President s would weve ever had. And a grandfather, whirl wind johnson hosted a tennis camp including for Althea Gibson and arthur ashe. My grandfather, a phenomenal physician, but somehow managed to be a student of the tennis game and transform that learning into a program that would, for decades, provide players an opportunity for africanamericans to integrate the sport. Watch the cspan cities tour saturday beginning at 5 p. M. Eastern, sunday at 2 p. M. On American History tv on cspan 3. Working with our cable affiliates as we explore america. Health and Human Services secretary, alex azar spoke before the Senate Finance committee this week about the president s proposed 2019 budget. He answered questions on a range of issues, including funding for medicare and medicaid, the Opioid Epidemic, Community Based clinic training and autism and also discussed the administrations approach for lowering Health Care Costs including Prescription Drugs. Mr. Azar was sworn in as hhs secretary in january of 2018. Hes a former deputy secretary and general counsel of the department under president george w. Bush. He was also an executive with the Pharmaceutical Company eli lilly. This half Hour Committee was led by senator orrin hatch. Okay. The committee will come to order. Before i begin, i want to express on behalf of the committee 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 tomorrow of the students and teachers at the school. In times like these, i know that thoughts expressed from those of us who are far away can sometimes seem empty and meaningless in the face of such a terrible tragedy. I will simply say that i am praying for all of those who are affected by these acts of senseless violence. That, of course, includes a member of our committee who i know is mourning the loss and pain felt by those in his home state. May they all find peace, healing and a speedy recovery. Now, i welcome everybody here to todays hearing which will be our third and final hearing on the president s budget for fiscal year 2019. And weve already had the treasury secretary and the acting irs commissioner an i peer before us and today well be talking with secretary azar from the department of health and Human Services. Secretary azar, i want to thank you for being here and cooperating with us and welcome back. Its 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 discussion. 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 hhss jurisdiction. Last month, as a result of countless hours of work by this committee, Congress Passed and the president signed a six year chip extension. A few weeks later, we had another four years to that extension as part of a bipartisan budget act. Thats ten more years of chip funding, which is, quite frankly, really a historic accomplishment. Senator ted kennedy and i created the chip 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, streamlined care coordination and improved 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 senator warner and another in the key passing of this bill and it doesnt end there, the bipartisan family Preventions Services act which will help keep more children safely with their families, specifically by funding Substance Abuse and Mental Health services that have shown to prevent children from entering foster care. All of this success is testament to bipartisanship and proves that it is possible for both parties to find Common Ground and Work Together, as always, theres more work to be done and i am optimistic that we can be just as effective in the coming months. Of course, these recent achievements wont mean much if theyre not implemented properly. Secretary azar, i look forward to working with you as this process moves forward. Id like to take a moment and talk about some of the specifics in the president s budget which recognize the need to eliminate wasteful spending. I rein in our National Debt for people at home. And i look at the president s course that could lead to an economical future. And one of those is the repeal of obamacare. The budget bakes in this repeal and replaces it with a statebased grant system. All told, the administration estimates that this would save more than 675 billion. Thats with a b. Many of us on the committee, i think all of us on the republican side share the desire to repeal obamacare and weve done some great work rolling back some elements of the socalled Affordable Care act. This congress. The starters, tax zeroed out the mandate tax and the recent budget bill, the socalled medicare extenders and repealed the independent payment advisory board, and in that same bill, we extended previous delays on 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 skyrocketing costs of health care in a meaningful and a well 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 promises of these programs for future generations. I know that anytime a republican mentions the fiscal predicament of medicare and medicaid, were essentially being accused of robbing the elderly and low income families of their health care, but none of these scare tactics will improve the outlook of our federal health care programs. Thats going to take some hard work and hopefully we can find a path forward there as well. Secretary azar, during your confirmation hearing, you emphasized that addressing rising drug prices would be one of your Top Priorities. As you know, ive spent quite a bit of time on this issue, working to ensure that patients have access to innovative and high quality medications. It can be tricky to balance the need to encourage investment and development of new and effective drugs and treatments while also working to make sure those in need could obtain access to those potentially life saving and life improving products. Some have made a crusade out of scapegoating the companies that develop drugs and treatments. And when this almost singular focus prevails, the result is policy that tends to be less than perfect. To put it charitybly. We saw an example of this in last weeks bipartisan budget act that increased the discount that manufacturers were required to provide under the socalled donut hole in Medicare Part d. Now, i voiced my opposition to the inclusion of this provision in the budget. Excuse me. In the budget agreement on the senate floor last week. I am working with my colleagues who share my concern on the increased manufacturer discount provision to mitigate its impact. And we should all strive further, as this budget has a number of other drugrelated policy proposals, implore that we should have a balance that we should all try to achieve. Secretary azar, you also emphasize 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 opioid related deaths my home state of utah has been especially hard hit and while the Drug Overdose rate has risen over the past decade, were starting to see a shifting tide thanks to the leadership of many foreclosures 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. And 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. Now, mr. Secretary, 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 bipartisan efforts to curtail this growing string of tragedies. To close, let me say as we all know, its congresss responsibility to pass a budget. The president s proposed budget merely sets the tone and provides us with the baseline for a debate. I hope that we can Work Together to implement many of the common sense reforms weve been debating for so long and 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 secretary azar about these and other matters. Before i close, i do want to note that we constantly were unable to get a quorum yesterday. If at any point a suitable quorum is present, i intend to pause the hearing and move to votes on the nominations of mr. Dennis shea, and mr. Cj mahoney. Thereafter well resume the hearing. Let me turn to my friend the ranking minority the Ranking Member for his opening remarks. New very much, mr. Chairman. Mr. Chairman and colleagues, 18 School Shootings this year. And im just going to continue by saying, when is enough . Enou enou enough. And 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 it and deal with it. And that, to me, is central to what were talking about this morning. Because were going to talk about health care and what weve been hearing on the news is that it sure sounds like there are a lot of young people that are frightened about what can happen at their schools. So we deal with lots of bills and lots of amendments, but like those students said, time to get over it, its time to act and weve learned in the last 24 hours enough is enough. And 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 noted, weve had some very positive developments here in the last few weeks. If you had told me in the winter of 2017 that wed have a 10year chip reauthoritization, everybody would have said, what planet is this person residing on . The chronic care bill, and i see senator isaacson who is with me on day one, senator warners not here, senator isaacson in this room, we launched to chairman hatch, to his credit, and pulled together a Bipartisan Group of colleagues. Lets make sure we understand what this chronic care bill is all about. When you have 10,000 people turning 65 every day happening for years and years to come you have to dig in. Chairman hatch made that possible. I want to thank the chairman, then of course a lot of people who worked 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 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. Im going to go through the examples. Start with discrimination against americans with preexisting conditions. People who have preexisting conditions count on having a robust 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 grahamcassidy proposal. That live ad mercifully short life last fall because in this room we blew the whistle on the fact it didnt lock in protections for those who have preexisting conditions. On top of that the administration is giving a green light to junk insurance policies that revived the worst insurance abuses of the past, such as skimpy coverage and dollar limits on care. So for millions of people with preexisting conditions the Trump Administration seems dead set making the care they need unaffordable and inaccessible. Next on the agenda of Health Care Discrimination is discrimination against women. When you get rid of the Consumer Protections in the Affordable Care act you return to an era when 75 of insurance plans in the individual market dont cover Maternity Care orbiter control. And under the trump budget, which arbitrarily attacks key providers, planned parenthood and others, millions of women would lose the right to see the doctor they trust, the doctor of their choosing. Then the trump again today Health Care Discrimination goes after americans who walk an economic tightrope. 1. 4 trillion cut from medicaid. Millions of americans locked out of the program. A scheme to wipe out key nationwide protections to cap the program especially end guarranty of those who qualify for medicaid. Now the Administration Reportedly is discussing lifetime limits for americans on medicaid. Both side used to agree that life time limits in health care were absolutely wrong, no exceptions. The 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 of a Cancer Treatment at age 45 . Are they going to be on the street in old age, capped out of nursing home benefits . Well be discussing that. Finally the trump agenda of Health Care Discrimination turns against Older Americans slashing the medicaid to the bone and transforming program into a cap program is extraordinarily threat to welfare of older people. Medicare helps to pay for two out of three seniors in Nursing Homes. It is essential for seniors that count on homebased care. Even for people 62 or 63, the trump budget hits them with an age tax, allowing Insurance Companies charge them far higher rates than they charge others. Bottom line, 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 was basically working for people who are healthy and wealthy and everybody else was on their own. Finally were going to im sure talk about the question of Prescription Drugs. The president famously talked about how Drug Companies were quote, getting away with murder. Those are his words, not mine. The president said they were getting away with murder by setting drug prices so high. The way he talked about the problem americans thought he was going to come out swinging with Big Solutions to the challenge. In the plan last week i still dont see a solution to the fundamental issue, Drug Companies set prices that are way too high. There is not a debate about the fact that the system is broken and it needs reform. But 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 catchup ball. 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 last week looks familiar. On