secretary of health and human services. If Jindal is the most conservative possibility, Baker is the most moderate.

Cons: Baker was one of several Republican governors to oppose the latest Senate health-care bill, the one proposed by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.). That might not sit well with Trump.

Rick Santorum, former senator from Pennsylvania:

Pros: Teamed up with Graham and Cassidy on their recent health-care bill. Beloved by religious conservatives.

Cons: Limited background in health policy. Also ran against Trump in the GOP primary.

--We're also tracking this tragedy as it unfolds: A gunman in a high-rise hotel opened fire on a country music festival on the Las Vegas Strip late Sunday, killing at least 50 people and wounding more than 200 in the deadliest mass shooting in modern American history. Read updates here.

PRICE CHECK

--Trump told reporters on Friday that he considered Price a “fine man” but that he “didn’t like the optics” of the secretary's expensive private flights and planned to make a decision on the secretary's fate by the end of the day. By that point, the president had already received Price’s resignation letter, my colleagues Juliet Eilperin, Amy Goldstein and John Wagner report. In that four-paragraph letter, Price said he regretted “that the recent events have created a distraction” from the administration’s objectives. “Success on these issues is more important than any one person,” he continued.

Not long after, HHS staff received a message from Price praising employees as “dedicated, committed” and saying it had been “a great joy” to serve with them. He closed it this way: “Duty is Ours — Results are the Lord’s!”

--Price had given every indication last week that he intended to fight to keep his job. The then-secretary said Thursday on Fox News that he planned “to not only regain the trust of the American people, but gain the trust of the administration and the president.” And in an email on Friday with a time stamp of 4:43 p.m. — just minutes before the White House announced his departure — Price detailed personnel changes and a “strategic shift” initiative that gave no hint of his own move.

Trump advisers said the president was particularly discomfited by Price’s behavior because he’d run as a champion for “forgotten” Americans for whom costly charter-plane travel seemed particularly egregious. “It speaks to people who think Washington is already beyond hope and out of touch,” said Barry Bennett, a  former Trump campaign adviser.

Here's a video explaining how it all went down:

--During his travels, Price regularly sent "Week in Review" travelogues to HHS's approximately 80,000 employees detailing his time on the road, and complimenting agency employees who “ensure the good stewardship of taxpayer dollars," the New York Times reports. At times they included links to a Flickr account, where agency staff members posted more than 1,800 photographs of Mr. Price’s globe-trotting and other agency work, including a recent dinner in Liberia.

Price didn't begin the "Week in Review" dispatches, which were also sent by Sylvia Burwell, his predecessor in the Obama administration, but they "outraged many members of the department staff, given that the travel took place at a time when the agency is facing hundreds of billions of dollars in proposed budget cuts, as well as certain budget-related restrictions on work-related travel for employees," Katie Rogers and Eric Lipton write.

--Democrats acknowledged that Price's taxpayer-funded jet travel was a poor use of government resources. But they stressed their underlying opposition to how he approached the ACA -- most recently pulling back on advertising for the upcoming open enrollment season -- and Price's backing of various GOP health-care bills that would have resulted in millions fewer Americans getting coverage.

From House Minority Leader Nancy Pelosi (D-Calif.):

House Minority Whip Steny Hoyer (D-Md.): 

Sen. Sheldon Whitehouse (D-R.I.): 

Rep. Adam Schiff (Calif.), ranking Democrat on the House Intelligence Committee: 

Rep. Earl Blumenauer (D-Ore.): 

Rep. Barbara Lee (D-Calif.): 

Rep. Hakeem Jeffries (D-N.Y.): 

--Republicans were pretty muted in their response. The ones who responded mostly praised Price's work in Congress and in the medical field.

Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, said this: “I understand and respect Tom Price’s decision, but the news is disappointing.  He has had a distinguished career as a physician and public health advocate, and I hope I have the opportunity to work with him again.”

The statement from House Speaker Paul Ryan (R-Wis.), via Bloomberg's Sahil Kapur: 

Fun fact: Now that Price is out of a job, he may have to eventually buy a health plan on Healthcare.gov. Several reporters noted this irony. From Bloomberg's Steven Dennis: 

Vox's Sarah Kliff: 

USA Today's Gregory Korte: 

AHH, OOF and OUCH

--On "60 Minutes,"House Majority Whip Steve Scalise (R-La.) has given his first interview  since he was badly wounded by a politically motivated gunman who shot him and four other Republicans practicing for a charity baseball game in Alexandria, Va., in June. Scalise was struck in the hip, with the round shattering his pelvis and femur and causing bleeding that brought him to the edge of death.

“A gunman came out with a lot of artillery just hellbent on killing a lot of us, and we’re just out there playing baseball, sitting ducks, and he just started firing away,” Scalise said in a CBS “60 Minutes” interview broadcast last night. “If you said to us, at the end of this, the only person who would be dead would be the shooter, no one would have believed it.”

“The first thing that came to mind, I prayed to God: Please, don’t make my daughter have to walk up the aisle alone,” Scalise recalled. “And obviously, after that, I prayed that I could see my family again.”

As Scalise lay wounded on the field, he recalled hearing Rep. K. Michael Conaway (R-Tex.) urging him to hang on as police subdued the shooter. “I just remember him whispering: ‘Stevie, don’t worry. We’re gonna get you. We’re gonna get you,’ ” he said. “He just kept whispering. And it was really calming.”

After the gunman was fatally shot by police, Scalise’s colleagues rushed to his side — including Rep. Brad Wenstrup (R-Ohio), a former Army combat surgeon. During the segment, Wenstrup described applying improvised tourniquets and bandages as Scalise awaited helicopter evacuation to MedStar Washington Hospital Center. Jack Sava, the surgeon who led the trauma team that treated Scalise, said the lawmaker was “hovering on the border between life and death.”

OOF: HHS released new data on Friday showing this year’s planned outages for the federal health insurance website, Healthcare.gov, which showed the website will be down roughly 11 percent longer compared to a similar six-week period last year, The Post's Juliet Eilperin reports. The site is slated to be unavailable for a total of 60 hours, compared to 53.5 hours last year, between Nov. 1 and Dec. 15.

HHS came under fire last week after announcing that Healthcare.gov would be unavailable for 12 hours nearly every Sunday during this year’s open enrollment season, which is just half as long as last year's. Some charged the Trump administration is trying to keep consumers from signing up for 2018 health plans, but an agency spokesman said the scheduled maintenance will take place during the lowest-traffic times.

“This year’s potential maintenance schedule is consistent with last year’s under the previous administration,” HHS spokesman Matt Lloyd said in an email. That maintenance helps federal agencies ensure the information consumers enter into the system can be verified, he explained. “System downtime will continue to be planned for the lowest-traffic time periods on HealthCare.gov, including Sunday mornings.”

OUCH: Congress just allowed the Children’s Health Insurance Program, which provides health insurance to 9 million children, to technically expire, although states still have enough funding to carry them through a few more months. The Senate had allowed the CHIP deadline to pass without action as it focused on passing a bill repealing the ACA; two committees (Senate Finance and House Ways and Means) are finally scheduled to mark up CHIP legislation this week

"The program was primarily funded by the federal government, with states paying a good deal less," The Post's Valerie Strauss reports. "States still have some CHIP money available, but if Congress does not act quickly to restore the program, they will start to run out. Several states and the District of Columbia are expected to drain CHIP funding by the end of this year and many more by March 2018, according to this government report."

HEALTH ON THE HILL

--Senate Republicans are preparing to at least partially abandon their quest to repeal the ACA and pivot instead to a massive tax overhaul, according to draft budget legislation they released Friday. According to the measure, which is a precursor to any tax reform bill Congress might pass, the Senate Finance Committee and House Ways and Means Committee will have until Nov. 13 to draft tax bills that cost no more than $1.5 trillion in lost revenue, my colleague Mike DeBonis reports.

"The budget notably does not direct two key committees with health-care jurisdiction -- the Senate Health, Education, Labor and Pensions Committee or the House Energy and Commerce Committee to draft legislation — a signal that Republicans are stepping aide, for now, from their abortive health-care efforts," Mike writes. "The Senate Finance and House Ways and Means committees have jurisdiction over some health-care matters, mainly tax-related, but they do not oversee insurance regulations or the Medicaid program — which are both major parts of the GOP health bills drafted thus far."

A few more good reads from The Post and beyond:

TRUMP TEMPERATURE
Poorer rural voters, who make up a large part of the president's base, are among those most impacted by the drug price gouging.
Mic
MEDICAL MISSIVES
Rebecca Bredow has been in a custody battle with her ex-husband, who wants their son to be vaccinated.
Kristine Phillips
Officials are tracking 40 high-priority drugs that could run short nationally if disruptions in manufacturing and distribution continue.
Laurie McGinley
Husband-and-wife team mixes science, celebrity — and research breakthroughs.
Laurie McGinley
INDUSTRY RX
Verzenio was approved Thursday by the Food and Drug Administration for HR-positive, HER2-negative breast cancer that has worsened after hormone therapy.
STAT News
DAYBOOK

Coming Up

  • The House Energy and Commerce Subcommittee on Health holds a hearing on patient access to investigational drugs on Tuesday.
  • The Atlantic holds a forum on prescription drugs on Thursday.
  • Politico holds an event on Medicaid on Tuesday.
  • The S&P Global Ratings’ Health Care Conference will take place on Wednesday.
  • The Brookings Institution holds an event on 21st century medicine on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the federal response to the opioid crisis on Thursday.
SUGAR RUSH

Alec Baldwin is back as Donald Trump in "Saturday Night Live" season debut:

Stephen Colbert tackles Price's resignation:

See seven reactions to Trump's criticisms of San Juan's mayor: