Meeting will come to order. This senator whitehouse. Let me ask first to put into the record a letter from our governor in rhode island which said in rhode island, we have seen exchange premiums decrease in two of the last three years. This has saved consumers 220 million since 2012. The story on the Affordable Care act is a good one. I would like to put this graphic into the record. To explain it briefly, the cbo estimate of where our healthcare costs are going to go in 2010 and then at this time, 2016 after the aca was in place they took a look at the Actual Experience and did new projections Going Forward based on the Affordable Care act, just in the following ten years, from 2016 to 2026, they are forecasting 2. 4 9 trillion in federal healthcare savings that relate back to the Affordable Care act. This is where that came in. We throw this thing out at our peril if you care about saving medicare, the savings to which are a significant part of this 2 . 9 trillion. With nothing to replace i described that over the weekend as jumping out of an airplane with no parachute but people trust you, we will build the parachute before you hit the ground. I am junior senator jack reed, an army ranger, actually did jump out perfectly well operating aircraft, he insisted on not just one parachute but two. I think the American People are entitled to know what they are going to be offered as an alternative. There has been conversation in this hearing about how republican ideas are floating around, i am sure there are republican ideas floating around but there is no republican bill, there is no republican plan, there is no republican proposal, our cards are on the table. It is obamacare. If you want to improve it make suggestions, we have always been open to that but on the other side of the table there is nothing and it is really hard to negotiate with nothing. I think the republicans have a responsibility to put a plan together. We talked about that when we met in my office. You told me you would want to keep letting people stay on their parents policies until they are 26. Is that true . The Insurance Industry has included individuals in their parents policies for lack i dont see any reason that would change. You would want to keep, you told me, the doughnut hole closed to protect seniors against pharmaceutical costs. The discussion is about pharmaceutical costs making certain we do these things the seniors are able to afford them. You did not want to reopen the doughnut hole for seniors. You consider reopening the doughnut hole. I think it is important, you know well the reopening of the doughnut hole would be a legislative activity. Your secretary of health and Human Services doing a lot of work to prepare this legislation and do the technical work, are you proposing in that role something that reopens the doughnut hole. Finally my recollection at that meeting and my notes, you would not want to return to the Insurance Company lifetime caps or Insurance Company denial of preexisting conditions or Insurance Companies looking at the files for the little tiny discrepancy than throwing somebody off their coverage when they have a significant claim. There are always ways to improve coverage that are in existence right now. The issues need to be continued. When and if we get a republican counterproposal to obamacare you expect to see those things in it. I dont know whether they would be in it or silent on it. Leave it in place. A legislative question, not at an administrative question. Throwing 8 able bodied people, were in job training. People with Mental Health issues. Are they ablebodied in your definition . We are not as specific as the definition was. What are you doing when you said ablebodied . Ablebodied individuals believe providing for an opportunity for individuals ablebodied without children to seek to gain employment what do you mean by ablebodied . Used that term again. That is what is we define in the regulation itself. People have an understanding what ablebodied is. It doesnt have the kinds of things you describe. That was a simple answer to my question, ablebodied Behavioral Health issues. The work is done not asking about some future universe, as you use that term in your budget. Individuals that demonstrated they were having challenges, precluded from seeking work or employment or education or the like that they ought to be attended to. Now, i am a fan of if they do good work, the American Academy of pediatrics, and think they do good work of for the American Lung association and that they do good work of the American Public health association, and all of that and others may have gone clearly on record, that Climate Change presents Significant Health issues. They signed a declaration on Climate Change and health, the science clear that this is happening. You on the other hand have said that the Carbon Pollution standards of the obama administration, quote, go against all common sense and that there are errors and obfuscation in the allegedly settled science of Global Warming which i will pursue this with questions for the rapid but my time has expired. It appears to every Scientific Organization in the country, legitimate, major ones and every american university, that is pretty settled. The only people who disagree have financial interests or any work getting done. It looks to me like making the statement you have taken the side of special interests against settled science and if we cant trust you on science that is settled as climate science, how can we trust you on Public Health science issues where there is a big special interest on the other side . The premise, the insinuation, the climate is obviously changing, continuously changing, the question from a scientific standpoint is what effect is Human Behavior and human activity have on that and what we can do to mitigate that and i believe that is a question that needs to be studied and evaluated and get the best minds available we are running out of thank you, senator whitehouse. Senator young, i believe, is next. Senator roberts thank you for holding this anger management hearing. I truly hope my colleagues feel better at least for one day after purging themselves of their concern, frustration and anger. I would like to note that i asked the technician running the sound session. The audio system is working. I thought maybe senator bennett doesnt know that. Marine di back in the good days. I cant hear you. I thought i would bring that up. It is working. Take care of yourselves. Congratulations on your nomination, thank you for being here today. As many of our colleagues noted, you will play a most Important Role to confirm and helping stabilize individual markets while congress does repeal the law and repair the damage that is caused and the reforms we believe will put our Healthcare System back on track. My home state of kansas we have three insurance carriers, and only have access to two of those and premiums rose this past year 30 down the road. It will be more difficult. There is no doubt with regards to uncertainty. And the incoming administration, and like in frozen, let it go. Amending or repealing, and laws and work. And something to meet obligation. It is nonexistent with fewer options in several states. And we are world. I have a concern back in the day, wrote the first version of the affordable healthcare act, dont know where that mark is today, sitting on the shelf somewhere. Day and night, and talking of the independent advisory board. The new coverage Authority Given to Services Task force and i would also mention the Outcomes Research institute called mccrory. And the four horses of regulatory apocalypse. They interrupt doctorpatient relationship. Can you share concerns, parishioners for what they do with good intent. I appreciate that senator. As we move forward, we recognize a patient at the center of this, making the decisions about the healthcare they desire, we should not go down that road. The medicare, medicaid innovation, strong proponent and advocate, i have seen in certain instances what is coming, to require certain treatment for disease entities that may or may not be in the best interest, and because it carries the full force of the federal government, for payment for those services, means we are answering the question who decides what care patients received by saying the answer should be washington dc and i reject that is where decisions should be made. I appreciate that answer. The finance committee, especially being chairman of the agriculture committee, i particularly nursed it in hhs, food and nutrition policy during the Previous Administration the fda, numerous regulations for guidance and unrealistic compliance states, this is the case for the implementation of the modernization act, more recently with a nutrition tax panel, over the same food supply and availability for information consumers but im concerned the administration is not consistently communicated to the food and agriculture regarding new or changing requirements, and mention the committee i serve on for seminary, sciencebased guidance, taking into consideration Regulatory Burdens engaging in other regulatory actions. Not only imperative but the science out to be transparent and available to the public. Under the Previous Administration we have seen increased activity and regulatory, on nutrition policies like issuing voluntary guidance, the same administration continuing to request Additional Resources from congress to comply to statutory requirements for the modernization act. Im concerned the administration did not prioritize the mission to protect the nations food supply instead focusing on nutrition policies, and discuss how you will focus on the duties like implementing the law of congress for agenda driven nutrition policy guidelines. The fda commissioner to make certain we are relying on science guiding the decisions we are making. And for folks that could see the decisions made and how they are being made. You know best what is going on and how it is affected by rules and regulations coming down from washington in so many areas but certainly in the agricultural arenas so we should be having a dialogue with every individual who wanted interest, to address needs appropriately. Senator baldwin. Welcome. You talk about 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. Just as many of us do. In terms the American People want to know, potential conflicts of interest, procedures with the office of government ethics, in your role fighting for them, not biased towards the powerful companies you have invested in and that have invested in you. You have taken questions, let me follow up a little bit to ask first, do you think drug price increases we have seen, sixfold increase in the cost of the epipen is a problem 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 again, it is important to mention we have done some great things in drug pricing whether it is the generic arena where prices have been held down and the part d area my time is limited, let me continue down this track. You have been asked already. 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 . If confirmed, the boss that i have will be the president of the United States. The prohibition on medicare negotiating. Individuals in the department, carrying out his wishes. Is that yes or no . You you stated his position recently that he supports price negotiation, people on medicare has the benefits of that. You press congress to do. The prohibition on that negotiation. I hope we find competed medication. It may be one of those, the negotiations occurred for seniors. You havent said yes or no. You talked about transparency. Would you support drop mandating any company that wants to increase prices on their drugs, release Public Information on how they set their prices because so many of these are without justification as you mentioned. In many areas, in this area, looking forward to exploring if confirmed with you to make that work. I wanted to go back to the first round of questioning with the chairman who showed a chart and it seems what was implicit in the back and forth, the act of repealing the Affordable Care act, only a small part of the Healthcare Industry. You talk about 6 being covered on individual market. The protections like coverage on your Parents Health insurance until you are 26 and mandating people be covered even if they have a preexisting health condition, things like eliminating caps that let so many into medical bankruptcy. Those apply across the Healthcare System. Appeal in no way limits us to a conversation, a small percentage of our population, this is about serious impacts for all of america. Would you be free . The Health Policy for Financing Health care to the American People is a very broad subject. Repealing the Affordable Care act, the impact does not narrowly confine medicaid to individual markets, it has impact on every american, medicare too, think of Accountable Care organizations driving so much innovation, that is not confined to the individual market, it impacts medicare very significantly. We in our office, thank you for your visit. And and if the informal care act is repealed, there were no longer be a mandate for Substance Abuse treatment, dont you agree . The Opioid Epidemic is rampant in timing families. Would you a short treatment would be Substance Abuse treatment, a replacement plan . Absolutely vital Substance Abuse and other things you would keep that protection for the Affordable Care act . Legislative decision but i look forward to welcome extraordinary 26yearold coverage take sure i heard the exchange because it sounded to me like you are saying you think insurers are just going to continue to do it, and there is no need for there to be an actual mandate. Young people between 18 and 26 on their Parents Health insurance, that is 5. 7 Million People who arent in the individual market because they are in their first job after high school that doesnt have Health Insurance or in school without. If it just a wink and a promise or do you support having in law the mandate that 2018 to 25yearolds they on their Parents Health insurance. It has been baked into the Insurance Programs that are out there right now but they could end at any time. Im committed to making certain every single american has access to the kind of coverage they want and has financial feasibility to purchase that coverage. Thank you, senator baldwin. Senator young. Good to see you here today. I have enjoyed our service over the past six years in the house, especially on the house ways and means committee, i had an opportunity to get know you personally and to observe your impressive skill set. Depth of knowledge in healthcare, your commitment more importantly, to alternative perspectives to identify where bipartisan consensus can be realized. Forging consensus around what is most notable is success on the Sustainable Growth rates which is something members of this committee, is a blunt instrument, to control healthcare costs, your leadership on the house side i dont think we could have moved towards more valuebased purchasing model so these are skill sets that will serve you well in health and Human Services no doubt. One area of the Affordable Care act speaking of bipartisanship, members of my party, your party, and indicated their desire to repeal from time to time, the center for medicare and medicaid, that is on account of the 1sizefitsall prescriptive and mandatory, like in recent years and you indicated you oppose the mandatory nature of demonstration projects. There is great value in innovating and experimenting across layers of healthcare. When cmm i continues to be a laboratory for healthcare experimentation, delivery models and payment models and so forth for medicare, medicaid, childrens Health Insurance and other areas, provide greater value and see what doesnt work. Like scientists operate. And scale up. I would like to know your intentions in this area. Or develop a new one, a variant to speak to this. Especially for the quality of care. And great possibility and great promise to do things that would allow us, for ways to change the payment model, and i strongly support that. I have adamantly opposed the mandatory nature of which cmm i has approached the problems. The first is a comprehensive joint Replacement Program which identified from cmm i 67 or 60 geographic areas where if you were a patient and received a lower extremity joint replacement for a variety of problems, dictated what kind of prosthesis, what kind of surgical procedure your doctor could do for you regardless of what is in your best interests. They may be aligned but they may not be aligned. If they are not aligned your position is incumbent on doing what the government says to do. The other area that was egregious was 75 of the nation at the demonstration model. It is 75 of the country and that will stipulate the kind of medications, in a mandatory way. The problem is that is an experiment. On every single experiment, healthcare experiment or medicare experiment or scientific experiment with people, we require their be informed consent to participate, and we would love to have you join us, to order your benefit and the benefit of more individuals across the land. If you dont want to do that you dont have to. The federal government doesnt do that. I suspect most often a patient doesnt know it is an experiment that is going on so if either of these models were put they scale them up. The rationale, where they arrived at that position, to advance the next model of cmm i whatever it might look like. I will be remiss in my remained in 90 seconds if i didnt mention indianas what we call healthy indiana plan. Vice president elect pens showed a lot of leadership working with incoming cms administrator to develop a model for medicaid indiana. Encourages recipients of medicare dollars to get some ownership over there help, uses private market insurance concepts to prepare hoosiers for more self sufficiently. I believe will be replicated to work on new healthcare legislation. It is an important proof of concept that medicaid will be more efficient than 1sizefitsall approach. I did some assurance that your lodestar will be state flexibility and innovation in the medicaid space so we continue to accommodate plans like hip 2. 0 as opposed to 1sizefitsall approach. That is one where states know best how to care in the best way there medicaid population and the greatest amount of flexibility we can give for states to enact those programs, what indiana has done is a best practice for many states to follow so i look forward to working with you. Senator murphy. Good to see you again. I hope you can understand our frustration over trying to divide the nature of this replacement plan. We hear you and President Trump praise these aspects of the Affordable Care act, and layout goals that sound eerily familiar to what we have been living with for the last six years, you dont want there to be a gap between the repeal in the replacement, coverage with the goal of more people having coverage, 6 people wont face discrimination, stay on their plans until age 26 and yet we dont have any specifics as to how that is going to occur. You and the president elect want to do everything the Affordable Care act does but do it in a totally different way. I will give up on trying to get at the specifics of the secret replacement plan, metrics about how we measure whether what you propose is a replacement is meeting your benchmark. The number of people covered, the cost of health care to individuals, the amount of money outofpocket people have to pay. At the end of four years, how will you look back on this replacement plan to measure its success and to the extent you can give me specifics to how you will measure this i appreciate it. I think you and you identify specific areas we need to be looking from a metric standpoint. What is the cost . The outofpocket cost for individuals higher or lower than it was, i suggest the cost is higher than it was when the Program Began for many of those individuals. They were promised the premiums with come down, and access to their doctor, many have access. Many things harmed by the Affordable Care act, i hope we can turn that around and decrease the outofpocket costs, increase choices for individuals, increased access to doctors and providers the Patients Want as opposed to a number of people who have insurance. We have 20 million individuals without coverage. As policymakers it is incumbent on us to say what we do to increase that coverage. The goal is to make certain every single american has access to coverage for their families. Having access to coverage, we have gone around the number of times. I go back to this question of conflict of interest issues that have been raised. On behalf of the American People, this whole administration is starting to look like a get rich quick scheme, we have a president who will not divest himself from his businesses and get rich off of them and the secretary of education, and got work of protections and make a lot of money for the industry. I want to walk you through another set of facts and timeline regarding 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 reimbursements or part d drugs, that would have decreased incentives for physicians to prescribe expenses, brandname medications in Drug Companies affected by this resistance campaign. Two days later you announced your opposition to the demonstration project. One week later you invested as much as 90,000 in a total of six pharmaceutical companies, not 5, not 7, 6. All six, amazingly they had drugs that would be impacted by this demonstration project. There are a lot of companies that wouldnt have been. But you didnt invest in any of those. You invested in six specific companies that would be harmed by the demonstration project, you submitted Financial Disclosures indicating that you knew about this. Two weeks after that you became the leader in the United States congress in opposition to this demonstration project. You had a letter with 242 members of congress, i led those letters, i know that is not easy and takes a lot of work to get 242 people to sign on. That is good staff work. Within two weeks of opposition to the demonstration project the stock prices for four of those Six Companies went up. You didnt have to buy those stocks knowing you were going to take a leadership role in the effort to inflate their value and the American Public take a look at that sequence of events, tell me how it can possibly be okay that you were championing positions on Health Care Issues that have the effect of increasing your own personal wealth. That is a damning timeline. My opposition to having the federal government dictate drugs available to patients. The fact of the matter, dont know whether you were here before, i didnt know any of those traits were being made. I had a direct account, all of those were made without the knowledge. It is the same accounts, the reason you know about them is i appropriately reported them, ethical and appropriate manner as required by the house of representatives. You direct your broker around ethical guidelines, not to invest in companies that are directly connected to your advocacy, seems like a great deal as a broker, he can take a look at the positions you are taking, she can sit back in this case, look at the legislative positions you are taking and invest in companies that she thinks are going to increase in value based on your legislative activities and you can claim separation from that because you have a conversation. That is a nefarious arrangement im astounded by. I have no conversations with my broker about any political activity at all. Other than her congratulating me on my election. Why not say stay clear of any Companies Directly affected by my legislative work. The agreement we have is diversified portfolio which is exactly, Investment Opportunities and make certain, it is a diversified arrangement with purchase of stocks. While staying clear of Six Companies affected by that issue. Any knowledge of those purchases. Thank you, senator murphy. Senator mikulski. There is added benefit to being one of the last in the chain to ask questions because it gives the clear idea where you are coming from on issues that are important to us. We have not had conversation about the real aspects of healthcare, an important a chance to hear from the nominee for education and i pointeded out for her, alaska is unique, sometimes it is unique and the challenges we face allow us to be innovative but there needs to be flex ability to implement the innovations which and alaskans on saturday in anchorage, and the director of the division commissioner, and representative of the only provider on the individual market, representatives at rural hospitals, doctors, and Tribal Health organizations, a good mix of individuals, different views and opinions about where we go with this replacement of the aca and what that would need to look at to address the needs and issues in a rural, frontier, the highest cost, healthcare costs down to one provider an individual market. They would tell you a difficult place, and a couple years ago, 27,000 alaskans that have coverage with the didnt see that before. There was good discussion about making sure they were able to retain the protections for alaska natives we saw under the Healthcare Organization act that came as part of the aca. Recognizing there are certain exemptions as part of the aca exemptions for medicare cost caring, 100 federal match from American Indians and alaska natives. And the ihs facility including tribally operating facilities. Very extraordinary collaboration that has gone on. And entities with our tribes, Tribal Health organizations that have allowed for increased sufficiency and increased health access, a great deal of discussion focused on what will happen, what will happen, to those who gained access through Medicaid Expansion, and what can we do to ensure Coverage Options are provided for those in this new era of healthcare reforms. A further question to that is should a block grant approach be considered . What efforts would be made to ensure that this unique trust responsibility for American Indians are continued to be fulfilled, these were concerns raised at this meeting and folks that hope that we can ask you publicly. A wonderful discussion about alaska. The medicaid system is imperative and vital for members of the population who receive their care through the medicaid program, federal state partnership as you well know and it is one that we absolutely must ensure that individuals dont fall through the cracks in whatever transition that occurs. And retaining the same level of medicaid participation or providing an option for Something Else that allows coverage that suits their needs, we are committed and adamant that coverage might be continued so they have our assurance we will work with you to make certain that happens. What about the concerns expressed by the Health Organization that the block grant approach that is utilized could impact some of the assurances and benefits . In its early stage, a legislative decision that occurs, not a Department Decision that occurs, the next decision, we look forward to working to ensure the individual especially in the Indian Health service that have real challenges and we need to make certain the metrics mentioned over here, the metrics we are looking at are actually clinical correlated metrics, looking at what makes a difference to the people receiving care and one of those promises we have to make certain the Indian Health Service Works and i think we can do better. I look forward to more conversation. Let me ask about some of the efforts alaska has made, relatively innovative as we attempt to stabilize the healthcare market. Reforms that created a Reinsurance Program for high cost, high risk individuals, we submitted 1332 statement of innovation, waiver and again, all with the hope to provide for some level of stabilization, and high risk pools or statebased reInsurance Programs will you consider . The whole array of opportunities make certain nobody falls through the cracks, 1332 Waiver Program is just beginning and holds significant promise, making certain we are able to ensure that things like reinsurance or high risk pools make it so that individuals do not lose their opportunity to gain access to highest quality care. One of the concerns we heard repeatedly. And innovative things, and advancing and feel they are too risky right now to move forward with any level of innovation they had hoped would take on because they are facing Regulatory Burden that they are in right now. You can do things administratively early on confirmed to this position. And what regulatory issues that could help reduce Regulatory Burdens and particularly rural hospitals. Concerns about the burden of regulatory guidelines and regulatory schemes that have washington dc especially for rural areas and not just the hospital, most of the folks in the rural area tend not to have any margin at all to cover the cost of this regulation and i heard from more than a few physicians and other providers such as regulatory schemes that came forward, close their doors and Indian Health services, real challenges in being able to provide services, those individuals have no care and that is unacceptable to me. I look forward to working with you on this. I have remaining senator warren, and mccain on the democratic side. Cassidy, burns, senator isaacson has three minutes. Congressman price, 100 million americans receive their healthcare through medicare and medicaid programs, people with disabilities, middleclass families, parents and nursing homes, and they all benefit from these programs. I want to understand the changes to medicare and medicaid that you have already proposed. The budget you recently authored as chair of the House Budget Committee would have cut spending on medicare by 449 billion over the next decade. Is that right . I dont have the numbers, i assume you are correct. 400 medicare, cut medicare by 449 billion. Fy 17 Budget Proposal would cut medicaid funding that goes to the State Government by more than 1 trillion. Is that correct . The metrics we use for the success of these programs yes or no. What we believe do you want me to read a number out of his . Im sure you are correct, what we believe is appropriate is to make sure individuals receiving the care are receiving care. I understand why you think you are right to cut it but i am asking the question do you propose a cut more than 1 trillion on medicaid . You have the numbers before you. Is that a yes . You have the numbers before you. I will take it as a yes. Im sure you are aware during his campaign for president president elect trump was very clear about his views on medicare and medicaid as senator sanders has quoted extensively. President elect trump said i am not going to cut medicare or medicaid. When president elect trump says im not going to cut medicare or medicaid, do you believe he was telling the truth . I believe so, yes. Given your record of proposing massive cuts to these programs along with several other members of this committee, i sent the president elect a letter in december asking him to clarify his position and he hasnt responded 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 use your Administrative Authority to carry out a single dollar of cuts to medicare or Medicaid Eligibility for benefits . What the question presumes is that money is the metric. My believe i am asking. From a scientific standpoint of patients are not receiving care even though we are providing the resources and it doesnt work for patients. Sorry to interrupt, we are very limited on time. The metric is money and the quotes from the president elect of the United States was not along this course. He said he would not cut these programs. That is the question im asking you. Can you assure this committee that you will not cut one dollar from either medicare or medicaid should you be confirmed to this position . I believe the metric ought to be the care the patients i will take that as a no. It is the wrong metric. We ought to be putting forth we are not asking if you think you have a better metric. Im asking you a question about dollars, yes or no. What we are to do is put for thank you. A simple question and frankly familiar to the millions of americans relying on medicare and medicaid today are not going to be very reassured by your notion that you have some metric other than the dollar that they need to provide these services. The one goal of the Affordable Care act was to push the Healthcare Industry to provide Higher Quality care at lower cost. And under the aca medicare was recently allowed to change the way that it pays hospitals for hip and knee replacements to something called a bundle. That means medicare pays a set price for the care associate with hip and knee replacement, and then the hospitals, not congress, will decide the most effective implants, reduce second surgeries, better fight infections, how to spend their money to deliver Better Service at higher cost. I supported this change because of the Research Shows it really means you get medicare, lower prices. The end of the policy is controversial because it affects how hospitals are paid which in turn affects how much money the manufacturers of his hip and knee replacements can make. One of the companies is the Company Raised by mr. Franken, senator franken, and that is Zimmer Biomed one of the leading manufacturers of hip and needs and they make more money if they can charge higher prices and some more of the products. The Company Knows this and so does the stock analyst. On march 17, 2016 can you purchase stock in similar ill been exactly six days after he bought the stock, on march 23, 2016, introduced a bill in the house called the hip act that would require hhs secretary to suspend regulation affecting the payment for hip and knee replacements, correct . I think the program to which i think you referred i am a strong supporter of because it keeps im not asking you about why you support it. Just asking, did you buy the stock and vintage introduce a bill that would be helpful for the companies you just bought stock in . The stock was bought, directed by broker who was making those decisions. I wasnt making those decisions speed and you said you were not making those decisions. Let me make sure i understand. These are your stock trades . They are listed under your name . They are made on my behalf spin was a purchase to an index fund . I dont believe the spirit through a passively managed mutual fund . Its eight direct broker at the broker directed a blind trust . So lets just be clear. This is not just a stockbroker, someone you pay to handle the paperwork. This is someone who buys stock at her direction, this is someone who buys and stills the sock you want them to buy and sell. Not true. So when you found out you decide not to tell them, wink wink, nod nod . Its what members of this committee, its the manner in which members of this committee, but its important to appreciate thats the case. I want to understand, when she found at your broker had made this trade without your knowledge, did you reprimand her . What i did was comply did you sell the stock . Spirit of what i did was comply with rules of the house and ethical and legal [talking over each other] all right. The time of the gentleman has expired. Spin 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 just burned another 15 seconds. Keep burning event and you will be up to two minutes. Okay. Your periodic transaction report notes that you are notified of this trade on april 4, 2016. Did you take additional actions after that date to advance your plan to help the company that you now own stock in . Im offended by the insinuation. Let me read what you did. You may be offended but heres what you did. Congressional records show that after you are personally notified of this trade, which is 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 plan mandatory initiatives, and just so there was no misunderstanding about who you are 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 make a point. I respect everybody on this committee tenuously. I respect the nominee, but this is very important for us to all understand under the Disclosure Rules we have, the way it operates, im sure senator franken had no idea if he owned part of Philip Morris when he made the statement he made about Tobacco Companies but he hasnt the wisdom tree Equity Income Fund Investment disclose in his disclosure which owns Philip Morris. So its entirely possible for any of us to have somebody make an investment on our behalf and as not know where the money is invested because the very way it works. I dont say that to anyway embarrassed mr. Franken but to make a point that anyone of us have mutual funds or investment managers, its entirely possible for us not to know. And to try and apply somebody is being obfuscating something or otherwise deny something, its just up the very thing to do and i just want to make a point. Is different than mutual funds. Its an investment in Philip Morris, right . My question was about senator warren, your time has been generously senator kaine. Im sorry. Senator hassan. Im happy to lead by to think senator cassidy was next, and he just came back in. He did but i was going back and forth. Ill be glad to thats generous of you then thank you. Congressman price, thank you for being here. 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 adult son at times is set up to 10 doctors and a couple of dozen medications. Our family knows 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 indiana, to have a bipartisan New Hampshire specific Medicaid Expansion plan thats providing coverage and out to over 50,000 hardworking granite staters. I have seen the advantages of the Affordable Care act and the flexibility the Affordable Care act gives states, right up close, and worked with a Republican Legislature to pass it. Its that context i bring it to this series of questions. First of all, as we talked about, opioid Overdose Deaths have been on the rise for several years and have hit New Hampshire particularly hard. We have it 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 Use disorder. I talked to one of them last week, 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. After a year on medicaid which by the way we have done in a particular way so that it is actually strengthened our Insurance Market in New Hampshire, so more insurers came in as result of the way we did Medicaid Expansion, anyway, she is now working and she just switched over to private insurance because shes got employerprovided insurance. So 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 americans with Substance Abuse disorders got an interesting Medicaid Expansion just like actually did will not lose their Health Insurance . I think, i enjoyed our conversation as well an of the subjects we delve into. I think it is imperative we as a nation make certain every single individual have access to the kind of Mental Health and Substance Abuse challenges that they have. Is that a guarantee that you will find funds to provide the treatment . Its the county im committed to making certain that we address that need which is a vital and important across this land. Im just concerned youre not unable to back up that guarantee if the Affordable Care act is repealed and im concerned about the impact that will have on states and people like actually 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 that . I think that as we mentioned with the choices for patients to be able to select the kind of coverage that they want instead of somebody else decide for them. Its so very important we remember the center of all of these discussions as a patient, and the patient knows best what he or she needs and thats the imperative i would put to you, that i am committed to making certain patients have the choices available. If they choose to select the kind of coverage, then they ought to be but Insurance Companies to operate at all like Substance Abuse disorders. An essential benefit under the Affordable Care act requires private insurers to cover Substance Use, misuse treatment. They didnt use to do that. They also have stopped covering a lot of things until the law requires of 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 give the patient at the center of all of this and make certain w where providing the kd of 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 convey good premium dollars but its just not offered. And the Affordable Care act said to the Insurance Industry are some basic things you have to offer. So that when a patient needs care, the coverage is there and they can get the care. And 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 administrator, if i am a privilege to serve and the capacity, but if all the policies adopted by the congress of the United States and signed by the president so we look forward to working with you to make certain those kinds of things are covered in those patients receive the care and with respect. Theres been lots of opportunity to make certain that those things happen. Until the Affordable Care act was passed it never happened. People didnt get the care they needed. Because of that a lot of people like actually were not getting better, were not getting treatment, providers dont exist to treat people if they can figure how theyre going to get reimbursed. The most important thing that our Treatment Community said in New Hampshire was Medicaid Expansion in 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 the 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 uses Birth Control . Well, i dont believe so. Well, you voted in support of a resolution to disapprove the District Of Columbia is nondiscrimination law, the, the Reproductive Health nondiscrimination act, which protects women in d. C. From being fired or penalized because of the Reproductive Health decisions. So your vote wouldve had 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 was that for 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, a selfinsured employer provide Health Insurance plan finds out that a female employee who earned the benefit with her hard work is using the benefit to provide Birth Control, to buy Birth Control, which the benefit provides and inspire should because the employer disapproves of the use of Birth Control fires are speaking i dont think thats the case. Spinner would you like us to provide examples for you . Id be happy to. You would be willing to say employers may not, you would support a law, a rule that employers may not discriminate against women for the Reproductive Health decision . I dont think that employers, that employers have the opportunity right now to be able to let somebody go based upon their Health Status or then why did you vote against the provision the . I dont believe thats what it did. You dont think that was your vote . I dont think thats what the building speed and we will follow up on that and again i wish i had more time because i have about eight more questions. I will submit them in writing. Thank you. Senator cassidy. Thank you, mr. Chairman. You all seem warm out but i been gallivanting with High School Students im pretty energized. Let me say for the record that when john king came for and i wanted ask a second round and you wouldnt let me. I confirmed with staff so ive been wanting to say that for two days now and i just want to say it. Ive got another set of questions and you said shut up. So anyway, nothing nothing personal. I would hipaa laws required now a grandfather taking his grandson on health calls . I love what youre saying about the patient physician relationship. You and i have both worked in hospitals for the uninsured. I as a gastroenterologist, liver doctor. Weve been talking a lot about obamacare and wonderful things but i keep one thing of my patients at the hospital for the uninsured with a 6000 deductible. Thats right spirit the patient you thought great, they dont have 400 in their accounts and have a 6k deductible six k. Deductible before they can be otherwise cared for . Just for the record, people dont lately. 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, no kids, no health stuff, was 39,000 a year. With a 6000 deductible. I put it on my Facebook Page because no one believed this is like what a family pays for mortgage and then some, and that was a very yearly premium. I applaud you for looking for some alternative thats affordable, making working for New Hampshire, california, massachusetts, god bless you but for states like mine and yours and arizona people cannot afford 39,000 premium. Does the empowering patient act repealed explicit repeal the Mental Health parity laws . I dont believe so. I dont think so either. Mental Health Parity would still apply and that does cover Substance Abuse. So that is of those provisions, that lost in effect. Secondly, weve been talking about does it have to be a covered benefit. Youre a big believer in Health Savings accounts. I got a Health Savings account be used to pay for doctors visits and essential medical services and even colonoscopies if necessary. Absolutely speaking as a gastroenterologist, that comes to my. Just also to point that out. When you speak about giving the Patient Power over her health care to allow her to choose, when we choose for her with a 39,000 premium. But when we allow her to choose just something which is affordable and she becomes an activated and informed consumer. I applaud fishing we dont agree with each other entirely but substantially and i applaud you for that. Al franken always calls me a luddite, different issue. Because im skeptical about, he calls me many things but a luddite among them because im skeptical about Electronic Health records and the negative impact upon the productivity. He thinks im some guy that calls a mouse a little furry thing when most people i see that indiana just laid off 5 of the step if the bloody end up on financial losses related to decreased productivity again directly attributed to the implementation of their h. R. Your department will be involved in meaningful use and things like that. I often find an Orthopedic Surgeon asking somebody about a smoking history is not a good use of their time. Not that it is an important but nonetheless hes not the person elizabeths the cessation program. You know what im saying. So what thoughts do you have, what can we do about this time and productivity stuff that has become the Electronic Medical record in meaningful use, keeping that which is positive but hopefully doing Something Better for the patient and for the position. The Electronic Medical record and Electronic Health records are so important because from an 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 what the role ought to be interoperability, to make sure that different systems and talk to each other so that it endures to the benefit of the patient. Ive had more than one physician tell me that the final regulations and rules were the final straw for the spirit and they quit. And they quit. Theyve got no more greater than you or i have. When that happens we lose incredible intellectual capital in our society that can care for people. What can we do about that . What practical things can we do . The thing that is imperative is to find out what things ought to be determined and checked, and the metrics that are used, that they actually correlate with the quality of care thats being provided as opposed to so many things that are required of the physician or the provided that make it so theyre wasting their time documenting these things so it fits into some matrix somewhere, that it doesnt result in Higher Quality of care or outcomes for the patient. If we truly work with those providing the care to see what is it we could ask you to measure that would really correlate with the outcome and the quality of care being provided, i suspect there are specific we could use. You are emphasizing the patient physician relationship. My wife is a retired Breast Cancer surgeon and shes to say she counseled the husband because the husband would be the one who was crying. She would be the one telling them, looking him in the eye, theres hope. This is not a death sentence. There is hope. I only imagine if you were not in practice typing up there is hope. Its a little bit of a different feel for the patient and her spouse. We have turned many into data clerks and it detracts as you said from the productivity but it detracts greatly from their inability to provide quality care. One of our big challenges, expensive medicines are used by a very few, how do with socialism that cost . Think of antibiotics. We just had some guerrilla, some german author, factory that that is apparently resistant everything. We can come up with gene therapy. Had we pay for that . I just want your thoughts. I care deeply about those and so do you with these Rare Diseases but devastating, how do we care for them and socialites that cost . Senator hatch, during his time about rare disease about the orphan drug act and the like that revolutionized the ability or the incentives for bringing to market drugs that address Rare Diseases. Its incredibly important, in sensitization is an important, to make certain that if individuals, companies are able to come up with things that cure diseases, that they are properly compensated for spirit in the era of personalized medicine where it might be in of wine, and up 1000, still very small but the cure 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 never dreamed about curing. And the challenge is how we afford to make that available to our society are real, and i think we need to get the best minds together to forget how to make that happen. I look forward to working with you to do so. I have a perspective that my colleagues cannot because i know Orthopedic Surgeons are the ones are called at 3 a. M. And is car wreck and some are so busted up there so what else to fix them. But if they dont fix it and they die. So they kissed the wife goodbye, climb out of bed, drive to the hospital, up all night and initiate a claim to schedule the next day. Make rounds add, get home at midnight and kissed the wife the night before they go to bed. You are the exact kind of person to have this job. Thank you and i yield back. Thank you, senator. Thank you, senator cassidy. Senator kaine. Thank you to the Committee Leadership and thank you, congressman price, for the visit the other day in the office. An observation and interview questions. Forgive me, i was at another so might be repetitive but i will try to move quickly. My worry as a virginian is your position about a whole range of programs that are basically about access and coverage, sort of the safety net that provides coverage to millions of people. You propose turning medicaid into block grant program. Thats exciting a lot of controversy in virginia in a legislator both democrats and republicans. You have repeatedly voted against the chip program for kids. One point calling it socialized medicine. Thats taken by medicaid and chip about 800,000 virginians. You propose a restructuring of medicare that cbo said would increase outofpocket cost for seniors, about 1. 3 million virginians. You support repeal of the portable correct. Theres about Hoffman Virginians on the exchanges and hundreds of thousands of others that otherwise benefited. You want to defund planned parenthood, tens of thousands use planned parenthood as their 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. And many of them have very limited means. Theres sort of a consistency to your position in some ways across all these programs that i view as critical to the safety net. I know senator franken and senator murray used the hippocratic maxson, first do no harm in comments before again. I would hope you would agree that as we approach the discussion of Health Care System access coverage, cost, quality, the president and congress should strive to do no harm. Would you agree with me . Absolutely. We shouldnt our people by reducing the number of people who have Health Coverage of reducing the quality of the insurance coverage. Thats what we should strive for, right . I think its important to appreciate there are challenges 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 we are honest and sincere about addressing this problem we had to step back and say why, what are we doing wrong . One out of every eight physicians is eligible to see seniors to longer sees medicare patients. If you are a new medical patient tried to find a physician, a new physician that sees medicare, new medicare patients, is a most impossible anywhere in i am with you in fixing challenges in Going Forward, more coverage, more affordable. Thats what my proposals have tried. We shouldnt harm people by doing things that would increase the cost, correct . I think we need to drive down the cost for everybody. We shouldnt harm people by creating anxiety about the most important thing in their lives, their healthcare and healthcare of the families. We shouldnt be doing that in congress, should we . One of my goals, i appreciate to bring this up, is to lower the temperature about what were talking about. This is real stuff for folks. These are their 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. The people need to know that nobody is going to be pulled out from under them speak i will join instability and lower temperature. I dont think lowering the temperature is consistent with rushing. In fact my experience in going around virginia is huge amounts of fear. We shouldnt harm the american economy. The healthcare is a biggest sector, 16 of it it, by injecting uncertainty. We should again try to fix the problems you have it in front of those that i might identify and do that anyway that provide some stability and certainty. Shouldnt that be article . Certainly is incredibly important. Im reminded of the fact the Congressional Budget Office has told us the aca has decreased the workforce by the equivalent of 2 million ftes. There are challenges we have throughout, and i would hope will be able to do his Work Together to solve those challenges spirit do you agree with the president elect that the replacement for the Affordable Care act must ensure that theres insurance for everybody . I have stated here and always that its incredibly important we have a system that allows for every single american faxes to the kind of coverage they need and desire. He stated a couple of days ago that we should negotiate with pharmaceutical companies under Medicare Part d to try to bring down Prescription Drug costs. Do you support that position of the president elect . I think the cost of drugs is in the instances a real challenge for folks and we need to do all we can can ask it would bring those costs down. Theres an offbeat question, just a coincidence based on today. I was at a hearing with nikki haley, or hayley is nominated to be u. N. Ambassador right before i came in. She played a really significant role in moving her state away from the use of the confederate battle flag in any official capacity. When you were a member of the Georgia Legislature you fought hard to keep the confederate battle flag as part of the Georgia State flag and you sponsored resolutions to make april confederate history heritage month in georgia in quote urging schools to commemorate the time of southern independence. Id like to introduce that resolution for the record, mr. Chair. I read the resolution with interest because of the phrase commemorating the time of southern independence, and i pulled it up and i note 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 and go back and refresh my memory. What is 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 have read at a specific question. I think slavery was an abomination. Do you think history resolution about, History Month that completely makes any reference omits any reference to slavery kind meets the basic standards of fair, balanced . I dont know that presume to become rancid. The work that i did as first Republican Senate majority leader and history of the state of georgia was to make certain 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 that time to make certain we were able to do so. You are aware theres an office of minority of health that was traded in the Affordable Care act, and that the aca, if it is repealed, unless it is separately reauthorized, that office also expire . Again, thats a legislative question. If i am privileged to serve and be confirmed and the secretary of health and Human Services, i look forward to make certain that we use the Resources Available to us and agencies available to us within the department to make certain every single american has the highest Quality Health care available. Why did you use the phrase socialized medicine to explain your vote against that chip program . I dont know that i recalled a conversation or that quote button happy to go back and look at it. Thank you. Thank you, mr. Chair. Senator scott. Thank you, mr. Chairman. Dr. Price, good to see you here today. Likewise spirit hoping for much success for you. Did i hear that you are at him or university . I was. Medical school . I did my residency at emory. My nephew 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. Excellencexcellent. I did have the privilege of serving with you in the house and enjoy our relationship, friendship, and looking forward to seeing your success as the secretary of hhs. I have a couple of questions that are state specific to South Carolina. We have over 20 Health Centers in south dublin with about 165 service sites, serving over 350,000 patients and almost every county in the state. Every county in South Carolina is either partially or completely designated as medically underserved. As rural hospitals continue to close, the centers have addressed they need for many communities in my state. They worked together with partners in the keener to address impacts on health likes of desert and lack of transportation to Preventive Health services which can save cost in the long run. A diabetic who does not take care, take their medication because they cannot afford it or have no way of taking apple will inevitably be a long run to the emergency room. What role do you think community Health Centers can play, particularly and rule and medically underserved areas . Thank you. Community Health Centers are a a vital part of the Healthcare Delivery system right now as they fill a void in so many areas, as you mentioned a cautious state and across might and literally across the country. I think over 13,000 that are the entry point and oftentimes the area of healthcare for so many individuals and we need to do all that we can to strengthen them to make certain the providers that are within tumor to Health Centers are the highest quality, that theyre providing the highest quality care and that they are able to access resources, intellectual resources and Clinical Resources that allow them to provide that care. Less than a decade ago South Carolina Emergency Rooms were full of people waiting for psychiatric exams so they could either be admitted or discharged. After implementation of the statewide telepsychiatry network, wait times have been cut from four days down to about 10 hours. The costs have been cut my almost twothirds. What do you see as a feature of telemedicine, particularly to address access to issues, what barriers can we anticipate . Telemedicine is an exciting innovation that will i believe allow for individuals especially in rural and underserved areas access to the intellectual capital and resources. From a clinical standpoint to make decisions on patient data before them without the able to save resources and safe patients in so many ways. We in georgia have a Stroke Program thats kind of a spoke and Wheel Program with the Medical College of georgia, theres a neurologist that works with telemedicine and has a network of clinics and hospitals around the state were somebody comes in with symptoms of a stroke. That physician is able to literally see tha the patient in realtime and determine one, whether or not they need medication, whether or not theyre having a stroke, whether they can be treated in the community, or whether they have to be transferred to the academic center. In the past it was a call on the ground, no ability to build a talk with someone who might have greater resources or knowledge, and all those 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 a vital and i think we need to accentuated the ability to use telemedicine. As you know im oftentimes telemedicine, telehealth is not paid for. Its not compensated. People eat, the clinicians eat those cost, the sm those costs that help the patient, yes, but make it so its much more difficult for them to provide them quality care. Thank you. Another interesting topic you should be i think certainly with from minority perspective, South Carolina like george has a High Percentage of africanamericans. As you probably know, Breast Cancer deaths are proximate one and a half times higher in africanamerican women, Prostate Cancer deaths are proximate 2. 5 times higher in africanamerican men and new diagnosis are often twice as likely i would love to your perspective on addressing some of the Health Disparities in connection with color specifically. This is an important area. I appreciate you bringing it up because i think so often what we do in this and other areas is to say we will set up disassembly or this agency here, and we have taken of the problem. What i dont think we do is lok at whats happened on the ground, the metrics as well as we could or should. We ought to be defined specific to whether or not we are improving the lives and health for individuals in challenged communities. And if we are not that we need to step back honestly answer to and say what we do to make certain that it works . I learned a couple of months ago, i the privilege of being in the clinic in atlanta. I learned theres a zip code and amanda within this metropolitan area of atlanta that has incredible disparities in terms of their Health Outcomes and status. High mortality, high rates of diabetes and high rates of stroke, high rates of myocardial infarctions. They are surrounded by incredible healthcare faciliti facilities, and when we see those kinds of things we need to drill down into the space and say whats going on . Why is that happening . And address the real challenge on the grant as opposed to saying okay, weve taken care of it because now we have an agency that says its addressed to take care of that. We need to do better metrics and accountability for whats going on. Im sure you guys of talk at some length about Rare Diseases. We have spirit sickle cell being one of the more important ones in africanamerican population. I would love to submit a question for the record to get your insight and your perspective on how we tackle so many of those diseases moving forward speed and look forward to that. Thank you. Thank you. Senator murray. Thank you, mr. Chairman. Congressman price, i did want o clarify your response to one of my previous questions. You admitted to me in our meeting that you come in your own words, talk to congressman collins about innate immuno this inspired you to use come in your own words, study the company and then 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 with a broker. I directed the broker to purchase the stock bu but i didt through a broker spirit 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 in into the record an article from Kaiser Health news that notes congressman price was offered a lower stock price for sophisticated investors bet i think thats an important part of the record. It will be included. Representative price, if you are confirmed as sect of health and Human Services you will be in charge of our nations familyplanning program and policies. You have said that you dont think cost is an issue for women in buying Birth Control, and stated, quote, bring me one woman who is been left behind. Bring the one. There is not one. You did say that, correct . I think what i said and what i meant was that when i have patients in my office who were unable to afford medication, we did everything we could to make certain that they got that medication. And what i meant to capture in that conversation was that if there are individuals were unable to afford that medication or any medication, that there are avenues within the 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 as india meet realtors, a Common Health conditions impacting women desperate no copay Birth Control is an essential tool helping women like me with endometriosis who otherwise would have to live with chronic pain. So no cave that copay Birth Control, she 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. And 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, when you commit to ensuring all 18 fda approved methods of contraception to continue to be covered so that women do not have to go back to paying extra costs for Birth Control . What i will commit you and her show you is that all americans need to know that we believe strongly that every single American Auto 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 want to ask you, im deeply concerned about the impact of your policies would have on women obviously. And in particular women often face barriers to access and health care they need. According to h as data, since the became law, the percentage of black women who report not having a regular doctor dropped by nearly 30 . While that measure for latinas, almost 25 . Your healthcare repeal bill and your Budget Proposal to cut 1 trillion for medicaid would disproportionately hurt women of color, for the company disparities in access to health care and undoing process that was made in the Affordable Care act. Are you committed to ensuring the women of color maintain access to quality, affordable healthcare . I appreciate, i dont agree with the premise. The program that i support undoubtably the president supports these 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 doctor that you want to get the kind of care they want at a price thats affordable and that is of the highest quality. Thats what we believe in and hope we will be able to Work Together to achieve that goal. The office of Minority Health was reauthorized as part of the aca. So we you committed 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 speedy so you will not commit to the office being maintain . I think its important we think about the patient of the scent of all this. Our commitment, my commitment to use to make certain i nor the patience and all patients in the scourge of access to so you wont commit to the office of minority look, there are different ways to handle things. I cant commit to you to do something in a department that one, im not in. I havent gotten in yet. You will be. Let me put forward a possible position i might find myself in. The individuals with a 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 and that agency and well call it Something Else and we will address the issues of Minority Health and a big, big way and make certain that let me just ask you one final question. As you are aware that, are you aware that blocks, latina, American Indians, native alaskans, do you think its responsible to propose cutting trillions of dollars of funding without a credible alternative to replace it for those folks . I disagree with the premise. The solution that we have what injure everything american regardless of their Health Status, regardless of economic status have the ability of financial feasible to purchase the kind of coverage that they want. I have a few seconds left, mr. Chairman. As you can see we have membership 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 of this election, what will happen to them personally. We have outlined some of those, and i hope that congressman price, as will have a significant number of questions from our colleagues, that you will fully 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 said appearance before this committee and how impressed i was with her appearance. I think youve done as well. I have also been impressed with her performance and the job, because while i disagree with the number of the policies she is taken, she has 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 with your, i appreciate your being here today. Based upon the figures i have you just endured the most extensive questioning of any sect of health and Human Services since 1993. Because of the rent of questioning, secretary burwell was in hearing for two hours and 10 minutes, secretary sebelius to our sweetness, daschle, two hours 10 minutes. Love it less than two hours. I dont have it for two others that you have been here nearly four. Next is a you will 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, to a conclusion and a consensus in this very important area of providing concrete Practical Alternatives to give americans access to healthcare they can afford. I was reflecting last night on the hearing, and today. They have been pretty testy. We often have strong opinions here because we have differences of opinions but i think thats a reflection of one, the election over the past year which became very uncivil. More so than i liked. And republicans can take our share of the blame for that. But also this issue, which for six years w weve been going att like the hatfields and the mccoys in West Virginia until almost we are forgot who killed who in the first place and we dont know, you know, we are not absolutely clear what we are fighting about. It would take a bedside manner such as you have tw to lower the temperature at senator mccain suggested. He and 12, he was among 12 democrats who wrote a letter suggesting they were willing to work with republicans as we go forward. I think it will take a little while to lower the temperature just because we spent six years as hatfields and mccoys, but im committed to try. Thats the way we usually work. I would like to get away from the testing us up last night and today and back toward the way we have learned to work. A couple of other things. I hope those watching are 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 i would eventually mean repealing parts of it, major parts of it, that that will not become effective until you are practical, concrete alternatives in place to give americans access to healthcare. In other words, you so we dont want to pull the rug out from underneath anybody. Im sure thats a shared view. Youll talk some about the importance of march the first. One thing we have to Work Together on is what do we do about individual market . And the fact that, theres already 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 having a 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 period to make sure that insurers are willing to sell into the markets of these 11 Million People continue to buy insurance, hopefully for more than one person. I think its also become clear that the time and we talked about agent to be resolved. Sequencing is as important almost as the policy. How do we get to where we are to where we eventually hope to go . The way i think about it as we go to work immediately on what i call a collapsing bridge, repair it. Thats the individual market. Make sure 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. I think we can make most of the decisions about the quote replacement or replacements or the new systems, new bridges, and a relatively short period of time. Weve been working on this for years. We have our opinions. We ought to be able to 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 to governors and insurance commissioners. So making decisions probably, making them together, if we possibly can, and then implementing it stepbystep and carefully so that people are able to access to lowercost 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. Im trying to do with the Electronic Healthcare records, and meaningful use. At vanderbilt which was an early adopter of the Electronic Healthcare records, they said stage one was very helpful. Stage ii they could deal with, states that he was terrifying. I had hoped that we could delay stage three and i have thought that it could be as simple as saying to the physicians and providers of the world look, if youre a doctor and your spending 50 50 of your time filling out forms, then either you are doing something wrong or were 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 and create any private 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 we passed the cures bill which had a number of provisions in it. It. We had six hearing on the subject and i invite you to work with us, if youre confirmed, to complete that. Senators wished to ask additional questions of our nominee, questions for the record are due by the close of business on friday, january 20 while other matters the hearing record will remain open for 10 days. Members submit Additional Information for the record within that time. The next many of our committee will be an executive session on january 24 at 10 a. M. Which has already been noticed. Thank you for being here today. The committee will stand adjourned. Thank you, chairman. [inaudible conversations] [inaudible conversations] new concrete alternatives for insurance, and eventually will be replacing some of the existing so the only effects for the 6 of the people in the country with insurance. I think insurance covers are saying by march 1 thing you get some indication of what were going to do to stabilize the market. So i think thats a rescue plan for the Obamacare Exchanges. Then i think we wait to see what the president elect suggests, work with the house of representatives and begin to see what new alternatives we can come up with. They governors will all be here march 1922nd, 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. You are steps we can probably begin to take right away on that. Once you put medicare site and focus on those three errors i find a lot of steps that we can take, begin the process that will go on eventually for some years. [inaudible] yes, this would be separate pieces of legislation. Some might be in the first reconciliation bill. Theres another reconciliation bill that is expected before the summer. It would be good if we could have a rescue plan of the individual market that could get 660 votes in the senate, it coud be passed that would be a good step back from the hatfields versus mccoys that we been in for six years. Obamacare is collapsing. Have you talked to any Health Analyst at cms, anybody who has the data, looking at it and says yes, the state insurance commissioner of tennessee, it is end quote virtual collapse. In our state, premiums are up 4060 this year. Blue cross pulled out of our three biggest metropolitan markets, and twothirds of her counties, those are obamacare subsidies, only have the one Insurance Company from which to buy. And across the country thats true in many other states. There is almost no one who will tell you that the Obamacare Exchanges are not virtually collapsing. And unless we act by around march the first, people will not be able to buy insurance with their subsidies and we do not want that to happen
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