Transcripts For CSPAN2 HHS Nominee Representative Tom Price Testifies On Capitol Hill 20170120

This is two hours and 40 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] the meeting will come to order. Senator whitehouse is next followed by senator young. Senator whitehouse. Thank you, chairman. Lets me ask first to put into the record a letter from our governor in rhode island, which says in rhode island im quoting here we have actually seen exchange premiums decrease in two out of the last three years. Ended that this has saved consumers nearly 220 million since 2012. So, the story on the Affordable Care act in rhode island is a good one. I would also like to put this little graphic into the record, which to explain briefly, the red line along the top is the cbo estimate of where our healthcare costs were going to go back when they were making the estimate in 2010. Then, at this time 2016, after the aca was in place they took a look at the Actual Experience up to that point ended a new new projection Going Forward based on the Affordable Care act and just in the following 10 years the green period from 2016 to 2026 they are forecasting 2. 9 trillion in federal healthcare savings that relate back to the Affordable Care act. This is where that came in. So, we forecasting out at our peril if you care about saving medicare the savings to which are a significant part of this 2. 9 trillion. We throw it out right now, according to the republican plan, with nothing to replace it. I have described that over the weekend at home and its like jumping out of an eric hit airplane with no parachute and someone telling you trust me, we will build you the senator we will build the parachute as you jump down. I think the American People are entitled to know what they will be offered as an alternative. Theres been conversation in this hearing about how the republican ideas floating around sure there are republican ideals, but no republican bill, no republican plan, no republican proposal. Our cards are on the table. Its obamacare. You want when pruitt . Make suggestions. Weve always been open to that. On the other side of the table there is nothing and its hard to negotiate with nothing and i think the republicans have a responsibility to put a plan together. We talked about that, mr. Price, when you and i met my office and my recollection of my conversation is that you told me that you would want to keep what he people stay on their current policies until they are 26. Is that true . I think the Insurance Industry has included individuals up to the age of 26 on their parents policies virtually across the board and i dont see any reason that would change. And you would want to keep, you told me, the donut hole closed to protect seniors against those pharmaceutical costs. Is that also true . The discussion we had was about pharmaceutical cost of making sure we could do what we could my recollection was more specific than that, that you did not want to reopen the dont offer seniors. Are you say now youre considering that . Im not saying that at all. You know well the reopening of the donut hole would be a legislative activity. But you will be the secretary of health and Human Services who will do a lot of work to prepare this legislation in the Technical Work behind it for the administration. Are you going to be proposing in that role something that reopens the donut hole. Ive a lot of seniors that want to hear of that. Im not aware of any discussions to do that. Finally, my recollection that meaning is you told me you not want to return to Insurance Company lifetime limits or Insurance Company denial of preexisting conditions or Insurance Companies going back and looking in the files for some little tiny discrepancy in throwing some off their coverage when they come in with a significant claim is that true . There are always ways we can improve coverage and those are areas in existence right now and i think those issues need to be continued to. So, when, as and if we ever get a republican counterproposal to obamacare you would expect to see those things in it . I dont know whether they would be in its or silent on it, but again [inaudible] then leave it in place . Thats a legislative question not administrative. In one of your budgets you had a proposal that would allow states to throw what you called abled bodied people off of medicaid unless they were working or looking for or in job training. People with addiction, behavioral health, Mental Health issues, are they able to bodied in your definition . Well, we were not as specific as what the definition was im asking you now, what did you mean when you said abled bodied in this provision . The fact that there are many many individuals who have worked for a long long time that believe that providing for an opportunity for individuals who are abled ablebodied without children to seek, gain employment or to study what you mean by ablebodied . Thats what would be defined in the regulation itself. You use the term without an idea of how you would define it . I think people have an understanding of what ablebodied is and thats the kind of things you described. That was a simple answer to my question, ablebodied does not involve people who up addiction, or Mental Health issues . The work that would be done im not asking in some future universe, as you use that term in your budget. Individuals that demonstrated that they were in fact having challenges that would preclude them from being able to seek work or employments or education or the like that they ought to be attended to. Now, im a fan of and think they do good work of the American Academy of pediatrics. Im a fan of them and think they do good work of the American Lung association and im a fan of and think they do good work of the American Public health association. All of those groups and many others have gone very clearly on record that Climate Change presents a Significant Health issues. They signed a declaration on Climate Change and health, which stated the science clear that this is happening. You come on the other hand, have said that the Carbon Pollution standards of the Obama Administration quote go against all common sense and thats there are errors in that allegedly settled science of global warming. I will pursue this with you through questions with a record because my time has expired, but if you could give a brief answer because it appears to every Scientific Organization in the country, although legitimate major ones and to really every American University that this actually is pretty darn settled science and that the only people who disagree with it are people that have financial interests in getting in preventing work from getting done and it looks to me like making this statement yet taken the side of the special interest against actually settled science and if we cant trust you on science as a settled as climate science, how can we trust your Public Health science issues where theres a big special interest on the other side . I dont agree with the premise of the answers to it continuation, but i will say climate is obviously changing and continues to change. The question from a scientific standpoint is what effective Human Behavior and human activity have on that and what we can do to mitigate that and i believe thats a question that needs to be studied and evaluated to get the best minds available some think the way you do, one. We are running out of time. Thank you, senator whitehouse. Senator young i believe is next, but i dont see him. Senator roberts. Thank you, mr. Chairman. Thank you for holding this anger management hearing. [laughter] i truly hope my colleagues feel better at least for one date after purging themselves of their concern, frustration and anger. I would like to note i asked the technician running the sound system, the audio system is working. I thought maybe the senator did not know that. He reminded me of my marine di back in the good days where the di would shout i cant hear you i thought it would bring that up that the audio system is working. Take care of yourselves. Doctor price, congratulations on your nomination thank you for being here today. Think you. As many of the our colleagues have noted you will play most Important Role when confirmed in helping to stabilize the individual market when congress does repealed the law and repair the damage it has caused and reforms of i believe well put our Healthcare System back on track. My home state of kansas, we have three insurance carriers left and we feel fortunate we have three. With each individual only having access to two of those and our premiums rose this past year over 30 . Down the road it will be more difficult if we dont do something and theres no doubt with regard to uncertainty and banks among consumers and i think its important to make clear that even if congress and the Incoming Administration were to do nothing, let it go. Like in frozen, let it go. Im and eat and repealing parts of the Affordable Care act. The laws not working and we have to do something to meet that obligation. Of the prices are unaffordable, markets nearly nonexistent with you or no options in several states and counties. We are not as rural as wyoming, but we are rural in my state of kansas. I have a concern back in the day when we sat in this committee and wrote the first version of the Affordable Health care act. I dont know where that mark is today. Sitting on a shelf somewhere. We went day and night and day and night and day and night and i was worried about something i called the rations and im talking about independent payment Advisory Board and the new coverage abilities given to the Us Preventive Services task force and i would also mention the Center Outcomes research institute. Not many people are aware of these. I even went to the floor of the senate and had people riding a horse and then the four horses of the regulatory apocalypse, but im worried about it and the provisions, which could interrupt the doctorpatient relationship allowing the government to dictate what coverage you can receive. Can you share some of any concerns that you have with regards to these, what i would call for rashers with respect to what they are trying to do with good intent. I appreciate that and i think its imperative that as we move forward that we recognize again that the patient should be at the center of this and anything that gets in the way of the patient and their families and physicians making the physician about what kind of healthcare they desire is we ought not go down that road. For example, the cmm i, im a strong proponent and advocate for innovation, but i have seen in certain instances was coming out of cmm i is a desire to acquire certain kinds of treatment for certain disease entities that may or may not be in the best interest of the patients and because it carries the full force of the federal governments and the payment for those services it means that we are answering the question of who decides about what kind of care patients received by saying the answer ought to be washington dc and i said the reject that there is where those decisions should be made. I appreciate that answer. I had a privilege of being a member of this committee, the finance committee especially being chairman of the always powerful Senate Agricultural committee and on particular interest in hhs and fdas work on food and nutrition policy. During the Previous Administration the fda delayed guidance and unrealistic states. This was the case of the implementation of the food safety modernization act and more recently with the Nutrition Facts Panel revision. I know we all share the goal of a safe food supply and availability of accurate accurate information, but im concerned that administration is not consistently communicate with the food in our culture industry regarding new or changing requirements. Would you commit to working with the secretary of agriculture and other relevant agencies not to mention the committee i serve on and similar in the house, if your department is issuing science based guidance and taking into consideration other regulatory burdens on establishing compliance and other regulatory acts . Yes, i believe thats not only imperative, but the science that is relied upon should be transparent and available to the public so people can see exactly what was the basis for the decisions being made. Under the Previous Administration, we have seen increased activity and regulatory action on nutrition policies such as issuing voluntary guidance, get the same administration continues to request Additional Resources from congress to comply with statutory requirements that includes safety modernization act and im concerned the administration did not prioritize fdas measure to protect the nations food supply , instead of focusing on nutrition policy. Is confirmed, can you discuss how you will look is on the court at the eight duties such as implementing the laws that Congress Passed rather than agenda driven nutrition policy guidelines. If i am confirmed and given the privilege of leading i would work specifically with fda commissioner to make sure we are relying on science, a science that is guiding the decisions that we are making and again, that the transparency is available for folks to see what cut her decisions are made and how they are being made in addition to working with policymakers. You know best whats going on in your state and how its being affected by the rules and regulations coming down from washington and in so many areas, but certainly in the agricultural arena, so we ought to have a dialogue with every single individual who has an interest to make certain we are addressing needs appropriately. Thank you, mr. Chairman. Thank you, senator roberts. Senator baldy. Thank you, mr. Chairman and welcome, congressman. You have already been asked about your investments in medical device companies, pharmaceutical companies as part of the prior questioning, but for the record have you also received Campaign Contributions over the years from Political Action committees associated with many of these same companies . I dont know, but i assume so just as many of us do. Okay. So, in terms i mean, the American People want to know, of course, when you get reviewed for potential conflict of interest and your procedures with the office of government ethics is that in your role of fighting for them is not bias of the powerful companies that you have invested in and that have invested in you and you have taken some questions on that, but lets me follow up a bit to ask first, do you think drug price increases we are seeing right now for example the sixfold increase in the cost and at the pin is a problem right now, for americans . As i mentioned there are certain areas where drug pricing increases seem to have little basis in rational findings. I do think, however, as i mentioned that i think its important to appreciate that we have done good things with the drug pricing whether its the generic arena where prices have been held down significantly let me continue down this track. You have been asked already that trump supports medicare drug negotiation. Will you work to repeal the prohibition on medicare negotiating for better drug prices on behalf of the American People if confirmed for this position . Well, i understand if im confirmed and if i had the privilege of serving as secretary that the boss i have will be the president of the United States will you work to repeal the prohibition on medicare negotiating drug prices . Following discussion and being informed by the individuals within the department and working with the president ended then carrying out his wishes. Is that a yes or a no . It depends on that activity. You stated his position recently in fact that he supports price negotiations, so people on medicare can have the benefits of that. Is that something you would press congress to do . In other words, repeal the prohibition on that negotiation . I think we need to find solutions to the challenges of folks gain access to needed medication and its may be that one of those is changing the way that the negotiations as you know the negotiations right now kirk for seniors with the pharmacy benefit management. You have not said yes or no, but you just talk about transparency. Would you support drug prices comparison mandating any drug company that wants to increase prices on their drugs, released Public Information on how they set their prices because so many of these appear to be without justification is you just mentioned. A lot of merit in transparency in certainly this area and i look forward to exploring if confirmed with you ways to make that work. I want to go back i went to go back to the first round of questioning with the chairman who showed a chart and it seemed like what was implicit in the back and forth was that the act of repealing the formal care act, which only impact perhaps a very small part of the Healthcare Industry. You talked about 6 being covered on the individual market. The protection like coverage on your Parents Health insurance until youre 26 and mandating that people be covered even if they have a preexisting health condition, things like eliminating limits that lets lets a summary into medical bankruptcy. Those apply across the Healthcare System, so repeal in no way limits us to a conversation just about a small percentage of our population. This is about a serious impact for all of america. Would you agree . I think that the discussion about what our Health Policy for financing and delivery of healthcare to the American People is a very very broad subject. If you repeal the formal care act that impact is not narrowly confined to medicaid in the individual market. It has impact on every american. Medicare, also. Accountable Care Organizations that are driving so much of our innovation. Thats not confined to the individual market. In fact, it impacts medicare very very significantly, so let me give one example. We in our office when you visited and thank you for your visit, we talked about the Opioid Epidemic. One of the significant issues is access it to treatment to overcome an addiction. Ezell ford will care act is repealed, there will no longer be a mandate for Substance Abuse treatment being covered. Is that something you agree with . The Opioid Epidemic is rampant in harming families and communities would you wish or treatment would be Substance Abuse treatment would be covered under a replacement plan that you would propose . I think it is vital Substance Abuse and other kinds of things so you would keep that protection of the Affordable Care act . Thats a legislative decision, but i look forward to working with you and a 26 euros coverage, i want to make sure i heard the exchange because it sounded to me like you are saying you think insurers will continue to do it so there is no need for there to be an actual mandates saying they must and mine do you with 5. 7 million young people between the ages of 18 and 26 on their Parents Health insurance that is 5. 7 Million People who are not in the individual market because they are in their first job after high school that does not have Health Insurance or in school, so is it just a wink and a promise or do you support having him all a mandate that 18 to 25 yearolds be able to stay on their Parents Health insurance. Like i say i think its been based into the Insurance Programs out there right now and what i absolutely committed to. Im committed to making certain every single american has access to the coverage they want and has the financial feasibility to be able to purchase the coverage. Thank you. Senator young. Doctor price, good to see you here today. I have enjoyed our Service Together the last six years in the house of representatives, particularly the four years weve been on the ways and Means Committee and i that opportunity not just you know you personally, but to observe your present skill set, your depth of knowledge in the area of healthcare and Health Policy, your commitment, more importantly to seeking alternative perspectives, trying to identify where bipartisan consensus could be realized and ultimately forging consensus around some Viable Solutions and the one i find most notable is your success on the sustainable [inaudible] its something the members of this committee are familiar with, but its a blunt instrument that was in place to control healthcare costs and without your leadership in the house side i dont think we could have mood towards a more value based purchasing model, so these are skill sets that will serve you well over health and Human Services, no doubt. One area of the zero formal care act, speaking of bipartisanship that members of my party in your party have periodically and quite vocally indicated their desire to repeal from time to time has been the center for medicare and Medicaid Innovation and that is perhaps on account of the onesizefitsall prescriptive and mandatory demonstration that occurred in recent years and you have already indicated that you oppose the mandatory nature of demonstration project, but i strongly believe for one that there is great value in innovating and experimenting across all layers of healthcare. Further, i think cmm i can continue to be a helpful laboratory for healthcare spear mentation with respect to delivery models, payment models and so forth, for medicare, the childrens Health Insurance program and perhaps other areas. They pack their money and provide greater value. We see what does not work, seal up what does work and for me its commonsense. This is the way scientists operate. They start with experiments and then they evaluate and then they scale up, so i would like to know your intentions and if you have strong convictions in this area . Do you intend to keep this Innovation Center or develop a new one, a variance of trying to please speak to this. I appreciate that and as i mentioned im a strong advocate and supporter of innovation at every single level. Its only through innovation we expand the possibilities for especially in the area of healthcare for increasing the quality of care. Im a strong proponents of innovation. Cmmi i believe has great possibility and great promise to be able to do things that will allow us to find ways in which we can change the payment model, which we are treating disease and the likes that will improve to the patients benefit and i strongly support that. I have adamantly opposed the mandatory nature with which cmmi has approached specific problems and let me also mention the first is the comprehensive joint replacement, the cg art program which identified from cmi 67 or 68 geographic areas where if you were a patient and you received a lower extremity joint replacement for a variety of problems than it was dictated to your doctor what kind of prosthesis, what kind of surgical procedure your doctor could do for you regardless of whats in your best interest. Now, they may be aligned, but they may not be and if they are not aligned than your physician is incumbent upon doing with the government says any other area that i think was more egregious was covering 75 of the nation in the medicare bought part b drug care ministration model. Not a demonstration model if its a 75 of the country and that would stipulate what kind of medications your physician could use in an inpatient setting. In a mandatory way. The problem i have with that is its really is not an experiment demonstration to see whether or not it works in every single experiment healthcare experiment or medical experiment or scientific experiment that deals with people, real people, we demand, we require there be informed consent for the patient to participate in that experiment. You say to the patient we are trying to this to see if it works better and we would love to have you join us and we think it may benefit you and other individuals across this land, but if you dont want to do it you dont have to. The federal government does not do that. They require individuals to participate and often times they dont even know its an experiment going on, so if either of these models were put in a small area, Pilot Project somewhere and we thought it works then scaled them up as you say. I thank you for the whole some response in the rationale behind how you have arrived at that position and i look forward to working with you to advance the next model of cmmi, whatever it might look like. I would be remiss in my remaining 90 seconds if i did not match indianas what we call healthy indiana plan, 2. 0. Vice president elect pentz showed leadership here with our incoming cms administrator to develop a model for medicaid, which is unique to the state of indiana. It encourages recipients of medicare dollars to give ownership over their health. It uses private market insurance concepts to prepare hoosiers for more selfsufficiency. I happen to believe that it will be replicated in other states if we can accommodate that as we continue to work on new health care legislation. But, hip 2. 0 is a important point of concept that medicaid can be more efficient than a one size and ive seen i just need assurance from you that you will be state flexible and there will be innovation in the medicaid space so we can continue to accommodate plans like hip to point out as opposed to a onesizefitsall approach. I think you are absolutely right. The Medicaid Program is one where the states know best how to care for in the best way their medicaid population in the greatest amount of flexibility we can give, i think, for states to enact those programs. What indiana has done is really eight best practice, i think, for many other states to follow, so i look forward to working with you. Likewise. Thank you senator young. Senator murphy. Think you mr. Chairman. Good to see you again, senator price. I hope you understand our frustration around trying to find the nature of this replacement plan. We hear you and president tromp prays all of these aspects of the Affordable Care act and layout two goals that sound really familiar to what we have been living with for the last six years. You said you dont want there to be agap between the repealing replacement that at least as many people will have coverage with the goal of more people having coverage, see people wont face discrimination, young adults will get to stay on their plan itself age 26 and yet we dont get any specifics as to how that will occur. It seems as if you and the president elect one to do everything that a formal care act does, but do in a totally different way, so i will give up on trying to get to specifics of this secret replacement plan and maybe ask you about the metrics about how we will measure what you propose is a replacement is meeting your benchmarks. For instance, the number of people covered, the cost of health care to individuals, the amount of money outofpocket that people have to pay. With you are at the end of your four years, how will you look back on the base replacement to measure its success and to the extent you can give me specifics as to how you will measure the success of the replacement, i appreciate it. I think you and you identified specific areas that i think we need to be looking from a metric standpoint. What is the cost . Is the outofpocket cost for individuals higher or lower than it was . Right now i would suggest the cost is higher than it was when the Program Began for many individuals in the small group market. They were promised the premiums would come down, but premiums have gone up. They would be promised they would have access to their doctor and many have not had access. Im talking about where we are. From where we are today if you look at the things that many of us believe have been harmed by the Affordable Care act, i hope we are able to turn that around and decrease the outofpocket cost for individuals, increase choices for individuals, increase access to the doctors of the providers that increase the number of people who have a insurance . Absolutely. We still had 20 million individuals without coverage and i think its incumbent upon us to say what we do to increase the coverage. The goal is to make sir never he single american has access to covers that they want for themselves and their family. I will just noted those are two different things, having coverage and having access to coverage. Were to come back to this question of the conflict of interest issue that has been raised and i raise a because there is a great concern on behalf of the American People, i think im. This administration is starting to look like a get rich quick scheme, a president who wont do fast himself from his businesses and could potentially get rich off of them. We had a secretary of state last night, secretary of labor who could gut Worker Protections that make a lot of money for his industry, so i want to walk you through another set of facts and another timeline regarding some of your interactions with the Healthcare Industry and get your reaction to it. On march 8, 2016, earlier last year cms announced a demonstration project to lower medicare reimbursement or part d drugs and that would have decreased incentives for physicians to describe incentive brandname medications and drug Drug Companies that were affected organize a resistance. Two days later you announce your opposition. One week later you invested as much as 90000 in a total of six pharmaceutical companies, not five, not seven, six. All six, amazingly, made drugs that would have been impacted by this demonstration projects. Theres a lot of Drug Companies that would not have been affected, but you did not invest in those. You invested in six specific companies that would be harmed by the demonstration. You submitted Financial Disclosures indicating you knew that you owned these stocks and two weeks after that, you became the leader in the United States congress in opposition to this demonstration project. You wrote a letter with 242 members of congress opposing and i read those letters and as not easy work it takes a lot of work to get 242 people to sign on. Good his staff work. Within two weeks of you taking the lead on the opposition to this demonstration project stock prices for four of those Six Companies went up. You did not have to buy those of stocks knowing you were going to take a leadership role in the effort to inflate their value. So, as the American Public takes a look at that sequence of events tell me how it can possibly be okay that you are championing positions on healthcare issues that have the affect of increasing your own personal wealth . Thats a damning timeline, representative price. My opposition to having the federal government dictate what drugs are available to patients is longstanding and goes back years and years. The fact of the matter is i dont know whether you were here before, but the fact of the matter is i do not know those trades were being made. I have a directed account broker and all of those trades were made without my knowledge and individuals on this panel have the same kind of accounts. The reason that you know about them is because i appropriately reported them in a appropriate manner as required by the house of representatives. But, you direct your broker around ethical guidelines. Do you tell him not to invest in companies that are directly connected to your advocacy because it seems like a great deal as a broker. You can just sit back and take a look at the positions you are taking sheet. She can sit she can sit back in this case and invest in companies she thinks will increase in value based on your legislative activities and you can plan separation from that because you do not have a conversation. Thats a nefarious arrangement that i am really astounded by. Of the fact of the matter is that i have had no conversations with my broker about any political activity at all other than her congratulating me on my election. Why wouldnt you at least tell her to stay clear of any companies that are directly affected by my legislative work . Because the agreement we have is that she provided diversified portfolio, which is exactly what everyone of you have in your Investment Opportunities and make certain that it order to protect ones assets that there is a diversified arrangement for purchase of stocks. I knew nothing about those. You can have a diversified portfolio while the staying clear of the Six Companies directly affected by your work . I did not have any knowledge of those purchases. Thank you, mr. Chairman. Thank you, senator murphy. Senator makowski. Thank you, mr. Chairman. There is added benefits to being one of the last in the chain here to ask questions because it certainly gives the clear idea of where youre coming from, congressman, on some of these issues. We have not had as much conversation about the rule aspects of healthcare, which are important to me. We had a chance last night to hear from the nominee for education and i pointed out to her as i have pointed out to you that alaska is a bit unique. Sometimes its really unique and the challenges that we face allow us to be somewhat innovative, but we need flexibility in order to implement some in the innovation. I had a chance to sit with a group of alaskans on saturday in anchorage. They were from everyone from the director of the division of insurance to our commissioner of health and Human Services. A representative, only provider on the individual market, representatives from small rural hospitals, doctors. It was representatives from the tribal help organization and it was a good mix of individuals. Obviously, we got different views and opinions about where we go with this replacement of the aca and what that would need to look like 12 address the needs and issues in a very rural, very frontier, very high cost, the highest cost insurance, the highest cost healthcare costs. We are down to one provider on the individual market, so we have all of the demographics that would tell you that this is difficult place to be operating right now. We, as a stay, moved to forward with Medicaid Expansion a couple years ago, some 27000 alaskans that now have coverage that did not see that before and there was also the discussion about making sure that we are able to retain the protections for alaska natives that we saw under the Indian Health care reorganization that became as part of the aca. Recognizing that there are certain exemptions included as part of the aca, exemptions for medicaid costs here revision and 100 match for American Indians, medicaid enrollees when they receive their care through an ihs facility including the tribe or tribal operating facility. Again, we have seen some very extraordinary collaboration that has gone on between our entities with our tribes, our tribal help organization that have allowed for increase efficiency, improved Health Access and so a great deal of the discussion was focused on what will happen, what will happen to those who have gained access through Medicaid Expansion and what can we do to ensure that Coverage Options are provided for those in this new era of healthcare reform and a further question to that is should a block grant approach be considered . What efforts then, would be made to ensure that this is very unique trust responsibility for American Indians and alaska natives continue to be fulfilled . These work concerns that were raised and folks hope i would have an opportunity to ask you publicly . Thank you and we had a wonderful discussion about alaska and i learned much about your glorious estate. The medicaid system is one that is absolutely imperative and vital for members of our population who receive theirs care through the Medicaid Program and its a federal state partnership, as you well know, and one that we absolutely must ensure that individuals dont fall through the cracks in whatever transition occurs, so whether its retaining the same level of medicaid participation or whether its providing an option for Something Else that allows them coverage that suits their needs, we are committed and adamant that that coverage be able to be continued, so they had our assurance that we will work with you to make certain that happens. What about the concerns expressed by the tribal help organization that if there is a block at rancho pro grant that it could impact some of the assurances and benefits that the tribal help organization have seen . This is in its early stage, obviously, and its a legislative as decision that occurs, not a department decision, but we look forward to working with you to ensure individuals especially if they need Health Services, which has had real health real challenges and we need to make sure the metrics we are looking at are actually clinical correlated metrics and we are looking what actually makes a difference to the people receiving the care and its one of those promises that we have to make certain the Indian Healthcare Service Works and i think we can do a lot better at that. I look forward to more conversation on that. Lets me ask about some of the efforts that alaska has made i think it relatively innovative as we have attempted to stabilize our individual Healthcare Market for the state moved forward with some reforms that created a Reinsurance Program for high cost, high risk individuals. We submitted a 1332 state innovation waiver and again, all with the hope that we will be able to somehow provide for some level of stabilization. What sort of consideration and federal support for high risk schools or state based reInsurance Programs would you consider . I think the whole array of opportunities available again to make certain no one falls through the cracks. The 1332 Waiver Program is one thats just beginning, but i think a holds significant promise in making certain we are able to ensure that things like reinsurance and high risk schools make it so that individuals do not lose their opportunity to gain access to the highest quality care at. And finally on our small rural hospitals, one of the concerns i heard repeatedly was the level of regulatory burdens that particularly our smaller rural hospitals are feeling stifled by. Some of the innovative things that one of our hospitals have done is looking at advancing. And they kind of feel that its too risky right now to move forward with any level of innovation that they had hoped to take on because they are facing some of the regulatory burden, but also the uncertainty they are in right now. You can do things, administratively early on should you be confirmed to this position. Have you looked to what regulatory issues could be addressed early on that could help reduce some of the regulatory burdens particularly to some of these small rural hospitals . Not specifically, senator, but i share with you that concern you have about the burden of regulatory guidelines and regulatory schemes that come out of washington dc especially for the rural areas and its not just the hospitals. Is the doctors that are provided care. Most of the folks in the rural areas tended not to have any margin at all to cover the cost of this regulation and i have heard from more than a few physicians and other providers who because of the regulatory schemes that have come forward have said they just cannot do it anymore. They have had to close their doors and Indian Health services is one of them where they are having real challenges in terms of being able to provide services, so when that happens those individuals have no care and thats unacceptable to me. I look forward to working with you. Thank you, senator. I have remaining senator warren, has an end came on the democratic side. Senator isakson has three minutes remaining. Senator warren. Thank you, mr. Chairman. Congressman price, more than a hundred million americans receive their health care through medicare and Medicaid Programs. Of these are seniors, people with disabilities, middleclass families, countless numbers of Young Children and that they all benefit from these programs, so i went to understand the changes to medicare and medicaid that you have already proposed. The budget you recently authored and as the chair of the Health Budget committee would have cut spending on medicare by 449 billion over the next decade. Is that right . I dont have the numbers in front of me i do. Than i assume you are correct. You said you would cut medicare by 449 billion dollars. Your fy 17 Budget Proposal also would have cut medicaid funding that goes to the State Government by more than 1 trillion. Is set correct . I think, senator, the metrics we use for the success of these programs did you propose the cuts of a trillion dollars for medicaid . What we believe is a part do you want me to read you the number . Im sure you are correct. We want to make sure individuals receiving the care are actually i understand why youd think you are right. Im just asking you the question did you propose the cuts of a trillion dollars of medicaid of the next 10 years . You have the numbers before you. Is that a guess . You have the numbers before you. I will take that as a yes and im sure you are aware as campaign for president , president elect trump was clear about medicare and medicaid as senators sanders has quoted extensively present electrons that are not going to cut medicare or medicaid. When president elect trump said im not going to cut Medicare Medicaid do you believe he was telling the truth . I believe so, yes. Okay. Given your record of proposing massive cuts to these programs along with several other members of this committee i sent a press to elect a letter in december asking him to clarify his position and he is not responded yet, so i was hoping you could clear this up. Can you guarantee to this committee that you will safeguard president elect trumps promise and while you are hhs secretary you will not usually administered of authority to carry out a single dollar of cuts to medicare or Medicaid Eligibility or benefits . What the question presumes is that money is the metric. In my belief i am. If patients are receiving care even though we are providing the resources that it doesnt work im sorry to interrupt, but we are limited on time. A quote from the president elect of the United States, he said he would not cut dollars from this program. That is the question im asking you. Can you assure this committee that you will not cut 1 dollar of either medicare or medicaid should you be confirmed to this position . I believe the metric ought to be the care i take that as a no . Its that its the wrong metric. We ought to put forth resort im not asking you if you think you have a better metric. Im asking you a question about dollars. Yes or no. I think im asking you a civil question in the millions of medicare that rely medicare and medicaid today are not going to be very reassured by your notion that you have some metric other than the dollars that they need to provide these services. You know, you might want to print out presstek electrons statement i am not going to cut medicare or medicaid and post about above your desk in your new office because americans will be watching to see if you follow through on that promise. Now, i would also like to followup on senator frankens question. I think there was something there that did not quite get answered and as you know congressman, the one goal of the 040 care act was to push the Healthcare Industry to provide Higher Quality care at lower costs and under the aca medicare was recently allowed to change the way that it pays hospitals for hip and Knee Replacement, just something called a bundle and that means medicare pays a set price for the care associated with hip and Knee Replacement and then the hospital, not congress, will decide the most effective implants, reduce second surgeries, letter to fight infections, how to spend their money to deliver Better Service at higher cost. Now, i supported this change because the researcher shows they really need to get better care at lower prices, but i know the policy is controversy all because it affects how hospitals are paid, which in turn affects how much money that manufacturers of the hip and Knee Replacements can make in one of the companies is a company that is in my biomed, one of the worlds most leading manufacturers of hip and knees and may make more money if they could charge higher prices. The Company Knows this and so does stock analysts, so on march 17, 2016, you purchased stock in this company. Exactly six days after you bought the stock on march 23, 2016, you introduced a bill in the house called the hip act that would require hhs secretary to suspend regulations affecting the payment for hip and Knee Replacement. Is that correct . I think the bbc i program think you referred to i am a strong supporter of im not asking you about what you support. Im just asking if he bought the stock and digit introduce a bill that would be helpful to the company you just bought stock in . The stock was bought by a broker who is making those decisions. I was not making those decisions he said you were not making those decisions. Let me make sure i understand. These are your stocks listed under your name; right . Yes. Was the stock purchaser and indexed fund . I dont believe so . Path to manage mutual fund. No, eight blind trust . Lets be clear, this is not just a stockbroker. Did you reprimand her . What i did was comply did you sell the stock . What he did was comply with the rules of the house and an ethical and legal manner and in a transparent way. Time is expired, senator warren spirit i believe senator murkowski went over by two minutes. Did i misread the clock . By two minutes . I think thats what was and i just burned another 15 seconds stupid keep burning them and youll be up to two minutes. Your periodic transaction report notes that you are notified of this trade on april 4, 2016. Did you, you take additional actions after that date to advance your plan to help the company that you now own stock in . I am offended by the insinuation. Let me read what you did. You may be offended but heres what you did. Congressional record show that after you were personally notified of this trade would you said you did know about in advance, that you added 23 out of your bills 24 cosponsors that also after you are notified of this Stock Transaction you sent a letter to seem as calling on them to cease all current and future play mandatory initiatives and for the center for medicare and Medicaid Innovation and just so theres no misunderstanding about how you were trying to help you specifically mentioned your two minutes are up. Thank you. Senator warren, who is next . Senator isakson has three minutes. I want to reclaim my remaining three minutes. I respect everybody commits a bit respect the nominee but its very important under the Disclosure Rules we have the way it operates any of us could make the mistakes that are being alleged the uninsured senator franken had no idea if he owned part of Philip Morris when he made the statement he made about Tobacco Companies but he has the wisdom tree Equity Income Fund Investment as disclosed in his disclosure which owns Philip Morris. Its entirely possible for any of us to have someone to make an investment on our behalf and as not know where that money is invested because the very weight works. I dont say that in any way to embarrass mr. Franken but to make a point. Anyone of us have mutual funds or investment managers, its entirely possible for us not to know and to try and employ somebody is being obfuscating something or an otherwise denying something that is a fact its just that the fair thing to do. Its a different then mutual funds. At an investment in Philip Morrisspin my question was about senator warren, your time has been generously senator mccain. Im sorry, senator hassan. Unhappy to lead but i think senator cassidy was next and he just came back in. He did but i was going back and forth. Ill be glad to do thank you. August in price, thank you for bringing this money. Mr. Chairman, Ranking Member murray thank you for the opportunity to participate. As you and i discussed, congressman, we share a concern for patients. My husband and i have two kids, and our adult son at time to set up to 10 doctors and a couple of dozen medications. So we know the strengths and weaknesses of our Healthcare System very, very well. As governor i was pleased to work with members of both parties to build on the example that senator young talked about in indian to have a bipartisan New Hampshire specific Medicaid Expansion plan thats providing coverage now to over 50,000 hardworking granite staters. Ive seen the advantage of the Affordable Care act and the flexibility to the Affordable Care act gives states right up close and worked with Republican Legislature to pass it. So its that context i bring to this series of questions. First of all, as we talked about, opioid Overdose Deaths have been on the rise for several years and has hit New Hampshire particularly hard. We have about the secondhighest rate of drug Overdose Deaths in the country. Under the Medicaid Expansion program that i just talked about made possible only by the Affordable Care act, thousands of New Hampshire citizens are getting the opportunity to get treatment for Substance Abuse disorder. I talked with one of them last week, a woman named ashley who had an addiction for almost a decade. Medicaid expansion gets passed under the Affordable Care act. She got treatment and she is now in recovery. And after a year on medicaid which by the way we have done in a particular way so that its actually strengthened our Insurance Market in New Hampshire, so more rangers came in as a result of the way we did that. Anyway, she is now working and she just switched over to private insurance because shes got employerprovided insurance. You have proposed repealing Medicaid Expansion in the budget that you propose, so yes or no, can you guarantee that you will make sure that the americans with Substance Abuse disorders who have gotten insurance through Medicaid Expansion just like ashley did not lose their Health Insurance . I think during attachment i enjoyed our conversation as well. Well. I think its imperative that we as a nation make certain that every single individual have access to become a Mental Health and the kind of Substance Abuse challenges that they have. So is that a guarantee that you will find funds to actually provide the treatment . Its a guarantee im committed to making certain that we address that need which is so vital and important. Im just concerned youre not going to be able to back up that guarantee of the Affordable Care act is repealed. Im concerned about the impact that will have on states and people like ashley who need the coverage. I also just want to talk about whether you agree that people with Health Insurance should have some very basic essential coverage is like checkups at the doctors office. Do you think Health Insurance coverage should provide for the . I think as we mention with choices for patients to be able to select the coverage that they want instead of somebody else decide for them. Its important we remember the center of all of these discussions is a patient and the patient knows best what he or she needs. Thats the imperative i would commit to you, make sure patients other choices available. If they choose to select the kind of coverage then they ought to be but if Insurance Companies to offer it at all, and essential benefit under the Affordable Care act, it requires private insurers to cover Substance Abuse and misuse treatment. They didnt used to do that. They also had stopped covering a lot of things until the law requires them to. So yes or no, the empowering patients first act would repeal the requirements that Insurance Companies cover Substance Abuse disorders. Do you think thats still a good thing . I think whats a good thing is to keep the patient at the center of all of this and make certain we are providing the options and choices for patients so they can address their clinical and medical needs. If Insurance Companies never offer it they dont have the option. They can pay good premium dollars but its just not offered and the Affordable Care act said to the Insurance Industry are some basic things youve got to offer, so that when a patient needs care the coverage isnt there. They can can get the care. Your answer and the empowering patient act would take that assurance away. Its not an option if insurance doesnt cover it. The good news for you is that as an administrator if im privileged to serve in the capacity that i follow the policies that are adopted by the congress of the United States and signed by the president. So we look forward to working with you to make certain that those kinds of things are covered and this patients receive the care that they need. And with respect, theres been lots of opportunity to make certain that those things happen and it till the Affordable Act was passed it never happened. People didnt get the care they needed. And because of that a lot of people like the ashley of the world were not getting better, when i getting treatment. Providers dont exist, dont pretreat people if they cant forget how they will get reimbursed. The most important thing that our Treatment Community said in New Hampshire was Medicaid Expansion of the Affordable Care act made it possible for them to stand up higher volume of treatment. So i look forward to working with you but im concerned about your unwillingness to commit to making sure that Insurance Companies cover these essential benefits. I am almost out of time and we havent even touched on the issue of womens health, which is obviously of great concern. Let me just ask a couple of questions. Yes or no, do you think an employer should be able to fire a woman because she use of Birth Control . I dont believe so. Well, you voted in support of the resolution to disapprove the District Of Columbia as nondiscrimination law. The Reproductive Health nondiscrimination act which protects women in d. C. From being fired or penalized because of the Reproductive Health decisions. So your but what about the effect of allowing employers to fire a woman for using Birth Control or for other decisions she makes about her own body and Reproductive Health. So how is that while consistent with the answer you just gave me . Again i think the question was about who is paying for that product. The question is whether an employer, who lets say and a selfinsured employer provided Insurance Plan finds out that a female employee who earned the benefit with her work is using the benefit to provide Birth Control, to buy Birth Control, which the benefit provides, and then pfizer because the employer disapproves of the use of Birth Control. I dont think thats the case. You dont think would you like us to provide examples for . I would be happy to. So you would be willing to say that employers may not, you would support a law, a rule, that employers may not discriminate against women for the Reproductive Health decisions . I dont think that employers ought, that employers have the opportunity right now to be able to let somebody go based upon their Health Status or the medications they use. Why did you vote against the provision . I dont think thats what it did. You dont think thats what your vote was . I dont think thats what the boat did. We will followup and again i wish id more time because of about eight more questions. I will submit them in writing. Thank you. Senator cassidy. Thank you, mr. Chair. You all seem warm worn out but i been gallivanting with High School Students im pretty energized. When john king came for an interview i wanted to ask a second round and you wouldnt let me. I confirmed with the steps i been wanting to say that for two days now. I was going to, i had another set of questions and you said shut up. Anyway, its nothing personal. Nothing personal. I would get the in regard now a grandfather taking his grandson on health calls . You know what im saying . I love what youre saying about the patient physician relationship. You and i both work in hospitals for the uninsured. I as a gastroenterologist liver doctor and weve been talking a lot about obamacare and wonderful things its done. But a given thing in my patient at the uninsured with a 6000 deductible. Thats right. 400 in their account and have a 6k deductible before they can be otherwise cared for. And just for the record people completely. I put on my Facebook Page. A friend of mine from home, his renewal for his individual policy for he and his wife, 60, 61 years old, no kids, no health stuff was 39,000 for a year. 6000 deductible. I put on my Facebook Page and no one believed, dislike what a family pays for mortgage and then some, and that was their yearly premium. I applaud you for looking for some alternative that is affordable. Maybe working for New Hampshire, california, massachusetts. God bless you but for states like mine and yours in arizona people cannot afford 39,000 premiums. Does the empower them patient act repeal the Mental Health parity laws . I dont believe so. I dont think so either but just, Mental Health parity would still apply and that does cover Substance Abuse. So there is those provisions, got lost and remains in effect. Secondly we been talking about does it have to be a covered benefit. Youre a big lead and Health Savings accounts. I can Health Savings account be used to pay for doctors visits . Absolutely. Essential medical services and even colonoscopies if necessary spirit absolutely. Gastroenterologist, that comes to mind. When you speak about giving the Patient Power over her healthcare to allow her to choose, when we choose for her we have a 39,000 premium. But when we allow her to choose just something which is affordable and she becomes a activated and informed consumer at the slot of academic literature to look at that. Spirit absolutely spirit we dont agree with each other entirely but substantially and i applaud you for that. Franken always calls me a luddite. Different issue. Im skeptical about come he calls me many things but a luddite among them because im skeptical about Electronic Health records and the negative impact on productivity. He thinks im just some guy that calls most people i see that they laid off 5 of their step. Theyre theyre blaming it up on financial losses related to decreased productivity, again directly attributable to the implementation of the rule. Your department is going to be involved with meaningful use and such like that. I often find an Orthopedic Surgeon asking someone about their smoking history is not a good use of the surgeons time. Not that it isnt important but nonetheless hes not the person who implements the cessation program. It shall be the interest. What thoughts do you have, what can we do about this time and productivity song that its become the Electronic Medical record and meaningful use, keeping that which is positive but hopefully doing Something Better for the patient and for the position . They Electronic Medical record and Electronic Health records are so important because from innovative standpoint allow the patient the opportunity to have their Health History with them at all times and be able to allow whatever physician or other provider access to that. We at the federal government have a role in that but that ought to be interoperability to make certain that different systems and talk to each other so that it goes to the benefit of the patient. Ive had more than one physician tell me the final regulations and rules related to meaningful use or the final straw for them. And they quit. They have got no more gray hair then you or i have. And when that happens we lose incredible intellectual capital in our society that can care for people. What we do about that . What practical things . The thing thats imperative is to find out what things ought to be determined and check, and the metrics that are used, that they correlate with the quality of care thats being provided as opposed to so many things that are required right now at the position or the provider that makes it so theyre wasting their time documenting these things so it fits into some matrix somewhere. But it does result in a Higher Quality of care or outcomes for that patient. If we truly worked with those providing the care to say what is it that we could ask you to measure that would really correlate with the outcome and the quality of care being provided, i suspect their specific things we could use. You are emphasizing the patient physician relationship. My wife is a retired Breast Cancer surgeon and shes to say really she counseled the husband as much as the white because it hasnt be the one those crying. She would be the one telling them looking them in the eye, theres hope. This is not a death sentence. There is hope. I only imagine if you are now in practice typing up there is hope. Its a little bit of a different feel for the patient and her spouse spirit we have turned many into data entry clerks and it detracts as you set from the productivity but it detracts greatly from their ability to provide quality care. One of our big challenge is how do we come up with expensive medicines that are only used by very few . How to socialize and that cost . Think of antibiotics. We just had some germ out theire bacteria that is resistant to everything. We can come up with gene therapy for very few, expensive to develop. I just want your thoughts. I could give you about those and so do you. How do we care for them . Talked only with senator hatch during his time about Rare Diseases and about the orphan drug act that revolutionize the ability or the incentives for bringing to market drugs that address Rare Diseases. Its important in subdivision, afghanistan but is important. In sensitization is individually covers able to come up with things that your diseases that they are properly compensated for. In the era of personalized medicine where it might be one of a thousand, very small picture could be a million, anything specific about that . We are entering a brave new world that is so exciting from a scientific standpoint to be able to provide this kind of personalized Healthcare Services to folks that will be able to cure things that we have never dreamed about curing. And the challenges how we afford to make that available to our society are real, and i think we need to get get the best minds together to figure how to make that happen. I look forward to working with you to do so. I have your perspective that my colleagues cannot because i know Orthopedic Surgeons are the ones who are called at three am when his car wreck and someone is so blessed up theres no one else to fix them. If they dont fix it and they die. So they kissed the wife goodbye, climb out of bed, trying to the hospital. They are up all night and then they see the clinic is scheduled for next date, make rounds in eating, hit him at midnight and kissed the wife good night before the go to bed. You are the exact kind person to have this job. Thank you, and i yield back. Thank you, senator. Thank you, senator cassidy. Senator kaine. Thank you to the leadership and thank you, congressman price for our visit the other day in office. An observation and if you questions. Forgive me, i was at another thought might be a little repetitive so i will try to move quickly. My worry as a virginian is your position but whole range of programs that are basically about access and coverage, sort of a safety net that provides coverage to millions of people. You propose turning medicaid into a block grant program. Thats exciting a lot of controversy in virginia and a legislature with democrats and republicans and youve repeatedly voted against the chip program for kids, at one point calling it socialized medicine. Thats the combined medicaid and chip about 800,000 virginians. You propose to restructure medicaramedicare that cbo foundd increase outofpocket cost for seniors, about 1. 3 million virginians. Usable repeal of the Affordable Care act. Theres a lot happening virginians on the exchanges and hundreds of thousands of others that otherwise benefited. You want to defund planned parenthood, tens of thousands of virginians use plan. As her primary health care provider. These are the basic programs that provide health Care Coverage for millions of virginians, theres some overlap but it would be millions, and tens of millions of americans. Many of them have very limited means. There is a consistency to your position in some ways across all these programs that i do is critical to the Health Safety net. I know that senator franken and murray use of the hippocratic maxim, first do no harm in common before acting. And i would hope you would agree that as we approach the discussion of Healthcare System access coverage, cost, quality, the president and congress should strive to do no harm, would you agree with them . Absolutely speak we shouldnt our people by reducing the number who have Health Coverage or reducing the quality of the Insurance Coverage they do have. Thats what we should strive for, right . I think its important to appreciate ther that are challes in these programs currently. One out of every three physicians who want to be able to see medicaid patients across this country doesnt see medicaid patients. If were honest and severe about addressing this problem we ought to step back and say why, what are we doing wrong . One out of every eight positions is eligible to see seniors no longer sees medicare patients. If you are a new medical patient trying to find a position, a new physician that sees medicare patients, its almost impossible anywhere. I am are with you on fixing challenges and Going Forward, more coverage, more affordable speed if thats what my proposals have tried to do. We shouldnt harm people by doing things that would increase the cost, correct . I think we need to dry down the cost for everybody. We shouldnt harm people by creating an exciting about the most important thing in their lives, healthcare and healthcare of the family. We shouldnt be doing that in congress . One of my goals in this debate, i appreciate to bring this up, is to lower the temperature about what were talking about. This is real stuff for folks. These are the lives. Can we lower the temperature in russia at the same time . I think we can move a pace but lower the temperature and provide stability to folks out there. People need i will join in the civility of lower temperature. I dont think lowering the temperature is consistent with rushing. In fact my each spring singling her is huge amounts of fear. We shouldnt harm the american economy. Healthcare is the biggest sector of the american economy, by injecting uncertainty. We should again try to fix a problem that youve written about are those that ive identified and do them in a way that provide stability answer to the shouldnt that . Its incredibly important im reminded of the fact that the Congressional Budget Office has told us the aca has decreased the workforce by the equivalent of 2 million. There are challenge we have throughout and i hope will be able to do is Work Together to solve those challenges. Do you agree with president elect at the replacement for the Affordable Care act must ensure theres insurance for everybody . I have stated here and always that its incredibly important that we have a system that allows for every single american exited, cabbage that they need and desire. He stated in the same interview that we should negotiate with pharmaceutical companies, under Medicare Part d to try to bring death Prescription Drug costs. The support that position . I think the cost of drugs is in many instances a real challenge for folks and we need to do all the began to exert would bring the cost down. Heres an offbeat question thats just a coincidence based on today. I was a with nikki haley, Governor Haley who was nominated to be u. N. Ambassador right before i came in. She played really significant role in moving or state away from use of the confederate battle flag in any official capacity. When you remember the georgia sledges that you were a member of the Georgia Legislature you fought hard to keep the confederate battle flag and you sponsored resolutions to make april confederate history heritage month in georgia end quote urging schools to commemorate that type of southern independence. Id like to introduce that resolution for the record, mr. Chair. Ive read the resolution with interest because the phrase commemorating the time of southern independence and a folded up and end of the resolution that commemorated the time of southern independence mentions nothing about slavery. Why did you support the resolution and do you still support it today . I havent thought about that in a long time but im happy to look at that and go back and refresh my memory about that time. The revolution aside, whats laudatory about the type of southern independence . I think every heritage has things that are good about it. Every heritage has things that are harmful about it, and some happy to answer a specific question and i think slavery was an abomination. Do you think history resolution about confederate, History Month the completely, any reference to slavery kind of meets the basic standards of fair, balanced . I dont know that it presumed to be comprehensive. The work i did at the first Republican Senate majority leader in the history of the state of georgia was a mix of we can forward with a flag that did not have the confederate battle flag on it, that address all of the concerns of the state and was adopted and supported by the state. We did so in a bipartisan way and i was privileged to work with now Atlanta Mayor kasim reed when he was in the Georgia Senate at the time to make certain that we were able to do so. You are aware the office of Minority Health at hhs that was great in the Affordable Care act, reauthorizing, and the aca is repealed unless it is separately reauthorize, at office would also expire . Again, thats a legislative question. If im privileged to serve and be confirmed and be secretary of health and Human Services i look forward to making certain that reuse of the Resources Available to us and agencies available to us within the department to make certain every single american has the highest quality healthcare available spin why does you use the phrase socialized medicine to explain your vote against the chip program . I dont know that i recall that conversation or that quote but im happy to go back and look at it. Thank you. Taking mr. Chair. Thank you, senator kaine. Senator scott. Thank you, mr. Chairman dr. Price, good to see here today. Likewise spirit hoping for most success for you. Did i hear you were at spin i did my residency there. My nephew just is in his first year of medical school at emory. I hope that he gets a quality education. He will and hes got an exciting road ahead. Excellent. I did have the privilege of serving with you in the house and enjoy a relationship, friendship, and look forward to seeing your success at the secretary of hhs. I have a couple of questions that are state specific to South Carolina. We had over 20 health ctr. And filling with about 165 Service Sites serving over 350,000 patients and almost every county in the state. Every county South Carolina is either partially or completely designated as medically underserved. As rural hospitals continued close, these centers have addressed the need for many communities in my state. They Work Together with partners in the community to address impacts on health like food deserts and lack of transportation to preventive Health Services which can save costs in the long run. I diabetic who does not take care, take their medication because they cannot afford it, or has no way of picking up what will inevitably be a long run to the emergency room. What role do you think Community Health centers can play tickle in rural and medically underserved areas . Thank you, senator. She moved to Health Centers are a vital part of her Healthcare Delivery system right now. They fill a void in so many areas as you mention across your state and across mine and literally across the country. There are over 13,000 that are the entry point and often times the area of healthcare for some individuals and when you do all that we can to strengthen them to make certain that providers that are within Community Health centers are the highest quality, that theyre providing the highest quality of care and are able to access resources, intellectual resources and Clinical Resources that allow them to provide that care. Less than a decade ago in South Carolina Emergency Rooms were full of people waiting for psychiatric exams so they could either be admitted or discharged. Discharged. After implementation of a statewide telepsychiatry network, wait times have been cut from four days down to about 10 hours. The cost have been cut by almost twothirds. What do you see as the future of telemedicine, particularly to address access issues . What barriers can we dissipate as well . Telemedicine is one of those exciting innovations that will ideally allow for individuals, especially in rural and underserved areas, access to the intellectual capital and resources. From a clinical standpoint to make decision on patients data before them without being able to save resources and say patients in so many ways. We in georgia had a Stroke Program thats kind of a spoken with program where the Medical College of georgia, theres a neurologist that works with telemedicine and has a network of clinics and hospitals around the state were so he comes in with symptoms of a stroke. Deposition is able to literally see that patient in realtime and determine one whether not need medication with not having store, where they can be treated in the community of whether they have to be transferred to the academic center. In the past it was a call on the ground, no ability to talk to someone who might have greater resources or knowledge and all of this patients try to get to the academic center. Huge waste of money and not having patients at the center of that decision. So telemedicine is vital that i think we need to accentuate the ability, used telemedicine or as you well know oftentimes telemedicine, telehealth is not paid for. Its not compensated. People eat, the clinicians eat those cost. They assume those costs that help the patient, yes, but make it so its much more difficult for them to provide the quality care necessary. Thank you. Another interesting topic that you should be fairly summary with, minority perspective, South Carolina like a georgia has High Percentage of africanamericans. You probably know, Breast Cancer deaths are approximate one 1 2 times higher in africanamerican women, prostate Prostate Cancer deaths are approximate two and half times higher in africanamerican men. I would love to your perspective on addressing Health Disparity in two minutes of color. This is important very and appreciate you bring it up because i think so often what e do in this and other areas is is okay, to set up this systole or this agency here and were taken care of the problem. What i dont think we do is look at whats happening on the ground, the metrics as well as we could or should. We ought to be defining specific whether o not we are improving e lives and health for individuals in challenged communities. If we are not that we need to step back honestly and sincerely and say what can we do to make certain it works. I learned a couple months ago i had the privilege of being at a clinic in atlanta and a learn theirs is a goat and a land within this metropolitan area of atlanta that has incredible disparities in terms of their health outcome. Higher mortality, high rates of diabetes, high rates of stroke and myocardial infarction. They are surrounded by incredible healthcare faciliti facilities. When we see those kinds of things we need to drill down into this and since it whats going on . Why is that happening . And address the real gems on the grant as opposed to saying okay, weve taken care of it because now we have an agency that is addressed to take care of that. We need to do better metrics and better accountability for whats going on spin im sure you have talked at some length about Rare Diseases. We have a spirit sickle cell being one of the more important ones in the africanamerican population. I would love to submit question for the record to get your insight and your perspective on how to tackle some of those diseases moving forward speed and look forward to that. Senator murray. Thank you, mr. Chairman. Congressman price, i did want to clarify your response to one of my previous questions. You admitted to me in our meeting that you and your own words talked with congressman collins about innate immuno. This inspired you come in your own words, steady the company and purchase its stock. And he did so without a broker, yes or no . No. Without a broker. I did not. You told me that you did this one on your own without the broker, yes . No, i did it through a broker. I directed the broker to purchase the stock but but i dt through a broker spin particularly that stock . Thats correct. Mr. Chairman, those answers really commit me to underscore the need for a full independent investigation and i would like to ask consent to enter into the record an article from Kaiser Health news that notes congas been price was offered a lower stock price for sophisticated investors that i think thats an important part of the record. It will be included. If you are confirmed as secretary, youll be in charge of our nations Family Planning programs and policies. You have said that you dont think cost is an issue for women in buying Birth Control and stated and i quote, bring me one woman whos been left behind. Bring me one. There is not one. You did say that, correct . I think what i said and what i meant was that when i had patients in my office who were unable to afford medication, we did everything we could to make certain that they got that medication. What i meant to capture in that conversation was that if there are individual or unable to afford that medication or any medication, that there are avenues within Healthcare System that physicians and others take to make certain that individuals receive the medication that they need. Let me tell you about my constituent shannon. Shannon has in dimitri osos, a Common Health impacting women and she says and i quote no copay Birth Control is an essential tool of helping women like me with endometriosis who otherwise would have to live with chronic pain. So no k Birth Control, its extremely important that she is just one. Women are really deeply concerned about the impact this election could have on their access to health care that they need. Ive heard from many of them. According to planned parenthood demand for iuds which is a form of longlasting contraception, is up 900 since the election. I want to ask you where you commit to ensuring all 18 fda approved methods of contraception continue to be covered so that women do not have to go back to paying extra costs for Birth Control . What i will commit to and it sure is that women and all americans need to know that we believe strongly that every single american ought to have access to the kind of coverage and care that they desire and want. Thats our commitment and that runs across the board. Let me be clear. Birth control is an essential part of womens healthcare and if you are confirmed, i will be holding you accountable for that. I also learned to ask you, id give the concerned about the impact of your policies, would have on women obviously, and in particular, women who often face barriers to access and health care they need. According to hhs data, since the aca became law, the percentage of black women who report not having a regular doctor dropped by nearly 30 . While that measure for latinas fell by almost 25 . Your healthcare repeal bill and your Budget Proposal to cut a trillion dollars from medicaid would disproportionately hurt women of color, for the company disparities and access to healthcare and undoing progress that was made in the Affordable Healthcare act. Are you committed to ensure that women of color maintain access to quality, affordable medicare . I appreciate, i dont agree with the premise. The program i support and i believe the president supports to make certain every individual has access to the kind of coverage that they want. Nobody wants individuals to not have the opportunity to see the doctors that one, to get the care they want at a price that is affordable and that is of the highest quality. Thats what we believe in that help we will be able to Work Together to achieve that goal. The office of Minority Health was reauthorized as part of the aca. So wil what you commit to maintaining and supporting this office and its work . I will commit to be certain that minorities in this country are treated in a way that makes certain, absolute certainty that access to the highest quality so you not commit to it being maintained . I think its important that we think about the patient at the center of all this. Our commitment, my commitment to you is to make certain that minority patients and of all patients in the center axis to so you will commit to the office of minority . Look, there are different ways to handle things. I cant commit to you to do something in the department that one, im not him. I havent gotten in. You will be. Let me put forward a possible position i might find myself in. The individuals within the Department Come to me and they say weve got a great idea for being able, greater efficiencies within the department itself and it results in merging this agency in that agency and well call it Something Else and we will address the issues of minority i have less than a minute less and i do pick you are not committed. One final question. You are aware that, are you aware that black, latino, american indian, alaska native almost twice as likely as white people to be covered under medicaid . Do you think its responsible to propose cutting trillions of dollars of funding without a credible alternative to replace it for those . I disagree with the premise. The solution that we have, and sure every single american regardless of their Health Status, regardless of economic status have the ability, financial feasibility purchase of the kind of coverage that they want. I have a few seconds left. We have members here who also have additional questions. I am deeply troubled by a number of responses. We have a lot of families who are very, very, very concerned since this election will happen to them personally. We have outlined some of those and i hope that congressman price will have a significant number of questions, from my colleagues, that joyfully submit them for the record. Thank you. Thank you, senator murray. Dr. Price, i want to thank you for being here. I only have a few comments. I dont have additional questions. I was reflecting back on Sylvia Burwell smith appeared before this committee at how impressed i was with her appearance. I think you have done as well. Ive also been impressed with her performance in the job, because while i disagree with a number of the policies shes taken, shes gone out of her way to adopt the same tone that ive heard from you today, which is to try to accept and work with people with different points of view and see if we can come to a consensus. So i thank you for that and i am impressed, again, i appreciate your being here today. Based upon the figures i have, you just endure the most extensive questioning of any secretary of health and Human Services since 1993. Because of the round of questioning. Secretary burwell was in the hearing for two hours and 10 minutes civilians for josh 20 20 minutes, daschle for two hours 10 minutes. I dont have it for two others did you been here nearly four. Next is a you go before the finance committee which will vote on whether you go forward to the president. Im very hopeful that your tone will help us come to a conclusion and a consensus in this very important area of providing concrete alternatives to get americans access to healthcare they can afford. I was reflecting last night on the hearing, and today. They had been pretty tested it with often have strong opinions you because with differences of opinions but i think thats a reflection of come one, election over the past year which came very uncivil. More so that i liked. And republicans can take our share of the blame for that. Also this issue which for six years weve been going at it like the hatfields and the course in West Virginia until almost with a god who killed two in the first place and we dont know, you know, not absolutely what we are fighting about. So it would take a bedside manner such as you have two lower the temperature is 30 mccain suggested it will democrats, he was among 12 democrats of her last suggesting youre willing to work with republicans as a go forward. I think it will take a little while to lower the temperature just because we spent six years as the hatfields and mccoys that im committed to try. Thats the way we used to work on very contentious issues. Id like to get away from the testing is of last night and today and back toward the way weve learned to work. A couple of other things. I hope those watching i i reassured by what they heard from you. What i heard from you, i believe i am correct about this, is that while we intend to repair the damage of obamacare and that would eventually mean repealing parts of it, major parts of it, that that will become effective will not become effective until their practical concrete alternatives in place to get americans access to healthcare. Nor do you say we dont want to pull the rug out from underneath anybody. Im sure that they shared view. You talk some about the importance of march the first. One thing we have to Work Together on is whether we do about individual market. And the fact counties, there is just one insurer for people with obamacare subsidies and we dont want to get into a situation later this year or in 2018 where there is, as i said, its like bus ticket in town with no buses. We may have to do some things on both sides of the aisle that we wouldnt normally do during this transition. To make sure that insurers are willing to sell into the markets so these 119 people can continue to buy insurance hopefully more than one person. I think its become clear that the timing with talk about is yet to be resolved really. Sequencing is as important almost as the policy. How do we get from where we are to where we eventually hope to go . We go to work immediately on what i call a collapsing bridge, repair it. Thats the individual market, make sure that people are not hurt by it and then Work Together to build a new bridges and then close the old bridge only when we have new bridges up. I think we can make most of the decisions about the quote replacement or replacements or the new systems, new bridges in a relatively short period of time. Weve been working on this for years. We have our opinions. We ought to be able to sit in the room and come to conclusion. In my opinion it will take several years to actually implement those decisions because in many cases we will be transferring responsibility to states and consumers. We want to do that after talking with governors and insurance commissioners, do it on a schedule that states can accept your their legislatures sometimes only meet every two years. So making decisions probably, making them together if we possibly can, and then implementing it stepbystep and carefully so that people are able to have access to lowcost insurance is what i hope i heard today. One other thing, senator cassidy, senator whitehouse, several members of this committee, maybe all of us, worked very hard. I know senator murray did as well, on trying to do with Electronic Healthcare records and meaningful use. At the vanderbilt which was an early adopter of the Electronic Healthcare records, they said stage one was very helpful. Stage ii they could do with. Stage three was terrifying. And i had hoped that we could delay stage three. And i thought that maybe could be as simple as saying to the physician and providers of the world, look at, if youre a doctor in your spending 50 of the time filling out forms, then either you are doing something wrong or we are doing something wrong and lets Work Together for the next couple of years to see if we can get that down to a manageable level to create an environment where physicians and providers can spend their time talking instead of typing. Youve got a bipartisan consensus here to work on that, at least we had last year when the past six years bill which a number of provisions in it. We get six hearings on the subject and i invite you to work with us, if you are confirmed, to complete that. Senators wish to ask additional questions of our nominee. Questions for the record are due by the close of business on friday january 20. All of the medicament bearing record remained open for 10 days. Numbers may submit Additional Information for the record within that type in the next meeting will be an executive session on january 24 at 10 a. M. Which is already been noticed. Thank you for being here today. The committee will stand adjourned. Thank you, mr. Chairman. [inaudible conversations] [inaudible conversations] [inaudible conversations] insurance covers are saying by march 1 they need to have some indication of what were going to do to stabilize the market. So i think thats a rescue plan for the Obamacare Exchanges which are collapsing, is clearly the first order of business. Then i think we went to see what the present invite suggests, work with the house of representatives and begin to see what new alternatives we can come up with. The governors will all be here march 1922. 1922. It will be a logical time for dr. Price if he is confirmed to talk to them about more medicaid flexibility. The Employer Market is a separate matter. A lot of that doesnt need to be changed very much. Small group market probably does. There are steps we can probably begin to take right away on that. Put medicare aside and focus on those three areas i find a lot of steps we can take to get a process that will go on for essentially several years. [inaudible] yes, these would be separate pieces of legislation. Some might be in the first reconciliation bill. Theres another reconciliation bill that is expected before summer. It would be good if we could have a rescue plan for the individual market that could get 60 votes in the senate and could be passed the way things that thinshrink it would be a step bk from the hatfields and the toys we had been in for six years. Have you talked to any Health Analysts at cmis can anybody who has the date and is looking at it and is saying the state insurance commissioner of tennessee says it in a virtual collapse. In our state premiums are up 4060 this year. Blue cross pulled out of our three biggest metropolitan markets. In twothirds of her counties those of obamacare subsidies only have one Insurance Company from which to buy. Across the country thats true