Planning and autism. He talked to senator or in chairs the committee. The committee will come to order. Before i begin i wantto discuss on behalf of the committee how we all feel. In light of yesterdays events in florida. I was personally horrified as i watched the news unfold yesterday, that 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. In times like these i know that the thoughts expressed by those of us far away can sometimes seem empty and meaningless in the face of such a terrible tragedy. I will simply say i am praying for all those affected by these acts of senselessviolence. That of course includes a member of our committee will i know is mourning the loss in his own state. May they all find peace, healing and a speedy recovery. I welcome everybody here. And todays hearing which will be our third and final hearing on the fiscal year 2019. Currently, we already have the treasury secretary and the acting irs commissioner before us and today we are talking with secretary as are from the department of health d and Human Services. I want to thank you for being here and welcome back. Its been a little over a month since you last appeared. This can cause nervous reactions. You are still very new to your position but were glad to have you back and you have a lot todiscuss. This committee has amassed a number of legislative victories. We want to take a few minutes to highlight these accomplishments as many are within hhs jurisdiction. Last month asa result of countless hours of work by this committee , Congress Passed a six year chip extension. A few weeks before we added another four years to that extension as part of the bipartisan budget act. That is 10 more years of chip ending which is quite frankly , a 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 we been able to deliver this much certainty t and security to the families of children who depend on chip. I want to commend my colleagues on both sides who joined in this effort and who share in the success, especially my colleague from oregon. Again, i want to thank everyone on this committee worked on this bill. Most notably, our Ranking Member. Senator wyden as well as senators isaac and warner were key in the drafting and passage very important bill. It doesnt end there but the budget bill also included family partisan family safe by sending Substance Abuse and Mental Health services that have been preventing children from entering foster care. All of the success assessment to bipartisanship and prove that it is possible for both 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. Of course these recent achievements will remain there not implement it. I look forward to working with you as is process moves forward. Id like to take a moment to look at how the president s budget would recognize the need to eliminate wasteful spending. I write in our National Debt and focus on protecting americans at home. I appreciate the president s budget take steps towards a course correction that will hopefully lead to more economically sound future all all still ensuring highquality and accessible healthcare. One of the key in critical assumptions of thes president s budget is a repeal of obamacare. The budget bakes into this appeal and replaces it with the state basedtr grant system. The initiation estimates this would save more than 675 billion that is a with a b. Many of on the committee, all of us on the public inside, share this desire toba repeal obamacae we have actually done great work on rolling back major elements of the socalled affordable cae act. This congress starters are text from bill zeroed out the individual mandate tax and recent budget bill the socalled medicare extenders and repealed the independent payment Advisory Board and in that same bill we extended previous delayslu on other obamacare taxes including medical device tax the Health Insurance in the socalled cadillac tax. As a budget points out we are not quite there yet and 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 cost of care and a governed way. Beyond the critical repeal and replace efforts we also need to start getting serious about medicare and medicaid forms. Both of these programs need to be put to more sustainable paths so that we can fill the promises of these programs for 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 low income families with their healthcare but none of these scare tactics will improve the outlook of our federal health care programs. That will take some hard work in hopefully we can find a task over there as well. The secretary, duringur your confirmation hearing youem emphasize that addressing arising drug prices would be one of your t Top Priorities. As you know, p we spent quite a bit of time on this issue working to ensure that we have innovative and access to highquality medications. It can be tricky to balance the need to encourage the investment new and effective drugs and treatments but also we work to make sure that those in need can obtain access to potentially lifesaving and life improving products. Some have made a crusade out of scapegoating the companies to develop drugs andlo treatments d when this almost singular focus prevails the result is policy that tends to be less than perfect to put it charitably. We saw an example of this in last weeks bipartisan budget act that increased the discount that manufactures were required to provide under the socalled donut hole in Medicare Part d. I have a voice in opposition to inclusion of this provision in the budget. Excuse me. In the c budget agreement on the set for last week. I am working with my colleagues to share my concern on the increased manufacturing and discount provision to mitigate its impact. We should all strive and further is this budget is a member of other drugrelated policy proposals and i am for the administration to take care to take a balance between access and innovation. It is a balance that i hope you all strive to achieve. Secretary is our, you also address the Opioid Crisis is another one of those Top Priorities and im happy to see that the president s budget stresses the importance of working together to fight this epidemic and the cdc estimates that each day our country experiences more than 100 opioid deaths and my home state has been especially hard and while the drug has risen over the past decade were starting to see a shifting tide thanks to the leadership of many officials in my state. With that said they need federal help andse i know that many in congress including several members of this committee have been outspoken leaders in this effort and i cannot commend them for their works. 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 tod the system plagued with issues. Mr. Secretary, i look forward to working with you in the coming months as we look to solutions to address this crisis and hope that we continue our bipartisan efforts to curtail this strain of tragedies. To close lettuce to say as we know it is Congress Responsibility to pass a budget and the president s proposed the tone and sets provides us with the baseline for debate. I hope we can Work Together to implement many of the commonsense forms we been debating for a so long. I hope 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 secretarys are about other matters and before i close because we were unable to get a quorum yesterday if at any hearingime during the it quorum is present i intend to pause the hearing and moved to vote on the nomination of mr. Dennis shea and cj mahoney. Thereafter we will resume the hearing and with that let me now turn to the ranking minority, Ranking Member for his opening remarks. Thank you very much mr. En chairman. Mr. Chairman and collie 818 School Shootings this year and im just going to begin by saying when is enough, enough we watch these young people from the high schools and i heard one in effect say we are kids and we cant fix this. You adults get over it and deal with it. And that to me is a central to what we arere talking about this morning because well a talk abt healthcare. And what weve been hearing on the news is it sure sounds like there are a lot of young people that are frightened about what can happen at their school. We deal with lots of bills and lots of amendments and like those students said time to get over it in time to act and we have learned in the last 24 hours 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 healthcare front did you note that 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 ten year chip reauthorization everybody would have said what planet is this person residing on. The chronic care bill and i see senator isaacson who was with me on day one and senator warner is not here but senator isaacson is in his room and we launched to his credit pull together a Bipartisan Group and lets make sure we understand, colleagues, with this chronic care is all about. Chronic care bill is about updating the medicaid and medicare guaranty and modernizing the program to deal with where most of the money will be spent in cancer and diabetes and Heart Disease and strokes and when i was director of the [inaudible] it was a different medicare program. Party for hospitals, part b for doctors and that was that. Because colleagues like senator isaacson and warner in our Bipartisan Group said when you have 10000 people turning 65 every day and it has been happening for years and years to come you got to dig in and chairman hatch made that possible i want to think the chairman and of course, a lot of people who work in the child for field are saying that the Families First bill wasl what they had been dreaming about for three full decades and now theyve come together 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 healthcare discrimination is back. Im going to go through the examples. Start with discrimination against americans for preexisting conditions. People who have preexistingn conditions count on having a robust private Insurance Market with strong Consumer Protection but the trump budget offers is chaos in the private Insurance Market and o the elimination of key Consumer Protections. The budget embraces the old Graham Cassidy proposal and that lived the mercifully short life last fall because in this room we blew the whistle on the fact that it didnt lock in production for those who have preexisting conditions. On top of that the initiation is giving green light to junk insurance policies the revised the worst insurance abuses of the past such as skimpy coverage and dollar limits on care. Millions of people with preexisting conditions the Trump Administration seems dead set on making the care they need unaffordable and inaccessible. Next on the agenda of healthcare discrimination is discrimination against women. You get rid of the Consumer Protections and return to an era where 75 of insurance plans in the individual market dont coverro Maternity Care or birth control. Under theud trump budget which arbitrarily attacks key providers, plan parenthood in others, millions of women lose the right to see the doctor they trust and the doctor of their choosing. Send the trump agenda of garretts Commission Goes after americans who walk in economic tightrope. 1. 4 trillion cut from medicaid and zillions of k americans outf the program in a scheme to white cap the programs especially in the guaranty of care for those who qualify for medicaid. Now the Administration Reportedly is discussing lifetime limits for americans of medicaid. Both sides use to agree that lifetime limits of healthcare were absolutely wrong, no exception. The ban on lifetime limits the Affordable Healthcare Act was one of the core protections and republican, republicans said they ought to stay introducing lifetime limits in medicaid raises the frightening question of what happens when someone maxes out after Cancer Treatment at age 45. Will they be on the street in kept out of nursing home benefits . We will be discussing that. Finally, the trump agenda healthcare discoloration turns against older americans. Slashing medicaid to the bone and slashing the program into a cap program is a extraordinary threat to welfare of older people. Medicare helps to pay for two out of three seniors in Nursing Homes and essential for homes to count on police care. Even for older people at age 62 or 63 there is bad news. Trump budget hits him with an age tax allowing Insurance Companies to charge them far higher rates than they charged others. Bottom line the agenda of healthcare discoloration is out in force in the central budget and in my view it is a comprehensive plan to drag the country back to the days when the Healthcare System was basically working for people who are healthy and wealthy and everyone else was on their own. Finally, we are going to i am sure talk about the question for Prescription Drugs. President famously talks about how Drug Companies work 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. Way he talks about the problem americans thought he was going to come out swinging with Big Solutions to the challenge and the plan released 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 needs reform. If pharmaceutical companies can come out of the gate within unaffordable prices patients will i suffer and i dont see where you fix that with some efforts to play catchup. The trump Prescription Drug plan lets pharmaceutical Companies Keep on to borrow a phrase getting away with murder. Finally, a lot of what the ministration puts forwardks last week looks familiar. On the pharmaceutical side some of it is borrowed from legislation and i propose a recommendation that for outsiders. There is value inni these ideas and theres 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 they are getting clobbered as the pharmaceutical window when they go in to get their medicine. I will wrap up by talking about different parts of the secretary agenda vital to kids. Chairman hatch and i have both mentioned family first and very proud of that effort because too long the Child Welfare system was basically been about splitting families apart. That is what family first seeks to reform because instead of just two lackluster options leaving young people in a family setting where they were still with his problems were sending them off to a future of uncertainty in foster care we have said we would allow to design space ways to keep Families Together and families healthier. They can use Foster Care Services to fund Mental Health and. The programs with the goal of preventing a prolonged slide into the crises that end with families breaking apart. I share chairman hatch is about thee Opioid Epidemic and it was good that additional funds were made available in the recent budget agreement and now weve got to do is make sure that the department moves quickly so the states can get away from business as usual and deal with the epidemic. We look forward to hearing from you, projects publicly. They indicated in our pre nomination hearing that he was going to take the initiative of being in touch on a regular basis and to discuss issues is already shown he is serious about that the call here recently. I appreciate it and look forward to our Work Together lets try to make it look like what has happened out of this co