Who has to go to another committee hearing. But i welcome everybody to this mornings hearing on the president s proposed budget for fiscal year 2018 with specific intention to the department of health and Human Services. So let me and i want to thank secretary price for being here. These hearings are an annual event for the finance committee. Secretary price, since this is your first time around, ill just warn you that these hearings can be a little grueling. So of course you already know that. Im grateful that the president and h. H. S. Are eager to work with congress to fix our Health Care System in order to ensure americans are able to access Affordable Health coverage. And with that i am going to turn to the Ranking Member who needs to get to another hearing and well show that deference. Senator wyden mr. Chairman, thank you very much for this courtesy. I know this is a businessy morning and im grateful for you doing this. I want to say thank you to senator stabenow who in my absence is going to do an alent job as she always an excellent job as she always done. This the spin of the truth by this administration was the Budget Proposal which double counted 2 trillion to maintain some whiff of fiscal responsibility while it slashed Health Programs and protections for basic and essential needs. The budget math is fake, but the extreme agenda that would deprive millions of americans of access to health care and wipe out Living Standards is not. Unfortunately, this morning, im going to be splitting my time between the finance committee and the intelligence committee, so i will be brief. There are several issues in the budget in the administrations agenda i am going to touch on. First is medicaid. Secretary price is the captain of the president S Health Care team. He has been the advocate for trumpcare, a bill that cuts medicaid by 834 billion in order to pay for massive tax breaks for the wealthy. 14 million americans would lose coverage, and millions more would see caps on their care. And if that wasnt enough of a cut, the Budget Proposal that came out a few weeks ago goes even further. It slashes hundreds of billions more from medicaid. In a program that covers nearly half of all births, 37 million kids, millions of working families and people with disabilities and two out of three nursing home beds in america, these cuts would be a staggering blow to americans of all generations. These facts and figures have been met by a wave of the hand from secretary price. When asked if his proposed cuts would result in millions of americans losing access to medicaid, he responded, and i quote, absolutely not. He went further, claiming, again, i quote, there are no cuts to the Medicaid Program, and he also said, and i quote, nobody will be worse off financially. Ive heard secretary price and others make the baffling argument that people are actually worse off when they have medicaid coverage, that their health doesnt improve as a result of the medicaid coverage. Often this argument is based on a brief and outdated study performed in my home state. Heres the bottom line on medicaid. 74 million americans rely on this program for basic health needs. Parents with sick kids, people with disabilities, seniors in Nursing Homes who have nobody to turn to for help if their benefits disappear. And in addition, thousands of oregonians who are healthy under my home states model. It would be a tough sell to convince those people that they are worse off being enrolled in medicaid, or that the Program Needs more than a trillion dollars in cuts. And Public Opinion is very clear. Two out of three enrollees are happy with the program. Seven out of 10 americans say congress ought to leave it as it is. No block grants, no per capita caps. Fortunately, the Budget Proposal hits the wall here in the congress, and theres a lot of debate left to be had on trumpcare. But right now, the administration is causing turmoil in the insurance markets, and its already having disastrous effects for millions of families. The president issued a oneday sdemreck tiff order undermining the Affordable Care act. And nobody on the trump team can give a straight answer of whether the administration will continue making cost sharing reduction payments that are key to making insurance affordable for working families. Because of this sabotage, insurers are pulling out of the markets and people are left without plans to choose from. You dont have to take my word for it, the insurers are very clear about why they are making these decisions. Furthermore on the campaign trail, the president said he wouldnt cut medicare. The Trumpcare Bill shrinks the life of medicare, and the Budget Proposal extends the mandatory cuts under the budget sequester by more than 30 billion. The food and Drug Administration, the centers for Disease Control and the National Institutes of health all slashed in the budget. The same is true in programs aimed at basic human needs, programs that fund meals on wheels, childcare, foster care. This is the budget you write if you think seniors and working families have it too easy. I want to thank the secretary for joining the committee. I apologize, again, for the hectic schedule. Its never an easy appointment for cabinet secretary, and i think he knows theres going to be some vigorous discussion this morning. I also, again, want to express my thanks to the chairman for his very gracious and ongoing courtesies on these kinds of matters. Thank senator stabenow for being willing to fill in and i again thank the chair. Senator hatch thank you, senator. Let me say im grateful that the president and h. H. S. Are in working on this effort and in essence eager to work with congress in order to ensure americans can access Affordable Health coverage. This may not be something that is going to be that easy to do and as we know time is of the essence in regard to this effort. Earlier this week, we received word that anthem is pulling out of ohios obamacare marketplace, potentially leaving more than 10,000 patients and consumers in 20 counties without any Insurance Options on ohios exchange for 2018. Now, this news is particularly frightening as we expect to hear similar notices from anthem as they reevaluate their participation in Obamacare Exchanges throughout the United States. Our whole country. Now, this recent story is just the latest in a long line of failures that my colleagues on the other side seem to want to continue under the guise that this is working. Its not working. All of these this demonstrates the need to move forward with repealing obamacare and replacing it with a more workable approach, one that will take serious that we can take seriously the ballooning Health Care Costs impacting every american family. Let me talk for a few minutes about the specifics of the president s budget. The budget assumes 250 billion in total savings from the repeal and the replacement of obamacare. And despite some insinuationses to the contrary, the bill does not incorporate the specific legislative proposal the American Health care act that is before congress right now. Therefore, it is not accurate to associate the specific medicaid savings the c. B. O. Has estimated from enactment of the ahca with the president s budget. To do so would assume a level specificity that, for obvious reasons, is just not there. Moreover, the president s budget does not cut 1. 5 trillion from medicaid. Nor does it assume that the specific medicaidreform proposals from the ahca will be enacted into law. Im quite certain that well hear a lot about that today, but any attempt to make that connection is simply unfounded. And any senator who harps on the ahca medicaid numbers here today either does not understand the explicit language and estimates provided in the president s budget, or they are simply attempting to muddy the waters in order to scare americans who rely on medicaid for health care coverage. Ultimately, the president s budget appears to accept the reality that the senate will need to come up with its own Health Care Reform proposal that includes a fundamental fix to medicaid, which is, quite frankly, long overdue. Anybody that doesnt agree with that just isnt living in the real world. In addition to the savings assumed from the repeal of obamacare, the budget also explicitly assumes 610 billion in savings from putting medicaid on a sustainable fiscal path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. All told, most of the budgets overall medicaid savings would be achieved by returning the focus of medicaid to serving those with the greatest needs the elderly, the disabled, and needy mothers and children and by giving states more flexibility to run their own Medicaid Programs. Any senator who would like to argue that the federal government should spend more medicaid dollars to provide coverage for nondisabled, childless adults at the expense of disabled patients who remain on waiting lists should explain why. Furthermore, any senator who would like to argue that the states are illequipped to handle their Medicaid Programs should explain why that is the case given that the overwhelming consensus weve heard from governors nationwide over the last several years is that states want more independence and flexibility to tailor the Medicaid Program. Washington needs to stop measuring the success of a federal program by how much money it spends or how many other programs are a part of it. Instead, washington needs to focus on how well a federal Program Helps those it is intended to serve and how efficient the program is at fulfilling its mandate. Long story short, we need to stop focusing on spending and pay more attention to outcomes. Because we may not be able to spend more. It doesnt appear that were going to be able to. The way things are going right now under the Current System, its a national tragedy. I think the president s budget, while it is by no means flawless, largely recognizes this reality, and the president and the administration deserve credit for that. I look forward to having an open and frank discussion with secretary price about his thoughts on these and other matters. Before we get to that let me just say that today we have the pleasure of being joined by secretary thomas e. Price. Secretary price, we want to thank you for coming. Secretary price is sworn in as the 23rd secretary of health and Human Services on february 10, 2017, as a policymaker and as a physician, surgeon in particular, he brings to the department a lifetime of service and dedication to advancing the quality of health care in america. Secretary price first began his career in care for patients as an orthopedic surgeon. He followed in the footsteps of his father and grandfather and began a solo medical practice in atlanta, georgia. Since its founding, that practice has grown to be one of the largest, nonacademic orthopedic practices in the country. Hoping to make a different type of impact on health care, secretary price ran for Public Office and was elected to four terms in the Georgia State senate and i believe would have continued on forever if he wanted to. During his tenure there, secretary price served as minority whip and later as the first Republican Senate majority leader in the history of georgia. Most recently, secretary price served as u. S. Representative for georgias sixth Congressional District from 2005 to 2017. During his time in the house, secretary price served in various roles including chairman of the house budget committee, chairman of the House Republican policy committee and chairman of the republican study committee. Secretary price received his bachelor and doctor of medicine degrees from the university of michigan after which he completed his orthopedic surgery residency at emery university. Emory university. Secretary price, we are grateful to have you here and well be happy to allow to you proceed with your testimony today. Secretary price thank you so much, mr. Chairman and i reserve the balance of my time stab know and members of the committee. I want to thank you for inviting me today to discuss the president s budget for the department of health and Human Services for fiscal year 2018. Its an honor to be here. Whenever a budget is released, the most common question in this town is how much, how much does the money spend on this program, how much does it cut from the other program . As a former legislator, i understand the importance of this question. But too often its treated as the only question thats worth asking as it relates to the budget as if how much a program spends is more important or somehow more indicative of whether the Program Actually works. President trumps budget request does not confuse Government Spending with government success. The president understands that setting a budget is about more than establishing topline spending levels. Done properly, the budgeting process is an exercise in reforming our federal programs to make sure that they do their job and use tax dollars wisely. The problem with many of our federal programs is not that theyre too expensive or too underfunded. The real problem is that many of them simply do not work. Fixing a broken Government Program requires redesigning its structure and refocusing taxpayer resources to better serve those most in need and thats exactly what president trumps budget will do at h. H. S. And across the government. Consider medicaid thats been discussed, the primary source of millions of lowincome American Families and seniors facing Challenging Health circumstances. If the amount of Government Spending were truly a measure of success, medicaid would be hailed as one of the most successful programs in history. 20 years ago actual spending on medicaid was less than 200 billion. Within the next decade, its estimated to top 1 trillion a year. Despite these significant investments, onethird of doctors in america who accept new medicaid patients dont. And some show that enrolling in medicaid does not necessarily improve your Health Outcomes newly eligible medicaid population. We need to have a way thats compassionate and sustainable. Under current law, federal rules prevents states from focusing on their most vulnerable communities and testing new ideas to improve Health Outcomes and care. This budget changes that. H. H. S. s mission of protecting the health of the American People involves far more than overseeing the nationS Health Care and Insurance Programs. H. H. S. Is the worlds leader in helping the Health Care Sector prepare for cyberthreats and responding to and protecting against Public Health emergencies. Recently i witnessed this important work firsthand visiting ebola survivors in liberia and representing the United States at the g20 minute steerial assembly in berlin and also in geneva. To support h. H. S. s unique federal role, preparedness and response, the president s budget provides 4. 3 billion for Disaster Services coordination and response planning, biodefense and emerging Infectious Disease research and development and stockpiling of critical medical countermeasures. In addition, today america we have been far less successful in verving, those are serious mental illness, the Opioid Crisis and childhood obese i as secretary i am committed to leading h. H. S. To address each of the three challenges and the president s budget calls for policy reforms that will enable us to do just that it calls for high priority Mental Health initiatives and Homelessness Prevention and childrens Mental Health. Focusing especially on those suffering from severe mental illness. In 2015, over 52,000 americans died of overdose. Most of them from opioids. This budget calls for 811 to support the fivepart strategy to fight this epidemic. To invest in the health of the next generation and help the 20 of schoolage children who are obese, lead healthy and happier lives, the president s budget establishes a new 500 million Americas Health block grant. Additionally, the president s budget prioritizes womens Health Programs by investing in research to improve Health Outcomes for women and increasing funding for the maternal and child block grant and healthy start. Across h. H. S. , funding is maintained for vital programs serving women, including