Head as theyre punching the information into a computer, as opposed to that sharing of information thats so vital and necessary between the physician and the patient for Quality Health care. So one, a recognition of the problem is incredibly important. A recognition of the importance of Rural Health Care in our nation and how it needs to be bolstered up. And then looking at the consequences of what we do as a government. As i mentioned earlier, oftentimes, i dont think we look at the chemical weapoonseq pass the rule and regulation and think its the greatest thing since sliced bread, but its harming the very individuals who are trying to provide the care. You dont get tha iormation unless you ask. I appreciate that. My time is up. Thank you, mr. Chairman. Thank you, mr. Chairman congressman, i enjoyed our visit yesterday. We had a discussion when you were kind enough to come visit me about the fact that i have in the state of florida 4 million plus seniors on medicare. And they are petrified of the idea of privatized medicare. And i talked to you about this and you talked about the premium support system that youre advocating, and you pointed to a study that was done by cbo. You mentioned that you would send me a copy and we havent gotten it. So what i did, i went and got the copy myself and it is september of 2013 and what it concludes is opposite of what you said with regard to highcost states like florida. Medicare is going to be spending 4 lower under the proposal that you were talking about in this cbo report. Lower than current law and beneficiary cost will decrease by 6 on the average, which is what you said yesterday. But in highcost regions like florida, youre going to have a higher beneficiary cost than current law. Under your premium support proposal. Annual premiums in florida would increase 125 , according to the the cbo chart on page 71. Cbo says that the annual premium in a highcost region would go up 436 compared to the current law of 1,600. Thats the 125 increase. So please help clarify what you were saying yesterday as it applies to florida. Thank you, senator. And i enjoyed our time together as well. When we talk about medicare, its important for everyone to appreciate, as i know you and your colleagues do, that the medical trustees, not republicans or democrats, the medicare trustees, have told all of us that a medicare in a very short period of time, less than ten years, is going to be out of the kind of resources that will allow us as a society to keep the promise to beneficiaries. That means we will not be able to provide services to medicare patients at that time, which is very, very close, if nothing is done. So my goal is to work with each and every one of you to make certain that we save and strengthen and secure medicare. I think its irresponsible of us as policymakers to allow a program to continue, knowing, knowing that in a few short years, its not going to be able to cover the services were providing. Thats the first point. That is the current medicare program, if nothing so done, as some have described it, goes broke. Second point is, my role, if im confirmed and have the privilege of serving of health and Human Services, my role will be one of carrying out the law that you all in congress pass. Its not the role of a legislator, i had when i was trying to formulate ideas to hopefully generate discussion okay, let me be so rude as to stop, because im running out of time. Remember that donald trump in the Campaign Said he was not going to cut medicare spending. And i would also point to you in a legislative solution, one of the greatest examples on medicare was 1983, when we were just about to go bust, and it took two old irishmen, reagan and oneil, to agree to come to made medicare in this case, it was not medicare, it was Social Security actuarial sound for the next half century. Let me ask you, representative price, you had made a statement that it was a terrible idea of people who had when he existing conditions, that they would have the protection of insurance against those preexisting conditions. And i would like to ask you is can you please, in light of President Trump, expressing his desire to retain this basic protection, do you think his proposal to continue the ban on discriminating against people with preexisting conditions is a terrible idea . Im not certain where youre getting that quote from . It came from politico talking points memo, may 1st, 2012. Oh, well, now theres a reliable source. What ive always said, senator, is that nobody you didnt say its a terrible idea . I dont believe ive ever made that statement. What ive always said about preexisting conditions, is that nobody, in a system that pays attention to patients, nobody ought to be priced out of the market for having a bad diagnosis. Nobody. Thats a system that may work for Insurance Companies, may work for government, but it doesnt work for patients. So i believe firmly that what we need is a system that recognizes that preexisting conditions do indeed exist and accommodate it and make sure no one loses their insurance or is unable to gain insurance because of a preexisting condition. Mr. Chairman, as i close, i would like to insert in the record the september 2013 Congressional Budget Office analysis of premium support system for medicare. And i would invite you, congressman, to please respond with the cbo report yesterday that you says supports your position, because this one does not. Look forward to that. Senator menendez . Thank you, chairman. Congratulations, congressman price. Let me ask you a series of questions. Given your medical training and time spent as a practicing physician, i have a couple of simple yes or no questions to start off with. In your medical opinion, does hiv cause aids . I think that the Scientific Evidence is clear that hiv and aids are clinically directed or. In your medical opinion, have immigrants led to outbreaks of leprosy in the United States . I dont know what youre referring to, but i suspect that there are instances where individuals have an Infectious Disease and they come to the United States im not asking about an Infectious Disease, im asking specifically about immigrants in the United States causing leprosy in the United States, in your medical opinion and scientific background. Again, i dont know what the incident to which you refer. Are you referring to a specific incident . There are statements that have been made in the Public Domain that immigrants have led to outbreaks in the United States. As the person whos going to be directed as the health of human and service, thats not only the countrys epicenter, i wan to know, in your opinion, is that a causation. Anytime you get two individuals together, in any relationship, whether its an immigrant or a visitor, and one person has an Infectious Disease, its possible that individual transmits that Infectious Disease. Including leprosy . Any Infectious Disease. In your medical opinion, do abortions cause Breast Cancer . I think the science is relatively clear that thats not the case. In your medical opinion, do vaccines cause autism . Again, i think the science in that instance is that it does not, but there are individuals across our country im not asking about individuals, im talking about science. Because youre going to head a department in which science, not alternate universes of peoples views, is going to be central to a 1 trillion budget and the health of the nation. Can you commit to this committee and the American People today that should you be confirmed, you will swiftly, and unequivocally debunk false claims to protect the Public Health . What ill commit to doing is doing the Due Diligence that the department is known for and must do to make certain that factual information is conveyed to and that factual information will be dictated by science, i would hope . Without a doubt. Okay. So let me ask you about medicaid, specifically. And let me just say, im a little taken aback about your answer on the question of immigrants and leprosy. I think the science is pretty well dictated if that regard, too. Let me ask you this, one of the most beneficial components of the Affordable Care act was the expansion of the medicaid program, that resulted in 11 Million People nationwide and over 500,000 in new jersey gaining coverage, many for the first time. Its one of the biggest programs on the republican chopping block, with prems to not only repeal the Affordable Cares medicaid expansion, but going further and gutting billions in federal funding to the states. Theres no doubt that this would result in catastrophic loss of coverage for tens of millions of lowincome families and lead to tens of billions in losses to safety net and other health care providers. Do you recognize medicaid to be a valuable program and consider the coverage it provides to 74 million americans to be comprehensive . Medicaid is a Vital Program for health care for many individuals in this country, but one that has significant challenges. Theres one out of every three physicians who should be seeing medicaid patients, who are not taking any medicaid patients. Theres a reason for that. If were honest with ourselves, we would be asking the question why. Well, if thats the case that one in three dont treat medicaid, you have to ask yourself, is that because medicaid reimbursements are so low . And since provider reimbursements are set at a state level, wont cutting federal funding and hitting states with higher costs only lead to lower provider rates . And how many doctors would actually treat former medicaid beneficiaries when they no longer have any coverage or ability to pay . So even if theres only one of three, theres still two of three that are providing the services. Imagine if you dont have coverage, which goes to my next question. You have advocated to, in essence, block grant medicaid. The essence of medicaid is an entitlement, which under the law it means, if i meet these ci criteria, i have the right to have that coverage under the law. When you move to a block grant, you remove the right and make it a possibility, subject to whatever funding theres going to be. Do you recognize that in doing so, you risk the potential of millions of americans who presently enjoy Health Care Coverage through medicaid no longer having that right . I think its important to appreciate that no system that any that the president has supported or that i have supported would leave anybody without the opportunity to gain coverage. Thats not my question. So let me reiterate my question. Medicaid under the law, as it exists today, is a right. Is that not the case, yes or no . Its an entitlement. And as an entitlement, doesnt that mean that you have the right, if you meet the criteria one is eligible. Meaning you have a right. When you move to a block grant, do you still have the right . No. I think it would be determined by how that was set up, if, in fact, that was what congress did. Again, the role of the department of health and Human Services is to administer the laws that you pass but i would simply say to you, i know in our private conversation, i appreciate you coming by to visit me. You suggested that your role is that of an administrator of a large department. Thats not even what the Vice President said when you were nominated. He said, he expected your experience both medically and legislatively to help drive policy. And even beyond the expectations of the Vice President in that regard, when we have regulatory abilities of the secretary to dictate regulation, that is policy. So please dont say to me, im just here to do what congress says. I respect youll follow the law and do whatever congress says, but you will have an enormous impact. Ultimately, block granting means a loss of a right. And then its just a question of funding and then well have a bigger problem with the number of providers really provided. So i hope we can get to a better understanding of your commitment to medicaid, as it is an entitlement as a right. Thank you, sir. Senator, your time is up. Well go to senator carper now. Congressman price, welcome to you and to your wife. I theres a verse of scripture in the new testament that speaks to the least of these, when i was hungry, did you feed me, when i was naked, did you clothe me . When i was thirsty, did you get me to drink, when i was sick in prison, did you visit me. When i was a stranger in your land, did you take me in . It says nothing about, when my only access to Health Care Coverage was going into the emergency room of a hospital, did you do anything about it . What we sought to do with the aca is to do something about it. And we didnt, in this room, invent the Affordable Care act. The genesis to the Affordable Care act goes back to 1993 when Hillary Clinton the first lady was working on what was called hillarycare. And a group of senators led by john chafy, a republican from rhode island, developed the legislation, cosponsored by, i think, 23 senators, including, as i recall, senator orrin hatch and senator grassley. And what he did in his legislation, what he proposed in his legislation was to huge really five major concepts. One to create large purchasing pools for folks who may not otherwise have access to Health Care Coverage. He called them exchanges or market places. And he proposed there would be a sliding scale tax credit to pie down the cost of people getting coverage in those exchanges. Within the different states. Third thing he proposed was the individual mandate. You would end up with insurance pools that Health Insurance companies could not begin to cover. It would be unworkable. He proposed, as well, employer mandates and proposed, as well, the notion that people shouldnt lose their coverage because of preexisting conditions. Those are not democrat ideas. Those were proposed by republican leadership, actually, in the congress at the time. And when governor romney developed his own plan in massachusetts a decade or so later, he borrowed liberally from those ideas. When the institute of what i and others call romney care, they thought they were doing a pretty good job on covering people, but not such a good on affordability. And what took place over time, you found out you had insurance pools where a lot of people were not very young, they were not very healthy, they were older and needed more health care. And as a result, the Insurance Companies, in order to find be able to stay in business, had to raise the premiums. I dont know if any of this sounds familiar to you,ut it sure sounds familiar to what weve seen in the last six years so with the Affordable Care act. To the ideas of senator schchaf and governor romney, weve added some things. Weve encouraged states to increase the number of people they cover under medicare by raising to about 135 the Poverty Level to which people can receive health care. Weve encouraged a focus on prevention and wellness, not just treating people when theyre sick, but trying to make sure people stay healthy in the first place. We provide funding for contraception, for problems that are intended to reduce obesity. We have programs to reduce smoking, the use of tobacco. This is not a yes or no question. What was wrong with that approach . What is wrong with that approach . And the last thing i say, before you answer, the Health InsuranceCompanies Found it difficult to stay in business and the state Group Exchange across the country, one of the reasons why they were unable to is because i think we didnt raise or have the incentive high enough to get young, healthy people, like my sons, into the exchanges across the country. S p, im told, has just put out about a month ago, an update looking at the Financial Health of the Insurance Companies in this country. And it sounds like they have seemed to have sort of figured it out. Because the Health Insurance companies has begun to stabilize. Your reaction to this, please . As i mentioned, either in my opening or in response to questions, the principles of health care that all of us hold deal, affordability and accessible and choices for patients, i think are the things that we all embrace. The next step, how we get to accomplish and meet those goals and those principles, is where it takes Work Together to do so. The program that you outlined has much merit, whether its making certain that individuals with preexisting illness and disease are able to access coverage, whether its the pooling mechanisms, which ive actively and aggressively supported for years, theres a lot of merit there. So, again, what im hopeful that were able to do is to, in a collegial, bipartisan way, Work Together to solve the remarkable challenges that we have. One of my physician colleagues used to tell me that he never operated on a democrat patient or a republican patient, he operated on a patient. And thats the way that i view this system. Its not a republican system, its not a democrat system, its a system that hopefully were focusing on the patients to, again, make certain that they have the acc