Serve as administrator of the centers for medicaid, medicare and Medicaid Services. Welcome, miss verma. Were so happy to have you here and your family as well. I appreciate your willingness to lead this key agency at this critical time. And i see that your family is joining us here today to lend support. So i extend a warm welcome to all of you and to them as well. Cms is the Worlds Largest health insurer, covering over 1 3 of the u. S. Population through medicare and medicaid alone. It has a budget of over 1 trillion, and it processes over 1. 2 billion claims a year for Services Provided to some of our nations most vulnerable citizens. Miss verma having dealt with cms extensively in your capacity as a consultant to numerous state Medicaid Programs, you know full well the challenges the agency deals with on a daily basis. And i suspect you also know that the job youve been nominated for is a thankless one, fraught with numerous challenges. The good news is there are opportunities in those challenges and i believe youre the right person for the job and you will make the most of those opportunities to improve our Health Care System. The failings of obamacare are urgent and must be addressed in short order. Over the past six years we have watched as the system created under obamacare has led to increased costs, higher taxes, fewer choices, reduced competition, and more strains on our economy. Under Obamacare Health insurance premiums are up by an average of 25 this year alone. Under obamacare americans including millions of middleclass americans have been hit with a trillion dollars in new taxes. And under obamacare major insurers are no longer offering coverage on exchanges. And earlier this week we learned that another Major Carrier will exit the market in 2018. As Congress Works to change course with regard to our Ailing Health care system, cms will play a major role in determining our success. I applaud the step the agency took yesterday under the leadership of hhs secretary price with its supposed rule to help with its proposed rule to help stabilize the individual Insurance Markets. But theres much more work to be done, and im confident that if youre confirmed, and i expect you to be, you will be a valuable voice in driving change. I would like to talk specifically about medicaid for a moment. The Medicaid Program was destined to be a safety net for the most vulnerable americans. As such i understand and value the moral and social responsibilities the federal government has in ensuring Health Care Coverage for our most needy citizens. Im committed to working with the states and other stakeholders as i think everyone on this committee is. And of course the American Public to improve the quality and ensure the longevity of the Medicaid Program. But we must also acknowledge that the Medicaid Program is three times larger both in terms of enrollment and expenditures than it was just 20 years ago. Additionally, the Medicaid Expansion under obamacare exacerbated pressures on the program at a time when many states were already facing difficult choices about which benefits and populations to serve. As a result we have the responsibility to consider alternative funding arrangements that could help to preserve this important program. We also need to consider various reform proposals that can improve the way medicaid operates. Miss verma, we will need your assistance in both of these efforts and your experience in this particular area should serve you well. On the subject of miss vermas experience i want to note for the committee that she has been credited as the Creative Force behind the healthy indiana plan, the states medicaid alternative. This Program Provides Quality Health care to its enrollees while ensuring that they are engaged in their care decisions. The Program Continues to evolve, hitting key metrics and overall enrollees are very satisfied with their experience, as i understand it. While we may hear criticisms of this program from the other side of the dais here today, we should note that hhs and cms leaders under the Obama Administration repeatedly approved the waiver necessary to make this program a reality. Ms. Verma has assisted a number of other state Medicaid Programs as well. Her efforts all have the same focus, getting needed highQuality Health care to engaged patients and to engage patients in a fiscally responsible way. This is exactly the mindset we need in a cms administrator. Now, miss verma, as if the challenges associated with medicaid are not enough, to keep you busy, as cms administrator, you will also be tasked with helping to ensure the longevity and solvency of the Medicare Trust fund, which is projected to go bankrupt in 2028. Thats already come down from 2032, i believe. All told, between now and 2030, 76 million baby boomers will become eligible for medicare. Even factoring in deaths over that period, the program will grow from approximately 47 million beneficiaries today to roughly 80 million in 2030. Maintaining the solve epsy of the Medicare Program while continuing to provide care to an everexpanding beneficiary base is going to require creative solutions. It will not be easy. But we cant put it off forever. And the longer we wait the worse it will get. Now that ive had a chance to discuss the challenges facing cms and some of ms. Vermas qualifications, i would like to speak more generally about recent events. Weve gone through a pretty rough patch recently on this committee, particularly as weve dealt with President Trumps nominations. I want to rehash the details of the past few weeks, but i will say that i hope that recent developments do not become the new normal for our committee. As i said before, im going to try to do all i can to restore and maintain the customs and traditions of this committee, which has always operated are w. Assumptions of bipartisanship, comity, and good faith. With regard to considering nominations, that means a robust and fair vetting process. A rigorous discussion among committee members. And of course a vote in an executive session. On that note maybe the icy treatment of nominees is starting to thaw today. At least i hope it is. One tradition that has been absent before this session has been the introduction on many occasions of nominees by senators of both parties from the nominees home state, especially in cases where the nominee and home state senator have a relationship. Im pleased to say that the senior senator from indiana is reaffirming that tradition by appearing here today and so is our other senator from indiana. I thank the senators for appearing today to introduce their constituent. Ill give them a chance to do that in just a few minutes. With that i look forward to ms. Verma sharing her vision and views here today. I also look forward to what i hope will be a full and Fair Committee process that allows us to process this nomination to report it to the full senate in short order. Ill now at this time recognize my my cochair on this committee, senator wyden, for his opening statement. Thank you very much, mr. Chairman, and welcome to you, ms. Verma, and to our colleagues from indiana. I just thought it was worth noting that with the hoosier basketball tradition ms. Verma, it looks like you have brought close to two squads of basketball players and we welcome you and your family today. Its obvious that the health care post were going to discuss today is not exactly dinner table conversation in many of america. But the fact is it is one of the most consequential positions in government. The agency is responsible for the health care of over 100 million americans who count on medicare and medicaid. It plays a key role in implementing the Affordable Care act. Thats why cms needs experienced and qualified people for the job, people who know the ins and outs of the whole system, medicare, medicaid, and private insurance. The agency needs a strong and experienced authority. And this is particularly true now when it does appear that some of my colleagues on capitol hill, many in the administration, are looking to make radical changes in American Health care. In my view many of these proposals would take the country back to the days when health care was mostly for the healthy and the wealthy. So were going to start with the promise of medicare, which has always been a promise of guaranteed benefits. That makes up more than half of the agencys spending, about 2 billion plus a day. With more seniors entering the program each year theres an awful lot to do to protect and update it for this yernty. That means addressing the high cost of prescription drugs. It means making the program work better for those with chronic illnesses like Heart Disease and cancer. Thats the majority of the medicare spending today. Its going to take bipartisan support. Guz und hight, senator grassley. Privatizing medicare is the wrong direction in my view. Its important to hear today, ms. Verma, how your views differ from some of the policy makers who are advocating those kinds of approaches and literally be interested in turning the program into a voucher system. Additionally, if confirmed youre going to play a key role implementing the medicare physician payment reforms. Its essential that they be implemented as intended by the congress because we want to start moving health care from paying for volume to paying for value. Also, the agency implements rules of the road in the private Insurance Market and today many of those rules amount to bedrock values for Health Insurance in the country. It means not discriminating against those with a preexisting condition no matter what. It means setting the bar for what type of medical Care Insurance companies have to cover. And it means letting young people stay on their parents policy until 26. Unfortunately, just yesterday the agency released a proposaled rule that in my view goes in the opposite direction. From where i sit the message from yesterdays rule is Insurance Companies are back in charge and patients are going to take a back seat. The open Enrollment Period, for example, was cut in half from three months to six weeks. If somebody dropped coverage during the year for any reins, Insurance Companies could collect back premiums before an individual could get Health Insurance again. And Insurance Companies would have free rein to offer less generous coverage at the same or higher cost. This again sounds to me like its going back to yesteryear, when the Health Care System really did work for the healthy and wealthy. Now, the administration has been saying, of course, that the best is yet to come. Evidence, it seems to me, suggests otherwise. The president could have taken steps to create more stability on a bipartisan basis but instead issued an executive order on the day he was sworn in that is obviously now creating market uncertainty he and anxiety. You dont have to look much further than humanas decision here in the last day or so. So we want to hear from you, ms. Verma, is this morning about how youre going to implement this program that millions of americans, you know, count on and how youre going to do it even though we have republicans here who want to unravel the law. In short, i want to see us get beyond what has come to be known as repeal and run. And repeal and run goes beyond disrupting the individual market. And the Medicaid Expansion that brought millions of lowincome vulnerable americans into the Health Care System. And this is an area obviously where you have extensive experience. I want to discuss some of the tradeoffs associated with those efforts. And im particularly concerned about the possibility as ive been informed that somebody making barely 12,000 a year would get locked out of Health Coverage for no less than six months because they couldnt pay for health care due to an upcoming rent check, for example, or an emergency car repair. Theres been an independent evaluation indicating that 2,500 people were bumped from coverage due to situations like this. Ive also seen in that same report that more than 20,000 persons were pushed into a more expensive, less comprehensive medicaid plan because they couldnt navigate this system that you all put in place. Now, i want to wrap up with just two last points. Chairman, one, with respect to taking these ideas on a nationwide tour, im not there yet. And i say that respectfully. Well hear more about the program. And heres the point with respect to the states. And we touched on it in the offic office. We authored section 1332 of Affordable Care act, saying that states can do better. If states have an idea, better coverage, lower costs, god bless them, were all for it. But we cant use 1332 or any other provision for the states to do worse. One last issue that i want to touch on deals with ms. Vermas work. As i understand it, you will a consulting firm. You all were awarded more than 8. 3 million nasdaq contracts directly by the state to advise the state and that was while you all were managing the programs, in effect you were the architect. At the same time as has been told to me you contracted with at least five other companies that provided hundreds of millions of dollars of services and products to these programs. Hp enterprises, millerman, maximus, Health Management associates, roche diagnostics. In at least two of these firms, hp and hma, the terms of the state contracts appear to have had you in effect overseeing work that the firms performed. Now, george w. Bush had an ethics lawyer, a fellow named richard painter. Wasnt exactly a liberal guy. And he said yesterday that this arrangement, ill quote him, clearly should not happen and is definitely improper. He in effect said that you were on both sides of the deal helping manage state Health Programs while being paid by vendors to the same programs. He said that was a conflict of interest. I want to hear you respond to his assertions. So were going to want to know more about your work for companies that did business with the state and one of the questions will be if youre the cms administrator, if youre confirmed would you recuse yourself from decisions that affect the companies who were her clients. I look forward to your testimony. With the two indiana senators youre running with the right crowd. Thank you, mr. Chairman. Thank you, senator. Im pleased to hand over my normal witness introduction duties today to a pair of our distinguished colleagues. Both senators from the Hoosier State will introduce ms. Verma as a statement and a testament to her work and to her as a person. I ask that the senior senator from indiana, mr. Donnelley, start the introduction and then turn it over to senator young. Senator donnelley, you go ahead and proceed. Thank you, mr. Chairman. Chairman hatch, Ranking Member wyden, members of the committee, thank you for inviting me here today. It is a pleasure to be here with my friend and colleague, senator todd young, to recognize this important accomplishment of a fellow hoosier. As you know, anytime the president nominates an individual for a leadership position in our government, it is an honor and a reflection of the tremendous trust and respect he has in that person. For this reason i am pleased to be here today, to help recognize miss seema verma for her nomination to be the next administrator for the centers for medicare and Medicaid Services, cms, and introduce her to this committee for your consideration. Ive always held a personal belief that we accomplish more when we Work Together. In indiana we call that hoosier common sense. In working collaboratively to help hoosiers get access to Quality Health care is something ms. Verma and i have had the opportunity to do together. As many of you are already aware, ms. Verma has played a central role in crafting medicaid policy in many states, including our own. In indiana she worked with governor daniels and then governor pence as well as other state and federal partners to take advantage of opportunities made possible by the Affordable Care act to expand medicaid through the healthy indiana plan, also known as h. I. P. Today h. I. P. 2. 0 has helped to lower our states uninsured rate, improve health care outcomes, and has played a Critical Role in combating the opioid abuse and heroin use epidemics. Hundreds of thousands of hoosiers currently have Health Insurance through h. I. P. 2. 0. And the program is an example of what is possible when we Work Together. As i have shared with ms. Verma and i will share with you, im deeply concerned about the future of health care in our coverage as well as the rhetoric surrounding the current debate. I firmly believe that maintaining access to critical programs like medicaid and medicare and building upon the progress of the aca is fundamental to both the physical and Financial Wellbeing of thousands of americans across our country. It is my sincere hope that this Administration Working with this committee and others will approach med sxair medicaid with the thoughtful and pragmatic consideration these critical programs deserve. Ive watched ms. Verma take this common sense hoosier approach. And i hope she uses this opportunity today to share with you her vision for how she can Work Together with all of the members of this committee and congress as a whole to expand access to Quality Health care and protect and build on the progress we have made over the last several years. With that, chairman hatch, Ranking Member wyden, members of the committee, thank you for allowing me to introduce miss verma. To ms. Verma and her family, congratulations on this tremendous honor. I look forward to ms. Vermas testimony, and i thank the committee for your hard work and your consideration of miss verma for this very important position. Well, thank you very much. Senator, you now can proceed. Well, thank you, chairman hatch, Ranking Member wyden and members of the committee. It truly is an honor to be with you to introduce a fellow hoosier, seema verma, to be administrator of the center for medicare and Medicaid Services. President trump simply could not have made a better choice in selecting seema to lead what is arguably the most Important Office within hhs, the office that covers the Health Care Needs of over 100 million americans with a budget of almost 1 trillion. In her 20year career as an innovator in the Health Care Sector shes worked extensively with a variety of stakeholders, from both sides of the aisle to deliver better access to health care. As president , ceo, and founder of svc, she helped several states to redesign their archaic medicare systems including in my home state of indiana. Seema revolutionized the Medicaid Program. As architect of the healthy indiana plan, which we know as h. I. P. Its the nations first consumerdirected Medicaid Program. She transformed a complex, ridged medicaid system into one where hoosiers are back in control of their Health Care Needs. Since 2007 h. I. P. Has achieved impressive results. Hoosiers are more likely to seek preventative care, take their prescription medications, and seek primary Care Services at their physicians office. Not the emergency room. Seemas idea is working and an important proof of concept that medicaid can be more than a one size fits all approach. She accomplished this with the support and buyin from people again on both sides of the aisle and at all levels of the process. By putting the mission above politics she demonstrated a willingness to work with anyone, anyone who is willing to do the same. She worked with democrats in the indiana state house. She worked with the Obama Administration. To find Common Ground on how to best provide Quality Health care to hundreds of thousands of lowincome hoosiers. And it worked. As cms administrator seema will have atability to use her extensive experience to help other states achieve what we have in indiana, Better Health outcomes for our most vulnerable. I look forward to working with her. I did you, sir. Thanks to both of you senators. Its a real honor for the committee to have both of you come and i know this member really appreciates it. Thank you. We know youre busy. So well let you go. Ms. Verma, were now going to turn to you for your comments and your feelings on this nomination, and then well turn to questions from the senators up here. Good morning, chairman hatch and Ranking Member wyden. I appreciate and am grateful for your consideration of the nomination by President Trump to be the administrator for the centers of med sxair Medicaid Services and i thank you for the time that many of you have spent with me in advance of the hearing, and i appreciate hearing about your priorities. Gf i begin my statement id like to take a moment to introduce my parents, mr. And mrs. Verma, my husband sanjay and my two kids maya and shawn. Sxreft of my family and friends that are here with me i appreciate, it thank you. Ive often been asked by my family and my friends as well as members of this committee why i would be interested in this job. I was honored and humbled and accepted President Trumps call to service because i understand what is at stake. I have never stood on the sidelines of our Nations Health care debate merely pointing out what is wrong with our Health Care System. More than 20 years ago when i graduate graduated from college i started my career working on National Policy on behalf of people with hiv and aids as well as lowincome mothers to improve birth outcomes. I fought for coverage, Greater Health care access and for improving the quality of care and have continued to fight for these issues for the past 20 years. But im deeply concerned about the state of our Health Care System as theres frustration all around. Many americans are not getting the care that we need, and we have a long way to go in improving the Health Status of americans. Doctors are increasingly frustrated by the number of costly and timeconsuming burdens. Health care continues to grow more and more expensive, and the American People are tired of partisan politics. They just want their Health Care System to be fixed. And i know this not simply because ive worked in health care but because of how intimately it has affected my own personal life. My mother is a Breast Cancer survivor. Due to early diagnosis and treatme treatment. And a few years back my neighbor aidan was diagnosed with a stage 4 neuroblastoma. He was only 4 years old. A large tumor had been growing for some time, maybe since he was born, and it was wrapped all around his kidney. Aidan went through excruciating, painful chemotherapy, radiation, stem cell treatment, and surgeries, all experimental. This may aidan will celebrate his 12th birthday. And both my mom and aidan are testaments to the grace of god and the ingenuity of the American Health care system. This is why people travel from all across the world to get care in the United States. I want to be part of the solution, making sure that the Health Care System works for all americans, so that families like my own and aidans have the care that they need. I want to be able to look my children in the eye and tell them that i did my part to serve my country and to have a voice for people that dont often have one. This is a formidable challenge but i am no stranger to achieving success under difficult circumstances. My father left his entire family to immigrate to the United States during the 1960s and pursued four degrees while working to earn money. On my mothers side, my grandmother was married at the age of 17 with no more than a fifthgrade education but my mother went on to be the first woman in her family to finish a masters degree. My parents made a lot of sacrifices along the way to provide me with the opportunities they didnt have and have taught me the value of hard work and determination. Im extremely humbled as a first generation american to be sitting before this committee after being nominated by the president of the United States. It is a testament to the fact that the American Dream is very much alive for those willing to work for it. And it is my dream and my passion to work on the front lines of health care to improve our system. Throughout my career ive brought people together from all sides of the political spectrum to forge solution thats worked for everyone. One of my proudest moments in my career was watching the Indiana Legislature pass the healthy indiana plan, which was a program for the uninsured with a bipartisan vote. Cms is a 1 trillion agency and covers over 100 million people, many of whom are amongst our nations most vulnerable citizens, providing high quality, Accessible Health care for these americans isnt just a luxury. Its a necessity and often a matter of life and death. Should i be confirmed, i will work with cms team to ensure that the programs are focused on achieving positive Health Outcomes and improve the health of the people that we serve. To achieve this goal i will work towards policies that foster patientcentered approaches, that increase competition, quality, and access while driving down costs. Patients and their doctors should be making decisions about their health care, not the federal government. We must find creative ways to empower people to take ownership for their health. We should support doctors in providing highquality care to their patients and ensuring that cmss rules and regulations dont drive doctors and providers from serving the people or beneficiaries. If confirmed i will work toward modernizing cmss programs to address the changing needs of the people they serve, leveraging innovation and technology to drive better care. I will ensure that efforts around preventing fraud and abuse are a priority because we cant afford to waste a single taxpayer dollar. I will work toward ushering in a new era of state flexibility and leadership to drive better outcomes. If i have the honor of being confirmed, i will carry this vision along with my strong belief in open communication, collaboration, and bipartisanship. I will work with you, be responsive to your inquiries, concerns and value your counsel. I thank you for your consideration of my nomination. Thank you so much. We really appreciate your willingness to serve. And i look forward to getting you through this process. Let me just i have some obligatory questions to give you. First, is there anything that you are aware of in your background that might present a conflict of interest with the duties of the office to which you have been nominated . So ive met with the consulted with the office of ethics and have indicated any areas where i thought would be an issue, and i will be recusing myself of any matters that will present any potential conflict. Thank you. Do you know of any person or any reason, personal or otherwise, that would in any way prevent you from fully and honorably discharging the responsibilities of the office to which you have been nominated . I do not. Do you agree without reservation to respond to any reasonable any reasonable inquiry . Im having a rough time getting these pages apart. Gee whiz. Any reasonable summons to pear and testify for any duly constituted committee of the congress. If you are confirmed. I do not. Youre willing to do that . I am willing to do that. Finally, do you commit to providing a prompt response in writing to any questions addressed to you by any senator from this committee . I do. Well, thank you. Let me now get into just some questions. I know youre aware of the historic bipartisan medicare access and chip reauthorization act that i had a lot to do with of 2015, or whats called macra. Among things the law got rid of the dreaded sgr formula and made improvements to how medicare pays physicians. Im pleased that our work on the implementation of these changes continues to be bipartisan. Both in how republicans and democrats in the congress have worked together and how congress had worked with the Obama Administration. In fact, the Obama Administration took great pains to engage physicians and other stakeholders through the initial implementation phase. Now, it strikes me that this process of consultation early and often should be the rule and not the exception. What is your view on how to engage stakeholders to approve dpsh to arrive at best policy decisions for medicare and other cms programs . Thank you, senator. And i applaud congresss efforts to pass macra. I think its an important step forward not only to providing more stability to providers but also moving us toward better outcomes. You know, in terms of stakeholders i think that the most important thing we can do is engage with stakeholders as quickly as possible on the front end and all the way through the process, understanding stakeholder perspective and what folks are going through on the front end. What their challenges are. And as were developing policies and programs to have that open communication i think is helpful toward any successful implementation. Its not a onetime thing. Its not just on the front end. Its all the way through the process. And even after the programs established, its always important to have that dialogue with stakeholders because they can tell you whats working and whats not working. And when you think of new ideas and youre thinking about implementing them, they can help you figure out whether its going to work or not. I know ive had that experience in my career and ive always found it very helpful and an integral part of success. As the baby boomer generation ages, the number of persons age 65 and older in the United States is expected to dramatically increase, fueling an increase in the demand for Longterm Services and support. Notably, medicaid is the primary payer of these services. What changes, if any, should be made to meet the expected increase in demand while ensuring the fiscal sustainability of the Medicaid Program . I think medicaid is a very important program. Its been the safety net for so many vulnerable citizens. When i think about Medicaid Program, i think about some of the individuals that ive met. One person in particular i think about is a quad ry pleenlic. Hes on a breathing machine and he requires 24hour care. I think about the mother of a disabled child. And this is the face of the Medicaid Program. As we think built Medicaid Program and where we are today, i think we can do better. We have the challenge of making sure were providing better care for these individuals. But the program isnt working as well as it can. Theres a very intractable situation where theyre having to go back and forth doing reams of paperwork, trying to get approvaled from the federal government, and at the end of the day are we achieving outcomes we want to achieve . As i think about the Medicaid Program i think theres an opportunity to make that program work better so were focusing on improving outcomes for the individuals that are served by the program. In 2014 i worked closely with senator wyden and leaders from the house ways and Means Committee to enact a bipartisan, bicameraal law called the improving medicare lets see here. Improving medicare transformation or impact act. It serveses a critical Building Block to serve future 34edcare postacute quality measurements and payment reform. Specifically, the impact act requires the collection of standardized data to help medicare not only compare quality across the different postacute care celtings but also improve hospital and postacute discharge planning. Our goal was to produce datadriven evidence that congress can use to debate the best way to align medicaid postacute payments. Our intention is to ensure that were able to do this type of thi thing. I want to ensure that beneficiaries are receiving the highest quality postacute Care Services in the right setting at the right time. Now, will you commit to working with me and members of congress and this committee and the postacute Provider Community on the implementation of the impact act . It would be my pleasure to work with the committee, stakeholders and anyone else that was interested to make that program a success. Well, thank you. Well turn to senator wyden. Thank you very much, ms. Verma, and thank you for your testimony. I want to start with a comment you made that you were committed to coverage, which of course is what this is all about. Unfortunately, what ive seen since the beginning of the year has been basically about rolling back coverage. And in fact congressman price sat in your seat a couple of weeks ago and refused to commit to making sure that no one would be worse off in terms of coverage. Now, the president said in his campaign, and i quote, were going to have insurance for everybody. The American People are going to have great health care, much less expensive and much better. Thats what the president said. Yesterday cms did the exact opposite. The first rule to come out of the agency, the agency that you would like to head, after secretary price was confirmed meant less coverage, higher premiums, and more outofpocket costs for working families. How would you square what President Trump said in the campaign with what cms did yesterday . In terms of the rule that you speak of, i have not been involved in the development of that rule out of respect for the committee and for the nomination process. I have not been involved in that. I have not been to cms. So i havent been involved in that, and i cant speak to that. What i can tell you is i am committed to coverage. Ive been fighting on this issue for 20 years. And i will continue to do that if im confirmed. But i just read you quotes, and its not like atomic secrets or classified materials. What the president said is very different than what cms did yesterday. And you read newspapers. Youre a very informed person. Talked about cutting the Enrollment Period. Im looking at the headline. Cut the Enrollment Period in half, which really is going to limit our ability to get the very people we need most, the younger, healthier people. So one more try. How would you square what the president said with what happened yesterday . I think the president and i are both committed to coverage. I cannot speak to the rule. I have not had an opportunity to review that. But again, i think the president and i both agree that we need to fight for coverage and make sure that all americans have access to affordable, highQuality Health care. What troubles me about yesterday is once again Insurance Companies are coming first and patients come later. Tell me one thing you would change to put patients first. One thing that he i would do is i think its very important that patients be in charge of their health care, that patients get to drive the decisions about their health care, that they get to make choices about what kind of Health Care Plan works well for them. I think its important that our patients have access to quality coverage, to the doctors, to their choice of doctors and their choice of plan. Could you get us a specific on that . Because thats an admirable philosophy but i still dont know. Yesterday was good for Insurance Companies, and it was bad for patients. Id like to have a specific example, and well keep the record, you know, open, of something you would do to put patients first. And i respect the fact that youve articulated a philosophy but i really want to know a specific about what youd do to put patients first. Lets move on with respect to another area of responsibility youll have, and thats prescription drugs and medicare because we all know these prescription costs are just clobbering families and seniors, the federal government and a whole variety of the stakeholders that you refer to. As the administrator of the agency youre going to have an opportunity to address this problem. The president s been vocal on it. Again, give me a specific change to Medicare Part d that you would suggest to bring costs down. I think that the issue of drug pricing is something that all americans are concerned about and the president is concerned about that as well. People want to make sure that when they need the drugs, when theyre going through an illness, i think about my mom, i think about my neighbor aidan, and when they need the drugs that they need, they want to know that they have access to it and that its affordable. So i think were all concerned about that specific issue. Part d i think has been a good program. It has expanded access to medications for people that didnt have it before. And i think the structure of the program in terms of how it puts Senior Citizens in charge of their health care, they can go on plan finder, go online my time is up, ms. Verma. I voted for part d. Still got the welts on my back to show for it. I asked you for a specific change Going Forward that you would do to help seniors and others hold down their costs. As you know, theres discussion of making changes so that medicare could bargain. Is there one specific you could give me . And the reason that the medicare question is so important is not only does this affect older people so dramatically but your experiences on the medicaid side. And i respect that. People have different experiences. So i very much would like to hear a specific on this key medicare issue that you would actually be for. I would be for policies that continue to put Senior Citizens in charge of their health care, that puts them in the drivers seat of making the decisions that work best for them so that they can figure out what plan covers the medications that they need, what plan is affordable to them and allows them to make the decisions about their health care and that gives them access to the medication thats they need, that doesnt limit that in any way and that is affordable to them. My time is expired. I still didnt get a specific example. I happen to be for a host of things on transparency, on negotiati negotiation, on trying to make sure we squeeze more cost savings out of the middle men. Im going to hold the record open. But ive asked you for specifics in two areas, putting patients first and how you would hold down the costs of part d. Respectfully, i didnt get a specific. Well hold the record open for it. I think senator grassley, are you going to call out names on your side or im next. [ laughter ] that didnt take much time. What im going to talk to you about is things that have happened in cms in the past. And hopefully coming from an administration that wants to drain the swamp, i think i would expect changes to be made under your leadership in this agency. And i would suggest you probably cant do anything about the suggestion im going to give you to respond to the last question of my colleague. But if you would push doing away with pay for delay programs between brand drugs and generics i think it would go a long ways to helping get drugs cheaper. Cms has told me that it does not have much authority to do anything against some frauds committed against its programs, even if those actions are in cmss own words, quote unquote, a clear violation of the laws. And common sense tells me that if its a clear violation of the law cms can do something about it. And if thats their attitude there i would ask you to see whether the past interpretation is right by checking that interpretation. But in a january 28th letter to me about the Medicare Drug Rebate Program cms said it could tell a manufacturer when its drug is misclassified and then, quote unquote, attempt to reach an agreement. In other words, after the moneys been stolen from the taxpayers take some trouble to get it back if you can reach an agreement. But there are a lot of tools the government has to fight fraud. And the most effective one we have the false claims act. Since 1987, when i got that law in place, the department of justice has used the false claims act to recover more than 33. 9 billion dollars just lost from just the Health Care Fraud alone. But cooperation between the department of justice and the Health Care Program administrators is very important in these cases. It seems like cms could at least have picked up the phone and given the department of justice a head ups when these manufacturers refused to cooperate and properly classify their drugs. So a Pretty Simple question, it might even be called a softball question, but its pretty important to me, would you commit to proactively cooperating with the department of justice in fraud cases and fully supporting the use of the false claims act to combat fraud on government Health Care Programs . I will absolutely do that. And i applaud your efforts on the false claims act. I think its been an integral component of preventing fraud and recovering dollars when there is fraud. So i thank you for your service and your work on that. Next question. In the fall of 2016 and in january of 2017 i sent several oversight letters to cms regarding the steps that it took to hold mylan accountable for misclassifying the epipen as a generic under the medicaid drug rebate program. Cms has publicly stated that it expressly advised mylan that their classifications of the epipen for purposes of the Medicare Drug Rebate Program was incorrect, end quote. However, cms has failed to fully respond to my oversight request and refuses to provide records of communication with mylan. Cms has also not been entirely clear as to what the authority has to do with to correct drug misclassifications. Because of epipens misclassification the government and states are owed hundreds of millions of dollars from mylan, congress and the American People are owed answers. So if confirmed, would you commit to fully responding to my oversight requests and providing the requested records of communication beyond mile sxn cms . I hope thats a short yes. That is a short yes. In light of epipens misclassification and potentially other drugs that have been misclassified under medicaid, what steps will you take to ensure that drugs are properly classified under medicaid . I think what happened with the mylan pen and the epipen issue is very disturbing. The idea that perhaps Medicaid Programs which are struggling to pay for those programs, that they could have potentially received rebates is disturbing to me. So if im confirmed, i would like to review the processes in place there in terms of the classifications, in terms of brand and generic tone sure that time of thing doesnt happen again. And what you just said you want to do i want to do. And thats why i want those communications from cms. I hope you can get them for me. Id be happy to work with you on that, senator. Senator stabenow. Thank you very much. And welcome. Welcome to you and your family. The first thing, many, many questions i have, first regarding medicare, do you believe that Medicare Programs should negotiate the best price for seniors on medicare . I think we need to do everything we can do to make drugs more affordable for seniors. And im thankful that we have the pbms and the Part D Program that are performing that negotiation on the behalf of seniors. Do you believe we could get a better price if medicare was negotiating as the va does, as other private entities do to get the best price for seniors . I think that competition is the key to getting good prices. And i is that yes or no on negotiation . I dont think thats a simple yes or no answer because i think there are many ways to achieve that goal, and the xwoel is to make sure that were getting affordable prices for our affordable prices for our seniors. Captions Copyright National cable satellite corp. 2008 captioning performed by vitac. Each week, American History tvs reel america brings you archival films give you context for todays Public Affairs issues. President trump has vowed to undo regulations he says are costly and hinders the economy. Up next, a 1982 pbs documentary by wvia media in pennsylvania about regulation of air pollution in national parks. The film details the process of turning general language into a general language in a 1977 amendment to specific regulations, revealing behindthescenes negotiations and debate between epa regulators and environmental and industry interests. This is 50 minutes
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