Transcripts For CSPAN USAID 20240704

Like to welcome to stage politico Vice President for client partnerships, heidi summer. Up next, white house counselor to former President Donald Trump, Kellyanne Conway and Samantha Power on Health Policies in the u. S. And spoke at Politico Health care summit in washington, d. C. Good afternoon, everyone, im ryan, the coauthor of playbook and the host of politicos playbook deep dive podcast and in addition to this being a public conversation here for you all, its actually our first live taping of the deep dive podcast, so thank you for joining you want to know more at this podcast, theres a q. R. Code in our program so please check that out. Welcome and thar you doing this. Thank you for having me. Thank you, everyone. Were headed into a rematch between former President Trump and President Joe Biden and the politics of health care will be central in this campai, and whoever wins this election, Health Care Policy will surely be central to house. Kellyanne, you were President Trumps campaign manager, his counselor in the white house, and youre also in charge of some aspects of Health Care Policy in the white house, and youve been doing an enormous amount of work in this political cycle on health care strategizing and politics so cant think of a better person to help us figure outol 2024. But before we get to all that, i do want to talk about and ask you about one question, news of the day that is related to health care and that is what the house did in this overwhelming vote this morning to potentially ban tiktok, which is a National Security challenge to the supporters of this bill, but also many see it as a health care problem, phone addiction for kids and addictive algorithms that run a lot of kids lives, at least my kids. You worked on this andepublicane house not to support this bill. And you helped, i convince donald trump to oppose this. Just quickly, tell us a little bit about your role in that and what you made of the vote. Sure, President Trump makes up his own mind, he does it through a post on his own and through squawk box on monday where he clearly said an empowered and emboldened Mark Zuckerberg whoremp believes interfered with the 2020 elections through half a million going to going to get out the vote and doing other things. He feels zuckerberg or another social Media Company consolidates that power and were creating tech barons by having Mark Zuckerberg in charge of facebook, instagram and now tiktok, that would not be good the other thing President Trump has pointed out is the sheer number of users. Ive seen up to 170 million quoted as the figure. U. S. And as President Trump said monday, his belief that you have a lot of young people in there, a lot of females and voters who like it and its not just for entertainment, maybe it started out that way and theres a lot of connection and im not even on tiktok and not o of the 170 million users but i believe in the First Amendment and 14th amendment and think constitutionally you saw the failed experiment in montana when the state tried to be the first state to ban tiktok they were sued by montanans and its a bill of retainer problem i paid a lot for my law degree and want to use it every once couldl security threat, no question. I personally want to hold china to account for any number of things. I think we should be holding starting. We dont we have confirmed the covid virus where it killed many worldwide and were telling them to gety and killing people. Were not worried about the persecution of religious minorities or worried about forced technology tran. Polling on not just this bill but an outright ban prior to that and where you as americans stand on whether or not to ban tiktok has an awful lot to do with where you sit on the spectrum of users. If youre a tiktok user you dont want that to happen. You say who cares, not realizing theres a slippery slope. But we ask the question very clearly, which of the following is the best way for the u. S. Government to hold china to account . And we gave 11 different rotated possibilities and allowed you to choose your top two. And of that listf 11, it was published in the Washington Post yesterday, anybody can see it, its open for you to see. The banning tiktok was dead last because its being beaten by the things i just mentioned like force technology transfers, like the covid virus, fentanyl clearly, the religious minority leaders, etc. So im all for holding them to account. We need to do that. The other thing is the c. E. O. Of tiktok first testified under oath in Congress People asking are not under oath but people answering them are, and he testified a year ago in march of 2023 and that was the best day for would have been the best d for the house and senate in a bipartisan fashion to ban tiktok and every day since then theyve lost a little bit of the argument. Let me tell you something, i have four teenagers at home, three are female and if youre telling me tiktok is truly burning their brains and bodies, what took you a year . We need to get to a now, National Security, Holding China accountable and protecting the american child. It took a year to followup. President trump was obviously for banning tiktok when he was in the white house. My question is, youve written a list of potential v. P. Candidates you recommended. The first name on that list, a lot of people but thewas tom co. Tom cotton said recently he would not meet with the head of he would not meet with the head of the hamas or taliban. So a couple questions, one, republicans in the to donald trs issue, obviously. Most of them supported the bill. But how big of an issue is this for trump as far astell . In other words, do you think its a deal breaker for a vicepresident ial candidate like tom cotton . Its not. Theres a lot to pack and let me try to do it quickly. Number one, when President Trump stated in august of 2020 that if congress put it ban tiktok or st from u. S. App squares and made it clear on squawk box, and it never came to his desk. Since then, he has seen how many users there are. He holds china to account in different ways, like saying to xixi jingping you need to schedule fentanyl and get it out and they scheduled fentanyl. Hes got a 10 tariff on china that he likes to do. He looks at taking them on in a larger package. Hes very clear on how he would take on china. But on this one he was very clear previously on this he would take him out and reversed himself. He hasnt reversed himself. I disagree. At the time they were looking for u. S. Owners. I was a part of those discussions. I can name the two Big Companies but you can figure it out. Microsoft is one of them. Was one of them trying to buy it. And so again how is that a reversal . How is it a reversal for him to say u. S. Ownership . Its also a matter of priority. To have it appear so quickly to be the biggest priority. And they didnt not listen to him. He didnt tell them to vote against the badont know a singf Congress Donald trump called and said please vote against this ban. Its not true. But he is centrally fused on zuckerberg and creating a major tech baron and someone he thinks that after 2016 when we utilize facebook and google and youtube and you name it because we didnt have money hillary had. I know ron desantis spent nine figures in iowa. Lets not this is important. We didnt have money for ads so we utilized social media and zuckerberg took a lot of heat in co and everyone else being blamed for Donald Trumps election. And since then has gone back, this kind of zuckerbg mone 17 o lets talk about a issue related to health care, which is abortion. This morning, neera tanden said the Biden Administration will make freedom and rights a core part of the agenda in his campaign and reproductive freedom is a core part of that. Then she took a ip moderate position on the other side is a nationwide ban. Is that right . Did she say the wordbortion . Im going to think she didnt. Theres a reason President Biden didnt say abortion in the state of the union last week. Just say the word it. It an uglt want to own it . Say the word. Because heres what i think, im very realistic on this, i think we should show compassion. We should reflect consensus and it requires concessions. Im 1000 prolife and many family members of mine are prochoice and i respect them and love them but i dont think we should have very popular states that have abortion well after the 34th week. Babies are being born in those states, in those same states at 23 weeks, 25 weeks. And thats an example i like to give because we couldnt have had this conversation 10 or 15 or 30 years ago where these babies are being born prematurely, surviving and thriving. I would challenge people like neera d ■hothers who cant say the word abortion. I would challenge them to explain why you cant come to a point where babies are being born president harris. I can name three babies in her state of california that were born long before she thinks abortion should still be legal. Can we get to the point where those three individuals, the only ones i know about, there are probably many more, are citizens of california like she is, can we just stop being science deniers, thek at you ang his thumb and thats a male organ. Stop pretending thats not what you see on a sonogram. Ban. There can be a federal minimum standard of 15 weeks. Its the second trimester. The baby can feel pain according to nonpartisan doctors and scientists and its a good way to just have the conversation. You think trump should come out for a 15week ban. Thats the minimum standard. And its not a ban. Shawn hannity a couple weeks ago when he was at the border and also said 16 weeks and four months. As president he committed to signing into law 20 weeks and was changed the nonpartisan doctors and scientists have shown evidence an unborn fetus fe but i think that to show concession and consensus is really the way to go. So if you ask people, are you■ not getting any of the story at this point. When you ask them granularly, which of the following expresses your view on abortion and give them choices, i dont want abortion ever, should always be illegal or prohibited, thats a very small number of americans now, 9 . It used to be as high as 14 and now its 9 . Then you overlay that, im for abortion in cases of rape and incest, and im for abortion in cases to the health of the mother or birth defects and not facing the first trimester. Ure asking Big Questions and want me to give you a sound bite and im not going to do that. Youre a political strategist. I can do that butdisrespects. I want to get to i. V. F. How would you rtion, i. V. F. A republican believes an embryo is human life and how would you advise them to talk about this issue. You have prolife advocates including in alabama who are very upset with the Republican Legislature and governor for this legislation that protects i. V. F. Youve been very outspoken that republicans need to be in that place, overwhelming be in the place of pro i. V. F. Trusting i. V. F. How do you advise the republican candidates who say you know what, i believe an embryo is a human life. I know a few people like that, i dont know many and you want them to be the rule and not the exception. A great example i think what happened in alabama lets talk about the legislators and governor of alabama. One question, youont■0 know anyone who believes that life starts at conception. I know many who believe that. Youre talking about embryosan. You want me to answer the question . Heres what actually happened. There was a case before the Supreme Court in alabama and it was a wrongful death action, two couples wanted to sue for wrongful death because three embryos were accidentally destroyed. You can sue for wrongful death is it death occurred and the only way death occurred is it a life is taken. The Supreme Court ruled and theres probably a lot of people in ts■ room hearing it for the first time because god forbid the media would cover the facts of the case. What happened next is important. Because what happened next is President Trump came out the next day within the next 2448 hours and put on truth social on february 23, you can read it and put it on his remarks the same day in south carolina, you can read it, that we should be encouraging people who want to bring life into this world, we should help them in any way we can to create life and to bring life into this world. And if youre prolife, you want to be prolife for the childs entire life. Hold on. He said the nrsc put out a memo quoting our polling, apart from our polling showed 86 of women and 85 of all americans support increasing access to i. V. F. And other fertility related treatments and really changed an opinion over time and inc majorl christians of prolife respondents and republicans and conservatives. Talk about something that has tripartisan consensus and not even bipartisan and kaye ivy the governor is prolife and the legislature came out in abilitye i. V. F. And other fertility related treatments in alabama. It was going the other way, in iowa the statehouse passed something that could criminalize i. V. F. Potentially. I havent read a stat gist at republicans to win, how do you advise republican candidates where life■ and destroying embryos is murder, how do you tell them to talk about this issue . They should say im prolife of happiness, the first one, the first is life and i tell them i wrote this this morning for a client. Then you say i have close people to me, family members and friends who are prochoice and love them and respect their opinion. And when i hear them say theyre prochoice, they say im an awful lot like a prolifer it. Im prochoice because i believe abortion should be available for those who have been raped or incest or to save the life of a mother and eileen throw in there not past the fir trimester early on. Then you have people say im prolife and say the exact same thing. Im prolife but here are my prolifers to say. Say to someone very politely and calmly and very respectfully in your life who disagrees with you on this issue. Say to them, you know what, youre always saying youre prolife, what are your exceptions . I think you should turn them around and say you show me your exceptions and ill show you mine. And then the prochoice say what . Because nobody ever asked them. What are your exceptions . Gender do you think is being aborted more when thats happening . Taxpayer funded abortion . After 15 weeks when the fetus can feel pain . Ive talked to two surgeons and they perform in vitro brain, heart surgery. Its amazing. They do it. I asked them one question, i know you give anesthesia to the mother, do you give anesthesia to the fetus . Why . Because we■ can feel pain. We have to stop denying science and stop the people who mask up your 5yeaol admit what they see after certain gestational age. I think there are areas of consensus we can come to. And i think that if you have isn abortion, abortion past the point of excruciating pain and abortion late term and■d i will not say and counsel science again saying, they would there are democrats for abortion up until the÷ moment of birth. You know why thats not the best way to say it, because nobody knows anybody who knows anybody who ever heard anybody about give birth and said, you know what, i dont really like stretch marks and not ready for another person in my life. Nobody knows like that. Waid to hillary clinton, you would rip that baby out of a mothers womb an hour before its delivered . Thats a metaphor for here . And people reflect and say can that be true . It changed a lot of the conversation. Sounds like the conversation in the campaign will be a conflict between each side accusing highlighting the alleged extremism of the other side. I think thats where were already headed but thats not wh is. My entire point is it most of america is not where the loudest, noisiest people are, you have to go where america is. Politics tell americans what is important to them and why, they tell us. It needs to be reflected back to them. One more thing to say, there have been six rep 1973, since re vs. Wade was passed and was the opinion in the United States Supreme Court. Ush, bush, trump. They all had the same position on abortion. Im prolife with the threeyou r causation . The difference of this campaign is dobbs, right . Thats interesting. Just so im clear, im also against the state initiatives, theyre 07 and was against them from the beginning. My firm left millions on the table and didnt do a■m single thing for any of them. I thought it was a terrible idea, it was too soon. If it took 50 years to overturn roe vs. Wade and will take morer 50 weeks to explain to people what it means and more importantly what it doesnt mean and to move hearts and minds. Weont even right now. We dont. I want you to say the word abortion and you should ask the not. All right. Noted. 2024, other Health Care Issues. We were talking about this the other day. The Republican Party since 2016 has transformed into a much more working class party and the democrats and republicans have shifd in a major way. Im curious if there are any issues that you think republicans should be or are addressing, should they be rethinking when it comes to Health Care Policy given the change in the■n health care is the one issue i warn republicans ignore at your own peril. It may not pop in anyones national when we say health care, insurance . Im going to get to that. Insurance. But people in health care it means access, affordability, reliability, cost of prescription drugs, it also means transparency, surprise medical billing. Its everything from long term care, medicare, medicaid for elderly relatives and maybe lower income relatives to, gosh, now were talking things like ozempic being covered and child diabetes. Women control 23 Health Care Dollars spent in the country. Guys, you wouldnt go to the doctor unless i told tu was time and made the appointment for you. Women areely the Health Care Consumers and providers. The vast majority of nurses, Home Health Care aids, hospice, Insurance Claim call and get a. Were at both ends of the Health Care Delivery and consumption system and if somebody says to me oh, but its not high in the polls, the border is, inflation is, ukraine is, israel is, abortion, whatever it is, that doesnt matter. Health care is always part of our congenital decisionmaking process. Is there very quickly, is there an issue you think the Republican Party needs to ring their approach . They should come out with a plan. We had at the Trump White House a Healthy America plan and i brought a copy with meere workie covid hit. Backstage we finally see the plan but nobody saw the plan. I saw the plan and we worked really hard on it and people worked a long time on that. It was hidden. No, parts of it im sorry, we worked we do kidney care and insulin and we brought the cost of insulin down. Getting to obamacare, should that be f theoing what . Getting rid of obama car . We should expose it. N. P. R. Said the biggest lie of the year is you can keep your is this hold on. This is important. Everyone was promised you would get Health Insurance and thats not true like the mom who raised me with a College Degree never would have had health care and still wouldnt. Theres a chance for an easy question. Youre cutting me off. I apologize but the clock is in my face. Healthy america plan, i have it backstage. Well put it on the show. Notes in the podcast. We expanded short Term Duration plans and at the end of deep dive we ask a final question posed by our last guest, in this case the last guest happened to have been katie rogers of the New York Times and didnt know you were question is, please show us the secret Trump Health Care plan no, kidding. And expand telehealth. What does success look like in your profession and what does it look like to you and give us a question for next weeks guest who we dont know who that will be . Ill say my profession is as a pollster market researcher and Data Analytics and a fully atto. In that position, success is judged by how many races your clients win and how much money you make. And ive done plenty and plenty. Ive had Great Success and im a very blessed person. I still always did and still do define success as pollster, i think one of the last touchstones we have to the American People and their voice and their choice isically sound, artistically smart polling and focus groups and Data Analytics. Why . Because thats how they tell you who they feel and what their aspirations are and frustrations and whats most important and why. Rather than asking silly questions whether youre for trump or biden, those will take care of themselves and change over time but what wont change is where you are on health care or crime or israel, etc. So i would say success is judged by how much were able to reflect and collect and reflect back to the people their will, their ideas and when you can share that with opinion electedl them, look, this is what the people are saying and particularly the forgotten man d woman. I have to get going. How about a question for next weeks guest . And i dont know who it is . No, dont know who it is. Ill revert to if you werent doing this and not living in washington, d. C. , what would you be doing and where would you live . Hilarious, that was the question from two wes ago. Keep going. I dont listen to your podcast but i will. Thank you very much. Sorry, we went a little bit over, but some very interesting insights there on tiktok. I think the reproductive rights debate in this campaign is going to be that. And i do think that we learned any time you ask kellyanne who is very, very sophisticated this it comes to abortion messaging, the go to is point out the extremes on the other side. I think obvious. And i think on trump and it was fascinating sounds like an off the cuff issue for trump and not something hes going to care a whole lot aboutx working with people who dont agree with him on this issue. So thank you very much for listening and participating in our first live podcast to welcow politicos Global Health reporter harmon hahn to the stage fothe next conversation. Thank you all. S hello, everybody. I know you listened to a very interesting conversation. My name is carmen hahn, a reporter at politico. Today were going to be speaking to u. S. A. Administrator Samantha Power virtually and were grateful for her to make the effort to talk to us even though shes not here in person. There she is. Administrator. Welcome. Im going to sit down. So we have a lot of things to talk about today. And its probably going to be quite ambitious for 20 minutes but i wanted to Start Talking about your work responding to the humanitarian and health needs in gaza to the reality were facing globally post pandemic. We had a major shock, a and ecod social shock and a lot of trust lost and were now working to rebuild it though many of us want to forget about the pandemic for better or worse. I want to talk to you about the fight against Infectious Diseases only being made harder by Climate Change and alsoork tg ill call low hanging fruit which is lead poisoning in children. Obviously, lets start with the news of the day which is gaza and obviously front of mind for a lot of people here and a lot of people abroad. President biden announced in his state of the union that the u. S. Would establish a humanitarian aid bridge in gaza. What more can you tell us about what will be established, what aid will the u. S. Give and what response have you heard so far from u. S. Allies . Thank so you much and thanks for having me virtually here and join you. I caught the tail end of the last conversation and ill refrain. On this ill say land access is everything. Before october 7 and the horrific killing of israelis and now the war that has ensued with 30,000 palestinian lives lost and many civilians killed in military operations, 500 trucks were making their way into gaza every day, commercial, some humanitarian. Were lucky these days if we get to and thats with major cities largely destroyed and a gathered on average you have about 560 people sharing a single toilet gives yo a sense of the sanitation peril so many Health Experts in the room would be alert to, the risk of dyreeal diseases and hunger because were not g President Biden authorized airdrops with 200,000 ready to eat meals have been dropped in the last week and this marine pier that would allow aid deliveries at full scale, much better than airops in termscient more and approach because even to get back the 500 trucks of destruction, we need to go well beyond that. So many of the Health Facilities have been destroyed by i. D. F. Cy hamas tunnels took advantage of hospitals and hamas fighters have sheltered in those place but that is a responsibility to protect Health Facilities because not only do you have patients injured in i. D. S or i. S internally displaced people surrounding themselves around hospitals because they believe they admre safe spaces. I was in the region about 10 days ago and talked to family members. One person had lost 300 members of his extended family and another had lost 16 grandchildren and all were people i described to and these are gauze gazans who wants tobe a millionaire . Have been killed by military operations by and large. Another thing they described is when injured, not being able to have the comfort of knowing you can get the medical care you need, andeeine extreme because of the inadequacy of the health system. Its not just food we need to pump in, u. S. Aid funds, medical facility run by the International Medical corps that sees 600 patients a day. But compared to what the Health Infrastructure w able 7, we rece that is not remotely what is needed. So repairing Health Facilities, supplementing the partially operating facilities and ensuring that again, attacks on Health Facilities donthe remaih facilities can stay operational as long as this war continues. Talking about that, a lot of the worlds attention now is about what will happen next in rafah. Prime minister netanyahu sd he will have his military launch an attack on that city and President Biden said thats a red line for the United States. And uid runs a Field Hospital in rafah what would happen to that Field Hospital and ability to provide care to more than a Million People indeed goes ahead with what is its offensive in that city. Let me first give some sense why President Biden has taken the position he has. The humanitarian position has been very challenged f gaza witf disorganization at the outset to delays, a lack of prioritization, also in in. Finally, you have a again, i want to call it close to adequate but you at least have the flowucks now increasing compared to where we were a couple weeks ago. But the pipeline goes through rafah to the degree theres humanitarian infrastructure, it is in rafah. What President Biden is saying its not just rafah and what happens to the massive number of displaced and estimates range to 1. 7 million. Where will they go . Gaza city is not in the state and its unexploded ordinance throughout the towns. Where will people go but even if one could find them shelter, how does the operation work, the marines airdrop, and what goes through rafah, something starting in the north the last couple days but not to scale, that will not be enough to address the catastrophic hunger and health and needs people face. Administrator, given your work on genocide, obviously you heard people saying this is a genocide. Some of the usaid staff have confronted you over this, do you think critics are right to call wh gaza genocide . You can hear my comments up to this point. My focus is on saving as many lives16xb as we can and scaling these operations and that will continue to be m y rkure dealig with a violation of the human rights laws given what you were describing . At u s to get as much to build these pipelines and scale these pipelines, absolutely we have engaged the israelis on my trip including the Prime Minister and the defense minister and others about the threat to existed about how important is to improve compliance with International Humanitarian law as the president s beginning even if hamas is insinuating itself, even if hamas doesnt care about civilian life and has proven that again and again, it doesnt relieve the obligation of combatants to observe those principles and protect civilians and clearly more needso to be done. Obviously, usaid has been working and implementing programs throughout the existence and for the first time in 20 program hasnt been reauthorized by congress when it came up for authorization in september and it also doesnt look like the■ee really high. And i was wondering in terms of how that feels on the ground, have■ you had any difficulties n the countries because sort of like the soulmate theyre facing . Thank you for drawing attention to this. I think there was a lot of focus on the risk of the fiscal year and reauthorization and theres been less focus. People need to be focused on the importance of multiyear reauthorization. Everyone in the world is aware of american politics are polarized and i know from my travels over the last decade as we got more and more polarized domestically, there also was the sense of the few initiatives tht hadnt run aground because of our differences politically and now lo andehold, i feel really superstrong bipartisan support including some very prominent republicans, really across the republican spectrum you might say as well as support from democrats, reauthorization has not happened. I think the main effect is as i true whenever we show our divisions is allies wondering, ok, well, does this mean we should spend our money elsewhere and will it go the way of worthy initiatives and is it going to get the money it needs and not only the authorizations. We can continue to live by what was in the authorization in terms of how we divide our resources and where we make our investments and in a sense, treating the previous authorization as binding on us and our actions the c. D. C. And. But our allies are wopped ring, well, whats up and how viable is this long term . This is happening on the authorization, wt is going to happen on the appropriations . Were going to have a harder time mobilizing resources around this incredibly successful 25 million lives. The other place that i think it creates vulnerability is around innovation and getting the Scientific Community to in the r d needed to protect children, for example, from child to child transmissions and other challenges brought to bear but there will be a market for the investments they make now and there will be uptake down road and the fact reauthorization is up in the air makes innovators question them. Administrat Infectious Diseases, even though the pandemic has ebbed in many places were seeing outbreaks of dengai and cholera and measles around the world including at home. Obviously, some of these are being made worse change and dengai might happen in the southern United States. Can you talk about u. S. A. s work on the ground to help the local authorities contain this so it doesnt spread further and eventually into the United States . Thank you very much for the question. Let me just say i benefit enormously from the leadership of atule, and you know his writings on Public Health and our lead at health aid and he has chosen Public Service and helped us with■ outbreak respone teams and we always had Disaster Assistance Response Teams that go in when theres a volcano or flood or war and now what■0 we have because Climate Change is bringing about much greater prevalence, all flooding of brakis diseases that flow from that, including cholera, we need to be quicker out to the field. We cant reinvent the wheel each time and need to have standing capacity and so with the growing number of cholera out■tbreaks, r structures here, weve had to work also to improve vaccination rates which are going to be an incredibly important part of the solution as well. So were trying to keep up. I will say we have our supplemental pending before congress thats refeed many as the ukraine, israel, taiwan supplemental and is a bit after misnomer because nearly half of to humanitarian Emergency Assistance budget to the world is caught up in that legislation as well. And just as any one of us why io important for the people of gaza or the people of ukraine, for their very existence here, it is also very■ important to be able to do Emergency Response when people are suffering outbreaks, combining our publicy with our y response machinery. I want to also talk about something thats slightly more hopeful since we talked crises d a few months ago you announced an initiative against lead poisoning. We hear a lot about the danger of lead pipes but we know that abroad children are still widely exposedded to leadoffing to developmental disorders and int. How are youla lead poisoning abroad because its affecting children so broadly. If anyone is on their phone or not listening or feels its repeated, things youve heard before, i promise you that you havent heard it before, lead, kids in developing countries, one or two of them have elevated levels of lead in their blood. This is really crazy in 2024. Globally the collective has been is getting rid of paint in spices and batteries reused, the global spent is 15 million annually. So usaid, we have misses in 80 countries, 51 of the countries were working has emerged and weve come to be aware 51 do not have even regulations banning lead in paint. We have a playbook and weve used it and its not perfect in this country as President Biden is definite in getting rid of residual lead in pipes and the 50 million being invested through the bipartisan infrastructure bill but globally, spices, paint, toys, the kid goes to school and p ha, next thing you know theres lead in their blood and no amount of lead in ones blood that is safe and we know that here and thats true globally. This is the unaddressed Global Health challenge and you mentioned the very beginning this i. Low hanging fruit. Eradicating lead from developing countries will take a little bit of time, not that much time but we think just within a few years we can get5j rid of lead in any new paint being brought online and in spices for just 30 million. Were just doubling thatagain, u some context of big diseases like h. I. V. To spend there, tends to be globally 10 million a year. If you could actually deal with an issue that is not only holding kids back, things we attributed maybe to faulty curricula or upbringings that leave something to be desired may be attributable to lead and killing 1. 6 Million People a year as well, older people, and thats more than aids and malaria combined. So we have the chance with very modest resources to tackle this and need more measurement and need to apply the playbook and get governments excited about forcing those regulations and usaid has an Important Role to play, leveraging the health work we already do because somof thisred awareness to get in a much better place. Administrator, my last question is about an internal issue at usaid which was quite important for people working on Global Health about a year ago. Many of the people working at Global Health at us is aid are contractors and last year there was a major issue with one of the contractors and i know many of them brought their complaints to you but because theyre a contractor, theres not much you can do and affected their morale and work on some of the Global Health issue i was wondering, is there a solution to that, have you found a way to deal with it where people can continue to do their work without being worriedbotheh insurance and other things like that that they were complaining about a year ago . Well, let that the vast majority of people who work at usaid are some form of contractor and when i got to usaid i was surprised to hear that because our Front Service officers and our Civil Service officers, direct hire, are doing incredible work but usaid would not be the organization it is and would not do Emergency Response or do the Incredible Health and saving lives on lead and h. I. V. Without Institutional Support contractors and without personal ontractors. So equity among the people who constitute usaid is a huge priority and for the fir time we set up a second deputy position at usaid for management and reform along with programming and responding to haiti and sudan and everywhere else. With that we sought to look the at our contracting process. It cant just betract wins if it leaves our work force in abysmal work spaces. Youre right there are limits legal and otherwise and constraints and of course we have a respoibil fiscally responsible as well because we want to make sure we can do the most work possible out in the world. Lets just say degree of attention it hasnt had before and its long overdue. Thank so you much, administrator. Unfortunately, this is all we have time for you so much for bg available to talk to us today even though youre not able to join us here in person. So ase a lot of work going on with the response to the humanitarian situation in gaza and you heard difficulties. Weve seen so much Media Coverage about it but its very important to hear from someone who is having sort of like a front row seat at everything thats going on and who is trying to respond as much as possible to whats going on there. Hopefully successful initiatives on lead poisoning trying to get kids healthier all over the world so they dont have to face the challgeth poisoning or the presence of lead in their blood brings throughout all their lifetime. And that pepfar continues though there are challenges in congress to get it reauthorized for reasons we widely rout. Thanks for your attention and thank to you the administrator and would like to now welcome Senior Campaign editor to our panel for Health Care Issues on Campaign Strategies in 2024. Thank you so much. Good afternoon, im steve shepherd, Senior Campaign and elections at politico and we have plenty to dig into in our next panel which will connect health care and politics to the 2024 election. When you combine traditional Health Care Policy and covid and abortion in the Associated Press vote cast voter survey in 2020 in the last president ial election, slightly more than half of the voters show a health care topic as the most important issue to their vote four years ago. And health care is again poised to play a pivotal role this fall with the presidency and both chambers of congress firmly up for grabs. In our next panel, were going to discuss both the role health care will play in the 2024 campaign but also the messaging well hear from both parties and what voters think about the issues and what priorities they have when it comes to talking about health care and well talk about theow election on health n the next congress and a potential new administration. Before we get started we do have a poll question for the audience ■. ■[ether youre joining us onle or here in the room around us, you can record your responses through our online summit platform and well share the results towards the end of our discussion. We want to hear from you, if republicans do win control of the white house and both chambers of congress, will they again mount a significant effort to repeal the 2010 health care law, the Affordable Care act . You can answer yes or no. This is sort of a simple two option question. So please check that out. Im going to be joined onstage in just a moment by a great panel of guests. Ill slide this way. As they come out here. Ill introduce them one by one. Molly ann brody, the executive Vice President and chief operating officer at k. F. F. , formerly known ats kizer Family Foundation and head of the Public Research at k. F. F. And former president for the american assiasearch. Shanta chambers is president of Health Equity and Community Engagement at the National Patient foundation. I asked her backstage what that entails and she said it entails a lot of front porch and pound cake conversations with individual people. Dont think she brought the pound cake but well look forward to dessert later. Roger severino, Vice President the Heritage Foundation and former director for the office of civil rights at the department of health and Human Services in the burnett is a Hospital Physician and assistant professor of medicine at Columbia University Irving Medical Center and also has a popular tik im told with over 500,000 followers where he debunks medical information. Thank you all. And ill have a seat. Since were talking about the 2024 campaign, there were two markers for the unofficial start of President Bidens reelection effort, the state of the union and on saturday he released a new 60 second ad thats in the le in the state of the union we heard taking on big phrma and lowering drug prices on insulin and abortion rightsn the ad he hit former President Donald Trump taking away the right to choose and promised to make the roe v. Wade framework the law of the land again. Molly, i want to start with you. In every president ial election ive covered, voters for whom abortion was the most important issue voted overwhelmingly republican. I know youve looked into this in some of your data, what does it changed . How now and how has its just a huge difference. And like you for my three decade career, whenever we measured abortion voters in our surveys in the election, that energy was mostly on the republican, on the right, it was white evangelicals who really sought to overturn roe vs. Wade but it entily shifted and in our latest survey that came out last week found one in eight voters tell us abortion is the most important issue to their is disproportiony democrat, young, 28 of black women tell us that they are mair decision about on where the candidates stand on abortion. So the energy now as we head into the next election is on the left and for progressives. Its an important for the progressives and a coffin for those on the right and the republicans to think about the fact that they used to have a lot oft energy and mobilization on the abortion issue and they dont have it right now at the moment. Shanta, imious, obviously youre working sort of at the ground level and a little detached from politics but when you hear the president in the state of the union last week talk about Health Care Issues and other issues that sort of involve health care, what do you hear and what resonates with you and what do you find in your porch and pound cake conversations that doesnt land right for some folks . Its important to understand Health Begins and ends in community. The presen o begins in the community, in the environment, not in the four walls of the Health Care System. So i think its critically important when we talk about he of all of these other factors that impact health, life, housing, like economic stability, like healthy food options and addressing food deserts. All of these factors we dont tend to have in they s we have n were talking about health. However, the inability for any of these things not to be addressed such as trsportation,■ housing, food security, access and affordability, we have to understand the Immediate Impact that they have on ones ability to be able to Access Health care and be able to adhere to health care. To be able to adhere to health care. So itcrthink about health in the context of community and we look at how do we make sure that the community that people go back to can support themlps them have tt possible opportunity for Optimal Health based upon what that means for them. Mr. Shepard i want to get to a couple other news of the day items before we pivot a little bit in this conversation. Roger, we just heard my colleague press Kellyanne Conway for the secret republican Health Care Plan. The reality is you have written administration. Plan written f conservative. If President Biden wants to take our plan, he is more than welcome to. Mr. Shepard of course last night former President Trump clinched the number of delegates he would need to win the conventioncan you walk through e bit a little bit of what the plan, the project 2025 plan is . And then sort of, since were going to be talking about Public Opinion here, what and sell when it comes to voters and what they are looking for in changes. Because we all know how all the areas we have seen in ministration after administration, all the areas where president s push to try and change the law, Health Care Policy is probably the most difful it is one of the most difficult but also one of the most important. I agree with you that health care touches everybody. We have project run by the Heritage Foundation and 100 other organizations who said look, we have to have an agenda foe dent that will empower people to make their own choices. Project 2025 is made up of a bunch of folks, many of which served in the Trump Administration and others. I served at hhs. We learned a lot of lessons. You have to do a lot of the work at the front and. You do the policy development as much as possible at the front so you hit the ground running. So we published a book and you can see it we vented, tested the tires, see what you think. The Biden Administration ipayint 2025. We hope the other candidate is as well. What we propose is very different from President Biden. President biden really pushed on two things. Price controls come which leads to rationing of drugs, and abortion. That is it. That is his maiw we are going to fix americasaiw broken Health Care System. I dont think that is a winning message. Think back when it comes to federal law, elective abortion, how many statutes treat elective abortion is a health care right . Zero. Zero federal laws treat abortion as a health care right. The American People time and time again have said so long as it is going to be legal some ples, weont want the American Public to be paying for it. We dont want to force doctors and hospitals, especially religious< ones, to be forced to participate in abortion. This administration is against those protections. If that is bidens p and b, im not sure that is a winning message. Mr. Shepard even though voters say they are very concerned about the cost of health care, and people are generally supportive of abortion rights. And in a lot of the elections we have had, have consistently voted, even in red states, in favor of abortion rights. How much concern is there that■u some of the elements of what you have worked on might be a tough sell . Mr. Severino there is a lot of demagoguery on the issue. Postdobbs, were settling into a new status quo for the moment. It is very unlikely that there will be a National Protection for unborn life. It is probably not in the cards. All this attention on if there will be a national ban, i dont think that will happen. You states prolife protecting unborn life and saving babies. Lets not forget the untold number of babies you can see today, some of which are starting to take their first steps, because those states defend human life and the Supreme Court did the right thing in t■■whe dobbs decision. Lets not forget that side of the equation. On the other way, they are doubling down on abortion. National limitation or protection. What can the president do with executive power . We have seen biden try and put abortion everywhere he canral gd agencies, dod, the va. Hippa. President trump would undo all of those and reestablish the prolife positions he had before. Mr. Shepard i want to move onto other topics other than abortion. We only have about 10 minutes remaining. Obviously voters hear Different Things when they hear about health care. That has become increasingly clear even after dobbs. Whether it is affordability, for abortion. Shonta, i want to go back to you real quick. Have of americans dont know about the Biden Administrations efforts to reduce drug cost. Putting the policy implications aside, why do you think people dont know about these efforts . Why dont they either get more credit or more blame . I think ts so much message clutter and so much information coming at people. We also have to realize thatatit is top of mind for folks. What is top of mind our decisions around, do i pay my medicaon or my rent, or do i pay my light bill . Or yes, i am on a therapy that requires h diet, but there is not a Grocery Store within 30, 60 miles from eight. Or the fact that if i do have to go to a medical appointment i ae off of work. So i am losing income, but i am incurring an expense. These other things that are top of mind of everyday people. And so were asking them to try to decipher all of this message clutter when they are basically saying, look, why cant g we design a Health Care System that is just as beneficial and serves the people on florida avenue here in d. C. E support those oh side of chicago, the same way that we support those who may be low income in these other areas . Keep wanting to put the onus and the responsibility on people and patients. The onus is on us t decipher thiso. We have to design a system that people can understand, people can a afford. Mr. Shepard you can get into what people think about health care via■a social media. It is a problem we are also grappling within the political world when we are talking about misinformation. One of the things i am wondering, a colleague of mine wrote a book that was published this week on political misinformation and the efforts to kimgg to debuk that in the 2020 election particularly. Would you saysinformation in thu have been doing it since the start of the covid crisis, misinformation has become more prevalent, oeffortight itv are paying dividends, or a little bit of both . I definitely think it has gotten worse, in terms of not just covid misinformation, vaccine misinformation, but misinformation in general. Social media gives everyone an equal platform to talk about whatever they want to talk about, whether or not they are an expert. What i found during the pandemic, because they started in socia york city. I joined tiktok as an outlet to destress, and i found itas■j the biggest sense of stress. I was facing the reality of an actual pandemic in the h the ime had on my patience and my community. And then seeing tiktoks talking about how the pandemic is not re that mass are going to give you cancer and the cdc is corrupt. Workers have to tackle this headon. We are the ones on the front line of desperate a lot of Health Care Information from social media and it is a doubleedged sword. They can provide a lot of resources for people but it can provide a lot of avenues for misinformation to take off and it can impact peoples health. There is a lot of conspiracy theories that really do not impact mne. I ret care, i am a doctor. But the implications of medical misinformation impact my patients. Patients come in very sick with covid in refusing the vaccine because of something they found on tiktok or twitterg their health. That is why i am very passionate about trying to debunk it as best i can. Opinion and health care from that 30,000 foot view and try to get a representative sample rather than individual anecdotes. Im curious, what is the biggest challenge in polling on health care . Whethe iings that may or may noe true, whether it is peoples own personal because its a really complex issue and also such a personal one for people. Ms. Brodie i think health care is, as we talked about before, it is something about the heah and wellbeing of your loved ones. It is the most personal issue. And i think when we are polling about it, we need to understand that in a relationship between when people need to think about accessing health care and the health and wellbeing of the family. You were talking about the issue of affordability. One of the things that is so important to keep in mind is that when people are talking about their economic concerns or their inability to pay their bills, health care is a huge part of that. In fact, when we ask people that when you say the economy is poor, or you say you are worried about the economy or want to talk about the economy, why do you say that . Health care always comes up right up at the top, along with all the other prices of being able to afford food and gas. So this is something people are making choices on on a daytoday basis. And the policies that we are talking about are complex, and sometimes even whepassed, it tae before the benefits start accruing to people. Before you asked about drug ira made a number of very big changes to the Medicare Program and its actually going to affect the ability for seniors to get and pay for drugs. And that is one of their top issues, it is something they are most concerned about. And with drug pricing, those benefits have not started accruing yet. So the Biden Administration and congress is not necessarily adding credit for it because they dont know about these things. So i think there is an enormous opportunity for candidates across the entire spectrum to be talking about health careaffordg it seriously as a part of peoples economic concerns and a part of what they are most worried about for their families. It also really is an issue that women do care disproportionately. Its a winning conversation for everyone. Mr. Shepard roger, we only have a few minutes remaining, i want to pin you down on a letting round. I want to ask you a two part question. One, the most consequential thing for everyday people in the project 2025 Health Care Plan that President Trump or wh republican president is good accomplish Via Executive action, and then the most consequentialng accomplisha congressional action, in your view. Mr. Severino sure. Well, pricing and transparency could be done with a lot of executive action. The more we do with pricing and transparency, the more we empower patients to do their own health care decisions. Legislatively, Something Like savings account. If you allow people to have control ofhewn Health Care Dollars, they are the best consumers. They know where the best doctors are for the money they get. And if you can have them share in anyt savings, we are going to revolutionize the Health Care System. They both go handinhand. Mr. Shepard so not repea■jling the Affordable Care act . Mr. Severino no. Hssas would be the better route. Need to reform obamacare, especially the subsidy part. Mr. Shepard a couple minutes remaining. Shonta, when you look at the issues floating around in the election, what do you think would make the biggest difference in improving access . Ms. Chambers i always come back to affordability. The patients that we serve, one of the number one challenges they raise well, two things. Affordability and costofliving. The reality is they are really trying to balance these two things, and they are having to make costofliving decisions in the context of medical decisions, which all have an overall impact on quality of life. Mr. Shepard our question, i am going to go a little off topic and ask a little about tiktok, since he has 566,000 followers there. Obviously the house voted today, the vote could lead to tiktokmd states. I want to put the china part of it aside and ask you, both from user and the user experience, former president mike pence has called digital fentanyl. I am over 40o i dont have tiktok. Do you think the benefit to peoples health, especially young people, if it was not available . Dr. Burnett i think it is a slippery slope and there needs to be some sort of reform with all social media. But i think banning just one app is not going to solve anything because there are plenty of other apps. As much disinformation as i see on tiktok i see probably 10 times more on twitter. It is just going to move to another platform. So removing a source where people actually get a lot of information from is probably more detrimental than beneficial. Mr. Shepard unfortunately that is all the time we have here today. I want to thank all of you for joining. Really appreciate it. This has been hopefully a conversation that gives you an idea of where the public is on health care, both from that 30,000 foot level, and then also the kinds of conversations individuals are having, then a little bit on some of what republican plans might be if they were to win in■0 november, and how some of these Health Care Issues we are all talking about might change when we convene here again next year. Ito invite our next panel and our next host. Our future of Health Reporter aaronhoemer be moderating the next group. Thank you all. [applause] ms. Shoemaker hi, everyone. Part of what we have been discussing today is the delicate balance between reducing drug prices for americans and protecting innovation American Pharmaceutical Companies are l also be doing into the fdas accelerated approval process. Is it helping patients access lifesaving treatments faster, or is it permitting effective treatments onto the market . And finally on this panel, we ll expand on todays conversation around antiobesity drugs like ozempic. They are shown to be extremely effective for people with obesity but also expensive. Who should get access to those drugs, and should the government pay for them . First we want we have a poll for the audience could whether can record your response through our Online Platform here here is our question. Do you think it is more likely the Inflation Reduction Act will mainly, a, make drugs more affordable, or b, stifle research. You can record your responses now. Now i want to welcome our panelists. We have president and ceo of thh and manufacturers of america. And Oklahoma State medicaid director. Thank you so much for being here. Now i am going to set the stage a bit. During the state of the union, President Biden said he wants congress to expand the Inflation Reduction Act and allow medicare to negotiate prices for more prescription drugs pretty meanwhile the drug including pharma has filed lawsuits to stop the ira. Following the state of the union , pharmas president sandy ira ihis stifling lifesaving research. So what did he mean by that . Thank you for having me and thank you for the question. The way the Inflation Reduction Act is structured, one of the provisions says as soon as nine years after a product has been on the market, allowed to come in and set the price for those medicines. That is for small molecules. Sp, pills you get at■p the counter. For pills you get at a hospital you get 13 years. After passage of the ira we ask our company, what is the impact of a law like that . Where instead of having the length of your patent in order to be able to recoup your, when you have shortened the amount of time to just nine years, what is the impact of that . Companies have to consider how to place their research dollars. What we have seen is companies are saying we respond to incentives in the law and disincentives. It now creates a disincentive to do research into small molecules. Will some of this still happen . Of course. Y is if you think about cancer or oncology, they often launch in a small population for specific cancer first and then continue to do Research Even after approval for that medication. Often times trying to get approval for multiple different medications. But if you only have nine years to recoup the costs when price setting having to say, how long can i continue to do research into multiple indications if i know that a t year nine government is going to stop the price of the medicine . Our fear is that will inevitably stifle innovation. It will prohibit or limit companys ability to continue doing the kind of research that, candidly, people want and that as a society we absolutely need. Ms. Schumaker i have a question adjacent to this for you. Do you for see medicare drug price negotiations eventually feare they better off . Will the negotiations ultimately cover alzheimers drugs . One thing whao consider in the landscape of drugs and treatments for alzheimers patients is the fact that who has covered lly. We should be holding ourselves to that same standard. For over 60 years now, medicare has covered all treatments for those 65 and older regardless of whether they were accelerated approvals or traditional approvals. The fact is an accelerated approval is a traditional approval. And the payment for those treatments should follow that same standard that we have seen for all other diseases. Recently with the change in that policy, wheres ems made the choice to not cover for the First Time Ever in accelerated approval, it actually had the impact of not only impeding access to treatments for those who could benefit, but it also gave a signal to the private industry that they, too, should follow suit and not provide approval. The Alzheimers Association has been working with cms and private industry to an this, but it has been too slow in that process. And we need to consider that and the standard it sets moving forward. And we will get ms. Schumaker one quick followup for you. Do you find the research and development argument1 compelling or do you think pharmaceutical companies are still likely to innovate even if they have less profit . Dr. Pike i think there is certainly something to be said for a pathway to payment. Being able to see a pathway to payment create greater we know that its going to take all individuals, private sector, the public sector, government, in order to make sure that the Research Pipeline has the funding it needs. Of phrma, but also within the federal government and the Nonprofit Sector as well. Ms. Reilly can i just add one thing . At times people say, well, you are not going to start researching. Of course were s g research. But the law arguably picks winners and losers and changes incentives in terms of where dollars go. When Medicare Part was first enacted we saw a huge increase in r d for medicine to treat Older Americans because we suddenly had coverage for medicines to treaten changes soe incentives that were in place and puts the thumb on the scale against researc molecules, which candidly, we need as a society. Most people prefer to take a pill. And small medic youll medicines can cross the blood brain barrier. And for things like cancer you need to have that medic is him of action to do it. Will it mean all Research Stops . No. But doesnt change where Research Goes . Yes, i believe it will. Ms. Schumaker president b says he wants medicare to negotiate prices for more prescription drugs and reduce outofpocket spending for more of the programs beneficiaries. Is that an idea that could benefit oklahoma residents . It could. I can also talk about the have e Medicaid Program in general. If medicaid prices go down, then that could affect the fallback provision so that medicaid is currently responsible for costs for members duly served by medicare and medicaid. There is the potentially there■ could be a potential impact on if prices are going down thrgh rebates, inflationary Protection Measures and other costsaving measures, there might be less opportunity for supplemental rebates on the medicaid side. That could definitely impact medicaid statement. Ms. Schumaker another thing i want to touch on lori, biden criticized phrmas exorbitant prices and set americans would pay less than half as much for the same drugs if they lived in thethis could actually be for ay of you. Why are we paying such high prices for drugs . What is going on what is often misunderstood as it relates to our industry as a couple of things. One, when people look at the price they often pay at the pharmacy counter, especially before they have reached the deductible in their health plan, the price theyre paying is price, the nonnegotiated price, even though they have insurance. That is how our system works. If you walk into the hospital mstomorrow, you pay the negotiad rate before your insurance kicks in. If you go to the pharmacy counter, you are not getting the value of the negotiated benefit. Today on average, pharmaceutical companies retain about . 48 out of every dollar. . 52 is going somewhere elsethen the pharmacy benefit managers are middlemen owned by insurance companies. There is a lot of work that could be done that we have been advocating for along with patient groups, aarp and others, to say lets address that part of the system. The medicine, they dont manufacture the medicines, but somehow they are eating up almost half of the cost of a medicine. S look at that problem to bring costs down for patients. Because we are providing discounts. Often in excess of 50 . By those discounts are not making their way back to the patient. Ms. Schumaker is there more pharmaceutical companies could do . Ms. Reilly part of the problem is today three benefit managers nego u. S. Most are negotiating on behalf of five that are larger than most european countries. They have a lot ofevere if theyl company we dont want to cover your medicine unless you give us this amount of rebate, that is exactly what happens. So our leverage is quite small in relation to theirs. So we need either action from employers who say we have enough, we want lower prices and we want to see that passed on to employees, or we nee supply chain costs should not take up 50 . Ms. Schumaker one more question on this and then we move on. But this is such a big issue in this election. Will phrma take into account politicians positions■a on vaccines . Dr. Pike we look at any candidate where they are o■nsues bipartisan. There are bipartisan members of both president ial candidates a that have talked about doing something to address pdm middlemen and cheers issues. Ms. Schumaker the phrma pac has given 70 contributions to republicans, the highest s 2006. Is that a reaction to the ira . Certainly when bills like the ira pass, its tough, candidly, to support members who dont understand the need for research and develop we are doing. But there are other issues we can work with members on. Not every member is going to agree with us on every issue, but pbm reform can bringms. Sche accelerated approval track. The fdas accelerated approval process is meant to direct done existing treatment. But its a controversial process. Some have proven unsafe or ineffective or were just expensive. Joanne, one of the examples is the alzheimers drug which came with that hefty price tag of around 28,000 a year. Recently they said they will not keep produci that. Is this a failure of the accelerated approval process . Dr. Pike absolutely not. The accelerated approval procesd utilized in a way that has improved and saved lives over time. We know that in that process, certainly the science was reviewed. The fda made it a decision to give it accelerated approval been reached at that time. And since then, we ahve certainly have another approval within the marketplace that has gone on to traditional approval as well. The accelerated approval pathway has been renewed year after year and has certainly been utilized in order to continuemarketplace. When we know that we have a fatal disease, when we know that there needs to be treatment. And certainly we know that that first treatment is never going to be a cure or be perfect. But we have to make progress with each one, and that is what we are seeing. Ms. Schumaker are people on medicaid in oklahoma able to access alzheimers treatments . S yes, they are. If a drug is approved by the fda, medicaid that includes accd approval program. In oklahoma that itheres an aus with that. So we watch those. Process, it might come out at a high cost. So, understanding the value of getting a dg individuals who are suffering while also balancing that with the cost and the state budget, and thinking about how we can■crove that process from a reimbursement standpoint. Ms. Reilly cannot jump in . Often times we talk about but its in hear high cost, we ignore how much we are spending. We are spending 345 billion to care for people not even including caregiver costs which is another 340 billion. I use the example, my mother lost her life to als. She thankfully had nebraska medicaid and lived her life for seven years on medicaid. To the tune of about a quarter of a Million Dollars a year to care for her, to be on a ventilator, to have her on nursing care. It w not medicine cost but it was 250,000. If tomorrow someone invents a medicine that delays thenset of als, extends life, my guest is a will have a high cost because it treats a relatively small population. But how likely are the costs ine system that will be offset as a result of it . If we delay the all onset of alzheimers we can serve save 33 of the cost that we see today. So i think when we have this conversation, not to diminish cost, but we have to look at what we are spending in totality and recognize that medicines are often an offset to that. We saw that in the case of hepatitis c, when hepatitis c medicines were introduced we heard a lot about the price tag. Since 2013, in total, medicaid agencies have saved 15 billion and that takes into account the cost of the medicine. These debates are important, but lets have a full conversation about all the costs. Mr. Rains i would love to say, i agree generally with that statement. When would say is there is a reality in Government Regarding annual and biannual budgeting. We dont always have the luxury of the longterm financial gain. We are thinking on an annual basis. That is an issue that has to be solved for and i completely agree. Unfortunately payment models do not keep up with the science and technology. But that is an issue we need solutions for, absolutely. We also have a tendency to forget within the equation of cost the human factor. Talked about her mother. The fact is there are over 600 million americans living with all timers put these treatments benefit them at the earliest of the disease, where delaying the progression of it is the most meaningful. To not just them and their family and the time that they have to make more memories, but also to be productive. To continue to be le decisions. I think that is part of the cost equation that even in the caregiving cost, we do not have the ability to monetize productivity and the ability to still be an active member of society and within their life choices. Ms. Schumaker i want to make sure we make time for our last topic, and that is antiobesity drugs like ozempic. Weve talked about how expensive alzheimers drugs can be. Weve also talked about why price might not be the only factorwith drugs like ozempic, expensive, effective. Butfor these . Mr. Rains medicaid directors around the country are researching and looking at this and watching the states that have paved the way in coverage. So i will say right now, there are a few exceptions to the fda programs they have to cover. One of those is for weight loss. So its an Optional Service to add thbut there has been researe around, yes, cost is not the only factor but when you are dealing with the realities of a fiscal year at a state, we have to look at, it is not likely hepatitis c drugs where you are given a round of treatment, it is a high cost but it is curative. What we have seen from the research so far is some glue tides and others are more of a lifetimetype benefit, which comes to a high cost. We look at thatding that we know there is a high prevalence of obesity, specifically in the medicaid population. We know that comes with associated cost for heart strip hea, diabetes. But looking in the long term and he studies around that, and total cost of care. Even when you improve the conditions, total cost of care is still higher with pharmaceutical intervention. Ms. Schumaker one last followup and then we are getting to the end. I read an oped recently who made an argument that publicly funding antiobesity drugs would save the Health Care System in the long run. Is that a fair argument . Mr. Rains it is fair to say that. H care system, it is the workplace, it is a lot of other areas of our economy that it could impact. I wish there was an economical way to do■kt, to where the state budget could be introduced reimbursed and all those fun things we like to talk about. But that is not necessarily reality. Buwe defity the benefits. Ms. Schumaker that is all the time that we have for the session. I want to thank everybody in the audience, online, and our wonderful panelists. We have heard a lot about drug pricing ends so very different opinions, which i always appreciate. And i want to welcome kevin back to the stage to introduce our xt conversation. [applause] announcer earlier today house lawmakers met to examine a proposed rule for the Consumer Protection Financial Bureau to regulate payment apps and digital wallets. Watch the entire hearing tonight at 9 00 eastern on cspan, cspan now, or online at cspan. Org. Announcer cspans washington journal, a live forum involving you to discuss the latest issues in government, politics, and■ eb Public Policy from washington, d. C. And across the country. Coming up thursday morning, the nati concerns posed by tiktok and the latest efforts in congress to regulate it. Thenbook, about his hiring by te Trump Campaign to investigate election 2020 voter fraud claims. Cspans washington journal. Join in the conversation live at 7 00 eastern monday morning on cspan, cspan now, our free mobile app, or online at cspan. Org. Announcer since in partnership with the cable industry, cspan has provided complete coverage of the halls of congress. From the house and Senate Floors to congressional hearings, party briefings, and committee meetings. Cspan gives you a front■ row and decided. With no commentary, no interruptions, and completely unfiltered. Cspan, your unfiltered view of government. Announcer the house approved aa nationwide ban of the vio sharing app tiktok, if it chinabaseditste. More than 150 million americans use tiktok. Thlegislation now goes to the senate where the Associated Press writes, its prospects are unclear. Lawmakers contend that bytedan is beholden to the Chinese Government which could demand access to the data of tiktoks