In the latest efforts to repeal the health care law, this is one hour. Good morning everyone. Not much going on in healthcare policy these days, is there . My name is tovar, im Vice President for Health Policy at the center for American Progress and i have the pleasure of introducing congressman pallone whos been a leader in protecting the integrity of the medicare guarantee and of the medicaid program. Making the nations food system saver, strengthening laws to keep our air and water clean , making health care more affordable and accessible and supporting initiatives that advance and protect public health. Mister pallone is the Ranking Member of the house energy and Commerce Committee which has jurisdiction over issues pertaining to energy, environment, commerce, telecommunication and healthcare. Theres a lot on his plate. From 2060 2014, congressman pallone served as top democrat on the Committee Subcommittee on health and is chairman during the 111th congress , Mister Pallone played a key role in authoring and passing the Affordable Care act so its a good time to have him here. Its a good time to have him here. Please welcome congressman pallone. [applause] thank you tovar and i want to thank the center for American Progress for this today. I have to say a few more things about the center. First of all, right now obviously we are in the Health Care Debate and the republican efforts to repeal the Affordable Care act. Has done fantastic work in my opinion educating the public about the negative impacts of the republican repeal, and of course your twitter is part of that as well. Theres so many things the center is doing that are being helpful because i often felt , im going to watch how i touch the mic. That most of the time after we passed the aca, there really wasnt a lot of information going on about the positive effects of this and in the last six months obviously thats changed dramatically to the point where very few americans , it was pulled and it was like 15 percent of americans, thats the same level of favorability of our governor, as you know. About 15 percent of the people view the republican repeal bill in a favorable light and a lot of it has to do with the center and other organizations out there pointing out the negative impact on the American Public and on their Health Insurance. And also i mentioned to tovar when i came in, i remember i think it was in fall 2015 when the center put out the report about drug pricing and high cost drugs and that played a major role i think not only in the democratic platform but also in Hillary Clintons comments and ultimately trump as well about how the high price of drugs needs to be addressed and was a priority mentioned many times during the president ial campaign on both sides of the aisle, the center had a lot to do with that as well. Im going to talk about drug pricing in my comments but i think after we sit down and topher start answering questions if we have a discussion we will talk more about the aca. Obviously i believe that what senator mcconnell is doing these last couple weeks , the changes initiated by senator crews and others in my opinion are just cosmetic. If anything, they make the bill worse than the original senate bill introduced and most notably the cruise provisions that allow Health Insurance companies if they enter the marketplace to also then offer junk plans outside the marketplace , that way the essential benefits package. It was dead enough when the senate bill says that states could waive the essential benefits package but now the cruise amendment and the latest mcconnell proposal that incorporates this is to go beyond that to even without the state waving it, the junk plans could be offered in states even more states, even those that dont waive it so i think again, we will talk a little more about it. The main thing i wanted to talk about was drug pricing so let me get to that. Some of you know that last week on the floor we did pass reauthorization of the user fee bill that was not only for drugs but also for medical devices and generic. That is now going to the senate. We expect them to take fairly quickly or at least thats my hope and obviously that bill also is going to help with generics. Generics in my opinion are still a major way to deal with drug prices effectively but the main thing i want to stress today is the problem with drug pricing is getting worse, not Getting Better even though we talked about this two years ago, even though it was part of the president ial campaign on that side of the aisle, even though president from continues to mention it from time to time, congress and the administration are not doing anything effectively about it. And we in our committee, the democrats on the energy and Commerce Committee have repeatedly asked our Republican Leadership on the committee to have hearings on the issue. And you know, they havent said absolutely no they havent done anything and we are six months into the twoyear session and there still havent been any hearings so were still hoping we will have them but to me, not only are we not addressing this legislatively, were not even having hearings on it. We did when we passed the fda user fee bill and committee , past a sense of commerce resolution which was done by voice vote, jan was the sponsor of it that said that the committee should address drug pricing. But you know, so far you know what the sense of congress are, they dont have any force of law so at least they indicated they do care on the republican side but we havent seen any action so were still going to push them. So the problem is that not only are hard drug prices, not only is the problem with hard drug prices getting worse, not only is it outpacing other increases in healthcare significantly, next year annual drug spending is expected to reach more than 500 billion in the United States. I can see the point, i dont even know if were there yet but i think at some point we will get to the point where drugs are maybe even the majority of your healthcare costs. Were not there yet but we could get there. So as a result of those high prices, Many American states , real barriers in terms of getting the medication they need which is why theres such an important issue. And it shouldnt be a partisan issue. We had a whole that the Kaiser Family foundation released this may that said that six in 10 americans said lowering the cost of prescription drugs should be a top priority and that was democrats and republicans so when you talk about republican americans, not the people that are elected or the leadership here, just republicans in general, they feel , democrats do which is probably the reason President Trump and Hillary Clinton talked about it during their campaign. So what can be done . Let me talk about what can be done and its complex. Some of these things are easy , like talking about negotiated prices, that might sound easy but a lot of these things are more complex and i want to stress there is no Silver Bullet so the reason i commencing Different Things as i dont think one thing alone is going to accomplish the goal or be a solution. So first thing i wanted to talk about is rams or risk evaluation and mitigation strategy. So that shows you the bureaucratic aspect of it here. And thats, this is the problem where brandname Companies Delay in bringing generics to market. And thats because they use the rems to block access for samples of branded drugs. In other words the generics are going to come to market, they have to have samples of the brandname drugs and the rems program is used by brand names to prevent that because they dont provide the sample. You might say is that a big problem . I think its a big problem. There was a july 2014 study conducted by matrix Global Advisors thats in the ongoing abuse of rems cost the Us Health System for . 5 billion in 2014, probably a lot more today. 5. 4 billion annually in teen. Its probably a lot more today. So we need to provide a way of reducing the ability of the brand Name Companies to block generics coming to market by providing access to the samples and theres actually a bipartisan bill called the fast generics act that was introduced by peter welch and i forget you republican response but it is bipartisan and this establishes an fda approved authorization process or american manufacturers to obtain samples of these branded products. And im not going to go into detail unless you want to, that was something that we considered during the fta markup and it wasnt passed but we talked about it and we couldnt get the votes for it but we need to get the votes for it obviously. At some point. The other thing deals with exclusivity or this is the second, that deals with exclusivity. Some of this is going to get a little in the weeds here, im sorry but thats why were at the center , they get into the week. So exclusivity of course, we have a process in various ways where companies have a period of exclusivity where theyre the only ones that can sell the product and they spend money and resources doing that. But and the exclusivity protects certain drug treatments from competition for a set period of time but today, drug manufacturers often retain that incentive even if they violated a criminal or civil laws so one simple thing is to say that if you do that, in other words if you do Something Like illegally promote the unapproved use of a drug treatment, you do something illegally either criminal or civil, i think they should lose the right to exclusivity for the related product which basically punishing bad actors if you want so thats the second thing i want to mention. The other thing, a third item is penalties for misclassification in the medicaid Drug Rebate Program. You pay , i guess you get a larger rebate, right, if you classify your product as generic. And a lot of times you have situations where Drug Companies have misclassified their product as generic and by doing that, they make a lot more money, they get a larger rebate so the best example of that was epipen. Epipen is a brand of drug, however mylan had classified the epipen as a generic drug for purposes of the Drug Rebate Program and that meant they got you know, the changes recently, they made more money. There was a settlement which you know, a lot of people think was inadequate. As a result, you know, they had to pay back i forget how many millions of dollars but actually 1. 27 billion is what we estimated the cost, i dont know what the settlement was what we like to see in legislation is stronger penalties so that you know, Companies Like mylan have a disincentive to do the wrong thing, to misclassify their product. Fourth item, i alreadymentioned in many ways this is probably the most significant and the one you hear about the most is the medicare price negotiation. We have prce negotiation with the v. A. , with the military, we dont have it with medicare. And we should get medicare the ability to negotiate prices with the Drug Companies, thats an easy one. Its not easy politically but its easy to explain. And President Trump during the course of the campaign and since then has said he would like to see that. The Congressional Republicans continue to oppose it. Under Medicare Part d the secretary , the hhs secretary is restricted by a noninterference clause from having any role in negotiating or setting prices so the first thing we would have to do is repeal that noninterference clause so that the secretary could do that. And then of course there are other aspects of that we can go into, i dont want to spend too much time. That was medicare, with regard to medicaid, what we really need to do there, medicaid is the state and federal match for the most part and so the federal government, the state decides they want to negotiate and in medicaid they can but there are ways for the federal government to help them do that so what were suggesting is that we create a federalstate medicaid negotiating pool for highcost drugs so under the rebate, under the medicaid Drug Rebate Program today, drug manufacturers and medicaid agencies have to enter into rebate agreements with the secretary and the safe and negotiated initial research but many states have tried to join together to let purchasing power of a higher cost drug which does not have the authority to facilitate those negotiations between the state and drug manufacturers and theresa lot of money lost as a result so what were suggesting is that we authorized cms and participating state Medicaid Programs to partner with sector contractors to negotiate elemental rebate for drug manufacturers. Again, will call it a medicaid purchasing, that is essentially with would require legislation as well. I want to talk a little bit about generics in the Medicare Part d program and the way we can provide greater financial incentives for generics and Medicare Part d. In the fda user fee legislation, we did incentivize more generic competition. We did that in the fda user fee bill and if you want to talk about moreof that, we can but there are ways to provide more financial incentives for generics and theres the rems that i mentioned before. What we are suggesting here is first of all, improvements to the part d appeals process because a lot of people are turned down and then they appeal they dont know how to go about it so we have this process so that seniors or the disabled dont just you know, abandon hope. That they actually can take an appeal. But we also can offer the lowest possible copayments. Right not now under medicaidpart d, weve been trying to keep the generic copayments low and thats saved a lot of money but its been much more difficult to do that with the lowincome subsidy, the lower income population. A lot of them, they are the Medicare Beneficiaries that have the highest drug spending. Their copayment amounts to step by statute so that means that part d plans cant lower generic copayments on their own to encourage the use of generics , lowcost generics as part of the program so what we would have to do is again, passedlegislation so that we could lower the generic copay and that would save money for seniors particularly low income, i mentioned the appeals process as well. I want to talk about a couple medicare improvements that we can make and talk briefly about transparency and then we will go to the questions part. In terms of the medicare improvements, one of the things that we can do is close the doughnut holes, when we did the aca we basically closed apart the doughnut hole over a period of time but that hasnt ended yet and there is still part of the doughnut hole that needs to be filled so i would advocate that we do that two years sooner than the current law and obviously that would help cost for seniors. We can also reduce costs for seniors and for the Medicare Program by tying reimbursement in Medicare Part d to the most common dosage of drugs. This hasnt really related to the opioid problem but a lot of the debate when we were dealing with opiates last session was the fact that a lot of times people would get a lot of pills. They would a sickly set on the shelf and other people would use it and that doesnt relate to this but what we do is, what we see is drug manufacturers package bottles that contain too much of the drug for most doses so that increases the cost cause youre getting more prescription drugs that you dont need. So and its billions of dollars, apparently so what we could do basically is incentivize companies to manufacturer files that more closely matched the need of the population and again, that can be done by legislation as well. The last thing i want to talk about is transparency and accountability of drugcompanies and their prices. We have some good actors, one of them is in my district, johnson and johnson, that both johnson and johnson and fantasy have agreed to disclose their drug prices increases every year. They went so far as, theyre going to put limits on how much it would increase prices annually and this is an important first half but obviously theyre doing this voluntarily, the only ones that are doing this as far as i know what for the past two years under the obama administration, the last two years of president obama, they set up a medicareand medicaid drug spending cash for that provided online tools where the public could view drug spending and utilization on certain drugs and it wasnt erfect but its obviously an effort to createtransparency and what i would say is that the trumpadministration should continue this. As far as i know they had, but they should because you know, without that i think it would be more difficult to get that kind of information. But also congress could take steps in legislation to Institute Reporting requirements for manufacturers in the Rebate Program and in medicare if a manufacturer increases the price of a coveredoutpatient drug significantly, they basically have to report it and i would advocate that as an important step legislatively. I mean obviously, if were going to deal with drug prices, we have to have the data that is actually happening because otherwise its more difficult and we had this in other parts of the Health Care System so its not that unusual to do something with it. The last thing i wanted to say and we will have topher come back up here is a lot of these initiatives are things that im going to work with our committee members, democrat and republican, tried to develop comprehensive legislation in the fall that includes the thing that i talked about. And essentially others as well, i havent mentioned everything. I basically talked about ways that i think would be most effective and probably be politically more viable, there are things out there that i think are less effective or maybe more difficult to do politically so i havent mentioned them i want dont want to suggest its the only thing but the main thing is we need to come up with Workable Solutions to address drug pricing and incentivize competition to encourage development of Affordable Drugs and i think those are some of thesteps that we could take in that regard and that we will work on. When we come back in the fall. So you want to come up here . What are we doing now . Are you going to ask me questions . Are we going to have a little dialogue . I think i want to say first of all that i think its incredibly important that perhaps have a proactive, positive agenda for reform. We cant just be about opposing trumpcare, we cant just be about russia ,thats not how were going to win the election. Dont even talk about russia. So we thank you for your initiative and all your work you are welcome. But i really think the sender plays a major role in this debate. There were reports that came out a couple of years ago. One thing you said i wanted to ask about the wound very interesting was when you were talking about Committee Hearings for the drug user fee legislation. We are going to have more Committee Hearings on that legislation than on trumpcare. You have been in congress for a long time. Almost 30 years. Have you ever seen such a secretive process in your entire career . It funny because i dont know what the circumstances were but in the last couple of weeks i spoke to a couple of publicans who said here comes regular order guy. They literally called me back. I got it from john dingell, maybe. We should have a subcommittee hearing, a full Committee Markup. Thats regular order, simplify. It seems like we are getting further and further away from to the point where in the house, where they did the repeal, they had a full Committee Markup. They just went to full Committee Markup. The only reason they did a full Committee Markup was because i kept screaming about it. He just went right to the floor. I think a lot of times republicans get away from regular order because they dont want people to know what they are doing. The markups you have on both house and senate that could be six or seven opportunities. If you go right to the floor there is only one. I think part of the reason they is because its less for people to know its going on. Some people are under the impression that if the senate there is a bill, chance that the house wont pass it. Can you give people a message about what is going to happen in the house . I think that is wishful thinking. It is quite clear the place to stop this bill is in the senate. The reason for that is because the senate represents the whole state. What happens in the houses because of redistricting. You have so Many Republican districts that are worried about an attack from the right for not repealing obama care than they are about the public in general. Because senators represent a whole state they will have a whoificant number of people were progressive or progressive leaning who will be outspoken. I think the place to stop this is the senate, not the house. We are talking broadly about access to prescription drugs and cost. Trumpcare andbout how it affects peoples access to prescription drugs . You talk about essential benefits and i just want to hear more about how bad trumpcare is. Let me thank you and the senator for really pointing out problems with trumpcare or the repeal. And the reason i say that is because we paid for the aca with 1 billion in tax increases, Drug Companies and medical Device Companies and some spending cuts. Repealedepublicans most of it. The house like 800 billion or 800billion, almost million, so there is no money left to pay for the subsidies. For people to buy insurance or pay for the Medicaid Expansion , so it is not a replacement at all. Im not being offensive either. Trumpcare implies that trump cares. If he does, maybe he does theoretically, but i do not want to give him attention. But he does not understand that this is not a replacement. What was your question again . Mr. Spiro how does the repeal affect access to prescription drugs . Rep. Pallone the reason i went on to that is because one of the things that got very little attention until the last six months was the essential or guaranteed benefit package. But its always something that i was very proud of and i would talk about was i remember in North Carolina i always wrote the story, but in North Carolina before the aca they were selling policies for 15 a month that didnt include hospitalization and i would say that is not Health Insurance, because North Carolina, unlike my state of new jersey, did not have to have a guarantee of benefits. You could sell junk insurance. It has become the focus of a lot of attention now. The New York Times wrote an article about it yesterday but for a long time nobody knew anything about it. And would not take up a lot of the time. I will never forget the day they were supposed to vote for a repeal in the house and they did not. They postponed it. That day i remember going to the clerk and i watched both cnn and msnbc and there was one of the commentators literally had a like a, a wall, that had the guaranteed benefits and it was the first time id ever remembered any media outlet actually talking about that. Which was significant because now its kind of a major part of the debate and of course if you allow what the senate bill and house bill and the senate will , where they initially did was the house bill to pass, is the essential benefits package, they could theoretically waive prescription drugs or limit in a significant way and you wouldnt have to have access to those drugs. And of course now, the latest amendments, which is basically ted cruz amendments, would basically make it even worse because it wouldnt even have to be up to the state to waive it. If you offer blue cross blue shield, if they offered the policy within the exchange, and have a guaranteed benefit, then the cruz amendments would allow you to sell insurance outside of the exchange and waive the essential benefits package. So you could have somebody, not only buying a policy without hospitalization, but did not have prescription drugs, or even worse, they say they were covering prescription drugs but theres a limitation on what they offer. And people do not know. They thought they were getting that Health Insurance. The only thing i would add mr. Spiro the only thing i thed add is putting aside ted cruz amendments, and putting aside the essential health benefits, when you have tax credits that are intended to buy met only covers about 50 of cost, as under the senate bill, then you are going to have thousands of dollars in a pocket costs,utofpocket including for prescription deductible for00 people with low income. So there are many ways how this is devastating. Rep. Pallone because people, remember under the aca, even though some plans have what i would consider high deductibles, there are limits on them and the house bill eliminates, and i think maybe the senate bill as well, eliminates those restrictions effectively. So they are going to get higher with the copay. And we do not know whether the costsharing subsidies even now, the president decides on a monthtomonth basis whether he is going to buy that he is going to provide them or not. So you know, thats not good. Its not a good situation. Mr. Spiro since you mentioned that, talk a little bit about the sabotage thats going on and you know, theyre blaming, theyre selling this bill by pointing to premium increases withdrawals as if it is the fault of obama care. Rep. Pallone i mean, there are two things. First is the direct sabotage and then theres the sabotage because they refuse to allow us to move and make changes that would improve obamacare. That is hopefully where we go, so i can mention it. There are so many forms of sabotage. The two most obvious are, my understanding is now that the aca requires you to have insurance and if you dont, then you pay a penalty through your income tax. My understanding is that if people did not check the box on the irs form to indicate whether or not they had Health Insurance , if they just ignored it and many people knew that was the case, now the Trump Administration is not enforcing it. So if you skipped it and didnt buy Health Insurance, you wont get a penalty. So once you eliminate the mandate, which of course both the house and senate bills due, the marketplace collapses. To they are already trying sabotage the marketplace by not enforcing the mandate. The other thing is the costsharing subsidies. With taxat get help credits and subsidies that pay for the premiums also get help proportionately for their income. And to pay for their deductibles and copays. Those are the cost sharing subsidies. But you know, the republicans took, they went to court and there are so many things, so much damage they did with court action, eliminating the requirements for states to expand medicaid, which means 5 Million People without would have medicaid do not. But one of the other things they did was to get the courts to rule that, to undermine the cost sharing subsidies. And so basically the court said that, i do not know if they said it this way, but effectively left it up to the administration to decide when to pay or if to pay them. And donald trump doesnt on a monthtomonth basis. In january he said, i am not sure i will pay the cost sharing subsidies. If the democrats are bad and they do not support repeal, i will not do it. So it is a threat and is incredibly surprising to me that the president of the United States would threaten democrats by saying, im going to hurt people. That is actually what he did. And i think the day when they have to decide whether to pay is like around now, maybe the 20th or 25th, the end of each month and he waved until the last day to decide whether or not he is going to pay the cost subsidies. Let me give you an example. In new jersey the insurance start thes have to filing of their rate increases or even indicating whether theyre going to sell insurance like they do and then finalize and could be changed between june and november. So horizon, which is about 70 of the market in new jersey, increase. A 24 and i asked the president , why are you raising, where you filing with a 24 increase . I cannot imagine Health Insurance cost has gone up that much. He said, they have not. I said, what is it . He broke it down and is that about 8 of what we filed is for the increased cost for Health Insurance. Because if thes repeal bill goes through and there is no mandate, we figure the healthier and wealthier will drop out and it will cost. And i do not remember, another 6 or 7 was because trump decides on a monthtomonth basis whether to pay for the costsharing subsidies so i dont know whether theyre going to be paid in the next year. So whatever. All these Different Things at to a 24 increase on what would actually be an 8 increase. He says if the repeal doesnt go republicansd the dropped it and you Work Together to improve the Affordable Care act, then by november we will get rid of all these things and it will be 8 . Right now, it is 12 , so that sabotage is creating all of these problems. Mr. Spiro so lets talk about drug pricing and drug cost. You laid out a number of reforms and i think there is a tendency on the left, or in the progressive community, to really focus on medicaid medicare negotiation as the Silver Bullet. And i think that raises some questions. Number one, if youre really serious about doing that, you have to have some sort of enforcement mechanism or its really just words on paper. Rep. Pallone you would be afraid even if we gave the secretary that authority, the price would not even actually do it, is that what you mean . Well, that is the issue two, the secretary that we have. But even if they were mandated, secretary burwell, that unless she is given the authority to set a formulary to in some way back up the threats, either by not covering the drugs or some other way, some other mechanism, we propose that there be sort of an arbitration as a backup to give the necessary threat to drug manufacturers that if they dont set a reasonable price through a negotiation that then there will be an arbitration that is, you know, conducted through a nonpartisan independent entity that evaluates all the factors so , so there is that issue. Rep. Pallone that sounds like a good idea to me. Is out front of this. Why that obviously indicates how much you thought about it. I think that would be a good idea. Mr. Spiro just as another example. In the senate a bunch of , senators have introduced legislation that as a backup would link prices to i think to the v. A. Rep. Pallone i think youre going to have to do Something Like that. Particularly if you did it i mean, if this were to happen it would be signed by President Trump and he obviously supports a negotiated price, and i guess the secretary would go along with it because he is in his cabinet. But i think you need Something Like that. It would be a good idea. Mr. Spiro the only other issue i want to raise, i think it is not right to think about it as a Silver Bullet and a put so much emphasis on it, because medicare negotiation is really just about medicare. And so its really important to think about this in a holistic manner and to think about, how youre going to address these prices as they are paid for through private insurance and so thats why i thought it was important that you lay out some reforms like the rems and exclusivity that really get out at the problem in the private sector. Rep. Pallone i agree. That is why we mentioned the other things, the medicaid Rebate Program. And i did also mention generics, because i worry that because of the Media Attention to some of these generics that, you know really have gotten out of line that arms of pricing, lot of the media or even members of congress think generics no longer play a role in pricing and reducing prices. And i think that is not true. So i want to emphasize that generics can continue to play a role. And thats why we address generics to some extent in our fta user bill and why i mention other things in regards to generics, because i want them to play is an advocate role in reducing prices as well. Mr. Spiro so i think maybe some people in the audience listening to your remarks and to your proposed reforms might be thinking this all sounds very a republicanhave president who, although he has talked about prescription drugs a lot, no one can believe a word that comes out of his mouth. [laughter] mr. Spiro there is a Republican Senate and house, so how do we get this done . What is the strategy here if we are not talking about a legislative strategy in the short term, like attaching it to some kind of must pass legislation, is it just about winning elections . Rep. Pallone no, no. I do not want to give you that impression, although i certainly like the majority and will do anything to achieve that. But look, there were many things. There were things that President Trump talked about during his campaign that i think myself and other democrats can agree with. One was the high price of prescription drugs, another was, you know, the renewed attention to the negative impacts of trade agreements, not moving on the transpacific agreements, renegotiating some of the others, major infrastructure initiatives, trillion dollar infrastructure initiatives. Granted, a lot of those have gotten much attention in the and the president has not moved much on them. Maybe with the exception of trade, we will see. The jury is still out on that , what he will actually do. But i think there is this notion out there, and i certainly hear it from my colleagues on the republican side that we are not , doing anything and they are going to get blamed for not doing anything. One of the reasons i think mcconnell talked about extending, he didnt talk about it, hes announced that they are going to meet in august. Not just because he wants to repeal the aca, but also because they havent done anything. There is no legislative accomplishments by this congress , or this administration. So my feeling is that if we continue to push and the Senate Continues to push and i continue to push, then at some point they will wake up and say wait a minute, i made these commitments as president and i have to follow through on them. So you know, with infrastructure, we in my committee put together a list lays down a which marker for infrastructure. And this would be the same thing. You said mr. President , that you wanted to address this issue so lets lay down some markers and put together some legislation that will tell you what to do. I do not think it is just an effort, you know, to bring this up for a vote in although we 2018. Certainly will get it done. To actually see if we can push them to address all of these things. It was interesting when Jan CzajkowskiCongress Resolution in the fda bill. I just thought we would have a vote and we would probably vote against the and all democrats would vote for it, and chairman walden said, oh no. We will accept that and it was done by a voice vote. So to me that was an indication they dont want to be on record, they may not want to do much but they do not want to be on record saying theyre not trying to , address drug pricing. Mr. Spiro last question. Then were going to turn to the audience to ask some questions. Lets say that the Senate Repeal bill fails. Do you think there is any chance of a bipartisan stabilization bill or fix i saw that 10 of maybeolleagues came out last week or the week before, including mr. Welch, with suggestions what do you think the prospects are for that . And what do you think it should be in it . Rep. Pallone that is the whole goal. Michael would be to drop the repeal, either because my goal would be to have them drop the boat, drop the repeal or , they have a vote and cant move forward. They have lost. They wont vote to move move the bill forward and mccain is out this week so the goal would be that before they leave in august that they dont pass the repeal and senator mcconnell says its over. It is over. Ump says and then i think we could quickly move toward some kind of improvement that addresses some of the concerns those democrats mentioned. I will not i do not have all the details of what they suggested, but things like mandating the cost sharing sidies, read insurance create more competition in the marketplace. I would like to see, i do not know if they will do this, but some way of mandating or creating a bigger incentive or for states to expand medicaid for those that do not have it. Those types of things, that would be the goal. I think it is realistic if they drop the repeal and dropped the the sabotage. I do not think we are there yet. As you know. I think it is very likely they do the repeal. I am afraid we have got to keep pushing to stop it. Mr. Spiro should we open it up for questions . Thank you for coming here today. My name is steve from public system. And just a quick comment, then a question. We are in alignment on a lot of andcies that you proposed, many of them are included in parts of legislation that we have supported. Their prescription drugs, exclusivity specifically, there is a bill in both chamfers of congress that would expand exclusive video by six months exclusivity by six months. It gets an additional six months, even blockbuster ones. We think it could cost billions of dollars. I would ask you, what would you say to any of your colleagues that would be thinking about supporting a measure like that . Rep. Pallone is a constant battle, as you know, on my part and others who are progressive to try to prevent exclusivity from being expanded right . , i mean, there are so many examples. The fight on orphan drugs. It is constant. Pharma constantly wants more exclusivity. And you know, all i can say is i generally speaking try to prevent expansion of exclusivity, unless there is a tradeoff that is really helpful to the public in terms of pricing or any other needs. I think it is a constant battle. The companies will always want exclusivity. They will always want to fight generics unless they own the , generic company. Which some of them have purchased. So you have to constantly be vigilant and fight it, unless it is absolutely necessary. I am phil. I am with the ms society. Have been at havin problem with exclusivity is with the Insurance Companies not with pharmaceuticals themselves. One of them is with the random adjustment of formularies not based on any scientific assessment. Step therapy is dangerous. Particularly with mental health, people with things like ms. You have to try whenever they tell you to try first until it fails. In some of these mechanisms with ms, it takes about six months to figure out that it fails and by then the damage is done. These formularies are purely based upon negotiating between Insurance Companies and big pharma as to how to get the cheapest price. So the drug you have been on for about 10 or 15 years, they then remove it. Rep. Pallone i agree. We certainly address, tilford eruched on the issue toph touched on the issue, it is something we should look at. I understand what you are talking about. I dont have specific suggestions on how to deal with that but it is certainly something we should look at in developing legislation. Mr. Spiro there is something the vicious dynamic at work here , which is the Drug Companies skyrocket prices right . That encourages Drug Companies to jack up prices even more. And it keeps spiraling out of control. So i think really at the end of the day the solution is going to have to involve, in the private sector, it will have to involve the deal between the Insurance Industry and pharmaceutical industry. Whereby, the pharmaceutical industry agrees to price reasonably and in exchange, the Insurance Industry agrees to provide reasonable coverage of those drugs and not throwing up g up barriers. That is the kind of negotiation that needs to occur. The problem is we have to set up a dynamic where we force that conversation. And there is nothing that is doing that right now. I mean, i think that was going to happen if Hillary Clinton had one, because there was a gigantic threat of regulatory action. But now there is obviously not that threat anymore. But that is what will have to come to pass i think. ,rep. Pallone one thing in the general sense i have found is that everybody rags on Insurance Companies. The main thing that i find i want is certainty. If you can provide certainty, which obviously this administration is not doing much of related to health care, that is helpful to them. It is kind of interesting to me that in this debate over essential benefits packages and the possibility of selling junk insurance, the New York Times article kind of got into it yesterday that the Insurance Companies for the most part have not opposed. Everybody thinks the Insurance Companies want to sell jump nk insurance but if you read the , article, you do not get that impression you get the impression that is not true at all. They dont even like what is being proposed. They do not like uncertainty. They want to know attempt they have to deal with, which is one of these. I mentioned the example with horizon in new jersey. It is obvious horizon in new jersey would much prefer the to not have the repeal go through, because then they would not have to speculate about what it is going to cost them if there is no mandate. Costsharing subsidies are not paid. Mr. Spiro if you have not read that letter that was released late friday night from blue cross blue shield, you should. Because it was extraordinary. I have worked in the senate for many years and i have never seen anything like that letter in terms of how strong it was and it was i think what you are saying they want certainty. , they also, i think, want to guard their public reputation. They do not necessarily want to go back to being the evil, bad guy i think. That is partly behind it. But it was quite something. One more question. Lets wrap up with one more question. You pick. [laughter] michael cipriano, the pink sheet. Congressman, i have a question about the user feed process. It is obviously supposed to go through the senate. The white house issued a Statement Last week about the house bill, raising questions about the generic exclusivity provision. The 180day exclusivity for competitive generic therapies. It was unclear if it was a veto threat or not, but if the president does veto the bill, are you confident that congress can override a veto if that happens . Rep. Pallone President Trump does not veto anything. He does not know what he is signing. I have no doubt he will sign it. But he probably will not know what is in it. I think you are right. But can you talk about the consequences if it were vetoed , and this bill was not reauthorized what would happen , in terms of the review of drugs . Rep. Pallone im sorry, i have no faith that the president would veto anything, to be perfectly honest. And obviously i have supported the bill, but i do not see it. There is a danger right now, the reason we are trying to move this quickly and there has been suggestion that senators might put holds on it for totally unrelated, even to health care reasons, you know how the senate , youu do not give me my know, my destroyer therefore i will hold up the fda bill. Im not saying that is the case, but i would not be surprised. The biggest problem is the people who work there. In other words, i think they will start to send out pink slips very soon if they have not yet. They will soon. I do not want the workforce to be affected. A lot of what we do in the fda bill is try to streamline and make sure the deadlines are good or even better. Then they are to get the reason we have the user fees, we get money to the fda so they can hire people and process drugs and medical devices quicker, and it is still cognitive to safety of course, so you do not want the workforce to start getting pink slips. People will leave, nobody will be hired. And then the process of review gets slowed down, which is the last thing i want. That is the main reason i cannot imagine that he would, you know, i did not read it as a veto threat. I did not read it that way. Mr. Spiro thank you for coming. Thank you you all for coming and thinking about something for a moment other than repeal. It is good to get my brain thinking about other things, too. So, thank you. [applause] [indiscernible conversation] coming up, from earlier today the commissioning ceremony for the newest Aircraft Carrier, the uss gerald r. Ford. Followed by members of the president ial Advisory Commission on election integrity, holding their first Public Meeting at the white house earlier this week as part of their inquiry into potential vulnerabilities in the federal election process. Navy officially unveiled a new Aircraft Carrier this weekend at a commissioning ceremony in norfolk, virginia. The uss gerald r. Ford is just over 1100 feet long and equipped with a Nuclear Reactor that can power the ship for up to 20 years without refueling. Instruction began in 2009 and is expected to be deployed within the next few years and house as many as 2600 crew members. Next, the commissioning ceremony which includes remarks from President Trump and several navy officials. It is just one hour. Please rise. And gentlemen, our platform guests. ,ommander Stephen BarstowUnited States navy, i ships chaplin