Trump 2021 budget request for his department. This is two hours and 15 minutes. [inaudible]. [inaudible]. [background sounds]. [background sounds]. [background sounds]. Good morning everybody. I think before i give my statement, we have several visits and 30 and i think we worked it out with senator white biden, and other people that we will keep this meeting going. So i am going to believe that the 1030 and vote once and then come back and i think the first vote always takes a long time. And then when he gets back, then he will vote. In other words, i will vote for the second there but i will stay over there and do them together. You know how it works out. I may not explain it very good. I want to welcome our witness, our secretary of health and Human Services. Honorable alex i appreciate the secretary a czar, your pairing before the committee to discuss the budget. The new budget, he oversees very Strong Department with programs that are crucial to the health and wellbeing of Many Americans and maybe all americans. The budget represents the administrations recommended funding for those programs as well as key policy proposals. While congress decides funding levels of program changes, we have a duty of course to review the administrations Budget Proposal. And secretary a czar is here to help us do that. As with any budget submission i disagree with some of the proposals but i do want to speak to a few issues where it reflects priorities that i have a lot of these priorities are shared by a lot of democrats and particularly working with senator so i mentioned rep. In my working to lower for strict Prescription Drugs rice prices. Top priority. President trump focus on this issue has been a real game changer. Particulate because in the state of the union, and has brought attention to that. Sec. Azar has been a point person in this effort as well. The secretaries also helped greatly with our legislative efforts and again referring to Prescription Drugs. And it has provided guidance and Technical Assistance as we develop to refine the bipartisan bill that the committee reported out 19 nine last july. Last year. I am pleased that the budget calls and congress to quickly pass this bill and includes a placeholder for a hundred and 35 billion reduced taxpayer subsidy. Two Drug Companies. Unless the secretary to expand on this so when we have questions and for now i will say that i look forward to continuing to work with the secretary the Ranking Member, and other senators to provide relief Prescription Drugs to these consumers. The budget also contains a number of proposals to improve Rural Community healthcare. And healthcare in iowa and other areas. But also, for most of the members of this committee. Its not really been a controversial issue in most cases. Ranking member and i continued to discuss how to help rural and other underserved areas in the Administration Budget further bolsters those efforts. I would like to also take a moment to highlight efforts to help hhs be more effective in executing his mission. I understand that hhs office of National Security is forging new ground with Intelligence Community to Leverage Technology and innovative ways to better streamline intelligence operations procedures and to mitigate counterintelligence threats. I encourage the intelligence communities have an even broader access to the office of National Security as a relates to its products and database. To allow then hhs to access Vital Information that he needs to mitigate threats to the department. It is funded partners and its inner agency colleagues. As you are aware on my oversight efforts, work to make sure that the office of National Security receives access to certain intelligence communities related material and that you have gained access to some but not all that you want. However more work needs to be done then. Recently assent to classified letters to the Intelligence Community component to help bridge the gap between the office of National Security and the icy counterparts. As ive said before, the lefthanded the right hand Work Together for the taxpayers as we have found out 911 may not have happened if we had more cooperation between the oil until intelligence people and the fbi is one example. Now of course hopefully that is better for the but its not as good as it should be. I will conclude by noting that hhs has many important challenges. Some are longstanding like high cost of Prescription Drugs. Other appeal to little notice. Such as coronavirus. While there is assured to be disagreements on many items in the budget, the issues i have highlighted are reminders that we can Work Together in the bipartisan way to get things done for the American People. Senator whidden. I appreciate your scheduling this so quickly and appreciate your working with me on a host of issues. We appreciate your being here and theyre willing to come as the budget comes out while that is issued. President trump healthcare agenda in my view ripped scores of nubile in the safety net that vulnerable americans are sure to fall through. The textbook example, is medicaid. Right now the administration is trying to do on its own, what a failed to get through congress. Block grant medicaid its a policy thing we debated in this very room. Back in 2017. It didnt make it out of the committee and it didnt get a vote on the floor it didnt go anywhere because its really horrible policy. That would hurt our people. And that said, the Trump Administration doesnt seem to mind. As trying to pull and administration run around the congress. To push the dirty work of medicaid block routes onto the state. In her whole lot of washington link now read about the flexibility they even gave it a name that goes in to the george hall of infamy. Scott healthy opportunity for adults. Make no mistake. The Trump Administration proposal to block grant medicaid, led by cms administrators, in my view would be the beginning of the end for the healthcare safety net. Its not about flexibility and certainly not about an opportunity to help the adult. It is about harsh cuts. Pedicabs in addition to the other cuts the Trump Administration has proposed medicaid. I will take a minute and see my good friend bob casey he was so eloquent on the subject and talk about what many kate really means for the American People. Medicaid pays for two or three Nursing Homes. That is because growing older in america cost a lot of money. Before is elected to congress, organization act. I spent a lot of time visiting the seniors in the homes. The majority of them, were folks who had to stretch every last penny to get by. So this is an issue that i take very personally. And even when our people do everything right, when they scrimp and save over decades and when they give up vacations and they didnt buy a boat, the lived modestly. They do everything they can to prepare for retirement. People run out of money when they get older. Politics is one is one surprise illness or injury, the bills start stacking up. Our family emergency or damage to home. At your semi strip that is the way life is. And then on top of that. We dont have savings. Millions of couldnt save just because they had to walk an economic tightrope, and have our People Struggle to keep up with 100 if they had an emergency. It doesnt mean that they have no right to see a doctor. Forget longterm care. Protecting those people is what medicaid in the Nursing Homes guarantee. Thats what it is. As i guarantee and it is what medicaid is all about. Without it, when it seniors turn. When theres any strap and head out as a nursing im supposed to stay open without coveting the services down to frighteningly four levels. Our lowincome seniors who want to stay in their homes how can they afford their healthcare. So when you hear all of this talk colleagues about flexibility. Innovative solutions, holding the states accountable. In my view, it is code for big medicaid cuts. The consequences are dangerous and they are personal. A couple of other points. The Trump Administration has gone to court for the entire preexisting conditions are gone and tax credits for healthcare on. Rule standing the worst insurance coveting abuses on. Millions of people, kicked off of their healthcare. And it would just be devastating for young people like jasper. Picture it on this card infamy, he is the little guy. Hes done hard. He was born with serious medical issues. Esther, one of my constituents Cystic Fibrosis and pancreatic problems. Hearing loss. Lots of costly treatments. And for him and his family, Affordable Care act is a lifelong to peace of mind they absolutely consider vital. Donald trump has no backup plan plan for jasper and his family. That didnt stop the president from staying during the state of the Union Address that he had made an ironclad pledge to always protect seniors with preexisting conditions. Donald trump protects preexisting conditions like sea lions protect salmon on her mighty columbia river. It is the kind of protection that comes with an uptick. In the mortality rate. So going to close with some comments about the Prescription Drug prices. A lot of raising events on this pretty big format list price on tv. That also was locked. Hes talk about requiring rebate going back to patients. In a height drug prices in the u. S. The drug prices abroad, nothing there. He had a policy to speed approval of generics. No apparent effects. The reality is patients are still getting mugged at the pharmacy counter. Drug prices are up again in 2020. So the set of demands kemeny has worked long and hard in the Prescription Drug issue. As has the house of representatives. As ive said in a number of occasions, chairman presley, has been a good partner on this and i hope we can find a way to move all of this good work forward. Bottom line is the president has been aching promises about bringing down the drug prices for three years and has not gotten done. We appreciate your being here. Particularly coming quickly. There is lot for us to talk about. Before calling the secretary. Were going to keep things going. While the abodes and the secretary, but if you want to ask questions because the secretary has to leave at 12. Thirty. And mr. As are mr. Azar secretary of the department as i have said, he served as general counsel and hhs for four years a 12 oh five and deputy secretary from oh five to seven. Secretary as are azar. Welcome. Thank you for inviting me to discuss the president s budget for fiscal year 2021. I am honored to appear before this committee for budget testimony as a changes as secretary for now the third time. Especially after the remarkable year of results that the men and women had hhs has produced. With support from this committee in many respects, this past year we have seen the number of Drug Overdose deaths begin to decline for the first time in two decades. Another record year generic drug approvals from fda and is sort dropped in Medicare AdvantageMedicare Part b, and Insurance Exchange premiums. The prisons budget aims to continue delivering these kinds of results and move towards a future where hhs is a programmed work better for the people we serve. Our Human Services programs and put people on the center and where markets Healthcare System is affordable personalized and was people in control and treat you like a human being and not like a number. That is the vision behind this budget. I want to know that hhs has the largest discretionary budget of any non defense department. That means that there are again this year, difficult decisions made in order to put the Discretionary Spending on a sustainable path. The president approach protects what works and makes a better and ill mention two ways we do that. First by facilitating patients that are markets in healthcare and second by tackling key impeccable health challenges. The healthcare reforms in the president s budget aims to budget patient at the center. It would for instance eliminate costsharing for colonoscopies after discovery of a polyp. A lifesaving preventative service. We would reduce patient coinsurance and promotes competition on paying the same for Certain Services and hospitals with outpatient settings. The budget endorses bipartisan and bicameral drug price legislation what the plans formulated by chairman presley and member wyden and maybe members of this committee as well as transparency efforts in many of euros have championed. These will extend the life of the hospitals Insurance Trust funds up or at least 25 years. We propose investing 116 million and hhs initiative to reduce maternal mortality. We propose reforms to tackle the World Health Crisis in america. Including extensions of telehealth and inflexibility for rural hospitals. The budget increases investments to combat the Opioid Epidemic including the state Opioid Response Program which we have focused on providing medication assisted treatment while working with congress to give states flexibility to address stimulus like methamphetamines. We request 716 million to extend implementation of the Presence Initiative to end the hiv the epidemic in america. Weve already begun during the Progress Health in four jurisdictions. Finally, the budget reflects how seriously we take the first of an Infectious Diseases such as the china coronavirus. Is been a top priority for me as i let the federal governments coordinated response as chairman of the president Coronavirus Task force. The budget prioritizes funding for cdc Infectious Disease programs and maintains Effective Investments and hospital preparedness. Us that we announce the 14th confirmed case of the china coronavirus in the u. S. And this morning, cdc will be announcing the 15th. Both of him came from wuhan and are in quarantine and as of today i can announce that the cdc has begun working with both departments in five cities to use it Surveillance Network to begin testing individuals with flulike symptoms for the china coronavirus. Many questions about the virus remain in this effort will help see whether there is broader spread than we have been able to detect so far. On the Human Services site the goals of the budget are similar. We [applause] on programs that luck in results while reforming programs like to drive statement business and sporting work on all the benefits and brings for wellbeing. This years budget is going to protect and enhance americans wellbeing. It works better than rather just spend more. I look forward to working with this committee as always to make that common sense goal a reality. Thank you. We will start out with what you probably would expect me to start out with. I referred to it in my opening statement. In that statement i commanded you for helping with your leadership and help lower Prescription Drug prices and particularly helping us with our legislation. Can you speak to the proposal in the budget to reduce Prescription Drug costs as location of our 35 million and reduce spending and also including in your answer, your general thoughts on how this could be helpful to me and senator widen all the people in this committee. Thus support our bill. Ive been delighted to work with you and Ranking Member wyden on this legislation. This package is reasonable on the bipartisan and he can really help in terms of helping to control list price increases to decrease outofpocket spending five patients especially by her singers. And the incentives in the Party Program to really give the plan the incentive to really negotiate hard against the big pharma. I dont understand why big pharma is a supporting. These are important reforms. Packages like this and other bipartisan efforts are important assuming seniors money. Something must price increases and Getting Better negotiations i think these are some of the best reforms we can work on together. Thank you. I am interested in Rural Health Care and this committee has been in the middle of that for at least three decades. It is difficult to keep high quality medical care in those environments. Over the past decades, i have championed landmark role healthcare legislation. Theyve had some successes. Things change rapidly while maybe not rapidly but they slowly change in