This is two hours and 40 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] the meeting will come to order. Senator whitehouse is next followed by senator young. Senator whitehouse. Thank you, chairman. Lets me ask first to put into the record a letter from our governor in rhode island, which says in rhode island im quoting here we have actually seen exchange premiums decrease in two out of the last three years. Ended that this has saved consumers nearly 220 million since 2012. So, the story on the Affordable Care act in rhode island is a good one. I would also like to put this little graphic into the record, which to explain briefly, the red line along the top is the cbo estimate of where our healthcare costs were going to go back when they were making the estimate in 2010. Then, at this time 2016, after the aca was in place they took a look at the Actual Experience up to that point ended a new new projection Going Forward based on the Affordable Care act and just in the following 10 years the green period from 2016 to 2026 they are forecasting 2. 9 trillion in federal healthcare savings that relate back to the Affordable Care act. This is where that came in. So, we forecasting out at our peril if you care about saving medicare the savings to which are a significant part of this 2. 9 trillion. We throw it out right now, according to the republican plan, with nothing to replace it. I have described that over the weekend at home and its like jumping out of an eric hit airplane with no parachute and someone telling you trust me, we will build you the senator we will build the parachute as you jump down. I think the American People are entitled to know what they will be offered as an alternative. Theres been conversation in this hearing about how the republican ideas floating around sure there are republican ideals, but no republican bill, no republican plan, no republican proposal. Our cards are on the table. Its obamacare. You want when pruitt . Make suggestions. Weve always been open to that. On the other side of the table there is nothing and its hard to negotiate with nothing and i think the republicans have a responsibility to put a plan together. We talked about that, mr. Price, when you and i met my office and my recollection of my conversation is that you told me that you would want to keep what he people stay on their current policies until they are 26. Is that true . I think the Insurance Industry has included individuals up to the age of 26 on their parents policies virtually across the board and i dont see any reason that would change. And you would want to keep, you told me, the donut hole closed to protect seniors against those pharmaceutical costs. Is that also true . The discussion we had was about pharmaceutical cost of making sure we could do what we could my recollection was more specific than that, that you did not want to reopen the dont offer seniors. Are you say now youre considering that . Im not saying that at all. You know well the reopening of the donut hole would be a legislative activity. But you will be the secretary of health and Human Services who will do a lot of work to prepare this legislation in the Technical Work behind it for the administration. Are you going to be proposing in that role something that reopens the donut hole. Ive a lot of seniors that want to hear of that. Im not aware of any discussions to do that. Finally, my recollection that meaning is you told me you not want to return to Insurance Company lifetime limits or Insurance Company denial of preexisting conditions or Insurance Companies going back and looking in the files for some little tiny discrepancy in throwing some off their coverage when they come in with a significant claim is that true . There are always ways we can improve coverage and those are areas in existence right now and i think those issues need to be continued to. So, when, as and if we ever get a republican counterproposal to obamacare you would expect to see those things in it . I dont know whether they would be in its or silent on it, but again [inaudible] then leave it in place . Thats a legislative question not administrative. In one of your budgets you had a proposal that would allow states to throw what you called abled bodied people off of medicaid unless they were working or looking for or in job training. People with addiction, behavioral health, Mental Health issues, are they able to bodied in your definition . Well, we were not as specific as what the definition was im asking you now, what did you mean when you said abled bodied in this provision . The fact that there are many many individuals who have worked for a long long time that believe that providing for an opportunity for individuals who are abled ablebodied without children to seek, gain employment or to study what you mean by ablebodied . Thats what would be defined in the regulation itself. You use the term without an idea of how you would define it . I think people have an understanding of what ablebodied is and thats the kind of things you described. That was a simple answer to my question, ablebodied does not involve people who up addiction, or Mental Health issues . The work that would be done im not asking in some future universe, as you use that term in your budget. Individuals that demonstrated that they were in fact having challenges that would preclude them from being able to seek work or employments or education or the like that they ought to be attended to. Now, im a fan of and think they do good work of the American Academy of pediatrics. Im a fan of them and think they do good work of the American Lung association and im a fan of and think they do good work of the American Public health association. All of those groups and many others have gone very clearly on record that Climate Change presents a Significant Health issues. They signed a declaration on Climate Change and health, which stated the science clear that this is happening. You come on the other hand, have said that the Carbon Pollution standards of the Obama Administration quote go against all common sense and thats there are errors in that allegedly settled science of global warming. I will pursue this with you through questions with a record because my time has expired, but if you could give a brief answer because it appears to every Scientific Organization in the country, although legitimate major ones and to really every American University that this actually is pretty darn settled science and that the only people who disagree with it are people that have financial interests in getting in preventing work from getting done and it looks to me like making this statement yet taken the side of the special interest against actually settled science and if we cant trust you on science as a settled as climate science, how can we trust your Public Health science issues where theres a big special interest on the other side . I dont agree with the premise of the answers to it continuation, but i will say climate is obviously changing and continues to change. The question from a scientific standpoint is what effective Human Behavior and human activity have on that and what we can do to mitigate that and i believe thats a question that needs to be studied and evaluated to get the best minds available some think the way you do, one. We are running out of time. Thank you, senator whitehouse. Senator young i believe is next, but i dont see him. Senator roberts. Thank you, mr. Chairman. Thank you for holding this anger management hearing. [laughter] i truly hope my colleagues feel better at least for one date after purging themselves of their concern, frustration and anger. I would like to note i asked the technician running the sound system, the audio system is working. I thought maybe the senator did not know that. He reminded me of my marine di back in the good days where the di would shout i cant hear you i thought it would bring that up that the audio system is working. Take care of yourselves. Doctor price, congratulations on your nomination thank you for being here today. Think you. As many of the our colleagues have noted you will play most Important Role when confirmed in helping to stabilize the individual market when congress does repealed the law and repair the damage it has caused and reforms of i believe well put our Healthcare System back on track. My home state of kansas, we have three insurance carriers left and we feel fortunate we have three. With each individual only having access to two of those and our premiums rose this past year over 30 . Down the road it will be more difficult if we dont do something and theres no doubt with regard to uncertainty and banks among consumers and i think its important to make clear that even if congress and the Incoming Administration were to do nothing, let it go. Like in frozen, let it go. Im and eat and repealing parts of the Affordable Care act. The laws not working and we have to do something to meet that obligation. Of the prices are unaffordable, markets nearly nonexistent with you or no options in several states and counties. We are not as rural as wyoming, but we are rural in my state of kansas. I have a concern back in the day when we sat in this committee and wrote the first version of the Affordable Health care act. I dont know where that mark is today. Sitting on a shelf somewhere. We went day and night and day and night and day and night and i was worried about something i called the rations and im talking about independent payment Advisory Board and the new coverage abilities given to the Us Preventive Services task force and i would also mention the Center Outcomes research institute. Not many people are aware of these. I even went to the floor of the senate and had people riding a horse and then the four horses of the regulatory apocalypse, but im worried about it and the provisions, which could interrupt the doctorpatient relationship allowing the government to dictate what coverage you can receive. Can you share some of any concerns that you have with regards to these, what i would call for rashers with respect to what they are trying to do with good intent. I appreciate that and i think its imperative that as we move forward that we recognize again that the patient should be at the center of this and anything that gets in the way of the patient and their families and physicians making the physician about what kind of healthcare they desire is we ought not go down that road. For example, the cmm i, im a strong proponent and advocate for innovation, but i have seen in certain instances was coming out of cmm i is a desire to acquire certain kinds of treatment for certain disease entities that may or may not be in the best interest of the patients and because it carries the full force of the federal governments and the payment for those services it means that we are answering the question of who decides about what kind of care patients received by saying the answer ought to be washington dc and i said the reject that there is where those decisions should be made. I appreciate that answer. I had a privilege of being a member of this committee, the finance committee especially being chairman of the always powerful Senate Agricultural committee and on particular interest in hhs and fdas work on food and nutrition policy. During the Previous Administration the fda delayed guidance and unrealistic states. This was the case of the implementation of the food safety modernization act and more recently with the Nutrition Facts Panel revision. I know we all share the goal of a safe food supply and availability of accurate accurate information, but im concerned that administration is not consistently communicate with the food in our culture industry regarding new or changing requirements. Would you commit to working with the secretary of agriculture and other relevant agencies not to mention the committee i serve on and similar in the house, if your department is issuing science based guidance and taking into consideration other regulatory burdens on establishing compliance and other regulatory acts . Yes, i believe thats not only imperative, but the science that is relied upon should be transparent and available to the public so people can see exactly what was the basis for the decisions being made. Under the Previous Administration, we have seen increased activity and regulatory action on nutrition policies such as issuing voluntary guidance, get the same administration continues to request Additional Resources from congress to comply with statutory requirements that includes safety modernization act and im concerned the administration did not prioritize fdas measure to protect the nations food supply , instead of focusing on nutrition policy. Is confirmed, can you discuss how you will look is on the court at the eight duties such as implementing the laws that Congress Passed rather than agenda driven nutrition policy guidelines. If i am confirmed and given the privilege of leading i would work specifically with fda commissioner to make sure we are relying on science, a science that is guiding the decisions that we are making and again, that the transparency is available for folks to see what cut her decisions are made and how they are being made in addition to working with policymakers. You know best whats going on in your state and how its being affected by the rules and regulations coming down from washington and in so many areas, but certainly in the agricultural arena, so we ought to have a dialogue with every single individual who has an interest to make certain we are addressing needs appropriately. Thank you, mr. Chairman. Thank you, senator roberts. Senator baldy. Thank you, mr. Chairman and welcome, congressman. You have already been asked about your investments in medical device companies, pharmaceutical companies as part of the prior questioning, but for the record have you also received Campaign Contributions over the years from Political Action committees associated with many of these same companies . I dont know, but i assume so just as many of us do. Okay. So, in terms i mean, the American People want to know, of course, when you get reviewed for potential conflict of interest and your procedures with the office of government ethics is that in your role of fighting for them is not bias of the powerful companies that you have invested in and that have invested in you and you have taken some questions on that, but lets me follow up a bit to ask first, do you think drug price increases we are seeing right now for example the sixfold increase in the cost and at the pin is a problem right now, for americans . As i mentioned there are certain areas where drug pricing increases seem to have little basis in rational findings. I do think, however, as i mentioned that i think its important to appreciate that we have done good things with the drug pricing whether its the generic arena where prices have been held down significantly let me continue down this track. You have been asked already that trump supports medicare drug negotiation. Will you work to repeal the prohibition on medicare negotiating for better drug prices on behalf of the American People if confirmed for this position . Well, i understand if im confirmed and if i had the privilege of serving as secretary that the boss i have will be the president of the United States will you work to repeal the prohibition on medicare negotiating drug prices . Following discussion and being informed by the individuals within the department and working with the president ended then carrying out his wishes. Is that a yes or a no . It depends on that activity. You stated his position recently in fact that he supports price negotiations, so people on medicare can have the benefits of that. Is that something you would press congress to do . In other words, repeal the prohibition on that negotiation . I think we need to find solutions to the challenges of folks gain access to needed medication and its may be that one of those is changing the way that the negotiations as you know the negotiations right now kirk for seniors with the pharmacy benefit management. You have not said yes or no, but you just talk about transparency. Would you support drug prices comparison mandating any drug company that wants to increase prices on their drugs, released Public Information on how they set their prices because so many of these appear to be without justification is you just mentioned. A lot of merit in transparency in certainly this area and i look forward to exploring if confirmed with you ways to make that work. I want to go back i went to go back to the first round of questioning with the chairman who showed a chart and it seemed like what was implicit in the back and forth was that the act of repealing the formal care act, which only impact perhaps a very small part of the Healthcare Industry. You talked about 6 being covered on the individual market. The protection like coverage on your Parents Health insurance