Transcripts For CSPAN2 HHS Secretary Azar Testifies Before H

Agencies as well. This is our first hearing on the president s fiscal year 2021 budget request. However, i want to start with a matter of urgency. The coronavirus, covert 19, cases are growing as is alarm, this is both domestically and internationally. The u. S. Government has responded to the covert 19 outbreak with aggressive measures, significant travel restrictions, mandatory 14day quarantine for individuals returning to the u. S. From province. Mr. Secretary, i support your declaration of a Public Health emergency, we are dealing with the likelihood of a global pandemic, interesting to note yesterday from the cdc that commented that with regard to the United States its not a question of if but a question of when we will face the issue seriously here. That said, i have serious concerns about the administrations responsiveness with respect to funding, i understand senators of both parties expressed a similar concern to you at their hearing yesterday. I have repeatedly asked for information about expenditures thus far and about the balances remaining in the Infectious Disease Rapid Response reserve fund and yet we have not received an adequate answer. In addition, you submitted a letter late monday night notifying the committee that you would begin transferring up to 136 million from other hhs programs including an ih and the lowincome Energy Assistance program and on monday the administration finally submitted a request for an emergency supplemental funding, but there is no supporting documentation. You must share that information immediately. In that request, the administration also asked permission to shift more than 500 million from ebola preparedness, that is a mistake and we are not robbing funding for other emergency activities to pay for this emergency. There was another 536 million 550 million of reprioritized funding and funding that was provided for fiscal year 2020 and that funding is coming from other hhs programs, we know of the we need to know a specifically where that money is being cut from, what the American People need is an emergency supplemental bill that answers these questions, supports development of therapies and a vaccine, fund state and local agencies and Healthcare Providers and strengthen our Public Health infrastructure and the American People, mr. Secretary, need to know that now. As you know, there was great alarm and consternation in the country about this. Another important issue, an issue that i like Many Americans find deeply disturbing is the administrations ongoing and cruel treatment of Asylum Seekers and children entering the United States. In recent weeks we learned that agent with ice are showing up at hhsfunded shelters to fingerprint 14yearolds in the unaccompanied children program. Thats outrageous. They are allowing ice agents to intimidate kids. I recognize that there is a statute, but it remains the responsibility of hhs to ensure the safest environment for the children, so i want hhs to make clear who its guaranties and children should ensure understanding of the process and i would and i expect my colleagues on the subcommittee would want to see a copy of that guidance. We also learned that oor took confidential notes from Children Therapy sessions and shared them with ice for multiple years. I appreciate your comments on stopping this, it should not have happened. You and i know this, that it cannot happen again. There needs to be a fire wall with dhs, orr is not an Immigration Enforcement agency. Its mission is to provide for the care and welfare of children. Turning to your budget, mr. Secretary, despite what you may try to say, this document would hurt millions of americans and you have to ask who is paying the price. It is not the wealthy or well off, no, it is the vulnerable who are the victims, it is the working people, middleclass families of this country who would be forced to do less with less, this is a time they need more help, but you are proposing to cut 10 billion from the department of health and Human Services, an 11 cut. You are leaving people at risk of potential pandemic by cutting 700 million from center of Disease Control prevention and especially Infectious Disease Rapid Reserve fund. You are telling suffering families that we will not do all we can help illloved ones from the the the National Institute of health, you would want to hit the brakes on the research. Its unacceptable. You would leave people without enough trained doctors and nurses by cutting hundreds of millions of dollars in Healthcare Careers like nursing, the Health Nation requires a trained healthcare force. You would force 6 million seniors to choose between eating, buying Prescription Drugs, heating or cooling their homes by eliminating lowincome Energy Assistance program and reject the bipartisan intention of this congress to save lives and address the Public Health crisis by ending the 25 million for gun violence Prevention Research. 100 americans are killed every day by guns, 36,000 per year, twothirds of which are suicides, a particular concern for our veterans. That is not all on the mandatory side you would take away Health Insurance from 20 million americans by Cutting Health care by 1 trillion over 10 years and eliminating the Affordable Care act and its medicare expansion Medicaid Expansion and you are telling federal court to appeal the affordable act. To date, you have not come up with a comprehensive plan to help. I could go on and i am not but the consequences of your budget would leave us as individuals and as a nation less healthy, less safe and less able with respect to Economic Security and so we will not allow you to go after millions of americans, instead we will continue to invest in Workforce Programs, medical research and the Public Health because it is what American People need and what the American People deserve. I appreciate the administrations request for increased fund to go reduce Maternal Mortality as well as additional funding to address tickborne diseases like lyme disease. As growth in incidents of lyme disease related to Climate Change and you propose to eliminate cdc Climate Change program. Increased funding of hiv initiative to reduce transmission of hiv by 90 over 10 years, we strongly share the ambitious goal, again, i have to note the contradiction at the heart of this because the administration is simultaneously proposing to call nihs portfolio, usids program, eliminate the Affordable Care act and eviscerate medicaid. These are programs special to combating hiv, in fact, medicaid is the largest payer for hiv care in the United States. So much to discuss today, we appreciate your being here and before we turn to you for your testimony, let me turn to our Ranking Member congressman cole for remark that is he would like to make. Thank you very much, congresswoman, thank you, mr. Secretary, i have prepared remarks that i will read in just a second. Before i do i want to begin by thanking you, i want to thank you and the professionals at the center for Disease Control and National Institute of health, the folks that you have super prizing our strategic stockpile. I think you guys have your team and working with other departments, working closely with Homeland Security, you have been briefing us on a regular basis, have done a really remarkable job in responding to something that this committee has been preparing for for years and this committee ought to be very proud of its work on a bipartisan basis providing tools for you and your colleagues to respond and through you i want to thank the president. The president has taken strong and Decisive Action in terms of protecting our borders and, you know, im pleased to see this supplemental here and, you know, i suspect we will change it in some ways, my good friend the chairman made points that i agree with her on and i wouldnt be surprised to see you back here but youre doing the right thing. Youve used resources that weve given you and come back for supplemental. I have no doubt that you will come back if you feel that you need them or need Additional Support and i have no doubt frankly that congress will be forthcoming. I have to tell you, ive heard a lot of stuff not on this committee and certainly but particularly in the other body that i have to tell you is just transparently political claptrap and thats what it is. When i hear people say, well, the president has done too little and too late, i think where have you been, we have been preparing for this honestly before this administration was here. We had 5 years in a row, substantial nih funding. I know my friend, the chairman, worked with me when i was chairman and i tried to work with her as Ranking Member, we have shared this goal all along the way. We have done the same thing at cdc, we have done the same thing with strategic stockpile. The subcommittee that came up with the Infectious Disease Rapid Response fund that gave you additional money to not wait around on congress or political theatrics but to start responding immediately and i think youve done that exceptionally well. When i hear you criticized by people that in many cases didnt vote for the bills, that gave you the tools, i regard that as political as opposed to substantive. Last point i want to make on this is i really appreciate the briefings that weve got, congress as a whole has gotten, our chairman did a wonderful job in bringing in folks and we had honest and open dialogue. The idea that we havent been kept relate informed or people have not said, look, we will do our very best, but this is unpredictable disease, this could spread at any time, these are not just warnings that i heard in the last 24 hours. These are things that your team have been telling us from the very beginning and suggest to me that the administration has been on top of this and, again, i appreciate the president in that regard from the very beginning. So i know i was going to open by asking you how has your last week been but i was afraid i would get an honest answer so i dont want to begin that way, but i do want to commend you, i mean, with all sincerity, youre one of the best cabinet officers that the president has and i think you and your team served this country very well and i think this incident is proof of that, not a contradiction to it. Secretary, wish you good morning, i look forward to hearing the hearing today, department of health and Human Services has broad responsibility covering almost every aspect of daily life and in the next year youre projecting almost a 1. 4 trillions in outlay, oversee health care for our seniors and native americans and ensure both the quality and safety of the nations food food drug supply. Your agency forms the backbone of the Public Health infrastructure and is responsible for the development of medical protections against Infectious Diseases and chemical biological, radiology and nuclear agents and committee amounts accounts for only a small fraction of your overall total, really just 8 of your outlays. In just the last 2 years, i was reflecting about your tenure as secretary, you responded to unprecedented storms leaving thousands of limited access to health care in puerto rico, humanitarian crisis at southern border and opioid addiction epidemic and most recently the spread of a new and Infectious Disease from china and i want to comment you and your leadership with this agency. First i want to address the aggressive budget that you put before us. We know the cuts proposed are deep and quite frankly unlike to be to be sustained and i know who writes the budget, they are called the omb, the office of management and budget and you get to submit things but you have to come out and defend the decisions that are made there and i appreciate that. You work for the president , you have to do that. But i want to stress continued cuts to Discretionary Spending will not solve the nations fiscal problems, period. Its not possible to balance our National Budget by chipping away Discretionary Spending. We must look to broader entitlement reform to achieve the valued goal of a balanced budget. Nearly 90 of your agencys entitlement spending on auto pilot. The authorizing committees and jurisdiction need to tackle the mounting problem of entitlement spending. I know, mr. Secretary, you know the figures but i hope those listening will take heed and recognize challenges with federal spending not within Discretionary Spending controlled by the Appropriations Committee. Second, i want to stress again that while small compared to total outlays, discretionary component that we are going to talk about plays a Critical Role for our country, moreover, several programs we will discuss touch the life of every american. I usually start with National Institute of health but today its fit to go highlight how important how important center for Disease Control is to protect the health of American People. In the span of a few weeks, we witnessed massive undertaking to respond coronavirus from china. Cdc was positioned to respond, deploy and protect. Hundreds of staff were marshaled quickly to work on different elements of the response efforts. While not everything is going perfectly, the agency has shown the value of preparing for the unexpected and having a transparent proactive communication strategy. I urge this committee to increase its support for the Infectious Disease Rapid Reserve fund at the cdc as ive said here before the threat of a pandemic is far greater than a terrorist event, having resources uncommitted and immediately available is vital. I know many are disappointed to once again see proposed reductions for the the National Institute of health. You and i have had candid conversations about this. I too agree with my chairman here that a reduction there is unwise, however, do i want to point out this budget actually is 12 billion more for nih than level proposed just 4 years ago. Its not as if you havent recognized the value there and frankly i think you will catch up to it some day and you will be with us and continuing this bipartisan effort to increase this spending. I urge congress to continue to maintain commitment to sustained increases for Biomedical Research and im pleased to see that with each budget the total request for nhi continues to increase. I hope decades from now future legislators commend the work of this committee for showing commitment to Biomedical Research and maintaining american dominance in basic science. Recent news reports highlighting efforts by the Chinese Government to steal intellectual property and use financial incentives to manipulate researchers stresses the importance of our advantage. We should be proud of knowledge gained from hard work of our scientists is the envy of the world but we must also understand protecting and safeguarding that information is necessary to ensuring the nations security. I also want to highlight your commitment to emergency preparedness, however, i was disappointed to see the reduction in project bioshield in the Infectious Disease Rapid Reserve fund and flat funding of stockpile and the Biomedical Advance Research and Development Agency or bard as its known, i attribute that to omb and we could k have that discussion later because this whole congress and Administration Needs a serious discussion on on spending but thats been true for a long time and under Previous Administrations as well. Our country needs to be ready to respond to any event to protect the health of the nation. These programs are the nations front line of defense against domestic chemical, biological or Public Health<\/a> emergency, we are dealing with the likelihood of a global pandemic, interesting to note yesterday from the cdc that commented that with regard to the United States<\/a> its not a question of if but a question of when we will face the issue seriously here. That said, i have serious concerns about the administrations responsiveness with respect to funding, i understand senators of both parties expressed a similar concern to you at their hearing yesterday. I have repeatedly asked for information about expenditures thus far and about the balances remaining in the Infectious Disease<\/a> Rapid Response<\/a> reserve fund and yet we have not received an adequate answer. In addition, you submitted a letter late monday night notifying the committee that you would begin transferring up to 136 million from other hhs programs including an ih and the lowincome Energy Assistance<\/a> program and on monday the administration finally submitted a request for an emergency supplemental funding, but there is no supporting documentation. You must share that information immediately. In that request, the administration also asked permission to shift more than 500 million from ebola preparedness, that is a mistake and we are not robbing funding for other emergency activities to pay for this emergency. There was another 536 million 550 million of reprioritized funding and funding that was provided for fiscal year 2020 and that funding is coming from other hhs programs, we know of the we need to know a specifically where that money is being cut from, what the American People<\/a> need is an emergency supplemental bill that answers these questions, supports development of therapies and a vaccine, fund state and local agencies and Healthcare Providers<\/a> and strengthen our Public Health<\/a> infrastructure and the American People<\/a>, mr. Secretary, need to know that now. As you know, there was great alarm and consternation in the country about this. Another important issue, an issue that i like Many Americans<\/a> find deeply disturbing is the administrations ongoing and cruel treatment of Asylum Seekers<\/a> and children entering the United States<\/a>. In recent weeks we learned that agent with ice are showing up at hhsfunded shelters to fingerprint 14yearolds in the unaccompanied children program. Thats outrageous. They are allowing ice agents to intimidate kids. I recognize that there is a statute, but it remains the responsibility of hhs to ensure the safest environment for the children, so i want hhs to make clear who its guaranties and children should ensure understanding of the process and i would and i expect my colleagues on the subcommittee would want to see a copy of that guidance. We also learned that oor took confidential notes from Children Therapy<\/a> sessions and shared them with ice for multiple years. I appreciate your comments on stopping this, it should not have happened. You and i know this, that it cannot happen again. There needs to be a fire wall with dhs, orr is not an Immigration Enforcement<\/a> agency. Its mission is to provide for the care and welfare of children. Turning to your budget, mr. Secretary, despite what you may try to say, this document would hurt millions of americans and you have to ask who is paying the price. It is not the wealthy or well off, no, it is the vulnerable who are the victims, it is the working people, middleclass families of this country who would be forced to do less with less, this is a time they need more help, but you are proposing to cut 10 billion from the department of health and Human Services<\/a>, an 11 cut. You are leaving people at risk of potential pandemic by cutting 700 million from center of Disease Control<\/a> prevention and especially Infectious Disease<\/a> Rapid Reserve<\/a> fund. You are telling suffering families that we will not do all we can help illloved ones from the the the National Institute<\/a> of health, you would want to hit the brakes on the research. Its unacceptable. You would leave people without enough trained doctors and nurses by cutting hundreds of millions of dollars in Healthcare Careers<\/a> like nursing, the Health Nation<\/a> requires a trained healthcare force. You would force 6 million seniors to choose between eating, buying Prescription Drug<\/a>s, heating or cooling their homes by eliminating lowincome Energy Assistance<\/a> program and reject the bipartisan intention of this congress to save lives and address the Public Health<\/a> crisis by ending the 25 million for gun violence Prevention Research<\/a>. 100 americans are killed every day by guns, 36,000 per year, twothirds of which are suicides, a particular concern for our veterans. That is not all on the mandatory side you would take away Health Insurance<\/a> from 20 million americans by Cutting Health<\/a> care by 1 trillion over 10 years and eliminating the Affordable Care<\/a> act and its medicare expansion Medicaid Expansion<\/a> and you are telling federal court to appeal the affordable act. To date, you have not come up with a comprehensive plan to help. I could go on and i am not but the consequences of your budget would leave us as individuals and as a nation less healthy, less safe and less able with respect to Economic Security<\/a> and so we will not allow you to go after millions of americans, instead we will continue to invest in Workforce Program<\/a>s, medical research and the Public Health<\/a> because it is what American People<\/a> need and what the American People<\/a> deserve. I appreciate the administrations request for increased fund to go reduce Maternal Mortality<\/a> as well as additional funding to address tickborne diseases like lyme disease. As growth in incidents of lyme disease related to Climate Change<\/a> and you propose to eliminate cdc Climate Change<\/a> program. Increased funding of hiv initiative to reduce transmission of hiv by 90 over 10 years, we strongly share the ambitious goal, again, i have to note the contradiction at the heart of this because the administration is simultaneously proposing to call nihs portfolio, usids program, eliminate the Affordable Care<\/a> act and eviscerate medicaid. These are programs special to combating hiv, in fact, medicaid is the largest payer for hiv care in the United States<\/a>. So much to discuss today, we appreciate your being here and before we turn to you for your testimony, let me turn to our Ranking Member<\/a> congressman cole for remark that is he would like to make. Thank you very much, congresswoman, thank you, mr. Secretary, i have prepared remarks that i will read in just a second. Before i do i want to begin by thanking you, i want to thank you and the professionals at the center for Disease Control<\/a> and National Institute<\/a> of health, the folks that you have super prizing our strategic stockpile. I think you guys have your team and working with other departments, working closely with Homeland Security<\/a>, you have been briefing us on a regular basis, have done a really remarkable job in responding to something that this committee has been preparing for for years and this committee ought to be very proud of its work on a bipartisan basis providing tools for you and your colleagues to respond and through you i want to thank the president. The president has taken strong and Decisive Action<\/a> in terms of protecting our borders and, you know, im pleased to see this supplemental here and, you know, i suspect we will change it in some ways, my good friend the chairman made points that i agree with her on and i wouldnt be surprised to see you back here but youre doing the right thing. Youve used resources that weve given you and come back for supplemental. I have no doubt that you will come back if you feel that you need them or need Additional Support<\/a> and i have no doubt frankly that congress will be forthcoming. I have to tell you, ive heard a lot of stuff not on this committee and certainly but particularly in the other body that i have to tell you is just transparently political claptrap and thats what it is. When i hear people say, well, the president has done too little and too late, i think where have you been, we have been preparing for this honestly before this administration was here. We had 5 years in a row, substantial nih funding. I know my friend, the chairman, worked with me when i was chairman and i tried to work with her as Ranking Member<\/a>, we have shared this goal all along the way. We have done the same thing at cdc, we have done the same thing with strategic stockpile. The subcommittee that came up with the Infectious Disease<\/a> Rapid Response<\/a> fund that gave you additional money to not wait around on congress or political theatrics but to start responding immediately and i think youve done that exceptionally well. When i hear you criticized by people that in many cases didnt vote for the bills, that gave you the tools, i regard that as political as opposed to substantive. Last point i want to make on this is i really appreciate the briefings that weve got, congress as a whole has gotten, our chairman did a wonderful job in bringing in folks and we had honest and open dialogue. The idea that we havent been kept relate informed or people have not said, look, we will do our very best, but this is unpredictable disease, this could spread at any time, these are not just warnings that i heard in the last 24 hours. These are things that your team have been telling us from the very beginning and suggest to me that the administration has been on top of this and, again, i appreciate the president in that regard from the very beginning. So i know i was going to open by asking you how has your last week been but i was afraid i would get an honest answer so i dont want to begin that way, but i do want to commend you, i mean, with all sincerity, youre one of the best cabinet officers that the president has and i think you and your team served this country very well and i think this incident is proof of that, not a contradiction to it. Secretary, wish you good morning, i look forward to hearing the hearing today, department of health and Human Services<\/a> has broad responsibility covering almost every aspect of daily life and in the next year youre projecting almost a 1. 4 trillions in outlay, oversee health care for our seniors and native americans and ensure both the quality and safety of the nations food food drug supply. Your agency forms the backbone of the Public Health<\/a> infrastructure and is responsible for the development of medical protections against Infectious Disease<\/a>s and chemical biological, radiology and nuclear agents and committee amounts accounts for only a small fraction of your overall total, really just 8 of your outlays. In just the last 2 years, i was reflecting about your tenure as secretary, you responded to unprecedented storms leaving thousands of limited access to health care in puerto rico, humanitarian crisis at southern border and opioid addiction epidemic and most recently the spread of a new and Infectious Disease<\/a> from china and i want to comment you and your leadership with this agency. First i want to address the aggressive budget that you put before us. We know the cuts proposed are deep and quite frankly unlike to be to be sustained and i know who writes the budget, they are called the omb, the office of management and budget and you get to submit things but you have to come out and defend the decisions that are made there and i appreciate that. You work for the president , you have to do that. But i want to stress continued cuts to Discretionary Spending<\/a> will not solve the nations fiscal problems, period. Its not possible to balance our National Budget<\/a> by chipping away Discretionary Spending<\/a>. We must look to broader entitlement reform to achieve the valued goal of a balanced budget. Nearly 90 of your agencys entitlement spending on auto pilot. The authorizing committees and jurisdiction need to tackle the mounting problem of entitlement spending. I know, mr. Secretary, you know the figures but i hope those listening will take heed and recognize challenges with federal spending not within Discretionary Spending<\/a> controlled by the Appropriations Committee<\/a>. Second, i want to stress again that while small compared to total outlays, discretionary component that we are going to talk about plays a Critical Role<\/a> for our country, moreover, several programs we will discuss touch the life of every american. I usually start with National Institute<\/a> of health but today its fit to go highlight how important how important center for Disease Control<\/a> is to protect the health of American People<\/a>. In the span of a few weeks, we witnessed massive undertaking to respond coronavirus from china. Cdc was positioned to respond, deploy and protect. Hundreds of staff were marshaled quickly to work on different elements of the response efforts. While not everything is going perfectly, the agency has shown the value of preparing for the unexpected and having a transparent proactive communication strategy. I urge this committee to increase its support for the Infectious Disease<\/a> Rapid Reserve<\/a> fund at the cdc as ive said here before the threat of a pandemic is far greater than a terrorist event, having resources uncommitted and immediately available is vital. I know many are disappointed to once again see proposed reductions for the the National Institute<\/a> of health. You and i have had candid conversations about this. I too agree with my chairman here that a reduction there is unwise, however, do i want to point out this budget actually is 12 billion more for nih than level proposed just 4 years ago. Its not as if you havent recognized the value there and frankly i think you will catch up to it some day and you will be with us and continuing this bipartisan effort to increase this spending. I urge congress to continue to maintain commitment to sustained increases for Biomedical Research<\/a> and im pleased to see that with each budget the total request for nhi continues to increase. I hope decades from now future legislators commend the work of this committee for showing commitment to Biomedical Research<\/a> and maintaining american dominance in basic science. Recent news reports highlighting efforts by the Chinese Government<\/a> to steal intellectual property and use financial incentives to manipulate researchers stresses the importance of our advantage. We should be proud of knowledge gained from hard work of our scientists is the envy of the world but we must also understand protecting and safeguarding that information is necessary to ensuring the nations security. I also want to highlight your commitment to emergency preparedness, however, i was disappointed to see the reduction in project bioshield in the Infectious Disease<\/a> Rapid Reserve<\/a> fund and flat funding of stockpile and the Biomedical Advance Research<\/a> and Development Agency<\/a> or bard as its known, i attribute that to omb and we could k have that discussion later because this whole congress and Administration Needs<\/a> a serious discussion on on spending but thats been true for a long time and under Previous Administration<\/a>s as well. Our country needs to be ready to respond to any event to protect the health of the nation. These programs are the nations front line of defense against domestic chemical, biological or Nuclear Attack<\/a> or Infectious Disease<\/a> outbreak, we know current funding levels are not enough to have the nation prepare for a largescale event therefore reductions in my view are misguided. Do i want to recognize the 50 milliondollar increase for pandemic flu while the current flu season has been milder than in years past, it still resulted in thousands of hospitalizations and hundreds of deaths including children. And im encouraged by the commitment expressed in the budget to increase vaccination rates and efforts to develop more effective vaccines. We will save lives with those investment t, your budget proposes 680 million for unaccompanied children program. This program has been a difficult and difficult and unpredictable history resulting in deficiency and highly contentious appropriation last year. Your agencys efforts to move the program to a more stable position to respond to increases in arrivals of the southern border is long overdue, building a system that can accommodate unpredicted arrivals tat southern borders is both necessary and responsible management of federal resources. Finally, again, i want to personally thank you for your the efforts that youve undertaken and your agency to protect the life of innocent children and respect the persons right to follow their religious believes. I support your efforts to align the title 10 family plan with current law and ensure separation between Family Planning<\/a> services and abortion. I also support your efforts to allow for the free exercise of conscious and Health Insurance<\/a> coverage and enforce current law provisions which prohibit discrimination based off of the decision not to support abortion. Again, i appreciate the job youve done for the American People<\/a>, i lock forward to your testimony here today. Now yield to the chair of the Appropriation Committee<\/a> congresswoman anita from new york. Thank you, i thank chair deloura for holding the hearing, secretary azar, thank you for joining us today. We sent you a letter requesting information on Additional Resources<\/a> for the coronavirus, despite urging warnings from congress and the Public Health<\/a> community, its taken weeks for the Trump Administration<\/a> to request these Emergency Fund<\/a>s while tens of thousands have become ill around the world, and i understand, well, as my colleague has said that may not be attribute today you but here you are today and i thank you. We are still overall request effectively come on the delete and alarming that the administration is proposing to take money from one emergency to pay for another which would leave us more at risk for emerging decides and irresponsible approach to combating what the who has said is a potential pandemic. House democrats will move quickly to enact robust package that will fully address this threat without jeopardizing other necessary programs. Now to the budget, mr. Secretary, you and i have been able to Work Together<\/a> on important issues and ii value your relationship and thats why its disappointing when you come before us with a budget thats really void from reality and President Trump<\/a>s disastrous budget filled with program cuts, opposed by the public and bipartisan majorities in both chambers and its unfortunate that instead of building the budget to build on historic investments secured in last years appropriation bills the president doubled down on partisan talking points to propose investing 2 billion for the wall, steal outright from veterans and Service Members<\/a> while proposing to cut initiatives that improve wellbeing of americans, exposes the Trump Administration<\/a> priorities for what they are, Campaign Promises<\/a> among many reckless proposals, your budget would cut cdc. Cdc by nearly 700 million just as cdc is combating opioids, vaping, we could use a whole hearing again on just the youth vaping issue. Ive never seen anything expand in all our Public Schools<\/a> even down to sixth grade. One of the worst flu seasons in decades and the coronavirus. Cut nih by 3 billion jeopardizing lifesaving medical research and eliminate preschool Development Grants<\/a> which would fill important progress states to build strong Early Education<\/a> systems. In addition, the irresponsible proposal to eliminate teen pregnancy prevention while assaulting medicaid and attacking the foundation of title 10 Family Planning<\/a> with domestic gag rule is a dangerous combination that will leave many women without access to quality care, result in more unplanned pregnancies. This is an assault on Womens Health<\/a> and the rights of women and their doctors, and i was dismayed actually shocked with the elimination of the federal funding we included inphysial year 2020 spending bill in first time in decades, gun violence Prevention Research<\/a>. I want to say that, again, im aware that you have supported this research in the past. The budget makes clear that the president does not intend to do anything to combat the gun violence epidemic in the country. In addition, rather than invest in the ability of state and local governments to combat the vaping epidemic which has led to at least 64 deaths, nearly 3,000 hospitalizations, this budget would consolidate cdcs office on smoking and health, cut funding at the very moment we need cdcs expertise and resources, so if a budget is a statement of values that its clear that President Trump<\/a> has no intention of protecting our young people or improving the health of americans. Thank you so much for being here. I look forward to continuing the discussion. Thank you, and i want to yield to the Ranking Member<\/a> of the full Appropriations Committee<\/a> congresswoman kate ranger. Thank you so much. Before i begin my prepared remarks on the crisis that we are dealing with right now i want to associate myself with Ranking Member<\/a> coles remarks with your good job and the planning thats gone on in this committee for such a long time. Id like to thank chairwoman deloura and Ranking Member<\/a> cole for holding this hearing. I also want to thank you secretary azar for your efforts to protect our nation from this new coronavirus. Your immediate actions have enabled us to get ahead of the virus and begin protecting our citizens. At the beginning of the outbreak, you told members of congress that you would let us know as soon as possible when more funding was needed an youve done just that. Im confident that congress will work with you to make sure you have the resources in hand to continue to respond rapidly to this dynamic situation. All americans should be reassured this morning that we have a robust Public Health<\/a> system that is able to respond in every state to an Infectious Disease<\/a> outbreak such as this. Congress has strengthened our state and local efforts with recent investments including 85 million in the most recent fiscal year 2020 appropriation for Rapid Response<\/a> for Infectious Disease<\/a>. This is the very situation that led the subcommittee under the leadership of my friend mr. Cole and chair deloura to create such a fund and im pleased to see that its enabling your agency no quick and proactive effort to keep our nation safe. I look forward to working with you and my colleagues in congress as we continue to prevent the spread of this and other diseases within our country. I thank you for being here to testify today and i yield back my time. Thank you very much, mr. Secretary, your testimony and as you know your full testimony will be entered into the record and now youre recognized for 5 minutes, thank you. Great. Thank you very much chairwoman, thank you very much for inviting me to discuss the president s budget for fiscal year 2021. Im honored to appear before the committee as budget for a third time. With support from this committee this past year, we saw drug overdoes deaths decline for the first time in decades. Another record year of generic drug approvals at fda, historic drops in medicare advantage, Medicare Part<\/a> d and Affordable Care<\/a> act exchange premiums. The president s budget aims to move toward a future where hhs programs work better for the people we serve. We are Human Services<\/a> program put people at the center and where americas Healthcare System<\/a> is affordable, personalized, puts patients in control and treats them like a human being, not like a number. Hhs has the largest discretionary budget of nondefense Department Agencies<\/a> which means the difficult decisions must be made to puttys cessionary spending on a sustainable path. It would eliminate costsharing for colonoscopies, a lifesaving preventive service. The budget would reduce patients costs and promote competition by paying the same for certain services, regardless of said ring. And it endorses bipartisan bicameral drug pricing legislation. The budgets reform will approve medicare and extend the life of the Hospital Insurance<\/a> fund or at least 25 years. We propose investing 116 million in hhs initiative to reduce Maternal Mortality<\/a> and morbidity, and we propose reforms to tackle americas rural healthcare crisis, including telehealth expansion and new flexibility for rural hospitals. The budget increases investments to combat the Opioid Epidemic<\/a> including opioid state Response Program<\/a> will we appreciate this committees work with us to give states flexibility to address stimulants methamphetamines. We request 716 million for the president s initiative to in the hiv academic in america by using effective evidencebased tools. This could he supports enable us to begin at the mentation already. Today im pleased to announce the Health Resources<\/a> and Services Administration<\/a> is dispersing 117 million in grants to expand access to hiv treatment and prevention by leveraging successful programs and Community Partnerships<\/a> such as the wine white Hiv Aids Program<\/a> and Community Health<\/a> centers to reach more americans who need treatment for Prevention Services<\/a>. The budget reflects how seriously we take the threat of other Infectious Disease<\/a>s such as the Novel Coronavirus<\/a>. By prioritizing funny for cdcs Infectious Disease<\/a> programs and maintain investments in hospital preparedness. We still have only 14 cases of the Novel Coronavirus<\/a> detected in the United States<\/a> involving travel to or close contact with travelers. We have three cases among americans repatriated from wuhan and 42 cases among african passengers repatriated from the diamond princess. The immediate risk to the American Public<\/a> remains a low but there is now Community Transmission<\/a> and a number of countries including outside of asia which is deeply concerning. We are working closely with state local and private sector partners to prepare for mitigating the viruses potential spread in the United States<\/a> as we expect to see more cases here. On med that would be sent a request to make at least 2. 5 billion in funding available for preparedness and response including for therapeutics, vaccines, personal protective equipment, state and local Public Health<\/a> support and surveillance to other four to working closely with congress on that request. Lastly, we comes to Human Services<\/a> the budget cuts but the programs the lack Proven Results<\/a> while reforming programs to drive state investment in supporting work in the benefits it brings will be. We continued the fy 22 investments cogs made in head start, and childcare programs which promote childrens wellbeing at adults and dependents. This years budget aims to protect and enhance americans wellbeing and deliver a more affordable personalized Healthcare System<\/a> that works better rather than just spends more i dont afford to working this committee to make that commonsensical unreality. Thank you very much. Thank you very much, mr. Secretary. Where going to step out of regular order for a moment. Chairwoman is sharing three at 10 30, with the department of Homeland Security<\/a> so i want to say thank you, you know, to my colleagues for your graciousness and allowing her to ask your questions before she has to excuse herself. You are recognized. Thank you madam chair and also thank you to the committee for the courtesy of being able to speak out of order. Secretary azar, since the initial passage in 2008 of my newborn screening phase lives acted as help ensure highquality diagnostics and lifesaving followup interventions for the over 12,000 newborn babies diagnosed each year with genetic and an doctor and conditions. As you know the newborn screening act codified the Advisory Committee<\/a> under edible disorders in newborns and children to help address the vast discrepancy tween the number and quality of state screening tests. Because of this committees work, today 49 states and the District Of Columbia<\/a> screen for at least 31 of the 35 currently recommended conditions. Last september the reauthorization of the newborn screening law expired and we passed a new reauthorization bill in the house and we continue to push our Senate Colleagues<\/a> to pass the bill out of their chamber. However, since october office has suspended the activities of the Advisory Committee<\/a> which is preventing it from completing its current work and commencing new business including a critical update to the recommended uniform Screening Panel<\/a> nomination process. Meanwhile, you have the authority to reinforce the 2014 newborn screening reauthorization to deem the Advisory Council<\/a> a secretarial Advisory Committee<\/a> to continue its charter. Given the essential role that the Advisory Council<\/a> place in our nations newborn screening system, why havent you used this authority and when will you expand the term of the committee until reauthorization occurs . Well, first, congresswoman, id like to thank you for your leadership with respect to Maternal Health<\/a> and as cochair of the congressional caucus on the turn to care. As you know which will help as a versus Public Health<\/a> john was in the is actually investing in thanks to your leadership and both chairwoman of this committee by increasing funding by 74 million to cdc, ihs to reduce Maternal Mortality<\/a> and morbidity with what you continue funding from maternal and Child Health Block<\/a> grants to states which provide states with additional flexibility for program such as heritable disorders. Also have 126 billion for healthy start for committeebased strategies to reduce disparities in infant mortality and to prove perineal outcomes for women and children in highrisk communities. With regard to the Advisory Committee<\/a> on in head up a disorders due the authorization, that committee has halted activities. Im happy to look into the question of its work as we work with congress around reauthorization of course of the neonatal screening act. Because you do have that authority to continue that committee. And you mentioned another issue that i am concerned about that in your 21 21 budget you propoo eliminate the hrsa and provide grants that provide grants to educators and parents help states expand the newborn screening programs. Without this funding how will this dates fill these new activities and improve followup care for infants diagnosed with our edible disorders annual operating update come to similar information from the federal clearinghouse of newborn screening information . Those are questions that i would like some answers to but you did mention you also rolled the newborn screening into the Maternal Child Health<\/a> block grant, is that what you just dated . So no, i was emphasizing we have within the Maternal Mortality<\/a> block grant that does provide addition that has flexibility to states for program such as the disorder so they could use a block Grant Funding<\/a> is my understanding to continue while were waiting for congressional reauthorization work on the concert is not one you put less money into the block grant and was in the programs you eliminated and then states are free to use the block grant money as they desire. Increasing funding for the block grant i think is an important investment but it does not guarantee the money will be spent on improving state newborn screening programs. So maybe we can work a little bit on that and talk a little bit more about the possibility of reinstating the committee. Happy to work with you on that. Thank you. Thank you. Thank you. Were going to return to regular order and a question for you, mr. Secretary. Just before he testified yesterday morning before a senate appropriations, omb files submitted supplement of funding request. Chairman lowey mentioned that we both ask you to split such requests three weeks ago and while were glad did administration has finally done so, what has been provided to date is unacceptable. It lacks the fundamental component of the supplemental request, including proposed language, supplemental documentation and omb did not transmit a budgetary with details into last night. To be clear, we want to be supportive. We realize the situation is evolving and you are adjusting to shifting circumstances. But it is important for the committee to better understand the needs Going Forward<\/a>. Once, can you tell us how much of the Infectious Disease<\/a>s Rapid Response<\/a> reserve fund has been used for this Emergency Response<\/a> . As i think im sorry. Has 105 million available from that fund been exhausted . We are at the point now where we have used or were with either committed or obligated the monies it at 105 million Rapid Response<\/a> fund. Thats why i sent you the notice last night about the reprogramming entrance of the 136 for future six for future publications we can continue our work. The 105 is gone . Committed or obligated. Its not there, okay . And are you going how quickly are you expending the funds . The actual run rate of the money going out the door i dont know. I believe were at about 20 make the last update weve given to the subcommittee by want to defer to staff. We can check with you on that. I do want to make sure you are getting information on spend rate as quickly as omb will authorize the release of that but were basically out of the 105, for which we are grateful you have funded. Its proven to be widely widely important come so thank you. Let me ask you to provide Additional Details<\/a> of the supplemental request to the subcommittee. But if voicing a twopage letter from omb and onepage budget table. I was around when the Obama Administration<\/a> submitted a supplemental request for ebola. They sent a 28 page document outlining the intended purpose of each component of the request, and that was demanded by this committee. I was there every time they came with much more information. Let me ask you these are the questions. How do you intend to reimburse state and local agencies for their expenditures on the ground . So weve got i appreciate your frustration with the twopage letter being the documentation. We have been working with your staff to provide this is the obama submission. Weve been working with her staff. We do have plans that were going to work with your teams to make sure we educate on and Work Together<\/a> to flesh out, its a very fast moving process a few understand. Within the 2. 5 billion, release 2. 5 billion request we would have the cdc have a major fund which would be for the Public Health<\/a> Emergency Fund<\/a> to allow them to work with state and local governments to reimburse for expenses of bound contact tracing, laboratory work, laboratory we are going to reimburse state or local agency . That is the goal to i the fund that would enable the feedback weve gotten from state and locals whether the grants or reimbursement and we would work with committee on the appropriate structure of how you think that should be done. I which is like to know what we think that is going to be, how much money is involved, et cetera, so we can we are all getting this question. Thats been there are five key areas that were not quite transmit invalid if i could mention the key strategic speed my time is going to run out. Ill get the five areas. How much of the funding is designated for International Activities<\/a> versus domestic preparedness . I believe in the most recent document i saw, the table you have access to, there is 200 million of usaid funding that maybe from existing sources. I dont know if thats new money or not, that may be existing money that would be dedicated on that. Were focused our 2. 5 billion requested at hhs franklin on u. S. Preparedness and response. And i would say say compared to the ebola response, were getting that stopped in west africa. We are now in east drc is a critical element. Here are our are mitigation, contain and mitigation preparation in the homeland because were not going to help the chinese stop this in china. China will do that or not be able to do that. Does the requests include funny to replenish the Infectious Disease<\/a> and Rapid Response<\/a> reserve fund, yes or no . I dont believe we use the Rapid Response<\/a> fund but what we would do is work with you on the 2021 appropriation to ensure that if properly funded in light of this. The funding request was locked in december before a this happened so we want to be flexible on 2021 funding to respond to this. Did omb reject any of your quest for emergency supplemental funding to respond to the coronavirus . On equity get into backandforth with the white house or a lengthy discussions but i want to let you know this to . 5 billion request dollars request has my complete and full support. It attacks the five critical success factors that i make clear idea to invest in and it supports that. Its alums i think are appropriate and if not if it doesnt find it enough will come back to and work with and against were trying to be flexible. We set a least 2. 5. 2. 5. We want to work on Funding Sources<\/a> as well as top light and that. The chair pointed out will put together a supplemental that will address this issue. Congressman cole. You gave me a promotion therefore a minute. Im sorry . [inaudible] i know shes got to get to i apologize. Thank you for allowing me to go had to go to mr. Secretary, i was alarmed to learn that almost 90 of active ingredients used our pharmaceutical manufacturer originate in china. What she would be doing and the United States<\/a> to ensure the safety of the American Drug<\/a> supply . Chairwoman, as you know this is really, this has brought to light the issue of the complete internationalization of the supply chain, not just for medical products but really across all of the economy. And so what were doing that is the fda is reaching out to all pharmaceutical manufacturers, device manufacturers, et cetera to make sure with visibility. The latest fruits of that work show there are 20 pharmaceutical products we are aware of today at fda with either the entire product is made in china or there is a critical active ingredient that is solely sourced within china. Those would be the most targeted to be concerned about. To date we are not aware of any expected shortages and we have aggressively proactively reached out to manufacturers for that information. Im told that are two manufactures, but fortunately the manufacture has a large, large stockpile supply of advanced production but we have to be very alert to this and we have to be candid that the could be disruptions in supplies. We experienced that of course with medical shortages, generic shortages due to solesource produces, manufacturing defects, inspection problems. We got an aggressive agenda for shortages we afford with this committee and authorizing committees to help alleviate shortages. Take they keep it would you p us informed . Yes. Thank you. I would like to recognize the chair of the committee to as a kerry as well. You are a very busy woman. We will all talk fast, thank you. First of all go the concerns raised by chair delauro on the coronavirus. We really do need these answers right away but id like to turn to another matter, which is impacting Public Health<\/a>. As you know ive worked to restore funding for gun violence prevention since former representative dickey first attached his amendment to the spending bill more than 20 years ago. Some of us were there. The fy 20 spending bill enacted with bipartisan support in december included 25 million for research split between the cdc and the nih. When you and i discussed this issue including at the budgetary two years ago you expressed support for this research and responded back, were in the sites gathering business. Well, clearly that sentiment isnt shared by the white house as the president s budget would eliminate this groundbreaking funding. Nearly 40,000 americans lose their lives you to a firearm each year. Hundreds of thousands more are injured why does the Trump Administration<\/a> not believe this is a Public Health<\/a> priority worthy of funding . Thank you for having funding that and were executing on the funding both at nih and cdc. Fact just on the 21st the cdc put out a new Research Funding<\/a> Opportunity Research<\/a> grants to prevent firearm related violence and injury to solicit investigator initiated projects with a deadline of may 5 for submissions of those. In terms of the budget submission and the continuation of that as you know with cdcs budget we prioritize Infectious Disease<\/a>, prepared a Single Health<\/a> security and said that did mean cuts and prioritization away from chronic and preventive activities which included the Firearm Research<\/a>. We continue at nih to always be open for business as we have always been for Firearm Research<\/a> within the peer review process of submissions. That will continue a pace regardless of whether Congress Accepts<\/a> the budget submission or not. With all due respect the administration chose to make these cuts. This wasnt a tough choice. It was the wrong choice. With limited time im going to go to another key issue, and i thank you, madam chair your resume can at least 64 people died last year and nearly 3000 hospitalized with vaping related respiratory illnesses while many but not all of these cases were attributed to vitamin d acetate, the crisis race series question about how little is known about vaping, particularly as concern grows that there could be longterm Health Consequences<\/a> such as heart disease, stroke, cancer and more. This is particularly alarming as the youth vaping rates have skyrocketed here so i was optimistic when President Trump<\/a> said he would clear the market of flavored ecigarettes, but after speaking to his lyrical advisors he turned his back on Public Health<\/a> for political gain and instead receded with an announcement that has left thousands of kids friendly flavored markets and allowed disposable ecigarettes to flourish. How many more people will have to be second or die for the administration to take this seriously and ban all flavors . Thank you for your passion around ecigarette and vaping issue and access for kids. I share that and want to keep working with you on this challenge. When the president made the initial announcement with me on september 11, we included all flavors other than tobacco in that statement because of the time we had the National Youth<\/a> Tobacco Survey<\/a> data which admit and mental together as a single category of use. We were actually at the time concerned about including menthol in the immediate removal from the market given the fact menthol combustible is a discrete eagle category used especially in Afghan American Community<\/a> and want to make sure that offramp would not be pulled away from folks. After making enough that we got the monitoring the future data out of in h that broke apart for the first time and showed menthol was really not being used by kids. Its much more like tobacco flavoring of the ecigarettes and it was the mint driving and that was what led to the modification of the flavoring question as we move forward to the submission deadline. We just also with regard to disposables, we dont have data on disposables and they did pull their flavors off the market with what they announced comparable kidfriendly flavors off of the market but well keep working and enforcing if anybodys marketing tickets will force against them, watched the date in terms of enforcement priorities. They all have to submit by may 2020 for court order for the pda at fda. Just a quick final question, frankly we need more resources to combat this epidemic, not less. So maybe you can think about why the administration recommended yet again to consolidate and then got funding for the office on smoking and health. I guess i dont have any time. Why dont you think about that and perhaps answer, just let e say in conclusion, this is an epidemic. I speak to my grandkids, six great, fifth grade. It is unbelievable whats going on out there so we have to take it seriously, because and strong and respond to this epidemic that is grown. Thank you very much. Thank you, madam chair. Thank you. Thank you again thank you. Madam chairman of the full committee, you all the time you want whenever you need it. Im sure our chairman will make sure yes, you do. This is your committee. Thank you im going to go over to Homeland Security<\/a>. We will miss you because we know we are really your favorite. [laughing] we always have been. Let me start couple things. I want to first associate myself very much with our chairman request requested additional detail on the supplemental, and that is meant to try to help you quite frankly because our job will be dispelled this supplemental to our collars on both sides of the aisle. I know will Work Together<\/a> to do that colleagues i do have a couple quick questions on the coronavirus i want to again, my chairman made this point i want to associate myself with others. I agree with her about ebola. I dont think you should sacrifice shortterm here. This is bad dealing with coronavirus. If we ever had an Ebola Outbreak<\/a> inside the United States<\/a>, it would be devastating such as dont think we should be penny wise and pound foolish on that. I would hope working together we protect that funding Going Forward<\/a>. I say that just to advise you of that and again i dont have any problem with people being prudent try to stretch the dollars as far as they can. Thats a good thing. This is what i think we have to do something different. I want to ask you one question at end of the attitude i want to get clearly on the record. If you do not have enough money in the 2. 5 billion you asked for, you will come back and ask for it additional funds, is that correct. Was absolutely. Ive talked to our leadership and are fully supportive of that. That. They understand this is difficult to estimate and that it could grow exponentially. Ive got the green light from our side of the office of law, if we have to go beyond this please feel free to all of your colleagues on the other side that we will work with you on that. Second question and again a compliment, i want to thank you, we dont have jurisdiction over funding on Indian Healthcare Service<\/a> but you do. You had a modest increase in that this year in a tight budget. I appreciate that and thank you and will do my very best i can best to give more than you ask for in that area but i do want to also alert you, budget does propose for the elimination of the good health and wellness of it in Country Program<\/a> of the cdc. That aint going to happen. That is a a program that we wok with tribal governments on. They are vastly underfunded in this particular area and so again, i sympathize with you dealing with omb, but i just virtue i certainly would be very opposed to that. Do you want to comment on some of the things you drew in travel health i be interested in listen to what you have to say. Absolutely. Thank you very much and i think you know our passion, my passion about tribal health. Weve even in tight budget of imus have tried to ensure appropriate investment in indian country. While our budget, as it would has noted, propose an overall decrease of almost 10 Discretionary Spending<\/a>, ihs is funded our budget request action at 6. 2 billion which is a 3 increase. Just by scale i think that reflects the prioritization of Indian Health<\/a> that were trying to make. Discretion of funding for has gone up by 24 between fy 2017 and 2020. Were working to improve polity, safety and our facilities. My deputy is out in south dakota inspecting our facilities that were trying to get brought up to certification to wear working as part of the appropriation we want to build up the whole quality Safety Culture<\/a> and mindset throughout ihs beyond just complies with cms certification requirements. Thats part of all were trying to do for Indian Health<\/a>. Again im very appreciative and we are going to with you wherever we can and occasionally stop to where we must. But let me move to another area. You and i have talked about this recently and its important for the committee to know weve had some very legitimate questions about rebirth particularly during coronavirus for state and local people but the reality is cdc revise i think 50 of all the funding for state and local Health Programs<\/a> in the United States<\/a>. I know own state is 60 . Its not as if you havent put a lot of effort out there already, and this is something that maybe state and local governments need to be looking at, not that include for any decrease from what we do but maybe they need to be doing more. I want to ask you how ready you think the state and local departments are to deal with this as we go forward and what additional steps you think we ought to take to strengthen those things without making them totally dependent on the federal cup . Thanks to this committee we, approximately two to the public of the circuit of the state and local level in the United States<\/a>, in addition or connected to that is the Public Health<\/a> Emergency Program<\/a> which funds over the last many years 675 billion a year to states to then get to locals. Precise for this kind of situation to be ready for Public Health<\/a> emergencies. I have been impressed by most states and local governments to degrees of cooperation and preparedness but it is also highlighted to me i believe there is a need for greater accountability and oversight with that money thats going out to ensure that it is, in fact, leading to readiness for Public Health<\/a> emergency. Last quick question because ill have about 30 seconds but i probably get more concerns about Mental Health<\/a> imagistic than almost anything else. I think thats pretty common for all this. Could you addressed quickly some of the things that would help us do with the Mental Health<\/a> problems i know all of us face . One of the most exciting things in our budget from my perspective is the proposal that would allow a state option was called the imd exclusion not just to extended inpatient expand capacity for Substance Use<\/a> disorder but also series mental illness. Leasing were without imd exclusion is approved for the waivers approved for states and Substance Use<\/a> disorder. An expansion capacity. I bring this as a state option which means its not subject to the budget neutrality issues of a waiver, thats a major investment that can allow that for series Mental Health<\/a>, just one example. Thank you very much, madam c. Thank you, mr. Secretary for being here. First off let me see your departments is in the final stages of regular issue regarding the interoperability of healthcare data. More than 10,000 of my constituents work and health i. T. Industry. I wanted to let you know the outcome of this rule is very important to a a district that appreciate you listening to the concerns of, to look for to the improvements that will happen in the regulation and want to thank you for your leadership. I have tried, ive worked directly with epic leadership and hearing their concerns. Often we put a proposal out and we precisely because we want to get that feedback about operationalizing and everything, so i hope we try to be reflective of these changes as much as we can. Let me try to get to the meat which may not be as pleasant. I would love to get to talks about the cuts to medicare and medicaid, the cuts to an eight to want to talk about the coronavirus. I need you to help provide comfort to the American People<\/a> that this administration and federal officials actually have addressed on this. Let me go down all of it and let me what i found in the news of the last few days. We had the secretary of Homeland Security<\/a> yesterday say the vaccine was so lets wait for the president said we are very close to the vaccine. And yet i think you and the cdc and other since it is more like 18 months. We have heard from commerce secretary wilbur ross saint the coronavirus could be good for your business because it hurts china. Weve heard larry kudlow say its contained we have heard Rush Limbaugh<\/a> a of freedom where say its no worse than the common cold. And yet weve also heard from cdc officials question if this will happen anymore but rather question of exactly when. Dr. Fauci for many of us really respects that its inevitable this will come to the United States<\/a>. Weve got those kind of,. Second, we know this first started information coming rent january 7 in the budget that was produced by the president on february 10 provided a number of cuts that would work to directly affected this from the almost 700,000,000 cuts to cdc, 167 million from office of offie assistant secretary for preparedness and response, 18 going from house preparedness response account and cuts to bio shield. We have seen recent reporting when hundred 50 Prescription Drug<\/a>s, this is an fda, are at risk of shortage of this outbreak worsens the yet the fda commissioner is reported not part of the task force that is planning the u. S. Response to the coronavirus. In 2018 the cdc cut 80 of its efforts as part of the global Health Security<\/a> initiative to prevent local disease outbreak because it was running out of money and is reported the department could go from working in oregon and countries to just ten ten countries. Also in 2018 the white house official that was responsible for leading the u. S. Response of the deadly pandemic left the administration and the global Health Security<\/a> team he oversaw was disbanded. And finally the tweet from the sporting from the president talked about low rating, fake news, doing Everything Possible<\/a> to make the coronavirus, spilled and correctly but im a journalism major, look as bad as possible including panicking markets, marcus been the help me, as this content, the common cold inevitable, tumors, 80 musk . Provide me some security the seminoles whats going on in this administration about the coronavirus. Thank you. Where shall i begin rex. The long list of what we try to do and we try to do this with members of congress, senate and the public and immediate is really flood you with information about this to make sure were we being transparent about what were facing. What would i will be doughnut as well as what our plans are. The risk is very low to americans. We have come as larry kudlow said from a Public Health<\/a> perspective, we technically are in a state of containment in the United States<\/a>. We have had 14 domestically identified cases here from nonrepatriation that has remained the case now for 15 days. But weve always been clear, number one that could change rapidly, and from outset i in the the Public Health<\/a> experts have said we fully expect we will see more cases in the United States<\/a>. We have to mentally prepared and also as a government prepared. If i can just reclaim my time. That still didnt provide me the comfort i was looking for. The variety of statements as a said are from two months, its nothing, its a common cold, too inevitable and i still think this an illustration seems to grasp onto. Let me ask you this. Youre looking for the funds. I also agree with the bipartisan concern around stealing it from people. I talked to senior widest official last year, one of his not white house what administration officials. One of his main concerns was ebola. Taking money from that would be ridiculous. We have redirected 3. 8 billion from the fans for the wall. The wall is not going to stop any real or imaginary migration and it certainly will not stop the coronavirus. Would you be supportive of taking some of that 3. 8 billion or any money for the wall and transferring it to take care of the coronavirus . So that ebola funding and all of the transfers proposed in the supplement i do want to be very clear, that is simply a concept of how you could fund half of the supplemental we are not met today. We wanted to give you ideas. On the ebola money, that in particular with ebola, it is thanks to the ebola supplemental funding we had before, its important to note we have now and approved vaccine and we have two therapeutic candidates. Ive been almost daily involved with the eastern drc Ebola Outbreak<\/a> that god willing is coming close to being under control. Certain on the epidemiological curve is looking like that is a scary situation stays ottawa to thank this committee for the support on ebola that weve had and we have no major weapon suits against ebola, which is really a revolution. If i could come specific last part of the question. Would you be okay with taking funds that a been redirected for the wall and redirected to stop coronavirus . I dont believe the administration would be supportive of that but congress will make decisions about how to find any such supplemental. Thank you, madam chair. I want to commend you for your initiative on advancing Kidney Health<\/a> to those people dont know that 750,000 americans have an irreversible kidney failure, and 90 are undiagnosed. Tonight in ten people do not know that they are on this track. It represents, its too late to slow the disease progression, so medicare spends more than 120 billion, 34 of total spending, and 7 of medicare spending despite representing 1 of medicare patients and this is only going to get worse. So i have been super excited about the initiative at the white house, that you have launched to go after some of the problems within our Current System<\/a> both to educate and inform and help people become more healthy come also to make sure we are getting more solid organ procurement the people are getting the transplants needed. And you are also going after the big fear for most people have transplants which is when is the coverage going to end . I cant afford that. I want to say thank you. Its a breath of fresh air to someone really taking on this issue. It represents a lot of hope for a number of us who have been laboring in this field. I wanted to ask him theres two things come im a lot of questions about the coronavirus and appreciate, i see multiple options from members who come from briefing summer staff and your team so thank you for keeping us abreast. I do think its going to change it to write like you i wanted to see some from office would be willing to come in and just sit down with me about with him something about this i think iterate and becomes communicable in the i know they keep saying its only 2 of people die with this as compared with the 2 represent the elderly. Almost every article ive read its sum some of seven years or older, or if someone with a chronic illness. I think we should be defending those folks to the best of our ability. I know we probably dont have the time to go into that now but i would just let somebody to come in and spend time with me on that, if thats speeded we would be happy to try to do that. Theres a question of the but he has so that might be speeded if you want to take a quick swing at it. Let me give this way, how does it spread . Is on tabletop . How long does it sit there . How does a a jump in the test kits. In terms of transmissibility, obviously as a respiratory illness it usually would transmit versus arizona station. But there might be fomite transmission we would sit on a hard surface. Dr. Fauci has spoken public about this. Of course we dont have hard data with regard to the so we would expect it in the several our range as opposed to multiple day range. But again we dont have studies on this or data on this but with the usual with the coronavirus but i would rely on dr. Fauci on that. In terms of the tally rates, we are seeing various estimates. The debbie hot must just in china, saw high rates rates of fidelity w. H. O. Team. Outside of the province i believe they were seeing numbers closer to. 7 . There again is right and we will have one of the top projects for us to get a step in Public Health<\/a> statements of our abilities, what is the mortality rate we would be applicable and a modern Health Care System<\/a> like the United States<\/a> with very aggressive active containment at the outset as well as Community Mitigation<\/a> efforts any that of spread here. It might be quite different than that in terms of assumptions. On testing, we currently have the cdc tests which invented in one week. That is at cdc and is now validated in 11 of the sites. We had an issue on the third stage, theres a third stage of the test. One of the 92 aspects of it, if its not done just right was having issues on quality control. Not leading to false positives, which is an inclusive result of one of the 92. We are workable fixing that but also perhaps with overengineered that test in the first stages may actually be enough to enable a faster test but were working to get that assumes possible to the remaining Public Health<\/a> labs. Labs. The commercial sector is looking at, the bedside diagnostics, referred from dozens and dozens of them at the fda will expedite work with them on that. Good. I know i cant more questions but could someone, id also like to talk about the pharmaceutical slowdowns. I realize the immunosuppressants, and other things happening both in india and china, china impacting india with shortages that weve seen that is leading to some of the major pharmacies retail pharmacies. I dont want to use they are being judicious and now theyre filling scripts. I only see that getting worse. Just to clarify for the public, those are general shortage issues that are not connected to the Novel Coronavirus<\/a>. We have not seen any shortages connected speeders i want i was home to come and talk to me about, i just want to do what the contingencies are and some for plenty. With that, thank you so much madam chair. Congresswoman frankel. Thank you. Thank you, madam chair. I want to talk about something that i think its actually one of the greatest Health Issues<\/a> here in this country but of what to say for the record and then i think my colleagues will follow this up. The public should know that mr. Trump fired the governments entire Pandemic Response<\/a> chain of command while in the white house. Im not going to get into that. I want to ask you a question. Couple questions. Would you agree doctors should not lie to the patients . Doctors should provide truthful information to their patients. All right. There is one. And doctor should give full information to the patients, all right you said doctor should not lie to the patients. I agree with that. Okay. They should give full information. If theyre in a statutory system that precludes certain information or Certain Communications<\/a> and then to comply with statutory okay, lets get back. Lets talk about the contradiction really of those two statements. Because im going to talk about title ix. Im sure you anticipate that. I want to say thank you for being here. Okay. Title x, thats like, i cant even read my own paper. All right. So the trump budget, title x, you keep it Stable Funding<\/a> 286 billion. What to Say Something<\/a> up title x. It is in the past been a bipartisan and very incredibly effective program. Its meant to ensure people who are struggling to make ends meet, who dont have Health Insurance<\/a>, they can still have access to Birth Control<\/a>, Cancer Screening<\/a>, std testing and treatment of those annual exams. Fortunately, in march of 2019 hhs published a rule which prohibits providers from providing first for abortion, even upon a patients request and oppose honors physical and requirements which under rule all abortion activities must be physically and financial separated. Let me just say this. I call this the trump abortion obsession. For example, even if a patient who came into a title x provider said, found out they were pregnant and had asked, do have an alternative to whether i i p this pregnancy or not . The provider is not allowed to tell that are not allowed to say. They are gagged. Because of this, planned parenthood announced it would leave the program and, unfortunately, the courts have upheld the administrations rule. Planned parenthood served 1. 5 million of the 4 million title x patients, and not going through all this statistics, but half the patients rely on title x funding do not have the provider they had been turning to. I want to ask you this. Do you have a list or could you provide us with a list of the new providers that have come into the program . I believe we could. Do you happen to know how many new providers there are . The number of new i just looking to see if i happen to have that here. I dont leave im just exact number of new providers but we could get that for you. Would it surprise you that as of one year after the rule was published, there would only been one new provider . Or maybe and the provider did not provide contraceptive services . I know the entity you are speaking of. That provider has subgrantees that would provide the full range of Contraception Services<\/a> required under title x. And there are several states that have no title x funding right now. Well, you know, i could go on and on about this, but let me ask you another question. Who should decide whether or not someone brings a child into this world . Whos in the best should someone had to call the governor or call you or call me . So with regard to title x, we are enforcing a title x law which congress prohibits referral for abortion as a method of Family Planning<\/a> and our final rule actually was upheld even by abortion is a medical service that is legal. Its legal, is that correct . Congress decides where federal money may be used in connection with abortion, and so the federal the statute in title x prohibits referral to programs in which i do understand that and as a result, what is called a gag rule which means providers cannot give their patients all the information they need to make important decisions, you have lost the biggest provider in the country, which is called planned parenthood. Are you where the planned parenthood does a lot more than refer to abortions or provide abortions . Std exams, mammograms. Im aware between 2020 20102015, clinics a closer over the past nine years Cancer Screening<\/a> and Prevention Services<\/a> at planned parenthood declined by over 60 . Contraceptive services declined by 30 and the art important preventive activities like hpd the vaccinations account for less than 10 of activities as wait a minute. Hundreds and hundreds of thousands of patients are taken care of, were taken care by planned parenthood. Mammograms, sgds, contraception. You need to check all right. Sorry about that. I would say she should go back to school. Thank you, madam chair. Mr. Secretary, thank you for being here with us today and for the update on the coronavirus. In the briefings you and administration, the team have been doing also want to thank you for all you and your team are doing, kind of roundtheclock on this. So appreciate that. I wonder if we could talk a little bit about some of the initiatives you are doing in the rural health space. I know you have a 4. Strategy. A few specific areas, what is the opioid situation, overdoses of opioids. Thats a huge concern in my district and i know naloxone is used in kind of the frontlines on this to help people. I wonder what hhs is doing to create an awareness for the general public as well as work with the pharmacists to make sure its accessible and available . And then anything you can do to help us understand the insurance aspects as well to keep costs down for people. Sure. With regard to rural health and the opioid crisis, i did want to mention that we have got funding of 23 23 million for the firt responder training program, which actually trains First Responders<\/a> in opioid overdose in Rural Communities<\/a>. We have the project aware rural set aside we have the Rural Health Outreach<\/a> program which maintains 80 million consistent funding there to support grants for primary care opioid use disorder treatment. Prevention and Behavioral Services<\/a> there. In terms of naloxone, with naloxone weve actually seen the generic position of that product, so weve seen 405 increase in naloxone prescribing we have the 2019 fda approved the first ever generic naloxone. We granted by rorty review to other naloxone product that would be used for emergency treatment. And we also are encouraging overthecounter by laying out what would be needed to do an otc of naloxone also. We have seen pricing, i think at this point with cms, with part d, weve encouraged placement on the selected character for naloxone which would be zerodollar copay and were seeing similar types of support in commercial insurance also. Thank you. Also want to talk about telehealth if we could. Its very important in these rural can reduce adages wonder if you could discuss how your proposed changes to medicare feeforservice advance payments will broaden access to Medicare Telehealth Services<\/a> . Absolutely. Weve got in the budget several proposals. One of them would be to modernize medicare telehealth so we would promote valuebased payments. We are moving barriers to telehealth and rural and underserved areas by expanding the availability and feeforservice we have advance payment models. Those abms taking sure telehealth is available in feeforservice so thats one. The next is to enhance our services and federally qualified Health Centers<\/a> and rural health clinics. That would allow the centers to actually be distant site provided in Rural America<\/a> which would make them eligible for payment under medicare feeforservice as part of that proposal and we would extend medicare telehealth for ihs and trouble facilities. As a note ihs is of course one of the most important rural Healthcare Providers<\/a> we have in america. Wonderful. If i could take you to the cdc for a minute. I know the cdc Surveillance Data<\/a> platform, can you give us an update on the status of that and plans Going Forward<\/a> . So weve got one of the finest surveillance platforms in the world in terms of cdc support of this. In fact, one of the critical elements of the emergency supplemental is to enhance that Surveillance System<\/a> for Novel Coronavirus<\/a>. What i want to get to is where were getting data on suspected flu cases nationwide and getting those tested for Novel Coronavirus<\/a> nationwide. We expanded that the six cities, so seattle, San Francisco<\/a>, los angeles, honolulu, chicago and new york currently have this enhance surveillance. We won and Early Detection<\/a> system because this will be the backbone of our effective dedication program. We are also something quite were talking with google and others about how can we leverage novel i. T. Social media interactions as part of a modern epidemiological Surveillance System<\/a> . Name may know things factor then we can get Public Health<\/a> reports in from local health agencies. Are we on track on these things . I know there is reports are due to you and congress. I i dont know about any particular reporting issues on that, but if we get the supplemental we would use transfer money immediately to try to enhance that Surveillance System<\/a> and then working on the rest of these initiatives. Particular question, be happy to get back to a new timeline or your deadlines. Thank you very much. Thank you, madam chair. Mr. Ranking member, and thank you, mr. Secretary. Real quick thing, i think reverie sixdegree of separation relationship. You collect for scalia. His aunt who was very, very proud of him was my both french and spanish teacher. [laughing] and he comes from princeton. I would ask you a couple of quick questions and ive questions regarding new jersey specific number one is that you were quoted as saying we have a 30,000 stockpile of masks and it bears a real pandemic, we need 300,000. Since we dont see parts of the nature come out of china, where will we get ours to be prepared . Thank you. First, id like to clarify something that i said yesterday in the senate Appropriations Committee<\/a>. I have been informed of some information thats a bit different than what i had at the time to clarify. First, we have more masks than the 30 million that i related yesterday. But we have a different mix of those masks that what weve been informed of. We have 30 million surgical masks. The would be the cause type tiedyed that your mask made to protect people from right. We have 12 million in 9590 russian certified mascot stockpot and we have about 5 million in 95 masks that leak may have expired, no longer certified. So where do we get the rest . What we talked about is approximately 300 million additional masks from the emergency supplemental that we forwarded from the reprogramming but where will we get them . From the reprogramming we will initiate immediately procurements to do domestic manufacturing around in 95 as cougars who can scale up. Forget the emergence of little money on the Strategic National<\/a> stockpile that would at on to those contracts are it will be, i want to caution it will take time because china as you rightly mention china does control a lot of the barometers as well as manufacturing. Thank you. I need to ask you on new jersey specific questions because new jersey has been designated a final effort which meet individuals who are contagious or could possibly be contagious could possibly be contained or courting in new jersey. Im interested in the costs associated with our responsibility to do that and you know new jersey is gearing up for that purpose. What do you think is an appropriate and fair model to reimburse the state for costs that might be incurred over incidences like that, including quarantine facilities, caskets, over time, service, that kindf thing . First, with regard to the emergency supplemental, thats exactly why were asking a large amount of money to state and local governments with larger skill containment activities. With regard to the particular issue of Newark Airport<\/a> Newark Airport<\/a>, individuals for been in china within the previous 14 days would be directed by dhs into newark and others. Weve worked very collaboratively with new york which if we have any cases that required actual quarantine, new york has taken this on out of the Newark Airport<\/a>. And then the others who are not, should be an impact on new jersey because at this point because were screening them with cdc and dhs people for Health Screening<\/a> and then the rest of the people going on. We screened total about 46,000 travelers and it yielded only i believe 17 nationwide who have needed to go into court and because they were in let me clarify something for my own self. That they are being, that they are being brought in and looked at in newark, theres no provision are no discussion about those individuals who need quarantine being on like the joint Mcguire Air Force<\/a> base which is more southern new jersey. I dont believe so but im happy, i can be corrected on that and we would get you up it information. My understanding was what we worked out was that newark with final inpatients to newark were going to new jersey but new york, im sorry. Would you please, because i understand thats going to of allowing that is going to expire on march 5 but if theres going to be this need we need to know what the Emergency Response<\/a> is going to be. Sure. I want to make sure i get your iq for information or if i could i could call your office out of hearing. I think ms. Frankel asked, made a comment about sort of the organization of the administrations response to pandemic diseases and things of that nature. And i was wondering why we dont have a quoteunquote jar, and why this administration is not organized in a way that there is a person at the top who represents sort of the policies and has some authority . Because i know we had to push back between cdc and the state department in terms of flying individuals who are contagious on airlines. So why dont we have that structure . What is the plaintiff such a structure and is their plan to have a czar . If i might come under the National Response<\/a> plan Emergency Support<\/a> function a for Public Health<\/a> emergencies im the lead. My is a lead agency. Help build these plans decades ago for pandemic preparedness. After 9 11. I serve as the lead on this while its a Public Health<\/a> emergency. I work on a daily basis with the chief of staff and the president , so if theres any deconfliction of agencies needed, that could happen there. We effectively get the same function and distill the longstanding doctrine that this should be led by hhs with the Public Health<\/a> emergency. Thank you very much. Thank you, mister secretary. After hearing your testimony the inference that no one in the Administration Knows<\/a> about coronavirus is stunning. Your knowledge as much as you can get about it. The other fake news, the budget referred to cuts to medicare and medicaid. I looked at that. Medicare and medicaid has been in every year in the president s budget. I know what the answer is. Only in washington is an increase call the cut. We believe it at that. Lets talk about the Emergency Fund<\/a>s. I have not been aware of anything that hasnt been done. We know moderna shipped their novel vaccine six weeks after the idea of making a vaccine shipped from phase i trial to nih. That is an American Company<\/a>. It is, right outside boston. This is stunning and this ways on the framework the Ranking Member<\/a> mentioned over the years of us preparing for this potential crisis. It is stunning that 6 weeks from compatible conceptualization, i urge you to speed that through the phase 3 trial and get it here before the next winter season. Another American Company<\/a> developing a novel approach to an antiviral that could be effective in coronavirus. That is pretty good i think. We have incentivized it is amazing the two companies that have taken the lead in a pharmacological approach to deal with this are american companies. What is disappointing, the president warned us china is a bad actor. We have the genotypes from china of the first cases of this. I dont believe we have the genetic sequence. That is a real problem. We can talk about what this country can do but when you talk about dna sequencing, nra sequencing of a vaccine it depends on an accurate genotype the china is unwilling to share with the United States<\/a>. I dont know why they arent willing to share. You can use your imagination why they are willing to share. To hold the president of the United States<\/a> responsible for the behavior of china in response to this is unconscionable. It is unconscionable. That is all i hear in the subcommittee. No one is talking about chinas role of withholding the genetic sequencing. It is important to figure out how the disease will affect americans ultimately. But there are other things and i want to congratulate you, making two novel vaccines, we thought about this in advance and then what we needed to do and i believe we are on track to dealing with this. I was in obstetric anesthesiologist. I have seen patients get very very ill. I havent seen a mother die. It happens more often than it should and i are you doing things about it. It is incredibly important and to begin strategies to fight coronavirus. We have to realize the antivirals, viruses develop resistance antivirals too, not just bacteria. Keeping the drug pipeline open and working is very important. For a year and a half medicare does not pay for oxygen therapy and i had cluster headaches that works for me, dont tonight a medicare patients. I am disappointed the administration hasnt taken action. The rebate mechanisms, driving up the cost of pharmaceuticals, i would ask you to take action on it. We have 2 one of the most frequent questions i get asked is what to do about Prescription Drug<\/a> prices. Instead of separating into opposing camps, lets agree on some common things we could do. Incredibly important to make sure as we know it is true in my district the number of overdoses continue to rise, the number of deaths has gone down, mostly i want to thank the department for what it has done. I yield back. Thank you. Thank you, mister secretary, for being here. I come from the state of illinois where we had some cases of coronavirus and i want to shift my line of questioning not just around appropriations even though we are at the subcommittee but more about preparing communities. 85 of the town they represent our 5000 or fewer, a lot of small and rural areas. With the expected increase in cases we learned about, what will you and your Department Due<\/a> to prepare our local Health Providers<\/a> to be ready for this . Thank you for your leadership on rural health and appreciate you coming over and meeting with me. Thank you. In terms of Rural Communities<\/a> and rural hospitals and providers and the coronavirus situation we dont know how broad the threat would be. It can be really localized and taking mitigation efforts. Doctor shelton is the top official, she tried to clarify one of the miss impressions people have had from the current active containment efforts. We are bringing people back from china or japan, repatriating them, active containment. We are using Ebola Treatment Centers<\/a> as isolation units even though they dont require that level of medical care because we are in active containment, we dont have another place for them to be so the impression is getting created that anybody who gets the coronavirus not only goes to the hospital but also goes to very intensive type negative airflow facility which Rural Communities<\/a> dont have. What she said is most people who get coronavirus will stay at home, treat it the way they would a severe flu or cold, managing symptoms, and publish clear information when you should seek medical attention. Went to go to the hospital for rare instances when that would be required. Part of it is managing that patient flow so we dont collapse our rural hospitals unnecessarily. The really important, we all Work Together<\/a>, educate the public and providers about that. No different in Rural America<\/a> than Rural America<\/a> how best to increase and head to the it will not be race to the emergency room. State and local support will be really important for local health agencies. Let me shift the discussion to your office in november and that was about Healthcare Provider<\/a> shortage. I will give you an example in the Congressional District<\/a> i serve, we have county called Henderson County<\/a> where the patient or physician ratio is 6995 patients to one. That contrast, if you look at cook county, our largest county in chicago, the ratio is 12001. You also have we have a hospital that took twee 7 years to recruit a position as we talked about this before. We worked together my colleagues and i in last years funding bill to direct the Health Resources<\/a> to provide a report to our committee within 120 days of how recruitment could be better handled to address these provider shortages. I did note that the president s budget, the proposal is to help the Workforce Program<\/a> by 824 million or 50 . I was wondering how your department will square that massive cut with ending provider shortages especially in Rural America<\/a>. I understand your concern and your question really lets us through tuition reimbursement, nurses, doctors, dentists and reimbursement system to serve in Rural Communities<\/a> and underserved areas. The other programs that we proposed cutting doesnt have demonstrable results in producing that kind of service in rural and underserved areas, it goes to institutions, subsidies around teaching. The other thing we want to do is reform graduate medical education which is why we advocate combining the medicare, medicaid, and childrens graduate medical Education Programs<\/a> and getting rid of the caps from the 1990s, freeze in place specialty to enhance our primary care doctors the site and other underserved specialty areas to get into rural areas. I have several followup questions i can get to you later because im out of time right now but thank you for being here and thanks for your answers. Congresswoman lee. Thank you very much, thank you, madam chair. To the Ranking Member<\/a>, thank you, mister secretary. A couple questions. Let me follow up on the masks. Last week i came through the International Terminal<\/a> from the bay area of San Francisco<\/a> and i noticed quite a few people had masks on but they werent in 95. The reason i knew this was because of the fire in the bay area. I have an aunt who is 95 years old and Senior Centers<\/a> where they were wearing masks. But came to find out they were useless in many respects. That is how i learned when there was only one place i could purchase it. I wanted to ask, rolling out education with regard to which masks are the appropriate ones to use and which are not because when i entered the terminal last week no one had a mask on. How are we letting the public know the difference between the masks and what you want to use. Im glad you asked about that. We have press conferences and all. Especially even coming out of asia where there is a culture of masks when one is cigarette risk of being sick, the sense that the mask is the be all end all of preparedness and response activities. It is an element in our armament mostly for healthcare workers and that is a mask that is fitted and has to be carefully fitted and can protect the worker. The other mask, just you and me wearing these masks, and what doctor foundry have said is that could be more harmful to you then not wearing a mask because if it is not fitted right you will fumble with it, be touching your face which is the number one way to get diseases, unclean hands touching your face so at every press conference i have been asked about masks i try to settle these expectations that that is not the be all end all. Basic Public Health<\/a> hygiene, washing hands, soap and water, not touch your face, coughing and your elbow, these are the best things for flu season, common cold, coronavirus that any of us can do. You are not adjusting the Public Access<\/a> the masks. We do not recommend that. Let me ask you about these cuts in your budget. First of all, hiv and aids. We know we can achieve and aids Free Generation<\/a> by 2030, you have a funding cut of 170 million which reduces the transmission of hivaids throughout the world and you have a cut in medicaid which is the largest source of coverage for people with hiv. It is estimated to be 42 of people. You are proposing an increase or a new money for ryan white and cdc, you are cutting medicaid which affects 42 of the people. I will do this quickly, you propose to eliminating teen Pregnancy Program<\/a> and i wanted to follow up with congresswoman frankels session with abortion the visit ministration has yet you move forward and eliminating programs that prevent abortions such as the teen Pregnancy Program<\/a>, you just 0 that out. You 0 out the racial and ethnic approaches to Community Health<\/a> which is the only federal program that funds Community Based<\/a> organizations to address Racial Health<\/a> disparities. For the most part you cut 30 million for the National Institute<\/a> of Minority Health<\/a> and health disparity. The impact of these cuts on minority communities, on young people, People Living<\/a> with hiv and aids are horrendous and i wonder how you justify cutting these programs which do good and help people and provide good quality Public Health<\/a> strategy. We clearly agree with you on the importance of solving Minority Health<\/a> disparities while supporting Minority Health<\/a>. We approach it in different programs and ways of doing it. 5. 7 billion for our Health Centers<\/a> which serve one in 12 americans and 62 of patients are racial and ethnic minorities, one of the gems of the health system. Area our hiv program, the one im very passionate about to end the hiv epidemic, the investment in hivaids is critical and that serves 75 of clients who are racial and ethnic minorities. You are cutting medicaid which there 42 of people. We are not proposing a cut to medicaid. We would slow the growth of medicaid from 5. One per year, to 3 per year increasing every single year of the budget outlook in terms of medicaid. It grows medicaid by not quite as much as the unsustainable current pathway for states. If we have a second go around, prevention, totally crazy. Thank you, madam chair, thank you for being here. When i was preparing for the hearing today i wanted to focus on the low Income Housing<\/a> Energy Assistance<\/a> program. There has been a lot of unpredictability because we simply cannot understand the formula that is being used in this impacts over 7 million families. I was planning on asking you to follow up on the request of this committee that you provide an explanation of the formula. I was given this particular this is the formula i was given yesterday by some advocates so i can understand why it is difficult for you to understand but i am wondering, i was planning on asking if you can tell us if you are going to have the formula exploration ready for us with the 120 day deadline we gave you. We ward on getting that you. Im not only with a request you had in terms of information but we will get that to you. It was in our fy 20 funding bill and you have 60 days left to comply with it. I would get cracking if i were you. Put coronavirus on hold. Maybe it doesnt matter because you completely eliminating it in this budget. Is that right . As we have before, with the budget environment, with budget caps you decided to eliminating we did recommend it is not an effective program, it is applicable other programs. Did use your up the budget item . You make the choice is whether to accept that. With that is your recommendation and basically you said that is because you think utilities cover this because many more states you cannot have your utilities cut off. That is correct as well as gao findings on the record fraud and abuse, it is a tight budget environment and making choices in a Discretionary Program<\/a> you decided seniors, families with children, that is going to be where we make our decisions in a tight budget environment. I want to note many of the Rural Electric<\/a> coop and municipal utilities and many of the larger utility companies, the rural and municipal have none of these protections and in many states, it is not based on income but the weather, and trying to figure out a federal formula that nobody understands. You not only eliminated it but decided to transfer 37 million to fighting the corona virus. That is another 750,000 families. This will be towards the coronavirus and you also did that with 535 million in ebola funding. Do you agree with those ebola stats . I mentioned on the emergency supplemental we proposed funding through various transfers and reallocations, congress can decide other Funding Sources<\/a> or no Funding Sources<\/a> for the money. The ebola money is useful to us, the most pressing need is the coronavirus. I agree with you. That is a pressing need but i certainly think you understand as secretary that Public Health<\/a> crises keep coming and that is why you prepare. Im mystified why the white house totally took apart the pandemic chain of command and you think you dont need it. This is one of the smoothest operations. Breaking news, the white house didnt inform you, there is a press conference at 6 00, the white house is in fact now saying we might need to appoint a czar to overlook this pandemic. Not at all, the president and i spoke as he returned from india and he said i want to keep being radically transparent, would you briefly this evening, lets invite the press in. Quite that simple. Quite that simple. You have taken that apart and recommended 700 million in cuts to the cdc. You underfunded our Emergency Response<\/a>, 6. 1 billion was what the president asked for in response to ebola. This president is asking for 1. 5 billion to address this pandemic, but how if you consistently underfund the cdc, taken apart the chain of command, youre using other critical Public Health<\/a> and security measures to fund this coronavirus even if these very low levels, possibly able to be transparent as you just said advocate americans and say your country is doing everything we can not only to prepare for this crisis but for those that we know are coming in the future. I am sorry, my time has expired. We are going to move to a second round and asking people to do three minute so everyone has a chance to say or do what they need to do and then we will wrap up. Just says here the white house is weighing to whether or not to appoint a coronavirus czar for spring epidemic. I dont put much stock in Anonymous Sources<\/a> in politico. We will see what happens. Let me move to a different area. I am told significant incident reports may prove past account of trauma or activity. The vast majority of children that end up in or care are fleeing unimaginable violence, Gang Activity<\/a>. And sharing incident reports collected by case managers. It is my understanding you have said secretary azar, you talked about consent with our children capable of giving consent to sharing notes from their controversial therapy sessions with ice . As we discussed, the transmission of the clinical notes should not happen. That was under the obama guidance that led to a misunderstanding where providers were put in clinical notes you completely into the serious incident reports, that should not have happened when we learned in august of 2019, we corrected the understanding of providers. A serious incident report must be completed, harm to self and harm to others echoing into the fir which gets transmitted to dhs, Important Information<\/a> about the child but that should be minimal information. We believe in respecting the psychiatrist a Mental Health<\/a> professional relationship. Our children who are not they are in our care and they have to consent to medical treatment all the time. It is part of how or has to operate. These are kids who left their parents, whose parents abandoned them, they consent, that is what they do whether they are getting vaccines to keep in touch with parents as best we can. That requires probably to have Legal Counsel<\/a> in order to provide a child with recommendations. I dont know whether you require Legal Counsel<\/a> if a child has asked to consent to severe clinical notes or incident reports to dhs. We provide Legal Counsel<\/a>. We serve as guardian for these individuals. I understand that but the guardianship, there have been changes made but guardianship hasnt been that substantial as we have found out about how we guard these children. It hasnt been the case. I would hope we get to direct legal representation. What guidance have you given clinicians to distinguish in the childs fire or their report that Gang Activity<\/a> or violence without associating that child as a gang member. There is an important distinction if that justifies sharing information with law enforcement. We would be happy to work with you. The guidance the went on in august of 2019 i dont know about the divide between witnessing versus participation. Would like to see that guidance and figure out what your oversight is with regard to the transmittal of this information. Thank you very much, mister secretary, for staying over 2 hours to talk about the importance of this subject. With regards to the budget request, i applaud the department for doing whatever department should do and they come to congress for emergency request which exceeds our budget caps, directly contributes without constraints of the budget to our deficit of asking for only half of it coming from new funding, and gained efficiencies. The 533 million from ebola, you mentioned we have a vaccine, we are participating with the National Community<\/a> controlling ebola. Instead of asking for new money above budget caps, 8 billion of something. Is there anything that could have been done . No. Thanks to this committee, Rapid Response<\/a> funds and transfer authority with emergency supplemental and using that money to see contracts to execute the expansions. We have novel vaccines, we have a novel antiviral having been developed. Used to be the maryland legislature, we meet every year but congress meets all year, dont we . Do you take august recess in october recess . Now we dont. We could, god for that this becomes more serious and it could be. We could come back anytime and pass for Emergency Fund<\/a>ing above our budget caps. We could. It is important to remember this request is only for 2020 funding. Through september of this year we said we would work on modifying 2021 requests based on the progress of the disease over the next week sentiments. The plan transfers that occurred as i read this charges 135 million out of 81 billion. I think it is less than 0. 2 . You are being generous about that. To clear up one question, the question came out, i recall in the obama budget i do not remember the case. What was cut . It was cut in Previous Administration<\/a> budgets, doing what previous following the lead of Previous Administration<\/a>s. I applaud you following the lead on that on other things i dont. Titles and funding, you and i understand what it was intended for. It was never meant to promote or Fund Abortions<\/a>. There are a vast number of americans believe taxpayer dollars to not be used to promote Fund Abortions<\/a> and i congratulate the administration on restoring title x potential purpose and allowing us to go home to my constituents who strongly believe or oppose abortion and believe the federal government has no role promoting or funding abortion so thank you and i yield back. Thank you, madam chair and Ranking Member<\/a>. I want to make sure i understand on this czar part, use the dont put much stock in Anonymous Sources<\/a> in politico. That is neither a yes or no. You had a conversation with the president. Have your discussed having a czar . Im not going to discuss my interactions and advice to the president but the president is the one who said consistent with the National Response<\/a> framework, support function 8 which i played a role in designing you dont anticipate a czar . I dont anticipate one. This is working well and if theres a need for a change than that would be for the president to decide perhaps there is a multiesf leadership. In your conversations you dont expect a czar to be appointed anytime in the near future. Jared kushner will have more free time. He takes on a lot of responsibilities. Back to the question ms. Granger asked, china are x, when you look at the amount of stuff that is being done this is your wheelhouse where you came from. I saw the president had a directive military personnel, buying american, are you concerned that so many of our drugs or essential ingredients in drugs are made in place like china, 90 of generics are 80 of production and the essential ingredient, to cause some problems given the recent commerce activities how they could hold things up in the h wuhan province where people may need to stop working. Are we going to get production back in the United States<\/a>. Having our supply chain, so intertwined with china, dependent on any other country is a challenge. I know i have a deep passion against getting drug prices down. There is a reason to be made a in china or india, lowcost manufacturing that very point. How much does it cost to produce a pill . 1,000 a pill. What is the production cost on average . The differences in generic manufacturing other production depend on the product. It would depend on the product. Manufacturing generics, it is materially different, lowercost countries than the us. The cost difference, are they saving a nickel or 0. 50 risking important to remember there is a very lowmargin highvolume business. What we may think of as a penny differences bankruptcy versus a Generic Company<\/a> with a different manufacturing competitors. I dont know the solution. I dont want to do something that causes generic prices to soar of course. I want to shift gears to the announcement for the healthy adult opportunity proposal. I noted, children in lowincome households would not be, quote, directly affected. One of the things that goes unnoticed is kids are 20 of the medicaid population, 20 or less of actual dollars spent. Any shift in medicaid needs to be done with a specific eye toward safeguarding the recipients of the program. Mostly for certain things, children are front and center in that. I wanted to know how the department is going i know the answer i heard before, states can do that. I dont trust my state will do that, trust but verify with regard to how my state will make sure the adults are protected and we will push the kids to the edge. Children with disabilities on medicaid say they are on back of the waitlist with regard to medicaid. How will the Department Step<\/a> in . This is different from some of the republican states rights questions. What if they havent seen the best instances of children being protected at the state level, how your department do that . I would just note first that the actual proposal or opportunity is literally called the healthy adult opportunity. It is an optional Demonstration Program<\/a> for states to restructure benefits for adult populations. It is important to remember this is not a mandatory change, it would only be of a state wanted to do it. It would require cms approval. There is no entitlement on approval. It is a pathway open to look at these. It doesnt allow stripping of benefits, limits on eligibility. That, even with regard to that, it requires coverage of essential Health Benefits<\/a> so even with regard to adult his name is in the title, all of those protections are in place and that is why for lowincome individuals were pregnant women or elderly adults, people who are disabled, the traditional medicaid populations are not impacted by this. It would be at issue. Glad you mentioned pregnant women receiving medicaid. That is the other piece. In my view the goal should be to keep medicaid as a safety net for those it was intended to serve and those who shouldnt, were not part of the original outlay we need to get them to different programs and options to get them care so we are not breaking the safety net, one of whom has multiple different abilities. Continuing the discussion on child health and disease particularly with regard to research you receive less attention and funding compared to other age groups. In the 2021 proposal what is the administration doing for Child Health Research<\/a> and childhood diseases . The president s pediatric Care Initiative<\/a> which you funded through nih is important because children and cancer have been neglected too long. Different of these profiles, to share information so we can help discover cures targeted for kids, the budget continues that funding with 50 million in 2021 on top of that. Congresswoman frankel. Your turn. Thank you. Going to get back to our last subject. The misinformation you put out or a spin. Planned parenthoods last report, 2. 4 million patients, 9. 7 million Services Provide<\/a> over 4. 7 million sdi testing and treatment, 2. 6 million Birth Control<\/a> information services, they estimated approximately 400,000 unintended pregnancies were a verdict, 500,000 breast exams, 1. 2 Million People<\/a> reached through education and outlay. I would say and most people in the public would say planned parenthood has done a really good service especially poor women, women of color in this country and your administration has, with a very cool gag rule, putting the gag rule on steroids, they gag you, put a piece of cloth across the doctors mouth. We all need to understand federal money is never used for abortions and planned parenthood has never used federal money for abortions. You get the little red sticker from somebody. The fact of the matter is now, with the new gag rule on steroids, a provider who does not use federal money for abortions cannot even tell somebody, when the going to the office, if a patient says what are my options . They are gagged. The provider is gagged. What planned parenthood has done which i think is very courageous but will hurt a lot of women is they said we are not going to be untruthful with our patients. We are an organization that a patient comes in for care we are going to tell them the truth and i wanted to give you another example of the alternatives that are being provided in this country, now that planned parenthood had to withdraw. In louisiana, alternative providers include dentists and nursing homes. And in florida, it includes school nurses. In ohio it includes food banks. I am running out of time. I will end by saying this. We need to be in charge of our own bodies in order to have full, productive lives, not donald trump be in charge of our bodies. With that i yield back. Just a couple quick questions. I know youre working hard on the president s request for hiv testing and hopefully illumination in the next 10 years this dreaded disease but the interior subcommittee did not provide Additional Resources<\/a> as part of this initiative. We had a little discussion about this. What can be done as we move forward . That is no criticism of our colleagues, they have a very lowbudget, chairman and i were talking about it. Very difficult to provide the resources they would like given the range of responsibilities they have so i sympathize with them but this is an Important Initiative<\/a> that we have to get funded. It is quite important. We use 20 congress had given us in 2019 to do four jumpstart project. We funded planning and all of the 57 jurisdiction so that as soon as you funded the president s request we would be able to get off to the races as we did with funding, 117 million i announced on executing. We have four jurisdictions, one of which was Cherokee Nation<\/a> we advance funded so they could get moving right away on it in anticipation of funding of probable territory. We have in this budget request a request of 27 million that would support critical needs of the disproportionately affected in indian countries, expanding hiv testing, connecting American Indians<\/a> to care, previously undiagnosed hiv infections in treatment so they can be if they are undetectable they can be not transmissible, getting prepped among people who are risk to ensure they cannot transmit to others and supporting disease surveillance in tribal epidemiology centers. Appreciate your efforts. A great time left, this is a big question but all of us now suicide rates have been rising in every state in the country. Im interested in what you have in your budget that might help us to do more in that particular area. We have been very active especially in with regard to our veterans, the suicide hotline has an important function. The first question you are asked if you call the suicide hotline is are you a veteran . If youre a veteran we have an immediate transfer over to a live person who will give immediate counseling tailored to veterans at the risk of suicide. We collaborated very closely with nih and dod and came out with Artificial Intelligence<\/a> algorithms that help us predict based on veterans history certain categories, certain individuals who are at much higher risk, those individuals into proactive intervention. We hope the collaboration between us and dod help with the devastating issue of veteran suicide issues. We are investing in Suicide Prevention<\/a> programs, 93 million Mental Health<\/a> Services Block<\/a> grant with increased 35 million and many other programs in the budget, it is very important priority. Mister secretary, i need you to check with your department. My understanding is new jersey was specifically told to house a deal with those individuals that come through the funnel airport and they were looking to use the joint air force base, the ability to use that is being illuminated as of next week. Two other things. Im pleased you find maternal morbidity and important issue. Nearly half of pregnancies are unplanned, women need to be able to have the healthcare they need. I have been helping moms act in the enrollment period. You can do that by executive order. It is a special enrollment period. I didnt know that for new pregnant women there is not currently a special enrollment period. It is not eligible, i did a lot of work with the special task force, as a result, we did a report by a series of working groups, and would your Department Care<\/a> to address the cut to the nih. To enter this report to ring the bell, into the record and i would likely opportunity to work with you particularly with access to services and things of that nature are addressed. That is valuable for our work on suicide. Congresswoman lee. I want to go to a couple remarks and questions. Since we began this when president bush was president. We try to make sure we are on target in reaching the 2030 goal of eliminating hiv and aids. This calls for a cut which does not make any sense if we Work Together<\/a> to get to our goals. Not sure what the rationale was, that is a significant cut. We need to increase it. With regard to teen pregnancy prevention, for the life of me i cant understand why you would illuminate this when we know for a fact, a wide range of images innovations to support the Sexual Health<\/a> of young people is extremely important, it helps develop it really develops the education, i cant understand why you eliminate that program. Also, young people who are already marginalized, eliminating this program what is the rationale and the basis for that and finally you mentioned Community Health<\/a> services which there are many gaps in rural and urban communities. They dont address the basic Racial Health<\/a> disparity and you know what they are. The Reach Program<\/a> provides strategies to address the basic Racial Disparities<\/a> in Chronic Health<\/a> and the National Institute<\/a> of Minority Health<\/a> impact billions of americans by providing the Health Delivery<\/a> system. To reduce help disparity as relates to minority communities. Why would you cut that . Always under attack through this budget. The funding levels i would say this obviously important to see the fruits of building a Public Health<\/a> capacity. As i traveled to rwanda and uganda and i saw the fruits of that important work. The teen Pregnancy Prevention Program<\/a> we disagree on whether those are interventions that based on evidence perspective deliver the rate of teen pregnancy was declining long before the tpp was put in place, serving less than one of the population and a longitudinal study during the Obama Administration<\/a> looked at 37 of those programs and found 73 of them had no impact or detrimental impact in terms of teen pregnancies. It not only fails in getting on people to delay but can harm young people. I want to correct myself, 67 days to cut the congressionally mandated report. A bigger challenge than we first reported. I want to add the president obama never proposed eliminating, and it was strong, bipartisan opposition, from your proposal to eliminate it. I ask unanimous consent to enter this letter, into the record but february 21st, concerning the dangerous practice we are seeing emerging asked oh rr, where you are obligated to act in the best interest of immigrant children in their care but reports are the notes being shared by oh rr with ice and it is being used against the children in deportation proceedings and controversial. What do you do to halt this. Glad you raised this. I had a discussion with the chairwoman about this, between the Mental Health<\/a> provider or the child, there are exceptions in which there was risk of harm and guidance put out in 2016 in the Obama Administration<\/a> that was not clear, one was clinician notes were provided and that is not correct for dhs, they cut and pasted notes during incident reports in the management system, harm to self or other by law and they couldnt paste it in and that was provided. In august of 2019 before any media reports we stopped at and issued corrective guidance, it is minimal information should go in instances of the report. As i think about places you can address this coronavirus and i dont know why we are building a Public Health<\/a> response once the pandemic threat is already here. Has the contract for homestead where we were paying 720, 000 a day to not house children, has that ended as of november 30th . I dont think it has entered out of november 30th, but i can claim why we have that contract which is in response to the effect the chairwomans concerns around the care for kids, increasing capacity but we need influx capacity, if mexico changes border policy and the number one priority is not letting me backed up at the border. That 80 million we spent not to house children you feel is better spent than putting that money to coronavirus . That is an incredible set of priorities. Thank you. Just recognize the Ranking Member<\/a> for Closing Remarks<\/a> and mindful of your thank you. I will be brief. Thank you for the hearing. Excellent hearing. A lot of good questions, excellent points made by every member of the committee and i look forward to working with you on the supplemental. The points you made were good points. We intend to Work Together<\/a> on this and certainly work with you, mister secretary. Let me finish by thanking you and your team. This committee has worked hard for five years on a bipartisan basis to create the institutions that are serving us very well now. Your entire department, specifically the nih and the cdc, strategic stockpile, creation of the Rapid Response<\/a> Infectious Disease<\/a> Rapid Response<\/a>, all those things put us in a position to do well and you have done a good job and you have been very transparent with us from day one of the congressional briefs have been excellent. A number of members of your department for this committee and a special Briefing Session<\/a> and my good for the chairman has been extremely helpful. The contrast between what i saw yesterday in the senate and what i saw on both sides of the aisle makes me very proud of the chamber and the subcommittee. We have a lot of people saying a lot of things that havent been participating in the process or have not been transparent. I also went to thank you. It is a sincere commitment that if we need to go beyond the initial recommendation to protect the American People<\/a> we are prepared to do that. I want to be prudent in the use of funds. And you made the statement you would rather do too much in retrospect than be accused of doing too little and you have been true to that commitment every step of the way. The people that work with you have as well. Im confident you will continue to do that. Thanks for your hard work and honesty and transparency. We will try to help you in the places you need help and help you in places you probably officially dont need think that we officially think you do. I look forward to that working relationship and thank you for your service to the American People<\/a>. Thank you, madam chair. Mindful of your time frame. The issue of suicide makes me review whether or not you want to cut 25 million from Prevention Research<\/a> where the focus is on suicide, mostly suicide with veterans, i dont care who how good the hotline is, we need to know what is going on in the minds of veterans and others to be able to understand why they are taking their lives. We are not going to talk about facilities today, but we are. Very flat out, i will tell you it is my goal, with an antifacility and millions of dollars being spent, and numbers declining as they are, we are nowhere near capacity at state license shelters, we ought to shut them down because we cant deal with the issues and other ways. The issue came up with regard to cuts, determining whether a federal Budget Proposal<\/a> count as a budget cut, a proposal that would reduce funding for programs, reduce the number of people who qualify for benefits relative to levels that would occur under current law. We are cutting 920 billion over ten years to medicaid, 750 billion over ten years for medicare. Let me just as you mentioned this, mister secretary. We are cutting Infectious Disease<\/a> Rapid Response<\/a> fund by 35 million, 41 . Youd are not replenishing it in your supplemental. The Public Health<\/a> data initiative, 20 million or 40 cut specifically asked by the director redfield in order us to modernize our efforts to transform Public Health<\/a> data into analysis so we can move more quickly to Public Health<\/a> workforce which we talked about today, 6 million, 12 . The epidemiology and Laboratory Capacity<\/a> program by 40 million, 18 . This flies in the face of what you have talked about in termsf what your goals are. Lastly, about information sharing with dhs. Is orr sharing information about rejected sponsor applicants with ice, dhs . So we have shared the names and addresses of 141 individuals who were denied sponsorship due to criminal history or fraudulent representation to orr they have bona fide relationship with the child. No parents were included in that group. Whenever you are prohibited by law from detaining sponsors based on probation that hhs collects a potential sponsors during the vetting process. Again i dont detaining sponsors. But also the department of Homeland Security<\/a> is complying with the legal restraints in the act what this is not parents. This is individuals denied sponsorship due to criminal histories or due to fraudulent representations to orr that they have bona fide relationship with the child. No parents being included in the group. Can you tell me is orr sharing information with dhs on in adults who does not fall into the categories included in the dhs writer . The prohibition on use of funds to detect a spot unless they have a certain specific criminal criteria . I would want to get back to you on the detail they are. We are complying with the writer but if theres anything beyond that i dont have the detail. I would like information. What kind of i will exist between orr information about sponsors and ice given that information sharing or Enforcement Actions<\/a> is prohibited . I use before enforcement may be prohibited but theres no firewall thats required. Information is shared and its been shared for i think quite some time. For instance, we share information on sponsors within 24 24 hours of discharge, and thats part of, couple things. One, the sponsor has to certify to us and to dhs that if they move the child that that would be reported. Renumber this as a child who is not legal in the country and subject to proceedings. And second, that the sponsor is in not legally in the country and about the border. Thats not safe for private first a place to chill. There is less than a check and information sharing. I think that is going on. When you get a very, very detailed view of the current information that is being shared and whether or not it is in contravention of the writer in the bill, and further to that is that, because ice walks into a state licensed facility and fingerprints. You may amend not know about it. Ice is transmitting ors transmitting clinical notes. There are all kinds of avenues which are being breached in terms of the privacy and the care of these children and the implementation of these children. We need to get to the point where thats no longer the case and that orr and dhs have all these concerns about the welfare of the children. And yes, i understand criminal activity. I understand Human Trafficking<\/a> but we have seen over the last year and half or more that we are moving into what is really unbelievable Mental Health<\/a> issues arising out of intimidation of children that are in our care. They are in your care but they are in our care, and were not going to continued to put up with that. Thank you for being here this morning. Thank you being upfront with us on issues. As my colleague said, we want to be ahead of this crisis on the coronavirus. We do not want to be behind the curve, so thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] health and Human Services<\/a> secretary alex azar will be back testifying at another hearing about the coronavirus this afternoon and the Trump Administration<\/a> hhs budget request. He will take questions from members of the house energy and commerce subcommittee on health. Live coverage begins one p. M. Eastern here on cspan2, online cspan. Org or listen with the free cspan radio app. The South Carolina<\/a> primary is saturday. Join us to the candidates reaction to the results. Live coverage saturday evening on cspan, dement cspan. Org, or listen live on the free cspan radio app. Sunday booktv features conversations on u. S. President s and race plus america as a superpower. Starting at noon eastern, a live conversation with author White House Correspondent<\/a> april ryan. I study for this at Morgan State University<\/a> just down the road. Studied for this. This is my vocation, not knowing that i would be under fire by asking questions. I have asked questions of each president , the same question except for one, if each president over the last 21 years, but asking questions now has me fearing for my life. Hurt latest book is under fire. Join the conversation with your phone calls, tweets, texs and facebook messages. And an ipp turn on after words in his latest book americas expiration date, cal thomas explores the rise and fall of nations historically and americas role as a superpower. Hes interviewed by author and cnn contributor amanda carpenter. We are not each others enemies as lincoln said. If we dont make this great experiment called democracy or Constitutional Republic<\/a> work for generations, we will expire. There is no guarantee things are looking great but when things are looking great, its time to shore up the foundations. Watch april ryan and cal thomas sunday on booktv on cspan2. At our table Jennifer Nuzzo<\/a> who senior scholar associate professor at the Johns Hopkins<\/a> center for Health Security<\/a> here to talk about the coronavirus and the response to it. Lets begin with this virus. What exactly is it and how is it that it became something that went from an animal to humans . Guest so its a respiratory virus. There are coronavirus is the sake of it among the population, frequent cause of the common cold but this is a new winter people dont have any immunity. Seems to be producing more severe symptoms thanon","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia802801.us.archive.org\/17\/items\/CSPAN2_20200226_143100_HHS_Secretary_Azar_Testifies_Before_House_Appropriations_Subcommittee_on...\/CSPAN2_20200226_143100_HHS_Secretary_Azar_Testifies_Before_House_Appropriations_Subcommittee_on....thumbs\/CSPAN2_20200226_143100_HHS_Secretary_Azar_Testifies_Before_House_Appropriations_Subcommittee_on..._000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240716T12:35:10+00:00"}