Look forward to your testimony. Of the past year our committee has been working to improve, strengthen, and streamline health and welfare programs under our jurisdiction. We have taken action to cut needless red tape, and make it more difficult for providers to deliver highquality care to their patients. We recently advanced targeted bipartisan reforms to improve medicare for the American People. Continuing the drive to strengthen a quality and care coordination. A role intee played developing comrades of regulation to repeal and replace the Affordable Care act. With the American Health care act that was passed by the house last may, we delivered marketoriented solutions that would increase flexibility, reduce costs, and return control of health care to the American People. While this bill is stalled, reliefs has delivered from obamacare. We also took action to prevent several Damaging Health care taxes from going into effect. When it comes to the welfare and antipoverty programs, we are taken significant action to strengthen families and communities and help more americans move themselves out of poverty and into prosperity. We have advanced bills to help improve americans child of welfare system so that more of our kids can grow up in a safe home surrounded by a stable family. We reauthorized and strengthened the maternal infant and Early ChildhoodHome Visiting program, an evidencebased program that provides real help to families in atrisk communities as they strive to build better lives. We have passed numerous bills to help more americans give get back to work. Im pleased that many of these important policies were signed into law. It is part of the bipartisan budget act. Our committee is not going to stop there. Inc. , including my constituents, are still struggling to access highQuality Health care at an affordable price. Too many people across the nation are seeing their families torn apart by the Opioid Crisis. Our local Companies Struggle to build job openings. This very issue is reinforced by a new Small Business survive survey. 1 5 cited the difficulty of finding qualified workers as their most important business problem. That is a larger percentage than any other issue in the survey. We have to find a way to bridge the divide. Im convinced the best way to do that is to expect rewarding work. Im pleased to see this same approach reflected in the president s budget request. Our committee has developed solutions we are either eager to work to build on them whenever possible. This includes taking action to reduce the cost of prescription , which im also pleased to see is a top priority in President Trump budget. Program hasmedicare delivered good results for seniors and American Families, republicans on this Committee Led that successful effort. Programto improve the and expand access to affordable Prescription Drugs by working with you and the white house on a marketoriented approach that does not shift cost onto the backs of taxpayers. I believe the best path forward to help the American People is to continue to emphasize ,ompetition, new innovation individual choice, rather than mandate from washington to interfere with efficiency and affordability. Secretary is our, our nation faces a number of decisions in making our health care and welfare systems work better in the long term for the American People. I am confident we can Work Together to advance solutions and improve lives. Thank you again for being here today. We will look forward to your testimony. I now yield to the distinguished Ranking Member for the purposes of his opening statement. Thank you, mr. Chairman. We look forward to your testimony. We are pleased that you are here. Notedl, like the chairman , is to advocate for the best possible opportunities for constituent. The budget the President Trump has presented means liens against his goals. It would create more obstacles for families. Last year, President Trump in our republican colleagues ran through a 2. 3 chile dollar tax cut for the wealthiest and strongest among us. He now attends to fill the deficit hole by slashing critical programs instead of building on them to expand new class opportunities to move up. Sabotages Health Care Programs by ripping the rug out from under the middle class and cuts to Health Care Programs these americans rely upon. Willons more americans lose their Health Insurance and Health Care Costs will continue to increase. Republican budget attacks preexisting condition protections by allowing companies to charge more for less coverage or deny coverage altogether. It creates an age tax were seniors will be charged significantly more due to their age. For millions of americans this budget would cause of their Health Care Premiums to skyrocket. The trump budget cuts 1. 4 trillion from medicaid and another half trillion for medicare. More and more baby boomers enroll in medicare, now is the time to strengthen the program. The could of done that by adding critical benefits, such as dental vision and hearing vision , not to arbitrarily cut it. 1. 4 trillion of cuts in medicaid will lead to cuts in health care for children, individuals with disabilities, and people who need longterm care. Medicaid has now become a middleclass benefit. It is the reason that your parents are not living in your attic. It is a key component of the opiate and Health Treatment programs that we all wish to address. Are moreand medicaid important than ever as our nation struggles to find longterm solutions to the opiate crisis. Everyone in this room has a Family Member or know someone who is directly impacted by an opiate or other drugrelated disorder. Slashing programs that are designed to help those individuals is not the responsible path. Health care is a crucial part of the economy here in the United States. In my district alone, hospitals are the largest employers. They are first class. Custom Health Care Programs would offer significant job losses as proposed in this budget. 200budget cuts more than billion dollars in payments to hospitals threatening additional closures. This would dismantle protections for struggling families and supports for americans getting and keeping their jobs. Budget cuts Employment Services for job seekers and employers, limits access to community colleges, introduces the number of working families receiving assistance in many states. And makes no additional job training investments for workers who need to upgrade their skills, slashes meals on wheels, and other key programs by eliminating the social Services Block grant. These proposals underline under mine the fight against opiate abuse. Instead of focusing on giving the strongest and wealthiest amongst us a 2 trillion cut and a taxes, we should be breaking down the obstacles so that the middle class families can indeed get ahead. I yield back, mr. Chairman. Thank you. The thenesses committee has received a written statement. We made a part of the formal hearing record. Welcome. You may begin when you are ready. Thank you very much. Thank you very much for inviting me here to discuss the president s budget for the department of health and Human Services for fiscal year 2019. It is just a great honor to be here with you today. Ofannot tell you the honor my life that it is to be able to serve as secretary of health and Human Services. Mission is to protect the health and wellbeing of americans. It is a vital one. The president s budget clearly recognizes this fact. The budget make significant Strategic Investments in hhss work, boosting Discretionary Spending at the department by 11 . Among other targeted investments that we are proposing, that is an increase of 747 million for the National Institute of health, 47 3 million increase for the fda, 15 7 million increase for Emergency Preparedness across the department. The president s budget especially supports for priorities that we have laid out for the department. Issues that the men and women of hhs already hard at work on. Fighting the crisis, increasing the affordability of Health Insurance, tackling the high price of Prescription Drugs, using medicare to move our Health Care System to a more valuebased direction. The president s budget brings a new level of commitment to fighting the crisis of opioid addiction and over dice overdose that is stealing more than 100 american lives from us every single day. Hhs has already dispersed unprecedented resources to support access to addiction treatment. The budget would take Us Investment to 10 billion in a joint delegation to dress the Opioid Epidemic and related Mental Health challenges. Privateing that we need sector and state level innovation to defeat the epidemic, the budget supports hhss hhs is effort. We are committed to bringing down the skyrocketing cost of Health Insurance, especially in the individual and group markets. So that more americans can access quality, a portable health care. This budget recognizes that this will not be accomplished by a onesizefitsall solution from washington. It is going to require states room to examine with models that work for them and allowing customers to purchase individualized plans that meet their needs. That is what the budget proposed a historic transfer of resources from the federal Government Back to the states. Closest tothose were the people and can best determine their needs. The budget would also restore balance to the Medicaid Program, fixing a structure that has driven runaway costs without a commensurate increase in equality. Prescription drug costs in our country are too high. President trump recognizes this, i recognize this, we are doing something about it. A raft oft has proposals to bring down drug prices, especially for seniors. We are proposing a fivepart reform plan to further improve the already successful Medicare Part d Prescription Drug program to lower outofpocket cost for Senior Citizens. These major changes will save tens of billions of dollars for seniors over the next 10 years, adding to savings we are ready generating with reforms to Medicare Part b under the 340 b Drug Discovery discount program. We want to say patients money on drugs. Provide strong support for the fdas efforts to spur innovation and competition in the generic drug markets. We want programs to work for the people they serve. That means empowering patients and providers with the right incentives to pay for health and outcomes rather than procedures and sickness. I for departmental priority is to use the tremendous power we have to medicare as the largest purchaser to move our whole system in that direction. The budget except to that. Takes step to that. Sporting investments in telehealth and advancing the work of Accountable Care organizations. The future of medicare must be driven by value and not the current signet ticket of vague proposals. Work fore programs run the people theyre meant to serve, including making insurance affordable for all. Making sure the programs are on a sound fiscal including that will another to serve future generations to. Making the necessary investments to keep americans safe from natural disasters and infectious threats. Thank you, mr. Chairman. Thank you for your testimony. We will shorten question time. Three minutes will now proceed and i will lead off. You might clear the priorities of President Trumps administration. Making health care more foregoing higherquality. Sure programs like medicare work better and last longer and addressing key issues like the Opioid Crisis. The a formal care act remains in place. Congressional republicans are committed to a smooth transition away from obamacare. Targeted ways for to increase market stability and allow more choice for families and provide relief for americans who have seen their premiums double. In have the opportunity. Egulation and guidance can you tell to the ministration to ensure Health Care Costs come down and a premiums go down . We have been looking for flexibility and state partners where we can help them design alternative programs here under the Affordable Care act that can help Liver Services to their people, for example the alaska waiver that created an insurance pool and allowed a higher cost individuals to the in a higher risk pool. We continue to look for state partners that want to be innovative and want to try different solutions. When we are talking about Health Insurance, there is no magic bullet. Organize right way to a competitive, wellrun, risk pool insurance program. Thats why im going to work with states to develop systems that work for people and make insurance more affordable. We all want folks to have access to affordable Health Insurance. That second priority, making programs like medicare work better and last longer, under the Affordable Care act medicare was slashed. If you should to that Important Program. Tax reform means wages go up. Thats one of the key funding mechanisms for medicare. We expect that to be helpful. Let me ask you this. Under the Budget Proposal, is inaccurate that medicare continues to grow under the trump budget at over in a percent annual growth and that your proposals actually extend of that the lightest the life of that Important Program . We are making some commonsense changes in medical with how we dore our payments. They do not been a fact impact the beneficiary. If anything, we help them with costsharing. Making these changes, we are only reducing spending over 10 years by about 200 and 50 billion dollars. Two at 50 billion. 250 billion. Medicare will grow on an annual basis over 10 years 9. 1 each year. With our proposed changes it will grow 8. 5 each year. We gain eight years of additional life of the Medicare Program as a result of these modest but important changes. Mr. Neil is recognized. Frameworkrall budget which takes the nation into deficits near 1 trillion a year or easily estimated 7 trillion over the next 10 years. Have moved away over what they used to say about budgets. In addition, they have decided they are going to make cuts to very important initiatives that many people in america rely on. They are, despite what is being said, making cuts to medicare. The budget proposes 500 and 23 billion in cuts. This will result in hospitals closes and losing jobs. For every member of this committee as well as congress, the hospital has no become the biggest employers. The budget proposes another 80 medicareo treat marbles. I dont believe these cuts are tied to improving efficiency or increasing quality. In fact, i believe they could jeopardize Quality Health care for many beneficiaries. All of this is done based upon the idea that we can cut taxes by 1. 5 trillion immediately when you consider the cost of borrowing that money over 10 years with the Federal Reserve board promising that they intend to raise Interest Rates by about by at least three opportunities and maybe four or five, the ministration is proposing these tricounty and cuts. A reminder, as a noted in my opening statement, medicaid now is longterm care in america. Its for seniors and nursing home care and these proposals would on the basis of justifying a taxcut for people at the very top. I ask you to reconsider these cuts Going Forward. Issue you can address the. Its a big employer. First, i would support the chance to get to sit with you and work with you in the years ahead. In terms of graduate medical education, what we are proposing their is too unified we have various streams for training doctors. They are frozen in place as of 1996. We are proposing to pull that together and give us the flexibility to train doctors that are focused on underserved specialties and underserved areas. Thank you. 45 years ago, sam johnson returned to america after seven years as a pow in vietnam. Every year we honor what we call the return of verse three of sam johnson. I recognize you, on behalf of our committee, and everyone in this room, welcome home yet again. [applause] god bl