The committee will come to order. Id like to welcome everyone to the this mornings hearing. Today we consider the nomination of sima vermia to serve as administrator for the centers for medicaid and mediCare Services. Welcome. Were so happy to have you here and your family as well. I appreciate your willingness to lead this key agency at this critical time. And i see that your family joined you here today to lend support, so i extend a warm welcome to all of you and to them as well. Cms is the Worlds Largest health insurer. Covering over one third of the u. S. Population through medicare and medicaid alone. It has a budget of over 1 trillion and it processes over 1. 2 billion claims a year for Services Provided to some of our nations most vulnerable citizens. Having dealt with cms extensively in your capacity as a consultant to numerous state and Medicaid Programs, you know full well the challenges the agency deals with on a daily basis. I suspect you also know that the job youve been nominated for is a thankless one with numerous challenges. There are opportunities in those challenges and i believe youre the right person for the job and that you will make the most of those opportunities. 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 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 middle class 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 Health care 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 a supposed rule to help with a proposed rule to help stabilize the individual insurance markets. But there is much more work to be done and im confident that if youre confirmed, and i expect you to be, you will be a valuable voice in driving change. Id like to talk specifically about medicaid for a moment. The Medicaid Program was destined 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 ain ensuring Health Care Coverage for our most needy citizens. Im committed to working with the states, and other stake holders as i think everyone on this committee is, and of course the American Public to improve the quality and insure the longevity of the Medicaid Program. 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 that at a time when many states were also facing difficult choices about which benefits and populations to serve. And 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 medicare operates. Miss 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 miss 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 on overall enrollees very satisfied with their experience as i understand it. 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 repeated the approved waiver necessary to make this program a reality. Miss verma has assisted a number of other state Medicaid Programs as well. Her efforts all have the same focus, getting needed high Quality Health care to engaged patients and to engage patients in a fiscally responsible way. This is exactly the mind set we need in a cms administrator. Now, miss 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. Thats 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 will continuing to provide care to an ever expanding beneficiary base is going to require creative solutions. It will not be easy. 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 miss vermas qualifications, i would like to speak more generally about recent events. We have gone through a rough patch on this committee, as we 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 i said before, im going to do all i can to restore and maintain the customs and traditions of this committee, which is also operated with assumptions of bipartisanship and comedy and good faith. With regard to considering nominations, that means a robust and fair vetting process. A rigorous discussion among Committee Members and, of course, a vote in an executive session. On that note, maybe the ic treatment of nominees is starting to thaw today, i hope it is. One tradition that has been absent before this session has been the introduction on many occasions of nominees by senators of both parties from the nominees home state, especially in cases when the nominee and the home state senator have a relationship. Im pleased to say that the senior senator from indiana, as we refer in that tradition, but appearing here today, and so is our other senator from indiana. I thank the senators for taking time to appear today and to introduce their constituent. Ill give them chance to do so in just a few minutes. With that, i look forward to miss verma sharing her vision and views here today. Also, i 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. Ill now at this time recognize our my cochair on this committee, senator wyden for his Opening Statement. Thank you very much. Welcome to you, miss verma and our colleagues from indiana. I thought it worth noting with the hoosier basketball tradition, miss verma, it looks like you brought close to two squads of basketball players and we welcome you and your family today. It is obvious that the health care post well discuss today is not exactly dinner table conversation in much of america. But the fact is, it is one of the most consequential positions in government. Agencies responsible for the healthcare 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, many in the 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 healthcare was mostly for the healthy and the wealthy. So were going to start with the promise of medicare, which has always been a promise of guaranteed benefits. That makes up more than half of the agencys spending, about 2 billion plus a day. With more seniors entering the program each year, there is 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 the majority of the medicare spending today. It is going to take bipartisan support. Privatizing medicare is the wrong direction in my view. It is important to hear today, miss verma, how your views different 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, youre going to play a key role implementing the medicare physician payment reforms. It is essential that they be implemented as intended by the congress, because we want to start moving healthcare 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 and the country. It means not discriminating 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 back seat. The open Enrollment Period, for example, was cut in half, from three months to six weeks, if somebody dropped coverage during the year for any reason, Insurance Companies could collect back premiums before an individual can 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 it is going back to yesteryear when the Healthcare System really did work for the healthy and wealthy. Now, the administration has been saying, of course that the best is yet to come. Evidence, it seems to me, suggests otherwise. The president could have taken steps to create more stability on a bipartisan basis. But instead issued an executive order on the day he was sworn in, that is obviously now creating market uncertainty and anxiety. Dont have to look much further than humanas decision in the last day or so. So we want to hear from you about how youre going to implement this program that millions of americans, you know, 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 coming to be known as repeal and run. And repeal and run goes beyond disrupting the individual market. It would also end the Medicaid Expansion that brought millions of low income vulnerable americans into the Health Care System. And this is an area obviously where you have extensive experience. I want to discuss some of the tradeoffs associati s associate efforts and im concerned about the possibility as i have 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 an upcoming rent check, for example, or an emergency car repair. There has been an independent evaluation indicating that 2500 people were bumped from coverage due to situations like this. Ive also seen in that same report that more than 20,000 persons were pushed into a more expensive, less comprehensive medicaid plan because they couldnt navigate this system that you all put in place. Now, i want to wrap up with just two last points, mr. Chairman, one, with respect to taking these ideas on a nationwide tour, im not there yet. And i say that, you know, respectfully, well hear more about the program. And heres the point with respect to the states. And we touched on it in the office. We authored section 1332 of the Affordable Care act. Saying that states can do better. States have an idea of better coverage, lower costs, 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 that i want to touch on deals with miss vermas work. As i understand it, you had a Consulting Firm, you were awarded more than 8. 3 million in contracts directly by the state to advise the state. And that was why you all were managing the programs and in effect you were the architect. At the same time, as has been told to me, you contracted with at least five other companies that provided hundreds of millions of dollars of services and products to these programs, hp enterprises, millman, maximus, Health Management associates, roche diagnostics. In at least two of the firms, 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, richard painter, wasnt exactly a liberal guy, and he said, yesterday, that this arrangement, ill quote him, clearly should not happen and is definitely improper. In effect said that you are on both sides of the deal, helping manage state 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 assertions. So were going to want to know more about your work for companies that did business with the state, and one of the questions will be if youre the cms administrator, if youre confirmed, would you recuse yourself from decisions that affect the companies who were her clients. Ill look forward to your testimony with the two indiana senators, youre running with the right crowd, and thank you, mr. Chairman. Thank you, senator. Im pleased to hand over my normal witness introduction duties to a pair of our distinguished colleagues. Both senators from the Hoosier State will introduce miss verma as a statement and testament to her work and to her as a person. I ask that the senior senator from indiana, mr. Donnelly, start the introduction and then turn it over to senator young. Senator donnelly, go ahead and proceed. Thank you, mr. Chairman. Thank you for inviting me here 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, anytime the president nominates an individual for a leadership position in our government, it is an honor and a reflection of the tremendous trust and respect he has in that person. For this reason, i am pleased to be here today to help recognize miss seema verma, and introduce her to this committee for your consideration. I have always held a personal belief that we accomplish more when we Work Together. In indiana, we call that hoosier common sense. In working collaboratively to help hoosiers get access to Quality Healthcare is something miss verma and i had the opportunity to do together. As many of you are already aware, she 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. Also known as h. I. P. Today, it improves Health Care Outcomes and has played a Critical Role in combatting the opioid abuse and heroin use epidemics. Hundreds of thousands of hoosiers currently have Health Insurance through hip 2. 0. A program is an example of what is possible when we Work Together. As i have shared with miss verma and ill 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 w