Transcripts For CSPAN HHS Nominee Representative Tom Price Testifies At Confirmation Hearing 20170129

You have described to a degree, but if you could elaborate can you describe how you will prioritize and oversee the larger range of issues for which you will be responsible. Tell us, what in your history has prepared you to lead the department of health and Human Services. Tom price thank you. As you and members know the mission of the department of health insert health and Human Services is to improve the health, safety, and wellbeing of the American People. In order to do that, i am committed to that mission. In order to do that you have to put together teams of individuals in east each sector of health and Human Services. My history of where ever i was or the work i did in communities was just to bring forward greatest quality of talent that we could assemble. The second is to understand the scope and the issues. Clearly having the experience both in the clinical arena as well as the legislative arena you can understand the scope of issues. Finally, focusing on results. Often times it gets kind of muddy here in washington, what we do. We name the programs. We make certain the resources are there to be able to provide the money for the programs to be run. Often times i think we dropped the ball on whether or not we are a college and commission. Are we truly improving the health and safety and wellbeing of the American People. One of the goals i have is to look at the metrics that we are looking at at the department and making sure that we are a couple she met mission. Publishing that mission. Accomplishing that mission. Began numerous initiatives, many of which have generated controversy. Could you tell us your position on the work and how it should or should not be continued in the future. Is soentative price it important to the quality of health care we need to provide. Innovation in fact is what leads Quality Health care. It is what expands the ability of Health Care Professionals to treat patients. Im a strong supporter of innovation. One of the roles that we as policymakers have is to incentivize innovation. The center for medicare, Medicaid Health innovation is one that might do that. I think however they have gotten off track. What they have done is defined areas where it is mandatorily dictating to physicians and other providers in this country how they must practice. Areaer it is a geographic including 67 or 68 areas in the country that have to perform a certain procedure in a certain way and use a certain implant in a certain way because the government says they have to without exception. Or whether it is 75 of the medicare drug demo, a demonstration product project , which dictates to physicians and other prayer letters providers what they must use. That to me is no longer an experiment or Pilot Project to determine whether or not an Innovative Solution might work. Changing the way that american medicine is practiced by folks making decisions here in washington, as opposed to patients and families and doctors making those decisions. Strong supporter of innovation, hope we can move cmm i in a direction that make sense for patients. Thank you. Medicare has lost more than 130 billion to improper payments in the last three years. The program has also been above the legal billing error Rate Threshold of 10 for the past four years. Trusteest medicare have issued concerns about looming medicare insolvency if we stay at the same spending levels, will your it ministration actively champion the Medicare Integrity Program so we can recover as much a much higher percentage of the billions of taxpayer dollars lost each year to billing mistakes and ensure that medicare will be in place for future american seniors . Also as a former practicing experiencewho has with medicare and Medicaid Programs do you have any insights into steps you think should be addressed to to address the multimilliondollar waste . Representative price nobody supports a bill that is not needed or has not been provided. This is one of those areas i think we need to focus on. I am certain that there are bad actors out there. I think they are a minority, but there are bad actors. I am certain if we were to focus specifically on those bad actors in real time, which is what happens in every other industry in the country. Realtime information is available and acted upon. Instead of trying to determine whether every single incident of care is necessary, if we were to focus on those individuals that were the bad actors specifically i think we could do a better job of not just identifying the fraud but ending at. Thank you. We will turn to you. Senator wyden thank you. I will start with the health care stock. Your position is that the trading was legal because in your view it complied with house rules. I think there are debatable legal questions and other matters. In eight immuno therapeutics is an obscure Australian Company who developed a treatment for immune system disorders and plans to seek fda approval. They are affected by congressional actions. Today the total value of your shares exceeds a halfmillion dollars. On the office of government ethics disclosure form you filed you significantly undervalued stock. You fail to include the value of more than 400,000 shares you bought at a significant discount during a private stock sale made available to specially chosen investors around labor day. You also significantly underreported the value of this purchase to the committee. It is worth more than twice what you reported. You heard about a stock from a health colleague who is a Board Director of this australian drug company and the largest shareholder. You got in on pricing placement, not available public to the public. In these placements you bought over 400,000 shares at discounts that were as much as 40 cheaper than the price on the austrian stock exchange. You are sitting Australian Stock Exchange. You are sitting on a committee over Major Health Care programs and trade policy. Yes or no . Doesnt this show bad judgment . Representative tom price if you said what you said was true. Wyden congressman, we have a paper trail for every comment. Yes or no, doesnt this show bad judgment . Representative tom price no. Lets let him answer the question. You kind of indicated he did something wrong. Let him explain why it was not wrong. Senator wyden it was a yes or no. I want to have him handle the problem. Senator wyden maybe it would be helpful if you laid out the accusation. Purchased stock in an s trillion Australian Company at discounts not available to the public. If i may, they were available to every single individual that was an investor at the time. Wyden that is not what we learned from company filings. Company filings at the Australian Stock Exchange state that the specific private placement would be made below market rate. Says, itury department is only offered to sophisticated investors in a nonpublic manner. We have a paper trail for everyone of the statements that i have gone into. Is set ontotocks committees, introducing legislation that directly impacts the value of the stocks. What legislation without being . Would that be. Senator wyden we will take you through various bills. Tom price the reality is that everything i did was ethical, and transparent. The reason you know about these things is because we have made that Information Available in real time as required by the house ethics committee. There is not anything you have diebolds here that has not been public knowledge. Wyden your stake is more than five times larger than the figure you reported to the ethics officials when you became a nominee. Tom price if you had listened to your Committee Staff i believe you would know that our belief is that that was a clerical error at the time the 278 u. S. Filed. 278 e was filed. We dont know whos and it was on. There was no malicious senator wyden congressman, you also reported it to a questionnaire to the committee and you had to revise the yesterday because it was wrong. Tom price the reason was when asked about the value i thought it meant value at the time i purchased some another value at a nebulous time which supposedly senator wyden this weekend the president issued a executive ordern instruct me department and agencies to do Everything Possible to roll back the a portable care act. If confirmed he will be the captain of the health team and in charge of him lamenting the order. Yes or no and lamenting the order. The executiveer order will you commit that no one will be worse off. Price i commit to working with you and every signal member of congress to make sure that we have the highest Quality Health care and every single american has a this to affordable coverage. Senator wyden that is not what i asked. I asked will you commit that no one will be worse off under the executive order . When you guarantee that no one will lose coverage under the executive order . I guarantee you that the individuals that lost coverage under the Affordable Care act we will commit to making certain they do not lose coverage under whatever replacement plan comes forward. That is the commitment i provide. Senator wyden the question again is will anyone lose coverage. You answered to something i did not ask. I will wrap up by saying come up by saying, what you commit to not implementing the order until the replacement plan is in place . I commit to you and the American People is to conduct keep patients at the center. Everyeans making certain single american has access to Affordable Health care that will provide the highest Quality Health care the world can provide. Senator wyden i will close by saying is what the congressman is saying is that the order could go into effect before there is a replacement plan. An independent expert says this could destroy the market on which millions of working families buy health care. ,n the questions that i asked will the congressman commit that nobody will be worse off, no one will lose coverage, we did not get an answer. Thank you. Chairman how can anyone commit to that . You havey, dr. Price, been accused of investing in securities and you disclosed the wrong value of shares you owned in immunotherapeutics. Dr. Price hass a diversified portfolio with Morgan Stanley in a broker directed account. Correct me if i am wrong on any of this, dr. , the portfolio includes both health care and nonhealthcare stocks. His Financial Advisor design the portfolio and directed all trades in the account. And not dr. Price has the discretion to decide which securities to buy and sell. On march 17, 2016 in a periodic rebalancing of the portfolio, the Financial Advisor directed the purchase of 26 shares in Zimmer Biomed worth under 3000. Price ofer notify dr. The purchase on april 4, 2016. On hisce disclosed them report on april 15. Began his legislative effort related to the copperheads of joint republic replacement project in 2015. With one exception, all of his stocks are held in three broker directed accounts. Direct he nor his wife or provide input regarding investments in these accounts. Immunotherapeutics is the one exception. Dr. Price decided to invest i will based on Public Information regarding his work on multiple sclerosis treatment is a disease as a disease. He has involved himself in treatment for years. He has put his own research into the company. Invested money in the company in january 2015 and report of the investments to house ethics in february of the year other than in february of that year. He also disclosed other investments. To divestas agreed all shares. Is that a correct . Tom price that is correct. I want to point out that anybody who knows me well knows that i would never violate the trust. I know the environment that we are in. You mention it in your opening statement. I appreciate you correcting the record. Collect mr. Chairman is to chairman, you just consumed two minutes beyond your opening statement. In the interest of fair play, is it appropriate for someone to note that two minutes is also owed to senator wyden . We already did go over two minutes. S we go forward i ask u2 chairman i will not link wish my role as chairman. I have always been good about giving time that you need. I will try to do that. Thank you. Chairman i will not allow things that are false to go forward without some sort of comment. We just cannot allow that to happen. Mr. Chairman, a unanimous dissent request. Bipartisan disclosure memo, i would like to ask that it be made part of the memo. Chairman without objection. Senator roberts. Senator roberts did you really wink at me and smile . Bless your heart. Thank you. Good doctor, thank you for coming. I think it is important to make clear off the bat that even if congress and the Incoming Administration were to do nothing, absolutely nothing amending or repealing parts of the Affordable Care act, the law is not working . It is collapsing. The prices are unaffordable and the markets nearly nonexistent. Few options to several states and counties. This year one out of every three counties in this country only has one insurer offering coverage on the exchange. What tools do you have, or will you have when you are confirmed which could be utilized over the next couple of months to provide individualnd improve insurance market, make them more appealing so that carriers will want to come back and provide more Coverage Options as we transition away from the Affordable Health care act . I think it is important for us to admit what the American People know that that is that this law is not working. Certainly has not been working for folks in the individual and group market. Premiums are up significantly, they were supposed to go down by 2500. There more than that. You have deductibles that have escalated to 600012,000 dollars. As you mentioned, you have states where there is only one provider. You have one third of the counties in this country where there is only one carrier. This is maybe working for government or Insurance Companies, but not patients. Try to reconstitute the individual in the Small Group Market. That begins by providing stability in our conversation and town. Tone. Those providing Insurance Products across this country, we understand. We hear the challenges that you have. They are exact exiting the market. We need to say, there is help on the way to allow us to reconstitute the individual and Small Group Market that allows for folks to gain the kind of coverage they want for themselves and their families, not that the Government Forces them to buy. It allows them to purchase coverage at a reasonable amount that makes it so they do not have deductibles that are out of through the roof. Where they dont have the ability to pay the premiums and the deductible. There are so many things we are to focus on to make sure, again, the American People have access to the highest quality care that is affordable for them. Dr. I have 84 critical access hospitals in my state. It is part of the Rural Health Care delivery system, under great stress. Have seen when i visit with hospital administrators all throughout campus kansas, there was a time when i knew every one of them. They are scratching their heads over regulations coming out of hhs cms. All of the other agencies that you oversee when you were confirmed. I mentioned the use program for Electronic Health care records. Minutesused to spend 10 or 15 minutes with patients, it is down to two minutes or three minutes. Criticalur rule for access hospitals numerous other documentation requirements it seems to me there is a lack of understanding of our provider shortages in rural areas. We are hanging on by a thread. How these one size regulations from washington simply do not translate to rural areas. My question is, how will you work to ensure an effective but smarter them a less burdensome rule making policy process . Critical, this is because as you mentioned in rural areas, georgia is the largest state east of the mississippi and we have a large ovulation. Critical access hospitals are so important to communities around the state, and truly around the nation. The regulatory scheme put in place is choking the individuals actually trying to provide the care. So much so that you have physicians and other providers leaving the practice. They are leaving the care of patients. Not because they have forgotten how to do it or they grew tired. It is because of the onerous nature of the regulatory scheme coming out of washington dc. The meaningful use process project you mentioned takes it more difficult. We turned physicians into data entry clerks. A you just have tosk what they are to ask whether are doing and you see patients at the top of their head, as they punch information into a computer as opposed to that sharing of information that is so vital between a physician and patient. A recognition of the problem is important. A recognition of the importance of Rural Health Care in the nation and how it needs to be bolstered up. Looking at the consequences of what we do as a government. As i mentioned, often times i dont think we look at the consequences. We pass the rule and regulation, we instituted, we think it is the greatest thing since sliced bread, but it is in fact harming the very individuals trying to provide care. You dont get that information unless you ask. I appreciate that. My time is up. Thank you. Congressman, i enjoyed our visit yesterday. Discussion when you were kind enough to come visit that i have,fact in the state of florida, 4 million plus seniors on medicare. Of the idearified of privatized medicare. I talked to you about this. You talked about the premium support system that youre advocating. Study that wasa done by a ceo. You mentioned you would send me a copy. We have not gotten it. Got itdid i went and myself. It is september of 2013. Is opposite ofes what you said with regard to high cost states, like florida. Senator nelson medicare is going to be spending 4 lower under the proposal that you are talking about in this report. Lower than current law and beneficiary costs will decrease by 6 on the average, which is what you said yesterday. In high cost regions, like aorida, youre going to have higher beneficiary costs than current law. Under your premium support proposal. Would premiums in florida 125 according to the page 71. On and as the annual premium highcost region, like florida, would be 3600, compared to the current law of 1600. That is the 125 increase. So, please help clarify what you are saying yesterday as it applies to florida. Tom price thank you. I enjoyed our time together as well. When we talk about medicare it is important for everyone to appreciate as i know that you and your colleagues to that the medicare trustees, not republicans or democrats, the trustees have told all of this us that medicare in a short amount time, less than 10 years is going to be out of the kind of resources that will allow us as a society to keep the promise to then a fish year to beneficiaries. That means that we will not be able to provide the services to medicare patients at that time, which is close if nothing is done. My goal is to work with each and every one of you to make certain that we save and strengthen and secure medicare. Ofhink it is irresponsible us as policymakers to allow a program to continue, knowing knowing that in a few short years it is not going to be able to cover the services that we are providing. That is the current Medicare Program if nothing is done. Role, if i am my able to be in confirmed and i have the privilege of serving as a secretary of health and Human Services, my role will be one of carrying out the law that you all in Congress Passed. It is not the role of a legislator, which i had when i was working to try to formulate ideas to hopefully generate discussion and give a solution. Let me be so rude as to stop because i am running out of time. Remember that donald trump in the Campaign Said that he was not going to cut medicare spending. You in also point to legislative solution one of the greatest examples on medicare is 1983 when we were just about to go bust. Two old irishman, reagan and oneill to agree to come to medicareent that made in this case, it was social sounds forry the next century. Representative price, you made a terrible that it was a of people who had preexisting conditions, that they would have the protection of insurance against those preexisting conditions. Ask you is, like to of you please in light President Trump expressing his desire to retain this basic protection, you think his proposal to continue the ban on discriminating against people with preexisting conditions is a terrible idea . Tom price i am not certain where youre getting that quote from. Politico talking points memo may 1, 2012. Tom price there is a reliable source. What i have always said, senator, is that nobody, nobody. You did not say it was a terrible idea . Tom price i dont believe i ever made that statement. About have always said preexisting conditions is that nobody, and a system that pays attention to patients, no one should be priced out for having a bad diagnosis. That might work for government and Insurance Companies, but not for patients. I believe firmly that what we need is a system that recognizes that preexisting conditions do indeed exist and we need to accommodate it and make certain no one loses their insurance or is unable to gain insurance because of a preexisting condition. Senator nelson as i close, i would like to insert in the record of the september 2013 Congressional Budget Office analysis of premium support system for medicare. You, congressman, to please respond with the cbo report that you said yesterday that supports your position. This one is not. Does not. Tom price i look forward to that. Thank you. Congratulations, congressman price. Andn your medical training time spent as a practicing physician, i have a couple of simple yes or no questions. In your medical opinion does hiv cause aiods . Tom price i think the Scientific Evidence is clear that hiv and aids are related. In your own opinion have immigrants led to the outbreak of leprosy in the United States . I am sure there are instances where individuals have an infectious disease. I am asking specifically about immigrants causing leprosy in the United States . In your medical opinion and scientific back ground . Representative price i dont know the incident to which you refer . Are you referring to a specific incident . Senator menendez there are statements made in the Public Domain that immigrants have led to the topic of leprosy in the United States, as a appointed director of health and Human Services, i want to know, in your medical opinion is there such a causation . Tom price any time you get to individuals together in any relationship, whether immigrant or visitor and one individual has an infectious disease, it is possible that individual transmits that infectious disease. Whether it is the flu any infectious disease. Sen. Mende does menendez do abortions cause Breast Cancer in your medical opinion . Rep. Price the science is relatively clear that that is not the case. Sen. Menendez in your medical opinion, do vaccines cause autism . Rep. Price the science says it does not. There are individuals across the country sen. Menendez i am not asking about individuals come i am talking about science. Because you will head a department in which science, not alternate universes of peoples views, is going to be central to a trillion dollar budget in the health of the nation. Can you commit to this committee and the American People that should you be confirmed, you will swiftly and unequivocally debunk false claims to protect the Public Health . Rep. Price i will commit to doing the Due Diligence that the department is known for and must do to make sure factual information is conveyed. Sen. Menendez and that factual information will be dictated by science, i would hope . Rep. Price without a doubt. Sen. Menendez let me ask you about medicaid. I am a little taken aback on the answer on the question about immigrants and leprosy. I think the science is well dictated. Ask, one of the most beneficial components of the aca was the expansion of the Medicaid Program that resulted in 11 Million People nationwide gaining coverage, many for the first time. It is one of the biggest programs on the republican chopping block, with proposals to not only repeal the affordable Medicaid Expansion but gutting billions in federal , funding to the state. There is no doubt that this would result in catastrophic loss of coverage for tens of millions of low income families and lead to tens of billions of losses to safety net and other Health Care Providers. Do you recognize medicaid to be a valuable program and consider the coverage it provides the 74 million americans to be comprehensive . Rep. Price medicaid is a Vital Program for health care for many individuals in this country, but one that has significant challenges. One out of every three physicians who should be seeing medicaid patients are not taking any medicaid patients. There is a reason for that. If we are honest with ourselves, that would be asking the question why. Sen. Menendez if that is the case, that one in three dont treat medicaid, is that because medicaid reimbursements are low . And since provider reimbursements are set at a state level, will not cut federal funding, and hitting states with higher costs only lead to lower provider rates . How many doctors would actually treat former medicaid beneficiaries when they no longer have any coverage or ability to pay . Even if there is only one of three, there are still two of three providing the services. Imagine if you do not have coverage. The ghost my next question goes to my next question you have advocated to in essence block grant medicaid. The essence of medicaid is an entitlement, which under the law, means if i meet these criteria, i have the right to have that coverage under the law. When you moved to a block grant, you remove the right and you make it a possibility subject to whatever funding there will be. Do you recognize that in doing so, you risk the potential of millions of americans, who presently enjoy Health Care Coverage through medicaid, no longer having that right . Rep. Price i think it is important to appreciate that no system that the president has supported or i have supported would leave anybody without the opportunity to gain coverage. Nobody. Sen. Menendez that is not my question. Let me reiterate. Medicaid, under the law as it exists today, is a right. Is that not the case . Rep. Price it is an Entitlement Program sen. Menendez doesnt that mean if you have the right if you meet the criteria, you are entitled to the services . Rep. Price one is eligible, that is correct. Sen. Menendez when he moved to you moved to a block grant do , you still have the right . Rep. Price it would be determined how it was set up , if in fact that was what congress did. The role of the department of health and Human Services to administer the laws that you pass senator menendez i would simply say to you in our private , conversation i appreciate you coming by to visit, you suggested your role was the administrator of a large department. That is not what the Vice President said when you were nominated. He said he expected your experience both medically and legislatively to help drive policy, and even beyond the expectations of the Vice President in that regard, when we have regulatory abilities of the secretary to dictate regulation, that is policy. Please dont say to me that i am here just to do what congress says. I respect that you will follow the law and do whatever congress says, but you will have an enormous impact, and based on your opinions on medicaid, block granting means a loss of life. That is a question of funding. We will have a bigger problem with the number of providers willing to provide. I hope we can get to a better understanding of your commitment to medicaid as it is, as an entitlement, as a right. Senator, your time is up. We will go to senator carpenter. Sen. Carpenter welcome to you and your wife. There is a verse of scripture that you mentioned, in the new testament, matthew 25, that says, when i was hungry, did you feed me . When i was naked, did you clothe me . When i was in prison, did you visit me . When i was a stranger in your land, did you take me in . It says nothing about when my only access to Health Care Coverage was going into the emergency room of a half itll did you do anything about it. With the acao do was to do something about it. Room, we did not invent the Affordable Care act. The genesis goes back to 1993 when Hillary Clinton the first lady was working on what was called hillary care. A group of senators led by john chafee, the republican from rhode island, developed legislation cosponsored by i think 23 senators, including senator orrin hatch and senator grassley. What he did in the legislation, what he proposed was to use five major concepts. One, to create large purchasing pools for folks who otherwise may not have access to coverage. He called them exchanges or marketplaces. He also proposed that there be a sliding scale tax credit to bring down the cost of people getting coverage in those exchanges. The third thing he proposed was the notion that there should be an individual mandate. They wanted to make sure people got covered. They realized that they did not mandate coverage, then you would end up with insurance pools that Insurance Companies couldnt begin to cover. It would be unworkable. He proposed as well, an employer mandate and he proposed as well, the notion that people shouldnt lose their coverage because of preexisting conditions. Those are not democrat ideas, those were proposed by republican leadership, actually. In the congress at the time. When governor romney developed his own plan in massachusetts a decade or so later, he borrowed liberally from those ideas. You may recall, the institute of what others call romney care, they did a pretty good job covering people, but not such a good job on affordability. What took place over time is, they found out they had insurance pools where a lot of the people were not young or healthy they were older and , needed more health care. As a result, the Insurance Companies, in order to stay in business had to raise premiums. , i dont know if any of this sounds familiar to you, but it sure sounds familiar to what we have seen in the last six years or so with the Affordable Care act. Through the ideas of senator chafee and governor romney, we asked have added things. We have encouraged states to increase the number of people they cover under medicaid by raising through 135 of the Poverty Level that people could receive health care. Onhaving courage they focus prevention and wellness. Trying to make sure people stay healthy in the first place. We provide funding for contraception. We provide funding for programs that are intended to reduce obesity. We have programs that are intended to reduce smoking, the use of tobacco. This is not a yes or no question. What was wrong with that approach . What is wrong with that approach . The last thing i will say is before you answer, the health , Insurance Companies found it difficult to stay in business in the state groups, the exchange across the country. One of the reasons why they were unable to is because i think, we didnt raise the fine, or if you will, the incentive was not high enough to get young, healthy people, like my son, into the exchanges across the country. S p has just put out about a month ago, an update looking at the Financial Health of the health Insurance Companies in this country. They have tried to figure out how to price this product, and it seems like according to s p, they seemed to have sort of figured it out because the health Insurance Companies have begun to stabilize, your reaction to this please. Rep. Price as i mentioned either in my opening or in response to a question the , principles of health care that all of us hold dear, affordability and accessibility , and quality, and choices for patients, i think are the things that we all embrace. The next step, how we get to accomplish and meet those goals and principles, is where it takes Work Together to do so. The program you outlined has much merit, whether it is making certain the individuals with preexisting conditions can access coverage, whether it is the pooling mechanisms, there are a lot of merits there. What i am hopeful we are able to do, in a collegial bipartisan way, Work Together to solve the remarkable challenges that we have. One of my physician colleagues used to tell me he never operated on a democrat patient or a republican patient, he operated on a patient. That is how i view the system. It is not republican or democrat, it is a system that hopefully, we are focusing on the patients to make sure they have the access to the highest quality care possible. Sen. Carper let me conclude by saying i will use an analogy, there is a large building and there are people in the building and was a fire in the large building but for some reason they couldnt use the stairways or the elevators. They looked out the windows and there were firefighters in the street, saying, go ahead and jump. We will save you. They dont have any safety nets. My fear is, if we repeal what i described, that we put in place, which were founded on republican ideas, good ideas, and we dont have something at least as good in place to catch those people as they fall from the building, we are going to do a disservice to them and our country. Senator burr. Sen. Burr the Affordable Care act was not passed with one republican vote in the house or the senate. Dr. Price, a couple questions to cut to the chase. Are all of your assets currently disclosed publicly . Rep. Price they are now and they always have been. Sen. Burr are you covered by the stock act legislation passed by congress that requires you and every other member to publicly disclose all sales and purchases of assets within 30 days . Rep. Price yes, sir. Sen. Burr you have been accused of not providing the committee of information related to your tax and financial records that were required of you. Are there any records you have been asked to provide that you have refused to provide . Rep. Price none whatsoever. Senator burr all of your records are in . Price ntative absolutely. Sen. Burr does it trouble you at all, as a nominee to serve in , this administration, that someone will hold you to a different standard than you as a member of congress . I might say, the same standard they currently buy and sell and trade assets on, does it burn you that they want to hold you to a different standard now that you are a nominee than they are as a member . Rep. Price well, we know whats going on here. Sen. Burr we do. Rep. Price as my wife tells me, i volunteered for this. Sen. Burr you and i have a lot in common. We both spoke out in opposition to obamacare early. We predicted massive premium increases. When the president promised, if you like your doctors, you can keep them, if you like your plan, you can keep it, we both said these promises would be broken, and they were. Over the last seven years, you and i, senator hatch, and others, have written our own Health Care Plans because we were, i think, brave enough to say, if youre going to be critical of something put your , ideas on the table. In your opinion, was it clear to the American People that repeal of obamacare was a promise that donald trump before he was elected president . Rep. Price i have no doubt that it played a prominent role in this past election, and the president is committed to fulfilling that promise. Sen. Burr as the nominee and hopefully, i think you will be the secretary of hhs what are , the main goals of the obamacare replacement plan . Rep. Price they are outlined in the principles, it is imperative we have a system that is accessible for every single american. That is affordable for every single american. That incentivizes and provides the highest Quality Health care the world knows, and provides choices to patients so they are the ones selecting who is treating them, when, where, and the like. It is complicated to do, but it is Pretty Simple stuff. Sen. Burr i want to thank you for not only testifying here, but in front of the Health Committee where john and i had you over there. You are brave to go through this, but the country will be much better off with your guidance and your knowledge. I yield back. Senator cardin. Sen. Cardin thank you and your family for being willing to do this. I want to talk about a few issues in the time i have. Yesterday, the president by executive order reinstituted the global gag rule, but he also did it in a way that is more comprehensive than the previous. The new policy would prohibit any federal aid to foreign organizations that provide or promote abortion. In the past the policy only applied to organizations that got global familyplanning money, now it will apply to Global Health funding. Potentially including Maternal Health programs and efforts to stop hiv and aids. My question is, if confirmed, how will you make sure that the u. S. Can fully participate in these Global Health efforts to help Maternal Health, to help stopping the spread and and the and ending hiv and aids, to make sure the next zika virus, that we can contain it so it doesnt cause the catastrophic effects. Gag rule isl enforced in a way that prevents us from participating in International Health organizations. Rep. Price i appreciate the question. The department is full of all sorts of heroes, and incredibly talented individuals. My goal, if i am given the privilege of serving, is to gather the best minds and the best talent we have within the department and without, and the determine the wisest policy for this nation to have as it relates to infectious disease. No geographic boundaries. We do incredible work, the work the cdc does and the work done by others in our nation that try to prevent infectious disease, worked to detect the spread of infectious disease, and provide a logical and methodical and aggressive response to the outbreak of any infectious disease. It is vital to protect the American People and we are committed to doing so. Sen. Cardin i hope you will look at perhaps unintended consequences from these executive orders that could compromise our ability to be as effective as we need to using all tools at our disposal. I want to get to tobacco regulation, an area that i think is now clear within the medical community, the impact that tobacco has. The fact that the family smoking prevention Tobacco Control act of 2009 authorizes the hhs secretary and the fda to regulate Tobacco Products, including restricting sale of tobacco to minors. The sale of tobacco to minors. It has been expanded to include the selling of ecigarettes. I know initially you did not support that legislation. If confirmed, can you commit to us that you would rigorously enforce that act to make sure our children are not subjected to the new forms of Tobacco Products . Rep. Price if im confirmed, the responsibility we will have is to enforce the law of the land and we will do so. Sen. Cardin this requires keeping up with new technologies used by the industry that may require modifications, as we see with ecigarettes. Are you prepared to not only enforce the law, but enforce our intent to make sure children are protected . Rep. Price i look forward to working with you on that. Sen. Cardin we will continue to debate the merits of the Affordable Care act. Im a strong supporter, and i think the millions of people who have coverage that didnt have it before, the quality of coverage that americans have now, and the rate of growth of Health Care Premiums are lower than they would have been. We will debate that later. The question is, what do we what is coming along. We have heard you say several times that the principles the president has articulated as to what would be in place of the Affordable Care act, i would like to drill down on the Central Health benefit. We talked about Preventive Care being available. We have now Mental Health and Addiction Services available. We know we have pediatric dental now available, which is important in my state because of the tragic loss of the monte driver in 2007. Can you assure us, as you look at what will be the Health Care System moving forward, that you are prepared to make sure that americans have Quality Insurance coverage to deal with issues like Preventive Care, Mental Health services, Addiction Services, and pediatric dental . Rep. Price what i can commit to is, i will do we will do all we can within the department with the knowledge and expertise that is there to define whether or not the program is actually working as intended or not. If coverage equals care in many instances, many individuals have coverage, they have a card but they dont have any care because they cant afford the deductible that allows them to get the care. We are committed to making certain that the Program Works, not just for government and the Insurance Companies, but for the patient. As you know we eliminated copays on preventative care. But i look forward to that. Senator isakson. Sen. Isaacson secretary to be, let me ask you a few questions. You have been asked a lot of questions with the intent of trying to get you to say, yes, you will cut medicare, when youre not trying to cut medicare. Yes or no. We have been hearing about the joint Replacement Program launched in your 2015. You and braced concerns about the program, saying it could harm patient care. Was this an administrative action to hhs that would cut benefits . Potentially yes. Cox last year, they propose a new way of reducing medicare spending on cancer drugs. Many of this oppose this. We are concerned with cutting benefits and there might be a cut to benefits for seniors. Is that correct . I believe so, yes. What about all the recent changes hhs has made to cut medicare . Nearly one third of beneficiaries are on advantage, with these not cut this . I believe so. My point being, anyone of us can sit at this table and say, give me yes or no answers and demonstrate the point we want to make. But all of us, are interested in saving Social Security for seniors, making medicare work and saving taxpayer money, is that true . Rep. Price yes. Senator isaacson one other point, any of us can take a financial disclosure, something they call desperate impact, when you take two facts and make a wrong, anyone of us could do it to disrupt peoples thoughts on somebody. It has happened to you a lot. People have taken things you have disclosed and try to extrapolate an evil that we keep you from being the secretary, when it should not be true. For example, it if you go to the annual report, there is an income fund. The Major Holding of that fund is pharmaceuticals, they are the people we jumped all over for the 2700 increase last year. We are not accusing the Ranking Member for raising prices. You could take that extrapolation out and indict someone . Is that not true . Rep. Price yes, sir. Wheel to be looking for the best person for the job and not trying to trick them into agreeing that something is wrong. I reserve the rest of my time. Senator wyden. I do not trade in healthcare stocks. My only point to senator funds,is you have mutual like most of us, they have holdings in pharmaceuticals. No one should accuse someone of holding pharmaceutical stock with a mutual fund. Continuing on this point of personal privilege. Mutual funds in particular, by independent experts ethics experts are considered a completely different category than personal trading and stocks. Even past republican ethics experts make that same point. They have never seen anything like the congressman has engaged in. Senator brown i struggled by the question,to if you repeal the Affordable Care act, will you commit that no one will lose insurance. Thats 22 million americans. That no one who loses will lose their insurance and you ignored the question and responded that no one who lost their insurance under the formal care act, to my knowledge, thats 2 million to 4 Million People, and almost all of them ended up getting reinsured, you said that no one who lost their insurance under the Affordable Care act will basically lose it after they have been reinstated. Ignored the 22 million and thats a problem we all face. I want to us you about something else. If you are confirmed, obviously, you will play a role in the repeal of the Affordable Care act. I would like to ask you yes or no questions. They really are yes or no questions. They are not meant as a trap. Turned down by Insurance Companies for 25 years before the aca. My question is, if you are confirmed, you will you maintain the current scope of the law and vigorously enforce discriminating the ban on discriminating against people with preexisting conditions. Representative price we will not abandon people with preexisting illness or disease. Were you commit to ensuring seniors who rely on medicare, continue to get the Preventive Care, no copays, no deductibles, continue to get Preventive Care with no outofpocket costs . Representative price Preventive Care and Wellness Care is vital for so many members of our population. Of i believe it is a part health care and health coverage. Senator brown i dont mean to be rude. But we did that under the aca. Stage for metastatic melanoma, she is still in her parents insurance. Her first three months of treatment cost 800,000. As secretary of hhs, if an insurer asks you for an exception on the current ban on , will youket maximums commit to stand up for patients like a grace refused to grant any insurer this exception . Price as ive mentioned, think patients should be at the center and that they have access to the highest senator brown undaunted as a goal, but your commitment that you will stand firm as the aca does on this provision of canceling care canceling insurance because they are too expensive. Representative price as i said, no one should lose their insurance because they get a bad diagnosis. Senator brown thanks to the law, alice benefits from contraceptive coverage. Will you protect the doctorpatient relationship by committing to ensure every womans right to access the form of contraception deemed best for her by her doctor at no cost as currently provided in the aca . Price ntative interception is imperative for many women in the system we all to have in place is one that allows women to be able to purchase the kind of contraception that they desire between brown, as the laws now the case in the aca. President trump said he is working with you on a replacement plan for the aca, which is nearly finished and will be revealed after confirmation. Is that true . is trueative price that he said that, yes. [laughter] senator brown not that he has done this before, but the but did the president lie . He said he is working with you. I know we dont usually use the word lie here because we are polite when president say statements that are true. Representative price i have had conversations with the president about health care. Senator brown which wasnt quite the answer. Will you commit with this president s plan, commit to maintain the protections for all ohioans that you just committed to and the replacement plan. Senator price our commitment is to make certain that a reasonable american has access to the highs quality coverage and care possible. Sen. Brown is the less sure if the president lied to us, the public, whether he is working with you. It sounds like you did. I want to find out about the childrens Health Insurance or graham. You said last week to staff that it has been a remarkably successful program. You once earlier had said it sounds like socialized medicine to you. I dont quite know that means. 95 of children in america are currently insured. 95 of americans are insured now because of Medicaid Expansion. This, funding for chip, think you know is set to expire in september. Would you advise the president to support an extension of chip and the pediatric quality be on the end of this year . Price ntative absolutely. But i want to expand. After last weeks hearing, the question was asked, quoting me that chip was socialized medicine. So i looked back at that article. As so often happens come as you well know, this may never have happened to you, but it was a characterization in the article by the author of the article to push a political point of view. I knew it was the case because i rarely if ever have used that word. I talk about patients as being the focus. Senator brown thats fine. Onchip, last week, a report to Congress Said we should currently expand the chip program for five more years. The you agree with this . Representative price i think it ought to be looked at and extended. Senator brown for five years . Price if wee could expand it for eight, that would be better than five. Sen. Brown ok. First of all,n dr. Price, thank you very much for your willingness to serve you and we need you. A couple of weeks ago, Congress Passed a budget resolution to a set of the process that gives the possibility of replacing the Affordable Care act with policies that were better, certainly to reduce skyrocketing Health Care Costs that have affected my constituents in ohio. It is not just the premiums. But the decibels and copays. I did join with for my colleagues. We talked about introducing an amendment that would have ensured that we would have time for the next step in the process and i think we got assurances for that. We need somebody at hhs in place who can work with us to be sure the legislative and administrative policies are working together and done carefully. Prior to the Affordable Care act, we had imperative insurance in ohio. Now we dont. Due to the increased relations and mandates, we have a dramatically decrease in competitive market. We had 17 insurers offering plans last year on the exchanges to 11 now. Now that 20 counties only have one company i offering offering plans. Now that we have begun this process of replacement and the president has issued this executive order, what can we do, tot efforts can you take ensure that my constituents in ohio have access to a portable Health Care Coverage with a Healthy Insurance market . Representative price what you laid out is the challenge that we have across the nation. Its important to appreciate that things have gotten worse for the individual and Small Group Market. That it is i believe a direct result of policies that have come from washington, d. C. , directly from the a formal character. If we are honest with ourselves and honest with their constituents about tried to solve the challenges that they have to gain access to coverage that they want, then we are to look at that and say how do we fix that. You make it so that individuals , that we allow for pooling mechanisms that provide for individuals to have opportunity to recreate and reconstitute that individual and Small Group Market, which now doesnt exist. Portland i appreciate your response about protecting people with preexisting conditions. One way you do it is through the risk pools, which many states had good risk pools before the formal care act it to help in that regard. As you know, congress regionally pass legislation the care and Addiction Recovery act to help with the opioid crisis. Fully now working to both fund and the funding is there in place to this new program. And now to implement it. A lot of implementation goes half of the funding goes to hhs and samsa. What should be done to ensure Addiction Treatment for those individuals currently getting Insurance Coverage through the exchanges are Medicaid Expansion and you commit for to us today to fully implement and opponent probably the new legislation representative price this is a scourge that has gone across the country. Communitiesty large and small, harming communities. And its growing. What we must do is absolutely, commit to carrying out the law as it was passed. But also, as i talked about this, some of the challenges, making certain that we get the right metrics in place. Are we actually helping with what we are doing. There may be better thinks to do. If there may be things that we think without to do but dont help. And we are to identify those as much in real time so that we can that out about a Program Works for the patients, for the individuals were actually being harmed. Senator portman one example, im sure you are aware of the imd rule that says, if you have an impatient treatment center, it has to be limited to 60 beds. Can you see if we can get that . Umber up to provide to provide more treatment . Oftentimes, these individuals have Mental Illness as well in the limitation of being able to keep folks in an inpatient basis, when all of the Health Care Professionals involved in their care say they ought to. In fact, that is not what is covered. So theyre put back on the street in the challenge is the revolving door. Senator portman with regard to the waivers come in ohio, ohio apply for a waiver. 1115 waiver for medicaid to cover people under medicaid. We were debt we were just we were rejected by cms. Do you believe, during this replacement time, we should be covering people under Medicaid Expansion, but moved to a program that is more flexible to provide more care under medicaid . Rep. Price i think there ought to be better ways to provide care for the people on medicare. We are listening to the governors and the state Insurance Commissioners who provide care. Senator bennett i want to thank my colleagues from ohio for his graciousness and not going to o over. The goal hereice, is access to the highest quality coverage and the high school he health care from americans. I think that is a worthy goal. Just piggybacking on wet senator portman was asking about, i am worried today, whether it is the Affordable Care act are not therefore do care act or not to the Affordable Care act. Rural parts of this country or the state are not getting access to highquality choices in terms of insurance. And ilittle bit think it is incumbent on all of us, whether we are trying to repeal the Affordable Care act or trying to fix the Affordable Care act, is incumbent on all of us not to make matters worse for Rural America in doing what we are doing. I know you share that goal. You talked about pooling. I want to ask you a little bit about your projected quality of insurance in these markets because, one answer that i received from folks, including yourself over the week am is making sure that people have coverage to buy catastrophic. Are i wonder if you also believe that it is essential that theres a floor for insurance providers. Some of the things that they forrdable care act require, coverage, including outpatient care, emergency services, hospitalization, maternity and newborn care, prescription drugs, labs, preventative care, such as Birth Control and mammograms, Pediatric Services like vaccines, routine dental exams for children younger than 19, im not going you to go through each one of those. But directionally, are we headed to a world where people in Rural America have to settle for coverage for catastrophic care or a place where there is regulation of insurance providers that say, if you are going to be in the insurance market, you need to afford a across stateour lines and a floor of the services you are willing to pay for. Rep. Price the has to absolutely be credible coverage. It is important that the coverage that individuals ought to be able to purchase is coverage that they want. Senator why should they pay month after months a cover something as basic as a hospitalization or Maternity Services or the rest of this list or there may be certain things on the list we disagree with, but im worried that were heading to a world where that thate is accepting a world no one else in the industrialized world has to accept. I accept your goal and i hope you can Work Together to make it so. You mentioned we should listen to the governors, which brings me to my second question and your answer to senator portman. In colorado, you may have heard of this, we have something called the Accountable Care collaborative, a unique approach to medicaid. A connection members with coordinated primary care providers while reducing barriers to access. It also provides coordinate care for those with medicare and medicaid. I can show you that the cost curve is really starting to turn around because of the coordinated care that is happening out there. When asked about the need for more state flexibility, which is an argument thats made to carry out innovative programs like the one in colorado, our governor said greater flexibility cannot make up for the lack of funding. Pull back government its financial commitments, we said we cannot afford to make up he difference. Do you agree with the assessment . While flexibility is helpful, it isnt replacement for critical funding needs. Rep. Price i think so. The decision of funding is a legislative decision. Senatorter bennetts that is a fundamental part of the Affordable Care act, the extension of medicaid. Rep. Price the decision whether or not to change that is something you and every member of the committee in congress will be involved in if i am fortunate to serve as the secretary of health and Human Services, we will carry out the law that you pass. Any reform or improvement that i would envision for any portion of the formal care act would be one that would include an opportunity for individuals to gain coverage, the kind of coverage that they want to the highest Quality Health care. Its a decision that you all what i believe is that any reform or improvement must coverage option an opportunity for every single american, including those that are either currently or close to medicaid population in a given state, which changes by state. Senator toomey thank you for joining us. I enjoy the conversation we had a while back. I think it bears reminding everyone come as we talk about obamacare that certainly the individual market is in a classic death spiral. The average selection is destroying that market. It is in a freefall in pennsylvania. 40 of all pennsylvanians in the Obamacare Exchanges have a total of one choice. That typically does not include whatever they had before and were promised with they could keep, which was never true. So weve got a system that is in collapse. What we are trying to do is figure out what is a better way to go forward. When we talk about repeal, sometimes i hear people say weve got to keep coverage of preexisting conditions. When i hear that, i think we are missing something. Theres obviously a number of americans who suffer from chronic, Expensive Health care needs. They have had these conditions all their lives or some other period of time. For many of them, the proper care for those conditions is unaffordable. I think we agree that we want to make sure those people get the health care they need. One way to force it is to force Insurance Companies to provide Health Insurance coverage as soon as they show up, regardless of what condition they have, which is kind of like asking the Property Casualty company to rebuild the house after it has burned down. But that is only one way. Am i correct, is it your view that there are other perhaps more effective ways, since obamacare is in a collapse, to make sure that people with these chronic conditions get the health care that they need at an affordable price without necessarily having the guaranteed issue mandate in the general population . Rep. Price i think there are other options, and it is important to appreciate the position we currently find ourselves in with policy in this nation is that those folks are going to have nothing because of the collapse of the market. Sen. Toomey right. Second topic is, and i think you and i share a goal of having health care that is much more driven individuals, families, patients, consumer centric rather than bureaucratic centric. Do you agree that to get there, we need to do more about the transparency of Health Care Outcomes so that informed consumers can evaluate among different physicians, different hospitals who really get the best outcomes . Do we need to do more . Rep. Price absolutely, and its not just in outcomes. We need to be measuring what actually makes sense from a quality standpoint and allow patients and others to see what those outcomes are. But it is transparency and pricing as well. If you are an individual out there and you want to know what something costs, it is virtually impossible to find out what that is. If we are honest with ourselves as policymakers, and we want to make the system patientfriendly, not insurancefriendly or governmentfriendly, but patientfriendly, then we would make that a priority. If confirmed, i hope to do so. Sen. Toomey i think cms can play a big role in advancing that. Ultimately, i think the more we diminish dependence on thirdparty payers and allow the evolution of a market that response to individuals, individuals will demand that information the way they do in any other market. The last point i want to touch on has to do with nih research, specifically alzheimers. It is my view that we often think of alzheimers as a disease and the category of its own. I say that because there is no disease like it that we know of that afflicts americans today. There are 5. 2 million americans with the disease right now. It is 100 fatal. It is the sixth leading cause of death. There is no cure, no treatment, nothing. And yet, for fiscal year 2016, nih spending is a grand total of 168 per diagnosed patient. It seems to me that the expenditures are wildly out of line with the severity and scope of this disease. I wonder if you would commit to working with me and others who share this view to ensure that we have a better proportionality in terms of the allocation of resources and the breadth and severity of illnesses. Rep. Price i think it is absolutely imperative, and i look forward to working with you. Sen. Durbin dr. Price, welcome, and thank you for your willingness to serve. There are a number of challenges ahead we need to take on. As i met with you a couple of weeks ago, one issue is the issue of Indian Health service. In 2010, there were problems uncovered in south dakota. The administrative action plan was set in motion to help many of these findings. Another issue popped up in 2015, and they continue to this day. After oversight hearings, it became abundantly clear that there was a lack of followthrough by the agency. My question is, will you continue to followup with me in writing that you will designate with someone designate someone at hhs to be a point of contact to ensure that, one, reforms are being implemented and, two, we continue to collaborate with the ihs . Rep. Price absolutely. This is an area of significant concern. In the Indian Health service, there are so many areas where we are not eating the goal of the highest quality care to be provided to individuals accessing that system. We are not doing what we ought to do. I make a commitment to turning that system around. Sen. Thune as a shared with you, senator barrasso and i introduced a bill called the ihs accountability act, which we believe will bring a lot of structural changes with the ihs. Many times, that act, although we think it addresses a love of the problems that have cropped up and was based on concentration from the tribes, merely is a first step in the process is necessary to improve that agency. If confirmed, what types of reports could you see yourself supporting when it comes to the ihs, starting with our legislation . You probably have not had a chance to look carefully at that yet, so i wont ask you to comment specifically to it, but are there reforms you could work with us on . Rep. Price i have the privilege of visiting some ihs the saudis in the state of wisconsin, and a couple this ihs facilities in the state of wisconsin, and a couple facilities were doing remarkable work. If i am confirmed getting into this area of the department, what we have not done is identified best practices within the system itself and shared those incident last the ability incentivized the ability to provide quality care in certain areas and make certain we are able to expand that across the country. Sen. Thune we look forward to working with you on that. Best practices is a great place to start. Those who have not been employed in facilities in our state. In 2009, cms issued a final rule that required Outpatient Services to be provided under direct supervision. Since then, the rule has been delayed. I share with you this as well. In my state, we have a lot of critical access hospitals, a lot of rural areas, it is sometimes difficult to get providers out of these areas. If confirmed, would you work to permanently extend the nonenforcement of the regulation of these hospitals in order to remove this burden . Rep. Price i look forward to working with you on it area i think there are areas from it working on it. I think there are areas where we are missing access to hospitals. In any other industry out there, the information has arrived and is moving at ross the land across the land with rapid speed and has done. However, it seems that in health care we have put up roadblocks with the expansion of technology, especially in the rural areas, and we are to be we ought to be incentivizing that so that patients can be receiving the highest quality of care. It is possible to reach one of the world specialists in stroke treatment by telemedicine. That is improving the lives of care of patients across our state. There are so many things we can do that would mirror that kind of technological expansion. Sen. Thune one final point i will make, i know you probably have been west and a good amount about what happened have been questioned a good amount about what happens next with respect to replacing obamacare. I hope we can work with you in beginning to shift a lot of the giving the states more flexibility when it comes to designing plans at work in our states. I think one of the problems we have had with this is that there is too much dictation from washington, d. C. , too much onesizefitsall. That is something most states would probably agree with and most providers would agree with as well. We look forward to working with you in designing programs to get that its ability to our states, and put them in charge of some of the issues that moves the power away from washington, where i think too many of the problems have been happening. Dr. Price, good to be with you again. I wanted to ask you a couple of questions that center on children and individuals with disabilities. First, with regard to children. I think if we are doing the right thing as not only a government, but as a society, if we are really about the business of justice and growing the economy. We should invest a lot and spent a lot of time making sure that every child has health care. The good news, despite a lot of not getting about point, not moving in the right direction, we have made a lot of progress. The urban institute, in an april 2016 report, i will not ask the report to be made part of the record, but i will read a line from it. It said as follows, on page three, it said that the decline in childrens uninsurance rate included a relatively steady pace and includes a significant drop following and limitation of the Affordable Care act key coverage provisions from 71 7. 1 to 4. 8 . That is a significant drop. That 4. 8 uninsured rate for kids was an alltime low. That means we are at a 95 insured rate across the country for children. Kaiser foundation, a separate authority, tells us that even with that, even with all that progress made in the last couple of years, and even some progress before that, we still have more than 4. 1 million children uninsured. Would you agree with me that we should get that number down, the number of uninsured children . Rep. Price i think that throughout our population, we are to identify individuals that are uninsured and strive to make certain that they gain coverage. And you would agree in regard to children especially . Rep. Price everyone in the population. Children are precious to her future. Sen. Casey we know the number we have arrived at, we know the percentage, would you commit, if successful in your confirmation, to maintain or reduce the uninsured number even further . In other words, that you would be able to commit to us today that the number of uninsured children will not increase during her time as secretary, were you to be confirmed, and the percentage of uninsured will not increase . Rep. Price our goal is to decrease the number of uninsured individuals in the population aged under 18 and over 18. Sen. Casey i hope you maintain that, because that is critically important. The reason i ask is not just to validate that as a critically important goal for the nation, but your answer seems to be in conflict with what you have advocated for as a member of the house, not only in your individual capacity, but as chairman of the budget committee. Looking at now, for reference, an oped by Gene Sperling, head of the council of economic advisers to two president s, clinton and obama. Chair of the National Economic council, i should say, is the proper title. In an oped on christmas day, the fifth paragraph, heres what he said referencing you and your budget proposals. He said, together, meeting the two areas of policy you have a long record on, full repeal of aca and block granting of medicaid, which we now know as Trump Administration policy, would cut medicaid in the Childrens Program funding by 2. 1 trillion over the next 10 years, a 40 cut. How can you answer the questions i just asked you about, making sure the number of uninsured children does not get worse under your tenure, with respect to what your policies would be be . Rep. Price with respect to you and mr. Sperling, its because you are looking at this in a silo. We dont look at this in a silo. We believe it is possible to put in place a system that allows for greater coverage for individuals, coverage that actually equals care. The aca actually increased coverage in this country. The problem is that a lot of folks have coverage, but they dont have care. They have their insurance card. They go to the doctor sen. Casey its one of the things that actually did. The Childrens Health program in the Medicaid Program the problem is a lot of folks have coverage, but they dont have care. They cut of a trillion dollars would adversely impact the childrens Health Insurance program and the Medicaid Program. It is totally unacceptable to most americans. Rep. Price and you are looking at that in a silo. You are not looking at what the reform and improvement would be. Sen. Casey we will see the rebuttal to not only what Gene Sperling has said, but a long line of Public Policy advocates and experts. I think the burden for you is to make sure you fulfill your commitment to make sure that no children will lose coverage while you are secretary. Rep. Price i look forward to working with you. Chairman hatch senator heller . Sen. Heller thank you, mr. Chairman. As you can imagine, i committed to ensuring that all have access to highquality, Affordable Health insurance. I have a letter that came to my attention january 10 from the nevada legislature. The leather can the letter came directly from the majority leader of our senate and the speaker of the assembly. Quick question. We have in nevada about 88,000 who have Health Insurance through the health exchange. 272,000 of veterans nevadans receive Health Care Coverage under Medicaid Expansion. Mr. Chairman, if i may, can i submit these questions to the record, on the record, and also, if i may, ask dr. Price if you could respond to this if he could respond to this particular letter . Chairman hatch im without objection. Sen. Heller also, if you could cc the governor . I think you are in a great position to answer these questions. Thank you. If i may, can i get your opinion on the cadillac tax . Rep. Price i think the cadillac tax is one that has made it such that individuals who are gaining their coverage through their employer there may be a better way to make it so that employees to gain coverage through their employer are able to gain access to the kind of coverage they desire. Sen. Heller the tax would affect about 1. 3 million nevadans, school teachers, Union Members, Senior Citizens. There is some disagreement as to whether these individuals are wealthy are not. There are some who believe the tax increase on obamacare does not affect the middle class. Do you agree with that . Rep. Price it does. Sen. Heller i do too. Do you believe schoolteachers are wealthy . Rep. Price everyone has their own metric of what wealthy is. Some people use Different Things to determine wealth, the greenback sen. Heller i would argue most teachers do not think they are wealthy. Do you think Union Members are wealthy . Rep. Price i do not. I dug that they think they are wealthy. Sen. Heller i agree with that. Do you argue that most Senior Citizens are wealthy . Rep. Price not if they are on a fixed income. Sen. Heller i would argue they are not wealthy. Thats the problem, a middleclass tax increase of 1. 1 trillion. I guess my question for you is, if i can get your commitment to work with this committee, to work with myself to repeal the cadillac tax . Rep. Price we will work to make certain that those who gain coverage through their employer have the access to the highest quality coverage possible in a way that makes the most sense for individuals from a financial standpoint. Sen. Heller does the cadillac tax make the most sense . Rep. Price i think there are other options that work better. Sen. Heller do you think it is a tax increase on middleclass america . Rep. Price i do. Sen. Heller ok. Nevada was one of 36 states that chose to expand eligibility for medicaid. We went from enrollment went from 350,000 to over 600,000. I guess the concern, and it is part of the i get to the chairman, is whether or not that will have an impact, and what we are going to do to see that those individuals are not impacted. It is probably the biggest question i have for you today. What are we going to do about those who are part of the Medicaid Expansion and how it is going to impact . Rep. Price as i mentioned to the other side, i believe it is a policy question that needs to be worked out through both the house and senate. We look forward to working with you and others, if i am able to be confirmed, and making certain that individuals who are currently covered through Medicaid Expansion either retain that coverage or have coverage through a different vehicle, but every single individual ought to have access to coverage. Sen. Heller dr. Price, thank you. Chairman hatch senator warner . Sen. Warner thank you, mr. Chairman, dr. Price. Since i have been governor, i have been working closely with senator isakson on the issue of how americans address the end of life. I think we both share personal stories on that subject. Sen. Isakson i have legislation that we call the Care Planning senator isakson and i have legislation that we call the Care Planning act, which allows discussion with Health Care Providers or faith leaders as needed, in a way to prepare for that stage of life. This year, cmx took a step by introducing a payment fee schedule for having conversations with these providers. It also ran a private ran a Pilot Program that allows hospicetype benefits to be given to individuals that are still receiving some level of services called the medicare care choices. I believe it is important that we do not go backwards on these issues. We are maybe the only industrial nation in the world that has not had this kind of adult conversation on this part of life and not limiting anyones choices. If you are confirmed, would you continue to work with senator isakson and i and others on this issue . Rep. Price i would be i would look forward to doing so. One of the issues is liability, and i cant remember if we discussed that in your office, but the whole issue of liability surrounding these conversations israel. We need to be talking about it openly and honestly, and working together to find a solution to just that. Sen. Warner i also think this is something that more families need to take advantage of. On friday, january 20, the president issued an executive order that says federal agencies, especially hhs should do everything they can to delineate any fiscal burden on any state or any cost, tax penalty, or Regulatory Burden on individuals or providers. If you are confirmed in this position, will you use this executive order in any way to try to cut back on implementation or following the individual mandate before there is a replacement plan in place . Rep. Price i think if i am confirmed, i am humble enough to appreciate that i dont have all the answers, and the people at the department have Incredible Knowledge and expertise. My first action within the department itself as it relates to this is to gain that insight, gain that information, so that whatever decisions we can make with you and governors and others can be the most informed and intelligent decision possible. Sen. Warner am not sure you answer my question. I understand your concerns with the cadillac tax. I know there are concerns you and others have raised about the individual mandate. There are some concern about the income tax surcharges during that its just remarkable to me, and its why so many of us tax surcharges. Its just remarkable me, and why so many of us are anxious, that the president has said he wants to keep people on their policies until 26, and at the same time it seems like there is a rush to get rid of all the things that paper that ability. I want your assurance that you would not use this executive order prior to a legal replacement to eliminate the individual mandate, which i believe would shore up the costs required . Rep. Price a replacement, an improvement of the program, i believe, is imperative to be instituted simultaneously. Sen. Warner you will not use this executive order as a reason to bypass the law . Rep. Price our commitment is to carry out the law of the land. Sen. Warner in the past, i know you have been a strong critic of the center for medicare and medicaid innovation, cmmi. In your testimony last week, a you saw great promise in it. If we want to achieve quality of care, weve got to have this kind of extermination. This kind of experimentation. There was a Prevention Program but last year cms certified that saved money on a beneficiary basis. Do you support cmmis delivery reform . Rep. Price i support making certain that we deliver care in a costeffective manner, but we must not do things that harm the quality of care being provided to patients. Sen. Warner the part of that quality of care, and i agree with you, would mean bundled payment models that move us toward quality over volume. Would you support those efforts . Rep. Price for certain populations, bundled payments make a lot of sense. Sen. Warner if these are successful, would you allow for expansion across the whole system . Rep. Price i think what we ought to do is allow for all sorts of innovation, not just in this area. There are things that have not been thought of that would actually improve quality and delivery of health care in our country, and we are to be incentivizing that innovation. Sen. Warner the cmmi is a tool we are to not discard. Chairman hatch thank you, senator. Senator scott . Sen. Scott South Carolina launched the nations first statewide partnership with the use of medicaid funds. 28 percent of babies in South Carolina are born to first time low income mothers. We also have a much higher than average infant mortality rate. Nurse Family Partnership is an evidencebased and has already shown real results, both in the health of the mother and the babys, but also in other aspects of the mothers life, such as Graduation Rates for teen moms and unemployment rates area what are your thoughts on a pay for Success Model to achieve success metrics . Rep. Price that sounds like a Great Program that actually has the right metric. That is the quality of care and improvement of lives. As you state, if it is having that kind of success, it probably up to be put out as the best practice for other states to look at and try to model. Sen. Scott thank you. I believe you are the director of the clinic at Grady Memorial Hospital in atlanta. Rep. Price i was. Sen. Scott grady hospital has the highest number of uninsured origins. Uninsured georgians. You talked about having coverage, but not access. Can you talk about how your experience at grady may inform you and direct you as a relates to the uninsured population . Rep. Price it was an incredible privilege to work at grady for the number of years i did. We saw patients from many walks of life, many uninsured individuals. They come with the same kinds of concerns and challenges that every other individual has. They have an additional concern, and that is, is somebody going to be able to help me . Thats why it was so fulfilling to have the privilege of working at grady and assisting people at a time when they were not only challenge from a health care standpoint, but challenged from a concern about whether or not people would be there to help. Sen. Scott i know you are aware of title i of the every Student Succeeds act. It allows for the population of head start to have access to resources. It seems to me that it would be imperative for the secretary of hhs and the secretary of education to look at ways to synergize efforts to helping the underprivileged child. Can i get your commitment to you will look for ways to work with the secretary of education where it makes sense to help serve the students on head start . It will be wonderful for us the taxpayer on one hand, the child on the other hand, and look for ways to make sure they both win. Rep. Price you have identified that we dont seem to collaborate under jurisdictional lines, not just in congress, but certainly in the administrative side. I look forward to that. Having as a metric, how are the kids doing . Are they actually getting the kind of service in education that they need . Are they improving . Are we just being custodian . Are we just parking kids in a spot, or are we actually assisting in improving their lives . If we are not asking the right question, not looking at the right metrics, then we will not get the right answer to expand what is working or modify it and move it in a better direction. Sen. Scott that is one of the more important parts of your opportunity in this position, looking at those kids at those ages, before you ever get into prekindergarten. The development of a child and theres first three or four years in those first three or four years need their potential to be maximized. Sometimes we think the educational system will allow the child to catch up. I thank you for your willingness to work in that direction. The last question has to do with the employer Health Care System that we are so accustomed to in this country. In my home state, we have 2. 5 Million People covered by their employer coverage. If confirmed as hhs secretary, how would you support american employers in their effort to provide Family Health coverage in a consistent and affordable manner . There has been some conversation about looking for ways to decouple having Health Insurance through your employer. Rep. Price i think the employer system has been a remarkable success on allowing individuals to gain coverage they might otherwise not gain. I think preserving the employer system is imperative. That being said, there may be ways for individual employers i have heard employers say, if you just give me the opportunity to provide my employee the resources so he or she is able to select the coverage they want, that makes more sense to them. If that works from a voluntary standpoint, then it may be something to look at. Sen. Scott that would be more like the hra approach. Rep. Price exactly. Sen. Scott the employee chooses the Health Insurance not necessarily under the umbrella of the employers. Rep. Price exactly. I think its the same tax benefit. Chairman hatch senator mccaskill . Sen. Mccaskill at the risk of being way away from you and you being somewhat i have worked with respected greatly, i want to gently correct something in your opening statement. The first nominee of President Trump was confirmed by a vote of 981. I would not consider that a partisan vote. The second nominee was confirmed via vote of 8811. Once again, i would not consider that a partisan vote. We are trying to look at each nominee individually. I had a chance to review congressman prices questioning of secretary civilians, and i can assure you, mr. Chairman, it was no beanbag. I think all this looks different depending on where we are sitting, and i wanted to make that point. As to passing obamacare without one democratic vote, we are about to repeal obama care without one democratic vote. This will be a partisan exercise under reconciliation. It will not be a bipartisan effort. What we have after the repeal is trumpcare. Whatever is left after the dust settles is trumpcare. I know the president likes to pay close attention to what he puts his name on. I have a feeling, congressman, even though you keep saying that congress will decide, you are not really believing, are you, that your new boss is not going to weigh in on what he wants congress to pass . We are not going to have a plan from him . Rep. Price we look forward to working with you and others sen. Mccaskill my question is are we going to have a plan from the president. Rep. Price if i have the privilege to be confirmed, i look forward to working with the president and bringing a plan to you. Sen. Mccaskill great. So the plan will come from President Trump, and you will have the most Important Role in shaping that plan, correct . Rep. Price i hope i have input, yes, maam. Sen. Mccaskill ok, whatever trumpcare inns of being, you will have a role in it. I hope that gets on the record. When we repeal obamacare, there will be a tax cut. Will americans making under 200,000 benefit . Rep. Price thats a hypothetical. Sen. Mccaskill its not hypothetical. When we repeal obamacare, there are taxes, and when it is repealed, there was no question that taxes will be repealed. I promise you, the taxes will be repealed. When those taxes are repealed, will anyone in america who makes less than 200,000 in of it from benefit from the repeal . Rep. Price i look forward to working with you on that plan, and hopefully that will be the case. Sen. Mccaskill no, no. Im asking, the taxes in there now, does anybody making less than 200,000 pay those taxes . Rep. Price it depends on how you define the taxes. There are many individuals paying much more than they did prior to that point. Sen. Mccaskill im talking about taxes. The cadillac tax has not been implemented, so that it does not affect anybody. Im trying to get a simple question, and i dont think you want to answer it, which is that when obamacare is repealed, no one who makes less than 200,000 will benefit. Rep. Price when confirmed, i look forward to working with you. Sen. Mccaskill we will move on. Your plan is converted medicare to private Insurance Markets with government subsidies, correct . Rep. Price not correct. Sen. Mccaskill we talked yesterday, and by the end of our conversation, you admitted to me that your plan for medicare in terms of people getting tax credits or subsidies or however you are going to pay for the medicare recipients will be having choices on the private market. You said, yes, it is similar to obamacare with the exception of a mandate. Did you not say that to me yesterday . Rep. Price with fairly significant exceptions. Sen. Mccaskill these people and dont need to be mandated for insurance. Its not like a 27yearold who knows he wont get sick. You dont need a mandate for the elderly, so it is not as relevant. That didnt you admit admit to me but didnt you admit to me that obamacare in the private market are pretty similar . Rep. Price there are similarities. What i said, though, is the mandate is significant. Sen. Mccaskill but we dont need a mandate for seniors, would you agree . Rep. Price what i hope is we dont need a mandate for anybody said they are able to purchase the kind of coverage they want, not what the Government Forces them to buy. Sen. Mccaskill ok. Finally, you want to block grant medicaid for states with an efficiency, correct . Rep. Price i believe medicaid is a system which is now not responding as necessary. It is incumbent on us as policy makers to look for a better way to solve the challenge. Sen. Mccaskill are you looking at a way to block grant medicaid . Its a really simple question, congressman. You are at a confirmation hearing for the most powerful Health Care Job in the country. I dont know why you are not willing to answer whether you are in favor of block granting medicaid . Rep. Price i am in favor of making certain medicaid response to patients, not the government. Im in favor of making sure it responds to patients in the government. Should i asked my last question or are we going to get a chance . Know if we are going to get another opportunity. I wont disappointed. And point wont disappoint. Prices re perus taxes across millions. For 2000 of an teen, 13. 8 million taxpayers with incomes has ledthe income to middleclass tax hikes so i thinkstion note are facts that are denied. Sen. Mccaskill i look forward to looking at those back, because somewhere in this mix weve got alternative facts. Chairman hatch i think these are right. Sen. Mccaskill well i think mine are right. May i respond . On this point, no alternative facts. The republicans at last years reconciliation bill cut taxes for one group of people. They cut taxes for the most fortunate in the country. That is a matter of public record. Its not an alternative factor or universe. People making 200,000 and up got their taxes cut. That was me reconciliation bill from republicans last year. Chairman hatch i dont agree with that, but we will see who is next. Senator grassley . Bow, senator castellini senator cassidy. Sen. Cassidy lets talk about medicaid. We getting a rosy scenario with obamacare, and the republican attempt to replace it seems odd. First, i want to note for the record that President Trump has said that he does not want people to lose coverage. He would like to cover as many people as under obamacare, he wants to cover those with preexisting conditions. Those will be your marching orders . Rep. Price absolutely. We both worked in Public Hospitals for the uninsured and the poorly insured, folks like medicaid. Lets talk about medicaid. Why would we see patients on medicaid at a hospital for the uninsured . If they want to see an orthopedic in private practice, does medicaid cover the cost of seeing an orthopedic patient . Rep. Price often times it does not. As you well know, one out of three physicians who ought to be able to take medicaid patients do not take them, and there is a reason for that. That is a system that is not working for those patients, and we up to be honest about that and look at that and answer the question why an address that. Sen. Cassidy when the house version of the aca past, the New York Times wrote an article about an oncologist that had so many patients for medicaid that she was going bankrupt, and she had to discharge patients from her practice. The Ranking Member says we cant have alternative facts, and i agree with that, but we also know that a journal article speaking about Medicaid Expansion organ, when they expanded, outcomes did not improve. I suppose that kind of informs you you say we need to make medicaid that needs to work better for patients. Rep. Price absolutely, and we need to look at the right missions. Coverage for individuals is an admirable goal, but it ought not be the only goal. We need a goal and health care especially to keep the patient in the center and realize what kind of coverage we are providing for people on the ground, real people in real life, and whether we are affecting them in a positive or negative way. If we are affecting them in a negative way, we need to be honest with ourselves and say, how can we improve that . Sen. Cassidy a lot of times, there is a conflation of per beneficiary payments from the state per medicare enrollee and block grants, which to me is conflation. I will note that bill clinton on the left and phil gramm and Rick Santorum on the right proposed per beneficiary payments some time ago. Would you agree this is how the federal Employee Benefit program pays for these federal employees . They pay per beneficiary payment to ensure. Bill clinton on the left and phil gramm and Rick Santorum on the ride proposed beneficiary payments on time ago. And how the federal employees Health Benefit program pays for these federal employees. They pay to a insurer. Wouldnt it be great if it werent representative price it is not a monolithic population. There different demographic groups within it, seniors and disabled and then healthy moms and kids by large. And we treat each one of those coat folks exactly the same. Senator cassidy is there any nuance . I dont see any offered in the question. Are you speaking about a per beneficiary payment . Are you speaking of each of those 4, 1 of those for . How do you dice that . Rep. Price absolutely. Those are the things we tend not to look at because they are more difficult to measure and more difficult to look at. That will we are talking about peoples lives, Peoples Health care, it is imperative that we do the extra work that needs to be done to determine whether or not yes, indeed, the Public Policy we are putting forward is going to help you and not harm you. Sen. Cassidy theres criticism about your proposal kurt beck accounts. I think we are both about your proposal for health bank accounts. I think we are both familiar with the rep. Price when people do engage in their health care, they tended to demand more. They tend to demand better services. And individuals that have greater opportunity for choices of who they see, where they are treated come up when they are treated and the like, have greater opportunity to gain Better Health care. Senator cassidy if we contrast the experience in Health Indiana with the experience in oregon, were a National Bureau of Economic Research published in the new england journal of medicine found no difference in outcomes in those that are fulfilled through a Medicaid Expansion nor again, contrasted that absence of outcomes, with that which indiana tried to engage payments become activated in their own care. Er usage fell, but outcomes improved. I kind of like your position. Things thanks for bringing a nuanced, informed view into the debate. It is kind of a relief to have someone in your profession in this Important Role, particularly knowing the importance of the doctorpatient relationship. In my dealing with cms and hhs overall, i think the bureaucracy has been short of a lot of that handson information that people ought to have. And secondly, when youre in my office, we discussed of the necessity of your responding to congressional inquiries and you very definitely said you would, tongueincheek said you are to say may be, because a lot of times they dont to do it. But since you said you would, i will hold you to that and appreciate anything you can do to help us do our oversight. As a result of oversight, i got a legislation passed a few years ago called the patient position sunshine act. The only reason i bring this up is because it took senator wyden and may working hard to stop the house of representatives from cutting that legislation in the cures act to that past. I want to make very clear that the legislation i am talking about doesnt prohibit anything. It has reporting requirements because it makes it very, very well, it brings about the principle of transparency. It brings accountability. Ive got some studies here that we did and some newspaper reports on them, particularly one of about a psychiatrist at Emory University that was not reporting everything that they should report and even the president of Emory University came to my office and said thank you for making us aware of this stuff. I want to put those in the record. Since you are administering this legislation and senator blumenthal and i will think about expanding this and legislation this legislation to include Nurse Practitioners and physicians assistants, i hope that i can get your commitment that you will enforce this act the way it was intended to be enforced. Even under the obama administration, after we got it passed, it was three years to get regulations carried out. In effect, it has only been working for two or two and a half years. So if you are confirmed, would you and the department of health and Human Services work with me to ensure this Transparency Initiative is not weakened rep. Price transparency in this area and some in the others is vital. Not just in outcomes or in pricing, but in so many areas so that patients are able to understand what is going on in their Health Care System. Senator grassley thank you. The last one deals with vaccine safety. You are a physician. I think you would agree that immunization is very important for modern medicine and that we have enable to get rid of small box way back in 1977, worldwide polio in 1991, at least in the western hemisphere, and all that. So as a physician, would you recommend that families follow the recommended vaccine schedule that has been established by experts and is constantly reviewed . Rep. Price i think that science and health care has identified a very important aspect of Public Health and that is the role of vaccination. Senator grassley thank you very much. I yield back my time. Senator stevan now. I would ask unanimous consent that a series of stories at a public or public forum with my colleagues, people concerned about policies that the nominee has authored and that was talked about today, that that be included in the record. Welcome congressman price. I appreciate a private discussion. Lots of questions. Lets see if we can move through some things quickly. You said this morning that you would not abandon people with preexisting conditions. Is that basically what youre talking about as high risk pools, one of the strategies you are thinking about . I heard that talked about this morning. Rep. Price high risk pools can be helpful in making sure that people with existing illness can be cared for in the highest quality manner possible. I think there are other methods as well. We talked about other pooling mechanisms, the destruction of the individual Small Group Market has made it such that individuals cannot find coverage that is affordable for them. One of the ways to solve that challenge is to allow folks in the Small Group Market the pull together. I think we talked about this in your office with the blue shield model being the template for individuals who are not economically aligned are able to pool together their resources solely for the purpose of purchasing coverage. Senator stabenow for about 35 years, we have tried high risk pools. 35 states had them before the Affordable Care act. Frankly, it did not produce great results. In 2011,. 2 of the people with preexisting conditions,. 2 , were actually in a high risk pool and the premiums were 150 to 200 higher than standard rates for healthy individuals, and they had lifetime and annual limits on coverage and cost states money. That was the reality before we passed the Affordable Care act. So when President Trump said last weekend that insurance was going to be much better, do you think that insurance without protections for those preexisting conditions or without maternity coverage or without Mental Health coverage or insurance that would reinstate tax on cancer treatments is better . Rep. Price i dont know that that is what he was referring to. Senator stabenow he said it would be better. If we went to highrisk pools instead of covering people with preexisting conditions or if we stop to the other coverage we have now, im just wondering if you define that as better. Rep. Price you would have to give me a specific senator stabenow let me give you an example. Rep. Price what may be better for you may not be better for me or anybody a lez. Patients need to be at the center of this, not government. Should government be deciding these things are patients senator stabenow . Prior tothe a formal care art, about 70 of a private plans that a woman could purchase in the marketplace did not cover basic Maternity Care. Do you think that is better, not to cover basic Maternity Care . Rep. Price i would presume she wouldnt purchase that coverage. Senator stabenow she would have to pay more just as in general for many women that being a woman with a preexisting condition. That is the reason why we have a basic set of Services Covered under health care. So its just a different way of looking at this. This is something where, sure, if a woman wanted to pay a premium, pay more, she could find Maternity Care. We said in the Affordable Care act thats pretty basic. And so did half the population, for whom Maternity Care should be included. Mental Health Services should be a guaranteed benefit in all Health Insurance plans . Rep. Price ive been a supporter of Mental Health care inclusion, yes. Senator stabenow so Mental Health should be a defined benefit under Health Insurance plans. Senator stabenow Mental Health should be treated rep. Price Mental Health should be treated on the same model as physical health. Senator stabenow i agree with you. Theres been a lot of discussion with the nominee for Office Management Budget Office talking about Social Security. I think people in medicare should be worried right now in terms of what we are all hearing. My time is up. My mom who is 90 years old she , does a lot more choices, she just was to be able to see her doctor and get the medical care that she needs. She is not at all supportive of the idea of medicare in some way being changed into premium support into a berkshire into a voucher. I am conveying to use someone who is getting there right now and she is not interested in more choices. She just wants care. Rep. Price i would convey to the medicare population that they dont have reason to be concerned. We look forward to assisting them in getting the gain and gain the