Senator hatch ok. The committee will call to order. Well first listen to the senator from oregon. Who has to go to another committee hearing. But i welcome everybody to this mornings hearing on the president s proposed budget for fiscal year 2018 with specific intention to the department of health and Human Services. So let me and i want to thank secretary price for being here. These hearings are an annual event for the finance committee. Secretary price, since this is your first time around, ill just warn you that these hearings can be a little grueling. So of course you already know that. Im grateful that the president and h. H. S. Are eager to work with congress to fix our Health Care System in order to ensure americans are able to access Affordable Health coverage. And with that i am going to turn to the Ranking Member who needs to get to another hearing and well show that deference. Senator wyden mr. Chairman, thank you very much for this courtesy. I know this is a busy morning and im grateful for you doing this. I want to say thank you to senator stabenow who in my absence is going to do an excellent job as she always does. This administration from day one preferred alternative facts and convenient spin to the truth. One of the most recent examples was its Budget Proposal which double counted 2 trillion to maintain some whiff of fiscal responsibility while it slashed Health Programs and protections for basic and essential needs. The budget math is fake, but the extreme agenda that would deprive millions of americans of access to health care and wipe out Living Standards is not. Unfortunately, this morning, im going to be splitting my time between the finance committee and the intelligence committee, so i will be brief. There are several issues in the budget in the administrations agenda i am going to touch on. First is medicaid. Secretary price is the captain of the president S Health Care team. He has been the advocate for trumpcare, a bill that cuts medicaid by 834 billion in order to pay for massive tax breaks for the wealthy. 14 million americans would lose coverage, and millions more would see caps on their care. And if that wasnt enough of a cut, the Budget Proposal that came out a few weeks ago goes even further. It slashes hundreds of billions more from medicaid. In a program that covers nearly half of all births, 37 million kids, millions of working families and people with disabilities and two out of three nursing home beds in america, these cuts would be a staggering blow to americans of all generations. These facts and figures have been met by a wave of the hand from secretary price. When asked if his proposed cuts would result in millions of americans losing access to medicaid, he responded, and i quote, absolutely not. He went further, claiming, again, i quote, there are no cuts to the Medicaid Program, and he also said, and i quote, nobody will be worse off financially. Ive heard secretary price and others make the baffling argument that people are actually worse off when they have medicaid coverage, that their health doesnt improve as a result of the medicaid coverage. Often this argument is based on a brief and outdated study performed in my home state. Heres the bottom line on medicaid. 74 million americans rely on this program for basic health needs. Parents with sick kids, people with disabilities, seniors in Nursing Homes who have nobody to turn to for help if their benefits disappear. And in addition, thousands of oregonians who are healthy under my home states model. It would be a tough sell to convince those people that they are worse off being enrolled in medicaid, or that the Program Needs more than a trillion dollars in cuts. And Public Opinion is very clear. Two out of three enrollees are happy with the program. Seven out of 10 americans say congress ought to leave it as it is. No block grants, no per capita caps. Fortunately, the Budget Proposal hits the wall here in the congress, and theres a lot of debate left to be had on trumpcare. But right now, the administration is causing turmoil in the insurance markets, and its already having disastrous effects for millions of families. The president issued a oneday executive order undermining the Affordable Care act. And nobody on the trump team can give a straight answer of whether the administration will continue making cost sharing reduction payments that are key to making insurance affordable for working families. Because of this sabotage, insurers are pulling out of the markets and people are left without plans to choose from. You dont have to take my word for it, the insurers are very clear about why they are making these decisions. Furthermore on the campaign trail, the president said he wouldnt cut medicare. The Trumpcare Bill shrinks the life of medicare, and the Budget Proposal extends the mandatory cuts under the budget sequester by more than 30 billion. The food and Drug Administration, the centers for Disease Control and the National Institutes of health all slashed in the budget. The same is true in programs aimed at basic human needs, programs that fund meals on wheels, childcare, foster care. This is the budget you write if you think seniors and working families have it too easy. I want to thank the secretary for joining the committee. I apologize, again, for the hectic schedule. Its never an easy appointment for cabinet secretary, and i think he knows theres going to be some vigorous discussion this morning. I also, again, want to express my thanks to the chairman for his very gracious and ongoing courtesies on these kinds of matters. Thank senator stabenow for being willing to fill in and i again thank the chair. Senator hatch thank you, in senator. Let me say im grateful that the president and h. H. S. Are in essence working on this effort and in essence eager to work with congress in order to ensure americans can access Affordable Health coverage. This may not be something that is going to be that easy to do and as we know time is of the essence in regard to this effort. Earlier this week, we received word that anthem is pulling out of ohios obamacare marketplace, potentially leaving more than 10,000 patients and consumers in 20 counties without any Insurance Options on ohios exchange for 2018. Now, this news is particularly frightening as we expect to hear similar notices from anthem as they reevaluate their participation in Obamacare Exchanges throughout the United States. Our whole country. Now, this recent story is just the latest in a long line of failures that my colleagues on the other side seem to want to continue under the guise that this is working. Its not working. All of these this demonstrates the need to move forward with repealing obamacare and replacing it with a more workable approach, one that will take serious that we can take seriously the ballooning Health Care Costs impacting every american family. Let me talk for a few minutes about the specifics of the president s budget. The budget assumes 250 billion in total savings from the repeal and the replacement of obamacare. And despite some insinuations to the contrary, the bill does not incorporate the specific legislative proposal the American Health care act that is before congress right now. Therefore, it is not accurate to associate the specific medicaid savings the c. B. O. Has estimated from enactment of the ahca with the president s budget. To do so would assume a level specificity that, for obvious reasons, is just not there. Moreover, the president s budget does not cut 1. 5 trillion from medicaid. Nor does it assume that the specific medicaidreform proposals from the ahca will be enacted into law. Im quite certain that well hear a lot about that today, but any attempt to make that connection is simply unfounded. And any senator who harps on the ahca medicaid numbers here today either does not understand the explicit language and estimates provided in the president s budget, or they are simply attempting to muddy the waters in order to scare americans who rely on medicaid for health care coverage. Ultimately, the president s budget appears to accept the reality that the senate will need to come up with its own Health Care Reform proposal that includes a fundamental fix to medicaid, which is, quite frankly, long overdue. Anybody that doesnt agree with that just isnt living in the real world. In addition to the savings assumed from the repeal of obamacare, the budget also explicitly assumes 610 billion in savings from putting medicaid on a sustainable fiscal path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. All told, most of the budgets overall medicaid savings would be achieved by returning the focus of medicaid to serving those with the greatest needs the elderly, the disabled, and needy mothers and children and by giving states more flexibility to run their own Medicaid Programs. Any senator who would like to argue that the federal government should spend more medicaid dollars to provide coverage for nondisabled, childless adults at the expense of disabled patients who remain on waiting lists should explain why. Furthermore, any senator who would like to argue that the states are illequipped to handle their Medicaid Programs should explain why that is the case, given that the overwhelming consensus weve heard from governors nationwide over the last several years is that states want more independence and flexibility to tailor the Medicaid Program. Washington needs to stop measuring the success of a federal program by how much money it spends or how many other programs are a part of it. Instead, washington needs to focus on how well a federal Program Helps those it is intended to serve and how efficient the program is at fulfilling its mandate. Long story short, we need to stop focusing on spending and pay more attention to outcomes. Because we may not be able to spend more. It doesnt appear that were going to be able to. The way things are going right now under the Current System, its a national tragedy. I think the president s budget, while it is by no means flawless, largely recognizes this reality, and the president and the administration deserve credit for that. I look forward to having an open and frank discussion with secretary price about his thoughts on these and other matters. Before we get to that let me just say that today we have the pleasure of being joined by secretary thomas e. Price. Secretary price, we want to thank you for coming. Secretary price is sworn in as the 23rd secretary of health and Human Services on february 10, 2017, as a policymaker and as a physician, surgeon in particular, he brings to the department a lifetime of service and dedication to advancing the quality of health care in america. Secretary price first began his career in care for patients as an orthopedic surgeon. He followed in the footsteps of his father and grandfather and began a solo medical practice in atlanta, georgia. Since its founding, that practice has grown to be one of the largest, nonacademic orthopedic practices in the country. Hoping to make a different type of impact on health care, secretary price ran for Public Office and was elected to four terms in the Georgia State senate and i believe would have continued on forever if he wanted to. During his tenure there, secretary price served as minority whip and later as the first Republican Senate majority leader in the history of georgia. Most recently, secretary price served as u. S. Representative for georgias sixth Congressional District from 2005 to 2017. During his time in the house, secretary price served in various roles including chairman of the house budget committee, chairman of the House Republican policy committee and chairman of the republican study committee. Secretary price received his bachelor and doctor of medicine degrees from the university of michigan after which he completed his orthopedic surgery residency at Emory University. Secretary price, we are grateful to have you here and well be happy to allow to you proceed with your testimony today. Secretary price thank you so much, mr. Chairman and i reserve stabenow and members of the committee. I want to thank you for inviting me today to discuss the president s budget for the department of health and Human Services for fiscal year 2018. Its an honor to be here. Whenever a budget is released, the most common question in this town is how much, how much does the money spend on this program, how much does it cut from the other program . As a former legislator, i understand the importance of this question. But too often its treated as the only question thats worth asking as it relates to the budget as if how much a program spends is more important or somehow more indicative of whether the Program Actually works. President trumps budget request does not confuse Government Spending with government success. The president understands that setting a budget is about more than establishing topline spending levels. Done properly, the budgeting process is an exercise in reforming our federal programs to make sure that they do their job and use tax dollars wisely. The problem with many of our federal programs is not that theyre too expensive or too underfunded. The real problem is that many of them simply do not work. Fixing a broken Government Program requires redesigning its structure and refocusing taxpayer resources to better serve those most in need and thats exactly what president trumps budget will do at h. H. S. And across the government. Consider medicaid thats been discussed, the primary source of millions of lowincome American Families and seniors facing Challenging Health circumstances. If the amount of Government Spending were truly a measure of success, medicaid would be hailed as one of the most successful programs in history. 20 years ago actual spending on medicaid was less than 200 billion. Within the next decade, its estimated to top 1 trillion a year. Despite these significant investments, onethird of doctors in america who accept new medicaid patients dont. And some show that enrolling in medicaid does not necessarily improve your Health Outcomes with the null newly eligible medicaid population. We need to have a way thats compassionate and sustainable. Under current law, federal rules prevents states from focusing on their most vulnerable communities and testing new ideas to improve Health Outcomes and care. This budget changes that. H. H. S. s mission of protecting the health of the American People involves far more than overseeing the nationS Health Care and Insurance Programs. H. H. S. Is the worlds leader in helping the Health Care Sector prepare for cyberthreats and responding to and protecting against Public Health emergencies. Recently i witnessed this important work firsthand visiting ebola survivors in liberia and representing the United States at the g20 Health Ministerial assembly in berlin and the World Health Assembly in geneva. To support h. H. S. s unique federal role, preparedness and response, the president s budget provides 4. 3 billion for Disaster Services coordination and response planning, biodefense and emerging Infectious Disease research and development and stockpiling of critical medical countermeasures. In addition, today america faces a new set of Public Health crises that we have been far less successful in resolving. Those are serious mental illness, the Opioid Crisis and childhood obesity. As secretary i am committed to leading h. H. S. To address each of the three challenges and the president s budget calls for policy reforms that will enable us to do just that. The budget calls for high priority Mental Health initiatives and Homelessness Prevention and childrens Mental Health. Focusing especially on those suffering from severe mental illness. In 2015, over 52,000 americans died of overdose. Most of them from opioids. This budget calls for 811 million to support the fivepart strategy to fight this epidemic. To invest in the health of the next generation and help the 20 of schoolage children who are obese, lead healthy and happier lives, the president s budget establishes a new 500 million Americas Health block grant. Additionally, the president s budget prioritizes womens Health Programs by investing in research to improve Health Outcomes for women and increasing funding for the maternal and child block grant and healthy start. Across h. H. S. , funding is maintained for vital programs serving women, including Community Health centers, Domestic Violence programs, womens cancer screenings and support, mother and infant programs and the office of womens health. This demands tough choices and in this challenging fiscal there are no easy answers. With this budget, however, the new administration charts a path toward a sustainable, fiscal future and ensures the dedicated resources provided enhance and protect the health and wellbeing of the American People. Members of the committee, i want to thank you for the opportunity to be with you today and your continued support of the department of health and Human Services. Its my incredible privilege to serve as its secretary. Senator hatch were proud of you. We know that you are an excellent you were an excellent member of the house senator hatch were proud of you. We know that you are an excellent you were an excellent member of the house and so far looks to me like youre getting on top of what these problems are. Although you were well on top of them before as a member of the house. The Opioid Crisis seems to be spreading across the country affecting families and communities in unprecedented waves. In fact, the New York Times reported earlier this week that Overdose Deaths are at an alltime high. Tackling this crisis is a priority for you and for president trump. So can you describe the efforts h. H. S. Is undertaking to address the ongoing Opioid Epidemic in the United States . Secretary price mr. Chairman, this is one of the scourges across the nation that just tears your heart out. 52,000, as i mentioned in 2015, fellow americans died of an overdose. 33,000 of an opioid overdose. We hear day after day after day. What the department has done is put in place a fivepart strategy to make certain that were identifying the kind of treatment and Recovery Efforts that work and assisting the tates. Want to make certain we have the overdose reversing drugs available wherever they need to be available and know were trying to surveil and make certain we know prior to strong drugs getting to the street from a Law Enforcement standpoint. Theres a Public Health aspect to this obviously to try to determine what the hecks going on. Why is this scourge as large as it is . Nd were putting resources into that. In addition, we want to make certain were doing the highest level of research to try to identify those pain treatments that are able to make it so theres not a need for individuals to seek it for its euphoric effect, pain medication for its euphoric effect. Finally, its important to look at how we manage pain in this nation. 20 years ago we started down this road of measuring pain as a fifth vital sign. Let me suggest to you that that has resulted in significantly greater use of opioids and Prescription Medications than would have otherwise been the case. So we got this fivepart strategy. You have been incredibly helpful. Congress has been helpful to make sure through 21st century cures to have the states get the evidencebased programs in place to help mitigate this challenge. But we continue to move in the wrong direction, mr. Chairman, and we will not rest if the department at the department and within the administration to bend that curve in the other direction. Senator hatch h. H. S. Recently published a report using the Previous Administrations data showing just how much Health Insurance premiums in the individual market have increased since 2013. Could you tell us what are the principal findings of that report . Report . Secretary price well, thank you so much. I know when i visited with folks in my previous position and since ive been privileged to serve as secretary, i hear over and over again how folks are just so terribly concerned about the cost of Health Coverage for them and their family. And there was this disconnect. You have to have the individuals talking about the wonders of the program that was in place and that you had all then you had all of these individuals who were so concerned because they didnt have the ability to afford the coverage or they didnt have the ability to get the care. The study we undertook that was undertaken at a group within h. H. S. Identified the average premium increase over the last four years has been over 100 . I think it was 105 . So more than doubled across the country. In fact, three states, the increases were tripled. In alaska and alabama and oklahoma. And what that means is there are individuals who, one, cant afford the coverage and, two, even when they can afford the coverage the deductibles have increased to a significant degree so they may have an insurance card but they dont have any care because they afford the deductible. Thats the challenge we are trying to address and make Certain Congress addresses so that individuals are able to afford the kind of coverage that folks want for themselves and for their families. Senator hatch well, as you may be aware, this committee has for several years now been keenly interested in the large backlog of medicare claims under appeal at h. H. S. The most recent reports we heard indicate the backlog has been reduced from a high of nearly one million claims to a current number closer to 50,000 claims. Now, that number still is unacceptably high. Can you tell me what h. H. S. Is doing to address the unnecessary backlog of medicare laims . Secretary price yeah, these are appeals that providers have ow, that number still is said that they dont believe the federal government is providing the kind of resources necessary for them to be able to care for their patients. As you mentioned, the numbers are staggering. Nearly a million claims. Were down to about 700,000 now. We can take care of somewhere around 20,000 up until recently a year. What weve done i met with the individuals. They are high quality folks. These are folks trying to get these appeals through the process and try to make the right decision. We put a focus on that. We talked to weve encouraged them to talk to the stakeholders, talk to the individuals out there about why we have this increase in claims. Theres a problem there. It means the system isnt working. To the degree that it should to allow those individuals to care for those patients and be compensated for that care. We identified the opportunity for the Administrative Law judges to be able to review higher claims and move in the direction of having magistrate judges review lower claims so we hope to get through a larger volume of claims on an annual basis. And then retried to decrease the burden of reporting. Were working on trying to decrease the burden of reporting for the providers so there is less likely a possibility they would need to feel the need or desire to file a claim. So this is a major problem. Were working through it and were committed to getting that number down to a reasonable number. Senator hatch well, im happy o listen to you. I you inherited a tremendous number of problems and i know youre fully capable of solving those problems. I think youre well on your way. I you inherited a tremendous the distinguished Ranking Member has agreed to allow senator isakson to go next. Senator isakson dr. Price, welcome back. Last time you were here were confirming you and now lecturing us to help you. We thank you for the work youve done in our state. You finished your trip overseas the distinguished ranking that began in liberia. What did you learn with regard to our response to the ebola which started there . Secretary price i appreciate your support and service to our great state. My first trip overseas, we stopped first in liberia. I wanted to do that because i wanted to express our appreciation to the americans who were working over there, especially during that ebola crisis and to also demonstrate our continued commitment for Global Health security and to thank the liberian government for what they had done to elevate and increase their ability in the area of Infectious Disease. What i saw was incredibly inspiring. And you all would be so remarkably proud of the American People who are forward deployed, if you will, in Global Health. Individuals from the c. D. C. , from the n. I. H. , from hrsa, who are doing all they can to make certain that we address the Health Challenges that exist around the world, especially in the area of Infectious Disease. It paid off in absolutely remarkable benefit and we saw that because of the most recent outbreak of meningitis that occurred in liberia. The detection that was done, the prevention of spread that was done and the treatment that was done was only possible because of the work that had been done in liberia since the bola outbreak and since that challenge was resolved. So i was just uplifted and inspired by the incredible work of the American People who are dedicating their lives to assisting the health of individuals overseas. Senator isakson well, c. D. C. Did a phenomenal job as did challenge was resolved. H. H. S. The president s budget is cut by 136 million the preparedness fund, a lot of which went to the initial response in ebola in africa along with the partnership with Emory University to bring those victims to the states. We need to work to see to it funding is there so we can have the same type of response the next time an outbreak takes place wherever it is in the worrell because were the worlds clinic, if you will, for emergencies and disasters like that. Secretary price yes. Senator isakson you had a partner by john knox. You may or may not know but he did surgery on my son. It took him nine months to recover. Eight of those months he recovered at home. My wife and i went to school. We took lessons in how to clean ports and put antibiotic drips so he could fight infection in his bone marrow. Since 1981 over time antibiotics and Home Infusion went away. There was not much reimbursement to encourage people to stay home. Senator warner worked with us to get Durable Medical Equipment in the 21st century cures act. I hope you will work with us to get Home Infusion wherever practical and possible. Cover it as a benefit so we can have more people recovering in a less expensive, more hospitable environment than in hospitals and hospital facilities. Ecretary price this is really important, senator. What we find health care and medicine is dynamic. It changes all the time. And so what used to be able to be done only in a hospital now can oftentimes be done as an outpatient or in the instance of recovery at home. Home and communitybased services are absolutely imperative for us to have the mportant, senator. Flexibility to be able to do that. Its one of the things we tried to concentrate on from a waiver standpoint in many different programs as well as trying to incent the flexibility within existing programs so we can cover those kinds of treatment in not necessarily just in the venue that was previously selected when that was the standard of care but in a new venue because it works better for the patient. Senator isakson lastly, ill go what you said about experimenting to see to have our medicaid coverage available and robust for our citizens. Your state and my state of georgia, we have 1. 9 Million People on medicaid. 1. 3 million are on children. 50 of all of the live births in georgia are paid for by medicaid. So as we go through the reforms that are necessary on medicaid, we got to remember were talking about first and foremost in our state and most others, children who benefit from those programs that are robust are hurt if theyre cut. We need to continue to provide the coverage necessary and incentivize the program to meet the needs of our children in georgia. Secretary price thank you, senator. Thank you for your leadership. Senator isakson thank you, mr. Secretary. Senator stabenow welcome, secretary price. There are so many things i would like to talk to you and debate you in terms of what was said and the position of the administration. I want to start with i think a ery important basic assumption that you have made and that is that the carrie lukas that the Affordable Care act is falling apart. We have to dismantle it. That the carrie lukas that do Something Different because its falling apart. And yet we know to me its like pulling a rug out from under somebody and say, oh, my gosh, they fell down. We have seen consistent moves by the administration, whether ts cutting in half the number of days that citizens have to sign up for insurance, whether its no longer aggressively doing outreach to younger, healthier people making sure verybody is in the pool so that costs dont go up or of days that citizens have to whether its doing whats been done to take away the commitments made to the Insurance Industry to make sure they would be covering preexisting conditions and having no caps on services and so on. And its laid out this morning in the Washington Post when we look at the question of whether or not the white house is going to let the Health Care System die. And i want to just quote a little bit in there because this is coming from the industry. The biggest source of industry anxiety right now is whether the administration and congress will continue to fund cost sharing subsidies that help seven million americans with a. C. A. Plans afford deductibles and copays and, quote, absent that funding, i dont know if were going to have much participation in the Exchange Market in 2018, said tennessee insurance commissioner julie, a republican who served who also serves as president elect as the National Association of insurance commissioners. The uncertainty, the uncertainty is one of the top reasons insurers have cited when explaining why they are posting higher rates for the next year or withdrawing from markets altogether. Ncertainty is one of the top reasons that they have cited why they are posting higher rates for the next year or withdrawing from markets all together. Blue cross blue shield filed a rate increase of 22. 9 . They said it would have been 8. 8 if the administration had committed to paying basically keeping the commitments that were passed as part of health reform. And finally on tuesday, Anthem Blue Cross blue shield was getting out of the insurance market. I dont know why we are cheering that people are going to have less opportunity to have health care if we spent a tenth of the time as we spent undermining the system. We would be making terrific strides to lower costs for people. Heres what was said by the North Carolina chief executive. We have to take a snapshot in time which is right now. Lack of action, a lack of action by the administration yields a result we are currently seeing. Higher premiums rather than lower premiums. And so my question, mr. Secretary, is why do you believe its in the best interests of American Families to sabotage the Health Care System that is today allowing American Parents to take their hildren to the doctor . Secretary price let me just correct a few statements. Nobody is interested in the system dying. What we are interested in making the system works for patients, families and doctors. Senator stabenow why are you not willing, then, to indicate that as long as we have a system we have, you are going to keep the commitments and reimburse the Insurance Companies so they have certainty . Secretary price nobody is interestsed in sabotaging the system and nobody is cheering the challenges that we have in the system. In your state alone, premiums were up 90 before this president came into office. The number of insurers were down before this came into office in your state. Senator stabenow i can assure after meeting, Blue Cross Blue Shield are going to file two rates. If they dont keep the commitment they are going to be much higher. The question is why wouldnt you keep the commitments made . I understand you have a different view in terms of what the system should look like, which i disagree with, but in the meantime, you have insurers, insurers that are saying the reason the rates are going up is because of uncertainty and instability created by the administration. Why is that a good idea . Secretary price if you read further in that article, it talks about the increase in costs and decreasing costs before this administration came into office. What we are tying to do is fix the challenge that we have. Senator stabenow i have more questions for another round. But lets start by making sure that the administration is keeping the current commitments following the current law while we debate what should happen next. Senator hatch you have enough time to answer that question. Secretary price yes, sir. Senator hatch you need more time . Secretary price im fine. Senator hatch well turn to senator cassidy. Senator cassidy senator cantwell and i put in a bill for direct primary care. As physicians, the way you lower costs is empower the physicianpatient relationship so if the patient has a problem instead of going to the e. R. , she can call her physician and the physician can give her the advice. Here is more investment than in the other relationships that are out there, say an Urgent Care Center see them once. Senator cantwell and i put it together because it can decrease utilization and decrease Health Care Costs and we dont decrease the cost of insurance unless we decrease utilization and the cost of health care. Any comments on that model and how you plan to make that . Secretary price its an incredibly helpful program. The opportunity that individuals may have to be able to have a personal physician, a primary care physician in all settings across our Health System would be i think absolutely beneficial to the ability for that individual patient to get the kind of care that he or she needs. Right now, you cant do that. What we want to do is move toward a system that allows for more Personalized Care and the d. P. C. Model holds promise. Senator cassidy let me talk a little about the per beneficiary payment and just a little history for those who may not know, but it was first introduced by president clinton as a concept and two senators as a way to align incentives between the patient, the state and the federal government. And i think we are seeing almost a modified version of that as states are going to medicaidmanaged care, aligning between the state as a payor with the Medicaid Managed Care payment. As you know, i introduced a bill in 2010 i dont know when it was, 112th congress, which brushed off the proposal and updated it, if you will. Secretary price exactly. Its so important, having taken care of medicaid patients in our practices, the medicaid population is not a mono legitimateic populations. There are individuals are healthy moms and kids and there are individuals in the medicaid population who were lowincome seniors and disabled, blind and disabled individuals and all those individuals need to be treated uniquely because of their unique individuals. Nd what we do as a system is say you have to take care of those people the same way which doesnt allow for flexibility in the program so states can say you have to take care of tailor their programs. Senator cassidy the way we do is somewhat different. But as an example, right now if states uncover waste, fraud and buse, they have to give it back what the federal taxpayer put in. If it is 50 federal government, 50 of that goes back to the federal government. That works to disincentivize the state to go after waste, fraud and abuse because they have to put it back. The state would keep 100 of waste, fraud and abuse, aligning the incentivize. Secretary price those kinds of modifications and improvements to a system that i believe we ought to be all embracing. Those things will allow the incentives and make certain that every individual in that interaction is working for the benefit of the patient, making certain there is not the fraud and abuse, making certain that the patient can see the physician. Making sure that the patient can get the treatment. Senator cassidy the mack act that i introduced, we have Incorporated States like california actually get more money and some big blue states actually do well. Florida does better. So in terms of having more dollars for certain category of patients in order to improve health care. When i hear folks condemn it without understanding it, this could be a missed opportunity to align those incentives to improve patient care and protect the federal and state taxpayer. I look forward to working with you. I yield back. Senator hatch senator carper. Senator carper i commend you for something you did 24 years ago and what you did is you cosponsored legislation authored by john chafee that stablished marketplace exchanges. You established the market exchanges in every state. But to also say in order to make sure that the Insurance Companies had a healthy pool of people to insure, that there would be an individual mandate. Cant force people to get coverage. And fine them and incentivize them. I want to congratulate you for cosponsoring legislation for an employer mandate and providing for the idea that nsurance cant deny coverage to people who have a preexisting condition. All those ideas are part of romneycare in massachusetts and all those ideas are part of the Affordable Care act. And part of the Affordable Care act that republican colleagues like the lease are least are those ideas. I like those ideas. I like Market Forces and harness to make Market Forces work. You came up with a good idea in 1993. And i just wish that you would work with us to try to make sure that those good ideas have a chance of working. And the reason why the marketplaces are failing like ohio, the reason why they are not working is basically undermining the individual mandate so people dont have to get coverage and young people arent. We have taken off the training wheels to stabilize the marketplaces and Insurance Companies, they lost their insurance in 2014. They loft less money. And they did better and standard and poors told us, they said they are actually recovered. They said we arent going to enforce the individual mandate or extend the cost sharing arrangements. Arrangements. That is lack of certainty for the Insurance Companies. They said we are going to raise premiums more. You are destabilizing the very gd these guys came up 24 years ago. Senator hatch those were ideas that were against it was part of the antihillary clinton care bill. Senator carper those were good ideas. But i know what your bill did and they were good ideas. And now we are undermining and undercutting them. Why . Dr. Price, why . Ecretary price i appreciate the observation. And i would add to that that there are significant challenges out there and there were so before this started. In your state, premiums were up 108 . In your state, fewer Insurance Companies offering coverage on the exchange before this administration started. What we are trying to do is address that individual and Small Group Market that is seeing significant increases in premiums senator carper how are you stabilizing the marketplace . The three rs. What are you doing on those . Risk insurance, risk adjustment, what are you doing there . Price price we put in a market stabilization rule that identified the special enrollment periods to make certain they were more workable for both in adjustment, what are you doingdr Insurance Companies and allowed the states greater flexibility in determining what a Greater Health plan was to provide greater stability and put out word to all governors across this nation on both 115 and 1332 waivers and suggestions what they can do to allow for greater market stabilization in their states and we look forward to working with you to try to make certain all those individuals, not just the individual and Small Group Market but every individual has access to gain coverage that works for them and their amilies. Senator carper when i came to the congress, i used to think that medicare waS Health Care coverage. You know where we spend most of our money . It is for old people and they are in Nursing Homes and a bunch of them have did he mention yeah. Its not just poor women and children. And there are people who are white males a lot of hite males a lot of veterans only hope and getting access to medical care because they dont qualify for v. A. Coverage is through medicaid. Mr. Chairman, this is an idea. I extend this idea with good intent. I spent eight years as a overnor. I loved being an governor. I loved being part of the National Governors association. The governor of michigan and i used to come here, we used to testify on welfare reform and we would say, these are the views of the governors. This is what we ought to do. This is an issue that cries out for getting governors to sit at this table and say this is why the system works and doesnt and like the idea of per capita caps. Thats what we ought to be doing. Secretary price we are doing all that we can to make certain states are able to address the challenges. Senator carper when barack obama left office, was it a Perfect Administration . No. Hen he left office there was an insurer in every state in this country. Thank you. Senator cardin i heard your ommitment to help all people in this country to get Quality Health care and thats something we all agree on. But i want to get some of the practical problems. I was in frederick burg closer to senator carper, very Rural Community and they dont have o senator carper, very rural the same access to Health Care Providers that we have in our urban centers. And i visited the Wellness Center where we have the chop tank qualified center that provides direct services to our he same access to Health Care Children within the Elementary School and they are capable of doing that and for many of these children, their only real ability to get access to primary care and to have someone who can check up on their health. And they are able to do it under current law, but they tell me as the legislation is passing from the house to the senate, that that direct reimbursement will be cut off. They also tell me that if they cannot continue their flows through the Medicaid Program, that they will clearly not be able to continue the services that they are providing today in carolina ine county. My question to you, i understand your commitment to help all areas. Today, our qualified centers are providing lifelines in many communities. They rely upon creative ways in rural areas to provide care including within School Settings and depend on the reduced numbers of uninsured and those covered under the Medicaid Program for comprehensive reimbursement in order to maintain their presence. So how do we ensure as we go through this transition that the administration is talking about that the children in carolina ine county are going to continue to get their Health Care Needs met . Secretary price there are significant challenges in the rural areas of our nation for the provision of Health Services and those have been present for a long, long time and there is a strong commitment on the part of our department and the president to make certain that rural Health Services are available. Whether its through grants to the states, whether through an opportunity for various Health Programs within schools or elsewhere and make certain children have the kind of health care and not just coverage that they need, then we are absolutely committed. One of the things that our budget includes is a Health American block grant to do this sort of thing to make certain that folks in rural areas in states have the opportunity to gain coverage and care that they need. I look forward to working with you to make certain we are able to make that happen. Senator cardin the other area that i want to cover, i want to know your commitment to deal with Minority Health and health disparities. We have separate agencies to deal with it. We have it at n. I. H. And as i look at the historic discriminations within our health care and recognize that health care is not equally available and our focus has not been all to communities equally and we are trying to compensate for that today, i worry about what you are doing in medicaid particularly. Every Minority Community i go to, they mention to me medicaid. And that there is no capacity at the state level to pick up the lag if the federal government withdraws its commitment either in the umbers of people who are covered or in the benefits that are reimbursed. So how do you square a commitment to continue down the path toll reduce Minority Health disparities in this country and the not only the reduction in the bill that covered or in the benefits that passed the house but also the president s budget with such a large cut this medicaid . Secretary price i cant remember if i mentioned it in this committee in my confirmation hearing or the other one in the health committee, but the disparities are in Health Outcomes are absolutely unacceptable to all because what we see and its not just rural versus urban areas. There are urban centers, i know one in atlanta where the zip code, the disparities are astounding in terms of the mortality that exists and chronic diseases that exist and that isnt because of lack of of services. Imagine if you had a Medicaid Program to provide increases sources to the that zip code and case manager for every single individual who has a chronic disease, thats not possible. You cant do that. Thats the kind of waiver but partnership that is important to make it so that we identify hose folks that need greater assistance because there are if we are going to end the disparities out there. Senator cardin im all for flexibility to the states, but i know the pressure on state budgets and i know in my state of maryland that our legislature has been pretty aggressive in helping the medicaid population, they cant pick up the slack. The waiver wont give them what they need in order to make the type of commitments in underserved areas. Senator hatch we are going to turn to senator casey. Governor kasich i wanted to start senator i want to talk about the letter that i sent to you recently about the house bill, h. R. 1628. But in particular wanted to reference the Congressional Budget Office report that came ut on the 24th of may and this is a nonpartisan report by c. B. O. And the joint committee on taxation. And i just delivered to the table a copy of the c. B. O. Report so you could go to the page. I direct your attention to page 17 of the c. B. O. Report. On that page, the following statement is set forth there, quote, Medicaid Enrollment would be lower throughout the coming decade, culminating in 14 million fewer medicaid enrollees by 2026, a reduction of about 17 from current numbers. It references this chart, which you see on page 19, showing the number is going down for medicaid over that time period because 2018 and 2026, all bars oing down. Reference that in the context of what you said on cnn on may 7, quote and the transcript is right in front of you, quote, there are no cuts to the Medicaid Program, unquote. Thats what you said. Do you still stand by that statement being made on cnn . Secretary price what is the baseline. I stand by that statement. 7, quote and the transcript is its relative to something. The baseline, its todays amount of money being spent on medicaid. He president s budget provides for an increase, c. P. I. Medical crines in medicaid case senator are you saying that the statement isnt accurate . Secretary price the constellation of activities regarding of how we would move forward. Senator c. B. O. Said there are fewer enrollees. Secretary price do you have the c. B. O. Report when the a. C. A. Was proposed in 2010 . Senator talking about the House Republican bill that was passed. Thats what we are talking about today. Secretary price they had a similar graph about the number of individuals that are covered now senator let me direct your attention to page 13. The top of that page, it says the following, the introductory sentence is, a reduction quote, the total deficit reduction includes the following amounts shown on table 3 at the end of this document. The first bullet is, quote, a reduction of 834 billion in federal outlays for medicaid. Do you still assert in light of that, you still assert that there are no cuts in medicaid . Secretary price it depends senator all im asking you is if you stand by that statement. Finally, let me go to a statement that was made in the c. B. O. Report and im going to page 19 and 20. At the bottom of page 19, the following is set forth, quote, under the act, meaning under the republican bill passed in the house, under the act, premiums for older people could e five times larger than those younger, but the size of the tax credits for older people would only be twice the side of credits for younger people. For older people with lower incomes, net premiums would be much larger than under current law on average. And that refers to table 5 at the end of the report. I ask you that in the context of another statement you made. This is meet the press in march. Quote, you said nobody will be worse off financially as a result of the bill. Do you stand by that statement . Secretary price i dont believe that statement was in reference to the bill but the Health Care Plan and i stand by that statement. Senator hatch your sometime is up. Senator i hope you focus on the proposed and the 15 million americans that get medicaid because they have a disability. We are all for discussion about making programs better but focus more intensively on those people and be truthful when you are commenting about something as important to american lives as the Medicaid Program. And i would argue, sir, you have been delitly misleading based upon those tatements. Secretary price with respect, that is precisely what we are focusing on. The American People and understand the health care we have for many of them is not working. Many of them in the Medicaid Program is not working. What we are trying to do and we would love to have your support and have a system that responds to the wishes, needs and Health Care Needs of all americans. Senator you have to start being straight with the American People. These are major cuts and the c. B. O. Said it. Nd you should be truthful. Senator hatch senator mccaskill. Senator mccaskill will we have a hearing on the Health Care Proposal . Senator hatch will we . Senator mccaskill on the proposal that you are planning to bring to the floor for a vote. Will there be a hearing . Senator mccaskill we have no idea whats being proposed. There is a group of guys in a back room somewhere that are making these decisions. There were no hearings in the house. I mean, listen, this is hard to take because i know we made mistakes on the Affordable Care act, mr. Secretary. And one of the crist sisms we got over and over again was that the vote was partisan. You couldnt have a more partisan exercise than what you are engaged in right now. We arent going to have a hearing on a bill that impacts 1 6 of our economy or offer a single amendment. It is being done with an eye to get it by with 50 votes and the ice president. Im stunned that that is what leader mcconnell would call regular order, which he said would be the order of the day when the republicans took the senate over. We are now so far from regular order that new members dont even know what it looks like. And i know that doesnt make you happy, mr. Chairman or senator grassley, because you have been in the senate so long, you know the value of the hearing process and the amendment process. And even though the vote ended up being partisan, just as yours will be, the amendment rocess wasnt. Both of you had amendments put into that bill. I want that opportunity. Give me that opportunity. Give me an opportunity to work with you. Thats what is so discouraging bout this process. So, mr. Secretary, i want to ask you this, a 27yearold young man who lives in Jefferson County and making enough money that he can do one of two things he can either by a Health Insurance policy or buy a new harley, and which do you think hes going to buy. Secretary price you tell e. Senator mccaskill he is going to buy a new harley because he is young and buys a new harley and lays it on the pafment and an 18wheeler and life flighted to the hospital, do you believe that hospital should treat him . Secretary price absolutely. Senator mccaskill in america we treat you whether you are insured or correct. Ecretary price there is a mandate that he buy insurance. Senator mccaskill you are going to do away with it. Secretary price is it working. Senator mccaskill under your scenario he doesnt have to buy insurance he buys a harley and life flighted and we deliver 3 million worth of care to him. Y simple question to you is, who pays for you . Secretary price it is spread among the entire system and no one pays for it. Senator mccaskill people pay for it. Secretary price or people provide the Services Without any compensation. Senator mccaskill what the hospital does, they call the Insurance Companies and we have to raise your prices for labor and delivery or for an angioplasty and that Insurance Company says we have bad news for you, because the hospital is charging more, we have to charge you more. Secretary price premiums were up 120 in your state. Senator mccaskill thats not true. Secretary price we will be glad to show you the numbers. Senator mccaskill when we add 24 million more uninsured who is going to pay with those bills . You disagree with the c. B. O. Score . Secretary price absolutely. Senator mccaskill if anyone is kicked off medicaid, who pays these bills. We are passing along these costs who have insurance policies. We are paying their bills by higher premiums. We are going to reverse that and create more uninsured. Senator hatch your time is up. Senator grassley has one more uestion. Senator mccaskill i was only over by 35 seconds, but i thought i did ok. Senator hatch you did so much better than the rest of your olleagues. Senator grassley i have one question because i have to run to another meeting. Im going to ask you this question and submit other questions for you to answer in writing. The Rural Community hospital Demonstration Program was established in a bipartisan manner to protect patients access to health care. Hese hospitals are collectively called quote, unquote, betweeners, another bipartisan piece of legislation, 21st century cures act extended this program. The language was very, very clear. The program was to be extended beginning on the date immediately following the last day of the initial fiveyear period. Despite this clear language, c. M. S. Proposes to begin implementation of this extension on or after october 1, 2017. This gap in implementation is inconsistent with congressional intent, which requires a seamless extension of this critical program. T is inconsistent with the way the agency implemented the first fiveyear extension of his program. I have a bipartisan letter to the administrator asking her to look at the alternative payment timing that was included in the proposed rule. I would like to submit a letter or the record, mr. Chairman. And by way senator hatch without objection. Senator grassley mr. Secretary, you were cc on this letter. I would hope you could give consideration to this request in this letter because in several states, many states, this is an issue particularly rural states, one of whom is alaska, as an example and i hope you can make sure we have a seamless implementation of this program. Secretary price absolutely. And well get back with you because my understanding in looking into this is as it was extended, the proposed rule was put out in april of this year and allowed for rural hospitals to apply to this program literally as we speak. And the deadline was the latter part of may. But we have a commitment and important for rural areas and well get back with you. Senator grassley i yield back. Is senator brown you highlight how this years budget proposes a 50 million funding increase. 11 million might seem like a lot of money, but you know what is a bigger number . 939 million the amount of money one state spent on fighting the opioids pidemic. 939 million. This chart came from the department of medicaids website. In 2016, ohio invested 939 million in fighting this epidemic. You know where that total came from, 650 million came from medicaid, 650 million came from medicaid. Espite this investment and the governor investing in prevention in medication, therapy and other treatment, eight people, if todays like most days, eight people will die. 4,000 people in the state of ohio died were on track to far exceed that number and in counties we have exceeded the number of the year before and this is only june. 43 people died in ky owinga county, the states second largest county in the state. 43 people since memorial day. This continues to devastate communities in my state. I agree with what you wrote in 43 people died in ky owinga your testimony, we are not winning this fight, but im confident we lose far more people, far more lives, far more families turned upside down if we werent spending this money. If medicaid werent spending this 650 million. Two weeks ago, my colleague, both members of this committee, senator portman, my ohio friend, senator carper held an important meeting about this epidemic to discuss proposals. The witnesses on the second panel of that hearing, a doctor and a police chief from newtown, ohio, one of the most conservative parts of our state and former head of drug control policy and a coroner, all voiced opposition to either ending the Medicaid Expansion or cutting the program. These four experts brought by senator portman to his committee all said dont cut medicaid. Dont eliminate or dont cut it or dont end the expansion. The coroner noted anything like Medicaid Expansion that limits peoples access to health care, i cant see any good coming from this crisis i cant see anything good coming from that risis. Police chief from newtown, ohio, a suburb, he is a front lines and said we should not be decreasing medicaid and talked about one of the programs that his teams are doing, signing people up. Sign them up for medicaid and 200,000 families in ohio are getting opioid Addiction Treatment who have insurance because of medicaid. Yet your administration talks down and criticize Medicaid Expansion. And he said taking away medicaid would make this fight more difficult. I dont want to imagine the number of Overdose Deaths we would have had in ohio. He has gotten criticism from. The Budget Proposal your team put together cuts medicaid by 600 billion in addition to the house a. C. A. Repeal. Medicaid covers a third of all Substance Abuse treatments. And ohio it covers 50 of all medication assisted treatment. Plans to address the opioid risis. What you are not telling to your readers, Donald Trumps second best state. You arent telling them what ou are doing and im sorry for this, how do you plan to increase access to treatment when you cut the single biggest ource by 600 billion . How does that add up in the rumpprice math in 2017 . Secretary price i visited your state, Southwest Corner of your state to visit with victims of opioid addiction and parents of kids who died one mom told me about her son who died in the bathroom in macys from an verdose. The scurge we have is unacceptable to you and unacceptable to me and the president. Our commitment is to make certain what we put in place is a program that actually works. You have seen the graphs. The numbers continue to go in the wrong direction. If we are going to be married to a system that has resulted in 52,000 Overdose Deaths in 2015, thats not a system i want to be committed to. I want a system that works for the parents who are suffering today because they lost a loved one. But i commit to working with you on to work with those who are addicted who want to gain recovery and treatment. So that is the system i look forward to working with you on. And whether or not it is paid for through the medicaid system or paid through imagine a system that isolates the individuals treatment for addiction and takes it out of the Current System we have so we can focus treatment on individuals. Imagine that system. The ability to treat those folks and the ability for the system to thrive fiscally better elsewhere. Imagine a system that results in 52 thousand americans senator brown how do you do this when 22,000 people are etting treatment in my statement. People are in and out and it takes three, four, five times. But if you want to cut medicaid. People are in and out and it talk about a Grant Program and all this talk and i know you mean it in terms of wanting to take care of people. But how does this work if you are going to cut the biggest revenue stream that takes care of these families . Senator hatch you are way over your time and then go to enator cantwell. Secretary price a system that actually works for the individuals who are suffering from this addiction. A system that actually focuses attention and focuses treatment on it, a system that recognizes we have greater surveillance and Pain Management that is flawed and has not put the resources into research so we can turn this curve in an appropriate direction, which is down. We continue to tolerate a system that allows for the kind of addiction and Overdose Deaths in this nation. Its unacceptable to me and i wont stand for it. Senator cantwell i have a couple of questions. There has been press reports that the department is working on a rule that would deny Birth Control for employees, are you aware of this . Secretary price there is a proposed rule that is out currently and on con she eveningsous objective. Senator cantwell you are proposing that you allow employers to discriminate against women to have Birth Control in the policy . Secretary price solicitation of input and in that process im not able to make any further comment. Senator cantwell you cant make a comment whether you think that Birth Control should be basic health offered in insurance plans . Secretary price it ought to be available. Senator cantwell are you promulgating the rule . Secretary price there is a proposed rule that has been put forward. Senator cantwell so tu think that employers should offer Birth Control as part of Insurance Programs and not be able to just say on a basis that they dont believe in providing it . Secretary price women who want access to Birth Control women who desire ought to have access to Birth Control. Senator cantwell this is a very big problem. Women cannot be discriminated against their employer who wants to cherrypick various aspects of womens health. If this is the intent of this rule, there will be a big fight on this issue. I wanted to ask you about proposed medicare cuts because the administration said they werent going to cut medicare. The budget includes a twoyear extension sequestration that would propose a 2 cut on hospitals and rural hospitals, the mandatory would be 30 billion cut from the Medicare Program. Does your budget include that . Secretary price i think what you are referring to is the continuation of current law and the budget acome dates or reflects current law. Senator cantwell you are saying the extension of the mandatory sequester is not a cut to medicare . Secretary price again, its the same kind of question, depends what your baseline is. If your baseline is current law, there are no deductions. Senator cantwell you believe we should be making these deductions to Rural Health Care facilities . Secretary price we should have a system that makes it so that the American People have access to the kind of care they need. Senator cantwell you are behind ill take this as a yes that you are behind this articular cut. And i would just say that our rural hospitals are struggling to make sure we are providing good care. There are lots of efficiencies with the delivery system. I have had a chance to ask you about this issue of rebalancing on the budget. Rebalance from nursing home care to communitybased care. That is something we wrote in the Affordable Care act and it is a huge savings to the budget. Is that something that you think the administration can et further behind . Secretary price as i mentioned, the Health Care Market is so important to embrace because we ought to be allowing and accommodating in our system for individuals to receive care where it best suits them and their priors. So you have identified an area where we ought to be able to accommodate that and the system should allow for it. Senator cantwell thank you, mr. Chairman. Senator hatch senator nelson. Senator nelson i just want to ask you about things that are in the budget, in your proposed budget. Something that we have heard a lot about are the costsharing reduction subsidies. 72 of floridas Affordable Care act consumers benefit from these. And thats why im asking. Now its hard to get a clear answer on this. The private market the private market providing under the exchanges cant take the uncertainty of knowing whether or not the subsidies are going to be there. Nsurers have confirmed this to y questions when proposing rate hikes or even pulling out of the markets because of the uncertainty. So can you confirm that the administration will continue to reimburse insurers for these subsidies that help so many of y constituents see a doctor . And i notice its in your budget through fiscal year 2018. What should we believe . Secretary price senator, as you know, this answer may not prove satisfying to you but the urrent court case is now house v. Price so im the defendant in that case. So what i can tell you is just what you said, the budget reflects the payment of the c. S. R. Payments through 2018. Senator nelson so does that answer mean if the court case went in the favor of the administration that basically those subsidies would be cut . Ecretary price what i can tell you again, and i would like to be share more but as the defendant in the case, im not able to do so. But as you noted, the budget acome dates and reflects for c. S. R. Payments through 2018. Senator nelson and the unfortunate dilemma is, mr. Chairman, that because of the uncertainty, it present difficulties an outcome that the a. C. A. , the Affordable Care act, is in the exchanges, which is bringing Health Insurance to millions and millions of people who otherwise could not fford. The uncertainty of whether or not those subsidies will be there in the future, in fact is undermining the ability of insurers to be able to project what their premiums are going to be and therefore to protect themselves, what theyre doing is jacking up their premiums, which is undercutting the whole reason for having the subsidies in the first place. Let me shift to the zika virus, mr. Secretary. As weve discussed, you know here are a bunch of cases, 1,400 in florida alone. And your administration 2018 budget states and i quote, outbreaks like zika will not be a onetime event, Capacity Building at all levels as well as innovation and diagnose particulars is needed to control these outbreaks and understand more of these. Yet the administration slashes the very programs designed to olster capacity at all levels. So, mr. Secretary, does your budget cut more than 7. 2 billion from n. I. H. . Secretary price as it relates to zika, i cant tell you about how proud i am at n. I. H. To get a vaccine. The c. D. C. Is doing phenomenal ork to make certain that the surveillance senator nelson i understand all that. Secretary price budget accommodates for handling any challenge that exists. Senator nelson i understand, does it cut 7. 2 billion from n. I. H. . Secretary price it identifies reductions that can be accomplished at n. I. H. And savings that can be accomplished by increasing fficiencies and making certain that we have the core mission of n. I. R. N. I. H. Senator nelson efficiencies are great. Black or white, does it cut 7. 2 billion from n. I. H. . Secretary price your number is accurate. Depends on what the baseline is. Enator nelson i have a couple of other questions, just simple yes or no questions. Senator hatch go ahead, but your time is up. Senator nelson i understand. But i want to ask yes or no questions. Does it cut more than 600 billion from the Medicaid Program on top of the cuts included in the housepassed health care bill. Secretary price no. Senator nelson your budget does not . Does it cut more than 1. 3 billion from the c. D. C. . Secretary price 10 reduction in Resources Available to c. D. C. Through appropriate authorities and we believe strongly that the c. D. C. Budget is what is needed to continue to protect not just the United States but the world. Senator nelson so is that a yes, cuts 1. 3 billion from c. D. C. Secretary price its a statement that affirms the president s desire to get folks that you dont measure of the success of a program by the amount of money but the outcome and the mission is accomplished. If we can accomplish the appropriate mission of c. D. C. With less resources, one would think that would be something to celebrate. Senator nelson mr. Chairman, i understand the reasoning behind it, does it cut 1. 3 billion from c. D. C. . Secretary price there is a 10 reduction in resources go to c. D. C. Senator nelson does that equate to 1. 3 billion. Does it cut 850 million from food and Drug Administration . Secretary price i dont believe. What we envision in the f. D. A. Is to shift the resources oming to f. D. A. And there is a 500 million increase through a modification and an improvement in the user fee process. Senator hatch senator, you are way over your time. You can submit questions in writing. Senator bennett. Senator bennet i will yield to senator roberts and i would like to go after him. Senator hatch well go to senator roberts. Senator roberts are we under the five minute rule or the 10minute rule . I guess were under the fiveminute rule. Welcome back, doctor. Secretary price good to be back. Senator roberts there are statements that you are responsible for people dying in ohio, for problems with the Affordable Care act in the last ight years, resources in rural areas which im interested in, the entire budget by the president or to be more accurate o. M. B. , and the chairman has been chided for not having regular order where we have in the senate today is called cloture and delay, hats not regular order. I sort of lost oh, the zika virus. Hindering infection of zika virus. Are you enjoying yourself . Secretary price the job is a great challenge and im enjoying the challenge, yes es, sir. Senator roberts i know you, in your time on this side of the table, you worked on this, people are having to drive 150 miles with regards to durable edical equipment and access to it. Last year we passed the 21st entury cures act and sought to impact temporarily the payment changes. To improve the effectiveness of payment amounts, reduce the beneficiary cost, save the Medicare Program money, do you think the agency needs to provide addditional regulatory changes to its implementation . What im trying to do is get a sense of whether legislation is needed. Secretary price legislation would be welcome that moved in the direction of allowing Durable Medical Equipment providers out there a greater opportunity to provide services to their clients, to patients across the land, regardless of whether legislation is forth come the department is looking very seriously at the issue of d. M. E. Because we believe strongly that the Previous Program that has been put in place is limiting the access to appropriate services for folks all across this land, especially in rural areas. Senator roberts i appreciate that. Im sitting here listening to my friends across the aisle with regards to their concerns ith reference to what is happening to our health care. I had a question that would be repetitive, the chairmans here happening to our health somewhere, you have talked about it, about whats happening with our premiums and copays. Here it is, blue crossblue shield kansas city announced theyre pulling out of Obamacare Exchanges next year. Nationwide premiums have doubled, in three states that have tripled, and yet i hear my colleagues saying stay the course. Full steam ahead. Full funding if in fact we could do that. Keep funding what is not working. And i must say thats 180 degrees from what has happened and trying to pin it on you is rather amazing. This is like blaming Butch Cassidy and the sundance kid for jumping off the cliff or to be more accurate we are in the obama car and its a lot like being in the same car with helma and louise and were going into the canyon. We got to get out of the car. And i think thats what youre trying to do. And i wish you well in that. And i dont think youre responsible for the entire budget thats been proposed by o. M. B. Im not really in fare of some of the things with regard to agriculture, we plan to change that we hope to get a senate budget. I dont know of any time the senate has considered any budget that came from a president seriously since reagan. So and then this other business of regular order, with regard to the chairman, i was here during that whole episode of when we put obamacare together. And days and nights and days and nights, it started in the health committee, that product is sitting on a shelf somewhere, gathering dust. I had one amendment that was on rationing. You know what im talking about with ipab and the rest of them. It failed on a party line vote. I came here. And again i had the same amendment on rationing. It failed on a party line vote. And then the product went to the floor of the house. And went behind closed doors and the lead and the eaders office and sort of like charlie rich, you know, singing behind closed doors. And out came obamacare. And weve had eight years of this now. And i just think blame you for all these deficiencies we are trying to correct on a bipartisan basis has been over the top. And my time, sir, has expired. Secretary price thank you and i endorse what you just senator hatch thank you and i endorse what you just said. Senator bennet. Senator bennet the numbers as i understand them are that theres about 834 billion of cuts in the house bill that the House Health Care bill and theres about 610 billion in savings or cuts to the Medicaid Program in the budget. Is it right to add those umbers together . Or is there overlap among those numbers . I want to make sure were accurate. Secretary price i dont believe its correct to add those numbers together. The budget, my understanding is the budget doesnt assume passage of the house bill. Senator bennet my understanding is it assumes passage of the house bill. Secretary price as it relates to medicaid, it assumes what is put in place is a block Grant Program that will reflect over a 10year period of time a savings of 610 billion. Senator bennet if we could Work Together id appreciate the opportunity to work with your staff to see whether in the end were talking about 834 billion or 1. 4 trillion. In either case, its a huge cut to the Medicaid Program. Even if its just 834 billion, think thats a 25 cut to medicaid. And i would ask you, i mean, i asked the Governors Office in colorado to tell me who is on medicaid in my state. And heres what they said. Id like to ask you whether you dispute any of this they said that when you look at who is on medicaid in colorado, nearly half the program are children. Is that does that strike you as probably right . Secretary price thats the ballpark for most states. Senator bennet and more than 40 of medicaid spending supports seniors and injured, people who have spent down their life savings for the privilege of being in a nursing home funded by medicaid, would you agree that thats right . Secretary price sounds a little higher than most state bus its in the ballpark. Senator bennet and then they said of the remaining adults on medicaid, the vast majority work but still cant afford Health Insurance on their own. Does that sound familiar to you in terms of colorado or other states . Secretary price theres certainly individuals who have medicaid coverage who are employed. Senator bennet what they would say is theres a tiny residual percentage of people that are that arent disabled, arent medicaid coverage who are elderly, arent children, and dont work but are on medicaid. Theres some small percentage of people. Is that does that is colorado different from other states . Secretary price we can get you the numbers for your state, im sure. Senator bennet do you see any reason to dispute what i just said . So here we have the secretary, i appreciate your candor, the secretary saying that medicaid is not supporting a whole bunch of people that should be working and arent working. Would you agree with that . Secretary price i think it varies from state to state. Certainly there are individuals who are able bodied without kids on medicaid who arent working. Senator bennet but thats a very small percentage of the people, i dont want to walk back through the list but thats a small percentage . I think this is important because this is the secretary of health and Human Services. Hes not saying there are a whole bunch of americans out there that are lazy, that are on medicaid because they dont want to work. It doesnt comport with the evidence. Its not true. Its certainly not true in my state. So the question then becomes if were going to cut the program by 25 , if you were running colorados Medicaid Program, and i have a story that ill share with your staff, from the denver post yesterday or the day before, a front page story about the 700 million a year by 2023 that the state is going to have to come up with to compensate for the withdrawal of the federal government, the medicaid reductions that are in that. Ust a housepassed bill, not your budget, but a housepassed bill. Whats your advice to us in our state about how we ought to handle those cuts . That 700 million to our state . When 40 of the people on the program poor children, when youve got a whole bunch of people that are in Nursing Homes, you have a whole bunch of people who are working but unfortunately cant afford private insurance, what are we what is my state supposed to do . Secretary price i think the constellation of programs that we would envision that would provide for greater opportunity for individuals to get Health Coverage as opposed to less right now i would remind folks again there are 20 million americans without Health Coverage. I dont know what the number specifically is in colorado but theres a significant number of individuals that dent have Health Coverage and what we would envision is a system that responds to those folks and individuals who find that its better for them not to be covered on the medicaid system but on a system that is more responsive. Senator bennet my time is up, with respect, and i do respect you, your time in the house and the fact that youre a doctor, to believe what you just said, you would have to first reject he findings of the Congressional Budget Office that the house bill throws 23 Million People off insurance, creates 23 million more people that dont have insurance. You have to believe that and youd have to believe that a 25 cut to medicaid that covers poor children, people in that dont have insurance. Nursing homes and people that are already working, cant afford insurance, are somehow magically going to be able to buy Health Insurance under a system that no longer regulates the Insurance Industry. Thats what were being asked to believe. I can tell you this, mr. Speaker, and mr. Chairman, because the republicans in the senate has not yet taken up the bill and i hope that we will if you set out to design a bill less responsive to the critics of obamacare in colorado, to republican critics of obamacare, you could not write a bill less responsive than the ouse bill. So my hope is that in the senate you could not do it my hope is that in the senate we will not do this in a partisan way but we will come together as democrats and republicans and address the Health Care System in a way that is actually believable to the people that i represent. What you just said is just not believable in any respect. To people at home. And im talking about republicans. To say nothing of democrats or independents. Senator hatch senator heller, youre the last one. Senator heller i want to be last. Orry, secretary, i guess im ot the last. Thanks for taking time, taking ome questions. Ill talk a little bit about nevada. Ur Legislature Just finished monday so as of two or three days ago it adjourned for the next two years. And one of the questions and comments being made is if the a. C. A. In its current form, what came out of the house were to pass, it would put a 250 million annual hole in nevadas budget. These numbers an indication im getting out of the Governors Office of he state of nevada also. Id like your reflection on that. If its 250 million a year, thats 500 million in a iennium, we dont go back into session for another couple of years and their concern is they have to call a special session in order to correct that kind of a budget offset. Do those figures sound accurate to you . Secretary price i dont think so. Because in and again the house bill doesnt anticipate, as i understand, doesnt anticipate any significant changes until 019. So from a financing standpoint, 2020 being the time when the ajority of it would the changes would come into play. Wed be happy to review the genesis of those numbers and see whether or not theyre accurate and if so how we can address that. Senator heller have you had an opportunity to do research on 1 2 . The reason i ask is because we had a member of our delegation on the house side that, he had conversation with you and the director of c. M. S. And between the two of you, you were able to convince him that these numbers perhaps arent as accurate or as dreadful as they come out of the Governors Office. Secretary price thats correct. Senator heller what kind of reflection did you have, do you recall the conversation you had . Secretary price i think there was specific language that accommodated that concern. Thats why i said i dont elieve any changes would occur over the ensuing two years. But again wed be happy to talk ith you and work with you an the gnchor and your state and see where they believe those numbers are coming from and determine their accuracy or not. Senator heller what do you consider being the growth of Health Care Cost . Secretary price the medicare the gnchor and your state and annual growth rate has been in the range of 2. 6 or 2. 8 annually. Senator heller what do you anticipate over the next 10 years . Secretary price ill get back to you on the specific amount. I think its increasing a little bit but i can get you the exact number. Senator heller are you working with leadership on our side as we go through the changes . Im going to guess leadership on our side has had discussions with you, c. M. S. , some of the particular changes that were looking at. In other words its including growth rate. I dont know what the growth rate is going to be, if its going to be c. P. I. Medical plus one, as they did in the a. H. C. A. Or c. P. I. Medical or inflation for that matter have you had any cushions . Discussions . Im trying to find an answer to this question, i cant get it out of our meetings. I wondered if you had any insight into what the rate may be that were proposing over the next couple of weeks to send to c. B. O. Secretary price as it relates to medicaid, the proposal in the budget is c. P. I. Medical plus one for those aged and disabled. C. P. I. Medical for the others. Senator heller do you still ebb course that . Secretary price thats whats in the budget. Senator heller if it was less than that, if it went to nflation rate, would you support that . Secretary price if it accommodates a sup remital manner, i would have to look at hat. What i have to support is to make certain that every single more than has access to the coverage they need. Senator heller c. P. I. Plus one for disability and what was the other . Secretary price aged. Senator heller if that were to change to just c. P. I. Medical or inflation would you support that . Secretary price in isolation i think that might be a challenge but that doesnt that doesnt address what the entire cons ration of constellation of whatever the plan is or program is because there are other ways to accommodate individuals who need Financial Assistance and we are committed to making certain that that happens. Senator heller over the next 10 years whats the rate increase overall over the next 10 years. Secretary price well get that to you, i dont have it on the tip of my tongue. Senator heller if its below that, would you have a problem with it . In other words if you tell me what it was and we calculate less than that would you support it . Secretary price i think whats important is to accomplish the goals we set out, to make certain that every single american has access to coverage they want. When you have that as your goal then it requires that you provide resources in an array of different ways to make certain that that is accomplished. Senator heller i want to make sure that the funding isnt below inflation. Secretary price in isolation i agree. Senator heller thank you. Thank you, mr. Chairman. Senator hatch senator stern. Senator thune we have a number of important issues to tackle in the health care space, i thank you for your work. I want to i discussed with with you at your confirmation hearing but i have serious oncerns. We continue to see significant problems even after two i. H. S. In north dakota enter the center for medicare and medicaid progress. They find problems with the pine Ridge Emergency Department after a recent unannounced site visit from c. M. S. These systemic problems over the years are what prompted other senators and i to introduce the restoring accountability in the i. H. S. Act. It will give i. H. S. The ability to terminate poorly performing employees, streamline the hiring process to recruit talented medical professionals more quickly and create incentives so those folks will stay on the job longer. My question is, will the department commit to working with us on this legislation and other reforms to improve the quality of care at i. H. S. . Secretary price absolutely. Ive been impressed with the commitment of individuals in i. H. S. And the resources we are trying to identify for new facilities, one of them as you know in south dakota, to make certain were living up to our responsibility and the commitment we have as a nation to in the i. H. S. Arena. Senator thune wed love to give you more tools to create the accountability we need. We look forward to working with you on that. Last year you and i both worked on legislation to address the application of medicare Competitive Bidding rates in noncompetitively bid areas. Ultimately the 21st century cures act required a delay in this and required them to report on how payment adjustments affect beneficiary access. That was supposed to be done by january 12 of this year. Im wondering if you can provide an update on the status of that report for the committee. Secretary price it remains in process. We have a significant commitment to make certain that the d. M. E. Program is functional functional and works for folks all across the land especially in rural areas. Senator thune and as you discuss regulatory relief, a focus of the administration, something we agree with, what the departments approach might be for addressing these beneficiary access challenges posed by the current reimbursement structure, something you can d in the interim to help bring relief. Secretary price absolutely. You cant have a system that awards, as you well know, awards contracts to entities that have never provided services in a geographic area. Thats the system we currently have. Or that awards contracts to servicers or providers that have never demonstrated the capability to provide that service. And sadly, thats the system that we have in place right now. So what were looking at is the entire array of the d. M. E. System and the goal is to make certain that all americans, regardless of where they live, have access to the kind of services whether its hospital beds, whether its wheelchairs, whether its home oxygen, whatever it might be in the d. M. E. Space, these are quality of life issues for so many, many people and from my perspective, we have failed to date in making certain that we ensure the kind of accessibility that folks need. Senator thune finally we discussed the rule that all Outpatient Services be provided under direct supervision which has been delayed annually since then for small and rural hospitals. You expressed interest in working with me on a permanent extension of the nonenforcement of this policy. Im wondering if you have an update on where things stand from the departments perspective. I think the permanent nonreinforcement of something as part of a bill we have out there and weve been trying to, we can sort of kick this down the road each year, but im hoping we get a permanent solution somewhere, if you could tell wruss you see things from your departments standpoint. Secretary price its an area of Significant Interest and i can tell you its a work in progress. Enator thune we hope we can get some permanent relief there and look forward to working with you going forward. Thank you, mr. Chairman. Senator hatch thank you, senator thune. Senator stabenow has a question or two, then well wrap this up. Senator stabenow thank you for your courtesies in morning allowing us to have thorough opportunities to ask questions. Secretary price thank you for being here. There are so many issues i continue to have great concerns about. But when we certainly when we look at this budget that impracticality, cuts medicaid, medicare, childrenS Health Care, Rural Health Care, research on lifesaving drugs, i could go on and on. But one type of cut i know we need is not in this budget. And thats a cut in the cost of Prescription Drugs. President trump repeatedly state head wanted to drastically bring down Prescription Drug prices through medicare negotiations. Saying pharmaceutical companies were getting away with murder. I support medicare negotiations. I have for a long time. 90 of americans support that. But this budget doesnt include any major proposals to bring down the cost of Prescription Drugs. Whether its medicare negotiating, safe importation of Prescription Drugs, transparency or any other policy for that matter. Even though the prices of the most popular drugs have increased by 208 . 208 in the last 10 years. However, the House Republican Health Care Plan, and i assume the senate one thats proposed, does give Drug Companies a huge 25 billion tax cut paid for by the people who are seeing their Prescription Drug prices go up, middle class families and seniors. Given that this budget the major policy document from the dministration, is it fair to say that lowering Prescription Drug prices is no longer a priority . Secretary price absolutely not, senator. We have at the department, the president has made this an absolute priority and charged us with making recommendations to his office on reducing drug prices and over the past six weeks, eight weeks, weve had a half dozen to eight stake holder meet wgs all sorts of individuals. Eve charged hrsa and f. D. A. And c. M. S. With coming up with specific proposals to make certain we can provide the president with the most and c. M. S. With coming up with effective way to be able to reduce the increase in drug prices. So no its an absolute priority and we look forward to working with anybody who is interested in holding down or bringing down drug prices for the American People. Senator stabenow should a family have to pay 800 for an epi pen for their child . Secretary price whats happened in the past is competition to bring down those prices was prevented by previous decision through the Previous Administration so were looking through the f. D. A. At exactly those kinds of things. Because to have our goal is to make certain that the American People have access to the kind of medication they need at a price they can afford. Senator stabenow which i wish was in this budget. Its not in the budget at this point. But should someone who learns they have hepatitis c have to pay 80,000 to get the drug they need to be cured . Secretary price well, youre identifying a drug thats saving lives. Senator stabenow 80,000 to have an opportunity to save their life. Secretary price the question is whats the right price for that drug . Senator stabenow is that the right price . Secretary price theres a way to determine that. The question is what is the right price and how do we incentivize innovation and make t so companies are able to identify these remarkable cures that are out there i dont know what the right price is but i know how you figure out. Senator stabenow id be anxious to know what the right price is. If you have Cystic Fibrosis and need the latest drug, do you need 300,000 do you have to pay 300,000 . Secretary price we should do we should be celebrating the way we can save lives. Senator stabenow i celebrate that, but its difficult when someone cant afford whats on the market. I celebrate innovation but innovation needs to be affordable so people have access to treatment to save their lives. Secretary price i agree. Senator stabenow is it present to give pharmaceutical companies a 25 billion tax cut in the Health Care Reform bill when theres nothing to bring down the cost of prescription rugs in that bill . Secretary price regarding whats in that bill as it relates to drug pricing. Senator stabenow im talking about the tax cut. Do you think its appropriate to give a tax cut to the pharmaceutical in a bill thats taking away health care from people and does nothing about lowering the cost of Prescription Drugs. Secretary price i dont know if thats what it does. Senator stabenow i do know thats what it does. Secretary price well, then you do. I believe its imperative we have a system in place that incentivizes innovation so we can real realize the remarkable, remarkable productivity and entrepreneurialship and innovative spirit of the american scientists at n. I. H. And elsewhere who are discovering these wonderful kinds of drugs to save lives. Senator stabenow i agree with that. Do you think tha industry should be spending more on r d today than they spend on advertising drugs to us . Secretary price i think that again the system needs to be such that it incentivizes innovation so we can realize the benefit of wonderful inventions. Senator stabenow thank you. All those ads are written off, we pay for them as taxpayers. I would love to help them write off more r d. Let me say, just for the record, we dont have to debate it today but you talked about a study over and over again about prices. I want for the record to say this is highly disputed study that youve been talking about that compares two different kinds of systems, doesnt include the tax credits that have substantially brought down costs out of pocket costs for real people. Another day i look forward to debating what i believe, and know in michigan, are other numbers. Thank you. Senator hatch ive been in the health care bids for in thiS Health Care business for 41 years. Every year we demand more and more money, more and more spending, more and more federal government, more and more interference, more and more intrusion and we wonder why it costs so much. Now all i can say is weve never had a better secretary than you. Nor have we had anybody more patient in answering all these questions. Im going i want to thank you for participating the way you have. I especially want to thank you, secretary price, for attending today. I think we can all agree this is not the most enjoyable activity you could have participated in today. But it is nevertheless extremely important, and my colleagues, these are important questions theyve asked. As i said many times before, id like to work with anyone, republican or democrat, who would like to resolve these important and pressing issue. Health care is no joke. To any american. And to those with diminishing access it means the world. I look forward to hearing from each of you in the coming weeks. I hope we can find ways to Work Together. Now for any of my colleagues who have written questions for the record, i ask that they submit them by june 15. Im not going this is going to have to be it. I dont have any more time. Do you have questions . Ive only been waiting for two hours. You use senator hatch you used 10 minutes. I just want to say one thing if i could, very, very briefly. Mr. Chairman, i mentioned earlier, my colleagues get tired, dr. Price, of hearing me describe myself as a recovering governor but i am. Ive enjoyed as a governor sit right where youre sitting and trying to provide a governors perspective on issues like this one. And one of the things we ask for is when we said give us the opportunity to have waivers. Senator carper give us an opportunity to apply far waiver on Health Care Reform. We asked for, with state well, did the race to the top, education reform stuff, we said lets make sure when the state apply for waivers, its a federal law. And we do. With medicaid, if im not mistaken, states can apply for wavers. Almost every state, maybe every state, has at least one or more wavers with medicaid. In some cases weve you cant get away cannot get a waiver. We ought to have a good discussion with governors whether that makes sense or there should be some broadening with respect to waivers. I always like to have some flexibility. Find out what works best in my state, maybe works well in others, maybe not. I think that could be a helpful thing to do. The other thing im going to ask for, in addition to your question, mr. Chairman, premiums rise in 2018, Affordable Health care act, ill say just one sentence. He second biggest reason, this is blue crossblue shield of North Carolina, reason for the sharp increase in rates is a lack, a lack of federal funding for costsharing deductions beginning in 2018. This is a problem we were talking about earlier. The administrations budget funds cost sharing. The president keeps talking it back in tweets, he said doesnt want to do this and its the question, it lacks a certain predictability for Insurance Companies. Drives up the prices. Lets keep that in mind. Senator hatch thank you, senator. You always add a great deal of understanding to these issues, i appreciate you doing that. Can i have a couple more minutes, mr. Chairman . Senator hatch no, im going to kill you if you keep this up. Senator carper i would die happy. Senator hatch youre doing a great job. Mr. Secretary, youve been very patient. I personally really admire you. I know you know this field very, very well. I know you know the problems. I know you know how difficult it is to solve these problems. I know you know that theres no quick answers to some of these questions that have been asked. You handled these very well today. I just want to personally think you and thank you and with that well adjourn this meeting. Secretary price thank you, mr. Chairman. [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Isit ncicap. Org] week ahead in Congress Rachel oswald spoke about the week ahead in congress, including a debate on iran sanctions. Host are these sanctions on iran new and why do senators in both parties feel theyre necessary now . Reporter these senators are coming after there was a big desire last year to impose sanctions. When as you remember iran carried out a spate of medium Ballistic Missile tests. President obama was in office at the time and he strongly pushed against democrats from pushing sanctions now. With him out of the office, that weight is now lifting. These are new sanctions. Theyre sanctions that would require the sanctioning of anybody directly
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