Transcripts For CSPAN3 HHS Secretary Confirmation Hearing 20171202

Department of health and Human Services. While we hold a courtesy hearing on the nomination of the secretary, it finance committee receives his paperwork and will vote hon the nomination. Senator murray and i will each have an Opening Statement and then former secretary and governor of utah whom we welcome today. Mike, good to see you and have you back. And senator young, whos a member of this committee, will introduce him after mr. Azars testimony, senators will each have five minutes of questions. We already have a good turnout so i anticipate a good vigorous questioning period. Confirmed to leave the department of health and Human Services, youll be leading a 1. 11 trillion budget. That almost equals the totals of the Appropriations Bills that Congress Passes each year to Fund Everything from National Defense to national laboratories. Medicare and medicaid. Our nations government run Insurance Programs for it poor and elderly. Mental hilth health and Substance Abuse. The National Institutes of health, where, with francish collins excellent leadership, the leading efforts to discover a cure for alzheimers, a new treatments for cancer. The food and drugged a menstruation where scott leeb has gotten off to an excellent start, speeding up the approval of generic drugs and access to regenerative medicines. And kwoul rr be faced with sky rocketing premiums in the individual Health Insurance mark lt that are currently a nightmare for the americans that dont receive a government subsidy to help pay for their Health Insurance and you have an opportunity to lead what they call it most important piece of legislation last year. The 21st century cures act which members of this committee agreed upon and gave broad new powers of the fda and included the first Major Organization senator casty and murphy especially worked on that oof Mental Health programs in a decades a well as significant more funding for the Opioid Crisis. I believe youre an excellent nominee for this yaub. Youv ror been confirmed by the United States senate twice. Youve offered to meet with every member of this committee and have met and spoken with 15 members. Youve served in the judicial clerk as law clerk for Supreme Court justice scalia. You know the executive branch having been h had hs general counsel and deputy secretary for two years and you know the private sector. A decade at one of the countrys major pharmaceutical companies. So you know the system of how drugs get to the manufacturer to patients. With all of these perspectives, you should need no on the job training and be able to take advantage of this exciting time in Biomedical Research to speed safe drugs through the system to patients more rapidly. I see your broad experience as one of your principal assets. Experience in health care is an obvious asset for someone called upon to lead the most Important Health care agency. One reason the fda commissioners done so well so rapidly is he knows the agency. Having been Deputy Commissioner and he knows the private sector well, having worked in it. Similarly dr. Collins knowledge of nih and experience in the genome projelkt has made him an effective leader at the National Institutes of health. So im glad to know that you will have the experience you need. Health care costs and drug pricing are issues this committee has studied to find solutions. We plan to hold a third hearing on how the supply chain effects what patients pay on december 12 to hear from the national academies. I would welcome your input as we continue to kbamen the price patients pay when picking up their preskripgdss. Its much broader than Health Insurance and only about 6 of the insured americans purchase their insurance in the individual market. But that is where we have had had much of their debate and discussion. 9 million individual market dont qualify for a subsidy and theyre getting hammered by sky rocketing prices. Premiums have increased in four years and additional 58 for this coming year. Both congress and the administration need act to provide relief for these americans. Senator murray and i members of this committee worked on an agreement co sponsored by 11 other republicans and democrats which they say will prevent a 25 price increase by 2020 by pairing cost sharing subsidies, decreasing the federal dollars spent and as a result lower the deficit and give states the up thort to use the innovation waver to find other ways to lower premiums. Alaska created a Reinsurance Program and lowered premiums by 20 with no new federal spending. Yesterday the president said he supported the Alexander Murray agreement becoming law by the end of the year. It has so much tin that appeals to so Many Democrats and independents, riltser hard to imagine our not passing something by 2020 and offers states flexibility to further lower rates. The democratic leader called it a good compromise and said it has the support of all 48 democrats. In the chairman and tom perez tweeted last month, Alexander Murray has widespread bipartisan support. As secretary there are many other steps you can take to stabilize the markets, such as approving states inovashz wavers and incentivize younger and healthier individuals to purchase insurance. The Opioid Crisis is a priority for the president and every member of this committee. Were having a hearing on the state perspective on the Opioid Crisis tomorrow. Youll be coordinating a Department Wide effort to help combat the opioid drug abuse. Deaths in tennessee went up by 12 from 2015 to 2016. In addition, deaths related to fentanyl have dramatically increases from 169 in 2015 to 294 in 2016. Congress has passed legislation to streamline programs, provide funding on the frontlines of this crisis including the protecting our infant sack, the comp are ehencive adiction and are ecovery act and the 21st century cures act. Weve included althman 16 million in the fiscal appropriations bill to help address this greeing and tragic crisis. As you implement these laws, we want to hear what is or is not working. We stand ready to work with you if additional tools are needed. I hope you will join me in advising the president this is a bad idea. The federal government does not need a new czar. Once confirmed, you need be to the one to take charge leading the federal government response and letting us know how to help. Zeen exciting opportunity to implement the 21st century cures act. As we continue oversight hearings i hope youll work with us to take advantage all this law offers, inhadcluding proems Precision Medicine initiative, the Vice President s cancer moon shot and the brain initiative. Cures also gave you and the federal authority to hire the scientists they need to make sure these exciting advances are safe and effective for americans. We all thought that was a big priority. I hope we take full advantage of this exciting time in science. And the law we passed to help insurance the safety of compounded drugs. Also hope well continue to look at how to Lower Health Care costs including the costs patients pay for preskrapgds trugs and how to keep people had healthy. Thal arer have to authorize the pandemic which provides the authority to insure our nation is prepared for and able to respond to Public Health emergencies such as hurricanes, Infectious Diseases like zika and bio terror attacks and another important bill, the one focussed on animal drugs. The generic animal drug user fee act. I look forward to working with you on this and hearing more about your priorities today. Senator murray sfwlp thank you very much, chairman alexander and to all of our colleagues for being here today. Thank you. And your family for being here and your willing noosz serve. In november of 2016 people started emailing me and calling, coming up to me in the Grocery Store and everywhere else with tears in their eyes wondering what the future held, especially for their health care and it hasnt stopped and because these worries and challenges are what this congress and the department were discussing today is suppose ood be focussed on. Im going to start with a few examples of the stories ive been told over the last year. My constituent from Mercer Island is a fourtime cancer survivor. She would not be able to afford her medical expenses or even stay alive without Affordable Care act protections. Kim from ellensburg shared her story about her addiction to opioids and her ability to overcome it with the right comprehensive treatment. Christina from marysville said before going to planned parenthood, she struggled to get Birth Control regularly. Those are just a couple examples. There are many others and so many pressing Health Problems this administration could be solving but it appears instead of solving problems, the department of health and Human Services so far has been determined to create problems. The department has not attempted to help people get high quality affordable coverage. They made it harder by stopping payments for out of pocket cost reductions, letting insurers cover fewer benefits. By cutting this years open Enrollment Period and slashing funding for consumper out reach and a lot more. Rather than allowing women to make their own health care choices, the department has tried at every turn to impose rightwing ideology on women and prevent them from getting care from provider that they trust. President trump went to states like New Hampshire and ohio and said he would confront the Opioid Epidemic head on. People believe he would make sure hard hit communities get the resources that they need but this administration and its Health Department did the opposite, proposed gutting medicaid which provides critical wrap around services and Substance Use Disorder Treatment to people who otherwise kds not afford it. They say that would crippal response efforts and all it took was a meeting with a few pharmaceutical executives for President Trump to go dark on the sky rocketing costs of drugs despite the promises about bringing prices done. In fact, its hard to find a Health Care Problem the leadership at hhs has not only failed to address so far but actively made worse. The department has proposed using Public Health funds rather than prevent costly illness and disease down the road and utterly failed to see the urgency of the Public Health crisis that is still unfolding today in the u. S. And puerto rico virgin islands. The administration is even rolling back protections that prevent discrimination against people who have historically been denied equal access to health care. But the absolute last thing our nations Health Department should be spending time on is encouraging more discrimination in our Health Care System. You and i do have stark disagreements but your nomnation could be an opportunity to reset, to put aside the extreme politics actively endangering people nation wide and start focusing on the mission instead of President Trumps ideological agenda. People across the country would be far better off if you took this opportunity. But i have to say, with concern, that my review of your record leaves me with serious doubts that you will. As a pharmaceutical executive you raised drug prices year after year. Eli lilly is currently under investigation for working under your tenure with other Drug Companies to needlessly raise the price of insulen and you oppose efforts to lower drug prices. Youve also made the clear on questions of women was health. You side with ideology or science and rightwing politicians over women. Although conservative experts, governors and even members of congress have rejected President Trumps attempts to sabotage the Health Care System and jam trump care through you said this would have spiked premiums, undermined protections for people with preexisting conditions, gutted medicaid, cost 10s of millions their health care, defunded planned parenthood and more. You said it didnt go far enough. This leaves me very concerned about whether you would faithfully implement the bipartisan agreement that chairman alexander agreed with andside the become law. And despite the follow through on tacktling the Opioid Epidemic, it is deeply disappointing that yet another nominee for the role of secretary of health hasnt supported committing the new resources we need for this effort. So, mr. Azar, i worry about your professional history and statements that point to a continuation of some of the extreme damaging and political driven approaches weve seen so far from this administration. So let me just return briefly to the stories i mentioned at the beginning of my remarks to make my final point. Right now julie is travelling around the country raising awareness about open enrollment to help more people get access. Kim is pursuing a masters in social work and helping people in Central Washington get the necessary treatment and services so they can overcome their addiction. Christina has become a vocal advocate for helping women in washington and nation wide to get care that works for their needs. Julian, kim and christina are doing more than their part to keep our communities healthy and well, so my question is why isnt our nations Health Department doing the same . They should have a secretary of health who will work for and with patients and families, not against them. And committed to policies based on science and not ideology. Im looking forward to your thoughts on the many serious concerns ive raised and how you would be an appropriate choice for this position. Im concerned President Trump has yet sent us in an extreme ideological driven nominee to take off where secretary price left off and women, seniors and families deserve a lot better. So im interested in your responses today. I hope i am pleasantly surprised and i want to say if you are confirmed, i want it make it very clear i have not and will not let this administrations so far lower my expectations for any of the department this committee over sees and i will continue doing everything i can to hold hhs to the highest possible standards of ethics and service for people in my state and across the country. With that, thank you very much for being here and i will turn it back over. Well, now welcome the nominee, alex azar and your family and friends in attendance. Theres a pretty good group of them and you may want to nrbt deuce them when you begin. Mr. Azar will first be introduced by governor mike levt. He served as president george w. Bushs secretary of the department of health and Human Services from 2005 to 2009. He worked closely with mr. Azar then while he served as his deputy secretary. Then the nominee will be introduced by his home state senator, senator todd young. Governor levt, please put the deuce mr. Azar and welcome. Thank you, chairman alex abder and senator murray and members of the committee. They have very ably dejibed the complexity and the importance of this role. And therefore its my privilege to introduce and to unequivocally recommend alex azar. He is up to the task. He is supremely well qualified to carry out this important work. As mentioned during my service as secretary of hhs, mr. Azar was deputy secretary. In essence he was the chief operating officer of this very large and complex department. Prior to his service he served as the general counsel under secretary thompson who i believe later will also introduce and robustly recommend him to the finance kmilty as they consider his nomination. That plus his experience in the private sector thats been mentioned leads me to conclude that there may not have been a nominee to this office of secretary better prepared to hit the ground running than alex azar. It was mentioned that. Had h. S. Is a long and complex place. While deputy secretary, alex azar was essentially the manager of the day to day operations of 90,000 employees and 1. 1 trillion budget. Just a brief example that i think would illustrate his capability. President bush had had a management agenda that laid out a criteria of several dozen different objectives and then had a dashboard of green, yellow, red. Alex set an objective to have every criteria green and he was the first deputy secretary in the if had tire federal government to achieve that. He was also deligated oversight of much of the regulatory process in a very skillful and lawyerlylike way, he managed to carefully and equitably adjudicate the process, which is robust at hhs. He is a world class policy thinker. A good communicator. Youll see that today. I can assure you if he is confirmed as secretary you can expect good communication on both sides of the aisle. He is an experienced diplomat. Experienced i think is a word that will be underscored here. I have seen him under fire. 9 11 he was part of the response. There was a point in time when katrina pandemic influenza and the roll out of Medicare Part d was happening at the same time. This is a person with great experience in a complex department. Most important can i just say hes an extraordinarily good human being. Hes rush got the kind of compassionate heart i believe it requires to lead the mission of this Important Department and i commend him to you and urge the senates conformation of the secretary of health and Human Services. Thank you for joining us again as you have before to help this committee. Senator young. Well, thank you, chairman alexander and fellow members of this committee, im grateful for this opportunity to introduce a fellow hoosier, alex azar, to be secretary. President trump made an outstanding choice in selecting alex to lead this Critical Agency which happens to be the largest civilian Cabinet Agency in the entire u. S. Government. Alex is, as has been said now by a couple of individuals, an extremely qualified nominee and hes a well known expert in the health care industry. His previous leadership experience, both as general counsel and deputy secretary of hhs and as president of indiana based lilly if corporated, lilly u. S. A. , which is the largest affiliate of one of the Largest Health Care Companies in the world will collective wlae be an effective combination as we work to solve our nations most Significant Health care challenges. Former h. H. S. Secretary Tommy Thompson said hes one of the most competent people i know an experienced leader with deep substantive health care knowledge. I agree. In addition to his impressive academic record which includes degrees from dartmouth and yale, he also clerked for the late Supreme Court justice, antonin scalia. He first Began Service in 2001 when the United States Senate Confirmed him to serve as the department pft general counsel. Since then alex has been a leading voice on health care reform, Health Care Innovation kw an as a and saying patients are paying to rr much. If anyone can help solve this problem, its alex azar. Hes the right person to help reform our broken Health Care System. And to insure the department succeeds in its mission to enhance and protect the well being of the American People. Alex was confirmed to both of his previous positions with unanimous bipartisan support. Confirmed twice by the United States senate for positions at hhs with unanimous bipartisan support. And im hopeful this time will be no different. I know hes a good man with a flart service. Gotten to know him personally over the years. I look fortwoord supporting his nomination and working together to insure all americans have access to high quality and Affordable Care. Thank you, mr. Chairman sdplp thank you, senator young. Mr. Azar, we now welcome you to give your opening remarks. Your full statement will bow incorporated into the record. If i could take just a second to introduced my family ive got here today. Im pleased to be joined by my wife jennifer, my daughter claire, my father dr. Alex azaar as with elas my sister stacey and her family. Unfortunately my mother linda and most tragically my step mother wilma died of cancer just in july. Im sad she could not be here for this moment. Having an opportunity for this does not happen without the support of family and their guidance. So thank you, mr. Chairman, Ranking Member murray, members of the committee to appear before you today as the president s nominee to bow the secretary of health and Human Services. Senator young and governor levt, thank you for those extremely kind words, your friendship, your mentoring over the years. I also thank President Trump for the confidence hes bestowed on me in nominating for this position. 97 years ago my grandfather, an impoverished teenager who spoke no english, stepped out on the ss argentina, completing his long journey from lebanon to america. As he entered the receiving hall at ellis island, he met an individual at a military uniform. That person possessed the power to admit him or send him back to poverty and uncertainty. That person was a member of the United States Public Health service. It is a testament to all that i love about this country that just 97 years after my grandfather went through his sixsecond physical on ellis island with no discernible prospects other than the religious freedom that america offers, his grandson might be charge of that very health service. The mission of h. H. S. Is to enhance and protect the health and well being of all americans. Through programs that touch every single american in some way every single day. We are at an historic time on delivering on that mission through innovation. Through its outstanding leaders and career staff, hhs is primed to meet that challenge. This task is humbling. Marshaling and leading the incredible resources of that department require innovating, never being satisfied with the status quo and anticipating and preparing for the future. I think i gained these skills in the dark days after 9 11 as we faced the health and human consequences of those attacks and preparedness for potential future, further biological chemical raidiaological or nuclear attacks. In the implementation of our completely novel drug benefit for seniors, by 4e7ing to build global, national and state pandemic u in our response to threats such as sars and monkey pox and make them as modern, responsive and empowering for the individuals and families we serve. Through innovation in the private sector. To bring life improving therapies to our people and people of the world and in harnessing the power to make us more efficient and capable of service our fellow amaircons. It is often difficult to prioriti prioritize. Nonetheless, should i be confirmed i do envision focusing my personal efforts in four critical areas. First, drug prices are too high. The president has made this clear, so have i. Through my experience helping to implement part d and with my Extensive Knowledge of how insurance, manufacturers, pharmacy and drug programs Work Together i believe i can bring the skills and experiences to the table to help had us address these issues while still encouraging discovery. Second, we must make health care more affordable, available and ta lrd to what individuals want and need in their care. Al premiums have been sky rocketing year after year. We must address these challenges for those that have Insurance Coverage or those left out by the Affordable Care act. Third, we must arness the power of medicaid to shift the focus on our Health Care System from paying for procedures and sickness for paying for health and outcomes. We can better challenge and leverage what is best enour programs and in the private, competitive market place to insure the individual patient is it sebter of Decision Making and his or her needs are boeing bhet Greater Transparency and accountability. Finally we must tackthal scourge of the Opioid Epidemic destroying so many individuals, families and communities. We need aggressive prevaengz and enforcement efforts to stop over prescribing and over use of these legal and Illegal Drugs and we need compassionate treatment for those suffering from dependence and addiction. These are serious challenges that require a serious minded sense of purpose and if confirmed i will work with the superb team to deliver great results. I thank President Trump for this opportunity to serve the American People and i thank you for your consideration of my nomination. Thank you, and ill begin. Im going to ask one question and id like to reserve two minutes at the end. During the nomination process for the secretary of agriculture, there are concerns about his close ties to the agriculture industry. He had been a farmer. During dr. Got leebs confirmation where he would approve moving treatments and cures through that agency, there was concern because he had work would pharmaceutical companies. Now youve irk worked with a Major Pharmaceutical Company. My own view is thats enough. Because having such familiarator with drug pricing is somebody who didnt know much about it, by the time they came in, theyd be gone before they figured out 5 mer. What do you sthie skeptics who criticize you for that . Especially those who question the increase in insulin prices while you were at a leader at eli lilly over that 10year period . Thank you for that question. I had the honor of serving in Senior Leadership there. So if i were confirmed, this is returning home. This is my place that i want to be. After hhs i did spend 10 years at lilly where i was the president of the u. S. Affiliate directly leading the sales and marketing of all nondiabetes, nononcology drugs in the United States. As the geographic leader i also supported operations for those other business units. I do believe, as the chairman mentioned that these public and private sector experiences do prepare me very fwrel the role of secretary. I think this is especially true in the case of drug prices. In particular the product that you mentioned, insulin. The Current System may meet the needs of many stake holders but that system is not working for the patients that have to pay out of pocket and we have to recognize that impact. Thats why the president , so many members of this committee on a bipartisan basis and i have talked about the feed to fix this system. I do think in my experiences with lilly in the private sector, understanding how the channel sees these issues. How manufacturers, payers, pharmacy benefit managers, distributors all Work Together, how the money flows in that. I believe i can hit the ground running to identify you and others for solutions here. Ill reserve the balance of my time. Senator murray . I think cost of high drug sz something i hear about more than anything else. It effects so many people in a negative way and im assuming you agree with the overwhelming majority of americans that costs are too high. Do you agree that congress and administrative actions are needed . I absolutely do, senator murray, thank you. You were president of a Major Pharmaceutical Company with it got worse, if slen was mentioned. Tell us how you would approach this as secretary . So, thank you, senator murray and i appreciate the chance we to sit down together. And in terms of your opening i hope i can earn your trust and will show you that this is the job of a lifetime for me and i would approach this not for any past affiliation, industry but to serve all americans to improve their health and well being. Appreciate that. I think there are constructive things we can do. But id also like to hear ideas from the committee, people at hhs, elsewhere. But let me throw a couple of things out. We need increase generic and branded competition. The more we get to to the market, it more competition we will have. That can help bring down costs to the system. We have to fight the system of gaming of the patent systems. When i was general counsel of hhs i actually led an effort to get rid of filing multiple patents to delay, delay, delay. It saved 34 billion over 10 years for the efforts we pushed. I think we need to look at why are americans paying more than those in europe and japan and is that fair were bearing the cost of other industrialized nations im running out of time. The skepticism comes from you were in the world of pharmaceuticals and prices didnt drop. How are you going to do as secretary. We can talk about that as later. The fox guarding the hen house is what i hear. So theres a lot of skepticism you will do it from within the agency when you stated before you dont think government should be part of the problem although you just said something different. I wanted to particularly ask a question about womens heths because so far under President Trumps leadership and former secretary price a fb of detrimental steps were taken including a pointing multiple extreme antichoice idea logs, underlining title 10, prevention programs and critically rolling back protections for women to have full coverage for Birth Control from their Insurance Plans. If confirmed will you commit to putting science and access to Health Care First rather than ideology and extremism . So, senator murray as we discussed in your office, if i am secretary im the secretary for all americans im there to protect and enhance the health and well being of all americans. I would faithfully implement those programs. We may differ in how those get implemented but i firmly believe in following evidence and science where it will take us in running the programs. Do you believe that all women should have access to the health care their doctor recommends for them . Yes or no . If its the conscience exception that hhs has come out with, i do believe we have to balance of course a womans choice of insurance that she would want with the conscience of employers and others and thats a balance. Thats American Values and its a very small group. The womans doctor recommends but you believe the employer has precedents . In terms of insurance. To force those very few, i believe its less than 200 have come forward. Very few employers that would be impacted by the conscience exception to respect frankly their rights as well as respecting womens access through the insurance. I disagree. I think womens access to health care their doctor requires for them should take precedence. Let me go to a critical question both senator alexander and i both raised. Will you dmiet implementing as intended and working with us to improve further accessible cover frj patients . Absolutely. I know some people today are claiming the bill we designed will fix other problems being proposed. Do you think the cost sharing production payments will be sufficient to make up for chaos if other tax cut proposals are passed . I think the work of this committee on a bipartisan basis is a wonderful model for addressing it. Recognizes there are problems with the Affordable Care act, its implementation. Their there are going to be some new authorities in the package that youre talking about. Those will be useful. But i do want to caution i dont believe it is a longterm solution to problems that there just inherent in the Affordable Care act and i think we still need to work to address in 2ur78s of getting to affordable insurance, choice of insurance, that insurance delivering real access to health care for people so not just a card but actual access and the insurance that lets the people get what they want and not what were telling them from the sebter. I think its an important stop gap to help along that way. I have a lot more questions but im way over time. Thank you senator murray. Senator paul. I dont think most americans like people who acumulate wealth. So if you ask americans sam walton built this great store and became very wealthy, most people dont think he somehow abused the system. I dont think americans have the same big warm fuzzy feeling for big farmau. I think many perceive they use their might to manipulate the system. Theyre using government to maximize their profits. Do you acknowledge the under the Current System, big farmau uses their cloud to manipulate the patent system to increase drug prices . There are clearly abuses senator in the system and thats why one of the steps i mentioned to senator murray i believe we have to go after is, is the gaming of that. I have always believe we have a haks waxman regime. It gives inovators the time period to sell the product but then there should be a moment when there should be full generic competition and thats a gift to the system and patients. But this is a huge problem thats been going fron decades. Weve had insulin since the 20s. 50 60 years or more with production and we have no generics. So everybody says theyre going to fix it but i tend to be a doubter because these problems go on and on and on. When you look at the drug problems, one of the things people proposed is it to allow us to buy drugs from europe, canada, mexico or australia. In fact this was the president s position when he said awill bring more options to consumers. Weve had legislation on this. Weve passed it several times and yet it never happens. Youve taken a position against reimportation. I have before publicly stated a position of unsafe deportation and the president has said the same. Reliable and safe. Do you think the drugs they use in the European Union are unsafe . We have had a succession of democratic and republican fda commissioners unable to certify under the law you would have to sit for and say that the European Union has unsafe drugs and it would be unsafe to buy drug flumz European Union or canada . Its been going on year after year after year. And people say were going to fix the drug problem and it never happens but what i think is important is this isnt capitalism. Walmart is capitalism. Bill gates is capitalism. Its not their fault even. Theyre just trying to maximize their profit by using government but were letting them do it. So you get an epi pen, you have it for 20 years, manipulate one thing in the spring and all the sudden another five years and another five years. So one of the things we could do is if you have a patent on the epi pen for 20 years, you get. If you make it better, you get a patent on the new, but we can have generics on the oiled and why dont we have generic insulin . But its going to take somebody who really believes it. I told you you have some convincing to make me believe youre going to represent the American People and not big farmau and im sure thats insulting and i dont pleen tootoo be but we all have our doubts because they manipulate the system to keep prices high. And weechb rr got to fix it and cant tempedly go at it it. You need to convince those of us who are skeptical youll be part of fixing 2 and wont be beholden to big farmau. As i said to you yesterday that issue of product with a modification on manufacturing process or delivery device. I completely agree with you. I think thats one of the important avenues we should be pursuing because there should be a time certain when competition begins and you shouldnt be able to simply make a change and evergreen your patent. On the drug reimportation, were going to give you a question to think about in writing. What i want you to tell me is why the drugs are not safe in the European Union and how you would make it safe. If theres a restriction that says we have to go through a committee, im fine with that. Needs to be expedited, happening. Everybody just says its not safe and we never do it. Thats bs and the American People think its bs. Could we have some rules . Yes. We just say its unsafe and so youre going to have to convince me youre at least open to the idea. The president is. If youre open to it and not just say its unsafe. Will say this is how i would do it and this is how i would make it safe, thats an honest reform. If you cant do that, i cant support you. So i hope youll come back with an answer that says this is how id make it safe. Thank you. Thank you, senator paul. Thank you, mr. Chairman. And i just following on my colleagues comments. Another option would be to figure out how to make our prices the same as the prices in these other places so people didnt have to go through the contorgz of importing from overseas. I want to congratulate you on your oappointment and willingness to serve in these difficult times. When president clinton left the white house, he left behind a projected 5. 6 billion surplus and thats what he gave to president bush. And then we fought two wars and we didnt pay for those wars, we enacted Medicare Part d, can youve mentioned a couple of times which was not paid for and then we had had had the worst recession since the Great Depression and when president obama became president , we had a 1. 5 trillion deficit. When he came to office. President trump ran for office and this is the one thing i would say he was consistent on in his primary. In the Republican Party nominated him and the American People elected him and izhad promises were these. He would eliminate our debt over a period of eight years, he would deliver a jienlt, beautiful maxive tax cut, he would pass quote one of the largest inhad creases in National Defense spending in American History while also saying quote im not going to touch Social Security and im not going to touch medicare and medicaid. Those are the solemn promises. In the nine years ive been here this congress has disgraced itself year after year by not passing a budget, by not being able to establish a set of priorities to the American People and we sit here today collecting 18 of our gdp in revenue and spending 21 of our gdp in expenditures. And on the floor this week disgracefully is a tax bill that would reduce that 18 to an even lower number, below at least a 1. 5 trillion additional deficit in our balance sheet. And as much as 2. 5 trillion. The concern that a lot of people have in my state is that after this incredibly unpopular tax cut is jammed through with no hearing that the administration is then going to break the president s promise to not touch medicare and medicaid and instead exploit the deficits that republican majority has created in the time that george bush was president and now in the time that donald trump is president to go after medicare and medicaid and i wonder if you could assure this committee that the president , through you, is the head of hhs, will honor the promises he made on the campaign trail to make sure that hes not go toing to cut medicare and medicaid which is what he said and i apologize for the long wind up but the history has been forgotten by my colleagues and i think its important. Thank you, senator and its a pleasure to see you and a plesher to meet with you yesterday. As i mentioned in my opening remarks, the third of those four areas i really want to focus on is about strengthening our Medicare Program because theres so much mistake, fraud, waste abuse in the program, inhad efficiency in how we pay for Health Care Procedures and sickness. 23 we can tackle that and move to a more value driven system of health care ux well do two things, one of sickness. If we can tackle this, we will stretch out the resources and keep the solvency longer as we face the baby boom generations. It will serve as a catalyst for the Healthcare System and free ride et cetera. I think its an opportunity and the president is committed making it efficient and possible for the people that we serve. I hope we can do that in a way that isnt affected by the idiotic politics of healthcare we have had for the last 10 years in this place. I completely agree incentives and disincentives are miss aligned. We need to align them. It is also true the reason were paying one dollar in for every three dollars were consuming in medicare is largely because of Medicare Part d which was not paid for when enacted by this congress under president bush and the drug prices, a double whammy. My concern, a fiscal concern for some reason i dont think is shared today by my colleagues on the other side of the aisle, im concerned beneficiaries in my state are going to pay a price for the effectlessness of washington, d. C. I dont think thats fair. Its a shared understanding of the facts. Senator collins. Thank you, mr. Chairman. Mr. Azar, i very much enjoyed our discussion in my office on drug pricing, an issue that is very important to all of us, as you can see. I want to follow up on a couple of issues. There was a recent nbc investigation that found that a wide variety of Prescription Drugs on certain Insurance Plans were actually less expensive when the consumer paid out of pocket. Than if the consumer used his or her Insurance Plan. An example of that was a customer who had a copay of 43 for a common cholesterol drug, where if she had not used her insurance she would have paid less than half of that, 19. I then met with a group of pharmacists in the state of maine. I was outraged to learn that they were under gag orders that prohibit them from informing their customers that there is this differential in price. That theyd be better off not using their insurance and paying outofpocket. Do you support prohibiting those kinds of agreements that prevent a pharmacist from giving true transparency on the drug pricing to their customers . Senator, first, again, thank you for the meeting, i really enjoyed our discussion. How can you not hear about that and have your jaw drop . Honestly . How can you not just find that frightening that that could go on . Yes. Those are the types of issues across the entire channel in Drug Distribution and payment that i want to bring the expertise i have to the table and work with you and others in hhs to try to resolve. That shouldnt be happening and many other things shouldnt be happening in the channel and how that system works. I think we can Work Together to come up with solutions to help patients when they walk in the pharmacy pay as little as possible. That absolutely should be our goal. I cant tell you how frustrated these pharmacists were that they werent able to get that information to their customers they knew were struggling to pay and a high copay. A second issue i want to explore with you today has to do with the investigation that the Senate Aging Committee undertook into sudden price spikes in off patent drugs. We found that the risk valuation and mitigation strategies or the rimm system, which were intended to manage drugs with increased risk factors were instead being abused by certain Drug Companies to block potential competitors from accessing a sufficient amount of the drug once the patent has expired, to do the bioequivalency exams that the fda requires. Ive had extensive discussions with fda officials about this. Dr. Janet woodcock testified that the fda has referred 150 cases of potential anticompetitive behavior to the ftc, the ftc claims it doesnt really have enough authority. The new fda commissioner has suggested there could be opportunities where the fda could partner strategically with medicare to prevent the deliberate blocking of generic competitors. From your perspective, how can we address this issue . Senator, i am aware of that issue also as one of the abuses that occur out there, to prevent full generic competition in the market and i would look forward to working with you and dr. Gottlieb to get to real solutions, how rims programs could be abused to block entry and once we get to the end of life, should be looking at do they continue to make sense . Are they legacies . Are they still required for safety, once we achieve the potential for generic status. There may be statutory changes needed, i do not know but i think we need to solve that. Thats one of the things that has to be solved. Thank you very much. When you referred to the end of life, you mean the end of patent life. The end of patent life, thank you for clarifying that for me. Thank you, senator collins. Senator, warren. Thank you, mr. Chairman. Mr. Azar, ill get right to the point. Your resume reads like a howto manual for profiting from Government Service. About a decade ago you worked in government helping regulate the nations most profitable Drug Companies. When you left, you went straight through the revolving door and became an executive at eli lilly company. Last year, they paid you about 3. 5 million for doing that. Not bad. Now, you want to go back through the revolving door and once again regulate the same Drug Companies, at least do it until you decide to go through the revolving door again. Now, i dont think private sector experience should disqualify anyone from serving but i think the American People have a right to know the person running hhs is looking out for them and not for their own bank account or for the profitability of their former and maybe future employers. I have some questions along that line. The first is, do you agree when a drug company lies about its products or defrauds taxpayers it should be held accountable by the federal government. Of course. Good. Because right before you went to work for eli lilly, you worked at hhs while they helped the Justice Department with an investigation of eli lillys drug xyprexa, approved by the fda to treat schizophrenia and bipolar disorder. But eli lilly decided to boost its profits by pushing the drug on Nursing Homes for uses like dementia and alzheimers with no proof that it would work. The word for that is fraud. And it cost the government and taxpayers billions of dollars. Eli lilly was still under investigation when you left Government Service and went straight to work for eli lilly. As the companys top spokesman you helped manage the fallout in 2009 when the company was forced to pay the largest fine ever imposed in a prosecution like this, more than half a billion dollars. At that time, eli lillys ceo said quote doing the right thing is nonnegotiable at eli lilly. Do you think that settlement represented adequate accountability for lie lilys criminal behavior . Senator, i want to be really clear the conduct in that case occurred and ended long before i ever even left the government or thought about going to lilly. I was never in that case when i was in the government. I think i learned about the investigation when it had been in the media, i learned about it when i was interviewing and wanted to do my own inquiring. You became the spokesman for eli lilly. I will tell you the conduct that occurred there was unacceptable. Theres not a leader at lil lil that would say that. It was a massive transformational experience for lilly. Was the settlement adequate accountability for their behavior. As you said, it was the largest i think for about a week and then another company had one. Do you think it was adequate, thats my question . It was certainly the largest ever. What i will tell you was it adequate . All right. Senator, what was important about that was that it changed behaviors. Im sorry. What is important is the question im asking whether or not there was adequate accountability. I do believe so. I dont have any reason to believe it was not. I dont believe there was adequate accountability. They made billions of dollars off this scheme and paid a half a billion dollars fine. They said thats a huge fine and it is a huge fine and they made far more money than they paid out. For me, thats not adequate accountability. Your ceo got to keep sleeping in his own bed at night. At the end of that year he was paid 1. 5 million for his troubles and another 3. 6 billion in socalled performance bonuses. I think the message was clear to other Drug Companies. Within eight months pfizer was caught doing the same kind of marketing and slapped with a criminal fine for more than a billion dollars. Since then there have been four more drug company settlements in excess of a billion dollars. These settlements have become a cost of doing business for the Drug Companies. As we speak, eli lilly is the subject of multiple lawsuits and investigations, accusing the company of conspiring to illegally raise its prices of its insulin products. But were supposed to believe that this time around, youre going to be willing to hold them accountable in way thats going to make a difference. Let me ask you, do you think that the ceos like John Lechleiter should be held personally accountable when Drug Companies like eli lilly break the law . Senator, there was a there was a period of time, where across the pharmaceutical industry there were various practices that then got resolved through litigation. What im actually quite proud of is the fact i was not there as general counsel, did not negotiate the settlement of that case, but the attitude that i saw top to bottom globally at the company around that was one of how do we make sure this doesnt happen again . How do we insure that the processes, the culture, efforts, oversight. Im out of time and i understand that im out of time. I just want to make it clear for the record, i asked the question about whether or not you think ceos ought to be held accountable when the companies they are running break the law. Im just trying to get a little accountability answer. If you have a yes or no answer, ill take it . Im satisfied with our discussion, thank you. Ill take that as a no, you would not hold them accountable. Thank you, senator warren. Senator cassidy has stepped out. Senator young. Thank you, chairman. Mr. Azar, youve been caricatured by some as a predatory avoricious big pharmacy representative. I would like to give you time to talk about thats opposed to an extended speech. Could you talk about the drug pricing issues. Thank you for that. Back in the Bush Administration when i was general counsel, there was a very clear abuse occurring where pharmaceutical companies were taking advantage of a loophole in the drug laws to allow them to have longer longer patent periods. What they would do is they would get to the end, they would file a new patent and then get another extension. What i said to our legal team was this is unacceptable, nobody has ever thought of a way to deal with this without legislation. Let us see, can we interpret the statute in a way that prevents that and drove that drove that drove that. We actually got to the point where we put out a rule that allowed only a single whats called a 30 month stay in litigation, basically, you got one shot at the apple instead of these multiple four or five that could cause a drug to last for years and years, longer. When we put that rulemaking out the Economic Impact of that rule was estimated to save consumers 34 billion over 10 years. That rule was later enshrined through the leadership of senator mccain into statute in the medicare modernization act. Id just like you to repeat that for a second for those who may not be paying attention and who may want to fuel a false narrative of that youre not sensitive to drug pricing. You catalyzed a process by recognizing an anomaly in the law that led to a regulatory change that saved how many billions for consumers in Prescription Drug prices . 34 billion over 10 years. Okay. My constituents will be happy to know that. Thank you. Mr. Azar, you participated last year in a symposium at the manhattan institute. Do you recall that . I do, yes. At that symposium, you stated were on the cusp of a golden age of pharmaceutical breakthroughs, but the problem is our outdated system for paying for Prescription Drugs is threatening to squelch Patient Access to this recent and innovative revolution by putting it on patients. A lot of hoosiers paid for their drugs through savings accounts. Is there something we can do with hsas or other think for health an drug costs . I think there is actually. When you have a high dibble plan, 2, 3, 4, 5, 6,000 you have to pay outofpocket before the insurance starts paying, the law says that the plan cant cover during that period of dibble unless its something is a preventive service. But the government hasnt put out really good guidelines about what can be covered as Preventive Services so that patients could have first dollar coverage in that deductible period, so that their Health Savings account could cover those Preventive Services and also changes that would allow more money to be put away into Health Savings account, more flexibility for use, anything that lets the patient have access to more money or lower copays when they walk into the pharmacy i think has to be part of what we drive towards. I asked about your past professional drug costs where you catalyzed a process to lower drug costs and i asked you about ideas, a narrow issue of Health Savings accounts and you put forward an idea to help the cost burden on consumers. Im encouraged by that and i hope others are as well. I have roughly 40 seconds left. Ill note President Trump indicated welfare reform is a priority moving forward and a priority of mine. Much of the categories that fall under welfare reform are under the jurisdiction of hhs. I will look forward and submit a question for the record to you, i want to see what sort of changes you anticipate hhs making through executive order as the administration is pursuing in other areas to improve our welfare systems and serve the least among us in a more effective way. With that, thank you, mr. Chairman. Thank you, senator young. Senator hassett . Thank you very much, mr. Chairman and Ranking Member murray. Good morning, mr. Azar. Congratulations on your nomination and congratulations to your family, too. This is a family affair. Were grateful for their willingness to support you in this work. As you know, New Hampshire has been ravaged by the fentanyl heroin and Opioid Crisis. Were in need of real resources to help those on the front lines combat it. Hhs used a flawed funding formula to allocate resources from the 21st century act. The hardest hit states like New Hampshire didnt get adequate resources and now even though we have asked them to change the formula hhs has declined to do that, to update the formula for the second year of funding. But another big problem is the Trump Administration has refused to request additional funding to fight the crisis, which has prompted many to question whether the president is truly serious about addressing it. We need this administration to send a supplemental funding request to congress for Additional Resources to combat the opioid addiction epidemic. So mr. Azar, if you are confirmed, will you commit to me today you will encourage the Trump Administration to ask congress for at least 45 billion in new supplemental funding to fight this crisis. A number that has had bipartisan support . So senator, thank you and im glad we were able to have the discussion about this terrible Opioid Crisis and the impact in New Hampshire. I dont know the number, but what i will commit to you if im confirmed, i am going to work across the government to assess, do we have the resources we need . If i do not believe we have the resources we need to address the problem and work with the president and congress to do that. I will tell you i dont know a governor of either Political Party who believes we have the resources we need. I dont know anybody on the front lines of this crisis who thinks we have the resources we need. Will you also commit to examining all substance misfunding and formulas and directing wherever possible under your authority more funds to the states hardest hit by the crisis. I dont know the precise issues around that formula, how much is in statute and how much is discretionary, but absolutely, i know your concern about the money going to New Hampshire. If im confirmed, to work with you and see what flexibilities there are and do we think its the right approach. The issue here is the money has been distributed basically on population opposed to the overdose death rate per capita in particular states. Lets move on to another issue. The drug company, allergen, has recently engaged in unacceptable behavior to shield the patents of its dry eye drug res stayrestasis for review. In september, they announced it had paid a native american tribe to take ownership of the patents and then licensed it back from the tribe and continuing to sell the patents as usual exploiting the doctrine of sovereign immunity to protect its profits. They are renting the tribal immunity to protect its profits. It is ultimately to stop generic versions of restasis from coming to the market. This kind of a deal was could a ploy recently by a court judge. So i would like to know what you think about this deal, yes or no, should Drug Companies be. Allowed to rent out tribal sovereign immunity to shield their patents from review. I do not know as secretary if i would have any actual enforcement issues. I want to be careful about any particular situation. But i would say i would share your concern about any type of abuse around extensions of patent or protecting from whatever legitimate processes there are for evaluating validity of patents. I appreciate that. If you are confirmed, i hope youll work with me and others on this issue understanding that there are multiple agencies that have some jurisdiction here. I wanted to touch on another issue. The country recently learned of the case of jane doe, a 17yearold young woman, who was forced to continue her pregnancy over a month while in the custody of a shelter that contracts with hhs hhs overseeing unaccompanied minors. Jane doe was eventually able to receive the abortion she decided was necessary for her and the court determined was necessary for her. Because of this case it came to light that the director of the hhs office, scott lloyd use disturbing ways to stop it. He prevented them from meeting with attorneys and suggested placing pregnant minors with sponsors who would override her about the pregnancy rather than with Family Members and visited pregnant minors to pressure them to continue their pregnancies. Political appointees in washington, d. C. At hhs should not be imposing their own ideology on these young women nor coercing them or shaming them for their choices, if confirmed as secretary do you agree you have an obligation to follow the constitution and all the laws of the United States even though you personally may not agree with . I am a lawyer and take the obligation of the laws by the courts as a solemn obligation, absolutely. Im glad to hear that and i know im running over. Ill follow up on the discussion with you. Thank you. Thank you, senator. Senator cassidy. Enjoyed our conversation yesterday, thank you. Im a physician and ive worked in the Public Hospital system taking care of the the uninsured. And poorly insured, medicaid patients. Now theres a lot of data out there that patients covered through medicaid oftentimes have worse outcomes than those covered through other forms of insurance, even when correcting for disease, burden and socioeconomic factors. Clearly, we should have a bipartisan interest in Outcomes Data showing who is doing a good job and not and if they are doing a good job, why try to improve it . Anybody question . No. Any thoughts about the data sets that are currently available . Im told that for medicaid and chip right now theres in theory a structure for this Outcomes Data to be accumulated and compared. But in practice, it is not. Thoughts on that . I do not know the data sets, but if confirmed, i will gladly look at that. I agree. We ought to always be evaluating our programs to see what works, what doesnt work, are there certain programs that work better than others . If people have access to care, and approaching quality we ought to do that. Yesterday, you were meeting informally with both sides to go over certain issues. I asked that because our ranking chair and chairman have been very good convening that. What can we do to have better data sets so Patient Outcomes can be monitored, an old axiom of healthcare if you dont measure it it doesnt improve. I think we need to measure that. I appreciate your invitation in the event im confirmed to any kind of convening partisan process to work through these difficult issues. If i am confirmed i hope you find my style is i dont believe i have the answer to every problem. These are complex vexing issues. I want to have a dialogue back and forth. Im a problem solver. My brand if theres a program not working, if it can be made better i want to work on solving that problem and get the best input and best ideas from the board of directors. From our problem if theres something you can do administratively we dont have to mess with it but if there is something legislatively we want to give our attention to this. If there are ideas what can be done administratively i would want those ideas also if confirmed. Let me have some ideas right now. Public health, i was working with senator schatz and others how to have a Public Health fund, doesnt take a special appropriation to give you my thoughts on that and compare it to under katrina and congress had to put the money up front to immediately drawdown. From my perspective we should be doing that for Public Health as well. What thoughts do you have in regards to how we can help you better respond to Public Health emergencies . I was actually, back in the Bush Administration one of the architects around project bioshield. I see in preparing for Public Health emergency and response the benefit of having predictable funding and ability for the government to be a reliable partner in that development process, so i would be very happy to work with you, obviously i cant speak for the administration but i personally. How do you safe guard for the money being frittered on things not Public Health emergencies used as a slush fund to coverage shortages elsewhere. One would have to draw the lines very clear. I would share that concern. You would need to make sure its really built into a development or Response Program for Public Health emergencies like a zika or an ebola. Like we have with counterdevelopment programs. Let me also Say Something to encourage and monitor. Sheldon whitehouse and i put i say shelt don mostly because if i say white house they think on pennsylvania avenue, we put something forward for health i. T. My physician colleagues just are retiring at age 55 because theyre just sick of Electronic Medical records and the dampening on their ability to interact as well as their productivity. So in the 21st century cures the health i. T. Act was included that gave some directives. Supposedly its progressing well. But nonetheless, trust but verify. Any thoughts about that how can we ensure that health i. T. Becomes an enabler as opposed to an impediment. I need to be careful here, because my father, dr. Alex azar, may jump to the table here and start telling you exactly the problems youre talking about. Im with you. I think that when secretary levitt was secretary and we started the journey on health i. T. , he was adamant. Electrification of Health Records without interopability is not useful. Thats just moving files to a different place. Im afraid weve done a bit of that. Weve electrified our record systems but we havent gotten interoperability. We have made it too complex with the point of entry with the doctor. I would love to work with this committee and certainly if confirmed work within hhs to drive towards interoperability and reducing physician burden. It should be an enabler, not something that detracts. The doctors eye should be on the patient, not on the computer screen. Fantastic. Amember, amen, brother. And i yield back. During our 21st century cures we veered off to the side and held six hearings on Electronic Medical records. All of us are interested in it. We made some progress with the last administration. We might set up ill talk to senator murray about it a round table, a less formal way thats bipartisan to try to continue that focus over the next couple of years. Senator baldwin. Thank you. Thank you, mr. Azar. Theres been a lot of discussion about experience, insights, as well as potential for conflicts already in this hearing today. Obviously experience and insights can be extraordinarily helpful, but weve heard from the president that he wanted to drain the swamp. Weve heard phrases like foxes guarding the hen house and the revolving door. That, the perspectives you would bring, having served so noting that, the perspective that you would bring having served in large pharmaceutical corporation in a leadership post brings a very specific perspective, especially as we tackle one of the critical problems of our day, the high cost of Prescription Drugs, often times life saving and life extending medicines for our constituents. We had a hearing recently in this committee on drug prices. I felt that there was a lot of finger pointing from the folks who were at our dias, talking about whether they were from the perspective of big pharma or pharmaceutical benefit managers or all of the other players in this system. And citing complexity, citing its their fault, not ours. But because of your background in the pharmaceutical industry, id like to not hear finger pointing but what can be done. I have many constituents who share their very personal stories about their challenges with the increasing and skyrocketing costs of, again, life saving or life extending medications. Greg from stoddard, wisconsin, has two adult sons, both with type i diabetes. They are now expending over a thousand dollars a month just to maintain insulin and test strips. When you were president at eli areli lly, you were there during a time that there were really radical increases in insulin prices. It increased more than 1,000 since 1996 and over 200 during your tenure. Can you tell us and more specifically, greg and his two sons with type i diabetes, why a lie creasing the list prices of why eli lilly and other companies are systematically increasing the list prices of drugs that are already on the market . So senator baldwin, thank you for that question. I really enjoyed our discussion the other day on this and other issues. So first on the finger pointing, ive actually been really clear, even when i was at lilly on this issue of drug pricing. Finger pointing is not a constructive enterprise. Everybody owns a piece of this, everybody in the system owns a piece of this. I think the government owns a piece of this. Thats why i want to serve because i think the experiences i bring can help me with the government. One company cant actually necessarily impact i appreciate that, but my question specifically is what would you tell greg and other constituents about eli lillys role . Yep. And the insulin price increases have been significant for all drug prices pretty much. The problem is the system makes it so that and greg, greg and his kids i should tell them its the system. The system has to get fixed. Thats the problem. What about the drug manufacturers are the starting point . They set the list price. What should i tell greg about the 200 increase during the time you were there in the price of insulin . What we need to do is work to fix so that greg and his kids have insurance that covers that insulin so they have low out of pockets so that the Drug Companies we have to get the list prices down also. That starts with the drug manufacturers. It does. This feels reminiscent of the hearing we just had. Its a complicated system and its this and that. It starts with the manufacturers setting the list price. Now, we talked i see im already hitting my time and i had lots of questions. Maybe well have a second round. You talked about generic and branded competition, you talked about fighting the game of the patent system and exclusivity. The two things i want to talk about should we get a second round or maybe submit written questions is the role of transparency and getting the pharmaceutical companies to justify their increases in price. I have a bill along with senator mccain to require that for Companies Planning on increasing their prices. And secondly, the role of negotiation, somebody in your role directly with the pharmaceutical manufacturers. Thank you, senator baldwin. Senator isaacson. Thank you, chairman alexander. I look forward to our meeting tomorrow. Im glad we didnt have our meeting before this. I want to ask a question i might have been talked out of asking you had you met with me before. In listening to your testimony, having heard ms. Warren over the years, being a senior that advised a lot of pharmaceuticals myself, the cost of pharmaceuticals, the pricing of pharmaceuticals, the gaming of the system, as you referred to in your remarks, is a huge issue. Id like to give you at the risk of being presumptuous, give you a home work assignment i hope chairman alexander and murray will back me up on. Will you come back to us in six months on your recommendation of what you are going to do to help end the gaming of the system in terms of pharmaceuticals . Absolutely. I think youre uniquely qualified having been a ceo of a Major Pharmaceutical Company and the responsibility youre about to take on to forthrightly say these are the things that are being abused by either the pharmaceutical companies or whoever it is. Im not interested in blame. Im interested in solutions. Lets try and end the gaming of the system. Oftentimes these debates and responses to the questions we ask end up obfuscating the solutions. Would you be willing to do that . Id look forward to the opportunity. Secondly, i live in atlanta, georgia and represent it in the United States senate and been 20 years in the congress of the United States. The home of cdc, the Worlds Health center. It got very little notoriety. It solved the ebola problem when it contained an outbreak and ended its spread. Same thing with zika. We were in an Important Partnership with four companies that built isolation chambers, Emory University being one of them. We were able to get the people under care, isolate them, treat them. All four who went to emery survived an ebola infection. That type of partnership is what were going to have to do for the avian flu in the future and many other things. I want your commitment you will continue to advocate for cdc and its funding and ability for the challenges of the 20th century. We dont yet know what they are but the solution will align our ability to be prepared when they come. Senator, the cdc and its leadership and career staff are the envy of the world and i share that view. And they have saved a lot of lives. Amen. And prevents so many tragedies from happening its just unbelievable. Have indeed. What theyve done. Last, this may seem to be a silly question, i was a salesman all my life, was on a Commission Income all my life. The medical loss ratio in the Affordable Care act includes the cost of a Sales Commission as part of the medical lossratio formula. Which in effect put most people who sold Health Insurance to individuals who bought in the market out of business. Because the commission they would be paid, although very modest, would throw it over the 85 cost ratio. Therefore they didnt do it. Most americans today buying in the market would look to try and find a way to get insurance. Theres no Financial Security for anybody to offer it to them because theyre priced out. Because of medical loss ratios formula. Senator coons of delaware and i have introduced legislation three years in a row to end that pie taking it out of the calculation for medical loss ratio. I think it would expose the access for citizens who need healthcare can get. Would you help us with that . Id be very happy to look at that. Its an issue i hadnt really focused on and glad you educated me on that before that. I had not known of that concern before. Well use some of our time tomorrow to do that. Thank you. Senator franken. Thank you, mr. Chairman. Congratulations on your nomination. Id like to ask you a few short yes or no questions, if thats okay. Mr. Azar, are you aware that the aca required health plans to cover evidence based Preventive Health Services Free of charge, right . Yes. Theres a provision there in that requires, i think hersa determines the services. I think it determines Preventive Services and those are part of the essential Health Benefits in the aca. Are you aware that hhs commissioned the institute of medicine, an independent, Nonpartisan Organization of highly respected experts on health and medicine, to review what Preventive Services are necessary for Womens Health and wellbeing. On that basis, the institute of medicine recommended coverage for all fda approved Birth Control methods free of charge. I believe thats the case, yes. Do you agree with the institute of medicines conclusion that access to free Birth Control is vital to Womens Health and wellbeing . Senator, separate from the issue of any Birth Control or which ones should be covered, one of the principals we have around thinking about the access to insurance is that it ought to be insurance that the individual wants to acquire and the level of coverage they want. If i have concerns my concerns are actually at a much more precedent level, not about this coverage, this drug, that product, this one or the other, but rather should there be flexibility for the individual to choose the type of insurance package they want. No animus towards any particular type of preventive service. Its more that our system ought to enable flexibility in there that does not exist with the current framework. But you agree that the institute of medicines conclusion to that free Birth Control is vital to Womens Health and wellbeing . I couldnt speak. I havent studied the report. Obviously we at hhs have important programs to provide Family Planning assistance and services. Do you agree with the institute of medicines conclusion that access to contraception free of charge reduces unintended pregnancy, which in turn reduces frequency of abortions . I havent studied it. It seems to make some sense, as you state it. Do you agree with the institute of medicines conclusion this is their conclusion that reducing unintended pregnancy also reduces the Health Risks Associated with such pregnancies and that contraception helps women to increase the length of time between births, which reduces Maternal Mortality and pregnant related complications . I think i think we all share the goal that unintended pregnancies, especially by teens is something we want to work to prevent and want to work to educate and we want to use our programs to support that. In light of this, do you agree with the Trump Administrations action actions to undermine the access to Birth Control . So on that issue, that is a balance between the essential Health Benefit and the conscience of the organizations involved. As i mentioned earlier, i think it was close to only 200 organizations whereas the obamacare, Affordable Care act implementation actually excluded tens of millions of people in grandfathered plans. This conscience exception has much smaller impact, i believe. I just want to focus here on the science. The law requires that Preventive Services be evidencebased. And this is evidencebased. Will you take steps as hhs secretary to make sure that women have free access to contraception . I will follow the law there. If the law requires it and the facts and science, i will follow the law there. But i also will, as the president has done, try to balance the conscience objections of organizations and individuals there. A number of my colleagues have expressed concerns regarding your track record and eli lilys track record on drug pricing. I just want to tell you i share their concerns, especially in eli lillys actions to spike insulin prices. I wanted to move im running out of time so im not going to be able to, but i wanted to get into medicare drug price negotiation. The president has said he is for medicare being able to negotiate in part d with the pharmaceutical companies on the price of drugs. Do you agree with the president that medicare should negotiate for lower drug prices . The president has generally spoken about the desire to ensure that medicare is negotiating and getting the best deal possible for drugs. Part d actually has a negotiation through the three or four biggest pharmacy benefit managers that negotiate and actually secure the best net pricing of any players in the commercial system. I sat on the other side of that. I can assure you of this. What id like to do is think about how can we take the learnings from part d maybe into part b . Part b does not have negotiation. Part b is the program when a physician administers a drug, like an ms drug, some quite expensive, the government simply pays the sales price plus 6 . Database price plus 6 . How could we think about ways to take the learnings from how could we think about ways to take the learnings from part d and actually bring lower costs to the system but also lower costs to the patient, because they pay a share of whatever medicare reimburses in part b. Thats a double win. It could lower for the system and lower for the patient on their outofpocket. Thats the kind of thing i would have energy to see where we could actually really save money and improve things for our patients. Im out of time but i would just note that the va is able to negotiate for prices for their drugs and i think in Medicare Part d we should be able to do the same thing they do in the va. Thank you, senator franken. Senator roberts. Thank you, mr. Chairman. Mr. Azar, alex, thank you for coming. Congratulations on your nomination and thank you for being here today. Its already been stressed about by my colleague about your prior work at the department of health and Human Services as well as the confidence in you shown by the senate. Sometimes we have to do a multitask here. I apologize for that. But at any rate, the confidence shown by the senate to unanimously confirm you to positions at that agency twice already and highlight the strength of your qualifications. I appreciate the chance we had to chat. I think it was monday. Some particular areas of interest for me, improving our rural Healthcare Delivery system as well as food supply and basing food nutrition policy on sound science. You are a hoosier but you did find a kansas girl to marry. As the folks in kansas know, theres Nothing Better than a shawnie Mission South raider. I wanted to make sure that you understood that. Thank you for bringing your family. As both a member of the Health Committee and chairman of the agriculture committee, also a member of the finance subcommittee so well get another opportunity to talk, im particularly interested in hhs and more importantly the fdas work on food and nutrition policy. We talked about that. A common message i hear is the need for regulatory certainty. Just a moment. I beg your pardon. Will you turn that off . Thank you. More importantly, fdas work on food and nutrition policy. A common message i hear is the need for regulatory certainty, in particular on the biotech front which is a critical tool for agriculture today. Back in january, both fda and the usda proposed rules and guidance on biotechnology. Recently, as a recent stake holder comments, the usdas animal plant and health spection Inspection Service has decided to withdraw the proposed rule, reengage stake holders and solicit comments to create a new rule. If confirmed, what steps would you take to engage and coordinate with other agencies involved with the regulatory review of Biotech Products to harmonize future rule making efforts . Im not familiar on that particular rule making with the pull back from ifis. I assure you that i would share both goals that i think youve articulated. The first is it is the job of the government when regulating to give clarity. They want to comply, they want to know the rules of the road. Can we give clarity. The second is especially in the area of food safety the level of coordination between hhs and the Agriculture Department is absolutely essential. It has to be a Great Partnership and they have to Work Together in the space because of shared jurisdictions there. I would commit to you to be an excellent partner as also dr. Gottlieb working with ag. I appreciate that very much. I just want to make one other observation, mr. Chairman. Ive been watching your children ive been watching these youngsters over here. And ive been watching your dad. Your dad is very proud of you and your wife is obviously very proud of you. I want to tell you young folks welcome to politics 101. Its a little tough. Were not playing politics here. Were asking questions that many members here have on their mind and theyre very important questions. I want you to be proud of you dad. Hes done a good job in the past. He will do a good job in the future. He will be confirmed in my view and not only by this committee and not only by the finance committee but also on the floor of the United States senate and then also by the president. Thats a long process. Sometimes it gets a little tough. We ought to be handing out selective earmuffs for young people. Put on earmuffs if it gets a little tough for you, take them off. Be proud of your father. Hes a good man. Thank you. Senator roberts. Senator whitehouse . Thank you, chairman and welcome, mr. Azar. I dont think there is much that you and i are going to accomplish today on the question of drug pricing, but i hope very much in office you will take the side of the American People and not just the pharmaceutical industry or worse yet the investors who have raided the pharmaceutical industry with no pharmaceutical background with the sole mission to jack up prices on necessary pharmaceuticals and extract money with monopoly authority. We know how to deal with that ordinarily. I hope you will help us deal with that. I want to talk about a different situation, which i think is an opportunity for considerable bipartisan progress. I want to start with two rhode island stories. You know what a medicare aco is. I assume . I do. We have two in rhode island. One is a very early one, coastal medical, which over four years has saved medicare 28 million relative to its benchmark while maintaining a 99 quality score. That makes it one of the best in the country. Its average per member per year expenditure is going down, while the satisfaction and health of its members are going up. Similarly, Integra Community Care network has saved medicare 12 million relative to its benchmark while achieving a 95 quality score. I say this not just to brag on rhode island providers, but because i think its the answer to a much larger question that we face which is heres the graph of Health Expenditures more or less in my lifetime for the country. 27 billion to 3. 2 trillion. Its a curve that is breaking the bank. We have got to figure out how to fix it. One of the ways that we can look at fixing it is to look at this oecd chart i use all the time that shows a lot of our competitor nations right here. Theres the usa as a big outlier. This maps Life Expectancy. This maps cost per capita. That puts us as the highest in the world and gives us Life Expectancy comparable to the Czech Republic and chile. Well below other nations that compete with us. Were actually beginning to see a little progress here. Let me explain what this is. This top line, the red line, is what cbo predicted for federal Health Care Expenditure back here when it made the prediction in 2010. Then events moved forward post the Affordable Care act. We got to here and sure enough, we were coming in below. Here in 2017, the baseline was rewritten by cbo. Repredicted. The difference in this tenyear budget period between what cbo predicted in 2010 and 2017 amounts to 3. 3 trillion in savings. So the case that i would make to you is that if we want to take on the Health Care Cost problem, weve got to take it on through entities like these acos, because there is a sweet spot that we can bring that cost back from our outlier position in the United States while improving the quality of care. Ive seen it happen in rhode island. The reason the cost is going down for coastal medicals patients is because they get home visits when theyre sick because theres telemedicine that gets their testing results in because a nurse will call them when they dont hear from them. Somebody does a house check to make sure there arent slippery rugs in the hallways that might cause a fall. Over and over again, it is better humane engagement that reaches the patient where they are that has this wonderful twin benefit of improving health and the Patient Experience while also bringing costs down. Were not seeing less increase in the cost curve from integra and coastal medical. We are seeing cost per member going down. Promise me you will work with us on that. Promise me you will not get idealogical when it comes to solving this problem and you will work to solve it in a sensible, bipartisan, thoughtful way. I would just say amen. Just hearing those stories is exciting to me. It is i think one of the great legacies of secretary burrwells tenure was launching so many of the alternative payment models that we have out there. Id like to keep driving that forward. That was that third leg of my priorities if i am confirmed as secretary, i think for those of us who care so deeply about improving quality, reducing cost in our Health Care System, improving integration, coordination, thinking about ways we can deliver better for our patients and beneficiaries. You theres just so much opportunity for bipartisanship here because we share so much of the same goals on this. Medicare can play such a role. Its the only payer that sits there with enough concentration of lives to change the system. Correct. I think United Health care as big as it is, i dont think theres a market that has more than a couple percent of patients and has to follow what medicare does. I would be so excited to work with you. Im going to invite you to come to rhode island and see these guys. I would love to. I look forward to that visit. Thank you, chairman. Senator casey . Thank you, senator whitehouse. Senator casey. Mr. Chairman, thank you very much. Excuse me i made a mistake. Senator murkowski is here. I failed to go to tat side, if youll excuse me. Senator murkowski. Thank you, mr. Chairman. I apologize. I know im at the end of the dais and came in later but there is added benefit to being one of the later ones and having the full opportunity to not only hear most of your opening comments, sir, but to hear the questions and inquiries in your responses back. Again, congratulations on your nomination. I will also be curious to hear your response to senator pauls inquiry regarding importation of drugs. Certainly for those of us in alaska where our neighboring country, our neighboring state is canada, many in my state wonder why we are not able to do more when it comes to safely importing. I too am curious to know what you might propose in that area. Senator baldwin mentioned the hearing we had some weeks ago about drug pricing. And i think a general level of just confusion and bemusement that many of us had, those who were here to provide testimony, were engaged in a fair amount of fingerpointing. When you try to drill down to how we can do more from a transparency perspective, i think this is something that we all recognize that we can do a better job with. Again, i look forward to more detailed response from you. Were going to have an opportunity to meet tomorrow. So i will probably hold more of my alaska specific questions for that time. One of the other discussions that we have had in this that this committee recently as we have been discussing the aca and some of the requirements within it. We had recommendations from some who have suggested that the Navigator Program that is currently in place no longer needs to be funded. The president really axed it. Not too many months ago. And it was pointed out that not all parts of america are equally situated. We dont have a drugstore on every corner in alaska. In most communities we dont have a drugstore. The role they played in helping to walk many alaskaens through the intricacy of insurance and what is available. Has been important to us. Nobody really asked that question here today. So i would ask for your view. Your plans. What do you see the role of navigators moving forward . How can you provide assurances in areas where we dont have the the professionals that could assist individuals. That they know their options. Senator, thank you. Its good to see you again. I look forward to discussing alaba alaska issues with you. Which we look forward to that. We recognize there are unique aspects and focussed on Behavioral Health with native people. Something im interested in exploring. In terms of the knave gaiter program and out reach. My view as it is with so much of the program is what works. Is do what works. And my im not at the department. I dont have the data. I havent seen everything. My understanding were focussed on Navigator Program elements that werent working in renewing and funding navigators. I dont know the specific about the alaska situation i can only tell you that i do general ruinly get it in the sense of you are understanding the unique of the frontier nature of alaska. And would be happy to work why you to see what are the ways to teal with that. For me its what works. Whats effective. What works what delivers for the program. I said pharmacies. And also those who hep us navigate through the insurance side. We dont have Insurance Companies on every corner as well. I lock forward to discussion on that. Theres been focus on Womens Healthcare. Preventive care. Eliminating the risk of unwanted regular si. I happen to believe that the more weg make contraception available and affordable to women the better. I was made readily available. Why we have been so reluctant to moou to over counter products for birth criminal. A control. Its just a flat amount out there. You have the requirement for a medical appointment, in order to get that prescription. Do you see a way or an opportunity for us to reduce the barriers from more affordable Birth Control pills, contraception, and in a way that can really help women in gaining greater access to contraception. So the over the counter regulatory rejoem is this monograph procedure. That commissioner im very glad has said is was probably out of date in the 70s. And needs updating and work. And whether legislatively to speed the aprufl of products for over the counter for the reasons you said. In cost availability. Cost to the system etc. Of course there are standards this are scientific and legal standards met by the sponsor of a product in terms of the ability to selfdiagnosis and selftreat. And user studies that need to be conducted. So it would be driven by that. Would be my view. On any product the fda has to decide on. The regulatory system needs a close look at. On how to generally think about over the could your honor and improving availability of products. I would encourage you. Thank you. Thank you, mr. Chairman. Good to be with you. We had some opportunity to talk in my office yesterday. Im grateful for that. Grateful for your willingness to put yourself forward again for this work thats difficult. I want to especially thank your family and extended family for their commitment. As much as Public Officials work hard. Their families often sacrifice more. I appreciate that commitment your family made. You and i have a home state in common in terms of where we were born. Not where we were raised. I know youre a johns town naift. We have a lot of disagreement on public policy. Especially healthcare. Because of the interaction between doctor price secretary price in and the committee i have to ask the question. When he came before the Committee Prior to his confirmation, members of the committee submitted questions to him for to answer on the record. In writing. And he didnt provide a lot of response. Ill be precise in this question. Do you commit to providing answers to all operative word all. All the questions you receive following appearances before this committee . Ill certainly be happy to comply with the senates nomination procedure. And the nomination setting and of course ongoing appearances before the committee with the protocol and procedures of the committee and the senate. Do you agree that answering questions for the record posed by Committee Members during the nomination process is part of that compliance . What i do not know is what the protocols are tone between the Health Committee. Im not familiar with the customs. The hearing before the Health Committee didnt occur there. Im not knowledgeable. I would be happy to get back to you on the question. Ill take it as a yes for now. I hope you familiarize yourself with the rules and respond accordingly. We should not have to engage in a back and forth on basic questions for the record. I want to ask you about in light of the debate on healthcare. The substantial debate that is been under taken over the last number of mornts on the Affordable Care act sdp medicaid. At least from my point of view. Especially medicaid. And in addition to that debate, some of the statements you made. I wont catalog the statements that have been critical. Commenting on the process. Now youre seeking appointment a confirmation vote on hhs secretary. That of course would confirm your responsibility you dont currently have. In light of that in light of the debate and just to be very clear i want to be precise in asking this, do you commit to faithfully implementing the Affordable Care act . If im confirmed as secretary my job to imflet the programs as passed by congress. Whatever they are. That would include the Affordable Care act is the law of the land and remains such. To implement it. In ways if it remains, if i obviously believe the administration believes statutory changes would be good and appropriate to replace the system. But if it remains the law my goal is implement a way that leads to affordable insurance. Choice of insurance. Insurance that leads to real ak says not a meaningless card. And insurance that is the benefits that people want. Not what we say for them. May i ask you about an issue that frarngly doesnt get enough attention. The effort that have been made by the administers to under mine the Affordable Care act. Thats my view. I use the word sabotage. Thats on appropriate description. Let me define what i mean. When i say sabotage of the Affordable Care act the following. Number one drastically cutting funding for advertising in out reach activity. Number two, terminating cost sharing payment. Spending funds meant to promote enrollment. To under mine the law and support repeal of the aca. Dollars should not be spent for that. Spreading falsehoods and misinformation about health oflt marketplace. Its one thing to be critical and concerned about that. Its another thing to spread falsehood. Working to role back Health Insurance protection and under mining coverage. Thats the predicate for the question. Would you oppose the efforts knowing you have a responsibility to faithfully implement the law. Would you oppose the efforts broadly as sabotage . Yes or no . I would disagree theres any effort o sabotage the program. People want to make it work. The csr was a legal decision that congress had not appropriated the money. Other elements i can speak tr myself how to approach. How about cutting advertising on. The advertising cuts actually were put the advertising for the this program many years into it at the level of Medicare Part d and advantage. At some point the Insurance Companies have to do their own job and fund their advertising. They are cut. They were cut to the level that it comparable. Advertising funding and these Insurance Companies should stand on their own two feet. Well have more time to engage. Thank you very much. Senator king. Thank you. Good visiting with you yesterday. I have one question about each of your four goals. What im looking for from you is a commitment to the healthcare safety net broadly defined. I voted against your predecessor. He commented negatively about planned parenthood and his brief tenure at the hhs proved he one kidding. I dont think we can have a secretary that doesnt support the safety net. Your first goal you say drug prices are too high. As a member of the ageing committee i became convinced senator colins was the later. Theres a new model that is patients as hostages. Patients who need drugs who cant afford to go out them. Without risk to their life or health. Are treat td as hostages by pharmaceutical companies. Theres a story in the Washington Post why treating diabetic keeps getting more expensive. According to to the Washington Post analysis of over the past two decades raised prices on the insulin. 450 above inflation. Closely. Convince me that ely lily pricing activity was not part of this patients as hostages Business Model . As i said in my remarks in response to chairman earlier today. Insulin prices are high and too high. The this system this system that we have, it may fit for the stake holders behind the scenes. But for the patient that youre talking about we have to recognize individual actors in the system have no sul cull. Everyone shares blame here. Throughout. And we need what we have to do is i want to be a productive engine if i can be secretary to work with you on solutions to fix that for the. Let me ask you about your second goal. Make health care more affordable and taylored to what individuals need. We must address the challenges for those who have Insurance Coverage and have been pushed out and left out of the Insurance Market by the Affordable Care act. Thats your reference to the aca in your testimony. It was interesting that you talk about people who have been pushed out or left out of the market. Of course you know the uninsurance rate has reduced in the country following the passage. Im not arguing its perfect. If you read your statement it suggests that people there are fewer people insured because of the aca. We had the Surgeon General in here recently from indiana. He said the uninsured rate in indiana has gone down. Because of the Affordable Care act. Because of the combination of medicaid expansion. And the availability of premiums to help folks afford. In looking at this question are you going to execute or wrecking crew. Thats not really an accurate or fair im happy to explain. We can do better. I believe that for. I do too. I believe for the folks in the individual market right now that too many of them are paying too much for insurance. Too many of them have insurance that. Was that opinion before the Affordable Care act passed . I thought that would happen. Given how it was structured. Unfortunately. The numbers of people uninsured in the country. Reporter higher than they are now. Bh you were at hhs. I have als been and i would want to work with you. Our goals are the same in the sense we want to improve access to affordable insurance. The president wants this i want this. We may only differ about tactic and approaches. My point was the forgotten man and woman who isnt in the individual market because the insurance. Let me ask you. I want solutions for them. We must harness the power of medicare o hit the focus on the Healthcare System from paying for procedure and sickness to paying for health and ou come. Amen. Why didnt you mention medicaid . Medicaid. I found it interesting in reading that sentence that you didnt say a word about medicaid. The only reason i dont mention medicaid in the context its not a lack of the commitment. Its really that medicaid doesnt have the same kind of payment rules that medicare has at the national level. That was my focus. Can i say this im a governor and i ran a Medicaid Program. Its interesting why wouldnt you agree that we can focus to paying for procedures and sickness shift that focus to paying for health and out come. The Medicaid Program can be part of that as well. It could. The governors and if governors are willing partners to try to drive that. Medicare the secretary has more levers in his or her control. Would you try to do the same thing in medicaid . Absolutely. If we can make medicare better we can serve more people. Thank you. Senator murphy. Congratulations on your nomination. I was very open to your nomination. Im very concerned about your answer to senator series of questions. I want to state it to you one more time. And give you a second chance. The administration shortened the open Enrollment Period by half. It has cut out reach funding by 90 . It has cut funding for navigators by 40 . Pulled out of state enrollment partnership. Is your testimony here today that this is all in service of an effort to make the aca better . Do you really believe that the goal of this administration is to help people sign up for the Affordable Care act . Im so obviously im not in the government. I dont have access to the data. My understanding was the choices made were about whats working and whats not. And no sense funding any aspect of the program that arent working well and a policy decision around advertising. Its time for that to be regularized and not a funding around advertising. You think the President Trump is taking these actions in the goal of making the Affordable Care act work better. I dont know President Trump was involved in lt decisions. Those are decisions made at the hhs level or matter of budgeting. But i think the goal is with the program you have, do as best you can. This one has a lot of problems in it. Im if the murray by partisan package helps its what does cutting the open Enrollment Period in half do to help . I wasnt involved. Nor did i study the comments on the change. The enrollment went from 90 days to 45 days. I dont know about the senate. For shorter efficient programs to. Let the plans know whos in their plan. So they can plan predictability for the following yore. If you run until the end of the year there, youre going to have its harder for the plans to set their actually basis for the open Enrollment Period and the pricing. If krou run it up to the end there, i know this from part d in medicare advantage, the closer you run up to january 1, it is very hard to immemt effectively and efficiently. This is not the insurers begging for it to be cut in half. You put that next to all the programs that would help people understand the fact the period has been cut in half. I think its strange. Im happy to look at that. I was not involved nd that. Okay you said there are things that the hhs secretary could be doing. To make the open Enrollment Period work better or, what do you think that you could do . In the face of the changes to make open enrollment work better and make sure people have the ability to choose wisely within the exchange. If you say these are changes that are made in the service of making the open Enrollment Period better. What else can . Just to clarify, i dont believe i said these are changes to make it bert but to eliminate what i think again im on the outside, im not sitting there looking at data running the program. I dont know the status of thinking on each individual element. My point is if something is not working why are we fiunding it . If the Navigator Program if certain vendors are not delivering, delivering one ben fi beneficiary enrolled. And uses resources to put it on the programs happen to be. That would be the approach i would follow. I dont know im not there. I havent been involved. I havent been at hhs for the Affordable Care act initiation or implementation. I havent studied each of the programs there. Let me follow up on some questions. I agree with her experience in the prift sector shouldnt be disqualifying. We want to make sure you are not simply bringing your advocacy on behalf of the industry you used to work for into government. Far ma has a number of major legislative priorities faster fda approval process. With Drug Companies continued legalization of direct to consumer advertising. I know you have been critical of specific practices of individual Drug Companies. Is this any major issue on far mas list that you disagree with . Senator, if i get this job, my job is to enhance and protect the health and well being of all americans. Not to. I get it. Give us an example. I dont have far mas policy. Thats how lit focus. I have been gone for a year. I dont know the list of ageneral agenda. Thats not my area of focus. How i can work with the congress. In the interest of all americans. My commitment is to the American People. Not to anywhere in the past. I thank you for that answer. Thank you. We have some senators who want to does additional questions. Well have a second round. Let me begin senator cass di asks. White house would have. And others about electronic healthcare record. We can do some things about that in congress. Most of what needs to be done youll have to do. Because its matter of administration. I urged the Previous Administration to delay meaningful use three. Because it was implementing it at the time changing the way doctors and provoiders are paid. I thought it would be wise to slow that down and get it right. And build confidence among the physicians and other providers. About what we were trying to do. I said that based upon visits with hospitals like Vanderbilt University and said meaningful use one was helpful. Number two was okay. And number three was terrifying. And i think so we ended up with six different hearings and a lot of interest in this. One thing that seemed to me to make difference would be simple. There was an ama study. That showed doctors believe their spending 50 or 60 of their time on documentation. And it seemed to me a good thing approach for this would be if thats true or not. Thats the perception. Might be for the secretary to work with the doctors in medicare. Half million of them. And say okay if you think youre spending that much time on documentation either youre not doing your job right or were not. Why dont we Work Together and set a goal. A goal to bring that for 60 down to some other goal. The next three or four years. And change the reality and the perception over time. It would seem to me that some manager technique like that is essential. The inopera blt is one problem. Excessive documentation is another. Its a big mess still. If you want to take your own medical record to another place the best thing you can do is copy themselves. Carry them over and hand them to the nebs doctor. Thats even in a sophisticated place. After we spent 35 billion. Can you make it a priority and use some of the skillful manager and executive experience background you have to help us improve a reduce excessive physician documentation. Both in reality and in per spepgs. What are your thoughts on that . In both of those areas thats a sensible approach. It is ridiculous if we have a system now where you have to collect your paper record to go to a different facility. That is a betrayal of the vision secretary laid out. Originally when we started down the journey and working towards. He would talk about the rail way system and if you dont get a single gauge it doesnt work. They never decided on a gauge. You have throe to get arpd australia now. We need to work on that. On the Regulatory Burden with physicians that would be my style of how to work. The affected individuals know whats wrong and whats happening. And get the input from them to see if there are appropriate change ts to be made. Dpet your father to help you with that. He probably as ideas. He will change the something in her administration. She believed the reality was different than the perception. It was the Patient Satisfaction survey that many of us were convinced was causing doctors and hospitals to prescribe more opioid in order to get a higher score on Patient Satisfaction. She was convinced that wasnt true. But it was true. That people believed that. So she persuaded obama to change the policy. I dont know exactly the amount of times the physicians are spending on documentation. They are fed up with it. That for a whole variety of reasons which you understand well, we need to change that. I would think some simple initiative working with physicians especially, and hospitals, to say lets if its 60 and the perception is 60 lets agree on a goal and take it to 50. Or 40. Or 40 lets take it to 30. And let us see whats being done about that. We cant do that well here. We can monitor it and encourage it. Make changes in the law. But its an administrative challenge. One i hope youll take up. And well let the senators here who are interested in that work with you. Thank you, again. Im very concerned about some of the responses. Particularly to senator murphy. Who talked about what many spooefr as this president directly. And his direction to the administration. Has been to make sure that aca doesnt work. The reason that we very adamantly support that is because many people are now getting access to care through insurance that didnt get it before. Those are the harder to reach people. Lower income. Tougher population. And they end up we all pay for them at the end of the day if theyre not covered. The goal is have adds as many people covered as possible. Have access and get preventive care. And dont end up in emergencies. Part of making sure that they get ak sesds is through the out reach and longer enrollment. You answered a question about the open enrollment that to make it in half had to do with the actual. The exact opposite is true. Insurance Companies Put the prices out. The open enrollment doesnt change the prices or actual cost. What it does it make sure we have time for the harder it reach people to get enrolled and they know what theyre doing and havent bought insurance before or have different kinds of access problems and takes time to reach them. And make sure they understand what theyre buying. Thats the intent of the longer enrollment. Which this administration cut in half. The sexd thing is the out reach. I was sproizurprised to hear yo answer saying Insurance Companies should pay for the out reach. They va dimhave a different goa. Theyre not looking for the tougher accident harder to reach people. They have a different goal. We have that goal. Thats why its so impairtive. In the bill, we reinstate that out roach money for the exact purpose. You will be hhs secretary if you are confirmed. Youll be responsible for making the out reach money is used and effectively. And the Enrollment Period is effective. I share your commitment. Any program i want to run as efficientive and effectively as possible. Thats any style. Thats my commitment to you. In particulars here im not there. I havent studied the particulars of why changes were made around the Enrollment Period. I offered a hypothesis. Pricing before and implementation after ward. I saw that with part d. Just the Insurance Companies have getting them card and getting them up and running. I havent seen that problem. I do want to be really clear. My style i want the programs to work for the people. I want to work with you. Ideas to work and programs to work. Do you share goal of making many people as possible. That havent been reached before should be part of what were working towards sfwl of course i do. Who do you think best equipped to do that . If the question that you ask there around advertising. Advertising budgets that money my understanding is at the lefl of part d. Television. I dont think thats your rourl out reach or hard to reach. That was the television is my understanding. I maybe wrong. So not about trying to reach potential beneficiaries and get people enrolled. It might be talking past each other on that issue. Or my misunderstanding. Okay. Im confused by your answer. I will say that. I want to ask one more question. In that is will you advocate for women to make their own healthcare decisions by supports a broad safety net. And ensuring all women are willing and able qualifying provider of their choice. The administration i believe your asking a question about particular provider that would be at issue. The administration has a perspective about whether that should be funded or not. Thats a legislative choice. If im secretary i will implement what Congress Passed and whatever Congress Passed. And the laws that we have there. Faithfully. That does concern me. I will turn over to my colleague. Thank you. Senator franken. Thank you. On monday, the la times published an analysis of the Senate Republican tax plan. Which repeals the individual mandate or the federal requirement that americans have Health Insurance coverage. The Analysis Shows that repealing this pr vision quote threatens to derail Insurance Markets and conservative rural of the country. And could leave consumers in these regions including most after ul most or all of alaska, iowa, missouri, nebraska, nevada and wyoming. As well as parts of many other states. With either no options for coverage or health plans that is are prohibitly expensive. In your Opening Statement you said that you want to make healthcare more affordable and available to individuals. Given this new data, do you support repealing the individual mandate as part of the republican tax plan knowing that it puts rural american coverage in jeopardy . What i do not support is forcing 6. 7 million americans to pay 3 billion of penalties to not buy something they dont want to buy through mandate upon them. And 90 of whom make 75,000 a year or less. That i do not support. Well, i think you understand the structure of the aca. Which is that you guarantee that you arent discriminated against for having preexisting condition. If youre not discriminated against the the motive to get care to get insurance buy insurance we have to mandate it. This is my understanding of the logic. To mandate it you have people dont wait until they get sick to get insurance. And that just the way and then you give subsidies to people who dont have the means to buy it. Thats the three legged stool of this. And if the individual mandate is repealed, the Congressional Budget Office estimates that 13 million more people will be uninsured. That premiums will go up by 10 . The murray deal which i worked on those negotiations and thank the chairman and Ranking Member for that. Those are helpful its helpful. But its a temporary measure that cannot offset these estimated price increases. Or coverage losses. And given this and gien that People Living in rural areas tend to be older, and have greater healthcare needs than the average population, what specifically will you do to make sure the People Living in rural areas are are not hurt by all the current efforts by the Trump Administration to under mine the Affordable Care act . So the as you articulated. The theory of the mandate was a ameri mechanism pool to risk. That was the theory. The challenge was Human Behavior decided otherwise. 28 Million People are not in the pool. And eroded the risk pool. I would love to come up with systems that create effective to insure them. And your rural citizens can have Affordable Care that gives them access and real choice. Half of the counties have one plan available. Right. I worry about that. The fact of the matter is that under the aca over 20 Million People who werent insured have insurance. And it feels to me that everything that this administration is has been doing, is basically aimed at under mining the market. And under mining the way the aca and under mining so that we can throw away these gains. But everything that is getting rid of the individual mandate putting out plans temporary plans. Short term plans. That will not cover the basic, you know the ten basic health guarantees. It just seems that this is a conscious effort to under mine the health of americans. And it just i think that as we go forward we have to find ways to make sure that people arent discriminated against because they have preexisting conditions and we have the largest pool possible and spread the risk. And make sure people have as many people have healthcare and if you repeal this, 13 million more people will be uninsured and premiums will rise. I think we share so many of the same goals and disagree about the approaches and tactics. My heart and my goal is share so much of what youre talking about in terms of Affordable Care for people. Thank you. Well continue with the second roupd of questioning. And conclude the hearing after the second round. There maybe one other senator who wants to come back. Next to senator warren. Im sure the concerns that have been raised by a number of colleagues this administration has spentd the first eleven months trying every trick in the book to destroy the Health Insurance in the country. Youre being considered the top job for over seeing. I want to start by asking about basic principle. Would you adwree its important that we have a system that allows for every single american to have access to the kind of coverage they need . I think we all share the goal that we want all americans to have access to affordable insurance. They desire. Is that a yes . As i framed it, yes. Good. Heres the problem. Those are the exact words that doctor price used during his confirmation hearing. Before this committee. He said exactly where youre sitting now. And said that. He pretended he cared about people being able to get healthcare coverage. And got confirmed and spent eight months doing everything he could to take away conch and crash the system. Thats the reason were trying to be specific about what it is you will and wont do. So i want to follow up on senator murphy and murray. They asked about shortening the time period for the enroll m. And you said you wanted to be dated driven about that. You thought maybe there was a data reason for doing that. That is that it was ineffective and somehow it hadnt worked. So let me ask the question. If youre confirmed as hhs secretary, and there are no data showing that cutting the Enrollment Period improves enrollment, will you commit to going back to a three month long period for insurance enrollment . If it doesnt mauk sense and work for the program. For the insurers that work in it and the beneficiaries. I would be hope to changing that back. I cant commit. Im not in the government. Thats the question. You have used data as an excuse. I agree with that. Im asking. If there are no data to support your hiypothesis that cutting te time period somehow might improve enrollment, will you commit to going bab to the three month period . I would need to look at the data. Thats the question. Im going to push to ensure the program is if a longer period is needed and effective. I dont know what factors there might be. Its not all about data for you. I dont know the other elements. Ill take that as a no. When secretary price was in office, he supported republican bills to repeal major portions of Affordable Care act. Will you oppose such bills . Senator, i in the Administration Support legislation that various forms of legislation that would have a system that leads to more affordable insurance more choice and more access. Theres i asked a very specific question. Because im trying to get this. This is what price said when he was in here. So im troying to get a specific question. Would you publicly oppose republican bills to repeal the aca like the ones we have seen so far this year . We should just wait and see . I would work with this congress and within the administration to build a system that helps people get affordable insurance. We will differ i guarantee you on what the contours of the system. That we have heard so far . All right. What about turning medicaid into a block grant. Secretary price pushed that idea while he was in office. Would you do the same . I have said before that i think looking at block granting and empowering states to be fiscal stewards there can be effective and approach. The contours of that the amount of funding and size. You support block granting. As a concept to look at. One needs look at abstract. The question is instead what is the previce program. The notion of a state being empowered to own up to the fact that you want to cut medicaid and gut the Affordable Care act like every other member of the Trump Administration. But you want to smile and pretend otherwise until you get the job. And yet you say exactly the same things that would let you pick up right where tom price left off in trying to gut the Affordable Care act. Price lied through his confirmation hearing. Now you come in here and say the same things he said. No one should be fooled. Thank you. I want to pick up where with left off on the question about the case of jane doe. At the end o that question you said that yes you agreed that you have an obligation to follow the constitution. And the law of the United States. Even if you dont agree with it is that correct . Thats correct. Im glad to hear that. As you know in the decision, women have a constitutional right to make their own Reproductive Healthcare decisions chlts yes or no will you commit to uphold the Constitutional Rights . I would always work to ensure implementation of the constitution and laws as currently interpreted by the court, yes. Thank you. Now i want to return to the issue of essential benefits for a second. You have said you would make the addiction crisis a priority if you are confirmed. And i appreciate that. But we need a lot more than lip service to make a dent in the epidemic. One of the key tools to combat the crisis is the set of ten essential Health Benefits requiring insurance cover Substance Abuse disorders. In october proposed the 2019 notice of benefit and payment parameters. Could let states erode the Health Benefits. If states develop their own benchmark the rule would set a ceiling on the generosity of benefits that states include in the plans. Before the aca was passed a third of plans on the individual market didnt provide coverage from Substance Use disorder services. I am concerned under the rule thats been proposed now states would decide to limit this critically important benefit. Given your stated commitment to address the Opioid Epidemic will you commit to jerejecting the harmful. I believe states are most effective in determining the benefit package for their citizens. Even with New Hampshire the circumstances of each state. But the problem of course then is when they do that the Insurance Companies come in and charge much more for that benefit. Thats the advantage the i will tell you nobody in my state plans to get an illness that the insurance doesnt cover. Nobody plans to become addicted to Prescription Drugs. After surgery. And then says too bad i didnt buy Insurance Coverage for the treatment. And the advantage of the essential Health Benefit is millions of people not only got coverage through the aca but coverage that actually addressed their needs. As governor and before when i was in the state senate. It was often the case. That Insurance Companies kept dropping coverage for things they couldnt make money on. And eventually the public picks up that cost. It has been critical to fighting the epidemic in our state. Last topic i want to touch on. Its about drug pricing. Some of it is about your past employment. At president of eli lily. I want to read a quote of yours. Theres a reason people are skeptical about your commitment. All players wholesalers like cardinal, pharmacies like walgreens. Benefit managers make more money when list prices increase. The unfortunate victims of the trends are patients. So basically in that quote youre admitting that high list prices are hurting consumers and creating profit for Drug Companies. Yet you continue and did this last spring, to push the blame. Here you have said its everybodys got a part to play. But may at a conference you pushed the blame on everyone but pharmaceutical companies. Saying setting list prices is something that everyone though setting list prices is something that manufacturers directly control. You have also blamed Insurance Plan designs for high drug prices. Its really the list price set by manufacturers that is driving the increases in what consumers are paying. Requiring lower cost sharing will lead to increase premium. I want to ask now that you will be taking off your Pharmaceutical Company hat. And will be responsible for advocating for consumers do you think its time the federal Government Take Action to limit the profit Drug Companies can make offsetting high list prices . The way we limit insurers right now. In my earlier remarks i certainly didnt mean to be suggesting that list price fts irrelevant or far ma isnt have a piece of this also. The challenge is as we think about the burden on the patient when they walk into the pharmacy, if the list price is 500 and they have to bare that 500 or if the list price is 250 and they have to bare that. Both of those can be unaffordable for the patient. So my point is where i want to work. Im way over. Were running out of time. Without some action by us it will be passed on in the insurance premium. Which will become unaffordable. Thank you. I too want to continue along the same lines that senator was asking you about. And also what we were talking about in round one of questioning. You mention your example at 500 a month. I told you a story earlier about greg from wisconsin. That mention die ann who lived in wisconsin has ms. Has taken medication or 23 years. To slow the progression of her ms. And kwh she became medicare eligible and therefore the way in which the family was insured and paying for medication, she and her husband had a heartbreaking discussion at the beginning of the year where by she and he decided that she would stop taking the medication. That reached 90,000 a year. No changes as far as i know in the ingredients or manufacturing process or anything else. It just had crept up, crept up. Over all of that time. So i want to return to the issue of transparency. We talked about this yesterday. I have offered along with my colleague mccain the fair drug pricing act. Which would require basic transparency from drug corporations. Understanding its a complex system. But that the list price setting starts with the drug corporation. It would require disclosure to the department of hhs. On elements like executive pay. Investment and research and development. Investment in marketing. Stock buy back. Etc. As a way to inform policy makers. So we can take better and stronger approaches to this crisis. In many respects. What are your views on requiring Drug Companies to make basic information public when they are intending to increase the list price of existing drugs . Even as i refer to in my opening, i generally am in favor of increase transparency within the Healthcare System. Its a good thing. We need to look to see if there might be counter productive aspects. As we discussed. We have to be careful there. As a general matter transparency can be good and useful. I would be happy to study that and work with you as part of the options that need to be on the table to think about this. Does help with reducing what a patient pays out of the pocket . Reducing list prices. Does help with reducing what the system ends up paying . Im very open to looking at these options with you. One note i want to make. Oftentimes the difference between pharmaceutical product prices in the u. S. And over seas has pointed back to the investment in research and development. In recent years the investment if you can call it that in stock buy back and dividend pay out has surpassed that of our. Is that a troubling trend in your opinion . I dont study the financials of the companies on buy backs for instance. But i certainly believe that one of the bedrocks of the rnd industry is the heavy investment. Where i was employed it was upward of 20 to 25 of revenue was invested. A large percent in the United States. As we talked earlier at the hearing, in reference to some of the entities that buy a product and increase the price. I am very supportive of that type of intensive work. Obviously if im in the role. I dont know the particulars of that. That issue. I havent connected the two things. Im very supportive. Its quite striking in a academic report i think earlier this year, i think over half a trillion dollars invested in stock buy back. And less than that now in the rnd. Its not specific to the pharmaceutical industry. But very pronounced in the pharmaceutical industry. The last point i would make is just to note for the record that i actually agree with President Trump regarding his emphasis on authorizing the secretary of hhs to negotiate directly with pharmaceutical companies. For lower drug prices in medicare. And hope that that is something that you will embrace. If confirmed. Thank you. Senator white house. Thank you, chairman. We talk nd the our last conversation about Accountable Care organization. Ways we can deliver better care at less expense. Theres another much more particular area where i think theres another by partisan opportunity. To improve care. In this case it would probably lower expense but that wouldnt be the point. Thats end of life care. Advanced care. Theres a very good group that you maybe familiar with called the coalition of advance care. That has very broad corporate and Institutional Support thats focusing in the areas. Active in the space. We have huge support from the catholic state in the country. The state counsel of churches has been helpful. Our Major Hospital groups and medical society have been extremely helpful. What we see is from time to time we bump up against problems within the medicare and medicaid billing system. Which in a general world might make sense. Once a state or community has decided its going to under take a path to deal more humanely with people in near the end of their lives suddenly those prescriptions become obstacles. And i think do more harm han good to the patient and probably the public as well. Heres my example. Medicare and medicaid patients arent supposed to receive both hospice care and Curative Care at the same time. If youre seriously focusing on the care of an end of life patient thats a completely stupid distinction. To force into the situation. Nurse practitioners have way too small a role in their role could be increased. The whole two night three day in patient stay rule. Before somebody can be moved ento a nursing home is nonsensical. In the context of somebody operating under a good end of life care based plan. Home Health Services ought to be provided without having to meet the whole definition of being home bound. Very often a dying patient can still move arn for a for a whil and is not fully homebound, but it will be cheaper for the system, better for the family, easier for the loved ones who are providing care to get home Health Services. So that rule, again, back fires. Finally, caregivers often need respite, and respite care is a very valuable thing because without that, you wear out the caregiver and now the system has to come in under vast expense pick up with potentially even inpatient treatment. Homebased respite care, where you dont have to put your Family Member into an inpatient place while you get your couple of days of respite would seem to make a ton of sense. None of those things are being done. And the result is that this very precious time life towards the end states want to make it better, that want to make sure that the wishes of the patient are honored and that its clear around the family what those wishes are so there arent horrible fights at the end of life, all of those things can be made so much better. And here is the government with all of these rules that may make sense, again, in isolation, but once you start to deal with end of life care in any kind of a comprehensive and humane fashion they begin back nierg your face. Will you work with us, particularly with rhode island to try to support models . We dont need to get rid of them entirely, but what we really want to do is to support waivers so when a state or a Community Steps forward with a really good humane im saying this sitting next to senator baldwin whos state is legendary for end of life planning by the way, so i dont i should give wisconsin some props here as well. Would you help us with that . So, senator, i just want to thank you for those very thoughtful comments and reflections. You know, as i mention in my in my opening remarks, my stepmother wilma died just in july and it was a blessing that she was able to be in her house in her bed for the whole time. Yeah. And i want to make sure people have that chance. And so, you know, happy to work with you. I think i think what we will find is that it actually helps the public fisk as well. But to be perfectly blunt, i dont actually care if we have to spend a little bit more money so the people at that the very tender time of their life and the family who are surrounding them at that very tender and important time life arent treated disrespectfully and arent pushed to make dumb decisions based on bureaucratic rules that simply dont make sense at that time. So, god bless you and thank you. Thank you, senator white house. Senator murray do you have any Closing Remarks or questions. Thank you so much for you and your family sitting through this. I do have some additional questions and i would ask that we do get timely and sufficient answers to our questions. Weve had that problem before under secretary price and both before confirmation and after your confirmation just really respectfully ask that we get timely answers so that we did do our jobs as well. I did want to put one issue on the table that we didnt have time to address, and that is hhs plans for implementing the preschool Development Grants program. We authorized that in our every Student Succeeds act, its something im very concerned about and im going to be watching very closely to make sure that that really Vital Program is implemented the way that congress intended to so that it helps us expand access to high quality, Early Learning and care for our most vulnerable children. I will follow up with you but know that i will be following that closely. Thank you for being here. I know youve got another hearing go through, numerous questions, well be looking at all of those. But if youre confirmed i want you to know that we will talk to you, work with you, and hope that you will be as responsive as we need to you be. Thank you, senator murray. Mr. Azar, thank you for being here, for your willingness to serve, for answering the questions. I do hope you will respond to the senators questions and we dont have any limit on the number of those questions but i hope there will be a reasonable number of questions. About a third of the members of this committee are also a member of the finance committee which is the committee that will vote on your confirmation and report it to the floor of the senate. I think youve seen today the diverse points of view on this committee and some people how we wonder how we could ever get anything done. But the fact of the matter is we get quite a bit done. Couple years ago we we fixed no child left behind in a twha president obama called a christmas miracle. Last year was a 21st century cures legislation that the majority leaders said was the most important legislation of the year. Youll have a chance to implement that legislation as well as the Mental Health reorganization that was a part of it. This year weve worked, senator murray and i have worked to see if we could find some area of agreement, even though its for shortterm on the Affordable Care act, which we were able to do. Its not law yet, but we were at least able to take a step. So there are a number of areas, and youve heard many of them today, senator whitehouse suggested two different areas of bipartisan legislation. Theres a lot we can do working with you and i think youll find that most us would like to create an environment in which youre able to succeed and will not be shy about giving you our points of view as you are able to tell today. My hope also is that we can talk about more and work with you on more than the individual insurance issue. For the last seems like forever, we have focused on Health Insurance and only 6 of the americans who buy Health Insurance on the individual market, theyre every single one important, but year after year we give ourselves, you know, its like going to college and taking only one course and earning a c, d, f on it every semester. We dont seem to be making very much progress. And the important thing about it is theres so much other important that we should be working on when we talk about health and healthcare and the agencies that you work on. Drug pricing is one this committee has a great interest in. I, for one, am excited about the fact that you know something about this. Health insurance is complex. I think drug pricing is businessen teen, and i think if we had a secretary who was new to the subject that he or she would leave after two or four or eight years without having accomplished much of anything because it would have taken that long to understand whats going on. You arrive knowing the subject and helping us answer the question where does the money go. Do we really need rebates . Can there be more negotiation on drug pricing . Should we really think seriously about finding a way to let americans buy drugs in the United States that are not approved by the food and Drug Administration . We havent ever done that before, and several senators think we should and well need to talk about that. We should be talking about wellness. Weve had two or three hearings on that that offers great promise for reducing healthcare costs. Electronic healthcare records weve talked about. Biomedical research, we hear a lot about the president s budget proposals and less about the fact that senator maur ray rand blunt for two years, hopefully for three, have increased funding for National Institutes of health at 2 billion a year and we added another 4. 8 in the 21st century cure. So were putting big new dollars into the National Institutes of health as well as big new authority into nih and the fda, all of which you will have a chance to take advantage of and to make something of. So i think its a very exciting time for your experience and background and energy to to come to this position. I think you can help families all over america and i hope if youre confirmed, which im confident you will be, that you will look to this committee both the democrats as well as the republicans as a resource to create an opportunity in which you can succeed. I ask consent to introduce four letters of support for alex azar into the record which it will be done. If senators wish to ask additional questions of our nominee, questions for the record theyre due by 5 00 p. M. This friday, december 1st. For all other matters the hearing record will remain open for ten days. Members may submit Additional Information for the record within that time. The next meeting fortunate Health Committee will be a hearing tomorrow, november 30, at 10 00 a. M. To hear from experts on the Opioid Crisis. Thank you for being here. The committee will stand adjourned. Join us on cspan 3 this weekend for American History tv. There here are a few highlights. Saturday at 3 00 p. M. Eastern in honor of the fifth anniversary of the 1967 public broadcasting act, the library of congress hosts a discussion about the history of news and Public Affairs programming with former pbs news hour anchor jim layer, he and talk show host tic cav vot. And at 8 00 p. M. , university of kansas professor on the role of African American ministers and politics and how churches help americans gain experience with organizing and running for political office. Sunday, remembering elections of the battle of midway from four World War Ii Navy veterans who took part in the battle. Sunday at 4 00 p. M. On real america, the film dreams of equality featuring a recreation of the womens rights convention. American history tv all weekend every weekend only on cspan 3. Sunday night on after words, janette conan on her book man of the hour shes interviewed by bruce darling of the National Academy of sciences and National Research council. I think because of his entire wartime experience, he became convinced that the only way for democracy to survive the best way to beat our enemies and be a strong country was to have a great School System where we showed that democracy was better than dictatorship and that we would have sufficiently brilliant people, talented people in government and science. And the way do that was to have the s. A. T. Which he helped invent and produce in schools across the country to get what he felt were the kind of leaders and technically advanced people we would need in positions of power if we were going to be a great nation in the hightech world that he foresaw approaching in the 50s and he on american life. Watch after words sunday night at 9 00 eastern on cspan 2s book tv. Next a hearing on the global efforts to combatals heimers disease. We heard from officials that the National Institutes of health as well as experts in the fields. Held by a House Foreign Affairs subcommittee there are is