Transcripts For CSPAN2 HHS Nominee Representative Tom Price Testifies At Confirmation Hearing 20170209

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] and. A leg to welcome everyone to do this mornings hearing for tom price to be the next department of health and Human Services. With his willingness to serve in this magnitude with obamacare was pushed through republicans in congress was warned the new Health Care Law would harm patients and families not to put too fine a point on it but the next hhs secretary as we work to repeal obamacare replacing with patients under reforms this is an important endeavor this should not be the sole purpose of the next hhs secretary. Having an annual budget of 1 trillion. I will be pete that. Blood department 1 trillion this centers for Disease Control and prevention is no exaggerations to say to affect the daily life in any other parts of u. S. Government. Dr. Price has the experience and qualifications necessary and many people share that view with the tremendous amount of experience in the practice of medicine and for example, to strongly support the nomination including the American Medical Association enthusiastically support him the American Hospital association is perhaps the health care their ship cancel said it best that it is difficult to imagine anyone more capable than congressmen tom price unfortunately with the clinical environment that does seem to matter to some of the colleagues. Some seem to talk about whether he is qualified but inside instead looking at his ethics on top of that we have heard complaints of the unreasonable demands from back confirmation process. But my democratic friends had taken in this approach to all cabinet nominees to delay the process with that standard is continued unabated. I have been in the senate 40 years and to reach beyond any reasonable dispute. I have done that with by fellow democrats on this committee. And on some occasions i have voted against confirming executive branch nominees but far more often than not i have often to defer to the occupants of the of whitehouse. I have taken some lumps for that. I raise all of this today i am more in what my colleagues are doing to the senate as an institution. I of not seen this partisan rancor i have never see a party in the senate publicly commit to virtually every nomination attacking every single comedy. I am not suggesting the senate start were bursting or she voted against their conscience but what i am saying is the same rules and courtesy m process and should continue regardless of who is president and return the white house changes hands quite frankly is a much lesser institution the committee has not been entirely immune to the nomination process and resaw that last week and we are likely to see more of that today. Case in point that is being rushed to be fully vetted. And to dr. Price submitted uh tax returns on September September 21st and by any reasonable standard that is sufficient time for fall and examination and by comparison and 16 days after she submitted her paperwork it was 17 days. The time between completion was more than that. More than that of the last zero and both of them with that extraordinary process to face of unfair attacks as day legislator and his finances and his questions that by and large from distorted attacks. From those that generally have applied in the past. And all of the attempts to have what is characterized dr. Prices use as outside of the mainstream and of course, and those with the status quo on health care. With those distortions of the records is a relatively new development that we can set a new standard to reverse recent trends in level turn to the distinguished Ranking Member and with health care from the new id ministration cuts of medicare and medicaid nobody hurt by the repeal and insurance for everybody. And to undercut these promises. I will start with undisclosed assets. Congressmen price owns stock in an australian biomedical firm that is called the new notes therapeutics his first purchase came in 2015 after consulting the companys top shareholder and a member in 2016 was invited to participate in the special stock sale the Company Offer the private placement to offer funds for testing on experimental treatment for fda approval and through this placement the increased his stake more than 500 and has said he is aware he paid of price below market it is hard to see if the claim passes the small test smell test specifically this private placement would be made below market places to be offered only to sophisticated investors in a nonpublic manner and also with the stock part when negative purchase himself and then the of matter that was omitted from the notoriety is disclosures and they state more than five times larger than the figure he reported to ethics officials when he became the nominee. Did at the time the disclosure was filed by my calculations the shares have a value of more than to the under 50,000 and today to hundred 50,000 now is more 1 million and now it is excluded from his Financial Disclosure and his fortunes could be affected directly with the treatys coming before the congress. It also appears the congressmen failed to consult the house ethics committee. That was required as theyre directly related to the two bills. To be made aware of them with the house of representatives to satisfied the legal issues it is hard to see this as anything but a conflict of interest and abuse of position mother they have been investigated for ethics violations in this also was not disclosed to look into those matters bin now on policy with the Affordable Care act specifically with the sacred replacement plan they already charge ahead endangers Americans Health congressman price is the architect if they lose their health care and less than two years but raise in less than 50 in two years. No cost contraceptive coverage for millions of women. Nearly 400,000 women would lose access. To see the price plan to take america back to the dark days with the healthy and wealthy with Great Health Care and the congressmans proposal and the congressmen and brings back discrimination and to raise cost and then in effect to take patience monday and then skip out of the care that they need. To reinstate lifetime limits on coverage and then charge higher rates because they are women. Two of minimum standards by defining exactly what health plans have to cover all of this from a bill called the powering patients and here is the constant and another example. And with the promise of guaranteed and to advocate privatizing with half a trillion dollars after the nomination he wanted to replace with vouchers. So seniors beyond what medicare pays when they go to the doctor. For seniors on the tight budget. To block grant and cap medicaid and medicaid in shares 54 Million People or americans rely and medicaid to pay for nursing home care in the pace for nearly half of all birthing care covers millions of childrens with Mental Health coverage and substanceabuse treatment as they are battling the opioid epidemic. I will close its two additional points. If confirmed the head of the hhs is the captain of the Trump Health Care team and the congressman says i agree with that but when i look to congressmens proposals idol see the patient at the center of health care. Ic money and special interest at the center of health care. Finally let me make a point with respect to the process. It is exactly the same process that this committee has used for 20 years applied to talk negative show, and ron kirk inventor specific details and to the record how this process is exactly what was done on a bipartisan basis. The q mr. Chairman. Senator a place for introduction would be the distinguished senator from georgia senator isakson so please proceed. Hq chairman and vicechairman and members of the Committee William proud to be a part of this economic be prouder. This is the second time i have introduced tamper good firsttime it was to the Health Committee that also serve above was proud to do that that was the best introduction i give based on the man i have known 30 years family man, member of our community and a legislator. But since last week things have changed and i feel like i am the character witnesses this simpson felony trial. And i think things need to be refuted subtle chide to begin to say things that need a perspective i am very proud he has filed his income tax returns and what came from those that came out in the memo about property taxes one only tax payment in tennessee and washington. Just late. I have done that myself a couple of times with the evaluation differences normal that doesnt matter what u. S. S. At at it is what you disclose of this wirth not whether not you disclose it. He is a good man and a family band i am proud to be here today not to defend him feed is not the defending big praise him for what he has done. With the secretary of defense what am i looking forward from him . First and foremost, he is a great family man. In just to be in National Industrial tennessee but could not be here today. He is active in his church and Committee Community and secondly i not have 1. 1 trillion that is how much she will oversee at hhs a look for somebody with experience he has said as a legislator and he is the type of person and some of their would trust with that amount of money if that were mine. This you understand health care parks, me tell you about his medical practice a consolidation of a number of small orthopedic firms largest provider in our state when a leading persons but the rand the practice for a while they saved my sons right leg in a terrible accident they are a great medical firm he and a stance medicine balls without legislative process to say you go to the senate and house we dont want someone to walk into a legislative meeting that has not been the process is a type of guy you can trust and someone who is accountable to say he is one of the are rare ones that when i have got question i will talk to tom in say what do you know, . He will tell me. Sometimes it is boring but he is always right. Be responsible for what you do and say. Let me tell you waste tory i was called by aarp go on the road for us to do presentations around the state you will say Social Security. We went unspent whole night with a roomful of seniors defending saving Social Security if anybody is passing that rumor and then ask aarp. He understands the value of medicare and i would not promote somebody he would take that away from you. For years ago i sat in this committee i ask all that i could put it came time to vote for her i did the tissue was the right person at the right time. Dr. Price is the right man that the right time for the right job. He is my friend and i have known him 30 years unquestioned character by i think you for taking michaels the their urge you to give him the courtesy of your time and a hope you see fit to dominate inaugural ball billion for the next secretary of health and Human Services. Few could it have a better introduction than senator isaacson not only highly respected but he is very articulate and did a very good job aho what negative about you and your teacher and this committee. I have some obligatory questions for the nominee. First is there anything you are aware of . That would prevent you to fill this irresponsibility . With any reasonable sum in this for appear before congress if you are confirmed . Du promise to give a prompt response in writing any questions that are submitted to you by this committee quick. I do. Those are the obligatory questions. Before we go to the questions the left the plan have a tendency to stay with everyone to state for the and just to engage in discussion for allard great nation and. Banks to Donny Isaacson for his incredibly gracious introduction. We have known each other 30 years and i am so grateful for his friendship and kindness and his leadership and service the we are blessed to have had it. Especially my wife of 33 years to joins me today with her support, encouragement and love she has given me the past 33 years i am more grateful for that. I hadnt met for the appreciation and to share that passion. Seventeen nominated to serve as the knicks secretary of hhs. My first professional calling was to care for patients as dave legislator with complex interactions taking place every single day and i hope to share with you hell my experience will shave man standing from the early age i had an interest in medicine are growing up on a farm in michigan want to move to suburban detroit. My fondest memories were spent with my grandfather who was a physician i would spend weekends with him and he would make crowns and that meant he got in his car to make house calls. I would ever forget the warmth and love he was greeted at every single day house berger after graduating a move to a land of which i have called home nearly 40 years i met my wife, and raise our seven. I did residency at everywhere ive returned to serve as the medical director of the orthopedic clinic. I have treated patients from all walks of life including many children berger anyone whos had the privilege of treating a child knows of filling it is to look into the eyes of a mom or dad to help heal their son or daughter mia memories are filled of patients and parents and after 25 years i started a solo orthopedic practice it eventually became one of the far just off practices in the country that i eventually served as chairman of the board. As a practicing physician i learned to the Broader Health care system and a couple of different memories stand out. The number of times where patients were angry figuratively standing between themselves and their physician making it so what the physician was recommending may or may not be possible through insurance regulators toward the government. Then i remember vividly there were more people in the Office Behind the door where we saw patients trying to fight with insurance regulators than in front of the door treating the patients and it became clear color Health Care System was losing focus on the patient. As a result i felt compelled to broaden my role to help the issues so iran for the Georgia State senate. Oftentimes it was remarkably bipartisan but this is the environment and i have been fortunate with the collaboration in just this past congress it was the bipartisan effort of a broken Payment System that is now then implemented properly to help insure that seniors have access to Higher Quality care. So the as the appreciation of what has been a lifetime of commitment to health and wellbeing pdf the commitment extends with accessibility. There are real heroes to keep the food save their our heroes among the dedicated men and women and men to achieve the american dream. And then to use compassion to beat compassion and to be accountable. Then across the spectrum of issues there is up lamp a promise to strengthen the resolve into those Senior Citizens to save and strengthen and secure medicare for todays beneficiaries and future generations that the medicaid population has access to quality care to maintain and expand medical innovation in the treatment and eradication of disease. And spending my life in service to them there is no doubt we share the same point of view addressing each of these issues our policies may differ but it is a commitment to public service. The work i did in communities was to bring forward the greatest quality of talent that we could assemble. Second is to understand the scope and issues and having the experience in the clinical arena to understand the scope. I think often times it gets kind of muddy. We named the programs and make certain that the resources are there. Are we truly in proving the fold and safety is the one of the major goals is to look at the metrics and the department to make sure we are accomplishing that mission. The centers fo the centers for medicare and Medicaid Innovation have begun numerous initiatives som, which generated much controversy. Can. The quality of care we need to be able to provide our citizens. Innovation is what leads Quality Healthcare and expands the ability of Healthcare Professionals to be able to treat patients of strong support innovation and i think one of the roles that we have is to incentivize information. The center for medicare and Medicaid Innovation is the vehicle that might do just that. Its defined areas where it is dictating to providers in the country all they must practice, so whether it is a Geographic Area that includes 67 or 68 areas of the country but have to perform in a certain way or whether it is 75 of the part of the demonstration project which dictates to other providers the drugs they must use in this setting that is no longer a Pilot Project to determine whether an Innovative Solution might work. Thats changing the way that american medicine is practiced as opposed to the family, doctors and patients. Strong support of innovation and hope we can move in a direction that make sense. Medicare lost more than 150 billion to improper payments over the last three years. The threshold of 10 for the past four years given the Medicare Trustees issue concerns about looming medicare insolvency we stay at the current spending levels will your administration champion the progress so that we can recover a higher percentage of the tax payer dollars lost each year to building mistakes and make sure that it will be in place for future american seniors and as a physician who has experience with medicare and Medicaid Programs do you have any insight into the steps taken to address the multibilliondollar problem of waste, fraud and abuse in these programs . Nobody supports care being built that isnt provided and this is one of those areas that we need to be focused. Im certain there are some bad actors out there and if we are to focus specifically in real time which is what happens in every other industry in the country where the realtime information is acted upon instead of trying to determine whether every single incident of care is necessary if we are to focus on those individuals i think we could do a better job of not just identifying the fraud that exists but ending the fraud. Congressman, im going to start with the trading and healthcare. Your position is that it is legal because it complied with house rules. I think there are debatable questions but theres other matters. The immunotherapeutic is an Australian Company developed for the treatment of immune system disorders but plan to seek fda approval. The fortunes are affected by congressional action. Today the total value of the share exceeds half a Million Dollars yet on the office form you significantly undervalued the stock and failed to include the value of more than 400 shares balked at a significant discount during a private stock sale made available to the specially chosen investors around labor day. You also significantly underreported the value of the purchase of the committee and is worth more than twice what you report it. You heard about the stock from a house colleague and the largest shareholder. They got in on private placements. In the private placements, you bought over 400,000 shares at a discount as much as 40 cheaper than the price on the Australian Stock Exchange. You were sitting at the time on the committees that had jurisdiction over major Healthcare Programs and trade policy. Yes or no, doesnt this show bad judgment . If what you said is true we have a paper trail for every comment ive made. Yes or no, doesnt this show bad judgment . No. Lets let him answer the question. You kind of indicated you did something wrong. I didnt understand why. It was yes or no. I want him to be able to handle that problem. Maybe it would be helpful if you laid out the accusation. While, you purchased stock in an Australian Company through private offerings at a discount not available to the public. They were available to every single individual that was an investor at the time. That is not what we learned from the company filings. The Australian Stock Exchange sites that this specific placement would be made below the market rate. The Treasury Department says it is only offered to sophisticated investors in a nonpublic manner. We have a paper trail for every one of the statements ive gone into and is set on the two committees introducing legislation that directly impacts the value of the stock. With legislation would that be . We will take you through the various bills, but it was decided on a number of occasions. The reality is everything i did was ethical, legal and transparent. The reason you know about these things is we made the Information Available in real time as it is required by the house ethics committee. There isnt anything that you have divulged here that has not been public knowledge. It is more than five times larger than the figure that you reported to the ethics officials when you became a nominee. And if you listened to your committee staff, you would know our belief is that there was a clerical error at the time but it was filed. We dont know where it happened, whether it was on our end with the end of the individuals. But there was no malicious you also reported in the questionnaire to the committee and you had to revise it yesterday because it was wrong. When asked about the value i thought and the value at the time that i purchased the stock, not the value of a nebulous time i want to get one other question is finite. This weekend the president issued an order instructing the depravity and other agencies to do Everything Possible to roll back the Affordable Care act. If confirmed, you will be the captain of the health team and in charge of implementing the order, yes or no under the executive order will let you commiwont you comeit if no one . I commit to working with you and every member of congress to make certain we have the highest Quality Healthcare and that every single american has access to affordable coverage. About is not what i asked. Will you commit that no one will be worse off under the executive order, will you guarantee that no one will lose coverage under the executive order . I guarantee the individuals that lost coverage under the Affordable Care act we will make certain they dont lose coverage under whatever replacement plan comes forward and that is the commitment. The question again, well anyone lose coverage and you answer to something i didnt ask. I will wrap up this round by saying well you commit to not implementing the order until the replacement plan is in place . As i mentioned, senator, what i commit to the American People is to keep patients the center of health care and what that means to me is making certain every single american has access to affordable Health Coverage that will provide the highest Quality Healthcare world can provide. Im going to close by way of saying that the congressman is saying is that the order could go into effect before there is a replacement plan, and independent experts say this is going to destroy the market on which millions of working families buy Health Coverage and on the questions that i asked, well the congressman commit that nobody will be worse off, nobody will lose coverage, we didnt get an answer. Let me just say, the price has been accused of investing in securities that have been affected congress and you discloshave youdisclosed the wrf shares you owned and in immunotherapeutic. Let me just say this is a diversified portfolio with Morgan Stanley and a broker directed account. Correct me if im wrong on any of this but portfolio includes healthcare and long healthcare stocks. The Financial Advisor designed and erected all trades in the account. They have the discretion to decide which securities to buy and sell. March 17, 2016 and a periodic rebalancing of the portfolio, the Financial Advisor predicted the purchase of 26 shares and worked under 300,000. The advisor notified doctor price of the purchase on april 4 and doctor price of disclosed them on the periodic transaction report on april 15. He began his legislative efforts related to the comprehensive joint replacement demonstration project in 2015 with one exception all of the stocks are held in three broker directed account. Neither he nor his wife, director providdirector provideg investments in these accounts. Any immunotherapeutic with one exception. Doctor price decided to invest based on Public Information regarding his work on multiple sclerosis treatment of the disease he has been involved in treating for years. He directed the investments based on his own research into the company and invested 10,000 in the company in january, 2015 and recorded the investments to the house ethics in february of that year. He made an additional investment in september the 2016 and also disclosed that investment regarding the value of the share he has all of the company. Is that a correct remark . I would point out anybody that knows me well knows that i would never violate the trust and i know the environment that we are in. You mentioned it in your Opening Statement and i appreciate you correcting the record. You just consumed about two minutes beyond your Opening Statement and in the interest of fair play, is it appropriate for someone to note two minutes is also owed to somebody on our side . As we go forward in this i just ask you to im not going to relinquish my role as cochair the errors that are promulgated here but i have always been good about getting the time that you need, so i will try to do that, but im also not going to allow things that are false to go forward without some sort of comment. We cant allow this to happen. Just a unanimous consent request, bipartisan disclosure then though i would like to ask the made a part of the record because it will document when i state it. Without objection, senator roberts. Did you really think at me and smiled . Bless your heart. Thank you. [laughter] good doctor. Thank you for coming. I think its important to make clear right off the bat even if congress and the Incoming Administration were to do nothing, absolutely nothing, and revealing parts of the Affordable Care act, the law is not working. Its collapsing. The prices are not affordable, markets are nonexistent, few options. This year one out of every three counties in the country only has one insurer offering coverage on the exchange. What tools do you have or will you have when you are confirmed which could be utilized over the next couple of months to provide stability and improved the individual Insurance Market to make them more appealing some insurance carriers would want to come back and provide more Coverage Options as we transition away from the Affordable Health care act . Its incredibly important to make sure what the American People know and that is that this law isnt working for folks in the individual Small Group Market. There are premiums that are up significantly that were supposed to provide down by 2500 now they are up on average. You have deductibles that have escalated six to 12,000. Youve got as you mentioned, states where there is only one provider. One third of the county where theres only one insurance carrier. It may be working for government or Insurance Companies but its not working for patients and so what we need to do the same effort to reconstitute the individual Small Group Market mt into that begins with providing stability in the conversation and in the tone and one of the goals i have is to lower the temperature in the debate, to say to those providing the Insurance Products across the country we understand. We hear the challenges you have. They are already exiting the market. What we need to do is say that there is help on the way to allow us to reconstitute the individual Small Group Market that allows folks to kind of coverage they want for themselves and for their family, not that the Government Forces them to buy that allows them to purchase coverage in a reasonable amount so they dont have deductibles that are through the roof, where they dont have the ability to pay the premiums and the deductible as well. There are so many things we ought to be focusing on making sure American People have access to the highest quality care thats affordable to them. I have 84 hospitals in my state and old part of the Rural Health Care Delivery System that is under great stress. As we have seen when i visited hospital administrators all throughout kansas, they are scratching their heads over the regulations coming out of hms but used the h. E. W. And the story goes on and on and all the other agencies that you would oversee if confirmed. I mention the Meaningful Use Program for the Electronic Health care records that you just spent 15 minutes and then they have to report it immediately on what is going on. The rule for the critical access hospitals, numerous other documentation requirements it seems to me there is a lack of understanding about provider shortages in the areas. We are just hanging on by a thread and have a onesizefitsall regulations in washington simply do not translate to rural kansas or any other area with sparse population. My question is how will you work to ensure a less burdensome rulemaking process . This is critical because as you mentioned, georgia is the largest state geographically east of the mississippi and we have a Large Population in the critical access hospitals are selfimportant to communities across the state and the truly around the nation. But the regulatory scheme that has been put in place is choking the individuals that are trying to provide the care so much so you have other providers that are leaving the practice of caring for patients, not because they forgot how to do it or theyve grown tired of it but because the onerous nature of the regulatory scheme coming out of washington, d. C. And the project that you mentioned makes it that much but difficult. We turned the physicians into data entry clerks. If you talk to patients, what they recognize us when they they going to see their doctor if they see the top of his or her head as they are punching the information into the computer as opposed to the sharing of information that is so vital and necessary between the physician and patient for Quality Health care so a recognition of the problem is incredibly important for the Rural Health Care in the nation and how it needs to be bolstered. Then looking at the consequences of what he do as a government. As i mentioned earlier often times i dont think we look at the consequences. We passed a rule and instead of it and think it is the greatest thing since sliced bread but its harming the individuals that try to provide the care. You dont get that information unless you ask. My time is up, mr. Chairman. Thank you mr. Chairman. Congressman, i enjoyed our visit yesterday. We had a discussion when you were kind enough to come visit me about the facts i have in florida with 4 million funds for seniors on medicare and they are petrified of the idea of privatized medicare. I talked to you about this and you talked about the premium support system that youre advocating. You pointed to a study that was done by cbo. You mentioned that you would send me a copy but we havent gotten it so what i did as i went and got the copy myself, and it is september 2013. And what it concludes is opposite of what you said with regards to highcost states like florida. Medicare is going to be spending 4 lower under the proposal you were talking about in this cbo report, lower than the current law and beneficiary cost will decrease by 6 on the average, which is what you said yesterd yesterday. But in highcost regions like florida, youre going to have a highest beneficiary cost than the current law under your premium support proposal. Annual premiums in florida would increase 125 according to the cbo chart on page 71. It says the annual premium and a highcost regions like florida would be 3,600 compared to the current law of 1,600. Thats the 125 increase. So, please help clarify what you were sayinare saying yesterday t applies to florida. I enjoyed our time together as well. When we talk about medicare its important for everybody to appreciate as i know you and your colleagues to the medicaree Medicare Trustees, not republicans or democrats, the Medicare Trustees have told all of u us to medicare in a and a t period of time less than ten years is going to be out of a kind of resources that will allow us as a society to keep the promise of the beneficiaries of the program. What that means is we will not be able to provide the services to medicare patients. We save and strengthen medicare and it is irresponsible as policymakers to allow a program to continue, knowing that in a few short years isnt going to be able to cover the services that were provided. That is the current Medicare Program if nothing is done as some have described it. The second point, my role if i am confirmed and i have the privilege of serving, my role would be one of carrying out the law that you in congress pass. Its not the role of the legislature when i was trying to formulate ideas. Two points to a legislative solution one of the greatest examples on medicare is 1983 it took reagan and oneill to agree in this case it wasnt medicare it was Social Security. Let me ask you you made a statement that it was a terrible statement of people that have preexisting conditions that would have the protection of insurance and what i would like to ask is in light of President Trump expressing his desire for this basic protection, do you think his proposal would continue the ban on discriminating against people with preexisting conditions as a typical idea . Im not certain where youre getting that quote from. The talking points memo may 1, 2012. Thats a reliable source. What ive always said is that nobody ive always said nobody in a system that pays attention to the patient nobody ought to be priced out of the market for having a bad diagnosis. It may work for the government but it doesnt work for patients so i believe what we need is a system that recognizes they do exist and we need to accommodate it and makes it and nobody loses their insurance because of a preexisting condition. As i close, i would like to insert and a record of the september, 2013 Congressional Budget Office analysis of premium support system for medicare and i would invite you that it supports your position because this one does not. Congratulations, congressman price. I have a couple of simple yes or no questions. Scientific evidence is clear. Have it where the two outbreaks of leprosy in the United States . There are instances individuals have Infectious Disease and come to the United States im asking about immigrants in the United States in your medical opinion and scientific background. I dont know the incidents to which you refer. If they lead to outbreaks and designated. Anytime yoany time you get to individuals together whether it is an immigrant or visitor one individual has an Infectious Disease that is possible that it individual transmits that Infectious Disease in any Infectious Disease whatsoever. In your opinion do abortions cause Breast Cancer . This audience is relatively clear that is not the case. Do vaccines cause autism . I think the science is that it does not. Individuals across the country are very vigilant talking about the science it be sensible to the trillion dollar budget and the health of the nation. Can you commit that should you be confirmed you will swiftly and unequivocally develop false claims to protect the Public Health let me ask about medicaid to specifically and i just have a little taking back one of the most beneficial components was the expansion of the Medicaid Program that resulted in the 11 million over half a million in new jersey theres billions in federal funding to the states and this is tens of millions of low income families that lead to tens of billions and other healthcare providers. Do you recognize medicaid to be a valuable program and consider the coverage for the 74 million to be comprehensive . It is vital but one that has significant challenges one out of every three physicians that should be seeing medicaid patients who are not taking any medicaid patients there is a reason for that. If that is the case, one in three dont treat medicaid you have to ask your self is because medicaid reimbursements are so low and assess provider reimbursements are set at a state level while cutting federal funding with tiger costs if leeds to the beneficiaries when they no longer have any coverage on ability to pay. So even if theres only one of three, they are providing the te services and imagine if you dont have coverage. Youve advocated to the block grant medicaid. Youve removed the right and make it possible that the accese subject to the funding. Do you recognize that in doing so you risk the potential of millions of americans presently enjoying healthcare coverage buf no longer having that right . I think its important to appreciate no system for president supported or i supported would leave anybody without the opportunity to gain coverage. Medicaid as it exists is not the case. Does that mean you have t the right if you meet the criteria when you move to a block grant. I think that it would be determined if in fact that is what congress did. The role of the department of health and Human Services is to deliver the walls that you pass. I know in the conversation i appreciate you coming by to visit me, you suggested your role is that of an administrat administrator. He said you expected your experience both medically and legislatively to help drive the policy when we have regulatory abilities to dictate the regulation tha thats that th to please dont say to me that i am here just to do what Congress Says i expect you will follow along and with the Congress Says that he would have the impact into based upon your previous opinions, ultimately block granting is then a bigger problem with the number so i hope we can get to a better understanding of your commitment to medicaid as it is an entitlement right. Your time is up an devoted to senator carper now. Congressman price, while so some. Theres a verse of scripture that you mentioned in the new testament in matthew 25 speaks to the least of these did you feed me, did you close me, did you give me to drink, did you visit me when i was a stranger in your land and it you take me and it says nothing about the access to Health Care Coverage going into the emergency room or hospital. Did you do anything about it . We didnt invent the Affordable Care act. It goes back when Hillary Clinton was working on hillary care and the republican from rhode island to develop legislation cosponsored by 23 senators including senator hatch and senator grassley. What he did in his legislation was to use the five major concepts one to create a large purchasing pool for folks that may not have access to Health Coverage. We call them exchanges were marketplaces and also proposed the tax credits to buy the cost of people getting coverage in those exchanges and within the different states. Third thing you proposed is the notion for the individual mandate and they realized they didnt mandate it would be unworkable. He proposed the employer mandate people shouldnt lose their coverage because of preexisting conditions. Those were not democratic ideas. Those were proposed by the leaders and win the governor developed his own plan in massachusetts prior to a decade or so later when they instituted it and what took place over time they found they had insurance pools where a lot of people were not young or healthy they needed more healthcare and if they would bthat theywould be able tn business and raise the premiums. I dont know if any of this sounds familiar to you. To the ideas of the senator sene have added some things and encouraged states to increase that number by raising 135 and encouraged the focus on prevention and wellness not just treating people with when they are sick but preventing it in the first place. We provide funding to reduce obesity and the use of tobacco. This isnt a yes or no question. What was wrong with that approach. Before you answer, did they find it difficult. We didnt have the incentive high enough to get people like my sons into the exchange across the country. They put out a report about a month ago. Of the health care that we hold so dear, quality, i think these are the things we all agree. The next step the program has much merit whether it is the pooling mechanisms again but i am hopeful to do is work in a bipartisan way to solve the challenges that we have. My colleague just told me he didnt operate on a republican or democrat patient, he updated on a patient. A system that is hopefully focusing on the patient to make sure they have the access to the highest quality care possible. Let me conclude by saying i will use an analogy there is a large building but for some reason they couldnt use the elevators and there were firefighters in the street saying just the job we will save you but they didnt have safety nets. Ive described the system largely founded on republican ideals that were good ideas but we dont have something at least as good in place to catch people as they pull from that building weve done a disservice to the country. Your time is up. Senator burr a couple questions to cut through the chase. All sales and purchases of the assets within 30 days. Yes sir. And you have been accused not providing the committee of information related to the financial records that were required of you are there any records that youve been asked to provide but refused to provide . Does it trouble you as a nominee to serve in the Administration Someone would hold you to a different standard than you as a member of congress and the same standard they buy and sell and trade assets on. As my wife tells me i volunteered for this. They promised if you like your doctors you can keep them. We both said thesthe dose of thd be broken. Weve writte lived in our own hh care plans because the word. The president is committed to fulfilling that promise. As the nominee, and i think you will be the secretary of hhs one of the main goals of the obamacare replacement plan. Its outlined in the principles in the system that is accessible for every american and affordable but incentivizes and provides the highest Quality Healthcare but provides choices. I want to thank you for testifying. The country may be better off with your guidance and knowledge. Thank you mr. Chairman for your willingness and being able to put up with your choices. I want talk about a few things. One, yesterday the president by executive order reinstituted the global gag rule but also in a way that is more comprehensive. It would prohibit the organizations that provide or promote abortions and. The health programs, the efforts and expansion of pixar to stop hiv aids. If confirmed how will you make sure that the u. S. Can fully participate in helping stop to make sure the next virus we would be able to contain it so it doesnt cause a catastrophic effects if the global gag rule is in place for the International Health organizations. Together thto gather the best td the best mind without determining what i is policy to have as it relates to this Infectious Disease. They try to prevent work in the Infectious Disease and to detect the spread of the disease and then provide a logical and methodical response to the outbreak of i just hope you would look at unintended consequences of these executive orders that could compromise the ability as we need to using the tools at our disposal. I want to get to tobacco regulation that is in the medical community and the impact of tobacco has and the fact th that. It authorizes the hhs secretary to regulate. If confirmed and yo can you cont that you would enforce that act to make sure children particularly are not subjected to the new forms of Tobacco Products . The responsibility we would have is to enforce the law of the land. It also requires keeping up with new technologies being used by the industry that require modifications. Are you prepared to not only enforce the law but the intent to make sure the children are protected . Listening to some of the exchanges as it relates to the Affordable Care act and will continue to debate the merits. Im a strong supporter and i think millions of people that had coverage and didnt have it before and at the rate of growth are far lower than it would have been but for that we will debate that later. We heard you say several times the principles the president articulated as to what would be in place of th the act and i wod drawoulddraw down more on benef. We talked about the Preventive Care now speaking of available. We also know tha that he has pediatric been told it is available which is particularly important in my state. Can you assure us as you look at what will be the Healthcare System moving forward that you are prepared to make sure americans have Quality Insurance coverage to deal with issues such as Preventive Care, Mental Health services, addiction and pediatric dental . What i can commit to you, senatosenator, as we will do ale can in the department with the Incredible Knowledge and expertise that is fair to define whether or not the program is actually working as it is intended or not. If coverage equals care in many instances i would suggest many individuals now have coverage. They have a card that they dont have care because they cant afford the deductible that allows them to get the care. We are committed to making certain the Program Works not just for government or Insurance Companies but for the patients. And weve eliminated any copayments on Preventive Care that we can talk about the specifics going forward. I would look forward to those discussions. Thank you, senator. Senator isakson. Let me ask you a few questions. Youve asked a lot of them with the intent of getting you to say yes you are going to cut medicare and try to improve it but yes or no to the questions. Question number one we have been hearing about the joint Replacement Program the secretary launched in 2015. You and many others raised concerns about saving money that it could cause harm. In other words, whether it is administrative action to cut the medicare benefits. Potentially, yes. Last year hhs rose to pay for cancer drugs to reduce medicare spending on these drugs. Many of us post from our site as well as others to cut the benefits and more often it would be a cut to the medicare benefits i is that correct . I believe that is correct. What about the recent changes needed to cut medicare payments to Medicare Advantage nearly one third of all Medicare Beneficiaries of the Medicare Advantage and at least cuts not cutting medicare. I believe so. Any one of us consider this to say give me yes or no answers and demonstrate the point we want to make that all of us republican, democrat alike we are interested in saving Social Security making medicare work and saving taxpayers money is that true . Absolutely. One other point anyone of us can take up a Financial Disclosure. Its a desperate impact where you take the two facts, one of them here and one of them there. Anyone of us could do it to disrupt the right peoples thoughts. Its been happening a lot because people have taken things disclosed and try to extrapolate something to keep you from being secretary of hhs when it shouldnt be true. For example if you go to the senators annual report, [inaudible] is a Major Holding of the fund for pharmaceuticals though we jumped all over for 127 increase tha but we are not accg the Ranking Member of the information pharmaceutical prices but you could take that extrapolation and guide somebody is that not true . I think thats correct, yes. We all need to be looking for the best person, man or woman from the job and not trick them into agreeing with something thats wrong [inaudible] thank you for your time and i will reserve the rest of my time. I do not trade in healthcare stock. My point to the senator from oregon as you have mutual funds like most of us have that have coatings and pharmaceuticals. Nobody should have used about by beating onl only pharmaceutical stock and mutual fund to continue on the point of personal privilege, mutual funds in particular by independent experts are considered to be in a completely different category than personal trading and stock. Even past republican experts made that same point. Theyve never seen anything like the congressman is engaged in. Thank you mr. Chairman. Welcome, congressman. I was troubled by your response to the senator when he asked the question will you commit if you repeal the Affordable Care act would you commit that no one would lose insurance i but almot 1 million in my state. Would you commit that no one would lose their insurance and youve ignored the question and responded no one that lost their insurance under the Affordable Care act to my knowledge that is two to 4 Million People in almost all of them ended up getting insured. You said no one would lose it after theyve been reinstated so you basically ignored the 22 million that i want to ask about something else. If you are confirmed, obviously play a role in the Affordable Care act. I would like to ask yes or no questions. Lynn suffers from a chronic condition turned down by Insurance Companies for 25 years before the aca. She would lose her entrance if the ban on discrimination based on existing conditions and my question is if confirmed would you maintain the current scope of the law and continue to vigorously enforce the law banning against discrimination of individuals with preexisting conditions yes or no . I commit to you that we will not abandon individuals with preexisting illness or disease. Victoria relies on Free Preventive Services provided by the aca. Will you commit to ensure those that rely on medicare continue to get their Preventive Care with no copayments, no deductibles and continue to get Preventive Care with no outofpocket cost . Preventive care and Wellness Care is absolutely vital for so many members of our population. I believe it is a part of healthcare and Health Coverage. Not to be rude but we did that under the aca. 24, diagnosed with stage four melanoma in the 2,015th, still on her Parents Health insurance which was purchased through the aca marketplace and benefits from the ban on annual Lifetime Coverage maximums. First three months of treatment cost 800,000 as the secretary of hhs and ensure what i ask for the exception to the current ban on outofpocket maximums to provide the executive order would you commit to stand up for the patients at this and refused to grant any injured or this exception . As i mentioned patients ought to be at the center and our goal is to make sure they all have access i want you to admit he could commit that you would stand firm as the aca does on this provision of canceling care, canceling insurance because they are too expensive. Prior to the hca she could not prefer of order preferred demented of Birth Control now because of contraception coverage can you set aside any personal or political views to protect the doctor patient political relationship for everybodys right to access to contraception deemed best by her or dr. As provided in the a. C. A quick. Contraception is imperative for many women in the system should allow women to purchase contraception that they desire. President trump said he is working with you on the replacement plan that is nearly finished is that true and correct. It is true that he said that yes. Laugh laugh. Not that he has ever done this before but did the president lie about this . He said he is working with you. We dont use the zero word live but did he lie to the public greg. I have had conversations to a the president about health care. Willing you commit with this president s plan to maintain protections for those that you just committed to in the replacement plan . Our commitment is to make sure they have access to the highest quality coverage and care possible. Lancelot sure if the president lied to us if he is working with you. The last series of one to find out about the childrens Health Insurance program you said it has been remarkably Successful Program and that it sounds like socialized medicine to ual know what that means an ill the chairmans interest in chip 95 percent of americans you discuss the importance of using the right metrics it is set to expire in september and if confirmed would do Vice President to support the extension and the pediatric members beyond september of this year class. Absolutely. After last weeks hearing with the Health Committee the same question was asked about saying that it was socialized medicine. So i went back to look at the article but it was a characterization to push apolitical point of view. I knew that was the case i rarely ever use that word i talk about patients as the focus. Guns are a. Thats fine but last weeks submitting a report that we extend the chip program for five more years. Do you agree . I think the chip program has to be looked at and should be extended. Five years . 80 years is probably better than five. Senator . I have a lot of questions banks for letting people go over. Ive not. And i would want that time back soleil passing a budget resolution to replace the Affordable Care act with policies that our better with the skyrocketing health care costs. Not just premiums but deductibles they have the pays and to give people more choices. We need somebody in place to be sure that the legislative and administrative policies policies, but prior to the Affordable Care act rehab a very affordable Insurance Market. Look at the increased regulations and mandates to a of a decrease competitive market now we only have 11 exchanges with 20 counties that only have one Health Care Insurance company and i know were doing better than the rest of the country. Some only have one for the entire state when now we have gone through this process what actions can you take the. That what you laid out as you noted but it is important to your appreciate for this Small Group Market and we believe it is a direct result of policies coming from washington d. C. Directly from the Affordable Care act. In to solve those challenges how do we fix that . For those that have the traces. And to recreate and reconstitute that individual and Small Group Market. And those who have preexisting conditions. In those have a good risk pool in that regard. As you know, with the addition and care act with the open your increases were now looking to fully fund to be in place and now to implement and do those new Grant Programs so what should be done to insure access to those individuals who are getting coverage through Medicaid Expansion and you commit to fully employment the new legislation . This is a skirred all across the country to destroy lives and families and it is growing. We must commit to carry out the law as it was passed. Also to make certain we have the right metrics. There should be things that we think we should do that dont help to identify those as much as possible to bring about a program from those that are holland. To say it has to be limited as 16 beds are you willing to look at the rule to get more backbone negative beds but slid back also the three day stay sometimes they have a Mental Illness and on the inpatient basis. And then end this revolving door. So based on these allegations with this 1115 waiver rejected by cms but do you believe during this replacement time could prove to rub program that was more flexible . Other has to be better ways because there are huge challenges for those folks on the ground and they will guide is an attraction. Senator . Thanks for your graciousness not going over. But the goal here is access to the highest quality coverage for all americans is that roughly where you are adequate. Is a worthy goal. But i am worried today the be Affordable Care act and especially in the rural parts of the country better not getting the access that they need. But i worried a little bit and it is incumbent upon all of us tries to fix Affordable Health care but is incumbent not to make matters worse. And i know that you share that goal. Into talk about your projected quality of insurance fell one is to make sure they have opportunity to have coverage for catastrophic care. In did is the central and to have emergency services. Negative care such as Birth Control in mammograms and routine dental exams. And those that have to settle for coverage of catastrophic care rather is regulation insurance providers so that has to be the floor of the services your billing to pay for. And they should be able to purchase the coverage that they want. At all want them to settle for something why should they have to pay out of pocket for something that will not cover as basic as a hospitalization . Bets i am worried were headed to that choice that no one else in the industrialized world except your goal. Mentioning we should listen to the second question in you may have heard of this. And those barriers to access those with a dual eligibility that the cost curve is starting to turn around. When asked about the need for more flexibility to carry out innovative programs for greater flexibility should the federal government pullback recently cannot afford to break up the difference. And for these critical needs . As the legislative decision. That is very fundamental decision. For every member and and then to carry out of law. Does the repeal of the Affordable Care act include medicaid that was part of the passage . Mckinney improvement is one that would include individuals to have coverage them with the Affordable Care act with the appeal blown negative repeal of medicaid. That this uh decision and must include in american that with of medicaid population. Senator . Congressman price thanks for joining us and trust to serve in this extremely important post it does bear reminding everyone talking about an obamacare that certainly the individual market and 40 of the grand total of one twice in very typically is not true so it is in collapse. Into talk about repeal. To keep coverage of preexisting conditions. And when i hear that obviously there is a number of americans who suffer theyve had these conditions all their lives in the proper care for those positions to make sure they agreed in to enforce Insurance Companies to provide health Insurance Coverage regardless of what condition they have the desired asking them to build the house after it has burned down. So in your view is that correct there are more effective ways with the preexisting chronic conditions get the health care that they need without necessarily having been guaranteed issue mandate from the general population . Is important to appreciate in a short period of time will have nothing. In jeff health care that is given by individuals. And to be eccentric of obamacare do you agree we need to do more about the transparency of and health care so consumers can evaluate for those who really get the best outcomes outcomes are important in this makes sense from a quality standpoint and the transparency pricing right now we dont have that. If you are in individual and want to know what something cost there is all sorts of reasons but to be honest to make them patient friendly to make the day prior the end of i am confirmed hopefully soon. Medicare and medicaid and ultimately be diminished the thirdparty payers to allow the evolution of a market they will demand that information. The last point is with nih research and alzheimers there is no disease like it there is 5. 2 million americans with the disease right now it is one digit percent fatal there is no treatment as other is the grand total of 160 and it seems those expenditures are with these scope of this disease and can you commit to working with me to ensure a better proportionality and the breadth and severity of illnesses. Senator soon . Select thank you for your willingness to serve better as i met with you a couple weeks ago when the issues that was of interest to be was the issue of Health Service in 2010 there were systemic problems with the industry negative action plan at hhs and that we continue to collaborate in view shared that does not meet the of highest quality care were not doing what we ought to do. To turn the system around. As i shared with you reintroduce the bill with the i h. As accountability act that we believe will bring about structural changes and cassette many times although we think it addresses many problems it is a first up in the process necessary to reprove that agency. If confirmed what types of reforms can you see yourself supporting . Starting with legislation . And want ask you to comment specifically but are their thoughts when it comes to reforms . I appreciate that. And and if confirmed to get into this area to identify best practices itself into a incentivizes with high quality care for individuals into extended across the country. Best practices is another way to start but is in 2009 cns issued a final ruling all outpatient therapy did services to be provided under drexler supervision every year after that has been delayed for the smaller hospitals. In my state we have a lot of rural areas if it is difficult to get providers out to these areas. So if confirmed will you work to permanently extend to move the Regulatory Burden in the are missing the boat. Of every other industry out there. If its possible that if you are suspected of having a stroke by telemedicine to access one of the worlds foremost specialist to start treatment by telemedicine and that is improving the lives and care patients and that is so many things we can do of technological expansion. One final point already with respect to replacing obamacare. So beginning to shift in those that are in the state that there is just too much dictation and that this something that most dates would probably agree whiff with in real accord to working with you to get the flexibility to our states with some of these issues in a way that removes that power from washington d. C. Mr. Chairman so those of four children and with disabilities doing the right thing as a society really about the business of justice region vesta lot the the good news despite moving in the right direction is we have made a lot of progress. The urban institute in to read a line from the urban institutes and to say as follows that it is said the decline of childrens on insurance rate has a steady pace including a significant drop following the implementation of the Affordable Care peak coverage positions so that is a significant drop that is millions of kids including the medicaid provisions as well. That means the year at 95 insured rate with uh Kaiser Foundation that will tell us even with that and even progress before that we still have more than 4 million children uninsured. Will lead you agree we should get the number down . Throughout the population wish should identify those that have coverage. And your budget proposals. Together, meaning the two areas of policies that you have a long record of, full repeal of aca and walk granting medicaid which we know was the Trump Administration policy would cut the childrens Health Insurance funding by about 2. 1 trillion over the next ten years. How can you answer the questions making sure that number of uninsured children doesnt get worse under your tenure if that is the case with regards to policies to the effect of the policies would be and now apparently contrary to what was said in the campaign. You are looking at this in a silo. We believe it is possible to imagine in fact they put in place a system that allows for greater coverage for individuals and coverage that equals care. Right now many of those individuals, the problem is a lot of folks have coverage but they dont have care so they have the insurance card. It would adversely impact the program is totally unacceptable. Its a whole long line of Public Policy experts and the burden for you is to make sure that you fulfill your commitment to make sure that no children will lose Health Coverage. Put your microphone on is on. Mr. Chairman as you can imagine ive committed to ensuring that all have access to high quality Affordable Health insurance. It comes directly from the majority leademajority leader oe senate and the speaker. They are good questions. Obviously they want the same answers all of us want we have about 80,000. If i may submit and also ask doctor price if he would respond to this particular letter to legislators they are very good questions. If i may add, the governor would also like answers to these questions. You are in a great position to answer these questions. If i may, the cadillac tax. It is such that individuals that are gaining their coverage through their employer may be a better way to make it so they would gain an employer access. Its about 1. 3 million of that, schoolteachers, union members, Senior Citizens and theres some disagreement whether they are wealthy or not. There are some in the kennedy that the tax increase in obamacare doesnt affect the class do you agree with that . Do you believe schoolteachers are wealthy . Everybody has their own metrics. That is my argument on this particular tax impact obamacare as a whole is a middle class tax increase at 1. 1 trillion. To work with each of the treasury secretary for the cadillac tax. Those that gain their coverage through their employer have the access to the best quality care and coverage in the way that makes the most sense for individuals in the financial standpoint as well. As i mentioned there are other options that work better. I want to go to the Medicaid Expansion for just a minute. By concern and part of a letter that i gave to the chair man is whether or not that would have an impact and what we are going to do but the biggest question we have today is part of the Medicaid Expansion and how that is going to impact. As i mentioned i to the question on the other side, there is a policy question that needs to be worked out in the house and senate and we look forward to working with you and others if i am able to be confirmed and make certain that individuals that are currently covered through Medicaid Expansion retained that coverage of every individual ought to be able to have access to coverage. Thank you, senator warner. Let me start with something that we discussed in my office. One issue ive been working on is the issue of how these americans addressed the end of life and to work through those issues i think we both share personal stories on the subject we call it the Care Planning a act. Its in the stage to prepare for this stage of life. They took a step into the fee schedule to provide initial reimbursement for the providers to have these conversations. We may be the only industrial nation in the world doesn thatt have this kind of adult conversation. To roll back those efforts i think its important to look at a broad array of issues here. Surrounding these conversations it is real. We need to be talking about it openly and honestly working together to have a solution to address that. This is something that more families need to take advantage of. On friday, january 20, the president issued an executive order that says federal agencies especially the hhs should do everything they can to eliminate the fiscal burden in any state or cost to the tax penalty or Regulatory Burden on individuals and providers. Doctor price, if confirmed to the position, will you use this executive order in any way to try to cut back on the implementatioimplementation or e individual mandate before there is a replacement plan in place . If i am confirmed im humble enough to appreciate i dont have all the answers and the people have Incredible Knowledge and expertise and my first action within the department itself as it relates to this is to gain that information so that whatever decisions we make with you and the governors and others can be the most informed decision possible. Im not sure you answered my question. What iowbut i wouldnt want to e happen as we take concerns you and others raised about the individual mandate there are some on the income tax surcharges it is just remarkable to me and why so many of us are anxious to see the replacement plan he said we wan had we wante prohibition on the conditioning to keep people on their policies and it seems like at the same time there is a rush to eliminate all the things that pay for the services and i would just want your assurance that you wouldnt use this executive order prior to a legal replacement and two eliminate the individual mandate that would shore up the cost of coverage and the shifting of costs that is required. A replacement, reform and improvement of the program is imperative to be instituted simultaneously or a at a time but you wouldnt use this as a way to bypass the law prior to a replacement place. Our commitment is to carry out the call of the land. I know that in the past youve been a strong critic for medicaid, medicare. I believe in your testimony last week you saw great promise and to me if we are going to move towards a system that emphasizes quality of care rather than the quantity of care we have to have this experimentation. There was one such in the Diabetes Prevention program that last year certified to save money on a beneficiary basis i know my time is running out so let me ask these questions i think they can be answered yes or no. Do you support the Delivery System demonstrations that have the potential to reduce spending without harming the quality of care . The second is the most important. I make certain we deliver care of a costeffective manner that we absolutely must not do things that harm the quality of care. I would agree that would mean bundled and episodic payment models to move towards quality over volume would you support those efforts . Bundle who bundled payments make a lot of sense. And would you allow the expansion across the whole system . We ought to allow for all sorts of innovation. There are things i havent thought of gets that would improve the quality and the delivery of healthcare in the country and we ought to be incentivizing that. This seems to be one of the areas i would like to see more but i think it is a tool that we ought not to discard. Senator scott. The nations first state wide pay for success with the Family Partnership with the use of the medicaid fund. 20 of the babies born in South Carolina are born to firsttime low income mothers. We also have a much higher than average infant mortality rate. The Family Partnership is an evidencebased and has already shown real results both in the health of the mother and in the babies. But also other aspects of the mothers life such as High School Graduation rates for teen mothers and unemployment rate. What are your thoughts on incorporating to pay for Success Model to achieve the metrics . It sounds like a Great Program that has th but has thec and that is the quality of care and improvement of linux. As you stated if it is having that kind of success, it probably ought to be put out there as a best practice for other states to model. I believe you were the director of the orb orthopedic. You mentioned something important. The hospital had the highest level of uninsured. You talk about having coverage but not access. Can you elaborate on how your experience may help inform you and direct you to the uninsured population . It was an incredible privilege to work for the number of years i did. We saw patients from all walks of life and many uninsured individuals. They come with the same kinds of concerns and challenges that three other individual has. They have an additional concern and that is is somebody going to be caring for me and able to helhelp the end of that me and s incredibly fulfilling to have the privilege of working and assisting people at the time they were not only challenge from that healthcare standpoint of the concern whether people would be there to help them. I know you were aware of the every Student Succeeds act. It allows for the population head start to have access to resources. It seems to me that would be imperative for the secretary of hhs and secretary of education to look at ways to synergize efforts to help the underprivileged student and child. Can i get your commitment that you will look for ways to work with the secretary of education where it makes sense to help serve the students with you and other programs it would be wonderful to have the taxpayer in the one hand and child on the other hand and look for ways to make sure they both win. Youve identified an area and that is we dont seem to collaborate across the jurisdictional lines not just in congress but certainly in the administrative side, so i look forward to doing just that. And having as they matured how are the kids doing . Are they getting the kind of service and education they need to, are we just been custodiansg custodians, are we just parking kids in a spot or are we improving their lives and able to demonstrate that . If we are not asking the right questions and working at the right metrics that allow us to either expand what is working or to modify and move in a better direction. One of the more important parts of the opportunity and the position is looking at those kids and before you ever get into pk for kindergarten, the development of the first three or four years of this powerful opportunities to do that once potential so they maximize and we think now the Education System will help that child catch up but there are things that have to happen in the Education System so thank you for your willingness to work in that direction. And my last question has to do with the employee sponsored Healthcare System we were so accustomed to the provides about 175 million americans with their insurance in my home state and of course we have about two and a half Million People covered by their employer coverage. If confirmed, the hhs secretary how would you support american employers and their efforts to provide the coverage on a consistent and affordable manner so differently theres been conversation about looking for ways to decouple having Health Insurance through your employer. I think the employer system has been absolutely a remarkable success in allowing individuals to gain coverage they might not otherwise. I think that preserving the system is imperative you do that being said there may be ways they see if you give me an opportunity to provide my employees kind of resource the s so that he or she is able to select the coverage that they want that makes more sense to them and if that works from a volunteer a standpoint for employees than it may be something to look at. So its not necessarily under the umbrella of the employees. Thank you mr. Chairman. Senator mccaskill. At the risk of being away i want to gently correct something in your Opening Statement. The first nominee of the President Trump was confirmed by a vote of 981. I wouldnt consider that a partisan vote. The second nominee was confirmed by a vote of 8811. Once again, i wouldnt consider that a partisan vote. So i do think they are trying to look at each nominee individually, and ive had a chance to review the congressmans questioning of secretary sebelius, and i can assure you mr. Chairman, it was no beanbag. It was tough stuff. I think all of this looks different depending on where we are sitting and i want to make that point. As to passing obamacare without one democratic vote, we are about to repeal obamacare without one democratic vote. This will be a partisan exercise under the reconciliation. It will not be he a bipartisan effort. What we have after the repeal is trump care. Whatever is left after the dust settles is trump care. I know he likes to pay close attention to what he puts his name on, and i have a feeling, congressman come even though you keep saying today that the congress will decide, you are not really believing that your new boss isnt going to weigh in on what he wants congress to pass . We are not going to have a plan from him . My question is are we going to have a plan from the president will he have a plan if i have the privilege of being confirmed i look forward to bringing a plan to you. The plan will come from President Trump and you will have the most Important Role shaping the plan is the secretarsecretary of health andn services, correct . I hope i have in, yes. So, whenever trump care ends up being, you will have a role in it and i think its important to get that on the record. When we repeal obamacare, we will do a tax cut. Does anybody in america who makes less than 200,000, or any of theareany of them going to bt from the tax cut . It is a hypothetical know its not hypothetical. When the repeal obamacare, there are taxes in obamacare and when it is repealed, theres no question that taxes are going to be repealed. I promise you that taxes are going to be repealed. When the taxes are repealed, will anyone in america thinks less than 200,000 benefit from the repeal of those texas clicks i look forward to working with you on that plan and hopefully that will be the case. No, no. The taxes that are there now, does anyone that makes less than 200,000 pay the taxes now flex it depends on how you define the taxes. There are many individuals paying much more than they did prior to that point. Im talking about taxes. Until the tax is implemented that doesnt affect anybody. Im trying to get to the simple question and i dont think you want to answer it that impact when obamacare is repealed, no one that thinks less than 200,000 is going to enjoy the benefit of that. I look forward if confirmed i look forward to making sure that is not the case. We will go on. I talked in my office on ending medicare as we know it coming for plan that you have worked on for years is converting medicare to private Insurance Markets with government subsidies, correct . Not correct. We talked yesterday and went through this in my office and by the end of the conversation, you admitted in bible quote you, but your plan for medicare in terms of people getting either tax credits for subsidies or whatever you will pay to medicare recipients would be thathen having the choices on te private market and you said yes it was pretty similar to obamacare with the exception is a mandate, didnt you say that to me yesterday . Is a fairly significant exception. These people will be mandated to get insurance its not what it 27yearold who doesnt think hes going to get sick. You dont need a mandate for people that are elderly, they have to have Health Insurance, so the mandate isnt as relevant. But didnt you admit to me that obamacare and the private market is very similar to what you are envisioning for medicare, didnt you used the phrase pretty similar . There are some similarities. What i said is the mandate is significant. Again, with obamacare we dont need a mandate for seniors would you agree that you dont have to tell seniors that they need Health Insurance . I hope we dont need a mandate for anybody so they can purchase the kind of coverage they want and not with the Government Forces them to buy. Finally coming you want to block grant medicaid for the state flexibility and efficiency, correct . I believe medicaid is a system that is not responding rg necessarily to the needs of the recipients and consequently it is incumbent upon all of us as policymakers to look for a better way to solve the challenge. Argue in favor of block grant medicaid . Im in favor of a system that is are you in favor of block printing medicaid, it is a simple question. The confirmation hearing for the most powerful job in health care in the country i dont know why you are not willing to answer whether you are in favor of block printing medicaid. Im in favor of making certain it is a system that responds to patients and not the government. I dont understand why you wont answer that and i dont have time. I dont know if we will get another round. Should i ask my last question or are we going to get another chance . Im going to allow additional questions. I hope not everybody will take the opportunity. [laughter] obamacare raise taxes on millions of americans across the income levels and in may of 2010 and ellis has identified significant widespread tax increases on the taxpayers earning under 200,000 contained an eca. For example, the 2017, 13. 8 million taxpayers with incomes below 200,000 would be hit with more than 3. 7 billion for the medical expense directions obamacare led to middleclass tax hikes. Somewhere in this mix we have alternative facts. In the last years reconciliation bill they cut taxes for one group of people. They cut taxes for the most fortunate in the country. That is a matter of public record, not his alternative or universe people. I want to know President Trump said in various ways he doesnt want people to lose coverage and would like to cover as many people as possible. To d do it without mandate do to lowercost those would be the marching orders is that the statement . Us go to you and i. We both worked in Public Hospitals for the uninsured. Lets talk about medicaid. Why would we see patients in the hospital for the uninsured if they want to see an orthopedic in the private practice was medicaid pay a provider well enough . The often times it does not. Its whether iwhether it is ther the like. But it isnt working for those patients an and we ought to be honest about that and look at that and answer the question why and then address that. They wrote an article about a michigan physician who had so many payments that she was going bankrupt and had a discharged patient practice. The Ranking Member said we cant have alternative tax but we also know that the Medicaid Expansion about how when the expanded medicaid in oregon the outcomes didnt improve. We need to make medicaid something that works better for patients. Absolutely and look at the right metrics. Its to keep the patient at the center and realize with care and coverage we are providing for people on the ground and in real lives and whether or not we are affecting them in a positive way or a negative way. But it would. But the population is not monolithic. With uh demographic groups and help the moms and kids and teachers are treated the same. If you are pressed of block grants and hear any nuances are you speaking about a beneficiary pavement how do you guys that . Utah is my state. We tend not to let those because theyre more difficult to measure but talking about peoples lives in health care, it is imperative redo the extra work whether or not that it will help you and not argue. There is a question about Health Savings account i love that because it activates the patient. And there was Better Outcomes. When people to engage they tend to demand more and look for Better Services with individuals who have greater opportunity fortresses with the greater opportunity in their health care. If we contrast that experience of indiana with the organ oregon to find no difference in the outcome from the Medicaid Expansion program, that to engage patients to become active in their own care. Built the outcome was improved and a lot like your position thanks for bringing that nuanced position. To statements before i ask a couple of questions that is a welcome relief to have somebody in your profession in this very Important Role particularly with the importance of the doctor patient relationship because in my dealings with cms our hhs over a long period of time might think the bureaucracy in short of that handson information people ought to have. When you were in my office we discussed the necessity of your responding to the congressional inquiries and use said you would. Tongueincheek he should save maybe because lot of times they dont but i will hold the you to that number appreciate that so we can do our oversight. I have legislation passed called the of physicians payment sunshine act require bring this up because last december we were working hard to stop them from getting that legislation. I want to make very clear that the legislation i am talking about this not prohibit anything believe reporting requirements because it brings about the principle of transparency and accountability. I have steadies year with the newspaper reports of a psychiatrist at Emory University that was not reporting everything that they should report. And they said think you for making a somewhere. But since you are a administering this legislation we will think about expanding this legislation and as the assistance i hope i could get your commitment that you will unforced this act the way was intended because even under the Obama Administration it was three years to get this regulation carried out. It was only working to 1 2 years. So will you work with me to enter this Transparency Initiative is not weakened by. It is vital not just in outcomes but in so many areas so they understand what is going on in the Health Care System. With vaccine safety immunization is already important for modern medicine and we could get rivet of smallpox of the western hemisphere so as a physician would you recommend that is the schedule was stablished by experts that is constantly be viewed quick. This science and health care has identified a very important aspect of Public Health that is the role of vaccinations. Mr. Chairman unanimous consent a series of stories from individuals in an for alms of people concerned about policies that the nominee has offered that is included in the record. Without objection. Congressmen price is appreciated our private discussion as well as this morning to move quickly you said this morning you would not abandon people with brief testing conditions. Is that what you talk about is that one of the strategies . The pools can be helpful for those that have preexisting can be cared for but there are other methods as well. We have talked about other pooling mechanisms the Small Group Market destruction makes it so they cannot find coverage the is affordable. One way is to allow the small group with the model as the template to pool together resources. Let me stress that over 35 years we have talked and tried 35 high risk pools without great results. 2011 0. 2 of the people with preexisting conditions were actually in the highrisk pool in the premiums were 200 higher than the standard rates also with lifetime and the new limits limits. That was the reality before the Affordable Care act. On President Trumps said insurance is going to be much better do you think without a permit to actions or without maternity coverage or insurance that would reinstate the caps is better . It nonfat is what he was referring to. Keys said it would be better if we went to the high risk pools or covering people with preexisting conditions then i am wondering. One is better for you plan not be better for me that is what i try to get across that patients need to be if the center. Not government. Who should be deciding . About 70 but did not cover basic maternity care. Day you think that is better crack. I presume she would not purchase that. She has to and then is the recent why so it is just a different way to look at it. One speed mexicos jubilee if mental what helped the shin virginia benefits paul service care plans breath. So that should be a fake it is all a the most negative physical models back right agree. Automatic care i have to send a with uh nominee for. Kippers silly believe people are admitted here should be very worried now. Also did the unification from my mom wahoos said she doesnt want choices she just doesnt want to see her daughter. But she is not supportive of the 80th but she is not interested in more choices. Madam senator. You dont have reason to be concerned. Mr. Chairman and congressmen price not just lacoste dumb point but from the physician standpoint. There are so many things that could be done would we could put a greater resources and individual attention to the individual patients. And of bill curve of patients and if you focus of those individual with a Higher Quality of care and then just to move them down into the mainstream. Specifically vice started that for example, we provided resources in the Affordable Care act to balance off of medicaid patients, off of nursing home care on to communitybased care because it is more affordable. Do you support that rebalancing effort . I take issue with your description of a war on medicaid is what we desire to do is make certain medicaid population is able to receive the highest quality care. I have cared for thousands of medicaid patients. The last thing we want is decrease the quality of care that they have access to and clearly the system isnt working right now. Homebased care, and it was a wonderful thing to do and we ought to incentivize that. So many things in medicaid would provide great quality of care we dont incentivize right now. In 20 other states, and the Affordable Care act, georgia received 50 million in transition for medicaid beneficiaries in communitybased care and shift 10 of longterm costs to that communitybased care so huge savings to you for feeling that part of the Affordable Care act . The medicaid population has access to the highest care possible, doing anything to improve that because so many of the medicaid population dont have access to the highest quality care. I hope you look at this model and the basic health plan model which is again, what i think you are proposing and the administration is refusing to refute, when the president said i will protect these but senator sanders brought this up. The white house chief of staff says we are going to medicaid spending. What we want to do is give them leverage in the marketplace. That is what the basic health plan does and communitybased care plan does, gives them the ability to get more Affordable Care, Better Outcomes and saving of money. If you could give us a response, my time is expired, look at those programs and tell me if you support those reforms in the Affordable Care act, thank you. Thank you, senator. We take our first round, and additional senator, we start with senator putnam. I have several ideas on how to lower the price of medicine, but i would like to set those aside and start with the president s idea, bidding and negotiation. If confirmed, you will be the captain of the president s health team and have to persuade republican this to change the law so that the president can fulfill the pledge, more affordable prices for medicine through bidding jazz captain of the health team, will you do that . Drug prices are afforded by individuals, access to Affordable Care, the negotiation of part d standpoint which i remind folks is a real success story, the cost of medications for seniors is half of what it was projected to be when part d past, pbms doing that right now. Specific idea, it is the president s, the question is will you advocate to republicans for authority to negotiate . Yes or no . What i was going to respond if you will allow me is to say right now the pbms i doing that negotiation. It is important to have the conversation and look at whether there is a better way to do that. I am certainly open to it. On saturday hundreds of thousands of women of all ages and backgrounds came to washington to speak out against policies you have opposed which includes the violence against women act, provisions in the Affordable Care act to prevent Insurance Companies from charging them or, access to nocost contraceptive coverage and choice to see the provider that they trust. Speaker ryan has publicly stated that no one will be worse off if the Affordable Care act is repealed but the nonpartisan Congressional Budget Office doesnt share that view. They have indicated, 400,000 women would lose access to care including life savings, cancer screenings, in the first year if planned parenthood is defunded and cut off from medicaid. This is not my opinion, democrats or republicans, this is a nonpartisan Congressional Budget Office. You are going to be the point person, would you advise the president to reject any proposal that cuts coverage for or otherwise limits a womans ability to see the provider that she trusts. There are multiple inaccuracies in your premise and i take significant issue with Congressional Budget Offices conclusion because as i mentioned it looks at it in a silo, this is what you are doing without doing anything else to provide coverage for individuals and that is not anybodys plan. Again, what is in the bill you wrote. All kinds of happy talk about silos, what we want to know is one thing above everything else, is there going to be a replacement before there is repealed. You have been asked this by a host of members, we havent been able to get any answers and it seems to me that your own will is out of step with what the new president has said. The new president said the two are going to be intertwined. Your own bill was repeal and run, come back some other time. And when you talk about silos, respect your right to be confirmed, the nonpartisan Congressional Budget Office says women who are speaking out in communities across the this country, women are going to lose access to those vital cancer screenings. That is not a partisan statement. That is from a nonpartisan agency. I hope you are not to reconsider your position. I respectfully disagree with the conclusion. Hopefully we can finish in the next 20 minutes. Thank you, doctor price, for your response. One of the major objectives of the Affordable Care act to deal with historic disk mitigation against minority communities in the Healthcare System. We could give you chapter and verse, medical research that was done was very much not directed towards priorities and Minority Community. The access to providers is always challenged in minority communities was the affordability of quality of Insurance Products not the same, there are various provisions included, and elevated the National Institute for Health Disparities as well as creating offices for minority Health Disparities in Health Related agencies. Are you committed to continuing progress so we have a focal point to bring attention to the needs of communities . An important question. Many in our society, you look at the right metrics not having the same quality of Health Others in society are. It is imperative on us as individuals and administrators to ask the question why. Then reached the plan, a Strategic Plan to help correct that whether it is through current offices or a different mechanism and you have a commitment to look at that. The National Institute minority Health Disparities funded program in maryland and baltimore to show disparities has been extremely helpful, i encourage you to look at that institute as a real, valuable resource to you to carry out that commitment. The Affordable Care act increased dramatically the funding for qualified Health Centers, allow access to care in minority communities which are you committed to maintaining discipline in Health Centers . They play a vital role in our nations Health Care System and i think it is imperative that we retain them or improve delivery of care in that area. The subject talked about by many members, medicaid. I mentioned medicaid, appreciate your response, blacks, latinos, american indians, twice as likely to be in medicaid than the white population. In my state 70 are people of color. It is by far the dominant population that relies on medicaid. I hope you understand our concern, when we talk about changing medicaid, talk about block granting medicaid, talk about new approaches to medicaid it sends a signal that what we are going to do is cut federal governments commitment to access of minorities. It is a major area of concern. We have seen budget grounds where cuts to medicaid dollar for dollar, reduce access to Minority Community for healthcare needs, states of challenged budgets, the more you put on the state the more likely it is many states will not be able to meet their full commitments to the medicaid population is. Share with me your vision as to you look at the resources we were putting into healthcare, Everyone Wants to do it more efficiently but if you look at the medicaid population, and making the problem even worse. How can you give me a Comfort Level you are committed to the minority, and let me at this table, anyone who has treated a patient with medicaid history, treated thousands of patientss, we as a society, as a major metric determining whether we are providing care the amount of money into the system. The doctor they want to see or measuring the wrong thing. My commitment, measure the right which looking at relative resources going into the medicaid population versus general population you will find in many cases it is less resources and as we set on quality education money is not the only thing but is part of the problem. Really urge us to recognize we have Better Outcomes in Healthcare System so you dont do that by taking money away from those people. Senator nelson. Thank you, mister chairman, congressman. Just to follow up on the last conversation, you said you did not recall having said it was a terrible idea, i quoted the source, politico, that was in most republican support, i am quoting from the political article of 2002, april 30th, most republicans 2012. Most republican support the Health Clause requirements, that Insurance Companies accept all applicants. The replacement plan on preexisting conditions put forth by the most prominent republican ignores the idea, preexisting conditions. It is a terrible idea. Representative tom price, and i want to insert the political article into the record for clarification. You have the opportunity to talk about puerto rico. Because of the origin, they are not treated like states where the poor, the population that you have, the more federal assistance for medicaid that you get. It is a block grant and the block grant will run out this year and they have a heck of a problem not only financially on the island but now, a third of the population according to cdc being affected with the zika virus. Want to comment on what you might do going forward. To find the resources to have access to the care that they need. These are american citizens and it is incumbent upon us to take that responsibility seriously. Senior citizens, on medicare, and almost 2 Million People get the healthcare, through the aca, Medicare Part d, what you try to do is close the amount of money seniors have to pool in your own pocket otherwise known as the doughnut hole. You want to comment about the years retained the federal ability to purchase their drugs. View of the fact the Senior Citizens, my motherinlaw and fatherinlaw, tread very carefully here. The concern about drugs for being available for seniors is accessibility of the drug they need and desire and so we need to make sure formularies arent limited and availability for medications. That they have available for them. Part of the aca, and Senior Citizens. It is imperative we provide the greatest amount of opportunity for seniors to gain access to the drugs they need. And to hear will be are doing now, the only solution that is possible. I am humble enough to believe there are better ideas out there and if we find a better idea that provides greater coverage more efficiently and more responsive to patients, and embrace that if it were to come along. As their senator and protector of Senior Citizens in florida i cant get away with an answer like that. And i am going to support your right to get drugs under Medicare Part d just like you are getting it now and not take it away. Understand and respectfully suggest if you use the line we are going to maintain the quality coverage we have right now unless we are able to improve it and then we might be able to do that. Be change if i were to give that answer i would be run out of the room with a group of Senior Citizens. Thank you, mister chairman. Senator menon does. One of the main policy priorities you share with speaker ryan is to radically form medicare, seniors would in essence receive a coupon to buy coverage. Despite the fact President Trump has made repeated promises throughout the campaign that he wont touch medicare it seems it is one of your top agenda items. I have heard serious concerns, not only from seniors worried about increased costs and decreased coverage but providers in my state concerned about serious negative impact underfunding will have on the ability to continue carrying for medicare seniors. If the stated goal of medicare privatization is to reduce federal doesnt it stand to reason every dollar the federal government saves is going to have to come out of the pockets of seniors on medicare . I disagree with the characterization of the program as you described it. It is inaccurate. Lets go through the specifics. Do you not seek to privatize medicare . No. Do you seek to ultimately offer a voucher as your way of creating greater for ability . No. It is interesting you say that because the study that had been done on your and speaker ryans medicare privatization plans, and will pay more than twice what they paid now since the vouchers that you would give out are by design far short what the current Medicare Program covers. I have no reason to believe, he is not interested in modifying medicare, for the position of the president has changed. If you talk about what my role as legislator was in fashioning legislation and trying to solve challenges we have in medicare i am happy to do that but that is not the role i would play if given the privilege of being confirmed as secretary of health and Human Services, that role would be to administer the changes that you will come up with, the programs let me respond to that. I have heard you at various times both here and before the Health Committee, and the administrative role or legislative role, it is disingenuous, the day of the hearing, before the Health Committee Vice President pens, and could not be more enthusiastic that someone with his background referring to yourself, and the president elect exhibition for healthcare reform helped us shape what the replace bill looks like once we repeal obamacare. Clearly they think rather than the Vice President , paying a policy development role, and not just the administration of whatever the congress decides. In your advocacy with the president as he deals with desire to replace obamacare, there has been more than an administrative role, and passed the prologue, your views as a legislator as to what you thought was best for the American People, and that in essence is a plan towards privatizing medicaid. If that is not the case commit to ensuring that under your watch medicare wont increase costs or limit the coverage to current and future beneficiaries as a result of a change in the plan . A couple things. The comments you referenced were related to the aca. As mentioned in the conversation in your office, i am humble enough to understand and appreciate the work i did as a legislator is not necessarily the work i would promote as secretary of health and Human Services. The work that has been done in the department, the experts within the department have significant knowledge and expertise in the work they have done. The essence of my question, if you dispute your past views will be your future views, that your past use of legislative activity are not going to be your advocacy, then i would ask you to go to the core of my question is are you willing to commit that we wont the increased cost or less coverage for seniors under a revision of medicare as you might advocate or the president might pursuit . What i can commit to you and will committee went have committed to you and others on this committee and other conversations to make certain seniors act best in the highest Quality Healthcare possible at an affordable price. Access without ability to afford it, i will end on this. That is what i said. Affordability is not just an affordable price but your ability to have the wherewithal even to access an affordable price. Medicare guarantees, as a right, guarantees seniors like my late other who worked in the factories of new jersey as a seamstress, wasnt in the unionized factory, didnt have private insurance. After working a lifetime of hard work to help her family achieve what they did, she faces enormous struggle with alzheimers at all points of her life. For her, her Healthcare Security was medicare and without it she would not have lived with the dignity she deserved in the twilight of her life so changing medicare from a commitment and entitlement to vouchers that may hope to create affordability but doesnt guarantee that is in fundamental shift in the nature of how we take care of seniors in this country. That is why i am so passionate about this. I want to explore publicly but your answer doesnt assuage me that in fact you are committed to medicare as we know it today in terms of the guarantee. Can we improve it . To guarantee that is what im concerned about. I sure those concerns and disagree with your characterization and can i share with you the story of my mom, who in the twilight of her years had an illness that took her from us and she enjoyed the benefits of medicare and without that might not have been able to have the care she received. I hope that will be compelling to you in the days ahead, that will instruct you how to pursue, thank you. I begin with comments of congressman price about not using the word socialized medicine. 2007 the congressional worker the congressional record talked about eligible for government run socialized medicine so referring i dont want to debate that but point that out that you may have forgotten to spend ten years, i understand that. What senator menendez said about medicare, slightly different twist, you expect lawmakers to push forward and overhaul medicare, eight months of the trump presidency. The budget director designee was said he would support raising the eligibility age of Social Security. He seemed to be open to raising the eligibility age for medicare 2 in his comments but like you he supported efforts to raise it in legislation in the socalled ryans better way program. That is an exact contradiction of what President Trump has said, he opposes cuts and raises the eligibility age. I ask you to clarify your position, i know you are busy but if Congress Passes legislation to raise the eligibility age for medicare as laid out in speaker ryans plan would you advise President Trump to veto that legislation . I dont anticipate a single piece of legislation related to just that. We have to look at the constellation. Something else is part of it, you would consider supporting raising eligibility age, no matter what else is in it you stand firm on that. It is my response ability to talk about various aspects, lay out the proplaps and cons and the consequences of the decision made by that. When i think about a barber in ohio, or a factory worker in logan, ohio, a woman who works in a diner in mansfield, someone working construction in troy, ohio and saying to them, the eligibility age is 65, you can work to older ages. I cant imagine the morality of telling these people who worked all their lives in their bodies, broken down more than ours do on these jobs that we would consider the possibility as you all did in the congressman ryans bill, studying to be. I struggle with the morality of a system that is broken. I dont agree that medicare is broken. You said good things about innovation. I want to ask you to get need to continue to work on this. Last summer, visiting my hometown of mansfield to witness the effective and cost efficient role of Community Health workers in reducing mortality rates, i will talk to you more privately and thank you for trying to get together in the last few days, about working to ensure Health Workers are recognized in the Delivery System reforms, they have been very effective in bringing down low birthrate, baby rate, cutting back the rate of infant mortality. My state may be last in black infant mortality and pretty bad overall, i want you to work with us on what the secretary and i began on dealing with Community Health workers, thank you. Last question. Thank you for your indulgence, mister chairman in the second round. Do you support guaranteed healthcare for the nations veterans . The commitment made by this nations veterans should receive healthcare. But we dont, not all veterans qualify for care through the va. There are a lot of them in your state and my state. Because of these gaps, initial Coverage Options like those provided the aca are critical to ensure they are covered. What is the answer . The va doesnt do it alone. The aca complements the va so it does so if we repeal the aca how do you guarantee healthcare for my state you thousands of veterans serve their country, we dont have real healthcare. There are real challenges in the va system. I am the only individual on the dais who has ever taken care of a patient. You want to repeal you want to repeal the Affordable Care act, you may the Affordable Care act in a way these veterans have guaranteed healthcare, almost all veterans have guaranteed healthcare, repeal the Affordable Care act with no plan that anybody has seen to make sure they have guaranteed Health Insurance. I understand and appreciate that. In many instances we are not keeping the promise. Working with you i appreciate you had said when i asked when President Trump said he was working with you on repeal and replace, you said he hasnt been working with you. You didnt call him a liar but that is putting 2 and 2 together that it adds up to four. What does that mean. If you and he are working together are you going to suggest that we find a way to repeal and replace, to make sure there is guaranteed healthcare for our nations veterans . I think it is vital as i mentioned before that every american have access to affordable coverage of high quality and that is our goal. When we replace the Affordable Care act after your party repeals it in this congress you will find a way for all 22 million americans including a lot of those are veterans, that they have Health Insurance, they dont lose it with a repeal and replace. Working with you to make that happen. That is not quite a yes. It is my answer. Thank you. Senator casey. They for the additional round of questions. We want to move to the topic i hope we got in the first round which is individuals with disabilities many of whom dont have the exact number but many of who relied upon medicaid. One of them is a child i got a letter from his mother about, pam southeastern for vania talking about her son row one simpson who was diagnosed in 2015 with autism and among other things, the great care that he gets and their family benefits from medicaid and she says without medicaid, quote, we would be bankrupt or my son would go without therapy he sincerely needs. Can you guarantee he will have that benefit from and he will have that coverage and protection medicaid provides if you are secretary of health and Human Services . We are committed to making certain that child and every other child and individual in this nation has access to the highest quality care possible. Not access, the medical care, and a better level of care. And the coverage of medicaid and all that that entails. The fact of the matter is in order for the current law to change you all have to change it given the privilege of leading others part of health. We should stop talking around this. You have led the fight in the house backed up by speaker ryan for years to block grant medicaid. To block grant medicaid. What that states will have to decide whether or not this child gets the medicaid he deserves. That is what happens. You put it back to the states and hope it works out. One estimate by the center and budget priorities, long before you are named, said that the headline, house budget chairs plan would cut medicaid by one third, this wasnt developed because you are in front of this committee. That is what they are saying, medicaid will be cut, the number, 1 trillion. Can you commit to us that no person with a disability currently covered by medicaid, rowan and everyone else, no person with a disability was covered by medicaid will lose healthcare coverage, not access, coverage under the block granting plan the administration now embraces. What i can commit to you is in a medicaid system im given the privilege of serving, working with cms administrators that the metrics we will use for rowan and every single other patient the quality of care they are receiving and whether they are receiving that care. The metric you want to use metrics are fine. Will you commit to ensuring rowan and everyone else who has disability that benefits from medicaid today has the same coverage, the same coverage, the same healthcare coverage they have today. That coverage or greater. That is the commitment you are making. For every person that benefits from medicaid and disability. The goal is, our desire is to make certain people have better healthcare, not less healthcare. It is astounding to be heres the problem with your answer. Until sunday there was a question as to whether or not President Trump or his administration would fully embrace block granting and medicaid. He said when he was campaigning that he would not touch medicare, medicaid and Social Security. As of sunday the administration has set on the record on at least one or two interviews that they are going to pursue block granting policy with regard to medicaid. What flows from that are the following. He has majority in both houses so what you have been working on the house for years that you could vote for may become the law of the land. This is a live issue. This is the real or some policy among house republicans, this is a potential enactment of law, block grant of medicaid. I hope you can keep your promise to make sure no one with a disability suffers mnuchin of care or coverage. That is the promise you just made and i hope you can make that in light of the trillion dollar cut in medicaid pursuant to block grant. Senator mccaskill, youre the last one. Thank you, another round of questions. Put in the record a table prepared by tax policy on december 15, 2016, that lays out what happens with repeal of all aca taxes including Premium Credit based on income level. If i could make that part of the record. Without objection. You were chairman of the Budget Committee. I will try i get frustrated when people wont answer especially when your record is so clear on this. I dont understand why you want to divorce yourself from your record, you were chairman of the Budget Committee, correct . Yes. In that role, you had the most important power of the chairman around here. You had incredible power to influence what was in that document, correct . Which document. The budget for 2017. Along with my colleagues. Was there anything in that document you disagreed with on principle when you supported it . Absolutely. What was in the document you disagreed with on principle . I would have to go back and look. It was a combined effort. As i mentioned or, if given the privilege of serving as secretary of health and Human Services i appreciate and understand it is a completely different role. I know it is a completely different role, that is not what i am asking you. What i am asking you is what do you believe in . What do you believe in . You have been respected around these halls for a man of integrity. You believed in certain principles and one of those was the principal you embraced as chairman of the Budget Committee to block grant decade. On the contrary. This great country and the people of this great country and the principles of healthcare that i do find, those are the principles we all share, we need a system that is affordable for everybody, a system that is accessible for everybody, a system that is of the highest quality. Not to a system that incentivizes innovation. I understand the aspirational goal you have but there is a record. There is a record and the record is as chairman of the Budget Committee controlled by your party, you put out a budget document and you said over and over again that youve favored block granting medicaid. Your budget in 2017 that you were the chairman of, that you want to run away from today as if it never happened. That is why i cant figure out why. You are going to be influential. What you really believe matters. You want to run away from that. You cut decade by 1 trillion in your 2017 budget. You may want to stand on the notion that whatever you do is fine and that is just not you were chosen because of your belief and your beliefs are reflected in your budget which as chairman of the Budget Committee. That is the deck i want to make and i have a hard time understanding why you wont say it wont turn out the way i believe that i favored block grants to medicaid. What i believe it is a medicaid system that is responsive to the patients and provide the highest quality care possible. I suggest to you that is not the medicaid system we currently have. And in this capacity, in the solution to provide the highest quality care for medicaid patientss. The argument being made in favor of block grants, and that is the argument, and the budget you crafted, you block grant things, gives the war efficiently. The social Services Block grant which you voted repeatedly to repeal. Said you wanted to 0 it out and you voted that way is a member of congress and i want to make sure you understand that efficiency and effectiveness you say you get with a block grant of medicaid is what is happening in my state which by the way came about with ronald reagan. They are deciding whether to use that money and know where it is being used in case you want to advise the president the way you voted, being used for residential treatments for detoxing hair when and day care for seniors to keep them in their home so not pay the bill on medicaid in a nursing home, being used for adoption services, being used for Case Management to save money so the cases are being managed effectively and efficiently in terms of accessing federal safety net programs. Will you continue to advocate as you have congress for repealing the social Services Block and. I think theres a better way to provide those services in a more efficient effective and economical way for individuals receiving the care and i would also respectfully suggest to you that another state flexibility model held up by many is the 10 if program, they have been extremely successful so there are different ways to do things. It out to be a collegial conversation, what the challenges are before us and working together to solve those challenges and that is what i would like to do. Im trying to point out the inconsistency of a block granting medicaid are good because of its ability and efficiency and block grants on social services are bad and that has been the record in congress. With respect for individuals to say state flexibility for medicaid is bad but stay flexible he for 10 if is fine, a little bit inconsistent as well. Thank you. We are going to close this so closing remarks. Thank you, mister chairman. We wrap up another quiet, subdued hearing. The first for you, congressman despite our policy differences, i very much respect your willingness to serve, you and i have a lot of mutual friend and i know, very supportive of your career and i respect is where we are in terms of substance. Several hours ago i asked you with respect to the executive order on the Affordable Care act, will you commit that no one will be worse off, and you ducked it. I asked guarantee that no one will lose coverage, you ducked that. I asked you, would there be a replacement before all of this that would hurt working families would go into effect and that was ducked as well. It seems to me there is a big gap between the answers you have given on the executive order with respect to repealing the Affordable Care act and what the new president said all through the campaign, everybody was going to be okay, nobody would be worse off, there would be no gap between repeal and replace. My colleagues have gone through debates about the medicaid block grant. Prediction, some of your biggest critics will be republican governors, republican governors, more diplomatic than me will see this as a trojan horse to cut spending and that is why a lot of us are concerned about shredding the safety net. I asked about womens healthcare and hear the concern is women all across the country are concerned that they are going to lose choice providers they want to have today and coverage and you just set i disagree with the Congressional Budget Office, how we are going to lower these pharmaceutical prices and you told me about pharmaceutical benefit managers, part d, and didnt answer the question, whether you get republicans to fulfill the president s pledge on bargaining so that is what concerns me, and the ethics questions, corrects one key point earlier in the hearing, congressman doesnt have control over brokerage accounts, first congressman hasnt provided copies of the agreement clarifying the level of control, but congressman told senator murray regarding purchase, quote, i did it through a broker, directed the broker, purchased stock, did it through a broker. Third on this point these are not blind trusts, just want the record to reflect that. I want to put articles in the record about investments in other healthcare stocks specifically in poor companies, that when you factor products. Without objection. I wrap up with one last point. Ever since i was director of the gray panthers, i was interested in one thing, changing a system largely for the healthy and the wealthy. As you and i talked about, i had eight democrats and eight republicans on a bipartisan bill to do that. I didnt get my way. The Affordable Care act had many, many good features and one of the was it made clear all across this country we werent going to go back to the days when healthcare was for the healthy and wealthy. I am especially troubled as we wrap up this morning, we have been at it close to four hours, that when you take all of these policies together that you have described this morning, that is where we are headed did the number that is where we are going to be and that is why i am so strongly opposed to these positions. My hope, we still have additional questions to look at on the ethics issues. Just tell the congressman on that, george bush, george w. Bushs ethics, in the paper this morning talking about your stock trade and said i havent anything like this before and i have been practicing and teaching about Securities Law for 30 years. There are troubling questions that remain with respect to this. Being told members have to get any written questions in by this evening but with respect to what we have heard this morning, and the lodestar that i see, america will end up with healthcare that works for the healthy and wealthy. Im going to oppose it, we are troubled by what we have heard today. I appreciate the chance to make closing remarks. If we keep going the way we are going to wont be any healthcare for anybody. We wont be able to afford it, wont be able to provide, many things are wrong with the Current System and it is pathetic and it is eating up the whole federal budget. I have been around here only 40 years but i never had a witness for any position in government who has performed as well as you have, who has an impeccable reputation in medicine in the congress. To be treated like if you dont agree with concepts of some of my colleagues, there is something wrong with you, is beyond the pale. Like i say, you not only have a great deal of experience in medicine, but you have been a great congressman. You have been assigned trying to get things under control around here and found that it is almost impossible because we have all these people saying we have to do everything in the world, dont care what the costs are. That is why this country is broke. We have got to find some way of delivering all these Healthcare Benefits to people without totally ruining the country so nobody gets Healthcare Benefits which is where we are headed did it. I dont know how in the world we can continue to buy off on this liberal claptrap dont have to pay the piper. What you have said is we are going to try within this Current System to make it work, to cover everybody and help people whether they be poor or rich. I dont know if you can say much more than that but i get a kick out of how many people are blathering about we got to do everything for everybody when we know we are 20 trillion in debt and this money doesnt go grow on trees. Every one of us wants to make healthcare work. Every one of us wants to make sure every deserving person in our society is cared for. I say that as a person who over the last 40 years every healthcare bill that works has my name on it starting with the drug bill. How about hatch waxman, name it all. The fact of the matter is you have been very forthright, very honest and you have indicated in spite of all the problems of trying to Fund Healthcare and all the problems around healthcare you are going to do your best to make sure healthcare is delivered to our American People. I wonder how many of my colleagues on the other side are going to vote for you and if they dont, it kind of says something about what is happening in this country. I want to thank you for being here today. I dont think you ducked any questions, you answered them forthrightly and may not have please individual senators but you did. I look forward to doctor price being confirmed and assuming his position so he can begin working with us in congress to improve the nations health. The whole Healthcare System. To ensure taxpayer dollars when used efficiently and effectively. We owe that to dedicated taxpayers and citizens of this great country. To that end, several groups and individuals have submitted letters of support from doctor price. I would like to ask those be entered into the record without objection. In closing, this Committee Takes its responsibilities very seriously. This was an intelligence committee, we have a lot of really great people on both sides on this committee and they are serious about what goes on but that is why we have such a thorough review process for nominees, that is why the committee is following and will continue following longstanding process in the future. I would ask that any written questions for the record be submitted by 8 00 pm tonight which is two hours more than what the democrats gave us. This is a timeline that is consistent with the committee consideration, and that is a direct quote by the way. I want to thank you and your family for sitting through this and answering these questions, the best i ever heard. Understanding there were no answers to these problems. I want to personally thank you. You had such a great life without doing this kind of stuff. You are willing to give your life, working for the American People doing what needs to be done in the area of healthcare and i want to commend you for it because i dont think there is a justifiable reason to vote against you. I would like to put in a statement under unanimous consent. Congressman price respond to the Health Committee. My estimation, this is the committee of jurisdiction, congressional is going to serve this country in this great capacity and we will vote for it and get him out of here, and hope if i get him out of here i dont mean out of this room, and where he can really help with medical expertise. It is apparent, no question about that in my mind, i cant understand why anyone would give you a rough time. It is good to ask tough questions and we have a lot of tough questions here today but you have entered them very well as far as i am concerned, much better than a lot of people who have held this position. Many of the others even recently could not answer these questions that you have been asked and it is wonderful that we have a doctor who has had a long life in medical practice willing to give up that life, give up the freedoms that you have to have to repeatedly come up here and justify everything you do down there. It is a wonderful thing and i personally want to congratulate you and your wife and family for giving so watch to this country. With that we will recess and reconvene again to vote on you promptly. [inaudible conversations] [inaudible conversations]. [inaudible conversations] when the senate reconvened at 10 eastern, they will debate the nomination of congressman tom price to the health and Human Services secretary. Secretary. A vote on his nomination would happen at 1 45 am eastern time eastern time at the latest. Live coverage of the senate here on cspan2. In the Senate Wednesday ron wyden, the only democrat on the finance committee, explained his opposition to tom price nomination as hhs secretary. This is one hour. Mr. President . The senator from oregon. Mr. President , as of thesi senate begins