Best practices within the ihs system itself and shared those and incense vized the ability to move that kind of activity that is providing highquality care for individuals in that system, in certain areas, and making certain that were able to extend that across the country in the ihs. Okay. We look forward to working with you on that. I think Best Practices is a good place to start. Obviously, those have not been employed in a lot of facilities in our state. In 2009, cms issued a final rule that required all Outpatient Therapeutic Services to be provided under direct supervision every year since then. The rule has been delayed. Either administratively or legislatively in small and rural hospitals. I shared this with you as well. In my statement we have a lot of critical access hospitals, rural areas, big geography to cover, and sometimes difficult to get providers out to these areas. So, the question is, if confirmed, will you work to
charge of some of these issues in a way that removes that power from washington, d. C. , where i think too many of the problems have been happening. Thank you, mr. Chairman. Look forward to it. Senator casey. Thank you, mr. Chairman. Dr. Price, good to be with you again. Thank you. I want to ask you a couple questions that center principally on children and individuals with disabilities. First with regard to children, i think if were doing the right thing, as not only as government but as a society, if were really about the business of justice, and if were really about the business of growing the economy, we should invest a lot and spend a lot making sure every child has health care. The good news, despite a lot of years of not getting to that point, not moving in the right direction, the good news is, we made a lot of progress. The Urban Institute in an april 2016 report, i wont ask i wont ask the report to be made
part of the record, but ill read a line from this Urban Institute report. Uninsurance among children 1997 to 2015 dated april 2016, says as follows on page 3, it said that the decline in childrens uninsurance rate occurred at a relatively steady pace and includes a significant drop following implementation of the Affordable Care acts key Coverage Provisions from 7. 1 in 2013 to 4. 8 in 2015, unquote. So, thats a significant drought. 7. 1 to 4. 8 is millions of kids have Health Insurance today that would not have it absent the Affordable Care act, including the medicaid provisions as well. That 4. 8 Uninsured Rate is at an alltime low. That means were at a 98 insured rate across the country
able to commit to us today, that that that the number of uninsured children will not increase under your during your time as secretary for ywer to be confirmed and the number of uninsured would not increase . Our goal it is to decrease the number of Uninsured Population under age 18 and over age 18. I hope you maintain that because i think thats going to be critically important. The reason i ask that question is not just to validate that as a critically important goal for the nation, but its your answer seems to be contrary or in conflict with what you have advocated for as a member of the House Of Representatives, not only in your individual capacity but as chairman of the budget committee. Looking at now for reference a an oped by gene spurling. With regard to with regard to your policies, the effect of what your policies would be, and now apparently contrary to what was said during the kaernlgs its now the policy of the Trump Administration to block Grant Medicaid . With respect to both you and to mr. Spurling, its because you all are looking at this in a silo. We dont look at it in a silo. We believe it is possible to imagine, in fact, put in place, a system that allows for greater coverage for individuals. As a matter of fact, coverage that actually equals care. Right now many of those individuals the aca actually increased coverage in this country. Its one of the things that it actually did. The problem is, is that a lot of folks have coverage but they dont have care. So, theyve got the insurance card. They go to the doctor. The doctor says, this is what we believe you need and they say, im sorry a cut of 1 trillion, a combined cut of 1 trillion that would adversely impact the childrens Health Insuranceprogram and the Medicaid Program is totally unacceptable i think to most americans, democrat, republican or otherwise. Youre looking at that in a silo. You arent looking at that in what reform and improvement would be. Were look at the rebuttal in not just what gene spurling said but a whole line of Public Policy, advocates and experts. And i think the burden for you, sir, is to make sure you fulfill your commitment to make sure no children will lose Health Insurance coverage while you are secretary. Look forward to working with you. Senator hiller. Thank you, mr. Chairman. Dr. Price, thank you for being here today. Thanks for your patience in working with us throughout this Confirmation Process. If you can put your mike on. It is on. Ill lean a little forward. Mr. Chairman, as you can imagine, i committed to ensuring that all have access to quality and Affordable Health care insurance. I have a letter from nevada legislature, directly from our Majority Leader of the state senate and our speaker of the assembly. And theyre good questions. Five questions. Obviously, they want to get the same answers that all of us want here. We have a nevada 88,000 nevadans who have Health Insurance through the exchange. 77,000 nevadans eligible for federal tax credits. 217,000 nevadans that receive Health Care Coverage under expansion. Basic questions. Mr. Chairman, if i may, can i submit these questions to the record, on the record, and also if i may ask dr. Price if he would respond to this particular letter, to these legislators. Again, i think theyre very good question. Without objection. Also if i may add f you could cc the governor also. I think the governor would also like answers to these questions. I think youre in a great position to answer these particular questions. Thank you, sir. Thank you. If i may, can i get your opinion on the cadillac tax . I think the cadillac tax is is one that has made it such that individuals who are gaining their coverage through their employer there may be a better way to make if so that individuals gaining their coverage through their employer are able to gain access to the kind of coverage they desire. The cadillac tax would affect about 1. 3 million nevadans. School teachers, Union Members, Senior Citizens. And theres some disagreement as to whether or not these individuals are wealthy or not. There are some on this committee that believe the 1. 1 trillion tax increase in obamacare does not affect the middle class. Do you agree with that . I think it does affect middle class. I do, too. Do you believe School Teachers are wealthy . Everybody has their own metric of what wealthy is and some people use things to determine what wealth that Arent The Greenbacks i would argue most School Teachers dont think theyre wealthy. Do you think most Union Members are wealthy . I doubt they think theyre wealthy. Yeah, i would agree with that. Do you think most Senior Citizens are wealthy . Most Senior Citizens are on a fixed income. They would argue theyre not wealthy. Thats my argument on this particular tax. In fact, obamacare as a whole is its another middle class tax increase of 1. 1 trillion. My i guess my question and question for you is, is that if i can get your commitment to work with this committee, work with myself to end and the Treasury Secretary to repeal the cadillac tax . Well, well certainly work to make certain those who gain their coverage through their
employer have the access to the highest quality care and coverage possible in a way that makes the most sense for individuals from a financial standpoint as well. Does the cadillac tax make the most sense . As i mentioned, i think there are other options that may work better. Do you believe it is an increase, Health Insurance increase, to middle class america . I do. Okay. I want to go to Medicaid Expansion for just a minute. Nevada was one of 36 states that chose to expand eligibility for medicaid. We went from iveng the enrollment went from 350,000 to over 600,000. And i guess the concern, and i think its part of the letter that i gave to the chairman, is whether or not that will have an impact. What were going to do to see that those individuals arent impacted. Probably the biggest question we have for you here today is what are we going to do about those that are part of the Medicaid Expansion and how thats going to impact them . Yeah, again, as i mentioned to a question on the other side, i believe this is a Policy Question that needs to be worked out through both the house and the senate. We look forward to working with you and others, if im able to be confirmed, and making certain that individuals who are currently covered through Medicaid Expansion either retain that coverage or in some way have coverage through a different vehicle. But every single individual ought to be able to have access to coverage. Dr. Price, thank you. Thank you for being here. Thank you. Senator warner. Thank you, mr. Chairman. Good to see you again, dr. Price. Thank you. Let me start on something we discussed in my office. One. Issues ive been working on since ive been governor, working very closely with your friend Senator Isaacson is the issue of how we as americans address the end of life and those issues. I think we both shared personal stories on that subject. Senator isaacson and i have legislation that is called the
care planning act that does not remove anyones choices. It simply allows families to have those discussions with their Health Care Provider and religious faith leader if needed or desired in a way to prepare for that stage of life. This year cms took a step by introducing a payment into the fee schedule to provide initial reimbursement for providers to have these conversations with others. This is mentioned in a multidisciplinary case team. It also ran a Pilot Program that allowed hospicetype benefits to be given to individuals who were still receiving some level of Curative Services called the medicare choice medicare care choices. I believe its very important that we dont go backwards on these issues. I think we talked about, maybe the only industrial nation in the world that hasnt had this kind of adult conversation about this part of life. Again, not about limiting anyones choices, but would you if youre confirmed, would you continue to work with Senator Isaacson and i on this very important issue . I look forward to doing so. And not be part of any effort to roll back those efforts that cms have already taken . I think its important to take a look at the broad array of issues. One issue is liability. I cant remember if we discussed that in your office. The whole issue of liability surrounding these conversations is real. We need to talk about it openly, honestly and Work Together to try to find a solution to just that. I would concur with that. But i also think this is something that more families need to take advantage of. On friday, january 20th, the president President Trump issued an Executive Order Th that that says federal agencies, especially hhs, should do everything they can to, quote, eliminate any fiscal burden of any state on any state or any cost fee, tax penalty or Regulatory Burden on individuals and providers. Dr. Price, if youre confirmed
in this position, will you use this will you use this Executive Order in any way to try to cut back on implementation or following the individual mandate before there is a Replacement Plan in place . Well, i think that if im if im confirmed, then im humble enough to appreciate and understand that i dont have all the answers and that the people at the department have Incredible Knowledge and an expertise. And that my first action within the department itself, as it relates to this, is to gain that insight, gain that information, so that whatever decisions we can make with you and with governors and others can be the most informed and intelligent decision possible. Im not sure you answered my question. I just what i would not want to see happen, as we take i understand your concerns with the cadillac tax. I know there are concerns about you and others have raised about the individual mandate. There are some that are concerned about the income tax surcharges. Its just remarkable to me, and this is one of the reasons i think so many of us are anxious to see your Replacement Plan, that the president has said we want insurance for everybody. He wants to keep prohibitions on preexisting condition, keep people on policies until 26. It seems like theres at the same time a rush to eliminate all of the things that pay for the ability to have for americans to have those kind of services. And i would just want your assurance that you wouldnt use this Executive Order prior to a legal replacement to eliminate the individual mandate, which i would believe helps shore up the cost coverage and the shifting of costs that are required in an insurance system. Yeah, i a replacement, a reform, an improvement of the program, i believe, is imperative to be instituted simultaneously or at a time in you will not use this Executive Order as a reason to, in effect, bypass the law prior
to replacement in place . Our commitment is to carry out the law of the land. In these last couple minutes i want to go on. I know youve been in the past a strong critic of the center for medicare and medicaid and innovation of cmmi. I believe in your testimony last week, you saw great promise in it. To me f were going to move towards a system that emphasizes quality of care rather than simply quantity of care, weve got to have this kind of experimentation. Theres one such program, the Diabetes Prevention program. That last year cms certified it saved money on a Per Beneficiary basis. I know my time is rung out. I think they can probably be answered yes or no. Do you support cmm Delivery System reform demonstrations that have the potential to reduce spending without harming the quality of care . The second clause is the most important one. I suspect making certain we deliver money that we deliver care in a Cost Effective manner but we absolutely must not do things that harms the quality of care being provided to patients. If part of that quality of
care, and id agree with you, would mean bundled and episodic payment models that actually move us toward quality over volume, would you support those efforts . For certain patient populations, bundled payments make a lot of sense. If these experiments are successful, would you allow the expansion of these across the whole system . I think that what we ought to do is allow for all sorts of innovation, not just in this area. There are things im certain that havent been thought up yet, that would actually improve quality and delivery of health care in our country. We ought to be incentivizing that kind of innovation. I would simply say, mr. Chairman, cmmi is an area i would like to have seen more but its a model and tool we ought to not discard. Thank you. Thank you, senator. Senator scott. Thank you, chairman. Dr. Price, good see you again. Launched the nations first statewide pay for Success Project with Nurse Family Partnership with the use of medicaid funds. 20 of the babies born in south
carolina are born to firsttime, low income mothers. We also have a much higher than average infant mortality rate. Nurse Family Partnership is an evidencebased and has already shown real results. Both in the health of the mother and the babies. But also in other aspects of the mothers life, such as High School Graduation rates for teen moms and unemployment rates. What are your thoughts on incorporating a pay for Success Model to achieve Success Metrics . It sounds like a Great Program that is actually has the right metric. That is the quality of care and the improvement of lives. And as you state, if its having that kind of success, it probably ought to be put out there again as a best practice for other states to look at and try to model. Yes, sir. Thank you. I believe you were the director of the