Transcripts For CSPAN3 HHS Secretary Tom Price Testifies On

Watch afterwards on cspan 2s book tv. Tom price recently testified before the Senate Finance committee about the president s 2018 budget request for his department. Lawmakers also asked about the current state of the Health Care Law and proposed cuts to medicaid. This hearing runs just over two hours. The committee will come to order. Were going to first listen to the distinguished senator from oregon who has to go to another Committee Hearing so well show that deference to him. I welcome everybody to this mornings hearing on the president s proposed budget for fiscal year 2018 with specific attention to the department of health and Human Services. But let me i want to thank secretary price for being here. These hearings are an annual event for the finance committee and, secretary price, since this is your first time around, ill just warn you that these hearings can be a little grueling. Of course, you already know that. Im grateful for the president and that the president and hhs are willing to work with congress to fix our Health Care System to ensure americans can access Affordable Health care coverage. For that, im going to turn to the Ranking Member who needs to get to another hearing and well show that deference. Mr. Chairman. Thank you very much for this courtesy. I know this is a busy morning, and i am very grateful to you for doing this. I also want to say thank you to senator stabineau who in my absence is going to do an excellent job as she always does. This administration from day one has preferred alternative fact and convenient spin to the truth. One of the most recent examples was its Budget Proposal which double counted 2 trillion to maintain some wiff of fiscal responsibility while it slashed Health Programs and protections for basic and essential needs. The budget mass is fake, but the extreme agenda that would deprive millions of americans access and wipe out Living Standards is not. Untore few nately this morning im going to be splitting my time between finance committee and Intelligence Committee so i will be brief. There are several issues im going to touch on. First is medicaid. Secretary price is the captain of the president S Health Care team. He has been the premiere advocate for trump care, a bill that cuts medicaid by 834 billion in order to pay for massive tax breaks for the wealthy. 14 million would lose coverage and if that wasnt enough of a cut, the Budget Proposal that came out a few weeks ago goes even further. It slashes hundreds of billions more from medicaid. 37 million kids, working families, people with disabilities and two out of three nursing home beds in ameri america, these cuts would be a staggering blow to americans of all generations. These facts and figures have been met by a waive of the hand from secretary price. When asked if his proposed cuts would result in millions of americans losing access to medicaid he responded, and i quote, absolutely not. He went further claiming again, i quote, there are no cuts to the Medicaid Program and he also said, and i quote, nobody will be worse off financially. Ive heard secretary price and others make the baffling argument that people are actually worse off when they have medicaid coverage, that their health doesnt improve as a result of medicaid coverage. Often this argument is based on a brief and outdated study performed in my home state. Heres the bottom line on medicaid. 74 million americans rely on this program for basic health needs. Parents of sick kids, people with disabilities, seniors in Nursing Homes who have nobody to turn to for help if their benefits disappear. In addition, thousands of oregonians who are healthy under my home states model, it would be a tough sell to tell them they would be worst off without medicaid. The Program Needs a trillion dollars in cuts. Public opinion is very clear. Two out of three enrollees are very happy. Seven out of ten americans say congress ought to leave it as it is. No block grants. No per capita cuts. Fortunately the budget hit the wall here in congress and theres a lot of debate to be had on trump care. Right now theyre causing turmoil in the Insurance Markets and its already having disastrous effects for millions of families. The president issued a one day executive order undermining the Affordable Care act and nobody on the trump team can give a straight answer about whether the administration will continue making cost sharing reduction payments that are key to making insurance affordable for working families. Because of this sabotage, insurers are pulling out of the market and people are left without plans to choose from. You dont have to take my word for it, the insurers are very clear about why theyre making these decisions. Furthermore, on the campaign trail the president said he wouldnt cut medicare. The trump bill shrinks the life of medicare. The Budget Proposal expands the mandatory cuts under the budget see quester by more than 30 billion. The food Drug Administration, the centers for disease control, the National Institutes of health all slashed in the budget. The same is true in programs aimed at basic human needs, programs that fund meals on wheels, child care, foster care. This is the budget you write if you think seniors and working families have it too easy. I want to thank the secretary for joining the committee. I apologize again for the hectic schedule. Its never an easy appointment for the cabinet secretary and i think he knows theres going to be some vigorous discussion this morning. I also again want to express my thanks to the chairman for his very gracious and Ongoing Court sis on these kinds of matters. Thanks, senator stabineau for being willing to return in. I thank the chair. Thank you, senator. Let me just say im grateful that the president and hhs are in essence working on this effort. And are in essence willing to work with congress to fix our health care in order to make sure americans can access Affordable Health care coverage. This may not be something that is going to be that easy to do. And as we know, time is of the essence in regard to this effort. Earlier this week we received word that anthem is pulling out of ohios marketplace, potentially leaving 10,000 patients and consumers in 20 counties without any Insurance Options on ohios exchange for 2018. This news is particularly frightening if we expect to hear similar notices from anthem as they reevaluate their participation in obama care exchanges throughout the United States, our whole country. Now this recent story is just the latest in a long line of failures that my colleagues on the other side seem to want to continue under the guise that this is working. Its not working. All of this demonstrates the need to move forward with repealing obamacare and replacing it with a more workable approach, one that will take serious that we can take seriously the blooming ballooning Health Care Costs impacting every american family. Let me talk for a few minutes about the president s budget. The budget assumes 250 billion in total savings from the repeal and the replacement of obamacare and despite some insinuations to the contrary, the budget does not incorporate the specific legislative proposal. The American Health care act that is before congress right now, therefore, it is not accurate to associate the specific medicaid savings the cbo has estimated from enactment of the ahca from the president s budget. To do so would specify a level of specificity that for obvious reasons is just not there. Moreover, the president s budget does not cut 1. 5 trillion dollars from medicaid nor does it assume that the specific medicaid reform proposals from the ahca will be enacted into law. Im quite certain well hear a lot about that today but any attempt to make that connection is simply unfounded and any senator who harps on the ahca medicaid numbers here today either does not understand the explicit language and estimates provided in the president s budget or they are simply attempting to muddy the waters in order to scare americans who rely on medicaid for health care coverage. Ultimately the president s budget appears to accept the reality that the senate will need to come up with its own Health Care Proposal that includes a fundamental fix to medicaid which is, quite frankly, long overdue. Anybody who doesnt agree with that isnt living in the real world. In addition to the savings assumed from the repeal of obamacare, the budget also explicitly assumes 610 billion in savings from putting medicare on a sustainable fiscal path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. All told, most of the budgets overall medicaid savings would be achieved by returning the focus of medicaid to serving those with the greatest needs, the elderly, disabled and needy mothers and children. By giving states more flexibility to run their own Medicaid Program. Any senator who would like to argue that the federal government should spend more medicaid dollars to provide coverage for nondisabled childless adults at the expense of disabled patients who remain on waiting lists should explain why. Furthermore, any senator who would like to argue that the states are ill equipped to handle their Medicaid Programs should explain why that is the case given that the overwhelming consensus weve heard from governors nationwide over the last few years is that states want more independence and flexibility to tailor the Medicaid Program. Washington needs to stop measuring the success of a federal program by how much money it spends or how many other programs are a part of it. Instead, washington needs to focus on how well a federal Program Helps those it is intended to serve and how efficient the program is at fulfilling its mandate. Long story short, we need to stop focusing on spending and pay more attention to outcome because we may not be able to spend more. It doesnt appear that were going to be able to. The rate things are going right now under the current system, its a national tragedy. I think the president s budget while it is by no means flawless largely recognizes this reality and the president and the administration deserve credit for that. I look forward to having an open and frank discussion with secretary price about his thoughts and matters. Before we get to that, let me just say that id like to say today that we have the pleasure of being joined by secretary thomas e. Price. Secretary price, we want to thank you for coming. Secretary price is sworn in as the 23rd secretary of health and Human Services on february 10th, 2017, as a policy maker and as a physician, surgeon in particular, he brings to the department a lifetime of service and dedication to advancing the quality of health care in america. Secretary price first began his career in care for patients as an orthopaedic surgeon. He followed in the food steps of his father and grandfather and began a solo medical practice in atlan atlanta, georgia. That has grown to be one of the largest nonacademic orthopaedic practices in the country hoping to make a different impact on health care secretary price ran for public office. Was selected to four terms in the Georgia State senate and i believe would have continued on forever if he wanted to. During his tenure there secretary price served as minority whip and later as the first Republican Senate majority leader in the history of georgia. Most recently secretary price served as u. S. Representative for georgias sixth Congressional District from 2005 to 2017. During his time in the house secretary price served in various roles including chairman of the house budget committee, chairman of the House Republican policy committee and chairman of the republican study committee. Secretary price received his bachelor and doctorate of medicine degrees from the university of michigan after which he completed his orthopaedic surgery residency at emory university. Secretary price, were grateful to have you here. Well be happy to have you proceed with your testimony here today. Thank you so much, mr. Chairman. Ranking member stabineau and members i want to thank you for discussing the president s budget for health and Fiscal Services for 2018. Whenever a budget is released, the most common question in this town, in washington, is how much . How much does the budget spend on this program . How much does it cut from the other programs . As a former legislator, i understand the importance of this question, but too often its treated as the only question thats worth asking as it relates to the budget as if how much a program spends is more important or somehow more indicative of whether the Program Actually works. President trumps budget request does not confuse Government Spending with government success. The president understands that setting a budget is about more than establishing top line spending levels. Done properly, the budgeting process is an exercise in reforming our federal programs to make sure that they do their job and use tax dollars wisely. The problem with many of our federal programs is not that theyre too expensive or too under funded. The real problem is many of them simply dont work. Fixing a broken Government Program requires redesigning its structure and refocusing taxpayer resources to better serve most in need. Thats exactly what President Trumps budget will do in hhs and across the government. Consider medicaid thats been discussed. The primary source of medical coverage for millions of low income families and seniors facing Challenging Health conditions. If the amount of government truly a measure of success, medicaid would be hailed as one of the most successful programs in history. 20 years ago actual spending on medicaid was less than 200 billion. Within the next decade its estimated to top 1 trillion a year. Despite these significant investments, onethird of physicians who ought to be seeing new medicaid patients dont and some Research Shows that enrolling in medicaid doesnt necessarily improve your Health Outcomes for the newly eligible medicaid population. This suggests we need Structural Reforms to power states to serve their unique medicaid populations in a way thats compassionate and sustainable. Federal rules prevent states from focusing on their most vulnerable communities to improve Health Outcomes and access to chair. This budget changes that. Hsss mission of protecting the health involves far for than overseeing the health care and Insurance Programs. Hss is the world leader in helping the Health Care Sector prepare for Cyber Threats and responding to and protecting against Public Health emergencies, recently i witnessed this important work first hand visiting ebowla survivors in liberia and representing the United States at the g20 in berlin and the World Health Assembly in geneva. To support hsss unique role, the president s budget provides 4. 3 billion for Disaster Services coordination and response planning, bio defense and Infectious Disease research and developing and stock piling of critical measures. America faces a new set of Public Health crisis that have been far less successful if resolving. Those are serious mental illness, Opioid Crisis and it childhood obesity. And the president s bud yet calls for investments in policy reforms that will enable to do just that. The budget calls for investments in high priority Mental Health initiatives for Psychiatric Care and suicide and homeless prevention and childrens Mental Health focusing especially on those suffering from severe mental illness. Over 52,000 americans died in over dose from opioids. This budget calls for 811 million to support the departments five part strategy to fight this epidemic. To invest in the health of the next generation and help nearly the 20 of School Aged Children who are obese, lead healthy and happier lives the president s budget established a new 500 Million Health block grant. The president s budget prioritizes Womens Health by investing in research and increasing funding for the maternal and Child Health Block grant and healthy start. Across hss funding is maintained for vital programs serving women including Senate Finance<\/a> committee about the president s 2018 budget request for his department. Lawmakers also asked about the current state of the Health Care Law<\/a> and proposed cuts to medicaid. This hearing runs just over two hours. The committee will come to order. Were going to first listen to the distinguished senator from oregon who has to go to another Committee Hearing<\/a> so well show that deference to him. I welcome everybody to this mornings hearing on the president s proposed budget for fiscal year 2018 with specific attention to the department of health and Human Services<\/a>. But let me i want to thank secretary price for being here. These hearings are an annual event for the finance committee and, secretary price, since this is your first time around, ill just warn you that these hearings can be a little grueling. Of course, you already know that. Im grateful for the president and that the president and hhs are willing to work with congress to fix our Health Care System<\/a> to ensure americans can access Affordable Health<\/a> care coverage. For that, im going to turn to the Ranking Member<\/a> who needs to get to another hearing and well show that deference. Mr. Chairman. Thank you very much for this courtesy. I know this is a busy morning, and i am very grateful to you for doing this. I also want to say thank you to senator stabineau who in my absence is going to do an excellent job as she always does. This administration from day one has preferred alternative fact and convenient spin to the truth. One of the most recent examples was its Budget Proposal<\/a> which double counted 2 trillion to maintain some wiff of fiscal responsibility while it slashed Health Programs<\/a> and protections for basic and essential needs. The budget mass is fake, but the extreme agenda that would deprive millions of americans access and wipe out Living Standards<\/a> is not. Untore few nately this morning im going to be splitting my time between finance committee and Intelligence Committee<\/a> so i will be brief. There are several issues im going to touch on. First is medicaid. Secretary price is the captain of the president S Health Care<\/a> team. He has been the premiere advocate for trump care, a bill that cuts medicaid by 834 billion in order to pay for massive tax breaks for the wealthy. 14 million would lose coverage and if that wasnt enough of a cut, the Budget Proposal<\/a> that came out a few weeks ago goes even further. It slashes hundreds of billions more from medicaid. 37 million kids, working families, people with disabilities and two out of three nursing home beds in ameri america, these cuts would be a staggering blow to americans of all generations. These facts and figures have been met by a waive of the hand from secretary price. When asked if his proposed cuts would result in millions of americans losing access to medicaid he responded, and i quote, absolutely not. He went further claiming again, i quote, there are no cuts to the Medicaid Program<\/a> and he also said, and i quote, nobody will be worse off financially. Ive heard secretary price and others make the baffling argument that people are actually worse off when they have medicaid coverage, that their health doesnt improve as a result of medicaid coverage. Often this argument is based on a brief and outdated study performed in my home state. Heres the bottom line on medicaid. 74 million americans rely on this program for basic health needs. Parents of sick kids, people with disabilities, seniors in Nursing Homes<\/a> who have nobody to turn to for help if their benefits disappear. In addition, thousands of oregonians who are healthy under my home states model, it would be a tough sell to tell them they would be worst off without medicaid. The Program Needs<\/a> a trillion dollars in cuts. Public opinion is very clear. Two out of three enrollees are very happy. Seven out of ten americans say congress ought to leave it as it is. No block grants. No per capita cuts. Fortunately the budget hit the wall here in congress and theres a lot of debate to be had on trump care. Right now theyre causing turmoil in the Insurance Markets<\/a> and its already having disastrous effects for millions of families. The president issued a one day executive order undermining the Affordable Care<\/a> act and nobody on the trump team can give a straight answer about whether the administration will continue making cost sharing reduction payments that are key to making insurance affordable for working families. Because of this sabotage, insurers are pulling out of the market and people are left without plans to choose from. You dont have to take my word for it, the insurers are very clear about why theyre making these decisions. Furthermore, on the campaign trail the president said he wouldnt cut medicare. The trump bill shrinks the life of medicare. The Budget Proposal<\/a> expands the mandatory cuts under the budget see quester by more than 30 billion. The food Drug Administration<\/a>, the centers for disease control, the National Institutes<\/a> of health all slashed in the budget. The same is true in programs aimed at basic human needs, programs that fund meals on wheels, child care, foster care. This is the budget you write if you think seniors and working families have it too easy. I want to thank the secretary for joining the committee. I apologize again for the hectic schedule. Its never an easy appointment for the cabinet secretary and i think he knows theres going to be some vigorous discussion this morning. I also again want to express my thanks to the chairman for his very gracious and Ongoing Court<\/a> sis on these kinds of matters. Thanks, senator stabineau for being willing to return in. I thank the chair. Thank you, senator. Let me just say im grateful that the president and hhs are in essence working on this effort. And are in essence willing to work with congress to fix our health care in order to make sure americans can access Affordable Health<\/a> care coverage. This may not be something that is going to be that easy to do. And as we know, time is of the essence in regard to this effort. Earlier this week we received word that anthem is pulling out of ohios marketplace, potentially leaving 10,000 patients and consumers in 20 counties without any Insurance Options<\/a> on ohios exchange for 2018. This news is particularly frightening if we expect to hear similar notices from anthem as they reevaluate their participation in obama care exchanges throughout the United States<\/a>, our whole country. Now this recent story is just the latest in a long line of failures that my colleagues on the other side seem to want to continue under the guise that this is working. Its not working. All of this demonstrates the need to move forward with repealing obamacare and replacing it with a more workable approach, one that will take serious that we can take seriously the blooming ballooning Health Care Costs<\/a> impacting every american family. Let me talk for a few minutes about the president s budget. The budget assumes 250 billion in total savings from the repeal and the replacement of obamacare and despite some insinuations to the contrary, the budget does not incorporate the specific legislative proposal. The American Health<\/a> care act that is before congress right now, therefore, it is not accurate to associate the specific medicaid savings the cbo has estimated from enactment of the ahca from the president s budget. To do so would specify a level of specificity that for obvious reasons is just not there. Moreover, the president s budget does not cut 1. 5 trillion dollars from medicaid nor does it assume that the specific medicaid reform proposals from the ahca will be enacted into law. Im quite certain well hear a lot about that today but any attempt to make that connection is simply unfounded and any senator who harps on the ahca medicaid numbers here today either does not understand the explicit language and estimates provided in the president s budget or they are simply attempting to muddy the waters in order to scare americans who rely on medicaid for health care coverage. Ultimately the president s budget appears to accept the reality that the senate will need to come up with its own Health Care Proposal<\/a> that includes a fundamental fix to medicaid which is, quite frankly, long overdue. Anybody who doesnt agree with that isnt living in the real world. In addition to the savings assumed from the repeal of obamacare, the budget also explicitly assumes 610 billion in savings from putting medicare on a sustainable fiscal path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. All told, most of the budgets overall medicaid savings would be achieved by returning the focus of medicaid to serving those with the greatest needs, the elderly, disabled and needy mothers and children. By giving states more flexibility to run their own Medicaid Program<\/a>. Any senator who would like to argue that the federal government should spend more medicaid dollars to provide coverage for nondisabled childless adults at the expense of disabled patients who remain on waiting lists should explain why. Furthermore, any senator who would like to argue that the states are ill equipped to handle their Medicaid Program<\/a>s should explain why that is the case given that the overwhelming consensus weve heard from governors nationwide over the last few years is that states want more independence and flexibility to tailor the Medicaid Program<\/a>. Washington needs to stop measuring the success of a federal program by how much money it spends or how many other programs are a part of it. Instead, washington needs to focus on how well a federal Program Helps<\/a> those it is intended to serve and how efficient the program is at fulfilling its mandate. Long story short, we need to stop focusing on spending and pay more attention to outcome because we may not be able to spend more. It doesnt appear that were going to be able to. The rate things are going right now under the current system, its a national tragedy. I think the president s budget while it is by no means flawless largely recognizes this reality and the president and the administration deserve credit for that. I look forward to having an open and frank discussion with secretary price about his thoughts and matters. Before we get to that, let me just say that id like to say today that we have the pleasure of being joined by secretary thomas e. Price. Secretary price, we want to thank you for coming. Secretary price is sworn in as the 23rd secretary of health and Human Services<\/a> on february 10th, 2017, as a policy maker and as a physician, surgeon in particular, he brings to the department a lifetime of service and dedication to advancing the quality of health care in america. Secretary price first began his career in care for patients as an orthopaedic surgeon. He followed in the food steps of his father and grandfather and began a solo medical practice in atlan atlanta, georgia. That has grown to be one of the largest nonacademic orthopaedic practices in the country hoping to make a different impact on health care secretary price ran for public office. Was selected to four terms in the Georgia State<\/a> senate and i believe would have continued on forever if he wanted to. During his tenure there secretary price served as minority whip and later as the first Republican Senate<\/a> majority leader in the history of georgia. Most recently secretary price served as u. S. Representative for georgias sixth Congressional District<\/a> from 2005 to 2017. During his time in the house secretary price served in various roles including chairman of the house budget committee, chairman of the House Republican<\/a> policy committee and chairman of the republican study committee. Secretary price received his bachelor and doctorate of medicine degrees from the university of michigan after which he completed his orthopaedic surgery residency at emory university. Secretary price, were grateful to have you here. Well be happy to have you proceed with your testimony here today. Thank you so much, mr. Chairman. Ranking member stabineau and members i want to thank you for discussing the president s budget for health and Fiscal Services<\/a> for 2018. Whenever a budget is released, the most common question in this town, in washington, is how much . How much does the budget spend on this program . How much does it cut from the other programs . As a former legislator, i understand the importance of this question, but too often its treated as the only question thats worth asking as it relates to the budget as if how much a program spends is more important or somehow more indicative of whether the Program Actually<\/a> works. President trumps budget request does not confuse Government Spending<\/a> with government success. The president understands that setting a budget is about more than establishing top line spending levels. Done properly, the budgeting process is an exercise in reforming our federal programs to make sure that they do their job and use tax dollars wisely. The problem with many of our federal programs is not that theyre too expensive or too under funded. The real problem is many of them simply dont work. Fixing a broken Government Program<\/a> requires redesigning its structure and refocusing taxpayer resources to better serve most in need. Thats exactly what President Trump<\/a>s budget will do in hhs and across the government. Consider medicaid thats been discussed. The primary source of medical coverage for millions of low income families and seniors facing Challenging Health<\/a> conditions. If the amount of government truly a measure of success, medicaid would be hailed as one of the most successful programs in history. 20 years ago actual spending on medicaid was less than 200 billion. Within the next decade its estimated to top 1 trillion a year. Despite these significant investments, onethird of physicians who ought to be seeing new medicaid patients dont and some Research Shows<\/a> that enrolling in medicaid doesnt necessarily improve your Health Outcomes<\/a> for the newly eligible medicaid population. This suggests we need Structural Reforms<\/a> to power states to serve their unique medicaid populations in a way thats compassionate and sustainable. Federal rules prevent states from focusing on their most vulnerable communities to improve Health Outcomes<\/a> and access to chair. This budget changes that. Hsss mission of protecting the health involves far for than overseeing the health care and Insurance Programs<\/a>. Hss is the world leader in helping the Health Care Sector<\/a> prepare for Cyber Threats<\/a> and responding to and protecting against Public Health<\/a> emergencies, recently i witnessed this important work first hand visiting ebowla survivors in liberia and representing the United States<\/a> at the g20 in berlin and the World Health Assembly<\/a> in geneva. To support hsss unique role, the president s budget provides 4. 3 billion for Disaster Services<\/a> coordination and response planning, bio defense and Infectious Disease<\/a> research and developing and stock piling of critical measures. America faces a new set of Public Health<\/a> crisis that have been far less successful if resolving. Those are serious mental illness, Opioid Crisis<\/a> and it childhood obesity. And the president s bud yet calls for investments in policy reforms that will enable to do just that. The budget calls for investments in high priority Mental Health<\/a> initiatives for Psychiatric Care<\/a> and suicide and homeless prevention and childrens Mental Health<\/a> focusing especially on those suffering from severe mental illness. Over 52,000 americans died in over dose from opioids. This budget calls for 811 million to support the departments five part strategy to fight this epidemic. To invest in the health of the next generation and help nearly the 20 of School Aged Children<\/a> who are obese, lead healthy and happier lives the president s budget established a new 500 Million Health<\/a> block grant. The president s budget prioritizes Womens Health<\/a> by investing in research and increasing funding for the maternal and Child Health Block<\/a> grant and healthy start. Across hss funding is maintained for vital programs serving women including Community Health<\/a> centers, Domestic Violence<\/a> programs, womens cancer screenings and support mother and infant programs in the office of Womens Health<\/a>. This budget demands tough choices and in this challenging fiscal environment there are no easy answer. With this budget however the new administration charts a path toward a sustainable fiscal future and ensures the dedicated resources provided enhance and protect the health and wellbeing of the American People<\/a>. I want to thank you for the opportunity to be with you today and your continued support of the department of health and Human Services<\/a>. Its my privilege to serve as its secretary. We know that youre excellent member of the house and so far it looks to me like youre getting on top of what these problems are, although you were pretty well on top of them before as a member of the house. The Opioid Crisis<\/a> seems to be spreading across the country effecting families and communities in unprecedented ways. In fact, the the New York Times<\/a> reported earlier this week that Overdose Deaths<\/a> are at an all time high. Tackling this crisis is a priority for you and for prurch. So can you describe the efforts hss is undertaken to this is one scourges across the nation that just tears your heart out. 52,000 as i mentioned in 2015 fellow americans died of an overdose, 33,000 of those of opioid overdose. We hear day after day. What the departments done is put in place a five part strategy to make certain that were identifying the kind of treatment and Recovery Efforts<\/a> that work in assisting the states. I want to make certain we have the overdose reversing drugs available wherever they need to be available and know that were trying to survey and make certain that we know strong drugs getting to the streets from a Law Enforcement<\/a> aspect. Why is this scourge as large as it is and were putting resources into that . In addition we want to make certain were doing the highest level of research to try to identify those pain treatments that are able to make it so that theres not a need for individuals to seek it for its euphoric effect. Finally, its important to look at how we manage pain in this nation. 20 years ago we started down this road of measuring pain as a fifth vital sign. Let me suggest to you that that has resulted in significantly greater use of opioids and Prescription Medication<\/a> than wouldve otherwise been the case. So weve got this five part strategy. You have been incredibly helpful and congress has been incredibly helpful to make through 21st century cures and resources so we can allow the states to identify, again, those evidence based programs that theyve got in place that can help mitigate this challenge. We continue to move in the wrong direction, mr. Chairman and we will not rest at the department or in the administration until we bend that curve in the other direction. Thank you so much. Hss recently published a report using the previous administrations data showing just how much Health Insurance<\/a> premiums in the individual market have increased since 2013. Could you tell us what the are principal findings of that report . Thank you so much. I know that when i visited with folks in my previous position and since ive been privileged to serve as secretary, i hear over and over again how folks are just so terribly concerned about the cost of Health Coverage<\/a> for them and their family. And there was this disconnect, you have this the individuals talking about the wonders of the program that was in place and that you had all then you had allful these individuals who were so concerned because they didnt have the ability to afford the coverage or get the care. This study that we undertook that was undertaken at the aspy group within hss identified that the average premium increase over the last four years has been over 100 . It was 105 , so more than doubled across the country. In fact, three states the increases were tripled, in alaska, alabama and oklahoma. And what that means is that their individuals who one, cant afford the coverage and two, even when they can afford the coverage, the deductibles have increased to a significant degree so that they may have an insurance card but they dont have any care because they cant afford the deductible. Thats the challenge were trying to address and make certain that Congress Addresses<\/a> so that individuals are able to afford the kind of coverage that folks want for themselves and for their families. Well, as you may be aware this committee has for several years been keenly interested in the large backlog of medicare claims under hss. The most report the backlog has introduced of nearly 1 million claims to a current number closer to 750,000 claims. That number is still unacceptably high. Can you tell me what hss is doing to address the unnecessary backlog of medicare claims . These are appeals that providers have said that they dont believe the federal government is providing the kind of resources necessary for them to be able to care for their patients and as you mentioned the numbers are staggering. Nearly 1 million claims, down to 7,000 now. We can take care of around 20,000 up until recently. What weve done is met with the individuals and their high quality folks. These are folks just trying to get these appeals through the process and make the right decision. We put a focus on that. We talked to weve encouraged them to talk to the steak holders and individuals out there about why we have this increase in claims. Theres a problem there. It means that the system isnt working to the degree that it should to allow those individuals to care for those patients and be compensated for that care. Weve identified the opportunity for the Administrative Law<\/a> judges to be able to review higher claims and move in the direction of having math straight judges review lower claims so we can get through a larger volume of claims on an annual basis. Then we tried to decrease the burden of reporting. Were working on trying to reduce the burden of reporting for the providers so that there is less likely a possibility that they would need to feel the need or desire to file a claim. This is a major problem. Were working through it and were committed to getting that number down to a reasonable number. Im happy to have to listen to you. Youve inherited a tremendous number of problems and i know that youre fully capable of solving those problems and i think youre well on your way. The distinguished Ranking Member<\/a> has agreed with me. Ill allow senator isakson to go next. Thank you, mr. Chairman. Dr. Price, welcome back. Last time you were here we were here confirming you and all the georgiaens are very proud of you. You just returned from your first trip overseas as secretary and that began in lie breera. I did. What did you learn particularly with regard to our response to the ebowla which ground zero i think was liberia. It was indeed. Thank you so much. I appreciate your support and your service to our great state. My first trip overseas was we stopped first in liberia and i wanted to do that because i wanted to express our appreciation to the americans who were working over there especially during that ebola crisis and to also demonstrate our continued commitment for Global Health<\/a> security and to thank the lie beerion government for what they had done to elevate an increase in their ability in the area of Infectious Disease<\/a>. What i saw was incredibly inspiring. And you all would be so remarkably proud of the American People<\/a> who are Forward Deployed<\/a> if you will in Global Health<\/a>, individuals from the cdc, from nih, who are doing all that they can to make certain that we address the Health Challenges<\/a> that exist around the world especially in the area of Infectious Disease<\/a>. It paid off in absolute remarkable benefit and we saw that because of the most recent outbreak of meningitis that occurred and that outbreak the surveillance that was done, the detection that was done the prevention of spread that was done and the treatment was only possible because of the work that had been done in liberia since the Ebola Outbreak<\/a> and since that challenge was resolved. So i was i was just uplifted and inspired by the incredible work of the American People<\/a> who are dedicating their lives to assisting the health of individuals overseas. Cdc did a phenomenal job as did hss. The president s budget is cut by 136 million the Preparedness Fund<\/a> a lot of which went to the initial response to ebola and africa to have the first place we could bring some of those victims. So we need to work to see to it that fund sg is there so it can have the same type of response the next time an outbreak take place. Were the worlds clinic if you will for emergencies and disasters like that. Yes. Secondly, you had a partner by the name of john knox. I did. John operated on my son kevin 30 years ago and saved his leg from a terrible injury and a terrible accident. It took him nine months to recover. Eight of those months he recovered at home. My wife and i went to school, we took lessons in how to clean ports and put down drips into him so he could fight infection in his bone marrow while he recovered at home. Since 1989 when that accident took place over time reimbursement for antibiotics and Home Infusion<\/a> went away. There was a drive to drive everybody in the hospital to recover. Fortunately senator warner worked closely with us to get reimbursement for Durable Medical Equipment<\/a>. I hope youll work to it we can expand coverage to get Home Infusion<\/a> wherever practical and possible covered as a benefit so we can have more people recovering in a less expensive more hospitable environment. This is really important, senator. What we find health care and medicine is dynamic. It changes all the time. So what used to be able to be done only in a hospital now can often times be done as an out patient or in the instance of recovery often times at home and home and Community Based<\/a> services are absolutely imperative for us to have the flexibility to be able to do that. Its one of the things that were trying to concentrate on from a waiver standpoint in many different programs as well as trying to insent the flexibility within existing programs so we can cover those kinds of treatments in not necessarily in the venue that was previously selected when that was the standard of care, but in a new venue because it works better for the patient. Lastly, i want to underscore what you said about experimenting to see how medicaid coverage available and row built for our citizens. Your state and my state, georgia we have 1. 9 Million People<\/a> on medicaid, 1. 3 of them are children. 50 of all the live births in georgia are paid for my medicaid. So as we go through the reforms are necessary, we got to remember were talking about first and foremost children who benefit from those programs being robust or hurt if their cut. I look forward to working with you to see to provide the coverage thats necessary and experiment with ways to neva incentivize the care. Thank you very much, mr. Chairman. Theres so many things i would like to talk to you about and debate you in terms of what has been said and the positions of the administration, but i want to start with i think a very important basic assumption that you have made and that is that Affordable Care<\/a> act is falling apart, oh, my gosh, look whats happening. We have to dismantle it. We do Something Different<\/a> because its falling apart and yet we know, to me its like pulling the rug out from under somebody and then going oh, my gosh they fell down. We have seen consistent moves by the Administration Whether<\/a> its cutting in half the number of days that citizens have to sign up for insurance, whether its no longer aggressively doing outreach to younger, Healthy People<\/a> making sure everybodys in the pool so that costs dont go up or whether its doing whats been done to take away the commitments made to the Insurance Industry<\/a> to make sure that they would be covering preexisting conditions and having no caps on services and its laid out this morning in the the Washington Post<\/a> when we look at the question of whether or not the white house is going to let the Health Care System<\/a> die and i want to just quote a little bit in there because this is coming from the industry, the biggest source of industry anxiety right now is whether the administration and congress will continue to fund cost sharing subsidies that help 7 million americans with aca plans, afford deductibles and copay. Absent that funding i dont know if well have much participation in the Exchange Market<\/a> in 2018 said tennessee insurance commissioner julie mcpeek a republican who has also serves as president elect of the National Association<\/a> of insurance commissioners. The uncertainty, the uncertainty is one of the top reasons insurers have cited had when explaining why they are posting higher rates for the next year or withdrawing from markets all together. Two weeks ago Blue Cross Blue Shield<\/a> of North Carolina<\/a> filed a rate increase of 22. 9 . It they said it would have been 8. 8 , not 22. 9 if the administration had committed to paying basically keeping the commitments that were cast as part of Health Reform<\/a> and finally on tuesday, Anthem Blue Cross<\/a> and blue shield announced it was pulling out of the federal chain. The president seemed to cheer that yesterday. I dont know why were cheering that people are going to have less opportunity to have health care if we spent a 10th of time as been spent undermining the Health Care System<\/a> working to make it better we would be making terrific strides to lower cost for people. But heres what was said by the North Carolina<\/a> chief executive brad wilson of Blue Cross Blue Shield<\/a>. We have to take a snapshot in time which is right now, a lack of action, a lack of action by the administration, he added, yields a result we are currently seeing. Higher premiums rather than lower premiums and so my question, mr. Secretary, is why do you believe its in the best interest of American Families<\/a> to sabotage the Health Care System<\/a> that is today allowing American Parents<\/a> to take their children to the doctor . Thanks, senator. Let me just correct a few statements. Nobody is interested in the system dying. What were interested is making sure the system works for patients and families. Then why excuse me. Why are you not willing then to indicate that as long as we have the system we have youre going to keep the commitments and reimburse the Insurance Companies<\/a> so they have certainty . Nobody is interested in sabotaging the system. Nobody is interested nobody is cheering the challenges we have in this system. In your state alone, premiums were up 90 before this president came into office. The number of insurers were down before this president came into office in your state. But i can assure you after meeting with the head of blue cross and blue shield of michigan theyre going to file two rates. One, if the administration keeps their commitments and one if they dont. And if they dont, theyre going to be much higher and so i think the question is why wouldnt you keep the commitments made. I understand you have a different view in terms of what this system should look like which i disagree with, but in the meantime, you have insurers, insurers that are saying the reason the rates are going up is because of uncertainty and instability created by the administration. Actually why is that a good idea . If you read further in that article it talks about the increasing cost and decreasing insurance availability for individuals across this country before this administration came into office. So what were trying to do is to fix the challenge that we have lets start by keeping our commitments. I have more questions for another round. Lets start by making sure that the administration is keeping the current commitments following the current law while we debate what should happen next. Thank you, mr. Chairman. Did you have enough time to answer that question . Yes, sir. If you need more time. Im fine, thanks. Well turn now to senator cassidy. Hey, dr. Price. Hey. Couple things im encouraged by in your budget, senator and i put in a bill regarding direct primary care and for those unfamiliar with it but as physicians you and i know the way you lower cost is empower the patient physician relationship so that if the patient has a problem instead of going to the er she can call her physician and her physician can give her the advice. Direct primary care is a contractual relationship so theres more investment perhaps than the other relationships that are out there, say in Urgent Care Center<\/a> where you might see the person once, never see them again. So i like it because it can decrease utilization and by decreasing utilization decrease Health Care Cost<\/a> and we dont decrease the cost of insurance unless we decrease both utilization and the cost of health care. Absolutely. Any comments on that direct primary care model. This its an helpful program and it gets to the point of the health care. The opportunity that individuals may have to be able to have a personal physician, a primary care physician in all settings across our Health System<\/a> would be i think absolutely beneficial to the ability for that patient, that individual patient to get the care that he or she needs. Right now you cant do that and so what we want to do is to move toward a system that allows for more Personalized Care<\/a> and the dcp model is one that i think holds great promise. If you would, and let me talk about the per capita cap or the per beneficial payment and just a little history for those who may not know, but it was first introduced by president clinton as a concept and senators phil graham and rick sanatorium simultaneously as a way to align incentives between the patient, the state and the federal government and i think were actually seeing almost a modified version of that as states are now going to Medicaid Managed Care<\/a> aligning the incentive between the state as a payor with the Medicaid Managed Care<\/a> company and the patient, i guess the way i look at the per benefit payment as you know i introduced a bill in 2020 2010 i dont know when it was 112 congress which brushed off the phil graham bill clinton proposal and updated it if you will. Your line between the federal and the state government. Exactly. Its so important because as you know, having taken care of as i did medicaid patients in our practices, the medicaid population is not a mon owe lithic populations. There are individuals healthy moms and kids. Theyre also individual in the medicaid population who are seniors, low income seniors and disabled, blind and disabled individuals and all those individuals need to be treated uniquely because theyre unique individuals and what we do as a system by and large is say youve got to take care of every one of those people exactly the same way which doesnt allow for that flexibility in the program so states can tailer their Medicaid Program<\/a>s to suit their medical population. I dont know if this is in the house bill because the way we do the per beneficiariry payments but as an example of aligning the incentives, if states recover waste, fraud and abuse they have to give back the federal government the portion the federal taxpayer put in so if its a 60 state, 40 state, 60 of that recovery goes back to the federal government, that works to disincentivize the state to go after waste, fraud and abuse because they have to kick it back under the per beneficiariry model that we put forward the state would keep 100 of waste, fraud and abuse if you will aligning the incentive for them to ring out that waste, fraud and bees. Its those kinds of modifications and improvements to a system that i believe we ought to be allembracing because its those kinds of things that would allow us to align the incentives but make certain that every individual in that interaction is working for the benefit of the patient, making certain theres not the fraud and abuse, making certain the patient is able to see the physician that he or she wants to see, making certain the patient is able to have the kind of treatment that he or she desires. Under the mac act which i introduced weve Incorporated States<\/a> like california actually get more money. Umhum. And sosome big blue states actually do well. Florida does better. So in terms of having more dollars for certain categories of patients in order to improve health care, so when i hear folks condemn it without understanding it, i feel like this could be an incredible missed opportunity to align those incentives, to improve patient care but also to protect the federal and state taxpayer. I look forward to working with you. I yield back. I want to take a moment just to begin if i could to commend you and senator grassley for something you did, gosh, i want to say 24 years ago and what you did is you cosponsored legislation authored by senator john chasy that called for creating marketplaces, exchanges. You called for not only establish and exchanges in marketplace in every state but to also say that in order to make sure that the Insurance Companies<\/a> had a healthy pull of people to insure that there would be an individual mandate that people had to get coverage. You cant force people to get coverage. Fine them if they didnt. I will want to congratulate you on cosponsoring legislation that provided for an employer mandate and that also provided for the idea that insurance cannot, you know, deny coverage to people who had a preexisting condition. All that is all those ideas are part of romney care in massachusetts and frankly all those ideas are part of the Affordable Care<\/a> act. And the part of the Affordable Care<\/a> act that republican colleagues seem to like the least are those ideas. I think theres a real irony in all of this and i like those ideas. I like Market Forces<\/a>. I like trying to harness Market Forces<\/a> and make them work. Yall came up with a good idea in 1993 andpy just wish to heck that you would work with us to try to make sure that those good ideas have a chance of working. And the reason why the marketplaces are failing in places like you mentioned in ohio in your statement, mr. Chairman, the reason why theyre not working is basically undermine the individual mandate so that people dont have to get coverage. Young people arent. Weve taken off the training wheels so to stabilize the marketplaces and Insurance Companies<\/a> they lost their shirts in 2014 because of it. They lost less money in 2015, it got better. They raised their premiums and their copays and deductibles and they did better. Rather than the marketplaces being a desk pile, theyre actually recovering. Until a new administration came in and said were not sure if well enforce the individual mandate and, by the way, we dont know for sure whether well extend the cost sharing arrangements. That provides unpredictability, lack of certain for the Insurance Companies<\/a>, what do they do, well raise our premiums more. Youre destabilizing the very idea that these guys came up with 24 years ago. If i can just interrupt for a second. Those were ideas that were against it was part of the antihillary care bill. They were good ideas. I commend you for them. I couldnt tell will you. I know what your bill did and frankly they were good ideas. And now were undermining, undercutting them. Why . Dr. Price, why . Senator, i appreciate the observation. I would add to that that there are significant challenges out there and their were so before this administration started. In your state alone premiums were up 108 before this administration started. In your state alone there were fewer Insurance Companies<\/a> offering coverage on the exchange before this administration started. So what were trying to do is to address especially that individual and Small Group Market<\/a> that is seeing significant increases in premiums, crease increases in deduction. How are you stabilizing the marketplaces . The three rs. What are you doing on those . Reininsurance, risk adjustment. We put in place a market stabilization rule earlier this year that identified the special enrollment periods and the grace periods to make certain they were more workable for both individuals and for Insurance Companies<\/a>. We allowed the states greater flexibility in determining what a qualified health plan was to provide greater stability for the market. Weve put out word to all governors across this nation on both 1115 and 1332 waivers and suggestions regarding what they can do to allow for greater market stabilization in their states and we look forward to working with you and other senators to try to make certain that all those individuals, not just in the individual and Small Group Market<\/a> but every single american has the opportunity to gain access to the kind of coverage that works for them and their families. Let me mention medicaid. When i came to the congress a long time ago before i was governor, i used to think that medicaid waS Health Care<\/a> coverage for mostly women with children, poor women and children. You know where we spend most of our money, most of the money we spend in medicaid today is for old people in their Nursing Homes<\/a> and a bunch of them have dementia when we talk about cutting 800 million its not just poor women and children, its those old people getting hurt. Its a lot of people between the age of 50 and 60 white males, a lot of veterans their only hope and getting access to medical care because they cant qualify for va coverage is through medicaid. Mr. Chairman, heres an idea. I extend this idea with good intent. I spent eight years as a governor. I loved being a governor. I loved being part of the National Governors<\/a> association of. The governor of michigan used dom here and the ways and means committee, were used to testifying on welfare reform. These are the views of the governors, democratic and republican. This is an issue that cries out for getting governors to sit at this table and say, heres how this is going to effect. This is why the waiver system works or why it doesnt work. This is why we like the idea of per capita caps and why it doesnt work. Thats what we ought to be doing. The 13 folks that have been picked to pick up a republican alternative to the house passed mess it would be a lot better informed if you can have this kind of hearing. This is fine. Thats something that may be move us toward a principal compromise. People want us to get stuff done. Thank you for joining us. Mr. Chairman, if i may just comment on that. I think its important for people to appreciate what the work the departments doing and we met the with the National Governors<\/a> association, met with governors on both sides of the aisle to solicit their input into the sessions that they would have regarding 1115 and 1332 waivers those that effect the Medicare Program<\/a> and individual market. Were doing were doing all that we can to make certain that states are able to address the challenges that they have. Dr. Price, just to be clear. When barack obama left office, was it a perfect administration, no. When he left office, there was an insurer in every county of every state in this country. Thank you. Senator carden. Thank you very much. Ive heard your commitment to make sure that youll do everything you can to help all people in this country get access to Quality Health<\/a> care and thats something we all agree on, thats what we want to get done. I want to get to some of the practical problems here. I was in frekz ricksburg on monday. Closer to where senator carper lives than i live. Very Rural Community<\/a>. They dont have the same access to Health Care Providers<\/a> that we have in our urban centers and i visited fralzburg Elementary School<\/a> Wellness Center<\/a> where we have the qualified center that provides direct services to our children within the Elementary School<\/a> and their capable of doing that and this is for many of these children their only real ability to get access to primary care and to have someone who can check up on their health and theyre able to do that under current law but they tell me as the legislations passing from the house to the senate, that that directory reimbursement would be cut off. They also tell me that if they cannot continue their flows through the Medicaid Program<\/a>, that they will clearly not be able to continue the services that theyre providing today in Caroline County<\/a>. My question to you, i understand your commitment to help all areas. Today our qualified senators are providing lifelines in many communities. They rely upon creative ways in rural areas to provide care including within School Settings<\/a> and they depend greatly on the recused numbers of uninsured and those covered under the Medicaid Program<\/a> for comprehensive reimbursement to be able to maintain their presence. So how do we insure that as we go through this transition that the administration is talking about, that the children in Caroline County<\/a> are going to be able to continue to get their Health Care Needs<\/a> met . I appreciate that. There are significant challenges in the rural areas of our nation for the provision of Health Services<\/a> and those have been present for a long, long time and theres a strong commitment on the part of our department and certainly on the part of the president to make certain that rural Health Services<\/a> are available. So whether its through grants to the states, whether its through an opportunity for various Health Programs<\/a> within school or elsewhere to make certain that children have the kind of health care and not just coverage that they need, then were absolutely committed. One of the things our budget includes is something called a new American Health<\/a> block grant which would provide resources to states to do just this sort of thing, to make certain that folks in rural areas of states have the opportunity to gain the kind of coverage and care that they need. I look forward to working with you to make certain that were able to make that happen. The other area i want to cover that you and i talked about it in my office during the confirmation process and ill bring up again today is i want to know your commitment to deal with Minority Health<\/a> and health disparities. We have separate agencies today to deal with it. We have an institute at nih. As i go around and look at some of the historic discriminations within our health care and recognize that health care is not equally available and our focus is not been to all communities equally and were trying to compensate for that today, i worry about what youre doing in medicaid particularly. Every Minority Community<\/a> i go to they mention to me medicaid and that there is no capacity at the state level to pick up the slack if the federal government withdraws its commitment either in the numbers of people who are covered or in the benefits that are reimbursed. So how do you how do you square commitment to continue down the path to reduce Minority Health<\/a> disparities in this country and the not only the reduction and the bill that passed the house but also the president s budget with such a large cut in medicaid . This is incredibly important and i cant remember whether i mentioned in this committee for my confirmation hearing or in the other one, in the health committee. But the disparities are in Health Outcomes<\/a> are absolutely unacceptable to all because what we see and its not just necessarily rural vurs urban area. There are areas within urban senators. I know of one in atlanta where there is take zip code where the Health Outcomes<\/a>, the disparities are absolutely astounding in terms of the mortality that exists, the addiction that exists, the chronic disease that exists and thats not because of lack of Services Close<\/a> by because its in the center of the city. But imagine if you would please a system that allowed for the Medicaid Program<\/a> in the state of georgia to provide increasing resources to that zip code to provide a case manager if you will for every single individual in that zip code who has a chronic disease within the Medicaid Program<\/a>, thats now knots possible. You cant do that. Thats the kind of waiver and partnership that i think is so incredibly important to make it so that we actually identify those folks that need greater assistance because there are if were going to end the disparities that are out there which you and i both have a commitment to ending. Im all for flexible of the states. I appreciate that, but i also know the pressures on state budgets and i know in my state of maryland where our legislatures been aggressive, they cant pick up the slack. The waiver wont give them what they need in order to be able to make the type of commitments to underserved areas. Thank you, mr. Chairman. Okay. Were going to turn to let me just see here, senator casey. Thank you, mr. Chairman. Secretary price, good to be with you this morning. Wanted to start by referencing a letter that i and i guess 14 other senators sent to you recently about the house bill hr 1628 but in particular wanted to reference the Congressional Budget Office<\/a> report that just came out on the 24th of may. This is a nonpartisan report by both the Congressional Budget Office<\/a> assisted by the joint committee on taxation. And i just delivered to the table next to you there a copy of the cbo report so you could go to the page. I direct your attention to page 17 of the cbo report. On that page the following statement is set forth there, quote, Medicaid Enrollment<\/a> would be lower throughout the coming decade culminating in 14 million fewer medicaid enrollees by 2026, a reduction of about 17 from current numbers. It then references this chart which you see on page 19 showing the numbers going down for medicaid over that time period between 2018 and 2026, all bars going down. I reference that in the context of what you said on cnn on may the 7th, quote, im quoting you now and the transcript is right in front of you, quote, there are no cuts to the Medicaid Program<\/a>, unquote. Thats what you said. Do you still stand by that statement that you made on cnn . The Medicaid Program<\/a> under the president s budget would increase by let me just yes or no. You can explain after that but yes or no. Do you stand by that statement you made on may the 7th on cnn . What i stand by is the statement that the president s do you stand by that statement . I think there are whats the baseline . There are no cuts to the Medicaid Program<\/a>, do you stand by that statement . Whats the baseline. If there are no cuts. Yes, i stand by that statement. Its relative to something. Go ahead. The baseline, if the baseline is todays amount of money being spent on medicaid, the president s budget provides for an increase, cpi medical or cpi medical plus one in the increase in medicaid spending for the programs are you saying the statement on the cbo report on page 17 is not accurate . Im saying that the statement on that the cbo made doesnt include the cons tellation of activities within the administration regarding how we would move forward on health care. Cbo says 14 million fewer medicaid enrollees so thats one. Do you have the cbo report on the aca when it was proposed in 2010, because what they said then, 25 million individuals talking about the House Republican<\/a> bill that was passed. Im talking about the cbo did they had a similar graph about the number of individuals that are covered now and, in fact, they were let me direct your attention to the same cbo report you have in front of you page 13. The top of that page, it says the following, the introductory sentence is, a reduction quote the total deficit reduction includes the following amounts shown in table 3, the first bullet under that is quote, a reduction of 834 billion in federal outlays for medicaid. So do you still assert in light of that and in light of the previous cbo statement you still assert that there are no cuts to the Medicaid Program<\/a> . It depends all im asking you to do secretary is to tell us whether you stand by that statement. I stand by that statement. Okay. Finally, let me go to a statement that was made in the cbo report now im going to page 19 and 20 you have in front of you. At the bottom of page 19 the following is set forth, quote, under the act meaning under the republican bill passed in the house, under the act premium for older people could be five times larger than for those younger people in many states but the size of the tax credits for older people would only be twice the size of credits for younger people. As a result, and heres the first bullet point for older people with lower income, net premiums would be much larger than under current law on average. Then it refers to table five at the end of the report. So i ask you that in the context of another statement you made. Now this is meet the press in march, the 12th, you said that nobody will be worse off financially as a result of the bill. Do you stand by that statement . I dont believe that statement was in wrerchs to the bill it was in reference to the Health Care Plan<\/a> that weve put forward and i stand by that statement. Senator, your time is up. I hope that you focus more on not just the proposed reforms you talk about for medicaid, i hope you focus on people like the 15 million americans that get medicaid because they have a disability. Were all for discussion about making programs better, but i think you should focus more intensively on those people and be truthful when youre commenting about something as important to american lives as the Medicaid Program<\/a> and i would argue, sir, you have been deliberately misleading based upon those statements. Senator, with respect, thats precisely what were focusing on. The American People<\/a> have understand an appreciate that the Health Care System<\/a> that we currently have for many of them is not working. Many of them in the Medicaid Program<\/a> its not working and what were trying to do and wed love to have your support, what were trying to do is to make certain that we have a system that responds to the wishes and the needs and the Health Care Needs<\/a> of all americans. We all agree on that but i think you have to start being straight with people about what will happen. These are major cuts, the cbo said it in more ways than one. I think you should be truthful about that. Let me start by saying, mr. Chairman, you and senator grassley i have a great deal of respect and admiration for so my first question that i would make of the chair is will we have a hearing on the Health Care Proposal<\/a> . Will we . Yes. I think weve already had one. No i meent praufl that youre planning to bring to the floor, will there be a hearing . Well, i dont know that theres going to be another hearing but weve invited you to participate. Thats not true, mr. Chairman. Let me just say, i watched carefully all of the hearings that went on the Affordable Care<\/a> act. I was not a member of this committee at the time although i wouldve liked to be. Senator grassley was the Ranking Member<\/a>. Dozens of republican amendments were offered and accepted in that hearing process and when you say that youre inviting us and i heard you, mr. Secretary, just say wed love your support, for what . We dont even know. We have no idea whats being proposed. Theres a group of guys in a back room some where that are making these decisions. There were no hearings in the house. Listen, this is hard to take, because i know we made mistakes on the Affordable Care<\/a> act, mr. Secretary. And one of the criticisms we got over and over again was the vote that was bipartisan. You couldnt have a more partisan exercise that what youre and gauged in now. Were not even going to have a hearing on a bill that impacts one sixth of tower committee. It is all being done with an eye to try to get it by with 50 votes and the vice president. I am stunned that that is what leader mcconnell would call regular order which he sank ta moanusly said would be the order of the day when the republicans took the senate over. We are now so far from regular order, the new members dont even know what it looks like. And i know that doesnt make you happy, mr. Chairman or senator grassley because you have been in the senate so long you know the value of the hearing process and the amendment process and even though the vote ended up being partisan, just as yours will be, the amendment process wasnt. Both of you had amendments that were put into that bill. As did other members of this committee. I want that opportunity. Give me that opportunity. Give me an opportunity to work with you. Thats what is so discouraging about this process. So, mr. Secretary, i want to ask you theres a 17yearold a 27yearold young man that lives in Jefferson County<\/a> and hes finally making enough money that he can do one of two things, he can either buy a Health Insurance<\/a> or buy a new harley and which do you think hes going to buy . You tell me. I think hes going to buy the new harley because he feels young and invincible and hes wanted a harley his whole life. He buys the new harley. He lays it on the pavement on the interstate an 18wheeler cuts him off and hes lifelined to the hospital do you believe that hospital should treat him. Of course. In america we treat you whether youre insured or not, correct . And theres a mandate that he buy insurance right now. Youre going to do away with that so were now in injure scenario, is it working . Thats not my question. Im saying under your scenario, he does not have to buy insurance, he buys the harley, its life lined to the hospital and we deliver 3 million worth of care for him. My simple question to you, mr. Secretary, is who pays for it . Sadly, it spreads among the entire system and frankly nobody pays for it from the federal government standpoint. Correct. So people pay for it . Well, or people provide the Services Without<\/a> any compensation. They have to make it work at the end of the year so what the hospital does they call the Insurance Company<\/a> and say we had x amount of uninsured care this year well have to raise your prices for labor and delivery or angio plasty and that Insurance Company<\/a> calls the Small Business<\/a> down the road. Well have to raise your premiums because the hospital is charging us more because we have to cover the ininsured care. And premiums were up 145 between 2013 and 2017. Thats not true. Yes, maam. Would be glad to show you the number. Glad to debate you the numbers. The point is that when we add 24 million more ininsured, who is going to pay those bills . We wont be adding 24 million uninsure. You disagree with the cbo scores. Yes. If anyones kicked off medicaid who pays those bills . I want to make sure everybody understands were just passing along these costs to people that have insurance policies. Theres 20 million that dont have insurance under the current system. We are paying their bills so were going to reverse that and create even more uninsured. Your time is up. Senator grassley has one question, hes been waiting here patiently and well. I was only over by 35 seconds, mr. Chairman. I think i did okay. Youve done so much better than the rest of your colleagues. I was very proud of you. Mr. Secretary, i only have one question because i have to run to another meeting. So im going to im going to ask you this one question and submit other questions for you to answer in writing. The Rural Community<\/a> hospital Demonstration Program<\/a> was established in a bipartisan manner to protect patients access to health care, these hospitals are collectively called, quote unquote, in betweeners and other pitch piece of legislation the 24 century cures that program. The language have very clear. The program was to be extended beginning on the date immediately following the last day of the initial five year period. Despite this clear language, cms proposes to begin implementation of this extension on or after october 1st, 2017. This gap in implementation is inconsistent with congressional intent which requires a seamless extension of this critical program. Further more, it is inconsistent with the way the agency implemented the first five year extension of this program. I have a bipartisan letter to administrator vurma asking her to look at the alternative payment timing that was included in the proposed rule. I would like to submit a letter to the for the record, mr. Chairman, and by way without objection. You mr. Secretary were ccd on this letter so dr. Price, very simple question, i hope you can give consideration to this request in this letter because in several states many states, this is an issue particularly rural states one of them is alaska as an example and i hope you can help us make sure that we have a seamless implementation of this program. Absolutely, senator. And well get back with you because my understanding in looking into this is that as it was extended the rule was the proposed rule was put out in april of this year and allowed for rural hospitals to apply to this program literally as we speak and i think the deadline was the latter part of may. We have a commitment to it and it is so incredibly important for rural areas and well get back with you and look forward to working with you on it. I yield back my time. Senator brown . Thank you mr. Chairman, mr. Secretary, thank you for joining us. You called the Opioid Epidemic<\/a> a key Public Health<\/a> priority and you highlight how this years budget proposes a 50 million increase in funding over previous levels, up to 811 million. That might seem like a lot of money and it is but you know whats a bigger number, 939 million, 939 million is the amount of money one state, my home state of ohio spent on fighting the Opioid Epidemic<\/a> last year alone. 939 million, my state spent. This chart came from Ohio Department<\/a> of medicaids website, governor republican kasichs website. In 2016 ohio invested 939 million in fighting this Opioid Epidemic<\/a>. 70 that have total 939 million came from . 650 million came from medicaid. 650,200,000 came from medicaid, despite this investment, despite governor kasich investing nearly a billion dollars in prevention, education, medication assisted therapy and other treatment, eight people if todays lining most days, eight people in my state will die from an opioid overdose. 4,000 ohioens died from overdose last year were on track to go far exceed that number in some counties weve already exceeded the number of the year before and this is only june. 43 people died in cuyahoga county, the states largest or second largest county in the state. 43 people since memorial day. This epidemic continues to devastate communities in my state. I know you know that. I agree with what you wrote in your testimony. Were not winning this fight. But im confident with we lose far more people, far more lives, far more families turned upside down if we werent spending this money, if medicaid werent spending this 650 million, dont take my word for it. Two weeks ago, my colleague both members of this committee, senator partman, my ohio friend republican, senator carper my delaware friend held an important meeting about this epidemic to discuss proposals. I want to quote from a couple people. The witnesses on the second panel of that hearing, a doctor and a police chief from newtown, ohio, one of the most conservative part of our state. He was the former head of drug control policy and a coroner from cuyahoga county, all have voiced opposition to either ending the Medicaid Expansion<\/a> or cutting the program. These four experts brought by senator portman to his committee all said dont cut medicaid, dont either dont dont cut it or dont end the expansion. The cuyahoga count coroner noted anything like Medicaid Expansion<\/a> being limited that limits peoples access to health care. I cant see any good coming from this crisis, from that i cant see any good coming from that in this crisis, especially with the high rates in mortality. Police chief from newtown, ohio, little town near cincinnati, hes in the front lines of this fight, he said, we should not be decreasing medicaid. He talked about one of the programs that his teams are doing in the Hamilton County<\/a> area signing people up for medicaid, then getting them into treatment. Right now 200,000 families in ohio are getting opioid Addiction Treatment<\/a> who have insurance because of medicaid, yet your administration continues to talk down to criticize Medicaid Expansion<\/a> and to suggest cuts in medicaid. He went on to say taking away medicaid would make this fight more difficult. I dont even want to imagine the number of Overdose Deaths<\/a> we wouldve had in ohio if our republican governor, im proud of what he did and hes gotten a lot of criticism from President Trump<\/a> and a lot of criticism from your party if he had not expanded medicaid to those 700,000 families. The Budget Proposal<\/a>, thasz thats in addition to the house medicaid covers a third of all Substance Abuse<\/a> treatments and communities across ohio and ohio it covers 50 of all medication assisted therapy or treatment. You sit in front of us. You have taxpayer funded Health Insurance<\/a>. We have taxpayer funded Health Insurance<\/a>. The 200 republican plus republican members of the house who have taxpayer subsidized Health Insurance<\/a> are all willing to take it away from these 200,000 ohioens getting only poid treatment. Your policy proposals, you say you your interested in fighting the epidemic, your policies opioid treatment. You flat fund substance treatment grants you reduce spending on prevention programs, you cannot treat a disease with just grant funding. You all of a sudden have found we can do all sorts of things with grants. No you cant. Maybe you dont i know i think probably senators dont meet enough people who are in these programs and benefitting from them. But you would never proposal we fight cancer through a 50 million increase in the Grant Program<\/a>. Is said increasing access to substanceabuse Disorder Treatment<\/a> is part of your departments plans to address the Opioid Crisis<\/a>. What you are not telling to your West Virginia<\/a> readers, youre not telling them what youre really doing. So my question is and im sorry for the preface but how do you plan to increase access to treatment when you cut the singest biggest source of funding for treatment by 600 billion in your budget. How does that add up in the trump price math of 2017 . Senator, you know i visited in your state to visit with victims of opioid addiction. Talked to parents of kids who died. One mom told me about her son who died in the bathroom of a macys from an overdose. This scourge that we have running across the country is unacceptable to you, unacceptable to me and unacceptable to the president. We are certain we put in place is a program that works. The numbers continue to go the wrong direction so we will be married to a system that has resulted in 52,000 Overdose Deaths<\/a> in 2015, thats not a system i want to be married to. What i commit to you and what i look forward to working with you on is a system that actually works for the parents who are suffering today because theyve lost a loved one. What i commit to you is for a system that works for those who want to gain recovery and treatment. So thats the system i look forward to working with you on and whether or not it is paid for through the medicaid system or whether or not its paid through manual a system that isolates the individuals treatment for addiction and takes it out of the system that we have so we can focus resources on the individual who needs the treatment of what that would do is make it so we could treat those folks and for the system to thrive fiscally elsewhere. But imagine the system working better than the one the resulted 52,000 americans a. But its curious for you to blame medicaid. Its not because of medicaid, how do you do this when 200,000 people right now are getting treatment in my state. Theyre getting treatment. Theyre not all successful. We know people are in and out and it often takes three or four or five times but if you cut medicaid how are you you can talk about a Grant Program<\/a> and all this good talk and i know you mean it in terms of wanting to take care of people. Youre a physician. I know all that. But how does this all work if you are going to cut the biggest revenue stream that takes care of all these families. You are way over your time, senator. Answer that and then im going to go to senator cantwell. Go ahead. Thats what im trying to encourage us to look at is a system that works for the individuals who are suffering from this addiction. A system that focuses attention and focuses treatment on it, a system that recognizes that we need greater Public Health<\/a> surveillance. In Pain Management<\/a> is what so we can turn this curve in the appropriate direction which is down. We continue to tolerate a system that allows for addiction and overdose it is unacceptable to me and i wont stand for it. Senator cantwell . I have a couple of questions. There have been press reports that the department is working on a rule that would deny Birth Control<\/a> for employees. Are you aware of this . Theres a proposed rule thats out currently, and on Conscientious Objection<\/a> and the contraceptive mandate. You are saying that employs could what is currently happening is solicitation of input and in that process im not able to make any further comment. You cant make a comment whether you think Birth Control<\/a> should be part of basic health offered in insurance plans. I think for women who want it it should be available. You are promulgating their rule . So you think employers should offer Birth Control<\/a> as part of Insurance Programs<\/a> and not be able to just say on a conscientious basis they dont believe in providing it . I believe women who desire to have access to Birth Control<\/a> should have access to it. Through their employ. I believe women who desire access to Birth Control<\/a> should have access to Birth Control<\/a>. This is a very big problem. Women cannot be discriminated against by the employer who wants to cherry pick various parts of Womens Health<\/a>. I want to ask you about proposed medicare cuts. I know the administration said they werent going to cut medicare but the budget includes a twoyear sequestration that would impose a cut on hospitals and rural hospitals. It would be a 30 billion cut from the Medicare Program<\/a>. Does your budget include that . I think that what youre referring to is the continuation of current law and the budget accommodates or reflects current law. So you is said the extension is not a cut to medicare . I think that again its the same kind of question that mr. Casey had. It depends on what your baseline is. If your baseline is current law, there are no reductions. So you believe we should be making these reductions to Rural Health Care<\/a> facilities . I believe that what we should do is make sure that we have a Health Care System<\/a> that is financial viable and feasible and makes it so the American People<\/a> have access to the kind of care they need. And you think that this so youre behind the cut ill take that as a yes that you are behind this particular cut and i would just say that our rural hospitals are struggling to make sure that we are providing good care. There are a lot of efficiencies with the delivery system. I had a chance to ask you about this issue of rebalancing on the Medicaid Budget<\/a> i dont know if you had a chance to look at that from rebalancing from nursing home care to Community Based<\/a> care. That is something that we wrote into the Affordable Care<\/a> act that states are doing and its a huge savings to the budget. Is that something that you think the administration can get behind . As i mentioned, the dynamism of the Health Care Market<\/a> is so important to embrace because we ought to be allowing and accommodating in our system for individuals to receive care where it best suits them and their providers. So youve identified an area where we ought to be able to accommodate that and the system should allow for it. Its hard to get a clear answer on this. The private market the private market providing under the exchanges cant take the uncertainty of knowing whether or not the subsidies are going to be there, insurers have confirmed this to my questions when proposing rate hikes or even pulling out of the markets because of the uncertainty. So, can you confirm that the administration will continue to reimburse insurers for these subsidies that help so many of my constituents see a doctor . And i notice its in your budget, through fiscal year 2018. What should we believe . Senator, as you know, this answer may not prove satisfying to you, but the Current Court<\/a> case is now house v. Price. Im the defendant in that case. And i can tell you that the budget reflects the payment of the csr payments through 2018. Does that answer mean if a court case went in the favor of the administration that basically those subsidies would be cut . What i can tell you, again, and id like to be able to share more, but as the defendant in the case, im not able to do so. But i can tell you as you noted that the budget accommodates and reflects for payments to csr payments through 2018. The unfortunate dilemma, mr. Chairman is because of the uncertainty it predicts an outcome that the aca, the Affordable Care<\/a> act is in the exchanges which is bringing Health Insurance<\/a> to millions and millions of people that otherwise could not afford it. The uncertainty of whether or not those subsidies will be there in the future, in fact, is undermining the ability of insurers to be able to project what their premiums are going to be and therefore to protect themselves, what theyre doing is jacking up their premiums, which is undercutting the whole reason for having the subsidies in the first place. Let me shift to the zika virus, mr. Secretary. As weve discussed there are a bunch of cases, 1400, in florida alone. And your administration 2018 budget states and i quote, outbreaks like zika will not be a onetime event, Capacity Building<\/a> at all levels as well as innovation in diagnostics is needed to prevent and control these outbreaks and understand more about these vectors, end of quote. Yet the administration slashes the very programs designed to bolster capacity at all levels. So, mr. Secretary, does your budget cut more than 7. 2 billion from nih . As it relates to zika i cant tell you how proud i am of the job at nih to work on a vaccine. Were in the phase 2b trials of a vaccine. The cdc is doing phenomenal work. Understand all that. Do we believe the budget accommodates handling any challenge that may exist from the zika threat. I understand but does the budget cut 7. 2 billion from nih . The proposals budget increases efficiencies and making certain that we have the core mission of nih accomplished through the resources that are made available. Efficiencies are great. But i want to know black and white does it cut 7. 2 billion from nih . I think your number is accurate. Senator bennet. Ive got a couple yes or no questions. Why dont you go ahead but your time is up. I understand. But go ahead. Its hard to get a yes or no question. Go ahead. Thank you. Does it cut more than 600 billion from the Medicaid Program<\/a> on top of the cuts included the housepassed health care bill. No. Your budget does not. Okay. Does it cut more than 1. 3 billion from the cdc . About a 10 reduction in Resources Available<\/a> to cdc through appropriate priorities and identifying efficiencies within cdc. We believe strongly that the cdc budget is what is needed to continue to protect not just the United States<\/a> but the world. So that a yes . It cuts 1. 3 billion from cdc . What it is is a statement that affirms the president s desire to get folks to appreciate you dont measure success of a program by the amount of money going into it you measure it by whether the mission is accomplished. If we can accomplish the mission with fewer dollars that is something to celebrate. I understanding the reasoning behind it i just want to know if it cuts 1. 3 billion from cdc . Does that equate to 1. 3 . I think your number is accurate. Does it cut 850 million from food and Drug Administration<\/a> . I dont believe so. The fda, what we envision in the fda is to shift the resources coming to fda and i think in fact there is a 500 million increase in resources coming to fda through a modification in the user fee process. You are way over your time, you can submit questions in written. I will yield to senator roberts who has been here waiting. That is very gracious of you. Part of the ten minute rule, an hour or five, six, seven . What are we doing . Im assuming were under the fivemin rule. I want to get in the weeds a little bit. Welcome back, doctor. Thank you. Good to be back. Youve been there are statements that have been youre responsible for people dying in ohio, all of the current problems in the afford Health Care Act<\/a> over the last eight years. Reductions in funding in rural areas which im very much interested in, the entire budget by the president or to be more accurate, omb, and the chairman has been chided for not having regular order. But what we are having time is cloture and delay. Ive lost count zika virus. Hindering infection of the zika virus. Are you enjoying yourself . The job is a great challenge and im enjoying the challenge, yes, sir. Im going to get in the weeds a little bit. In your prior life on this side of the witness table i know you shared my frustration with the Competitive Bidding<\/a> program. Im not going to go too much further into this except we do not have the providers which we used to have and people are having to drive 150 miles with regards to Durable Medical Equipment<\/a> and access it to. Last year we passed the 21st century cures act and sought to reduce temporarily the impact of the payment changes. So to preserve the intent of the program and reduce the amount and save money doesnt need to provide the implementation so what im trying to do is get a sense of whether legislation is needed. Legislation would be welcome. That moved in the direction of allowing the Durable Medical Equipment<\/a> providers out there the greater opportunity to provide services to their clients, to the patients across the land, regardless of whether legislation is forth coming, the department is look very seriously at the issue of dme because we believe strongly that the Previous Program<\/a> that has been put in place is limiting the access to appropriate services for folks across this land especially in rural areas. I appreciate that. Im sitting here listening to my friends across the aisle with regard to their concerns with reference to what is happening to our health care. I had a question that would be repetitive and the chairmans here somewhere and you have talked about what is happening with our premiums and our copays. Here it is,and nationwide premiums have doubled in three states and tripled. And, yet, i hear my colleagues saying stay the course. Full funding if we could do that, keep funding what is not work. I must say it is 180 degrees from what is happening and trying to pin it on you is amazing. Like Butch Cassidy<\/a> and sundance kid for jumping off a cliff or to be more accurate, we are in the obama car and its a lot like being in the same car with them ma thelma and louise and were going in the canyon. But we have to get out of the car. I think that is what youre trying to do and i wish you well in doubt because settled think youre responsible for that entire budget i am not in favor of some of the things with regard to agriculture. We plan to change that. That i know when the senate ever has considered since reagan. And this other business of regular order with regard to the chairman, i was here. During that whole episode of when we put obamacare together and days and nights and days and nights. It started in the health committee. That product is sitting on a shelf somewhere gathering dust. I had one amendment on rationing with ipad and all the rest of them. It failed on a partyline vote and then it came here and again i had the same amendment on rationing and it failed on a partyline vote and then the product went to the floor of the house and went behind closed doors in the leaders office. And sort of like charlie rich, singing behind closed doors and out came obamacare and weve had eight years of this now and i just think blaming you for all of these deficiencies that we are trying to correct on a bipartisan basis has been over the top. And my time, sir, has expired. Thank you, and i endorse what you just said. I just want to understand the medicaid cuts and however you want to characterize them, characterize them but the numbers as i understand them are there are about 834 billion of cuts in the house bill that House Health Care<\/a> bill and about 610 billion in savings or cuts to the Medicaid Program<\/a> in the budget. Is it right to add those numbers together or is there overlap in those numbers . I dont believe its correct to add those numbers together. And the budget, my understanding is the budget doesnt assume panel of the house bill at all. My understanding is that it does assume passage of the house bill. As it relates to medicaid it assumes what is put in place is a block Grant Program<\/a> that will reflect over a theyear period of time a savings of 610 billion. If we could work together. I appreciate the opportunity to work with your staff to see if we are talking about 834 billion or 1. 4 trillion. In either case its a huge cut. Even 834 billion is a 25 cut to medicaid. I asked the Governors Office<\/a> in colorado to tell me who is on medicaid in my state. Heres what they said. And i would like to ask you if you dispute any of these. When you look at who is on medicaid in colorado, more than half the program are children. Does that strike you as right . Thats ballpark for most states. And 40 of our medicaid spending supports disabled and seniors, many who are in longterm care facilities. These are people who spent down their life savings for the privilege of being in a nursing home funded by medicaid. Would you agree thats right . I think its in the ballpark. Rough justice. And they said of the remaining adults on medicaid, the vast majority work but still cant afford Health Insurance<\/a> on their own . Does that sound familiar to you in terms of colorado or other states . There are certainly people with medicaid coverage who are employed. They would say there is a tiny residual percentage of people that arent disabled, arent elderly, arent children, and dont work but are on medicaid. There is some small percentage of people. Does that is colorado different from other states . We can get you the numbers for your state, im sure. That would be great but do you see any reason to dispute what i said . I appreciate your candor, the secretary is saying that medicaid is not supporting a bunch of people that should be working and arent working. Would you agree with that . I think it varies from state to state. There are certainly individuals who are ablebodied without kids on medicaid who arent working. But thats a small percentage of the people. I dont want to walk back through the list. I think weve agreed thats a small percentage. So just i think its important because this is the secretary of health and Human Services<\/a> and hes not saying there are a whole bunch of americans out there that are lazy, that are on medicaid because they dont want to work. It doesnt comport with the evidence. Its not true. And its certainly not true in my state. Then the question is if we are going to cut the program by 25 if you were running colorados Medicaid Program<\/a> and i have a story to share with your staff from the denver post yesterday a front page story about the 700 million a year by 2023 that the state is going to have to come up with because of the housepassed bill. What is your advice to us in our state about how we ought to handle those cuts . That 700 mfl million to our state . When you have a bunch of people in Nursing Homes<\/a> and a whole bunch of people that are working but unfortunately cant afford private insurance, what are we what is my state supposed to do . I think that again, the constellation of programs that we would envision that would provide for greater opportunity for individuals to get Health Coverage<\/a> as opposed to less right now. There are 23 million americans without Health Coverage<\/a>. There is a significant number of individuals that dont have Health Coverage<\/a>. What we envision is a system that responds to those folks and individuals who find it is better not to be on the medicaid system. My time is up and with respect. I do respect you a lot for your service in the house. To believe what you just said you would have to first dis you would have to first reject the findings of the Congressional Budget Office<\/a> that the house bill throws 23 Million People<\/a> off insurance, creates 23 million more people that dont have insurance. You have to believe that and believe that a 25 cut to medicaid that covers poor children, people in nursing home and people who working and cant afford insurance are going to magically be able to buy insurance under a system that no longer regulates the industry. And i can tell you this because the republicans in the senate havent taken up the bill and i hope we do. If you set up to design a bill less responsive to the critics of obamacare in colorado, you could not write a bill less responsive than the house bill. So my hope is that in the senate you could not do it. My hope is that in the senate, we will not do this in a partisan way but come together as democrats and republicans and address the Health Care System<\/a> in a way that is believable to the people i represent. What you said is not believable in any respect to people at home, and im talking about republicans, not even democrats and independents. Senator heller. Mr. Price. I want to be the last. Let me just see. Where does. Sorry. I guess im not the last. Okay. Thank you for being here. Thanks for taking the time and take some of our questions. I want to talk about nevada and the ahca. That seems to be the topic of discussion here. Our Legislature Just<\/a> finished monday. So as of two or three days ago it adjourned for the next two years. And one of the questions and comments that is being made is if the ahca were to pass in its current form it would put a 250 million annual hole in nevadas budget. And these numbers im getting out of the Governors Office<\/a> also from the state of nevada. Id like your reflection on that. If its 250 million a year. Thats 500 million a biennum. Their concern is they will have to call a special session to correct that kind of a budget offset. Do those figures sound accurate to you . I dont think so. Because and again the house bill doesnt anticipate any significant changes until 2019. So from a financing standpoint the 2020 being the time when the majority of it would the changes would come into play. So wed be happy to review the genesis of those numbers and see whether or not theyre accurate and in so, how we can address that. Have youhood an opportunity to do some research on nevada . The reason i ask you this question is we had a member of our delegation on the house side he had a conversation with you and the director of cms and you were able to convince him these numbers are not as accurate or as dreadful as they come out of the Governors Office<\/a>. Thats correct. What kind of reflection did you have . I think there was specific language that accommodated that concern, which is why i say i dont believe any changes would occur over the ensuing two years but wed be happy to talk with you and work with you and the governor and your state and see where they believe those numbers are coming from and determine their accuracy or not. What do you anticipate being the growth rate of Health Care Costs<\/a> over the next ten years . What have you calculated . It depends what population youre talking about. The medicaid population annual growth race is in the range of 2. 6, 2. 8 annually. Thats historic. What do you guys anticipate over the next ten years . I can get back to you on the specific amount. I think its increasing a little bit. But i can get you the exact number. Are you working with leadership on our side as we go through the changes . Im going to get the leadership on our side has had discussions with you and cms and the particular changes were looking at. Its including growth rate. I dont know what the growth rate is going to be, if its cpi medical plus one as in the acha or just cpi medical or inflation for that matter. Have you had any discussions . I cant get an answer out of our meetings. Im wondering if you have insight into what the rate may be that were proposing over the next couple of weeks to send to cpo . As it relates to medicaid the proposal in the budget is cpi medical plus one do you still endorse that . Thats what if it was anything below that, would you support it . If they went to inflation rate would you support that . I think it depends what the entire program looks like. If we are accommodating anyone with challenges in a supplemental manner i would have to look at that. But what i support and what i think is important is to make sure every single american has access to the coverage they need. Cpi plus one. Cpi medical plus one. For disable and . Aged. If that changes to just cpi medical or just inflation would you oppose that . It depends on what that program looks like. In its liegs thsolation that mi challenge. There are other ways to accommodate individuals who need Financial Assistance<\/a> and we are committed to make sure that happens. What is the rate increase overall in the next ten years . Well get that to you. I dont have it on the tip of my tongue. If its below that if we calculate if we have a pro z proposal that is less than that would you oppose it . I think its important to make sure we accomplish the goals that we have set out and that is to make sure that every american has access to the coverage they want. And when you have that as your goal and then it requires that you provide resources in an array of different ways to make sure that is accomplished. I want to make sure that medical inflation as it increases over the next ten years that the funding mechanism we have isnt below that. If it is we dont meet your goals. In isolation, i would agree. Thank you. Thank you, mr. Chairman. And your time is up. Secretary price thank you for being here today. I appreciate the budgets attention to the need to repeal and replace the collapsing Affordable Care<\/a> act and the Budget Programs<\/a> integrity provisions. We have a number of important issues to tackle in the health care space. I thank you for your work. Thank you. I discussed this with you at your confirmation hearing but i have serious concerns about the Indian Health<\/a> service. We continue to see problems even after two facilities in south dakota entered the systems improvement agreement. Cms continues to find deficiencies at both facilities with the pine Ridge Emergency Department<\/a> in an emergency jeopardy status. The problems over the years are what we introduced the restoring accountability in the ihs act. It gives ihs the ability to terminate poorly performing employees and recruit medical professions more quickly and create incentives so they will stay on the job longer. My question is, will the department commit to work with us on this legislation and other reforms to improve the quality of care at ihs in. Absolutely, senator. I have been impressed with the commitment of individuals in ihs and the resources that we are trying to identify for new facilities, one of them, as you know, in south dakota to make sure that we are living up to our responsibility and the commitment we have as a nation in the ihs arena. We love to give you and more tools to create the kind of accountability that we need and our legislation accomplishes that. We look forward to working with you on that. Last year we worked on legislation to address the application of medicaid Competitive Bidding<\/a> rates. And required the department to study and report to the committees of jurisdiction how it affects beneficiary access by january 12th of this year. Im wondering if you have an update on the status of that report for the committee. I think it remains in process and we have a significant commitment to make certain that the dme program is functional and works for folks all across this land. And additionally, as you discuss regulatory relief which is the priority for the administration and something we agree with, maybe what the departments approach might be for addressing these beneficiary challenges posed by the reimbursement structure. Something you can do in the interim to bring some relief. You cant have a system that awards, as you well know, awards contracts to entities that have never provided services in a Geographic Area<\/a> and thats the system that we currently have or that awards contracts to servicers or providers that have never demonstrated the capability to provide that service. And sadly, thats the system that we have in place right now. So what were looking sat the entire array of the dme system and the goal is to make certain that all americans, regardless of where they live, have access to the kind of services, whether its hospital beds or wheelchairs or home oxygen, whatever it may be in the dme space, these are quality of life issues for so many, many people and from my perspective, we have failed to date in making certain that we ensure the accessibility that folks need. Thank you. And finally during your confirmation hearing we discussed the rule that all Therapeutic Services<\/a> be provide under direct supervision which has been delayed for small and rural hospitals. And im wondering if you have an update on where things stand from the departments perspective. I think the permanent nonreinforcement is part of a bill that we have out there. And weve been trying to we have kicked this down the road each year but im hoping for a permanent solution. Im wondering if you can tell us where you see things. Senator, its an area of Significant Interest<\/a> and i can tell you its a work in progress. All right. We hope that we can get some permanent relief there and look forward to working with you and your team there going forward. Thank you, mr. Chairman. Thank you, senator. Well wrap this up. Thank you, mr. Chairman. Thank you for your courtesies this morning and allowing us to have her thorough opportunities ask questions and secretary price thank you for being here. There are so many issues i have great concerns about but and certainly when we look at this budget that cuts medicaid, nursing home services, child health care, research on life saving drugs. But one type of cut that i know we need is not in this budget and that a cut in the cost of Prescription Drug<\/a>s. President trump repeatedly stated he wanted to drastically bring down Prescription Drug<\/a> prices through medicare negotiation saying that pharmaceutical companies are getting away with murder. I support medicare negotiation and have for a long time and 90 of americans support this. But this budget doesnt include any major proposals to bring down the costs of Prescription Drug<\/a>s whether its medicare negotiating, safe importation of Prescription Drug<\/a>s, transpairsy or any policy, for that matter. Even though the prices of the most popular drugs have increased by 280 . 208 in the last ten years. However, the House Republican<\/a> Health Care Plan<\/a>, and i assume the senator one that is proposed does give Drug Companies<\/a> a huge 25 billion tax cut, paid for by the people who are seeing their Prescription Drug<\/a> prices going up, middle class families and seniors. Given this budget is the major policy document from the administration, is it fair to say that lowering Prescription Drug<\/a> prices is no longary priority . Absolutely not, senator. In fact we have at the department and the president has made this a priority and has charged us with making recommendations to his office on reducing drug prices and over the past six to eight weeks we have had a half dozen to eight stake holder meetings with all sorts of individuals. We have charged hersa and fda and cms with specific proposals to provide the president with the most effective way to be able to reduce the increase in drug prices. So no, its an absolute priority and we look forward to working with anybody who is interested in holding down or bringing down drug prices for the American People<\/a>. Should a family have to pay 700 for epipens for their child . Regarding they pen what has occurred in the past is the ability for competition to hold down those prices was prevented by a previous decision through the previous administration. So were looking through the fda at exactly those kinds of things because to have our goal is to make certain that americans with k have the medication at price they can afford. Which i wish was in the budget. Should someone who learns they have hepatitis c pay 80,000 to get the drug they need a be cured . Youre identifying a drug that is saving lives. 80,000 for someone to save their life . The question is whats the right price for that drug . Is that the right price . Theres a way to determine that price and the question is what is the right price for that and how do we incentivize innovation and make it so that companies are able to identify these remarkable cures that are out there. I dont know what the right price is. But i know how you figure out what the right price is. I will be anxious to know what you think the right price is. If you have Cystic Fibrosis<\/a> should you have to pay 300,000 . I think what we ought to do is celebrate the invention and work that individuals are doing to save lives. I celebrate that. Its difficult if someone cannot afford what is put forward on the market. So we certainly celebrate that innovation. That innovation needs to be affordable so people have access to treatment and that can save their life. I would agree. Is it appropriate to give pharmaceutical companies a 25 billion tax cut in the Health Care Reform<\/a> bill when there is nothing to bring down the costs of Prescription Drug<\/a>s in that bill . Well, i regarding whats in that bill as it relates to drug pricesing. Do you think its appropriate to give a 25 billion tax cut to the pharmaceutical industry in a bill that is taking away health care from people and does nothing about lowering the cost of Prescription Drug<\/a>s . I do not know if that is what it does. I do know. Then you do. I think it is impairtive that we incentivize innovation so we can realize the remarkable productivity and innovative spirit of the american scientists at nih and elsewhere who are discovering these drugs to save lives . I agree with that. Do you think the industry should spend more on r d than on advertising drugs to us . The system needs to incentivize innovation so we can realize the benefit of wonderful inventions. Just for the record, all those ads are written off. I would love to help them write off more on r d. As i close let me say that just for the record, we dont have to debate it today but you have talked about a study over and over again about prices and i want for the record to say this is highly disputed study that youve been talking about that compares two different kinds of systems and doesnt include the tax credits that have brought down out of pocket costs for real people. Another day i look forward to debating you what i believe and know in michigan are very flawed numbers. Thank you, mr. Chairman. Let me just say im been in thiS Health Care<\/a> business for 41 years. And every year we demand more and more money, more and more spending, more and more federal government, more and more interference, more and more intrusion and we wonder why it costs us so much. We have never had a better secretary than you and never had anyone more patient in answering all these questions. Thank you for participating the way you have. Especially want to thank you, secretary price for attending today. I think we can agree this is not the most enjoyable activity you could have participated in today but it is nevertheless extremely important. And as ive said many times before id like to work with anyone, republican or democrat who would like to resolve these important and pressing issues. Health care is no joke. To any american and to those with diminishing access, it means the world. I look forward to hearing from each of you in the coming weeks and i hope we can find ways to work together. For any of my colleagues who have written questions for the record i ask they submit them by june 15th. Sorry, i dont mean to interrupt. Im not going to this is going to have to be it. I dont have any more time. Do you have to have questions, senator carr . Ive only be waiting for two hours. You can he came in large part so he could answer one of my questions. I just want to say one thing if i could. Very brief. Sure. Mr. Chairman, i mentioned earlier my colleagues get tired describe myself as a recovering governor but i am. I have been sitting where you are and providing to provide a governors perspective on issues just like this one. And one of the things that we ask for welfare reform is give us the opportunity to have waivers. Apply for a waiver on what were going to do for a welfare reform and that was granted. When we did the race to the top, the education reform stuff in the last administration we said, lets make sure that the states can apply for waivers to the federal law. And with medicaid states can apply for waivers. At least every state as has one or more waiver. There are some cases where you cant get away from it. And we have to have discussions with governors about whether that makes sense or there should be a broadening. I always like to have some flexibility. Find out what works best in my state and that could be a helpful thing to do. The other thing, a request, mr. Chairman, something here from Blue Cross Blue Shield<\/a>. The premiums to rise. The single biggest reason this sharp increase in rates is a lack federal funding for cost sharing reductions beginning in 2018. In the administrations budget they fund cost sharing. The president keeps talking it back. He doesnt want to do this. Raising questions and its the lack of certainty and predictability that drive up the prices. So lets just keep that in mind. Thank you, senator. You always add a great deal of understanding to these issues and i appreciate you doing that. In that case, could i have a couple more minutes . No, im going to kill you if you keep this up. I will die happy. No, i think youre doing a great job. Mr. Secretary, youve been very patient and i personally really admire you. I know you know this field very, very well. I know you know the problems. I know you know how difficult it is to solve these problems. And i know you know that theres no quick answers to some of these questions that have been asked. You have handled these very well today an i want to personally thank you. And with that well adjourn this meeting. Thank you, mr. Chairman. Thank you, mr. Chairman. Secretary of state Rex Tillerson<\/a> is on capitol hill to testify on the president s 2018 budget request and priorities for his department. That is before the senator Foreign Relations<\/a> committee here on cspan3. Later in the day, live coverage of attorney general Jeff Sessions<\/a> taking questions from the senate Intelligence Committee<\/a>. He is expected to be zd about contacts with russian officials during the 2016 president ial campaign and other issues raised by former fbi director james comey who appeared before the Committee Last<\/a> week. This is the first time that the attorney general has testified before Congress Since<\/a> being confirmed in february. That is also live here on cspan3. In case you missed it on cspan. Gerald callaway on the possible threat of Climate Change<\/a> on national security. If you go back to older field manuals, one said weather and terrain are the most significant aspects of battlefield combat whether its the open seas or runways or the hill youre going to climb when they are in change and they are in change right now, the military is concerned about that. The military has long had an interest in dealing with things like this and forecasting what might happen. Jim sensen brenner at a town hall meeting. Why dont you have a single payer system and remember what i said in the beginning of the meeting and that is that interruptions, you know, are not going to be tolerated. Would you please sit down, sir. You do not have the floor. Would you please sit down . Would you please sit down or go out in the hallway. Ill leave. Thank you for leaving. Maine senator angus king. Ill ask you the same question why are not answering these questions is there an invocation of executive privilege . Not that im aware of. Why are not answering . I dont feel it is appropriate. And ann wagner on changes to the the dodd frank act. And we released a report called was the cop on the beat. This is on the inadequate role in investigating the fraudulent account scandal. 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