Transcripts For CSPAN2 HHS Secretary Tom Price Pressed On Budget Cuts 20170331

You to the subdmooit committee. Were looking forward to hearing your testimony. Mr. Secretary, your responsibilities are many. Your departments responsible for ensure properly payments of medicare and medicaid dollars for overseeing buy kbroe medical research that could save millions of lives, for helping families break the cycle of poverty and protecting our nation against bioterror and pandemic events. The cuts promodes this month are extensive and span the reach of your agency. I believe theres always fat that can be trimmed and priorities that can be reordered, but i will ask you some questions this morning about whether this budget leaves america sufficiently prepared to respond to a pan demmic, a new disease like zika or bioterrorism event. Ill ask questions about how youll fulfill your mission of enhancing the health and wellbeing of americans at these levels of funding and ill ask how you will work to solve some of the challenges in your agency including those related to the Indian Health service. And ultimately this subcommittee needs to know in detail what cuts you propose and what missions you are either downgrading or eliminating. I know some of these details will be forth coming in the weeks ahead, but we look forward to hearing what youre able to share with us today. And we recognize there are limitations in that regard. As a reminder the subcommittee and witness will abide by the fiveminute rooil rule so everybody will have a chance to get their questions asked and answered. Now im going to going off script for a minute. I want to begin also just welcoming you here as our former colleague, 12 years, and not only had the privilege of serving with you and obviously in congress but in the same conference and on your committee which you chaired. And i couldnt have been more pleased with your selection by the president. I think you are not only a very good person and extraordinarily well qualified for this job, i have no doubt youre going to do a brilliant job for the American People during your tenure in health and humaner is vitss. Having worked with you i know you know how to balance a budget and make the tough decisions that have to be made for the country Going Forward. And, you know, we achieve of that balance in the bugts that you were the that you crafted and some cases i think with appropriate balance between entitlement spending and Discretionary Spending. And i think thats probably one of this committees chief concerns. I think the president is absolutely correct that we need to spend more on defense, dont have any doubt about it at all. And i think hes absolutely correct as well that it needs to be done in a fiscally responsible way, with off jetti youve setting other budgets. Were operating off a skinny budget, we may see Something Different in may and we may see Something Different in the years ahead, but in my personal view, these are focused too tightly on nondefense discretionary offsets and particularly with respect to your agency. I take considerable pride in the fact and i know my colleagues on both sides of the aisle do, that in the light 90s and early part of the 21st century congress, Republican Congress frankly but with democrat support was able to double the budget at nih and our predecessor speaker gingrich deserves considerable credit and mr. Porter, my good friend, Ranking Member of both the full committee and the subcommittee often point out, they did a tremendous job, i think, for the American People. We then had about a dozen years of flat funding, and i take considerable pride that it was Republican House and senate again in 2016 that restarted the cycle of increasing funding at the nih. And when i say flat funding, i know my colleagues would be the first to point out flat funding means reduce funding because youre obviously loose on the count of inflation. I can give the numbers in terms of the number of grants we were funding in 2003 verse whats we were funding in 2015. Went down from 1 in 3 to 1 in 6. That was a lot of good science i think left on the table. So im pleased that we were able to restart that what a call a virtuous psych until 2016. I take considerable pride it was Republican Senate and Republican House that did it but with our support of our friends on the other side of the aisle. And we did that again in the 2017 budget which im hopeful you will get to operate without a continuing resolution before the end of next month, and youll see there will be never very substantial increase for the National Institute of health. Going forward, and also for the center for Disease Control. And youve heard me say this before, but i really believe it. These two institutions in particular, theres lots of good things in your budget, but these two in particular are every bit as important for the National Defense and National Security of the American People as the pentagon is because, frankly, youre much more likely to die in a pandemmic than a terrorist attack. So maintaining the ability to rerespond to be terrorist attacks, to respond to unexpected things like ebowla and zeke i can, extremely important for the country. I know you see it that way as well. Youre in a tough position and have to make tough decisions and i respect that, but this committee and certainly me personally will be very hesitant about about looking at cuts to the nature that were talking about. And frankly pretty insistent on finding a way in the total budget to not only maintain the offsets that the president wants to, but spread them more broadly across the full budget, but do it in ways that we can continue this investment in what i think is really cutting edge and important Biomedical Research and certainly at the center for Disease Control whats literally the frontline of defense. Id much rather fight ebowl la in west africa than dallas. So i just i say that sought there just up front because we will have some differences, but i want to make it clear theyre not differences in the basic thrust of what the president s trying to do. Its just that doing what congress is supposed to do and trying to think maybe more broadly across the entire bubt budget, as i know youve done before, ive seen do you it. And try to make sure that we prioritize whats generally important. And defense is genuinely important. These things are part of the defense of the country and its development too. I look forward to our discussion, i know it will be thoughtful. I know you will make good decisions on behalf of the American People Going Forward because i know who you are and ive had the opportunity to serve with you. And this committee looks forward to working with you fully and openly and transparently. We had an excellent relationship with your predecessor and secretary burwell whos someone i think very highly of but i know well have an excellent relationship with you. And i know how well youll serve the American People so this Committee Republican and democrat alike looks forward to working 2000 achieve that common goal. And i know thats the president s goal as well. Had is the beginning of a process, i hope we get to the end of a process where all of us can take a great deal of satisfaction and that weve achieved the objectives that we all share and frankly discharge the duties that were all obligated to discharge. With that, i want to turn to my good friend the Ranking Member from connecticut for any opening remaerkz shee cares to make. Thank you very much mr. Chairman and welcome mr. Secretary to the subcommittee and your first appropriations hearing. Certainly not welcome to the congress which say place that you know well. We meet during perilless times for the future of healthcare in our country. With the threat of rising premiums, rising did he duct ablds and the uninsecured, americans were protected last week when speaker ryan pulled a bill from the floor that would have repealed the Affordable Care act, the fate of their healthcare now lies in your administrations hands. I have been deeply disturbed by President Trumps recent threats to sabotage Health Insurance for the millions of americans that rely on the Affordable Care act every day. And last week from the oval office he said, and i quote, the best thing we can do politically speaking is let obamacare explode, end quote. On february 27th, he told the National Governors association, again i quote, let it be a disaster because we can blame the democrats. Politically it would be a great solution. I find this speech to be insulting to the millions of workers, children, and Older Americans whose futures are on the line. The healthcare of the American People is not a political bargaining chip. The idea that the president of the United States would intentionally undermine the health and the Financial Security of millions of americans for personal political gain, my view, is malicious. Mr. Secretary, i hope that you will assure us today that you intend to be use your position to strengthen the individual market place thats used by millions of americans instead of sabotaging it for any political gain. I hope you will tell us today that you concur with speaker ryan when he says that the Affordable Care act is the law of the land and that we will there will be no further attempts to repeal it. But rather take a look at the ways in which we can improve and strengthen the Affordable Care act. Moving from the failed repeal of the Affordable Care act to the Budget Proposal. I think you know what my response is on the Budget Proposal. Unfortunately, i do not have anything complementary to say about your budget request. In fact, i think it say disaster that will have literal life and death consequences for american families. 15 billion in cuts to hhs is untenable. Much like speaker ryans Health Care Bill that failed last week, the Trump Administrations budget request for the department of health and Human Services would eliminate Critical Resources and programs for lowincome and working families. It would also decimate the National Institutes of health, the worlds foremost Biomedical Research institution, severe negative consequences for Public Health departments across our country. To be clear, President Trump is proposing to cut nih funding by 6 billion. This is really an understatement since we just saw that the administration wants to cut an additional 1. 2 billion from nih in 2017 as well. And i hope you will tell us whether or not you agree or disagree with that additional cut. Cutting billions from nih would be devastating. Cancer research, alzheimers research, hiv aides research as well as research to prevent any cure of any other disease that is causing misery for millions of americans and their families. Make no mistake, this cut will turn back the clock on lifesaving Biomedical Research that you know and i know and the chairman knows and everyone on this committee knows has the power to save lives. Mr. Secretary, we know today, we need to know today, do you agree that we should cut 6 billion from the nih . And i would just might add that this is 6 billion below what you voted for in the a. M. That bus last december. We are choosing to hamper our progress as a nation, we are choosing to ravage our medical community. President trump is also proposing to eliminate the low Income Home Energy assistance program, lie heap which allocates 3. 4 billion each year for heating and cooling homes for nearly 7 million lowincome households. Earlier this week i heard subpoena from constituents who depend on this. Susan derk by, connecticut roar anguish creased faces and please for help filled the room. They came from people like amanda diaz who works 40 hours a week while taking care of two Young Children and a sick mother. Chris an keenny, a former nurse left disabled, a girl that recently graduated from a griffen hospital training program. These programs are vital. Amanda diaz said. She said people like me dont just stay home, i work, i have a fiveyearold daughter who has asthma and my mom has lupus. Diaz says minimal heating assistance she received probably kept her daughter and mother from getting sick last winter. Ms. Keenny said, and i quote, how does this government think we can just cast people aside . A disabled former nurse, she wiped tears from her eyes and she said, they are putting numbers down but we are talking about humans. These are the words of folks. They rely on this program to keep their kids healthy, to keep their families safe. And President Trump is also proposing to eliminate the Community Service block grant program, a Critical Program that connects people with job training, nutrition programs, lie heap and more. He would propose slashing funding for the centers for Disease Control which gives to state Public Health departments, drafltically reduces surveillance, epidemiology, Laboratory Testing as well as immunizations and Emergency Preparedness activities in the states. I was pleased to read in your testimony about your commitment to Emergency Preparedness and how we need to foster that effort. In each of these cases, President Trump is proposing to eliminate programs that help lowincome workingclass families, often the same families that put their faith in him during last years campaign, or hes proposing to cut programs like the nih, the cdc that benefit all americans and at the same time hes preparing to introduce a maxsive tax cut for corporations and millionaires just as he did in the failed healthcare bill last week. For decades, republicans have advocated massive cuts to hemg and education funding, such as with hr 1, the very first thing that republicans did when they took the majority, which proposed cutting the nih by 1. 6 billion and 10 . Unfortunately, President Trumps budget is finally showing the destructive impact that those cuts would have on our communities. Cuts to medical research, cuts to Public Health departments, cuts to home heating and cooling for lowincome families, cuts to meals on wheels for Older Americans, cuts to nurses training, cuts to family caregivers, cuts to Family Planning service and the list goes on. My insesincere hope is that President Trumps budget is dead on aifr rifle. Its cynical, vindictive and will cause real harm to millions of american families. Mr. Secretary, i look forward to finding out whether you support these reckless cuts. I sincerely and truly hope not. Additionally, i read your testimony and i know that you do not have all the numbers yet and i would ask the chairman if we could have the secretary return in may to testify when we know the full extent of this budget when it comes around to may. I thank you and i look forward to your testimony and to our discussion. Thank the general lady. We have the privilege this morning of having my good friend the Ranking Member of the full committee here as well, and just for the record, i want to say i was very privileged last night to be with her when she received lifetime award from Alzheimers Association for the distinguished work shes done over the worse of her career. We have some of those folks associated with that effort here and we thank you for your good work as advocates and we certainly thank you for honoring our colleague and dear friend. With that the general ladys recognized for whatever remark she cares to make. Now youre being so very gracious, but i think we should tell the group that i was honored to be honored with you, my friend. And i also want to say. I was kind of hoping youd bring it up, but. And i do want to say, because i was glad you referenced it in your opening remarks, i was part of this committee when the republican, john porter, doubled the money for the nih. And i know of chairman coles commitment to alzheimers, to the whole range of diseases which we focus our efforts and find cures and prevent the terrible pain that this illness has caused. I also remember, mr. Chairman, when we used to say there are democrats, republicans, and appropriate eightors and we have to get our work done. So i am very optimistic that at the end of this process we will make major changes to the bugts, the skinny bugts that have been submitted to us. So with that, my friend, i want to join you in welcoming our guest today, secretary price. This really is a strange hearing. You come before us with a quote skinny budget that doesnt contain many numbers and the few clear details would have catastroic results for americans. Heres what we know about President Trumps budget. The nih would be cut by as much as 5. 8 billion, resulting in 3,000 to 5,000 fewer annual Research Grants. Nursing Training Programs would be eliminated. Without lie heap, 6. 8 million elderly and vulnerable americans would be left without heating assistance in the winter, cooling assistance in the scorching summer heat. And the department of health and Human Services would be cut by 18 putting critical priorities at risk. The 18 cut to hhs could endang biosecurity, medical research, Mental Health counseling, Substance Abuse, Early Childhood development, combating disease and he demmics, vaccine development. I dont think i have enough time to list all the cuts. But you know how serious they are. There are no two ways about it, its just not possible to make an 18 cut without decimating investments that americans rely on. So, we should be honest with the American People. President trumps budget plans are nothing more than a broken promise while special interest loopholes remain intact. If youre working hard every day and still cant make ends meet, youre out of luck in trumps america. You also come before us days after trump care crashed and burned with policy proposal constantly changing in an effort to appease the right wing in its final days. Im not certain that any person in this room, perhaps including you, mr. Secretary where are could articulate the Trump Administration policy on healthcare other than repealing the Affordable Care act and taking healthcare away from 24 Million People. I certainly hope, mr. Secretary, that last weeks failure of trump care has made clear that the American People want the aca to be strengthened. And i think working together democrats and republicans, if we look at it with open eyes, we can strengthen our healthcare system, especially in light of the news overnight that republicans have backed at trying to repeal the bill. I dont understand that. Instead of working together to improve, to strengthen the Affordable Care act, without a plan in place, theres talk of repealing it again. And i want to make it very clear that we will call out any attempt by your department to undermine Americans Health coverage. So i help youre not inclined to seek a, quote, death by a thousand cuts approach testify to decimate the aca. So i really do look forward to hearing from you about the administrations plans for the department which you lead. I also hope this will not be your only visit and that you will return to testify on the full budget when it is released in may. So, again, i thank you for appearing before us, i thank the chairman for having this hearing, and i do hope we can Work Together as we move forward democrats and republicans, for the pep of this country, those who were here talking to us about the impact of alzheimers, for all those who have really suffered, we can make the bill better. And rather than tear up the aca, lets Work Togethering to stre ten and improve it. Thank you. Again, secretary, thank you for coming here before us. And we look forward to hearing whatever testimony you care to give. Thank you, so much, mr. Chairman, chairman cole and ranking mem member de lor row, chairman Ranking Member lowey, thank you so much for the opportunity to be with you and discuss the president s budget blue print for the department hemg and Human Services for fy 2018. Since i was sworn in last month as secretary i had the opportunity to meet the employees working right acrosses the street at at many of our agencies litd rally around the country. Ive been continually impressed well, the myriad ways that hhs supports local communities in times of emergency. Often in ways that the American People never know about. When californias orrville damn risked breaching in february, hhs was ready with its preparedness to help meet the needs of that community and when a Natural Disaster strikes, local authorities rely on hhs data to know which households in their community were energy did he pendant and in need of assistance. This kind of federal support rarely makes headlines but for the farmer who lives miles from any First Responder and downstream from a distressed damn or from the snowin elderly who requires oxygen hhs can be a lifesaver. Two weeks ago the president released his first budget blue print for spend pgt it requests 609 billion for Discretionary Spending at hhs. The blue print makes strategic vefments that will let is respond more efficiently to Public Health medical marijuana emergencies, empower americans to make the best decisions for their healthcare needs and prevent waste fraud abuse within the department particularly within medicare and medicaid. The vision for hhs has only been laid out in Broad Strokes and specific decisions on programs and account levels are still under consideration. Those details, as well as propozals on mandatory spending will be included in the president s full 2018 Budget Proposal which is expected in midmay. There are three priorities id like to highlight today. Our nations Mental Health and Substance Abuse crisis, resources for Emergency Preparedness and response and the fight to end childhood obesity. Drug overdoses have risen steadily over the past couple decades largely thanks to the misuse of opioids and they are now at epidemic levels. A staggering 52,000 americans died of overdose in 2015. And drugs are now the leading cause of death from injury in america. I know this issue has hit home in many of your districts and your communities. As a physician, and as an american, it breaks my heart to see a deadly epidemic rage across our land. And as secretary of health and Human Services it ask my responsibility to ensure that were tackling it with all Resources Available. The budget blue print reflects this commitment and hhs is investigating effortstor combat opioid misuse, reduce deaths from overdoses. Those invest menlts continue the 500 million for funding. Many americans are struggling also with Substance Abuse, they also suffer from Mental Illness if the the administration plans or continued investment in high priority Mental Health ibz issues including suicide prevention, serious Mental Illness and childrens Mental Health. Another critical function of the department is Emergency Preparedness. Hhs office of the assistant secretary for preparedness and response coordinates the prevention of, preparation for and response to Public Health emergencies and disasters, can which can frang out break of infeks infectious disease. And create a new federal Emergency Response fund which will allow hhs to rapidly respond to Public Health threats. With support from this subcommittee hhs has played a key role in fighting the zika virus, advancing diagnostics and providing resources to pregnant women. They continue to monitor the zika situation especially as we enter another mosquito season in the United States. They monitor the h 7 nb 9 flu in china. The childhood obesity, nearly 20 of Americas School children are obese. We owe it to theyll and their families do better and i look forward to working with you to augment the departments worthy efforts in this area. I want to thank again chairman Ranking Member, and the members of this committee for the opportunity to testify today and for your continued support of the department. Its an incredible privilege for me to serve the American People as the secretary of health and Human Services and i appreciate the opportunity to be here today and i look forward to our conversation. Mr. Secretary, whoever helped with you your opening remarks, keep them because they were 13 seconds, man. It was really good. Let me begin, mr. Secretary. As you know, the National Institute of health is the primary funder of basic Biomedical Research in the country. The Foundation Upon which all treatments an cures are based. The nih also supports trans transnational and Clinical Research on campuses at over 2,500 Research Institutions across the country. Discoveries by nih funded researchers since its inception have resulted in new treatments and cures for diseases and have greatly extend the Life Expectancy and quality of life for americans. Congress has provided significant and steady increases in funding for the nih to help bring researchers closer to finding cures for diseases like cancer and alzheimers. Im extremely concerned about the potential impact of the 18 cut the administration is proposed at the nih. Could you please describe how your proposed budget would enable the United States to maintain the Biomedical Research enterprise and continue progress in developing new treatments and cures within this funding level . I appreciate the chairmans perspective and i chair your commendation for nih. Ive had the privilege of visiting many of the staff divisions an operating divisions within the department and i had a visit with nih and was incredibly impressed, have been always in my Public Service incredibly impressioned with work that they do. Nih, as you know, is part of a Large Department that comprises over a third of the discretionary budget at the department of health and Human Services. The funding level thats proposed of 25 billion remains over a third of the entire proposed budget for the department. I was struck by the the need for efficiencies in decreasing duplication and the like within our entire department, but i was struck by one thing at nih, and that is that about 30 of the grant money that goes out is used for indirect expenses, which, as you know, means that that money goes for something other than the research thats being done. And i think what the budget is trying to do is to, being the first step in this process, is trying to bring process, is trying to bring focus to the kinds of things that we ought to be able do to get a greater bigger bang for our buck, if you will. The research thats done at nih, as you know, is incredibly important and i support that and want to make certain that are young scientists and scientists who have been there for a long time know how much we value the work that they do and want them to be able to continue. So our goal is to fashion a budget that focuses on the things that work, that tries to decrease the areas where there are duplications or redund answer scissor waste, and whether or not we can, indeed, get a larger larger return for the investment of the american taxpayer in this area which is so vitally important. We look forward to work wug to stretch those dollars further as well. So wed be interested in your input as we go along and you learn more on that. Vent experiences with zika and ebowla, other diseases highlight the importance of our investment in Public Health preparedness to protect americans from biological threats both naturally occurring and manmade. New threats can emerge at any time for example the number of h 7 n 9 virus have sky rocketed in china and if the virus becomes for easily transmittable we could see an out break of particularly deadly flu strain in our own country. Congress recognizes the importance of Public Health and preparedness. In fy 2016 we provided additional funding for the cdc project bioshield and barta. We continue to continue these investments in fy 2017. The fy 2018 budget blue print request does not include much detail on the administrations plan to support Public Health and preparedness against biological threats. Please describe how you intend to maintain and enhance our preparedness with the top line funding youre proposing right now for your total agency. Thank you, mr. Chairman. My opening remarks, a mentioned, Emergency Preparedness and response is one of the absolute priorities. This san area where the American People simply expect us do our job and do it well so that they can rest assured at night that theyre safe. Ive been incredibly impressed with the people at the department who are in the preparedness and response area. I get a briefing almost daily on the work that theyre doing, an update on the h 7 n 9 situation in china and thankfully we havent seen a transmission from of ian source to humans at this point. So our goal is to make certain that the resources are available so that we can accomplish the mission that is to keep the American People safe. I appreciate that and just before i yield to my good friend the Ranking Member, as you present the fuller budget later, please take into account, i mean, cdc plays an incredibly important role. We always focus on nih. This ability to respond and protect is every bit as important to protect our fellow citizens against terrorists so very important that that agency remain robustly funded because sadly on your watch we can almost guarantee there will abe pan demmic, there will be something, thats just going to happen. So in is a place not to be pen nipwise and pound foolish. I want to yield to the good lady friend from connecticut. Thank you very much. Mr. Secretary, im going to ask a bunch of questions and because i just have five minutes what id like do is be able to get a yes or no answer on these questions. The will the administration commit to defending and continuing the cost sharing efforts for lowincome consumers . The administration has done that so far, but despite the house lawsuit against doing so. Will you commit to defending and continuing these payments, yes or no . Ranking member, as you know, the day that i was sworn i changed from house v. Burwell to house v. Price so im a party to that lawsuit and im not able to comment. The clock is running out for insurers for 2018. Will the administration make a decision before the next Court Deadline of april 21st if not sooner . Im not able to comment. Do you agree should the administration reject many costsaving payments for the past three years and a half the insurance will drop out of market and raise premiums because of your decision . As i said im a party to that suit. But youre not a party to whether or not whether well, if it if the cost sharing stops, thats a judgment question. Will premiums go up and will insurers drop out of market . This side of the question is incredibly important because premiums has risen and its the commitment of this administration to make certain that were able to bring down costs for the American Consumer so that that theyre able to afford the question is about the cost sharing of opportunities, and that will will that drive up the costs . Thats what im not able to comment on. Okay. Let me then move to will you up hold the laws of the land even though you oppose . Thats my sworn oath, yes. Did that include enforcing the individual mandate, yes or no . The long yes or no. So long as the laws on the books we at the department are obliged to up hold the law. Youre aware. Cost not enforcing the mandates cbo estimated in december without the mandate premiums would jump by 20 . Will you work to avoid such premium hikes by enforcing the current law . Cbo puts a whole lot of stock in the individual mandate and we would suggest that the proof isnt there to suggest that the individual mandate actually increase. Will you work to avoid such premium hikes by enforcing the current law . Beg your pardon . Will you work to avoid premium hikes has as has been projektded by cbo yes or no. I would suggest that current law is increasing premiums and what the commitment of the administration is to make certain that every single american has access to affordable coverage. The office of the Inspector General is investigating hhss halting of advertising during open enrollment in january. Do you intend to halt advertising again this year, yes or no . I havent will any discussions about that. That was done prior to my arrival. Will you maintain or expand the level of funding and activity provided during the 2017 open enrollment . What were committed to is making certain that the American People have access to affordable coverage. Will you maintain or expand the funding for the marketplace call service Data Services hundred and navigators . Yes or no . Thats questions depend on the outcome of this process where this is the first step in the appropriations process so well see what theres a judgment call about whether or not this is i dont know where the decision was made to cut off the advertising during the open Enrollment Period in january, but that cut off peoples information about whether or not they should enroll or not. So are you will you continue that effort to disallow advertising to let people know about enrollment . If that happened before my arrival what will you do . Were committed to make certain that every american has affordable so you will do the advertising. Were committed to making youll do advertising. I wouldnt commit to the any specific entity because many of these things thats what were concerned about, mr. Secretary. Let me talk about past four years every eligible person, every corner of the nation has at least one Insurance Company offering a number of health plans. That was because the secretary of hhs worked with Insurance Companies, government state Insurance Commissioners to ensure access. Have you engaged with these key partners to date . Absolutely. Weve met with many insurers across this country and what they tell success theyre cream e extremely concerned about the marketplace telling us they arent concern given the current construct of the law how theyre going to continue to cover folks. Thats why we believe we need to move in a direction that allows individuals the greatest amount of choices in the coverage that they receive. We need to make certain that every single american has access to the kind of coverage they want and that its affordable. The sad point is that the current law is making it so that its unaffordable for so many americans. I would assume by your son sation that there will be continue to be an attempt unlike what mr. Ryan has said or speaker ryan said, about looking at repealing the Affordable Care act rather than looking at strengthening it and improving it. You can answer. Is that i question . Yeah. Repeal or strengthen and improve . As i say, the department, the administration is committed to making certain that the American People have access to affordable coverage but does that include repeal . Time. I understand, mr. Chairman. We believe that the current law has harmed many individuals. So you will continue to move out repeal is what i gain from that conversation. Thank you very much mr. Chairman. Thank you. I know the demands on the Ranking Members time are always great so i want to move, obviously, to her for whatever questions she cares to put. Thank you very much, mr. Chairman. I do have some additional yes, no questions four. Does the Trump Administration believe women should pay more for Health Insurance than men . We believe is that individuals ought to be able to have access to the kind of coverage that they select for themselves and for their families not that the government would you say yes or no when youre comparing men and women . I dont believe thats a yes or no question. What we believe that you as a woman and my wife should be able to select the kind of coverage that they wont not what the Government Forces on you. Does the Trump Administration believe Maternity Care should be a covered benefit under federal law. Again, individuals should be able to select the kind of coverage that they want not what the Government Forces them to buy. How about preexisting conditions, does the Administration Believe federal law should prohibit price kmangz or allow people to be denied coverage based on a preexisting condition skbl the president s been really clear about this as have i and that is that nobody ought to be priced out of the market because of a preexisting illness or injury. And it is impair activity that we have a am that works for patients, system that doesnt work for patients is not a system that works at all. Ill move on because im not sure that i understand that. Maybe we can have further discussions. Id like to talk to you about title 10, Family Planning. As you know, title ten funded Healthcare Providers serve more than 4 millionlow income women and men every year offering contra acceptive counseling and services strooeng screening for s tds, screening for cervical and Breast Cancer, health education, primary Healthcare Services, twothirds of title ten patients have incomes below the federal poverty level, 60 of women who receive Healthcare Services from a title ten funded clinic consider it their primary provider. In my home state of new york more than 300,000 women and men are served each year by title ten providers. In your state of georgia, almost 100,000 women and men are served each year by title ten providers. Mr. Secretary, does your fq 2018 budget maintain funding for the title ten Family Planning program . Theres a really important because often times as you mentioned its an individuals only line of opportunity to gain access to the kind of care that they need. And one of the priorities of this administration, and of this budget is to make certain that direct services, Healthcare Services are a priority. So is funding for title ten providers included in your budget . The on going conversations and i appreciate your input and look forward to having those conversations. The large specific budget will come out, as i mentioned, in my opening remarks. I do look forward to that and i hope that we can agree on the funding of this program because im not sure i got an answer to this question. Are you eliminating funding for title ten Family Planning services . Are you hesitant to tell this committee whether you want to cut funding for tight willing ten Family Planning, or can we have a real discussion understanding that new york, georgia, many other places, men and women depend on this for their Healthcare Services . Well, i hope we have a real discussion. And conversation. And as i mentioned, the specifics of the budget for fy 18 will come out in i believe its midmay. Okay. I have a minute left. As you very well know, Health Insurance companies are required to cover contraceptive Services Without a copay. Will you commit to ensuring that policy continues while you are secretary of hhs . Are women going to have to return to paying out of pocket for contraceptive. This is again one of those areas where we believe that individuals ought to have access to the kind of coverage that they want, not that the Government Forces them to buy and so we look forward to continuing the conversations, but to making certain that the American People have choice in the kind of coverage that they receive. But if they choose to have these services covered, will you support it . If they choose to have those services covered, absolutely. Thats the kind of thats the kind of program that they envision and that is one where individuals are able to collect selected kind of coverage that they want, not that washington thinks is best for them. Thats one of the problems that we believe has occurred with the Current System. Its clear that we have a lot of discussions ahead of us because i think maybe, maybe it would be good for you to visit the title ten services that are being provided in the clinics in georgia and you can come to new york we could have a tour too. I look forward to that visit and i would just say to the general lady that i visited many title ten facilities n my capacity not just as a physician but as a member of congress and know the importance, as i said, of those taent ties often times being the only avenue, the only venue for care for many individuals across our land. I really appreciate that, and as i close i do hope you can have that discussion with both democrats and republicans and that we understand how important these services are for people who couldnt afford to go other places to get those services. Thank you. Thank you. Thank you mr. Chairman. Thank you. I want to go next to my good friend and distinguished chairman the subcommittee on energy and water, the appropriations committee, mr. Simpson from idaho. Thank you for being here today, secretary price. I want to congratulate the president on select you as chairman of hhs. Often times as secretaries you have sometimes signatures secretaries appointed to various positions where theyre experts on policy and dont know politics and others that he know politics but dont know policy you know both of those and i look forward to work with you and i know youll do a tremendous job. I get confused easily and by a lot of questions that get answered and Opening Statements and those kind of things, ive got a few yes or no questions for you also. Do you want or believe that all americans ought to have access, access to affordable healthcare regardless if they choose to purchase it or not . Yes. Do you believe that healthcare consumers ought to have choices in healthcare Coverage Options . Absolutely. Do you believe that americans are smart enough to determine what is in their own best interests if given choices without the federal government mandating what is in their best interests . I do. Thank you. I think were on the same page. Now, to something really important. Lil little pa rokkial question. The cdc, his and Health Services all have dental divisions headed by dental directors. Unfortunately, hearsa has not followed suit and the last administration downgraded the chief dental officer to senior dental adviser. Theres a bipartisan support on this committee and weve put in report language the last two appropriations, i believe, to resource the hearse achieve dental officer position. Will you work with me and other members of this committee to restore this position so we can proeply prioritize oral health. I know your passion for this and comes from your history as a dentist practicing dentist and ive asked follow tokz look into that and see. I dont see any reason why we im happy to work with you but i dont see any reason why we shouldnt be able to accomplish that. It has been mentioned several times here and as you know having been a member of congress nih is very important to this committee and very important to congress and we will look at the funding levels that come up. They do vitally important work, in fact, its not only the work that they do, but they, with their Biomedical Research advances, its also they positively contribute to the economy last year 2 billion increase, saw an increase of 27,122 jobs and more than 4 billion in economic activity. So we all know the importance of nih. In the skinny budget, this is kind of the fult cult part that we can only talk about the skinny budget not the full budget so its kind of a strange time, the budget mentions a reorganization of nih. Is that a reorganization in structure of nih or reorganization as you mentioned earlier of priorities and Funding Priorities and how we fund things and if what youre looking at is trying to get more money into the Actual Research . I think thats important and thats something that this committee would support. Yeah. I think its both. We we obviously were not we havent made a presupposition about what the end point is in all of this, understanding and appreciating that nih is a Massive Organization that does incredible work. But as i mentioned professional, i think to the chairman is that again i was struck by the amouni was struck for 30 of the grants that go out indirect cost which you said, isnt for the specific research itself. We ought to be looking at that. Thats an amount that would cover much more than the reduction thats being proposed. So if, in fact, there are greater efficiencies that could be had so that you could provide more grants for individuals to be able to study all sorts of array of diseases and challenges that we have, they do incredible work and we need to support it. I appreciate that. It is one of the things ive complained about, i told people nih is probably the best kept secret in washington, d. C. The good news is they do great work, the bad thing is its kind of a secret. A lot of the research they do is grants out to universities and hospitals and those types of things. When they discover something, it is, you know, John Hopkins University did this and stuff. What the taxpayers dont know, its their tax dollars that went to grant to discover that. Somehow weve got to get the message out of the work that nih does to the average taxpayer. When the average taxpayer see what is theyve been done theyll be supportive of whats going on. I appreciate you saying that. Weve got to be trumting what it is we do. The American People that their tax dollars are spent wisely. And so whether its in preparedness and response or whether its in discoveries, we need to make certain that the American People know the incredible work thats being done on their behalf. Thank you. Weve moved to my good friend, general lady from california. Welcome mr. Secretary. Thank you. As was mentioned, your labor hhs budget summary recommends a reorganization of the National Institutes of health. This includes a proposal to consolidate the agency for Health Care Research and quality in to irh. At the same time, the president proposes nearly 20 reduction in nihs budget, making it nearly impossible for nih to fulfill its own core mission, let alone the mission of another agency. I strongly believe that the Research Portfolio is an essential part of the Health Research continuum. Because it is the only federal agency whose entire mission is to generate evidence and how to improve Health Care Quality facilitate access to care and control health care cost. Given its important mission, how will your department operationalize moving into nih and do you plan to make it an institute or a center within nih or is this simply a way to eliminate arc . Appreciate the question. As you know, this is the first step in this process and i would love to have your feedback on this. But we envision the opportunity for the nih to assume the duties, the important duties of arc and meant to decrease or reduce or eliminate the duplication and redundancy, and clearly some of the kind of things that are being done at nih are also being done at arc, we look forward to fold arc into nih and to gain those efficiencies and make sure were continuing to fulfill the mission. Well, im very concerned that arcs important Health Services Research Portfolio would take a backseat to basic science and Clinical Research within nih, especially when funding decisions are being made within a shrinking nih budget. But my other big concern about assuming arc into nih is the long tradition of congress being hands off when it comes to directing Research Within nih. Because in the case of arc, Congress Absolutely should be directing Health Services Research Since the federal government is paying for such a large percentage of health care in this country. So i really hope that you take a look at it because and i repeat, it is the only agency that has the sole mission as looking at Health Research, what are the safest and more accessible and affordable ways to provide that. And i appreciate that. And in my visit to nih and i i expect that many of the members of the committee have been there, i was really struck by the fact and i knew this but to walk the halls is you gain a different appreciation, that down one hall is where the research, the Scientific Research is being done and the scientists, the clinical scientists are working and then on an adjacent hall are inpatients are being seen and cared for. So thats where we believe that there are some significant redundancies within the system itself. Obviously what we want is to make certain that the clinical perspective is gained, as well, and much of that is being is occurring currently at nih. But will there be a specific institute or center within nih. Will it have its own. We havent answered that question yet, thats part of the reorganization, but i look forward to your perspective and and input. Im extremely concerned about your proposal to eliminate 403 million, approximately one half of the title seven and title eight Health Professionals and Training Programs, current operating budget. In todays increasing diverse population, hersa title Training Programs have been invaluable as a tool in creating a pipeline whoever wemingly return to practice and diverse and under served areas. Additionally, over five decades of the title 8 work force programs have played a Critical Role in bolstering nursing education, as well as building the supply and distribution of qualified nurses for all Hillary Clinton savings, particularly in rural and under served areas. Your budget favor scholarships and loan programs for addressing shortages. Well these are successful programs, do you have any compelling evidence that scholarship and loan repayment programs also build minority student pipeline, support retention and enhance the diversity of the Health Work Force with the same success that title 7 programs have shown . The work force issues are really pivotal, as you know, were have the wrong trend in terms of work force, not just for nurses, but other Healthcare Providers. I was hoping for yes or no answer here. One of the things that we believe are important is to focus on those areas where there is a Service Component to the payment back of the loan or the moneys being provided for education. Thats where weve tried to put the focus and the resources. Do you have items time is expired. We believe theyre theres significant success in that area. I would like to see that. Okay. Move to distinguished vice chairman gentleman from arkansas, mr. Womack. Thank you, mr. Chairman. I thank our witness this morning and i join the chorus of people, particularly those with strong opinions on this side of the die yes, sir dyess as we celebrate, were very proud of you and look forward to your service. Mr. Secretary, i was pleased, in your Opening Statement when you dedicated a portion of it to a problem that continues to challenge our country, thats this opioiod epidemic. Im pleased in your Opening Statement that youre committed to doing whatever is necessary within the constraints of our budget and these sorts of things that were going to do something about this. As you mentioned in your statement, cures, the cures act, but 500 million the Opioid Epidemic and give us the plans are of the agency to direct these funds so that we get specific out comes where we can actually move the needle on something that is seems to be moving away from us. And i thank you for the question. As i mentioned there, there are 5 the thousand deaths in overdose last year. 33,000 opioid related deaths. Every one of us know a family thats been just harmed to a significantly or communities that have been harmed by this crisis. I hope the Committee Members know that have drug addiction. And. Evidence of commitment by this congress to identify the challenges that we face and put resources, put hard resources behind it. The grants that will go out on that, that will be going out in first of those grants will be going out in april and well work through over the next number of months and make certain what were trying to do is identify those areas, states and areas that are having success in their treatment, how can how can wi put the greatest amount of resources in an area that will demonstrate and have the greatest amount of success in return. Thats the process were on. They havent gone out yet. Its a work in progress. As you know. The knee jerk reaction of the congress is throw money at the problem. And sometimes we throw money at the problem without any real specific idea as to how its going to be utilitized and there are many examples across the federal government spectrum where money is just not money is important, money drives a lot the end of the day, we because of constrained budgets, we need to make sure were targeting the money to the things that actually will work and im pleased to hear you say that youre looking at state programs, those that have had some beneficial results as a potential model for how a lot of this money is going to be utilized. Thats good. We double down our effort, section when we pass the comprehensive addiction and recovery act, section 303 of that act requires thatop atiav t caty pde f approved medications. How will hhs implement this requirement to ensure patients are provided with the range of options . This is another important area, weve got to make sure the resources are going, they can be utilitized in a way that will benefit the end user for the patient. Ive shared with the Department One of my perspective that is we need to think about people and patients and partnerships. And its to identify those areas and states, yes, but local communities, as well, who are actually able to accomplish the goal on the mission of mitigating the problem, getting people who are who have been hooked in this devastating challenge to be able to treat them in a way, treat provide treatment that increases the likelihood of them being able to conquer this challenge that they have and thats what were looking at mr. Chairman, im on the defense subcommittee. And i have a european command brief that i need to get to, i wont be here for a second round of questioning, i thank you for the time and i appreciate the service of dr. Price, wish him the very best as i do the atlanta braves. We do miss the go braves after every pledge of allegiance. We use to hear, your fellow georgians are much more muted than you are, mr. Secretary. I want to go to general lady from california, ms. Lee, recognize her. As i look at the budget and deep cuts which disproportion natalie impact the poor, low income, people of color, really impact everyone accept the very wealthy in our country. See, once again, i have to say mr. Secretary, i see what steve bannon meant when he talked about deconstructing the administrative state. As secretary of an agency, that millions of people rely on, it boggles my mind to know that you and your Agency Support this kind of a budget. It appears what you want and your agency wants to actually deconstruct the department that you are leading. The Affordable Care act is the law of the land. The president , however, sin cli said that it was going to explode on its own. Im concerned that your agency, through this budget and its policies, really are trying to make it explode by some of these cuts. So a couple of questions, first, and again, you can answer these yes or no because theyre pretty straightforward. Are you planning to narrow the essential benefits that ensurers are required to whatever we can do to make that happen. Thats an essential benefit under the law of the land. Do you believe that theyre required to cover maternity, newborn and care. Its important for every single american to choose the kind of coverage they want, what the government is best. This is the law of the land, mr. Secretary. Do you believe that it also said well enforce the law of the land. Okay. Then youre going to make sure carry out the law of the land. The essential benefits are covered, insurers should be required to cover Mental Health services. If its aspirational, we believe, again, that every american ought to be able to its not its the law of the land, mr. Secretary. Its not aspirational. It all depends what your question is. Were committed to carrying out the law of the land. Insurers are required prescription drugs, thats the law of the land, do you believe that insurers should cover prescription drugs . Or committing were committed to fulfilling the oath. Im committed to fulfilling the oath that i took, which is carry out the law of the land. Thank you, mr. Secretary. Now, let me ask you about the cuts as it relates to hiv and aids, the overall budget. As you know weve got a huge problem in america throughout the world and were making some progress and bipartisan way, i have to ask you, do you believe that we need to continue in a bipartisan way to address hiv aids cry sees both here and abroad as we have done in the past. This is one of those, Great Success stories, ryan white which started i think in 1990 and weve seen incredible process in the treatment, detection of treatment of hiv aids. Thats why we believe and well continue to make as a priority the direct services, direct Care Services in the ryan white area. Mr. Secretary, though, do you agree with the proposal. To hiv and aids. As i said, what we are what we endeavor to do, what we will make as priority is those direct services, whether its through the program or other. So you agree with the cuts, ryan white and all the other programs, based on the 350 million cut that youve proposed . As i said, what we believe im not sure where that number is coming from, the final numbers will be out in may. With Minority Health institutions, with this 11 million cut, again, its included as part of the Affordable Care equity. How did this justify upholding the law of the land with this cut. Were absolutely committed to looking at at health despairties and the challenge that exist there. Ive been incredibly struck by even in metropolitan areas, i use to represent a district outside of atlanta and atlanta theres a zip code that mr. Secretary, with an 11 million cut, how can you say that . What we as i said, what were trying to do is make as a priority, the Community Health centers, the kind of direct Services Available to individuals and find efficiencies in the system. Its a tough budgetary time to find efficiencies in the system. Hour goal our goal is to make sure that we concentrate on those individuals and have it as a focus, Higher Health out comes for them. You cant do that with an 11 million cut, mr. Secretary, going back to the Affordable Care act, this is the law of the land and expanding the initiatives under health equity. I think what i would say in response to that, as i think mr. Woe mack said, we tend, in this town, to be we measure oftentimes the wrong things. I would suggest that the amount of resources going into a problem, but not measuring the out comes, you mentioned, yourself, that the out comes, the health despairties dictate arent as we believe they ought to be, yet we continue to believe that simply throwing money at the problem is the solution. We believe that its important to look at that, identify what the metrics, what were actually measuring, whats the data. Data shows its beginning to work. Your time is expired. Thank you, mr. Chairman. Youre welcome. The chair reminds all of us, himself included, were trying to enforce the fiveminute rule here so that everybody can ask their questions. And the secretary has ample opportunity to provide a response. So with that, on the basis of order of arrival, youre next. Thank you, mr. Chairman. Mr. Secretary, well co. And also congratulations and i just reflect that your lifetime of service as a physician, as a Public Servant and now in this role, i really believe youre important place to make contribution to moving our country forward. So thank you for serving and its great to see you again. First i wanted to talk with you about some of the managed care issues and perhaps you may be aware that in some states, outstanding payments to Medicaid Managed Care organizations exceed 3 billion. In fact, theres one example of individual managed Care Organization unpaid receivables approaching even exceeding 500 million by states and theyve received little of their allocated federal match dollars. And im becoming worried that the instability this creates puts managed Care Organizations, medicaid providers, and most importantly, millions of medicaid beneficiary ris relying on these benefits at risk and i just wondered if you can comment, if the department has any plans or tools in the tool box to address this issue. I appreciate the question because this is really important. If youre as a formally practicing physician, if i didnt know whether or not that income stream is going to be continuing, it wasnt clear to me whether i could continue to care for spa shents, thats the challenge that you identified whether its hospitals or fa physicians or other providers. Having been there short time, were going to put significant focus on how these payment streams can be much more predictable and certain. If there is you cant you cant ask these folks to land out there and stand out there for years at a time and not have some resolution. So were committed to working through that process. As a quick follow up on that, one of the issues thats been raised is the Social Security act as an antifactoring provision that prohibits medicate palts to anyone other than a provider and what this does is prohibits, you know, mcos from assigning their medicaid receivables to lenders who are not considered providers. I didnt know if theres anything that can be done to clarify some of the antifactoring provisions so that some of these providers can access and states are having difficulty make pg payments. Im not familiar with that specific item, were happy to work with you and see if theres a solution there. Okay. Thank you. And i appreciate your comments on Emergency Response. I wonder if you can offer some more information. Would you as secretary manage that fund. Thats the new task force. We would be controlling over that and determine exactly what level and what kind of resources would be appropriate for that fund. But thats a work in pro thats a work in progress and would love to have your feedback. What what are your account on barta, do you believe theyll have the resources it needs to continue its mission moving forward. Its really important. This has to do with whether or not were prepared in the event of a potential bio terror attack and the like. And the focus that we believe is important to make certain that it is a priority and that we have the Resources Available to accomplish the mission to keep the American People safe in the event. Okay. Thank you. Then one last question on poison control. I know in michigan we have a poison control center, people can call, you know, the center in michigan received over 70,000 calls from citizens, hospitals, Healthcare Providers, pharmacists, nurses, ems providers, the opioid situation where people need to answer quickly how to respond. In the past, my understanding is they were funded at 18. 8 million and will you continue or do you envision continuing this kind of a structure, or this kind of funding for poison control centers. Were working through the funding for all levels, especially in the area of opioid abuse and overdose. The numbers are staggers, as you well know. Weve seen remarkable challenges in our communities far and wide. Whether the greatest resource or the greatest venue of making sure theyre able to be resuscitated from overdose, whether thats poison control or elsewhere. We want to make sure were doing the kind of things that will effect the patient. Thank you mr. Secretary and i look forward to working with you moving forward. Thank you, mr. Chairman. Its great to work with you. So let me just try to follow up a question at the end and kind of ran out. Last week. What is the position, is it to repeal the Affordable Care. The position is that we find ourselves right now in a position where the Current System is not i got that answer before for me, i guess the question, specifically, he said he was going to move on last week, this week it looks like theyre still trying to do a repeal. Are they not moving on like the answer was last week or is it that you are still trying to repeal the law. We have to fix the problem. Theres a huge challenge out there for folks that got one third of the counties that only have one insurers. So the administration is still trying to repeal. Maybe this is a better were trying to make sure that individuals have access to coverage and care. The failure of trump care, was it due to the democrats, which is one tweet. Is it due to the tea party, or was it do to 18 of the public supporting it. What was the reason, why did it fell last week, in your assessment. Ill let others make their conclusions about that. Make sure they have the highest quality. You dont know necessarily why it failed last week . I understand. Nih, you know, i think youll her it from many of us, very important in my state of wisconsin. Theres a document yesterday that got some press, it looks like it came from omb suggesting in the 17 budget to cut nih, i think, 1. 2 billion, was your office consulted on this document . There were conversations that a staff level about that document coming forward. I dont know if their conversations about the specific reduction in there. Are you supportive of the 1. 2 billion cut and. As i mentioned before, i think what we need to do is identify savings so that we can provide the greatest amount of bang for the American People and i support the priorities of the budget. So you support this document. I support the priorities of the budget . In this specific document for 2017. Thats a work in process, as well. I think weve gotten into the 28th. Turns out to be ironically the 1 hundredth day of Trump Administration, hopefully we dont have a shutdown on that day. You voted for the 21st that we finally put some additional money in nih i know youre supportive of that when you were in congress. That youre supporting, our problem is, you just mentioned the overhead and indirect cost, indirect cost, what are some of those costs or indirect cost that 30 youre trying to address. They may go facilities, they may go for all sorts of things at the either university or that dont have to deal with the specific research being done. You might want to wait another month or so when it gets a little better. Im sure senator johnson and baldwin will welcome this invite as well. Were studying right now with a lot, everything from flu viruss to zika, diabetes, heart disease, colon and lung cancer, ebola, everything, were doing a lot of work, we have a real Class Research university. You mentioned new researchers, i think when i talked to folks around some of these costs, theyre afraid no matter what theyll see very money going for the cures we just voted for, you and i in the 21st century cures act. I would like to extent that invitation, weve got amazing stuff happening and i would love for you to see that first hand. Amazing cheese, as well. You know, again, the president said that he was going to remove barriers for entries into the country and talk about other concerns he had around cost of prescription drugs, you know, i guess if you look at the prices of drugs in other countries and ireland, particularly, one i looked at very closely. Do you think thats fair to the American People . The president is committed to this, as you well know, hes said on multiple occasions i guess, specifically, whats your department doing from negotiating drug prices, whats your department doing to try to address concerns. Were in the process of the white house of formulating a strategy to address that as i said, the president has on multiple occasions voiced his commitment to making certain that we do as a nation have a strategy to bring those prices down. Ill volunteer as democrat to help on this side. The 28th of april is also the chairmans birthday and im certain that my colleagues on both seeds of the aisle and the president will not allow that to happen on my birthday. Maybe they want you to take a holiday. And i go to my good friend, the gentleman from maryland who has considerable expertise in these areas because it was professional background. Gentleman is recognized. Thank you very much. And doctor its good to see you. Its good to be calling we finally have someone who truly understands Health Policy in a way its difficult to do if you havent delivered care to patients. Obviously, a lot of it is unintelligible. I mean, they only assume the statutory changes; is that correct . They just were scoring, that piece of legislation. And in fact, the secretary, we know, thousands of times in the aca, secretary will, whatever, that you have you do have, and this could be a very short yes and no. You do have the ability to make regulatory changes that would dramatically lower the cost of insurance for americans. 1,442 time it is aca said the secretary. And the cbo took no account of that at all, and their score. And let me get over to obviously, were all very interested in nih, you bring the issue of indirect cost, i know how how its done are you aware the American Lung association issues a grant. Research grant to research of hopkins or somewhere else, they pay no indirect cost, they dont allow them. The American Heart Association maximum 10 . We have people in room, 10 . Bill and Melinda Gates foundation, 10 , thats it. Robert woods johnson foundation, 12 . Yet the nih are allowing grants to go out at much much higher. Its very interesting that the private sector doesnt hold these indirect costs to be so valuable as to pay them. When the taxpayer dollars involved, somehow we do, the indirect cost total for last year was 6. 4 billion, actually if we just issued our grants with American Lung association rules, we could fund more research than we do now, with the president s skinny Budget Proposal of 5. 8 billion cut. Let me move on, youre also in charge of the Medicaid Program in nhhs. Medicaid is a broken system. Its a broken system, in fact, youre aware, i assume, of the oregon experiment paper. This is the premier medical journal that showed when you enrolled people in these medicaid expansions on a lottery basis randomize is great. You couldnt design a study that well, showed that there was actually no difference in out come we diabetes, hypertension. It actually testified as to how broken our concept of medicaid is a solution for the American People is. Beyond that, if you go to the payment accuracy. Gov. It shows that the improper payments and Medicaid Program, last year on 346 billion, with 36 billion, almost 10. 36 billion of improper payments in a program that scientifically doesnt help people. It doesnt help their out come very much. I would hope. And medicaid medicare similarly, 41 billion improper payments. We were promised when the Affordable Care act is passed. Well eliminate waste, fraud, abuse and health care. Last year we had 41 billion in medicare. As secretary, do you commit to us, that as we commit funds to the department and the department is going to take a real hard look at how just between those two programs, its 77 billion. 77 million. If you put Medicare Advantage in there. Its 90 million. Commit to us youll take a real hard look at those issues. Absolutely. Its to try to find the waste and abuse. As you well know in the Medicare Program, for every dollar thats spent on trying to detect fraud and abuse, theres a 12 return on every single dollars that is spent. This is an area thats significant savings that can be handled. It seems like a good idea. Hoip that you, you know, fda side, the labor rule is an issue, please take a look at it. You know, Small Business owners come to me every day with issues. Thank you very much, i yield back, mr. Chairman. Thank the gentleman, just want to remind the gentleman, i too am a doctor, im not the kind of doctor that can help you. With that, i want to go to the general lady from massachusetts. Before i do, i want to say she may be the smartest member of this committee she was kind enough to send me two extra tickets to the president s inauguration, probably in higher demand in oklahoma than massachusetts, but the gesture was very much appreciated. We are always pleased to help you. Thank you mr. Chairman. Thank you mr. Price for being here with us today. Thank you for your call. Im sorry i was unable to connect with you before. I share your characterization of this crisis as heartbreaking, thats what it is, the families in my District Across this country, this is an issue that doesnt care if its a red state, plu state, what level of education you have, how much money is in your bank account. Its an equal opportunity killer. But it also ties in to the Affordable Care act and the mandates because as you know, Addiction Treatment was one of the ten essential benefits that were covered by the Affordable Care act that mandated that is meant this provision has helped 2. 8 Million People with drug use disorders get the treatment that they need. If we repeal that provision, that will take out 5. 5 billion annually from the treatment of low income people with mental and Substance Abuse disorders. The number that you used is higher than the numbers ive seen of 32,000 detds a year from overdoses. This is a staggering impact on our country. Will you support mandated coverage for Addiction Treatment . To clarify, the 52,000 is thats from all overdoses not just opiod and 32,000 from opioid. This happen flat. Its an awful scourge. This is remarkably important to make sure we have treatment available for folks. Thats why were going to make it a priority. Im struck, however, by the 20 million individuals who dont have any coverage at all through the aca. I believe there are reasons for that, they either took the penalty or asked for a waiver. I would suggest, respectfully, that we ought to look at why that is. Why sit that 20 million americans say, no thanks, i dont want that coverage, even though its mandated or even though theres a penalty for it. I would hope we could Work Together and fashion a program that would attract those individuals to get the kind of coverage they want for themselves and their family. And i would be delight today work with you on that. I would like to know, specifically, do you support a mandate for Insurance Coverage for streemt. What we believe is that every single american needs excess to the kind of coverage they want. Do you support mandating it . Thats the law under the aca. Do you support that mandate . We support the ability for every single american to have access . Can you answer me specifically, yes or no. Do you support a mandate that Insurance Companies cover Addiction Treatment. Thats not a yes or no question. It actually is. Because the answer to is that we believe its absolutely vital that every single american have access to the coverage that they want for themselves. Im going to take that as a no. If you either support a mandate or you dont and there are certainly ways that we can increase coverage. But if you dont support a mandate and youre concerned about people who even with mandated coverage have chosen not to avail themselves of treatment, how would you how would you answer the question to the families at home who are ravaged by addiction, that at that point in time and try to buy themselves coverage, is that what you envision. Theres certainly other ways to provide coverage and care for folks that dont require the federal government to dictate to people what they must purchase. Do you see the mandate as dictating to people what they must buy. Do you see those as equivalencies . Is that yes or no. Yes when the federal government decides exactly what coverage you must purchase and its deciding what coverage you may not purchase. So you would see that the mandate that we have under the current Affordable Care, two Insurance Companies that they cover Addiction Treatment, that that is somehow limiting peoples options; is that right . As i said, what we believe is that every single american needs to have the opportunity and be able to afford the kind of coverage they see for themselves and their families. Will you protect access and medicaid funding levels to ensure that those people do not lose their access to Substance Abuse. Substance abuse and Addiction Treatment is absolutely a priority. As you heard from dr. Harris, the medicaid is broken. When i talked to my former colleagues, they tell me its impossible to care for individuals in the medicaid system. Youve got a third of the physicians in this country who ought to care for medicaid patient who is dont, its not because they dont want to see them its because the system is terribly broken. I dont see how were going to improve that system, but i do want to ask you one more question ladys time has expired. Ill get you on the second round. Thank you. And i thank you the general lady. Next we go to general lady from the state of washington. Thank you, mr. Chairman, and thank you for being here. I can only imagine. But even with your background as physician, congress and caring for folks, its got to be e lek tering from a fire hoese, we appreciate it very much. Nearly all these receive a vaccine while pregnant or its recommended. Pregnant with chronic conditions such as asthma, diabetes, depression are faced with difficult decisions whether to take a medication or that they have no information or background on or whether just to fight through whatever their condition is. I work with a number of folks to get included in the 21st century language around task force at nih asking them to examine the gaps and knowledge for pregnant and medication and National Institute of Child Development has begun implementing this task force. Expected moms need more data and information in order to make informed treatment decisions and they need it yesterday. I just want today bring this to your attention and ask for your help in prioritizing this as we move forward. This is one of those areas where people assume that the data exist but in fact it doesnt and the kind of studies that are necessary to make certain that moms and families know that something is either safe or not so they can make an informed decision. Thank you. On to a different one. Every year thousands of americans donate a kidney or a portion of their lung or liver or pancreas to save the life of family member, friends or total strangers, Organ Donation does save lives. And ive introduced the living donor protection act with congressman adler, it was remarkable to me as i sat and listened through some of these statistics about 118,000 people on the transport wait list. Everybody has two kidneys, almost everybody has two kidneys. Its one of those things that we can right now i think its about one and 12, 12 people die a day waiting for that every ten minutes we add people to that list. This is something that were having part of the reason we introduce the living donor protection act was because what weve seen in some instances is Insurance Companies will discriminate against someone who has given an organ when they dont realize in order to give a organ, you have to be the most healthy, tiptop, everything has to work well before youre allowed to be considered. Companies will discriminate against them. Were trying to get some of those things fixed and addressed. I wanted to raise it to you. I think what i was looking at some of the numbers ive seen. Kidney disease is ninth leading cause of death, in front of Breast Cancer and prostate cancer, in fact, 26 million americans have it. Most of them dont even know. This is going to be a real challenge in our future. We want to encourage those folks who can donate to do so. I just wanted to raise that to your level, as well. And one more thing since i have a few more moments. Give im going to read it fast. Given the unprecedented advances in jangi nettic testing and screens, im concerned that folks we represent will receive test like cell free dna screenings without the appropriate preand post genetic counseling, oftentimes these tests can mean different things. The information thats given out isnt always given out accurately with all the drawbac drawbacks. I wanted to ask your view on this issue and the importance of making sure theres accurate genetic count lo genetic or screening and theyre aware of the pitfalls. People make decisions based on these tests. Its important that the individuals that are conveying the information are knowledgeable. Sometimes the risks or the consequences of the results of the test. Sometimes theres not. You need to be able to treat that with compassion and knowledge, as well. Absolutely. Well, with that, ill yield back the balance of my time. You win gold stars and you always do. Again, just to make sure everybody has an opportunity for a round of questioning, my good friend the gentleman from tennessee is recognized for his questioning. Thank you mr. Chairman, and secretary price, i know youll appreciate this, having been a great member of this body, i was delayed this morning because i was asked to preside as speaker pro tem at the last moment, i apologize for being here a little bit later. Let me echo the applauds on the people of this dyess thank you for your service, not only to this house, the administration, and country. Its a very difficult time. Health care is a very complex issue. Youve got my full support and, again, profound thanks. If i may begin, i actually have a nonappropriations question to start off with and its regarding an issue for federal drug testing programs, sir. The department of transportation requires Trucking Companies to follow hhs guidelines when screening Truck Drivers for drug use. Its my understanding that samsha has been working on developing guidelines for hair testing as a federally accepted method for several years. And congress strongly endorsed and accelerated development of these guidelines in the fast act. It has been over a year and samsha has still not yet produced these guidelines. I wanted to make sure that you were aware of this, sir, and as the completion of these guidelines will greatly improve truck safety, and secondly, would like to know if you might have any insight as when we might expect them to be completed. I appreciate the question and i learned of this yesterday. I wasnt aware that work was going on and appreciate the focus on it and we will get we will were looking into that and ill get back to you on the specifics of when you might anticipate an answer. Thank you, sir. Earlier you were kind enough to answer a colleague for my dear friend, but i would like to revisit that, if i may. Mr. Secretary, as you know, hhs leads federal preparedness response actives for public emergencies, including developing, stock piling, like vaccines and treatments, four National Security threats. For the last decade, bio medical advanced research and development authority, barta and project bio shield have successfully partnered with bio pharmaceutical manufacturers to develop and stock pile products to protect americans from the most urgent threats we face, like an thrax, smallpox. Its been supported by members on both sides of this committee for more than a decade. Im glad to see youve been a longtime supporter of bartas critical mission. Unfortunately the previous administration, i would argue, did not prioritize it in the development of Counter Measures at hhs. Can you commit to ensuring barta has the resources it needs to this critical. Its absolute priority. The American People expect us to be prepared and be able to respond in the event of a collage, especially in bio terror area. So it is an absolute priority of the departments. Thank you, sir. My final question, secretary price, the National Academy of science is reported, theres a declining number of Research Grants awarded to early investigators, rise in the age of grant recipients and the suggestion that there may be a research drain. Last year more than twice as many ro 1s, the nih grant are awarded to principle investigators who are over 65 and under 36. That is a total reversal from 15 years ago. Currently nih work against young scientists they dont have the preliminary data to support their application. Young researchers cannot get the preliminary data without significant funding creating a catch 22 for the young investigators. With these concerns in mind, do you have any input on how we can empower and encourage the next generation of researchers to keep their talents going towards american scientific innovation. This is imperative. There has been a flip. And in terms of the age of the grantee and we need to get to the bottom of that. I dont have an answer as to why that has occurred, but were looking at that and well continue to look at that so that we can indeed address it. These young scientists, we want them to remain here. We want them to be here and be able to use their talents for the benefit of all. Thank you, mr. Secretary. I believe my time is up, again, i wish you every success in your endeavors, sir. Thank you. Chair has announcement. The secretary has a hard stop at noon. He has another meeting that i know he has to attend. I want to guarantee youre free to get up if were in the middle of a question. I know hes got to go at noon. To deference to try and to get in as many people as possible. Well move to twominute question, im going to ask folks to adhere to that. We have a member that was here and if they get back, theyll get their five minutes in the same way that all of us had an opportunity to ask. I think im actually next up, right . Okay. My two minutes and i will hold myself to this, mr. Secretary. Number one, thank you very much for taking the time yesterday to meet with chairman and myself about the Indian Health service that direct responsibility on this subcommittee but part of your department i do sit on the subcommittee than my mr. And thats important here, too. Youre aware American Indian continue to live with Health Disparities greater than any other Racial Health with a Life Expectancy fourandahalf years less than other americans. In some states like montana, American Indian men have a Life Expectancy of 20 years less than their white counterparts. I know you havent had an opportunity to flesh out your budget, here. I wanted to know how you expect your budget request, hopefully, to help the Indian Health service. Another hhs operating division to address health despairties and indian country. I think the chairman and youve been such a champion on this. This is one of those areas, where as i learn more and more, it is readily apparent to me that the kind of work that we must do has to increase in the Health Service to make certain that we decrease those despa despairti despairties, yes. Were also looking at the things that actually mean something, that is the out come, i was struck yesterday during our meeting with the graph that they all shared with the per capita amount of resources, federal tax resources that are going to the Indian Health Services Compared to medicare, medicaid and other federal health programs. And it just is very clear to me that this needs to be a focus. It is a focus. Its a priority of the department to make certain that we move in a positive way to address the real challenges that are in the indian community. I thank the gentleman. I look forward to working with him on that issue. With that i go to my good friend Ranking Member. Mr. Secretary, yes or no answers do you support the elimination of liep, yes or no, move, i dont have time. Do you support the elimination. The responsibility do you support elimination . Yes or no. The responsibility of the department is to make sure that the needs of the american so you support sh the elimination of csgb. What were trying yes or no . Elimination of communities and that there are partnerships. No, okay. Nih, the 1. 2 billion that was talked about, do you support that if your staff was looking at, you must have been involved in that and cut to nih in 2017. In 2018 do you support the 6 billion cut to the nih . Its been clear in the remarks that have been by both me and other on the panel and by on the committee. Is it 6 billion cut to the nih, do you support it or no. That there are efficiencies. So you support a 6 billion company nih. Let me ask you three or four other questions here. Have you divested yourself of all Health Care Related investments, yes or no . As i said to Confirmation Committee yes or no. And the answer is yes. Have you fulfilled the terms of ethics agreement worked out with the office of government ethics . Yes. Will you send a letter containing all of all of that is publicly available . Can we get a available . So well get it on our own. My last 17 seconds, it would appe appear, mr. Secretary, if all of those who want to talk about the Opioid Crisis if you voted to repeal the Affordable Care act, you would have vote today make it worse in this nation. You dont believe in ensurer covering pregnancy, newborn care, Mental Health services and Substance Abuse treatment, all of which come out of your department, mr. Secretary, i think youre at the top of doing what ms. Lee has talked about is deconstructing an agency and dismantling health care in this country. I would respectfully dispute that characterization. Im sure you would. I want to now go to the general lady from alabama. She has a full five minutes because this is her first opportunity to ask questions to the secretary. General lady is recognized. Thank you, mr. Chairman. Hi. So glad to have you here. Proud to call you mr. Secretary. So were real glad to have you in front of us today. I want to talk about wage index, hospitals are facing some acute financial pressure because of this health care despairty created by this specific medicare regulation and its adversely impacting alabama, the wage index doesnt get a lot of attention, although it should. Its a serious problem for a large number of states and it needs to be addressed. It was created to account for geographic differences in believe that its broken. Hospitals in my home state have been punished for operating efficiently, receiving one of the lowest medicare reimbursements in the country because of the flawed wage index system. So it creates this disparity that effectively punishes efficient hospitals in most rural states. In many of these states these hospitals have seen the area wage index levels rapidly decreasing over the years, reducing the medicare reimbursements in order to subsidize increases to hospitals in a handful of states. So, secretary price, i really just want to hear from you about whether or not you would be willing to work with us to repeal this wage index and replace it with a more accurate and fair system that would help us relieve some of these financial pressures that are placed on so many hospitals, including the ones in the great state of alabama. This is really important because i mentioned to another questioner there are folks who are providing care that arent able to provide care for folks not just in the Medicaid Program but in the Medicare Program as well and oftentimes its because of programs, policies, formulas that are just theyve outlived their usefulness. Its a demonstration of the lack of ability of the federal government to be nimble and flexible and respond to changes in the market so that the patients can be cared for in a better way. We are absolutely committed to working with you and others to try to identify the most flexible, the most effective way to provide treatment for the patients of not just alabama but the entire nation. Well, and i appreciate the work that the hospital association, you know, at the national level, but certainly in our state as well the work that they have done to try to draw some more attention to this issue and so im grateful for any opportunity to work with you. I understand that this is not going to be necessarily a partisan issue as much as it is an issue amongst the states because there are winners and losers and i just i believe in fairness and i think that there are people that are un states, particularly rural states, that are being unnecessarily on the losing end of this. Just real quickly i have spoken about in this Committee Many times the achievements of prek in my state and so i just want to touch on it really quickly. And i guess i can skip through some of this because my time is running out, but can you describe for us in as much detail as you can how the president s fy 18 Budget Proposal can ensure that a new competition will take place under the preschool Development Grants program and your plan for that competition, how will the Department Support improved collaboration and coordination amongst Early Childhood programs at the state and local level through the preschool Development Grants program to better serve low income kids and families . Yeah, this is really important as well and it is a work in progress and we look forward to working on you to make certain that the resources are there and available. There are programs that are effective, there are some that arent effective and we need to make certain that we are providing the resources for those that are effective and thats a commitment that we have. Great. Thank you so much. Thank you, mr. Chairman. Good to see you. I yield back. Thank you for yielding back the extra time. The gentle lady from california is recognized for two minutes. Given the two minute timeline ive redrafted my questions so that you can answer it yes or no. And this has to do with lead poisoning and prevention in Public Health fund. The ongoing flint water crises and the exit contamination in my own district underscores the severity of Public Health crises posed by lead poisoning in many communities across the country. According to the best estimates available lead poisoning impacts approximately half a million u. S. Children age one to five. Cdcs National Center for environMental Health currently receives 50 million for lead poisoning made possible by the prevention and Public Health fund. Cdc uses this relatively small amount to fund 29 states, d. C. And five u. S. Cities to conduct lead poisoning prevention activities. If efforts to eliminate the Prevention Fund through aca repeal are successful cdc would lose 12 of their annual budget including all of the lead poisoning Prevention Funds. Given the serious impact of lead poisoning on our children, will you protect the prevention and Public Health fund and expand the cdc lead Poisoning Prevention Program to all 50 states, d. C. And the territories . I will make sure that we address the issue without a doubt as flint demonstrate that had we need to make certain that water is safe to be consumed by the American People and the role that cdc has is significant. But will you protect the Prevention Fund . Its a simple yes or no and i have one more question and i have 28 or now 26 seconds to ask it. Whatever way were able to accomplish the goal and the mission to keep the American People safe in the area of this in this area we will do it. Okay. Will you ensure that the cdc has sufficient resources to maintain its critical surveillance and prevention activities across the country and around the globe . Thats an absolute commitment that we have and a goal. Is that a yes . It is our commitment to make certain that the cdc can accomplish its core mission. Okay. Im afraid its not a satisfactory answer. With that we will go to my good friend the gentleman from maryland, he is recognized for two minutes. Thank you very much. Again, pleasure having you here in front of the committee, dr. Price. Im going to go back to the medicaid issue because its a huge issue, its the most rapidly growing portion of the mandatory side of our budget as you know and, you know, again, that oregon study published in the new england journal, researcher from harvard and m. I. T. , those are the two researchers that did the study showed there was no outcome difference. In fact, ill read you the letter. Because sometimes they publish these and the new england journal publishes letters to the authors. There are four letters, this is from a professor at the university of South Carolina l. A. Said remember these assignments are based on lottery, whether or not they got into the program or not, his conclusion was awarding lottery winners equivalence of cash prizes worth 6,600 per year, you got 6,600 worth of medicaid, rather than medicaid might have improved their Health Outcomes and well being even more. If you go into the data in the study there are only four things that they showed a significant difference with less than 0 30 improvement. Cholesterol screening, just having a screening pap smear, mammogram, and psa test. Added together thats 200 worth of value. We pay 6,600. The fact of the matter is one thing we should put on the table is actually looking at whether or not we should allow the people who we put on the medicaid System Access to perhaps considering private insurance as an alternative. Its an important policy question because the Medicaid Program we believe is broken. There are individuals in our society who absolutely need to have coverage and care, but if we are not accomplishing if we are not measuring the right things, if all we are looking at the Medicaid Program saying this is how much money were putting into it but not measuring the kind of care being provided and whether or not folks are improving their Health Status within in a program we are not doing a service to the folks that are providing the resources but we are certainly not doing a service to those that are receiving the care. Thank you very much. Yield back. Gentle lady from california is recognized for probably the last two minutes. Thank you, mr. Chairman. I will be very quick. If we can then i will. Thank you, mr. Chairman. As you move, mr. Secretary, to deconstruct your agency do you support an increase of more than 54 billion for the pentagon by paying for it through cuts at your agency, health and Human Services . I think that its important to address the premise mr. Secretary, just yes or no. Im the secretary of health and Human Services and im charged with a department of incredibly committed so your answer is no you dont what i have and the opportunity to work with are 76,000 individuals who are as dedicated mr. Secretary, do you support increase in the military budget by over 54 billion by cuts at your agency. Deconstructing the department is not a goal. So you dont support it by paying for the increase in the pentagon budget . You dont support the cuts in your agency to pay for the 54 billion. Im secretary of health and Human Services, if youd like to ask a question about health and Human Services i would be pleased to answer. Also as you move to deconstruct your agency do you believe that low income people deserve the same access to Quality Healthcare as upper income individuals, the same Quality Health care . Thats been an absolute priority of mine since the day i entered no, since the day i went to medical school is that every single american needs to have the access to the highest quality of care and i must take issue with you, again, that it is not the goal of this secretary to deconstruct the department mr. Secretary, your budget is deconstructing your agency by this department effects every single american and it is my responsibility to make certain that we provide the services in the most but, mr. Secretary, your budget does not say that. It is a roadmap to deconstructing the entire agency which you head. Thank you. And i yield my time. Gentle lady is recognized for what really will be the last question. Thank you very much, mr. Chairman. I want to go back to the budget and the opioid line item. It says in your budget there is an increase of 500 million from fy 16. So i want to be clear. That is level funding that you are proposing for fy 18 because we already we already have 500 million in there. I think the 500 million is the 500 million from the cures act, yes, maam. So there is no increase its just level funding. Thats correct. I want to follow up on the question about the defense funding and nih. As we look at the alzheimers folks who are here and we know the scourge that alzheimers is and that it is taking one out of five medicare dollars, with whatever inefficiencies may be at nih and we can have a long discussion about how we fund our universities and the Research Partners they are and what indirect costs really go to, why would you decrease the budget overall . As i mentioned before i believe to others this is a tough budget year, there is no doubt about it and this is an opportunity to it returns 60 billion in our economy never mind the good that it can do as far as a win for patients, a win for science and a win for our bottom line. Its an opportunity to focus on those kinds of things that will allow us to accomplish the core mission and to actually get greater dollars, more dollars to the research that must be done in order for us to remain at the forefront of my final question is mr. Severino is now the head of the office of civil rights for hhs. He opposes the implementation of section 1557 of the aca which prohibits discrimination based on race, color, national origin, age, disability or sex in federally funded programs. Do you support those prohibitions on discrimination in healthcare . As ive said before we will uphold the law of the land. Thank you. Thank you. I thank the panel. I very appreciative, mr. Secretary, your time and frankly your accessibility to the members of this committee, your outreach to us before your testimony, your willingness to meet. I know a number of my colleagues certainly including me have had the opportunity to sit down with you and your staff and i very much appreciate the accessibility and as we Work Together trying to solve our common problems and again, i think i expressed the sentiment for this committee, certainly from me, you were a tremendous appointment by the president , we know you are going to do a brilliant job for the American People and we look forward to working with you every step of the way. Thank you, mr. Chairman. Thank you, mr. Secretary. Meeting is adjourned