Meeting will come to order. This senator whitehouse. Let me ask first to put into the record a letter from our governor in rhode island which said in rhode island, we have seen exchange premiums decrease in two of the last three years. This has saved consumers 220 million since 2012. The story on the Affordable Care act is a good one. I would like to put this graphic into the record. To explain it briefly, the cbo estimate of where our healthcare costs are going to go in 2010 and then at this time, 2016 after the aca was in place they took a look at the Actual Experience and did new projections Going Forward based on the Affordable Care act, just in the following ten years, from 2016 to 2026, they are forecasting 2. 4 9 trillion in federal healthcare savings that relate back to the Affordable Care act. This is where that came in. We throw this thing out at our peril if you care about saving medicare, the savings to which are a significant part of this 2 . 9 trillion. With nothing to replace i described that over the weekend as jumping out of an airplane with no parachute but people trust you, we will build the parachute before you hit the ground. I am junior senator jack reed, an army ranger, actually did jump out perfectly well operating aircraft, he insisted on not just one parachute but two. I think the American People are entitled to know what they are going to be offered as an alternative. There has been conversation in this hearing about how republican ideas are floating around, i am sure there are republican ideas floating around but there is no republican bill, there is no republican plan, there is no republican proposal, our cards are on the table. It is obamacare. If you want to improve it make suggestions, we have always been open to that but on the other side of the table there is nothing and it is really hard to negotiate with nothing. I think the republicans have a responsibility to put a plan together. We talked about that when we met in my office. You told me you would want to keep letting people stay on their parents policies until they are 26. Is that true . The Insurance Industry has included individuals in their parents policies for lack i dont see any reason that would change. You would want to keep, you told me, the doughnut hole closed to protect seniors against pharmaceutical costs. The discussion is about pharmaceutical costs making certain we do these things the seniors are able to afford them. You did not want to reopen the doughnut hole for seniors. You consider reopening the doughnut hole. I think it is important, you know well the reopening of the doughnut hole would be a legislative activity. Your secretary of health and Human Services doing a lot of work to prepare this legislation and do the technical work, are you proposing in that role something that reopens the doughnut hole. Finally my recollection at that meeting and my notes, you would not want to return to the Insurance Company lifetime caps or Insurance Company denial of preexisting conditions or Insurance Companies looking at the files for the little tiny discrepancy than throwing somebody off their coverage when they have a significant claim. There are always ways to improve coverage that are in existence right now. The issues need to be continued. When and if we get a republican counterproposal to obamacare you expect to see those things in it. I dont know whether they would be in it or silent on it. Leave it in place. A legislative question, not at an administrative question. Throwing 8 able bodied people, were in job training. People with Mental Health issues. Are they ablebodied in your definition . We are not as specific as the definition was. What are you doing when you said ablebodied . Ablebodied individuals believe providing for an opportunity for individuals ablebodied without children to seek to gain employment what do you mean by ablebodied . Used that term again. That is what is we define in the regulation itself. People have an understanding what ablebodied is. It doesnt have the kinds of things you describe. That was a simple answer to my question, ablebodied Behavioral Health issues. The work is done not asking about some future universe, as you use that term in your budget. Individuals that demonstrated they were having challenges, precluded from seeking work or employment or education or the like that they ought to be attended to. Now, i am a fan of if they do good work, the American Academy of pediatrics, and think they do good work of for the American Lung association and that they do good work of the American Public health association, and all of that and others may have gone clearly on record, that Climate Change presents Significant Health issues. They signed a declaration on Climate Change and health, the science clear that this is happening. You on the other hand have said that the Carbon Pollution standards of the obama administration, quote, go against all common sense and that there are errors and obfuscation in the allegedly settled science of Global Warming which i will pursue this with questions for the rapid but my time has expired. It appears to every Scientific Organization in the country, legitimate, major ones and every american university, that is pretty settled. The only people who disagree have financial interests or any work getting done. It looks to me like making the statement you have taken the side of special interests against settled science and if we cant trust you on science that is settled as climate science, how can we trust you on Public Health science issues where there is a big special interest on the other side . The premise, the insinuation, the climate is obviously changing, continuously changing, the question from a scientific standpoint is what effect is Human Behavior and human activity have on that and what we can do to mitigate that and i believe that is a question that needs to be studied and evaluated and get the best minds available we are running out of thank you, senator whitehouse. Senator young, i believe, is next. Senator roberts thank you for holding this anger management hearing. I truly hope my colleagues feel better at least for one day after purging themselves of their concern, frustration and anger. I would like to note that i asked the technician running the sound session. The audio system is working. I thought maybe senator bennett doesnt know that. Marine di back in the good days. I cant hear you. I thought i would bring that up. It is working. Take care of yourselves. Congratulations on your nomination, thank you for being here today. As many of our colleagues noted, you will play a most Important Role to confirm and helping stabilize individual markets while congress does repeal the law and repair the damage that is caused and the reforms we believe will put our Healthcare System back on track. My home state of kansas we have three insurance carriers, and only have access to two of those and premiums rose this past year 30 down the road. It will be more difficult. There is no doubt with regards to uncertainty. And the incoming administration, and like in frozen, let it go. Amending or repealing, and laws and work. And something to meet obligation. It is nonexistent with fewer options in several states. And we are world. I have a concern back in the day, wrote the first version of the affordable healthcare act, dont know where that mark is today, sitting on the shelf somewhere. Day and night, and talking of the independent advisory board. The new coverage Authority Given to Services Task force and i would also mention the Outcomes Research institute called mccrory. And the four horses of regulatory apocalypse. They interrupt doctorpatient relationship. Can you share concerns, parishioners for what they do with good intent. I appreciate that senator. As we move forward, we recognize a patient at the center of this, making the decisions about the healthcare they desire, we should not go down that road. The medicare, medicaid innovation, strong proponent and advocate, i have seen in certain instances what is coming, to require certain treatment for disease entities that may or may not be in the best interest, and because it carries the full force of the federal government, for payment for those services, means we are answering the question who decides what care patients received by saying the answer should be washington dc and i reject that is where decisions should be made. I appreciate that answer. The finance committee, especially being chairman of the agriculture committee, i particularly nursed it in hhs, food and nutrition policy during the Previous Administration the fda, numerous regulations for guidance and unrealistic compliance states, this is the case for the implementation of the modernization act, more recently with a nutrition tax panel, over the same food supply and availability for information consumers but im concerned the administration is not consistently communicated to the food and agriculture regarding new or changing requirements, and mention the committee i serve on for seminary, sciencebased guidance, taking into consideration Regulatory Burdens engaging in other regulatory actions. Not only imperative but the science out to be transparent and available to the public. Under the Previous Administration we have seen increased activity and regulatory, on nutrition policies like issuing voluntary guidance, the same administration continuing to request Additional Resources from congress to comply to statutory requirements for the modernization act. Im concerned the administration did not prioritize the mission to protect the nations food supply instead focusing on nutrition policies, and discuss how you will focus on the duties like implementing the law of congress for agenda driven nutrition policy guidelines. The fda commissioner to make certain we are relying on science guiding the decisions we are making. And for folks that could see the decisions made and how they are being made. You know best what is going on and how it is affected by rules and regulations coming down from washington in so many areas but certainly in the agricultural arenas so we should be having a dialogue with every individual who wanted interest, to address needs appropriately. Senator baldwin. Welcome. You talk about 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. Just as many of us do. In terms the American People want to know, potential conflicts of interest, procedures with the office of government ethics, in your role fighting for them, not biased towards the powerful companies you have invested in and that have invested in you. You have taken questions, let me follow up a little bit to ask first, do you think drug price increases we have seen, sixfold increase in the cost of the epipen is a problem 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 again, it is important to mention we have done some great things in drug pricing whether it is the generic arena where prices have been held down and the part d area my time is limited, let me continue down this track. You have been asked already. 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 . If confirmed, the boss that i have will be the president of the United States. The prohibition on medicare negotiating. Individuals in the department, carrying out his wishes. Is that yes or no . You you stated his position recently that he supports price negotiation, people on medicare has the benefits of that. You press congress to do. The prohibition on that negotiation. I hope we find competed medication. It may be one of those, the negotiations occurred for seniors. You havent said yes or no. You talked about transparency. Would you support drop mandating any company that wants to increase prices on their drugs, release Public Information on how they set their prices because so many of these are without justification as you mentioned. In many areas, in this area, looking forward to exploring if confirmed with you to make that work. I wanted to go back to the first round of questioning with the chairman who showed a chart and it seems what was implicit in the back and forth, the act of repealing the Affordable Care act, only a small part of the Healthcare Industry. You talk about 6 being covered on individual market. The protections like coverage on your Parents Health insurance until you are 26 and mandating people be covered even if they have a preexisting health condition, things like eliminating caps that let so many into medical bankruptcy. Those apply across the Healthcare System. Appeal in no way limits us to a conversation, a small percentage of our population, this is about serious impacts for all of america. Would you be free . The Health Policy for Financing Health care to the American People is a very broad subject. Repealing the Affordable Care act, the impact does not narrowly confine medicaid to individual markets, it has impact on every american, medicare too, think of Accountable Care organizations driving so much innovation, that is not confined to the individual market, it impacts medicare very significantly. We in our office, thank you for your visit. And and if the informal care act is repealed, there were no longer be a mandate for Substance Abuse treatment, dont you agree . The Opioid Epidemic is rampant in timing families. Would you a short treatment would be Substance Abuse treatment, a replacement plan . Absolutely vital Substance Abuse and other things you would keep that protection for the Affordable Care act . Legislative decision but i look forward to welcome extraordinary 26yearold coverage take sure i heard the exchange because it sounded to me like you are saying you think insurers are just going to continue to do it, and there is no need for there to be an actual mandate. Young people between 18 and 26 on their Parents Health insurance, that is 5. 7 Million People who arent in the individual market because they are in their first job after high school that doesnt have Health Insurance or in school without. If it just a wink and a promise or do you support having in law the mandate that 2018 to 25yearolds they on their Parents Health insurance. It has been baked into the Insurance Programs that are out there right now but they could end at any time. Im committed to making certain every single american has access to the kind of coverage they want and has financial feasibility to purchase that coverage. Thank you, senator baldwin. Senator young. Good to see you here today. I have enjoyed our service over the past six years in the house, especially on the house ways and means committee, i had an opportunity to get know you personally and to observe your impressive skill set. Depth of knowledge in healthcare, your commitment more importantly, to alternative perspectives to identify where bipartisan consensus can be realized. Forging consensus around what is most notable is success on the Sustainable Growth rates which is something members of this committee, is a blunt instrument, to control healthcare costs, your leadership on the house side i dont think we could have moved towards more valuebased purchasing model so these are skill sets that will serve you well in health and Human Services no doubt. One area of the Affordable Care act speaking of bipartisanship, members of my party, your party, and indicated their desire to repeal from time to time, the center for medicare and medicaid, that is on account of the 1sizefitsall prescriptive and mandatory, like in recent years and you indicated you oppose the mandatory nature of demonstration projects. There is great value in innovating and experimenting across layers of healthcare. When cmm i continues to be a laboratory for healthcare experimentation, delivery models and payment models and so forth for medicare, medicaid, childrens Health Insurance and other ar