Was it your decision to not have her . No. Etary azar sda ann was there. Mr. Doggett not the disease expert who was the truth expert, not the out on tuesday, especially drawing the president s attention, in saying will see communities spread in the United States. Its not a question of if this will happen. Is a question of when and how many people in this country will illnesses. Do you agree with her statement . Secretary azar first, i know doctor extremely well, over decades. I have the highest respect for we believe no. Mr. Doggett do you agree with the fact . Secretary azar communities spread mr. Doggett do you agree with her or not . Context azar theres need. Community spread could be in a town, a locality, or could be nationwide like china. Have but day could before in Northern California let me ask you ecretary azar could be a community case. We dont know. Mr. Doggett in saying disruptions to everyday life may severe, but people might want to start thinking about this now. L with her on ith that . Secretary azar that was a statement of a range of possibilities. Yes. Were dealing with there are elements. Mr. Doggett the question is hether or not the administration is moving based on this serious concern or just face on this y that will go away when the spring flowers come out. Secretary azar thats a misrepresentation. Some of the specific things the administration is and is not doing in that regard, beginning question of facemasks. m sure you saw the story that the n95 mask thats important to those who are health care that many hospitals only had a week supply. Of what is the administration assure that theres an adequate supply of those masks . Secretary azar were asking you masks. Us buying mr. Doggett i see. So we dont have them now. Of large chain pharmacies also say that theyve ad theyve run out of masks for the public in general. On the question of lab tests. Know, last friday, the association of Public Health laboratories said that only had the capacity to test people for the virus and in the ase of what might be First Community spread in california, its taken four days that person whether had coronavirus. ve had this experience in san antonio where for anyone to determine whether those people the ocean liner in apan who are now at Lackland Air Force base, we have to send the test off to atlanta to get an answer on that. Testing people on the base, transporting them town. Congressman castro and i wrote you about this back in on 13. Uary despite numerous calls, touests, its been deifficult get any answers on that, though my staff advises finally in the of this hearing some message came through from you about that. Our localities, even considering to put people in recreational vehicles to keep they have the f coronavirus in full. City of san antonio has not eceived any reimbursements to date. Its unclear whether the administration has in place a lan to send extra reimbursements to localities problem. H the this is not only serious, it can be deadly. In the approach. Mr. Neal i thank the gentleman. Let me recognize the gentlelady walorski, to mrs. Inquire. With mrs. Walorski thanks for seeing a good hoosier face in this committee. Willette me correct the record good friend, mr. Pascrell. I have not seen or heard heard any i have not evidence that any senior official is lying about coronavirus. Say that, you know, i think we need to be very factual when we talk about this. Secretaryu have been, azar. I think its important for the American People to know this is priority one at the administration. I have not seen any evidence theres anybody lying about whats happening with just want to ut i roceed by seeing 10 years ago democrats rammed obamacare through the Congress Based on the slogan if you like your plan it. Can keep if you like your doctor youll be able to keep your doctor. That slogan, of course, turned out to be a lie. Fact, it was rated as olitifacts lie of the year in 2013. Fast forward to today, and a majority of House Democrats 1384, the d h. R. Medicare for all act, which outlaw all lly private insurance plans, all the coverage and force every a rican into onesizefitsall government plan. From just 10 years we went if you like your plan you can keep it to if you like your bad, its gone. What a difference a decade makes. Contrary to what my colleagues the other side of the aisle might say, americans do like insurance. Te a recent gallup poll found 71 rate their private coverage as excellent or good. The American People and the hoosiers that i represent want that Health Insurance that they like. Want that Health Insurance taken away and replaced with a massive new especially rogram, one that would require massive ew taxes on workers and families. Secretary azar, can you talk about the Financial Impact for all and what kind of impact it has, potentially, on seniors and middleclass serve in that i indianas Second District . Secretary azar it would be absolutely devastating. We have 180 million americans get their insurance through their employer or importantly union. Their insurance would be taken away. Collective bargaining rights that they have given up in for insurance would be taken away without compensation in wages. Seniors in on medicare, a third of them depend on private insurance, medicare evermore popular private option with added often dental, vision benefits and benefits for them, taken away as part of this. It would be devastating for seniors. Mrs. Walorski the rising rate of Maternal Mortality across the country is something i have been and mely concerned about im glad to see the Trump Administration is actually tackling this headon. Your budget describes the improving Maternal Health in america initiative, aimed at mproving Maternal Health outcomes through evidencebased programs. Ow do you see the maternal, infant, and early Child Home Visiting Program fitting into the departments Maternal Health initiative . So that Program Gives pregnant women and families, particularly those risk, necessary resources and skills to raise children who are physically, emotionally healthy and ready to learn. So its a very important part of Maternal Health initiative. Mrs. Walorski i appreciate your efforts. Let me bring attention quickly administrations proposal to strengthen tanf andses on work and families direct alignment with the republicans job for success success act. Are you worried about a lack of accountability in tanf . Secretary azar i absolutely am about the lack of accountability in tanf. We have dozens of states who are work ing their participation rates without contribution to it. Its been perverted from the tanf which ning of is to get people to work, get them trained. We got to create real again. Ability mrs. Walorski i appreciate it, mr. Chairman. I yield back. Recognize thet me gentleman from illinois, mr. Davis, to inquire. Mr. Davis thank you, mr. Chairman. For ecretary, thank you being here today, and thank you testimony. Granted y of 2019, you South Carolina a waiver of federal antidiscrimination to allow miracle jews, nistries to reject catholics, persons of other nonreligious persons, and lgbtq individuals from being caretakers of foster youth. Statement of administration of is to n and families promote the wellbeing of hildren and families and the director of the Childrens Bureau is to act in the best nterest of the children in its care. The waiver prioritizes the an gious beliefs of organization over the best interests of abused and children. Contrary to the stated mission of the administration for families. Nd as secretary, your position is it is acceptable for miracle heal to use health and Services Provided funds to persons ws, catholics, f other faiths, nonreligious lib any lgbtq from being mentors of our caretakers correct . Youth, secretary azar so, first, to larify, the coalition for Jewish Values as well as the Roman Catholic diocese of charleston is supportive of the taken. H we have we have to support the prompt placement of children in loving homes according to the best child and we he need as many providers, aithbased and nonfaithbased as possible to participate. We should not be in the business of kicking out faithbased provide roviders who are the backbone of our foster care placement. Mr. Davis so the question is correct . Isretary azar your question not an appropriate question. You stated it as if we are as are encouraging that. We are encouraging more providers, not fewer providers, the priority is kids getting placed, not who the providers are. Davis let me ask you, as chair of the subcommittee for urisdiction over programs critical to helping families and children in need, this budget is deeply disturbing and destructive to the health of the our vulnerable members of nation. At a time when the republicans windfalls to the wealthiest corporations and individuals, be slashes 200 billion childrensid and the health program. Cuts childcare assistance for families. Thes nearly 2 billion from temporary assistance for needy amilies program, or tanf, eliminates the social Service Block grant, undermines adult services, meals on wheels, Substance Abuse rural s, programs in areas, and mentoring. That these sure us cuts are not going to negatively or take away Services Members most vulnerable of our society . Secretary azar so to achieve ur budget targets and the Overall Administration caps agreed with congress, we had to make some very difficult choices to eliminate programs that are less effective, invest in priority mostly those port hat provide direct services to individuals. Your microphone on, dan . R. Davis so the answer is were cutting programs that are vital to the wellbeing of these vulnerable populations, because e had to make some tough, hard choices . Secretary azar were removing programs that are ineffective, results andt proven also focusing on those that most deliver direct services instead of those that provide support. Cture mr. Davis thank you, mr. Chairman. I yield back. After we recognize mr. Lahood, well recognize ratio members on the democratic side. Mr. Lahood is recognized. Secretary, mr. Welcome. Our country and Health Care System is well served by your leadership. You testified yesterday for almost seven hours. You did the press conference and youre here today for three, four hours. Thank you. Want to talk about Rural Health Care. Before i do that i listened to mr. Doggetts comments. A different watched press conference than i watched last night because i objectively watched that entire press i think it nd couldnt have been more reassuring to the country. He team of physicians, researchers, medical personnel that were put in place by this administration and under your gave confidence to the country. I know he mentioned, talked a ittle bit about Community Spread. I wonder if you can just comment on that for a second. Secretary azar thank you. That exchange could unnecessarily worry the american public. , when the c. D. C. Says ween the president will quite likely see cases and Community Spread, that could be in one town, a locality. A neighborhood. It could also be nationwide. We say could, could, could. For all o prepare eventualities and we have to public about eventu eventualities. We, responsible stewards, prepare for them. We have this 15th case in could be the first potential Community Spread in the United States. We have to do the epidemiology it. Nd we have been consistent from day one about this messaging across government. F the mr. Lahood thank you for clarifying that. Enjoyed hearing your comments at the beginning on your Rural Health Care task force and utting the governor in charge of that. Appreciate that. I am concerned about Rural Health Care. I have a district, 19 counties, missouri, and nd very interested in this subject. I know as part of your fourpart strategy to transform Rural Health Care, increasing rural is a to health care priority. In illinois over the last five years, frequent mental distress by 14 and suicide now is the third leading cause 1535 h for people ages in illinois. Health care providers in my district are focused on the need for increased Behavioral Health and Mental Illness services to address these troubling statistics. While there are many examples of Innovative Health approaches in my district, i just want to one. Out Unity Point Health in peoria, illinois, is working on broaden accesslp to Behavioral Health providers through community organization, partnerships. Started a ly Nonprofit Organization called unity place, that will work to etter understand the unique Mental Health needs of Rural Communities in my district and how to transform our behavioral to ensure better delivery for these necessary systems and services. I wonder if you could discuss youve the successes seen from some of the programs and how the Department Plans to to programs like the Behavioral Health workforce and work, education, and Training Program zero suicides . Secretary azar we need better behavioral and Mental Health as well asal america all of america. We need to have a Sustainable Business model. Make sure o work to theyre economically viable. We need to look at suicide, health promotion. Third, we have to use telehealth. Elehealth can be an important part of Behavioral Health delivery in Rural America using innovation. Nd we have to get the next generation of providers, whether or primary tioners care or p. A. s and let people of tice with the maximum their will, especially in Rural America. R. Lahood we look forward to working with you on that. Thank you, mr. Secretary. Thank you, mr. Secretary, for being with you. The budgets that have come out f this administration in each year have been truly upsetting, and the budget this year is no different. Before and im going to say it again, that i think are outsidents budgets of touch with the needs and concerns of everyday americans. Once again, the administration putting the wellbeing of the ultrawealthy and corporations that of hardworking american families. And the people that i represent every day would suffer greatly under the devastating cuts that are in his proposal. Mr. Secretary, could you clarify if the administration thinks hat children and adults should go hungry and a simple a yes or do . Nswer will secretary azar so the administration is fully funded congress e what the did previously, the head start program. Ms. Sanchez the question is hether or not he thinks children and adults should go hungry because this dministrations budget is cutting 181 billion from snap over the next 10 years. Also a 500 million cut supplementalis up the nutrition, w. I. C. Were latino. The administration, through these devastating cuts, are millions ofrder for americans to receive help with something as simple as putting food on the table. I might remind you that one isevery five snap recipients a military family at that. Im not sure what your values in the district that i represent, we dont believe in letting kids go in needr those that are go hungry. A country is great and as rich as the United States of america not see Food Insecurity among its population and lashing the budgets of vital programs that provide basic necessarities to human beings in to human cessities beings in this country, those programs should not be on the chopping block. Be ess i shouldnt surprised, though, because this s the administration that puts children in cages so i could see food is not a priority for them. Here i come from, peoples actions are worth a lot more than what they say, than what their lip service is. In his state of the union address, said, and im also g him directly, ive made an ironclad pledge to american families, we will patients with preexisting conditions, and we will always protect your medicare. Why is this administration arguing in favor of a lawsuit that would do the exact opposite. And thats take away protections for people with preexisting conditions. My district has over 300,000 nonelderly people with a preexisting condition. Why is he trying to mess with their health care . These sabotage attempts to our Health Care System and our immigration system are hurting and scaring millions from getting much needed medical care. As much as you want to stand up here and defend the president , this administration has made it more than clear on where they stand with the american public. This budget is not fair for hardworking families in my district or for families across this nation. Nothing that you can say reverses what the actions show. Thank you, mr. Chairman. Chair neal let me recognize the gentleman from new york, mr. Higgins, to inquire. Mr. Higgins thank you, mr. Chairman. Mr. Secretary, on monday, january 13, of this year President Trump in a tweet said, and i quote, that i was the person who saved preexisting conditions in your health care, end of quote. How did he do that . Secretary azar the president s going to ensure that any Health Care Reforms protect preexising conditions. Unlike the Affordable Care act where a 55yearold cupple in missouri making 70,000 a year and are unsubsidized would pay over 30,000 a year in premiums and have a deductible of over 12,000. Thats a meaningless insurance card. Thats not actual protection of preexisting conditions. Hes the one committed to actually doing that if congress will work with him. Mr. Higgins concurrently, is trying to invalidate the only law that exists that protects people with preexising conditions. So, in other words, before the enactment of the Affordable Care act, Insurance Company could deny you coverage if you had a kid who was stuck with childhood cancer. You cant do that anymore. Its against the law. There are a number of preexisting conditions whereby an Insurance Company could jerk you around just because you were born into a predisposition, a redisposition to a preexisting condition or chronic illness. There was a lawsuit in the fifth Circuit Court of appeals challenging the constitutionality of the Affordable Care act. The only law, the only law that protects people with preexisting conditions. And it was july of 2019, called texas versus azar. Thats you. And there was a suit brought by 18 state attorneys general and endorsed by the administration to invalidate the individual mandate and thus the entire Affordable Care act. Again, the only law, the only law on the books that protects people with preexisting conditions. How do you reconcile that . Secretary azar first, thats actually a false statement. Erisa protects individuals with preexisting conditions. The 180 million individuals who have insurance from the private sector, employers, as well as their unions. Medicare protects for 60 million americans individuals with preexisting conditions. Medicaid protects individuals with preexisting conditions. And in the Affordable Care act litigation, this is a litigation position not a policy position. And the president s made it clear that he will veto any piece of legislation that doesnt ensure the individual market actual effective and real mr. Higgins mr. Secretary, claiming my time. The replacement to the Affordable Care act that congress tried to repeal and was defeated in the senate had a provision as it relates to preexisting conditions. And that provision said that Insurance Company could not deny someone coverage for a preexisting condition, but the coverage didnt have to include the treatment for the preexisting condition. That is fact. Heres my concern. With respect to what we are dealing with now. While the flu and corvid 19 which is a disease caused by the coronavirus, may not be preexisting conditions, those with preexisting conditions, as congestive heart failure, young kids under the age of 5, elderly are at greater risk because of their preexisting onditions to become much worse riggered by this flu, this covid 19 we are dealing with. Its very clear to me and anybody that looks at this based on fact that the only law that exists that protects people with preexiing conditions is the Affordable Care act. Are you trying to destroy that. I yield back. Chair neal i thank the gentleman. Let me recognize the gentleman from ohio, dr. Wenstrup torques inquire. Mr. Wenstrup mr. Secretary, thank you for being here. Let me in light of the recent conversation, one, in the bill that we passed in the house of representatives we were giving states the opportunity for a waiver if they had a high risk or preexisting Condition Program that actually functioned better than the federal program. That was the purpose of that. Let me go again to the budget. Medicare gets another president s budget, medicare gets 25 years of life under this budget, medicaid grows year over year. Let me point out that this is theres more than one body in this government that we have. Budgets arent law. They are a template. And you can rant all you want, but i find it interesting to complain about the president s budget when there is no house budget. Present your house budget and thats what drives the conversation. So i would be hesitant to be too critical of the president s budget if you dont have one yourself to make the recommendations. Its easy to criticize, but its better if you have your own solutions. Mr. Secretary, im glad to see you here and that youre going to focus on Rural Health Care. Thats very important to me as you are probably aware. We have a nice Bipartisan Task force with representative sewell, davis, arrington, and me. We want to address work force shortages, reimbursement, and payment schedules. Have some flexibility, especially for rural areas. Digital and telehealth. What we have come to call the social determine nance of health, which i know are valuable and important to you that we address those issues. Another focus i have in particular, too, is on graduate medical education. We can talk about health care all we want. If we are not graduating enough physicians and dont have residency programs for them, none of this makes much difference, does it . So i think that thats one of the things that i would like to work with the administration on. Along with these priorities for rural health, which i know are priorities of yours. We can do better. Residency programs in rural areas, a lot of times, people stay where they train. Thats very common in medicine as we both know. So how can the task force here on ways and means coordinate efforts with h. H. S. To really serve our Rural Communities better . Secretary azar wed love to Work Together on improving rural health. One of the ideas you just mentioned around graduate medical education is in the budget which would merge medicare, medicaid, and childrens graduate medical education, take it off the books for medicare, put it on general tax revenue, which is where it should be, and allow flexibility so we get out of the structures that were frozen in place in the 1990s and allow people to have g. M. E. In Rural America. Have primary care, psychiatrists, to have that flexibility to meet our underserved needs. Mr. Wenstrup its not just rural. We have urban underserved areas that would benefit. My district, southern ohio, as you are well aware. Thats ground zero for our drug problem. Not just opioids. Meth, on and on. Can you tell me about additional flexibility in the president s budget that would allow us to use tools at our disposal, especially locally, to fight the broader Substance Abuse epidemic. Secretary azar absolutely. I was delighted last year when congress added to the state Opioid Response Grant Program the ability for states to use money for methamphetamine and other stimulants. In states i know i spoke of in the governor of ohio, in some sits methamphetamine is becoming more of an issue than opioids. Some states its always been. Weve got 15 of the 36 states that report Overdose Deaths by drug time. Meth use was responsible for more deaths than synthetic opioids. That flexibility is crate cal. Mr. Wenstrup my time is up. I look forward to working with you and your team and my colleagues across the aisle. Chair neal let me recognize the gentlelady from alabama, ms. Sewell, to inquire. Ms. Sewell thank you, mr. Chairman. Mr. Secretary, in my alabama district we are always fortunate to get through each month without a hospital closure. I found out yesterday that we would not be so fortunate this month as one of my rural hospitals is going under. Without finances to pay their staff, one of our hospitals is set to close next week. When it closes, almost 150 people will do without a job, and over 20,000 residents will lose their only hospital, leaving them to have to drive within an hour to get to another hospital. Sir, i have a letter that ill present to you today asking for your Emergency Assistance in trying to keep this rural hospital opened. The stakes are high. I know they are high and i know this administration wants to focus on that, but i saw that in the budget this year that theres a proposed cut to dish payments. These disproportionate payments go for indigent care. Im quite concerned in addition to having a budget that doesnt reflect, i think, an emphasis on providing health care needed, especially for those indigent in Rural America, i was glad to hear you are setting up a rural health initiative. As dr. Wenstrup said, our chairman, chairman neal, set up an underserved and Rural Health Care task force. Its a Bipartisan Task force of which im cochair along with dr. Wenstrup, mr. Arrington, and mr. Davis. We look forward to working with you, and i think one of the things we need to start working on is the fact that these dish payments, which are so critically important for indigent care, especially in Rural America, that we save those. I saw in the president s budget that he wants to accelerate the cut of these payments to this may. What would happen is the president s budget would cause a 4 billion cut in f. Y. 2020 and 8 billion cut each year 2021 to 2025. This was not good for alabama. Its certainly not good for Rural America. My constituents and the Health Care Providers in my district cant stand another cut. I look forward to working with you as well as with the Rural Task Force that we set up to try to address that. Id like to now turn to c. M. S. Administrators proposal, the c. M. S. Administrator called for a proposal in medicaid fiscal accountability. It is causing a lot of angst in alabama. Three of our major hospitals, the c. E. O. s have asked for the proposal to be withdrawn. Health care in alabama would be decimated by this proposal. The c. M. S. Is administrators proposal is called the medicaid fiscal accountability. Mr. Chairman, id like to submit for the record the c. E. O. s of three of our major hospitals in alabama thats Childrens Hospital of alabama, u. A. B. , as well as assention or st. Vincents. Chair neal so ordered. Ms. Sewell c. M. S. Post suggested that the comment letters like the letters i am going to submit were alarmist estimates about the impact on beneficiary access as being overblown. I assure you, mr. Secretary, that the fact that the c. M. S. Administrator is now this rule would change the way the imbalance that we currently have between state and federal funding, and it does so without having an analysis. Id like for your assurance that we would work with c. M. S. To try to get either this rule withdrawn or actually have an adequate analysis of how this state and federal funding imbalance would occur and how it would impact beneficiaries in alabama. Do you have any thoughts about this proposal, will you work with us secretary azar on that proposed regulation i have been hearing a great deal from states and hospitals. We want to work with them on this. Ms. Sewell thank you, sir. Thank you. Chair neal i thank the gentlelady. The secretary and i talked about that a couple days ago as well. Thank you. With that let me recognize the gentlelady from Washington State, miss dell ben ms. Delbene, to inquire. Ms. Delbene thank you, mr. Secretary. We have in active containment mode when it comes to the coronavirus. I know there is work happening on a vaccine and other medical Counter Measures. Right now i assume you would agree we are dependent on the ability of Public Health departments to identify, quarantine, and monitor those at risk of contacting the virus and its state and local Public Health that are going to do the lions share of that work. Secretary azar they are the backbone. State of washington, king county, have been as always tremendous partners in Public Health measures and great wonderful to work with. Ms. Delbene thank you. After reviewing the supplemental request to address the coronavirus, there is light on details, and in just a few weeks advantaging the potential cocoronavirus exposure in our state, the Washington State department of health has spent over 1. 7 million. W much county in my district which had the first case, they spent 200,000 just to manage and monitor individuals who came in contact with that one person. And king county, which you mentioned, which is home to seattle and Tacoma International airport, which is doing screening now, is spending 56,000 a day to identify, mon torques and guarantee possible pashe monitor, and quarantine possible patients. My question is can you give us a commitment that the administrations going to support back filling state and local Health Departments for the work they are already doing on the coronavirus, as well as support them Going Forward . Secretary azar of course states are already receiving the 675 million annual payment for the pub lig Health Emergency preparedness. I think washington gets about 17 million for that. But the supplemental proposal does, in fact, cover and well work with congress on what the appropriate amounts are. We have to think over 600 million in there for c. D. C. Well work with you if more is appropriate. To support state and locals who are having to engage in added expense, hiring contractors, lab work, contact tracing. So there is no current mechanism for reimbursement like that, but well work with you on what the appropriate america nism would be for that. Ms. Delbene in the zika supplemental back in 2016, they back filled state and local Public Health departments. Did you know that . Secretary azar we are not opposed to doing that. We are happy to work with you as we work on a supplemental package for appropriate reimbursement for states if thats what congress would like to do. Ms. Delbene that ended up being 45 million to those state and local governments. This is critical these folks dont have lots of dollars to invest. I think its important that we backfill. I hope we have your commitment to do that. Secretary azar the state and locals are the backbone of our Public Health response, which is coordinate everything we have to do here. Ms. Delbene i didnt get a yes. Secretary azar i said we are in agreement. We want to work on the supplemental package to make sure the state and local governments are fulfill funded, including if there is reimbursement needed f Congress Wants to do that. We want to make sure the needs are bet. Ms. Delbene also i just wanted to quickly ask you in the president s budget n. I. H. Is cut by 7 . Given theres been a bipartisan majority in the house to support increased funding for n. I. H. , because of the critical work we do, we have done that consistently now, in fact this current fiscal year increase of 2 billion. That would take that away. How do you support supporting a decrease to n. I. Hirks funding . Secretary azar Congress Every year has been increasing the budget at rates that exceed the growth of revenue for the United States. Its 28 up since f. Y. 2016. Congress obviously will make the final decision on this. I have the largest nondefense discretionary budget. If i have to meet a 9 decrease, n. I. H. Is the largest discretionary pocket of that. We know congress will make different choices as they have. Ms. Delbene thank you. Chair neal let me recognize the gentleman from texas, mr. Arrington, to inquire. Mr. Arrington thank you, mr. Chairman. Thank you, mr. Secretary, for your leadership. Your good work to make our Health Care System more affordable, to give great access to maintain and improve the quality of care. I think you are doing a great job. I appreciate all your efforts, your sense of urgency. Your commitment to taking on this very serious threat of the coronavirus. I think im comforted you are leveraging every tool and resource, public and private. My comment there is whatever we can do to help you, please let us know. We are all in this together. I represent hardworking farmers and ranchers that put the food on our tables and clothes on our backs. Im proud to be their voice here. I was with a good friend from college days at texas tech, pat green, a famous texas singersongwriter. One of his songs, titled, small town family dream goes like this. Daddy was a farmer like his daddy was before. It only seemed fitting i walked through the same door. The only problem with it is, two few of the next generation of farmers and ranchers are going to walkthrough that door. We dont do some very critical things with respect to Sustainable Health care. We have a farm bill. Republicans led the effort, but it was a bipartisan bill. This president s working to hit reset with china and get fair and reciprocal trade relationships that put our producers first. Put america first. We have reduced the tax burden. We have removed some of the unfairness like with respect to the death tax. People literally sell their family farms that are handed to them because they cant afford to pay the taxes. We have reduced unnecessary and ridiculous regulations like the waters of the u. S. I could go on and on. I just appreciate all the good efforts. But we have to give these young families that are going to be our ag producers and provide the country with a safe, affordable supply of food, give us ag independence, like energy independence. Strengthin our nations security that. Will only happen if they have access to basic care. We have had great discussions and i appreciate your leadership in this area, but half of the 2000 roughly Rural Community hospitals are operating at a net loss. And thats up 40 over the last three years. We are in a crisis mode. We have lost over 100 hospitals the last several years. A few of those are in my district. I want to thank the chairman and Ranking Member for allowing me to be part of this leadership team, this task force, ms. Sewell, mr. Wenstrup, mr. Davis. We have met. We are of one accord. And we are ready to tackle this. I believe our chairman and my colleagues on the democrat side are going to solve this. We are not going to let this get bogged down in the petty politics of this place. We are going to do something to give these guys some breathing room out there. We talked about telemedicine, telehealth. I ran a Telehealth Company where we were piping in Specialty Care to rural hospitals in childrens texas. It was saving lives. I appreciate your efforts around that. Was reading about the virtual mamente payment, virtual care, the payment code are you changing to encourage and leverage technology. Revise the medicare wage index so that we have greater fairness in lowwage communities. I just want to say thank you. Im cant wait to get to a place where we have that solution and we get it across both sides of the aisle. Both chambers and to the president. So that we can give Rural America a fighting chance to continue to bless this nation. Thank you. Chair neal thank the gentleman. Let me recognize the gentlelady from california, ms. Chu, to inquire. Ms. Chu i would like to discuss how rumors and misinformation about the ongoing outbreak of coronavirus is impacting Asian Americans throughout the country. As a representative of a district with one of the highest chinese american populations in the country in los angeles, i believe its our responsibility as Public Officials to stem misinformation and reassure our constituents not stoke fear and resentment. This is critical because we have already seen examples of xenophobia directed at Asian Americans in this country. A woman on the subway in new york city was attacked by someone calling her vial names because she wore a facemask. In indiana, two hmong guests checking into a hotel were told asians were not welcome. In california a 16yearold high school student, a boy, was sent to the emergency room after being attacked at school by bullies who accused him of having the coronavirus simply because of his ethnicity. Even just looking asian has been enough to insight attacktories hurel ininsults and accuse the individuals of being disease carriers. Yesterday i sent a dear league letter to my colleagues in the house and senate urging them to refrain from repeating unfounded conspiracy theories and instead to commit to only sharing verifiable information from reliable sources like the c. D. C. And local Public Health agencies. Secretary azar, as recently as tuesday you referred to covid 19 as the china coronavirus which a reporter pointed out could further fuel these racist incidents. Secretary azar i have been listening carefully all morning and i commepped you because you have been using only the term coronavirus and not china coronavirus. I thank you for that. Will you commit today to no longer refer to the virus by region but by the term coronavirus or designated official name covid 19 . Yes or no is sufficient. Secretary azar yes. I took that feed beak to heart to that reporter. It was shorthand for easy understanding. Are you absolutely right. We must ensure nobodys discriminated against based on ethnicity. Ethnicity is not what causes the coronavirus. Ms. Chu in fact, will you affirm racial stereotyping is not an effective way to prevent the spread . Secretary azar thats correct. Ms. Chu thank you for that. Secretary azar, another yes or no question. On january 24, your office of civil rights issued a nfts violation to my state of california erroneously claiming california is in violation of the weldon amendment because we ensure that all Health Care Coverage offers the full range of Reproductive Health care, including abortion. Whats worse, in this notice o. C. R. Threatens to reskend hundreds of billions in federal funding for california, but does not specify where this funding will come from. Secretary azar, this funding that h. H. S. Is threatening to take from california come out of our c. D. C. Emergency preparedness funds to help combat the spread of coronavirus . Yes or no. Secretary azar the state of california has refused to bring that to compliance. I referred that to our lawyers to look at what appropriate penalty would be. But they just be proportionate and related to the nature of the program involved. Ms. Chu i want to ask yes or no. Were you aware there was a 2016 determination by the office of civil rights that the determined california was in compliance with the weldon amendment and that nothing has changed since then in californias approach . Yes or not. Secretary azar i believe there was different leadership coming to that conclusion. We believe its a black and white straight answer of straight violation of the law. Black and white violation of law. That forces nuns to buy abortion coverage. The weldon amendment this conching passed says you may not force an insurer orr planned sponsor to pay for abortion coverage for any reason. Ms. Chu i yield back. Chair neal let me recognize the gentlelady from wisconsin, ms. Moore, to inquire. Ms. Moore thank you so much, mr. Chairman. Its really four minutes certainly is not enough to cover all the questions. Ill try to get through this as fast as possible. Thank you for appearing, mr. Secretary. The budget proposes to cut over the budget window, 21 billion for medicaid transportation. And i guess a lot of arguments could be made for dynamic scoring. Dont you think that missed appointments for cancer treatments, diialcies, people dialysis, people who have high Blood Pressure would increase the cost of health care . Secretary azar the medicaid transportation proposal would be to make that an option benefit. That has been a source of tremendous fraud and abuse ms. Moore there is no evidence there is a lot of fraud and abuse in the program. Secretary azar i beg to disagree. We believe there is evidence of misuse of the program. Ms. Moore well agree to disagree. I only have four minutes. The medicaid fiscal accountability rule, which really changes the ability of for states to meet their maintenance effort in various ways, this will tremendously reduce the ability of states to meet their commitment to medicaid. To what extent does the budget account for that and continue to provide Medicaid Service to the needy population . Secretary azar i dont know if the reform to the state intergovernmental transfer is in the m4 proposed regulation is built into the administrative budget. But i have told the chairman that i am hearing very clearly through this process the feedback of states and hospitals. We are going to take that feedback to heart. Ms. Moore thank you for taking the feedback. Its necessary. Let me talk about the tanf proposals. Theres a slight increase in childcare, thank you for that. But you also cut the social Services Block grant. You zero out the Health Opportunities Health Worker Opportunity Program which might enable some welfare recipients to get meaningful employment. How do you this is a program that was stuck at 1994 levels. How do you justify a cut in welfare when we continue to see people the growing need . Especially for childcare. Secretary azar actually, in terms of tanf given the booming economy, historic low unemployment rates, we should see and are seeing a decline in ms. Moore we are kicking people off, sir. My question specifically is you are reducing opportunities for people to, in fact, get Economic Opportunities by zeroing out the Health Worker Training Program. Somewhere where welfare recipients might logically go. Also, childcare, by cutting out the social Services Block grant funds, reducing tanf funding, you are increasing the burden of by definition these are women with children, to be able to receive childcare. Even with the small uptick of childcare funding, it will tremendously reduce the ability for states to provide childcare. Whats the reasoning behind this, sir . Secretary azar this has been a major investment area for us. We pros o a 1. 3 billion increase in childcare, including 1 billion mandatory ms. Moore never has the childcare pot been big enough. They have always combined it with tanf funds, with supplementary funds, with social Services Block grant funds. You are cutting those other things. Do you understand my point . Secretary azar i understand your point. The social Services Block grant is one that doesnt have discernible outcomes. Goes for basically ms. Moore it feeds elderly people. It has outcomes in our communities. I know you are glad my time is up. Chair neal i thank the gentlelady. Let me recognize the gentleman from georgia, dr. Ferguson, to inquire. Mr. Ferguson thank you, mr. Chairman. Mr. Secretary, thank you for being here. First off i want to thank you for your service to america in this position. It is an enormous branch of the federal government. I know it is an extreme challenge to manage all the moving parts. Thank you so much for your efforts there. Id like to start with a couple of questions on Antimicrobial Resistance. Its a good time to talk about given what we have seen the Public Health crisis that the potential Health Crisis we have with dealing with the coronavirus. As you know the Antimicrobial Resistance letter that i and several of my doc caucus colleagues sent earlier this week, you are aware, i hope you are aware that that came from us, this issue is critically important. Now giving the fact that we have more emerging threats to Public Health, its going to be an important issue in the future. As you are aware the letter focused on the marketplace challenges hindering the development of new antibiotics. I want to give your thoughts along those lines. I also want you to comment on the challenges with the creation of new antibiotics to fight superbugs. How are we going to meet that demand . Can we do that domestically . I think we have seen some exposure here so many so much of our pharmaceutical pipeline comes from china. We have seen what happens there. Can you speak a little bit to that very quickly . I have another question. If you can speak to that. Secretary azar absolutely. Scientifically and technically we can and are making advances. Barreda, Funding Development of antibiotics, we have 16 novel antibiotic projects. We have 30 projects for a total of 54 in our current portfolio. We dragged three new antibiotics across the finish line with f. D. A. Approval. The bigger challenge not scientific. Its market based. And effectively it looks like we are facing a market failure problem because we are asking companies and us to develop an antibiotics, then to use it sparingly. Which is not Sustainable Business model. I have asked my team, want to work with you, how do we think about this maybe in the Counter Measures approach of government, backing, etc. , for a market failure situation. Mr. Ferguson with that in mind, would you be willing to continue to work with congress to develop solutions to this problem . Secretary azar absolutely. Its vital. Mr. Ferguson if i could enter the letter that we chair neal so ordered. Mr. Ferguson there is a recent oped in the Washington Times that highlights that. Chair neal so ordered. Mr. Ferguson finally, mr. Secretary, in talking about eliminating ineffective programs, i believe the administrations budget does not propose reauthorizing the Health Professional opportunity grants. And correctly asserts that the program is duplicative of 47 other Training Programs that the federal government operates. In addition, its been shown to be completely ineffective at improving work outcomes. A recent longterm evaluation analyzed impacts on participants using a three year randomized trial and evaluation confirmed that the program had no impact on employment or earnings and did not decrease the individuals public assistance use. Last year every one of my colleagues on the other side of the aisle voted to expand this program by over 500 . Its baffling to me we continue to fund ineffective programs that waste government taxpayer dollars. If folks cared about helping families and poverty, they would spend more time making sure the federal dollars go to those programs that actually work. Most importantly, the best way out of poverty is a job. Being prepared for those jobs. We need to have the most effective training there. With that i yield back the balance of my time. Chair neal let me recognize the gentleman from michigan, mr. Kildee, to inquire. Mr. Kildee thank you, mr. Chairman. Thank you, mr. Secretary, for being here. I assume you have some awareness of the flint, michigan water crisis. Are you generally aware . Secretary azar yes. Mr. Kildee thank you. I want to address that. I was pleasantly surprised to see that the c. D. C. s fiscal year 21 budget highlights the really good work done by dr. Mona hannah and her team at the flint lead registry in response to the water crisis f i could read directly from the budget document. Quote, c. D. C. Worked with local Health Departments to connect more than 90 of the children with elevated lead levels to followup services. Medicaid expansion increased access to Screening Health Care Education and social services for affected children in the flint community. C. D. C. Support his enabled Michigan State university to implement an innovative one of a kind lead exposure registry, creating the model for the nations first leadfree city, unquote. So this budget document also creately states that lead exposure harms a childs health. We all know there is no safe level of lead can affect growth and development. Hearing, speech, i. Q. , academic achievement, and behavior. We are really seeing this in terms of behavior. Even though my hometown of flint has made progress since the water crisis, lead poisoning is still a problem for children and families and well be grappling with this for a long time. Congress authorized the flint lead registry in a bipartisan effort through my legislation which was signed into law in late 2016. And im now working with my colleagues on both sides of the aisle to reauthorize this program. We do these things in fiveyear bites. We need to get it reauthorized. My first question is simple. Whether the Trump Administration, who obviously view this is work as important and successful, will commit to work with us to reauthorize the flint lead registry . Secretary azar well be happy to work with you on that. I cant be a statement of administration position, but its a critical Public Health priority well work with you. Mr. Kildee im also pleased to note that the administration in this document highlighted the critical importance of flints Medicaid Expansion waiver, which was very much a part of the response to the lead crisis. The expansion also expires next year and my office has been working with the state of michigan and with officials in the city of flint to get the expansion extended. It was planned to be extended at the time it was initiated. As we know these waivers have life spans to them. Secretary azar, i think more importantly because this does fall clearly within your jurisdiction and authority, can i get a commitment from you to work with michigan officials, my office, and with people representing the city of flint to extend this expand the waiver and extend it so that children can continue to receive the Critical Services that the highly successful lead registry makes them eligible for . Secretary azar i dont have the details on that waiver, but well be happy to work with you and the state todirble check with the c. M. S. Administrator and see if there are any issues and be happy to work with you on that. Mr. Kildee will i note this is important. This is the most important priority for me in terms of the work of your department at this moment. I want to make sure that we continue to do this work. I am concerned that in an era where it appears that there is a desire on the part of the administration to reduce expenditures in medicaid, that these very important programs will be difficult to continue. I just hope that we can reconcile those two. Chair neal let me recognize the gentleman from pennsylvania, mr. Boyle, to inquire. Mr. Boyle first id like to highlight serious concerns about a recently proposed change to medicaid. In your medicaid fiscal accountability rule. Im leading a bipartisan letter with my ways and means colleague from the other side of the dais, representative kelly, that dives into the impact this proposed rule would have on health care for. So most vulnerable pennsylvanians. Mostly children, seniors, and lowincome individuals. Seeing the administration admitted to not knowing what the impact of this rule will be, we are asking, again, on a bipartisan basis, to work with we are asking for you and this administration to work with all the stakeholders to ensure that this proposal does not place an insurmountable burden on our hospitals, networks, and providers. In the interest of the brief amount of time i have ill let our letter speak to the specifics, but i just wanted for today to bring this letter to your attention. I look forward to your response. Second, i did want to ask you about the coronavirus. Happening literally at the same time as draconian cuts are being proposed by your administrations budget. Specifically im referencing the Budget Proposal to cut the centerers certainties for Disease Control by 16 . Is it appropriate to stand by a 16 cut to c. D. C. At the same time we are facing a unique worldwide Health Crisis . Secretary azar the changes at c. D. C. Are chronic disease an prevention programs. The increases we have 135 million proposed increase on Infectious Disease Global Health security and preparedness. We already had in there increases. Of course the emergent supplemental undoubtedly there will be significant funding. Mr. Boyle we are also seeing to use a phrase, robbing peter to pay paul, in temples directing this increased funding you are shifting. In the interest of time, let me just devil into other point of our response to coronavirus. At a time like this making sure that the people can trust what government officials are saying is really paramount. We have seen that in previous crises. I was concerned just yesterday the president called a press conference and you referred to only 15 cases of coronavirus, and the c. D. C. Has confirmed its 60. The president said that americans are not at risk to contract the disease, but literally the same date c. D. C. Confirmed an american living in Northern California contracted the disease without traveling outside the u. S. Where apparently coming in contact with another patient known to have the infection. Who should Americans Trust . The president or the c. D. C. . Secretary azar your statements misrepresent what the president said. He said there are 15 asdy in my opening statement. There are 15 cases from individuals in the United States. Who traveled to wuhan on their spouses. There are 45 additional cases from individuals repatriated from wuhan or the diamond princess. Thats what the president said. Thats our data. Thats the c. D. C. s data. Mr. Boyle thank you. Reclaiming my time. Since i only have under a minute i do want to reiterate something i went into at length a couple weeks ago when the o. M. B. Director was in front of the Budget Committee and focused at length on the scale of the proposed cuts to medicare and medicaid. I just want to briefly read into the record what not me but what the American Hospital association has said about these this proposed 500 billion cut from medicare and 900 billion for medicaid. Quote this budget would result in hundreds of billions of dollars in cuts that sacrifice the health of the seniors, the uninsured, and lowincome individuals. We in congress cannot allow these cuts from this administration to move forward. I yield back. Chair neal let me recognize the gentleman from california, mr. Nunez, to inquire. Mr. Nunez as i follow up what i said yesterday, i want to enter into the record a piece from mornings wall street journal called trump versus the coronavirus. Of note the author writes, i quote, medicare for allcies in the u. S. With minimal private hospitals or physicians would collapse beneath a real virus crisis. Medicare for all would smother the publicprivate infrastructure in the u. S. That develops, manufacturers, and distributes lifesaving therapies for viruses or anything else. Chair neal so ordered. Mr. Nunes there are several legislative proposal to address the high cost of Prescription Drugs. Some them have no chance to be enacted into law. Like speaker pelosis h. R. 3, which the president has already said he would veto. However there is a broad bipartisan agreement that Medicare Part d needs to be reformed and modendized. H. R. 19. The only bipartisan, bicameral drug reform bill would cap seniors drug prices at no more than 259 per month. Thats real relief we can accomplish right now. Mr. Secretary, the administrations budget includes a part d out of pocket cap and further policies to improve that benefit. How are the part d reforms in h. R. 19 consistent with the budget and how would it lower patient outofpocket costs . Secretary azar one kick clarification, the case yesterday it is not from the repatriation. I wanted to clarify that. As to h. R. 19, and part d reform, what we can do is riment seniors out of pockets to no more than 3,100 year. The first ever catastrophic cap on what people people would pay. Seniors would pay for their drugs. And we could allow them to opt into spreading that cap over the course of the year, such that each month the senior would be guaranteed to never pay more than 258 a month for their drugs no matter what the cost of their drugs. What an historic opportunity we have if we could get our act together and work on a bipartisan, bicam bicameral bay sis. Mr. Nunes your budget is secretary azar consistent with the budget, absolutely. Mr. Nunes we hear a lot of proposals the federal government should intercept and dictate drug prices to manufacturers. When congress created Medicare Part d it did so with the belief that private organization, which are already administering employer sponsored drug benefits, could be used to administer a medicare drug benefit. And under Medicare Part d drug plans compete against each other to provide the lowest price to beneficiaries. I have one question, do you think the government can negotiate a better deet deal than what the plans have been able to negotiate over the past 15 years . Secretary azar as peter who ran the Congressional Budget Office in o. M. B. Under the obama Administration Made clear, you cant get a better negotiation than these massive middlemen get unless you have a restricted formulary. Meaning, unless the United States government for all seniors is willing to deny access to drugs and ration them to seniors, you cant get a better deal than these middlemen do. Its basic economics. There are not going to heand you more money because they like you. Mr. Nunes thank you. I know you have a real crisis on your hands. I want to be respectful of your time. With that i yield back the balance of my time. Chair neal i thank the gentleman. Let me recognize the gentleman from pennsylvania, mr. Evans, to inquire. Mr. Evans thank you, mr. Chairman. Mr. Secretary, i read the Mission Statement of the health and Human Service mission of this department is to enhance the health and wellbeing of all americans providing for Effective Health and Human Services, costing advances in science. My understanding thats the Mission Statement. I want to talk about the Health Care Environment back in my district in philadelphia. The city of brotherly love. I know how many people will notice the philadelphia is the home of the nations first hospital, Pennsylvania Hospital. It was founded by ben franklin in 1751. And i was born at that hospital a few years later. Since the founding of Pennsylvania Hospital has become renowned for its innovation in patient care and treatment practice and medical research. The city of philadelphia has become one of the nations most Critical Centers for health care, Health Care Research in the country. While we have seen so many innovators in our city, we have also seen our fear of challenges. Over the last 20 years philadelphia has experienced 20 hospital 10 hospital closures with the latest one being hanaman hospital which made National News when it filed bankruptcy last summer. When a hospital shutters its doors, it does more than loss of ability, its a loss of hundreds if not thousands of jobs. Its a loss of resources and patients, families that have come to trust and rely on for generations. Some say they dont feel safe. If that loss of education for medical research. It is either the increase burden on neighboring hospitals or the scrambling for patients to find new doctors who they have to travel far distance. I have gone back home and they tell me i want my hospital back. What is happening in philadelphia can happen anywhere. Hineman is the canary in the coal mine. The loss in this hospital and all the disruptions that came with it should serve both as a warning and testimony to attention we must pay to this subject. Hospital closures are a lot of underlying issues. This is something that requires , the congress and the executive branch of us working together. There is no simple answer. But the reason i read your Mission Statement is the budget inconsistent with your Mission Statement. I know you dont have full responsibility of the budget because there is a budget office. But you make recommendations. So taking your Mission Statement and taking what i read in the case of philadelphia, in your own judgment, maybe you wont say it or maybe you will not say it, but your Mission Statement and actually what you have heard, please tell me that theres some incost sin continuecy here with this same. Secretary azar we never have unlimited funds. One could use that rationale for just unlimited expenditures on anything. One has to pick programs that work and make sense. I did want to say, i want to thank you and the chairman for arranging for the meeting that we are going to have to focus on hineman hospital. Youre right, the hospitals a vital parts of our community, whether rural, urban areas, underserved areas. Your leadership has been very important. I look forward to our event there. Mr. Evans i like to thank you and your staff along with the chairman who came to the city for having this discussion. Its not unique to where it all started in america. I keep reminding that to the chairman. Tells me ben frankly from there. The fact of the matter is i yield back. Chair neal ben franklin of massachusetts. Let me recognize the gentleman from illinois, mr. Schneider, to inquire. Mr. Schneider thank you, mr. Chairman. Thank you, secretary azar, for coming before our committee. As you know my home state of illinois had the second confirmed case of coronavirus. As well as chicago ohare, directly adjacent to my district, one of the select screening airports passengers for china. That means we have primary, secondary, and tertiary quarantine sites. These facts have sparked a fair degree of concern and worry among my constituents. I am a strong believer in the axiom, prepare for the worst. Hope for the best. I wish coy with confidence simply ease my constituents fears by saying our administration is fully prepared and has the situation under control. Right now i would fikelike saying so would be a stretch of the truth. The Trump Administrations administration has been at best lethargic. At worst shortsighted. The budget you are presenting to our committee today only further weakens the agencies like the c. D. C. Critical to the response to the coronavirus outbreak. On top of that, the president and your department are requesting a mere 2. 5 billion in emergency funding. You said it was a chess game. To put in context how insufficient this fund something, our Illinois State government projects a 15 decrease in g. D. P. In the worst Case Scenario of a widespread outbreak. That totals to 131 billion per year per per year or 10. 5 billion per month. State would need 1,000 state responders at the cost of 70 million every 30 days. Illinois alone will need 500,000 units of personal protective equipment. Gowns, gloves, masks, shays fields totaling 35 million there. And the cost of the current standard 14 days of guarantee, including housing, food, medical sport r support, and Law Enforcement is iestimated at 10,000 per individual. Thats for one person. These numbers are staggering. And that is only one state representing a mere fraction of the national need. You just said a few minutes ago we need to prepare for all outcomes. Secretary azar, do you think the president in your agencies budget request is sufficient to be prepared for just the most likely, let alone the worst Case Scenario . If not do you expect states, communities, and local hospitals will bel need to, be able to foot the rest of the bill . Secretary azar we do believe it is the appropriate response for the remaining months of 2020. The president has made it very clear well work with congress on a bipartisan, bicameral basis to secure additional money such that Congress Sees fit. I did want to mention it is not part of our doctrine for pandemic that we would be using mandatory institutional quarantine like we dealt with in chicago there. Thats unique circumstances of federal quarantine from these passengers coming in from out of the country. In this active containment period. It would not be part of the expectation for americans it would be home isolation. Mr. Schreiber that case in california secretary azar because we are still in an active containment strategy, put people into mandatory quarantine, at some point if we were in a mitigation mode, people will stay at home. Just like with sue veer flu. Mr. Schneider my constituents in general would feel more confident if we were preparing to protect us against the worst case f we are asking for all the funding and never had to use t you are not. Which is, i believe, unnecessarily putting our communities and our nation at risk when lives are at stake. We also this may be the question you need to answer separately, deal with the logistical issues like supply chain management. We need to deal with today not. To can you provide us with concrete examples of how the agency is preparing for shortages and supplies like gowns, masks, etc. . What you plan to do in the future and make sure we have things placed where we need them, when we need them. Secretary azar we are using on the transfer and reprogramming money to initiate contracts for gowns and masks and with the emergency supplemental funding that we hopefully will get, we will acquire massively more amounts of that. We have started the seed contract so we can build on those quickly. Mr. Schneider i yield back. Chair neal the gentleman from texas kansas, mr. He its mr. Estes, is recognized. Mr. Estes thank you, mr. Chairman. I thank you for being here. Its been a long morning to work through this. Under your leadership h. H. S. Has been refoist focused to address. So major issues that impact many americans, including in my district and across the kansas. We have to remain committed to protecting access to quality Rural Health Care. Addressing the need for more transparency in our medical billing system. And ensuring we are helping families in need. I want to thank you for so many of your policies that you put in the budget that would allow flexibility to combat Substance Abuse of any sign that it takes. I know in our state methamphetamine is still an issue. As well as epyoids. Wanted to ensure that the state Opioid Response Grant Program addresses all aspects of how to treat those devastating addictions. Since last year i have been working closely with district attorneys and Health Care Providers in the state looking at how do we increase support against those addiction programs. I appreciate the support from the federal level and important we make sure that we continue to make sure those federal resources get out to the states. I do appreciate the administrations collaboration with congress and want to continue to help improve our health care, make sure we keep Prescription Drug prices lower, make sure we i also look forward to continuing this vital work with you. Im particularly proud to hear about your announcement earlier today about former governor from kansas, jeff collier, to head up the h. H. S. Rural health initiatives. Our former governor and medical doctor, kansans know hes a dedicated to Rural America and patient wellbeing. I can personally attest to his qualifications and know hes very fit for this. Can you help talk through a little bit about how you want to make sure that there is a major focus on Rural Health Care in america with this initiative . Secretary azar absolutely. We really have four parts to our Rural Health Care strategy which involves first we have to get an economically sustainable model. Just as i was talking about congressman evans about it. Its about we cant paper over facilities if the economic model doesnt work. We have to make them work. Part of that was changing the wage index to redirect moneys to rural hospitals. But then how do we make them actually sustainable . One of the Budget Proposals that im excited about is to stop rural hospital closures is the critical access hospital plan that would let you switch to be an emergency room and outpatient and not have to be inpatient, as well as get you can you continue to watch this hearing online at cspan. Org. Also later in our program schedule. Well leave here to honor our nearly 41year commitment to lively gavel to gavel house coverage. Members today taking up a bill regulating Tobacco Products and videotaping. Live coverage on cspan. The speaker the house will be in rder. The prayer will be offered by the prayr chaplain, father conr. Chaplain conroy let us pray. Merciful god, we give you thanks for giving us another day. As we meditate on all the blesings of life, we especially pray for the blessig of peace in our livesand in our world. Coronavirus has already caused pmarkets, International Trade ad travl, and the healthare industry worldwide. We ask your blessings on those men and women whose life work