Director Francis Collins about their 2018 budget request, as well as various kinds of medical Research Done by the agency. This is about two hours. Senator roy blunt chairs the twohour Senate Appropriations hearing subcommittee. Will come totee order. The appropriations subcommittee labor,r, wealth health, Human Services, and agencies will come to order. For my opening statement, i , whoke to recognize we had an opportunity to meet and talk about her cancer fight and the success she has made nih awhen we were out at few days ago. We are glad you are here. And i was just told the young us of your six children just got their drivers license, so good luck with that. Good luck with all of that. We are all glad to have a chance to meet with her. Im glad to have dr. Collins and the other Institute Directors here today. The budget, of course, proposes cuts. Rest assured, i think this committee will find them unacceptable, the 7. 5 million cut from nih would, according to analysts, this funding would cost nearly 90,000 jobs nationwide, result in 15. 3 million 15. 3 billion of lost economic activity. In my home state of missouri, that equates to a loss of nearly 1700 jobs and 292 million of economic activity. The cut is one that i think you can, rest assured, this committee will not take. I fundamentally disagree with the proposed funding reduction, however this is not the first president to propose a reduction. President obama for post a 1 billion cut in his budget last year. We went 3 billion beyond his proposal, i am not sure we could do anything like that this year, but i also mentioned in a hearing earlier this week that when his budget was submitted to the senate, 98 senators voted against it and one senator voted for it, so we have a long history of congress asserting itself on issues of how to allocate money. I believe this committee will do the same thing this year. Last two years, with significant encouragement from the whole committee, particularly from senators murray, alexander, in durban, and the whole committee we had the whole committee out will committee we had the whole committee out on nih, the biggest delegation to go there. The afternoon. F i hope you, dr. Collins, and or Institute Directors know how much your work is appreciated. In the last two years, we have increased nih funding by little more than 13 , and we will be listening carefully to your presentations today. Before that, i would like to turn to senator murray for her opening comments. Thank you to you and all of your team for being here today. We appreciate all that you do to champion the critical work of nih. You have been a great partner, and we really appreciate your leadership and all of your teams. I look forward to having a discussion today about the devastating impact the president s budget would have on nih. As you all know, President Trump has proposed cutting nih by 22 , most of it by arbitrarily capping indirect costs, resulting in the lowest running for Biomedical Research since 2002. Three months after releasing this proposal, we have no basic information from the administration on how nih would implement a 7. 5 billion reduction without severe to Research Facilities and tens of thousands of scientists that rely on its grants to support their work. Facilities like the Fred Hutchinson institute in the home state in my home state of example whereone scientists have pioneered bone marrow transplants and are searching for cures to cancer sexy. Iv cap scene this could to radically scale vaccineir efforts to. This could radically scale back their efforts. I hope that both parties, once again, reject President Trumps Budget Proposal and continue to Work Together, as we have to ensure nih is able to carry out its final work that gives hope to those living with chronic and lifethreatening disease. Economic tal or bolster Economic Growth and competitiveness. But i have to know that todays hearing takes place in the midst of a very Pivotal Moment for our Health Care System as a whole. All week, ourrd republican colleagues appear to be dead set on jamming their version of trumpcare through the senate in a matter of days. Beenis a bill that has subject to no hearings, no public debate, and no expert testimony. Is the bill so secret that apparently, until just moments ago, Many Republican senators were telling present constituents they cannot say what was in the bill. It was so secret that even President Trumps Top Health Care advisor, he told us last week that he did not know what was in it. Secret and so closely guarded that not even the 13 male senators who made up the socalled working group could comment with certainty on what was in that or when it would be wrought up for procedure. In fact, the bill is so secret that even the White House Press secretary cannot can term weather President Trump or any in the white house, for that matter how i have seen the bill, which begs the question, as i have said this week, what are Republican Leaders so ashamed of . And is becoming very clear now that those who wrote the Trumpcare Bill knew they would not be able to go back home and defend it because based on what we are now learning, this bill is going to be the same kind of Trumpcare Bill that went in the house, and it will have tremendous impact on patients and families. Higher costs for families, especially seniors, and people with preexisting conditions. Insurance companies no longer will be required to cover basic health care, like Maternity Care or Mental Health services. Women would lose access to their theyrs, and to the care need at planned parenthood, and plenty of people across the country would see their medicaid coverage taken away. That means people nationwide who are finally getting treatment for Substance Use disorders like opioid addiction or Mental Health care or access to a primary care doctor under medicaid are going to lose that access. Democraticof my colleagues have said, this is not a health care bill, it is an attack on Families Health and financial security. I want to reiterate my message to Republican Leadership, it is not too late to dump this Trumpcare Bill. It is not too late to make the right choices and work with us as democrats to fix our Health Care System. As the chairman and others on this committee should know by now, democrats stand ready, as we always have, to Work Together to actually make health care more affordable and accessible for patients and families across the country. We cannot begin that conversation until Republican Leadership has reversed its course. Lastly, i do have to say that after hearing this week about so many of my republican colleagues feeling frustrated about this bill and the process, who were angered about being shut out of this process or receiving orflicting information, maybe even shocked by the text just released, you have the power to do something about it, not to complain. You could assist us on hearings, open debate, increase transparency, because lets be very clear people across the country are really worried about the approach that is being taken. They are watching, they will be paying close attention, and we need to get this right, not what is being jammed through the senate. Back to you. Thanks, senator murray. We are pleased to have the Ranking Member of the committee with us today, the chairman does not have a statement but i think you may, senator leahy. I request my statement be printed in the record. Thank you. Thank you, chairman. Im glad to be here with you and, of course, with senator murray. I completely agree with her statement. This is important, and dr. Collins, good to have you here and your whole team. My mother, when she was still with us, she was a firstgeneration italianamerican, and she saw on dr. Collins was going to be here, she said say hello to that nice young man. Or rather, save on this affects. You have tohe fact support the middle growth middleclass and support the most foldable. Has been a shining example, but sequestration has had devastating effects. I think those consequences will last for generations. My children and grandchildren. This budget makes it even worse. Deep budget cuts, those have drawn the most bipartisan opposition. Said. Ard what sen. Blunt the most bipartisan criticism has been reductions for the National Institutes of health. Blunt to commend chairman and Ranking Member murray in their efforts to bolster the nih budget in recent years. This budget we have been given by the white house turns the progress upside down, it slashes and ih resources nih resources wanted 1 . 21 . ,ou know better than i do medical research, you cannot just turn it off or a few years, wese studies and trials, will come back in five years and pick them back up again. You cannot do it. You dont hit pause on studies. You cannot have ups and downs based on the whims. Based on whims. The cap on research is being done around the nation, universities and other entities. Im not being parochial, but i mentioned the university of vermont, they receive grants every year. It is unlikely they could continue their research on this budget. They have been doing cuttingedge research and cancer, among other things. A full copy of their letter to be placed on the record. Without objection. Sen. Leahy this is where we can lead the world. Not only that, we can make life so much better for our own people. And people around the world. Toill fight for every dollar be gained back that i can. And you very much, mr. Chairman. Thank you, sir. Dr. Collins, we are pleased you are here. We look forward to your opening statements, and when you are through, we will go to opening will go to questions. Dr. Collins to my right, dr. And thenodes, gordon, andoshua you have already recognized dr. Fauci feared on the far nearsighted, gary gibbons. We brought the 18 today. A team today. It is a great honor to be with you today. I am privileged to continue in this role as nih director geared i want to thank all of you for your sustained commitment to nih, a commitment that ensures that we remain a leader in Biomedical Research. I would like to highlight several areas of exceptional scientific opportunity. I would like to introduce you to a few patients and also talk about some young researchers who are working hard to make these dreams come true. I will show a few images over on the screen. Lets start with an opportunity that shows the transformational power of investing in nih basic science. Imagine you could determine the precise molecular structures of proteins like you see here. Interactactly how they with each drug. This is starting to happen things to a new technology. This image shows the structure of a protein channel, indicated in a great mesh, it regulates salt and water balance in the lungs. Folded misfolded in Cystic Fibrosis. Give mutation that causes Cystic Fibrosis was discovered in my own Research Years ago. Only now, are we able to design better drugs to help cystic abilynns, like little feud she is doing pretty well now. That this ago, she probably would not have made it the on her teens. Havenger, aired today, we no longer. Drugs that help cf. Among the early stage investigators tackling this fromenges is a scientist alabama. He plans to transform in fundamental ways the way we design and deliver drugs for all kinds of conditions. We need that. Treatments only exist today for about 500 of the 7000 diseases for which a molecular cause is now known. Among those in desperate need of a breakthrough is sickle cell disease, a disorder in which red blood cells clog. Today, the only way it can be cured is from a bone mero transport. Transplant beard it can work well for some people, like chris shown here. He is now essentially cured. Most that dont have a well matched most do not have a well matched bone marrow. What if we could correct the sickle cell in a patients blood cells . Once, i wouldve said it is unlikely. That is changing. There is a new gene editing system. The goal is to fix the underlying genetic defect and make the patients own cells healthy. If courtney and other scientists can get this to work for sickle cell, think what they might be able to do for thousands of others. Are 86 billion neurons in the brain. Brain disorders are taking and a normas toll on and a normas toll on our economy. Enormous toll on our economy. Lets imagine that using tools and technologies created by the Brain Initiative, you could easily identify someone at risk for alzheimers and apply effective ways of defending the disease that has touched effective ways of correcting the disease that has touched so many. Investigator from Massachusetts General Hospital is among those taking on this challenge. Her work is focused on the largest known group of people in the world with inherited alzheimers. A Family Living in the mountains of columbia. Using pet scans to compare the brains of family members who have the alzheimers gene with those who do not. Curing alzheimers will not be easy, but they have the talent and drive to make it happen. You all are part of that. Your emphasis on alzheimers and related Dementia Research in fiscal 2016 and 2017 is enabling progress toward our mutual goal toward effectively treating these devastating conditions. All of us are motivated today by a sense of urgency to help haitians in need of breakthroughs. The next generation of innovative and passionate researchers will be the critical part of that bright future. Nih announced the next generation researchers and initiative to bolster support to early and mid career investigators like a three you see here. Our Nations Health and wellbeing depend on your strong support for them. Thank you, mr. Chairman, my colleagues and i welcome your questions. We are glad you are here. I was pleased with the president s decision to continue your leadership at nih. Many of us have advocated for that and we are pleased to see it happen. Your team and what your team does is inspiring to all of us. We will have a fiveminute round of questions. I think there are a lot of competing things going on today so we will try to keep that as close to five minutes as we can, starting with me. Want to askareas i ask specifically about in the president s proposal, one was to eliminate the Fogarty International center. I think particularly with the zika process we are going through, that center was pretty actively involved. Be about whatmay the center does as opposed to commenting on it necessarily the president s view of this. I appreciate the question, im going to let dr. Comment onndeered that. Center is the fogarty critical to what we do. Nationally and internationally. Know nous diseases borders. Some cogent examples of how the fogarty training of International Scientific colleagues has benefited the United States of america, and the two in most recent memory are the Ebola Outbreak and the zika outbreak, not to mention the longstanding commitment trials inids, and subsaharan africa. These trials are almost all led by International Scientists trained by fogarty grants. Mightegard to ebola, you recall that in africa, they had 11,000 deaths. If that had gone beyond those aliders to places like m or nigeria, it couldve been a bigger catastrophe. Went toted individuals mali or nigeria, it did not make much press because it was a success, but the investigators were able to isolate and stop it in those countries before it , particularly in nigeria, the most populous country in africa. Each of those individuals were people who were trained at the Fogarty International center. We look upon them as our true colleagues. I refer to them, and i mean it sincerely, as our brothers and sisters in the battle against infectious diseases. If this were a metaphor of a military thing, they would be our closest allies. They may be where a different uniform, but they are our allies. The impact of the folk training has been extraordinary. We really need to continue. Cinderblock senator blunt the agency for Health Care Research and equality would be consolidated into, i believe a proposed a new institute in your organization youd if you want to comment about that generally come and if that was not going to happen, all their are there alternative ways to do that without creating a new institute . Dr. Ankford the 8 the agency is focused on Health Safety and quality. How to prevent Health Problems such as hospital readmissions, infections from intravenous catheters for example. Withve close connections them and we regularly look at our portfolios to make sure we are being complementary and not duplicative. If it were the case that ahrq was moved into nih, we would there out how we could make best of that circumstance in order to