WASHINGTON • President Donald Trump's selection of a secretary for the Health and Human Services Department could be a turning point in a healthcare debate that has polarised Washington, as he faces a choice of working with Democrats to fix the system or continuing his so-far failed efforts to dismantle his predecessor's programme.
The resignation of Mr Tom Price as secretary last Friday, over his use of costly chartered jets, capped a week of setbacks on healthcare for the President, who made the issue a centrepiece of his campaign and his first eight months in office.
Mr Trump's decision on a successor could be a chance to shift the debate, but he faces the prospect of an arduous confirmation battle.
The President has sent mixed signals since the latest effort to repeal and replace former president Barack Obama's Affordable Care Act (ACA) collapsed in the Senate.
He asserted that he had the votes to pass the repeal legislation early next year, while offering to negotiate with Democrats who are adamantly against it.
The White House had no comment last Saturday, but two advisers who asked not to be identified said two top candidates were Mr Scott Gottlieb, commissioner of the Food and Drug Administration (FDA), and Ms Seema Verma, administrator of the Centres for Medicare and Medicaid Services.
Both have been vetted by the White House, nominated by Mr Trump and confirmed by the Senate to their current jobs within recent months, a significant selling point.
But Mr Trump may not necessarily fill the post quickly. He has left the Department of Homeland Security in the hands of an acting secretary since Mr John Kelly left in July to become White House chief of staff.
The President appears to be in no rush to fill the post despite a series of hurricanes and a roiling immigration debate, issues managed by the department. He said last Friday that he would make a decision on the nomination "probably within a month".
If Ms Verma is picked to succeed Mr Price, it would be taken as a sign among many that Mr Trump wants to continue vigorous opposition to the ACA, with the government doing the minimum required by the law to implement its provisions.
Ms Verma, an ally of Vice-President Mike Pence, worked closely this year with Republicans in Congress on their proposals to undo the law and to cut Medicaid, the programme for more than 70 million low-income people.
Still, some progressives have interpreted her work under the healthcare law in Indiana, where Mr Pence was governor, to mean that, while she opposed the ACA, she was committed to finding ways to enforce it if it remained on the books.
Mr Gottlieb has more experience in Washington and was seen at the time of his appointment as the more moderate of candidates being considered.
In his first months at the FDA, he has deftly balanced the concerns of patients and pharmaceutical companies, while taking steps to combat the opioid epidemic and speed access to lower-cost generic drugs.
His nomination would be seen as a signal that the President might want to take a different approach to the healthcare debate.
"We have the votes on the substance but not necessarily on the process, which is why we're still confident that we can move healthcare forward and get it done in the spring," White House press secretary Sarah Huckabee Sanders said before Mr Price's resignation.
NYTIMES
