Subcommittee on health in Human Services, education and related agencies will come to order. Thank you sec. A desire for being here. It has turned out to be a more eventful week than we anticipated but we are grateful you have shown up as we asked to at the time we asked you to. The budget you suggested, the request, many of the same kinds of cuts that occurred in 2020, and i am sure we will have questions about that. It is not unexpected. You will recall when i called you with the final budget numbers from the 2020 budget, my first comment was, the good news is you didnt get what you asked for. Hopefully that will be the case again this time. You propose a 10 cut, similar cut you proposed in the past in programs that we would be very reluctant in the health care workforces and preparedness programs and research programs, all have been about earlier today at the members reading on the current virus. Rural programs we would be reluctant to discuss. We will need more money this year in my view than the top line number is likely to give us. I do appreciate that in this budget, unlike some in the past, the administration has tried to focus on priorities where we , endingcrease spending the hiv epidemic, the effort to do that and to improve Maternal Health and to fight the Opioid Epidemic. And also to maintain some of the other investments we have made, hight also looks at quality childcare, headstart, and Child Care Development block grants and suggests they appreciate what has been allowed in budget in the past to happen there. Many of the increases this budget requests are financed by unrealistic cuts, cuts that we dont want to make come in my opinion, and cuts at the end of the day you probably wouldnt want us to make, like eliminating Childrens Hospital graduate medical education. That is not going to happen. Eliminating , highly unlikely to happen. Cut in Health Care Research that i think by now, in the last five years ive had chaired this committee and senator murray and i have worked together on this topic on this committee, we are not likely to cut Health Care Research. I hope we can continue our pattern of increasing research at this incredible time. We are making a difference and has seen life expect to and see Life Expectancy numbers go up in quality of life for americans go up with the innovative opportunity in health care. Expectancy rose sinceirst time in 2014. The first decline in cancer death and opioids with Overdose Deaths are of that. New treatments, screening tools, vaccines, all make a difference. This is such an incredible time to move forward in all of those areas based on what we know and what we think is in the future with technology and other things. I know you had to make difficult decisions with the budget number you had and we will have to do the same thing. Hopefully we can Work Together to identify priorities and find Common Ground and hopefully our committee will be able to Work Together, as we have made an effort to do for several years now. Subcommittee, the created an Infectious Disease fund to provide flexibility funding for the department for immediate response. You have used that money as intended, that first 105 million. I will let you respond to the coronavirus that let you respond to the coronavirus in ways that you wouldnt have otherwise. However, responding to this particular effort not only takes a Rapid Response, but if we are going to be partners in this, it takes sharing of information and i encourage you to continue to do that. We gave you Broad Authority in the Infectious Disease fund, but Broad Authority means broad responsibility to be forthcoming with information. When we give you this authority to spend money, i think everyone on this committee would like a similar kind of treatment in your response to how that money is being spent. We ask every day for the department to give us specifics on spending money with the proposal that came out that you and i had a chance to talk about yesterday, i think we have a better sense of the path forward than we would have before. But whether it is your department or omb that makes it hard for you to share information, i just encourage you once again it is going to work better if we have the kind of sharing that allows you to have the flexibility that you would like to have. One comes with my sense of obligation and the other thing and the sharing of information to be part of that flexibility that we have given you. We are going to talk a lot today, i suspect, or at least i am, about the virus and the supplemental and the time you think the supplemental fills the gap and what the backup plan would be if it is not adequate. I appreciate, secretary, your strong leadership at the ddc, nih and overall at hh. I look forward to your testimony today. Andave both the chairman the vice chairman of the committee with us. I know that senator murray and i are glad to have both of them. Senator murray, lets go to you for your opening comments. Sen. Murray thank you very much for being here. Just say iry, let me am alarmed by the recent developments we have seen in the office of Refugee Resettlement and how it handled children in its care following President Trumps inhumane separation policy. I have raised questions with you before and i hope we can continue that today as we review this administrations Budget Proposal administrations Budget Proposal. I hope we can talk about other Health Care Issues i am hearing from my constituents. When it comes to helping families who are struggling to afford health care, this administration has continually said one thing and on the opposite. At the end of the day, none of the empty promises say as much about Health Care Priorities as his decision to champion a partisan lawsuit that could be catastrophic for families, because if republicans get their way in court, they will get protections for preexisting conditions, strip away health care for families who got it through exchanges and expansion and give power back to the Insurance Companies to offer lowquality coverage and leave patients with Higher Health care costs. Lawsuit, that partisan President Trumps partisan lawsuit exposes the truth behind that spin. Despite the promise to the contrary, this budget would 500 billions would slash from medicare and medicaid. It takespage seemingly huge steps backward on our nations boats most urgent challenging challenges, proposing a small tap forward with hiv pans missions but takes an enormously backwards with medicaid, which covers more than 2 5 of patients with hiv care, not to mention slashing investments in combating hiv overseas. These medicaid cuts would take us in the wrong direction when it comes to addressing mental and Behavioral Health challenges, like the ongoing Drug Overdose crisis or the increasing suicide rate making it harder for people to get the care they need. In some states that have expanded medicare, it covers four out of five people receiving treatment for opioid addictions. To make matters worse for Behavioral Health, the budget eliminates funding for the new Suicide Prevention initiative at the cdc which congress included last year and our bipartisan spending bill. Then there is the Maternal Mortality rate, which is worse here in the United States than developed country in the world. The deaths are mostly preventable in the impacted women are mostly black and native americans. Instead of treating this like the emergency it is, this budget offers a sleightofhand. It proposes expanding the maternal initiative created in 2018 by 75 million, and i appreciate that. To that pales in comparison proposed cuts over 100 times that amount from medicaid, which actually pays for nearly half of the births in this country. Continues the harmful trend of putting ideology over evidence and Patient Health by excluding planned parenthood from federal funding and eliminating the teen pregnancy program. At a time when our nation is facing a Health Professional shortage, this budget proposes cutting nearly 800 million from programs that support tuition assistance, loan forgiveness, and training for several hundred thousand Health Professionals annually. At a time when too many families are forced to choose between paying for health care or other basic needs, this budget seems to go out of its way to make things worse for People Living on the brink of poverty. It eliminates safety net programs and critical assistance to millions of people, like the low Income Assistance program that helps him afford heating and cooling and block grants that gives resources to challenge poverty. It eliminates the block grant and reduces programs that help families facing adversity from keeping their heads above water. As it continues, the strong bipartisan investment in start, thisd head budget eliminates funding for preschool Development Grants which provide highquality preschool to tens of thousands of families. Finally, mr. Secretary, i have been in close contact with Health Experts dealing with the coronavirus outbreak which you declared an emergency last month. As we work to bring hundreds of americans to chinas Hubei Province and the cruise ship home and quarantine them for two weeks at a cost of roughly 6 million per flight, i have been pressing for more information about what resources are needed. I sent a letter to you and ms. Mulvaney expressing deep concerns about this. You finally sent a supplemental request last night, and i am very concerned this request is not enough to ensure that we are putting all the necessary resources towards this emerging threat, including making sure our states and local Public Health departments have what they need to respond to this crisis and be reimbursed for those costs. I am very concerned about how thin the details on that are, because despite with this budget proposes, not a single Public Health expert has told me the thing we need to do right now is s program by 9 or cut critical programs by 80 million and cut the Rapid Response fund by 35 million cut programs. Paredness this will not help us deal with that. While i see the efforts to contain the virus, i have to say this is unacceptable. It is important that we stay ahead of this crisis and we are ready when additional cases are detected in the u. S. , meaning we cannot plan at the last minute. The budget is a reflection of our values and that applies here. While President Trump may not his values,th about it shows he is not serious about fighting for Family Health care or addressing National Crises like drug addiction, Maternal Mortality or suicide. He is serious about cutting medicare and medicaid and critical programs and safety net programs and workforce programs and more. Families across the country should know that we, as democrats, have no intention of letting those cuts happen and will continue to fight for patients. Thank you, chairman. Chairman shelby . You bring a lot of experience time in your job. I would like to focus on the Current Crisis that face us in the world and could be here and how you are going to deal with it. People, i think the American People are concerned and should be. I am concerned. This is a serious, serious disease that if it keeps spreading, nobody knows better than you what it could do. It could be an existential threat to a lot of people in this country. , this isot politics doing our job for the American People. I dont know i know the request you made the supplemental 1. 25 billion, but money should not be an object. We should be trying to contain and eradicate as much as we can this in the u. S. And make sure it doesnt spread in the u. S. , help our friends all over the world who are disadvantaged. Some people believe this is a lowball number. I dont know. I would like to hear from you on this, because this is not the time to try to shortchange the American People on anything or say omb has done this or that or whoever it is or whatever administration it is, democrat or republican. This is the time to step up and you probably know this better than i do. There is a lot of concern in America Today and will be, is this going to spread . We brought some people into this country. Where is it going to go and how are we going to contain it . I look forward to your testimony. Thank you for your service, again. You, chairman. Senator lahey do you want to waive your time . Time i i do have do have it is vague and best on the coronavirus. Here and glad you are look forward to your opening statement. Maybe you can answer some of these questions even in that statement. Sec. Azar thank you very much. Thank you for having me and inviting me to discuss the president s ajit fiscal year 2021. President s budget president s budget for fiscal year 2021. Committeert from this , this past year we saw the deathsof Drug Overdose decline, another record year of generic approvals from fda, and historic drops in medicare managed to Medicare Part d and Affordable Care act premiums. Ae budget aims to move toward future or hhs programs work better for the people we serve, where Human Services programs put people at the center and where the Health Care System is affordable, personalized, and puts patients in control, teach you like a human being and not a number. Hhs has the largest discriminant rate budget than any other nondefense means Discretionary Spending must be on a sustainable path. This committee made important investments in hhss large programs including at the national into students of Health National institutes of health. We want to protect it and make it better. The first way to facilitate patient in markets and the second to tackle key impact of health care challenges. Care cares health aims to put the patient at the center and would eliminate cost sharing for colonoscopies, lifesaving preventive service, reduce patient costs and promote competition by paying the same for Certain Services regardless of setting. The budget endorses bipartisan, bicameral drug legislation. These will improve medicare and extend the life of the hostile Insurance Fund by at least 25 years. We propose investing 160 million in hhss initiative to reduce Maternal Mortality and morbidity. We aim to tackle health crisis, including telehealth expansion and new flexibility for rural hospitals. We want to combat the Opioid Epidemic and the opiod response program. We appreciate this committees work with us to gus flexibility to address methamphetamines with us to address flexibility and amphetamines. Epidemic. End the hiv thanks to funding appropriated by this committee, we have begun and lamenting this initiative. The budget reflects how seriously we take the threat of other searss, such as the china coronavirus by giving threat of other diseases, such as the coronavirus. U. S. Of thes in the coronavirus due to travel. Three cases were repatriated from wuhan and 40 cases among american passengers repatriated from the diamond princess. While the immediate risk to individual members of the American Public remains low, there is no Community Transmission and a number of countries, including outside of asia, which is deeply concerning. We are working fully with state closely with state and local agencies to prevent the spread in the United States, as we will likely see more cases here. And i8 will announce the launch of a Clinical Trial for investigation of antiviral at the university of nebraska medical center. 2. 5equests to make billion in funding available for preparedness and response, including for therapeutics, vaccines, personal protective commitment, state and local support, and surveillance. I look closely forward to working closely with congress on that. The budget cutbacks cuts back on pogroms without proven benefits. Fy 2020nue the investments congress made in headstart and childcare which promotes wellbeing and adults wellbeing. This aims to protect and advance americas wellbeing and deliver a more affordable system that works better rather than just spends more. I look forward to working with this committee to make that common sen