Health and Human Services secretary took questions on the president s proposed budget for 2019. He was asked about funding for medicare and medicaid, combating the Opioid Epidemic and the cost of Prescription Drugs. He testified before the Senate Finance committee. The committee will come to order. I want to express the sadness we all feel in light of yesterdays events in florida. I was personally horrified as i watched the news unfold yesterday though i was also moved to hear some of the stories of the heroism displayed by some of the students and teachers at the school. Am praying for those who were affected. May they all find peace, healing, and a speedy recovery. I welcome everybody here to todays hearing which will be hearing on final the president s budget for fiscal year 2019. We have already had the treasury secretary and hearing acting i. R. S. Commissioner appear before us. Today well be talking with secretary aczar from the department of health and Human Services. I want to thank you for being here and cooperating with us and welcome back. It has been just a little over a month since you last appeared before us. This could cause some nervous reactions. You never know. Of course you are still very new to your position but we are glad to have you back because we have a lot to discuss. Since you were last year this committee has amassed a number of legislative victories. I want to take a few minutes to highlight these accomplishments as many are within h. H. S. s jurisdiction. Last month as a result of countless hours of work by this Committee Congress passed and the president signed a sixyear chip extension. A few weeks later we added another four years to that extension. That is ten more years of chip funding which is quite frankly really an historic accomplishment. Senator ted kennedy and i created the chip program more than two decades ago and despite always enjoying bipartisan support at no point in the programs history have we been able to deliver this much certainty and security for the families and children who depend on chip. I want to once again commend my colleagues on both sides who joined in this effort who share in this success, especially my colleague from oregon. It was no small feat. In addition to the chip extension the chronic care act, another bipartisan legislative product out of this committee, was also signed into law recently. This new law will improve care for Medicare Beneficiaries living with chronic conditions stream line care coordination and improve quality outcomes without worsening medicares shaky fiscal status. Again, i want to thank everyone on this committee who worked on this bill most notably our Ranking Member senator widen as well as senators ikesenson and warner who were key leaders in the drafting and passage of this important bill. It doesnt end there. The budget bill also included the bipartisan Family First Prevention Services act which will help keep more children safely with their families specifically by funding Substance Abuse and Mental Health services that have been shown to prevent children from entering foster care. All of this success is testament to bipartisanship it is roves that possible for parties to find Common Ground and Work Together. As always there is more work to be done and i am optimistic that we can be just as effective in the coming months. These wont mean much if they are not complemented properly. I look forward to working with you as this process moves forward. Would like to take a moment o talk about some of the specifics in the president s budget for the need to eliminate wasteful spending, rein, in our National Debt and focus on protecting americans at home. I appreciate the president s budget takes steps toward a course correction that will lead to a more economically sound future all while still ensuring high quality and Accessible Health care. One of the key and critical assumptions in the president s budget is the repeal of obamacare. The budget bakes in this repeal and replaces it with a state based grant system. All told the administration estimates this will save more than 675 billion. That is with a b. I think all of us on the republican side share this desire to repeal obamacare and we have actually done some great work on rolling back major elements of the socalled Affordable Care act this congress. For starters, our tax reform bill zeroed out the individual tax. Te recent budget bill also included the sow call medicare extenders and repealed the independent payment advisory board, and in that same bill we xtended previous delays on other obamacare other obamacare taxes, including the medical device tax, the Health Insurance, and the socalled cadillac tax. But as the budget points out, we are not quite there yet. I hope we can take additional steps in the future and i look forward to continuing our discussions on how we can stop the recent budget bill also included the sow call medicare extenders and cost of health care in a meaning skyrocketing governed way. Beyond the critical repeal and replace efforts with obamacare we also need to start getting serious about medicare and medicaid reforms. Both of these programs need to be put on a more sustainable path so that we can fulfill the programs for se future generations. I know that any time a republican mentions the fiscal predicament of medicare and medicaid we are essentially asking to be accused of robbing the elderly and loik families of their health care. But none of these scare tactics will improve the outlook of our federal health care programs. That is going to take some hard work and hopefully we can find a path forward there as well. During your confirmation hearing you emphasized that addressing rising drug prices would future generations. I know that any time a republican mentions the be one priorities. As you know top priorities. I have spent quite a bit of time on this issue working to ensure that patients have access to innovative and high quality makeses. It can be tricky to encourage he need of new and effective drugs and treatments while also working to make sure that those who need can obtain access to those potentially drugs and treatments lifesavin and lifeimproving products. Some have made a crusade out of scapegoating the companies that develop drugs and treatments. When this almost singular focus is policy e result that tends to be less than perfect to put it charitibly. We saw this last week that increased the discount manufacturers were required to provide under the socalled donut hole in Medicare Part d. I have voiced my opposition to the inclusion of this provision in the budget. In the budget agreement on the senate floor last week. I am working with my colleagues who share my concern on the discount provision to mitigate ts impact. I implore the administration to take care to strike a balance between access and innovation. It is a balance that i hope we should all strive to achieve. Now you also emphasized that addressing americas Opioid Crisis is another one of your top priorities. I am happy to see that the president s budget stresses the importance of working together to fight this epidemic. The c. D. C. Estimates that each day our country experiences more than 100 opioidrelated deaths. My home state of utah has been especially hard hit and while the Drug Overdose rate has risen over the the past decade we are starting to see a shifting tide thanks to the leadership of many officials in my state. With that said, they need federal help. And i know that many in congress, including several members of this committee, have been outspoken leaders in this effort. I can commend them for their work. We are committed to continuing our Bipartisan Committee process to address the Opioid Epidemic especially through mandatory Program Proposals that can bring about meaningful and enduring change to a system plagued with issues. I look forward to working with you in the coming months as we look for solutions to address this crisis and i hope that we as a committee can continue our ipartisan efforts to curtail this growing string of tragedies. To close let me just say that as we all know it is Congress Responsibility to pass a budget. The president s proposed budget merely sets the tone and provides us with a baseline for debate. I hope that we can Work Together to implement many of the commonsense reforms we have been debating for so long. I hope that we can continue to work to set aside our differences in order to find beneficial solutions. I look forward to having an open and frank discussion with the secretary about these and other matters. Before i close i do want to note that because we were unable to get a quorium yesterday, if at any point during the hearing a suitable quorm is present i intend to pause the hearing and move to vote on the nominations of mr. Dennis shea and mr. Cj mahoney. Thereafter we will resume our hearing. Turn to my t me friend the Ranking Member for his opening remarks. Thank you very much, mr. Chairman. Mr. Chairman and colleagues, 18 School Shootings this year. And i am just going to begin by aying when is enough enough . We watch these young people from the high schools and i heard one in effect say, you know, were kids. We cant fix this. You adults get over my friend the Ranking Member for his opening remarks. Thank you very much it and d with it. That to me is central to what we are talking about this morning, because we are going to talk about health care. And what we have been hearing on the news is that it sure sounds like there are a lot of young people that are can tened about what happen at their school. So we deal with lots of bills and can lots of amendments. But like those students said, its time to get over it. Its time to act. Weve learned in the last 24 ours enough is enough. Mr. Chairman, i want to pick up first on the point you made, because in the last couple of weeks on the health care front as you have noted weve had some very positive developments here in the last few weeks. If you had told me in the winter of 2017 that we would have a 10year chip authorization, everybody would have said what planet is this person residing on . The chronic care bill and i see senator ikesson who was with me on day one, senator warner is not here. Senator isaacson in this room we launched chairman hatch to his credit pulled together a Bipartisan Group of us. Colleagues, lets make sure we understand what this chronic care bill is all about. The chronic care bill is about updating the medicare guarantee and modernizing the program to deal with where most of the money is going to be spent cancer, diabetes, heart disease, and strokes. When i was director of the gray panthers there was a real difference Medicare Program part a for hospitals and part b for doctors, and that was that. Because colleagues like senator isaacson, senator warner and our Bipartisan Group said when you have 10,000 people turning 65 every day and it is going to happen for years and years to come, you have got to dig in. Chairman hatch made that possible. I want to thank the chairman. And then of course a lot of people who work in the Child Welfare field are saying that the Families First bill was what they had been dreaming about for three full decades. That came together here in the last couple of weeks and i want to thank you for that, mr. Chairman. Now, on a not so positive note, the budget season is at hand again. So the trump agenda of Health Care Discrimination is back. I am going to go through the examples. Start with discrimination against americans with preexisting conditions. People who have preexisting conditions count on having a private Insurance Market with strong consumer protections. What the trump budget offers is chaos in the private Insurance Market and the elimination of key consumer protections. The budget embraces the old graemecassidy proposal, outlived a mercifully short life last fall. Because in this room we blew he whistle on the fact that it didnt lock in protection for those who have preexisting conditions. On top of that, the administration is giving green light didnt lock in protection for to junk insurance policy that is revive the worst insurance abuses in the past such as skimpy coverage. So with millions of people, the Trump Administration seems dead set on making the care they need unaffordable and inaccessible. Next on the agenda of Health Care Discrimination is discrimination against women. When you to junk get rid of the Affordable Care act you return to an era when 75 pshts of the insurance plans dont cover Maternity Care or birth control. Under the trump budget which arbitrarily attacks key providers, planned parenthood, and others, millions of women could lose the right to see the doctor they trust, the doctor of their choosing. Then the trump agenda of Health Care Discrimination go after americans who walk an economic tight rope. Trillion cut from medicaid, millions of americans locked out of the program, a scheme to knock out nationwide programs especially ending trillion cut millions of the guarantee of care for those who qualify for medicaid. Now the Administration Reportedly is discussing lifetime limits. Both sides used to agree that lift limits in health care were absolutely wrong. No exception. A ban on lifetime limits in the Affordable Care act was one of the core protections. And republicans republicans said they ought to stay, introducing lifetime limits in medicaid raises the frightening question of what happens if somebody maxes out after Cancer Treatment at age 45 . Are they going to be on the street in old age capped out of nursing home benefits . We are going to be discussing this. Of ly, the trump Agenda Health care discriminates against older americans. Medicare helped to pay for two out of three seniors of Nursing Homes and is essential for seniors who count on homebased care. Even for older people theres bad news. The trump budget hits them with an age tax allowing Insurance Companies to charge them far higher rates than they charge thers. The agenda of Health Care Discrimination is out in force in this trump budget and in my view it is a comprehensive plan to drag the country back to the days when the Health Care System the agen Health Care Discrimination is out in force in this trump budget and was basically working for people who are healthy and wealthy and everybody else was on their own. Drugs Companies Set price that is are way too high. If pharmaceutical companies can come out of the gate with unaffordable prices patients will suffer and i dont see where you fix that with some efforts to play catch up on. The trump Prescription Drug plan lets pharmaceutical Companies Keep on to borrow a phrase getting away with murder. Finally, a lot of what the administration put forward looks fam la on the pharmaceutical side. From f it is borrowed legislation i from legislation i proposed recommendation that is came from outsiders. There is value in these ideas. There is an opportunity to move on a bipartisan basis. But that is not what the American People were promised. The American People were promised a muscular approach, a position where the American People would know that their government was on their side and helping them deal with this question of their getting clobbered at the pharmaceutical window when they go in to get their medicine. Ill wrap up by talking about part of the secretarys agenda vital to kids. Chairman hatch and i both mentioned family part of first proud of that effort because for too long the Child Welfare system has basically been about families apart. That is what family first seeks to reform because instead of just two lack luster options leaving young people in a family setting where they were still families apart. That is what family first going sending them off to a future of uncertainty in foster care, we said we would allow states to find safe ways to the keep Families Together and families healthier. Foster dollars to for services with the goal prolonged slide oster into the crises that end with families breaking apart. I share chairman hatchs view the the Opioid Epidemic. It is good that additional funds were made available in the recent budget agreement. And now that we have to do is make sure prolonged slide that moves quickly so the states can get away from business as usual and deal with the epidemic. We look forward to hearing from you. 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