The committee will come to order. Id like to welcome everyone to this morning steering and today were going to consider the nomination of seema verma to serve as administrator of the centers for medicare and medicaid services. Welcome, ms. Verma, to the we are so happy to have you here and your family as well. I appreciate your willingness to lead this key agency at this critical time. I see that your family has joined you here today to lend support. I extend a warm welcome to all of them and to you as well. Cms is the Worlds Largest health insurer, covering over onethird of the u. S. Population through medicare and medicaid alone. It has a budget of over one trillion dollars and it processes over 1. 2 billion claims a year for Services Provided to some of our nations most vulnerable citizens. Ms. Verma, having dealt with cms extensively in your capacity as a consultant to numerous state Medicaid Programs, you know full well the challenges the agency deals with on daily basis. I suspect you also know that the job youve been nominated for is a thankless one, fraught with numerous challenges. The good news is that there are opportunities in those challenges and i believe you are the right person for the job and that you will make the most of those opportunities to improve our healthcare system. The failings of obamacare are urgent and must be addressed in short order. Over the past six years, we have watched as the system created under obamacare has led to increased costs, higher taxes, fewer choices, reduced competition, and more strains on our economy. Under obamacare, Health Insurance premiums are up by an average of 25 this year alone. Under obamacare, americans, including millions of middleclass americans, have been hit with a trillion dollars in new taxes. And under obamacare major insurers are no longer offering coverage on exchanges, and earlier this week, we learned that another Major Carrier will exit the market in 2018. As Congress Works to change course with regard to our ailing healthcare system, cms will play a major role in determining our success. I applaud the step the agency took yesterday under the leadership of hhs secretary price with its proposed rule to help stabilize the individual insurance markets, but there is much more work to be done and i am confident that, if you are confirmed, you will be a valuable voice in driving change. Id like to talk specifically about medicaid for a moment. The Medicaid Program was designed to be a safety net for the most vulnerable americans. As such, i understand and value the moral and social responsibilities the federal government has in ensuring Health Care Coverage for our most needy citizens. I am committed to working with states and other stakeholders, as i think everyone on this committee is, and the American Public to improve the quality and ensure the longevity of the Medicaid Program. But we must also acknowledge that the Medicaid Program is three times larger, both in terms of enrollment and expenditures, than it was just 20 years ago. Additionally, the Medicaid Expansion under obamacare exacerbated pressures on the program at a time when many states were already facing difficult choices about which benefits and populations to serve. As a result, we have a responsibility to consider alternative funding arrangements that could help to preserve this important program. We also need to consider various reform proposals that can improve the way medicaid operates. Ms. Verma, we will need your assistance in both of these efforts, and your experience in this particular area should serve you well. On the subject of ms. Vermas experience, i want to note for the committee that she has been credited as the Creative Force behind the healthy indiana plan, the states medicaid alternative. This Program Provides access and Quality Health care to its enrollees, while ensuring that they are engaged in their care decisions. The Program Continues to evolve while hitting key metrics and, overall, enrollees are very satisfied with their experience. While we may hear criticisms of this program from the other side of the dais here today, we should note that hhs and cms leaders under the Obama Administration repeatedly approved the waiver necessary to make this program a reality. Ms. Verma has assisted a number of other state Medicaid Programs as well. Her efforts all have the same focus, getting needed, highquality care to engaged patients in a fiscally responsible way. This is exactly the mindset we need in a cms administrator. Now, ms. Verma, as if the challenges associated with medicaid are not enough to keep you busy as cms administrator, you will also be tasked with helping to ensure the longevity and solvency of the Medicare Trust fund, which is projected to go bankrupt in 2028. That already come down from 2032 i believe. All told, between now and 2030, 76 million baby boomers will become eligible for medicare. Even factoring in deaths over that period, the program will grow from approximately 47 million beneficiaries today to roughly 80 million in 2030. Maintaining the solvency of the Medicare Program while continuing to provide care to an ever expanding beneficiary base is going to require creative solutions. It will not be easy. But we cant put it off forever, and the longer we wait, the worse it will get. Now that ive had a chance to discuss the challenges facing cms and some of ms. Vermas qualifications, i want to speak more generally about recent events. Weve gone through a pretty rough patch recently on this committee, particularly as weve dealt with President Trumps nominations. I dont want to rehash the details of the past few weeks, but i will say that i hope that recent developments do not become the new normal for our committee. As ive said before, im going to do all i can to restore and maintain the customs and traditions of this committee, which has always operated with assumptions of bipartisanship, comity, and good faith. With regard to considering nominations, that means a robust and fair vetting process, a rigorous discussion among committee members, and a vote in an executive session. On that note, maybe the icy treatment of nominees is starting to thaw today, at least i hope it is. One tradition that has been absent here this session has been the introduction, on many occasions, of nominees by senators of both parties from the nominees home states, especially in cases when the nominee and the home state senator have a relationship. Im pleased to say that the senior senator from indiana is reaffirming that tradition by appearing here today. And so is our other senator from indiana. I thank the senator for taking the time to appear today and introduce their constituent. Ill give him a chance to do so in just a few minutes. With that, i look forward to ms. Verma sharing her vision and views here today. I also look forward to what i hope will be a full and Fair Committee process that allows us to process this nomination and report it to the full senate in short order. I will now at this time recognize my cochairman on this committee, senator wyden, for his Opening Statement. Thank you very much, mr. Cha, ms. Verma and your colleagues from indiana. I just thought it was worth noting that the hoosier basketball tradition, ms. Verma, looks like you brought close to two squads of basketball players, and we welcome you and your family today. Its obvious that the health care post were going to discuss today is not exactly dinnertable conversation in much of america, but the fact is it is one of the most consequential positions in government. The agencies responsible for the health care of over 100 million americans who count on medicare and medicaid. It plays a key role in implementing the Affordable Care act. Thats why cms needs experienced and qualified people for the job. People who know the ins and outs of the whole system, medicare, medicaid, and private insurance. The agency needs a strong and experienced authority, and this is particularly true now when it does appear that some of my colleagues on capitol hill, meaning and administration, are looking to make radical changes in American Health care. In my view, many of these proposals would take the country back to the days when health care was mostly for the healthy and the wealthy. So were going to start with a promise of medicare. Which has always been a promise of guaranteed benefits. That makes up more than half of the agencies spending, about 2 billion a day. With more seniors entering the program each year, theres an awful lot to do to protect, and in my view, update the medicare guarantee for this century. That means addressing the high cost of prescription drugs. It means making the program work better for those with chronic illnesses, like Heart Disease and cancer. Thats a majority of the medicare spending today. It will take bipartisan support is intact, senator grassley privatizing medicare is the wrong direction in my view. Its important here today how your view differ from some of the policymakers who are advocating those kinds of approaches literally be interested in turning the program into a voucher system. Additionally, if confirmed your play a key role in fomenting the medicare physician payment reforms. Its essential that may be implemented as intended by the congress because we want to start moving health care from paying for volume to paying for value. Also the agency implements rules of the road in the private insurance market. And today many of those rules amount to bedrock values for Health Insurance in the country. It means not discriminate against those with a preexisting condition no matter what. It means setting the bar for what type of medical Care Insurance companies have to cover. And it means letting young people stay on their parents policy until 26. Unfortunately, just yesterday the agency released a proposed rule that in my view goes in the opposite direction. From where i sit, the message from yesterdays rule is Insurance Companies are back in charge, and patients are going to take a backseat to the open Enrollment Period, for example, was cut in half from three months to six weeks. If somebody drop coverage during the year for any reason, Insurance Companies could collect back premiums before an individual could get Health Insurance again. And Insurance Companies would have free reign to offer less generous coverage at the same or higher cost. This again sounds to me like its going back to yesteryear when Health Care System really did work for the healthy and wealthy. The administration has been saying the best is yet to come. The evidence seems to me to suggest otherwise. The president could have taken steps to create course to build on bipartisan basis, but instead issued an executive order on the day he was sworn in that is obviously now creating market uncertainty and anxiety. You dont have to look much further than humanities decision in the last day or so. We want to hear from you about how youre going to implement this program that millions of americans count on and how youre going to do it, even though we have republicans here who want to unravel the law. In short, i want to see us get beyond what is come to be known as repeal and run. Repeal and run goes beyond disrupting the individual market. It would also in the Medicaid Expansion that brought millions of low income, vulnerable americans into the Health Care System. This is an area obviously where you have extensive experience. I want to discuss some of the tradeoffs associated with those efforts, and i am particularly concerned about the possibility as ive been informed that somebody making barely 12,000 a year would get locked out of Health Coverage for no less than six months because they couldnt pay for health care due to it upcoming check, for example, or an emergency car repair. Theres been independent evaluation indicating that 2500 people were bumped from coverage due to situations like this. Ive also seen in the same report that more than 20,000 persons were pushed into a more expensive, less cover hints of medicaid plan because they couldnt navigate the system ass less comprehensive that you will put in place. I want to wrap up with just two last points, mr. Chairman, tier one with respect to taking these ideas on a nationwide tour. Im not there yet. I say that respectfully. Well hear more about the program and your support with respect to the states. We touched on in the office. We authored section 1332 of the Affordable Care act saying that states can do better. States have an idea better coverage, lower cost. God bless them, were all for it but we cant use 1332 or any other provision for the states to do worse. One last issue i want to touch on deals with ms. Vermas work. As i understand it you had a Consulting Firm. You all were awarded more than 8. 3 billion in contracts directly by the state to advise the state, and that was while you all were managing the programs. In fact, you would architect. At the same time as has been told me you contracted with at least five other companies that provided hundreds of millions of dollars of the services and products to these programs, hb enterprises, milliman, maximus, Health Management associates, roche diagnostic. And in at least two of these firms hp and hma, the terms of the state contracts appear to have had you in effect overseeing work that the firms performed. Now, george w. Bush had an ethics lawyer, a fellow named richard painter, wasnt exactly a liberal guy, and he said yesterday that this arrangement, and i will quote him, clearly should not happen and is definitely improper. He in effect said you on both sides of the deal, helping manage States Health programs while being paid by vendors to the same programs. He said that was a conflict of interest. I want to hear you respond to his assertion. We are going to want to know more about your work for companies that do business with the state and one of the questions will be if you are the cms administrator, if youre confirmed what you recuse yourself from decisions that affect the companies who were your client we will look forward to your testimony with the two indiana senator. Yorunning with the right crowd, and thank you, mr. Chair. Thank you, senator. Im please to head over my normal witness introduction to a pair of our distinguished colleagues that both senators from the Hoosier State will introduce ms. Verma and a testament to her work and to her as a person. I asked that the Senior Center from indiana mr. Donnelly start the introduction of internet over to senator young. Senator donnelly, you go ahead, proceed. Thank you, mr. Chairman. Chairman hatch, Ranking Member wyden, members of the committee, thank you for inviting her today. It is a pleasure to be here with my friend and colleague, senator todd young, to recognize this important accomplishment of a fellow hoosier. As you know any kind of president nominates an individual for a leadership position in our government, it is an honor and reflection of the tremendous trust and respect he has in that person. For this reason im pleased to be here today to help recognize ms. Seema verma for her nomination to be the next administrator of the centers for medicare and medicaid services, cms, and introduce her to this committee for your consideration. Ive always felt a personal belief that we accomplish more when we Work Together. In indiana we call that hoosier commonsense. In working collaboratively to help hoosiers get access to Quality Health care, is something ms. Verma and i have had the opportunity to do together. As many of you all are already aware, ms. Verma has played a central role in crafting medicaid policy in many states, including our own. In indiana she worked with governor daniels and then governor pence as well as other state and federal partners to take advantage of opportunities made possible by the Affordable Care act to expand medicaid through the healthy indiana plan can also know as hip. Today hip 2. 0 has helped to lower our states uninsured rate, improve Health Care Outcomes and has played a Critical Role in combating the opioid abuse and heroin use epidemics. Hundreds of thousands of hoosiers currently have Health Insurance through hip 2. 0 and the program is an example of what is possible when we Work Together. As ive shared with ms. Verma, and i will share with you, i am deeply concerned about the future of health care in our country as well as the rhetoric surrounding the current debate. I firmly believe that maintaining access to critical programs like medicaid and medicare and building upon the progress of the aca is fundamental to both the physical and Financial Wellbeing of thousands of americans across our country. It is my sincere hope that this administration, working with this committee and others, will approach medicare and medicaid with a thoughtful a