Transcripts For CSPAN3 HHS Secretary Tom Price Testifies On FY 2018 Budget 20170619

Targets, with having advisors on the ground . Should we be at war in yemen . Cspan programs are available at cspan. Org. Right on our home page or by searching the video library. Up next, testimony from health and Human Services secretary tom price on President Trumps proposed 2018 budget request for his department. He discussed a range of issues including proposed cuts to medicaid and allowing businesses to opt out of providing insurance that covers Birth Control to female employees. Held by the Senate Finance committee, this is just over two hours. The committee will come to order. Were going to first listen to the distinguished senator from oregon who has to go to another Committee Hearing so well show that deference to him. I welcome everybody to this mornings hearing on the president s proposed budget for fiscal year 2018 with specific attention to the department of health and Human Services. But let me i want to thank secretary price for being here. These hearings are an annual event for the finance committee and, secretary price, since this is your first time around, ill just warn you that these hearings can be a little grueling. Of course, you already know that. Im grateful for the president and that the president and hhs are willing to work with congress to fix our Health Care System to ensure americans can access Affordable Health care coverage. For that, im going to turn to the Ranking Member who needs to get to another hearing and well show that deference. Mr. Chairman, thank you very much for this courtesy. I know this is a busy morning, and i am very grateful to you for doing this. I also want to say thank you to senator stabineau who in my absence is going to do an excellent job as she always does. This administration from day one has preferred alternative facts and convenient spin to the truth. One of the most recent examples was its Budget Proposal which double counted 2 trillion to maintain some whiff of fiscal responsibility while it slashed Health Programs and protections for basic and essential needs. The budget mass is fake, but the extreme agenda that would deprive millions of americans access to health care and wipe out Living Standards is not. Unfortunately this morning im going to be splitting my time between finance committee and Intelligence Committee so i will be brief. There are several issues im going to touch on. First is medicaid. Secretary price is the captain of the president S Health Care team. He has been the premiere advocate for trump care, a bill that cuts medicaid by 834 billion in order to pay for massive tax breaks for the wealthy. 14 million americans would lose coverage and if that wasnt enough of a cut, the Budget Proposal that came out a few weeks ago goes even further. It slashes hundreds of billions more from medicaid. A program that covers nearly half of all births, 37 million kids, millions of working families and people with disabilities and two out of three nursing home beds in america. These cuts would be a staggering blow to americans of all generations. These facts and figures have been met by a wave of the hand from secretary price. When asked if his proposed cuts would result in millions of americans losing access to medicaid he responded, and i quote, absolutely not. He went further claiming again, i quote, there are no cuts to the Medicaid Program and he also said, and i quote, nobody will be worse off financially. Ive heard secretary price and others make the baffling argument that people are actually worse off when they have medicaid coverage, that their health doesnt improve as a result of medicaid coverage. Often this argument is based on a brief and outdated study performed in my home state. Heres the bottom line on medicaid. 74 million americans rely on this program for basic health needs. Parents of sick kids, people with disabilities, seniors in Nursing Homes who have nobody to turn to for help if their benefits disappear. In addition, thousands of oregonians who are healthy under my home states model, it would be a tough sell to tell them they would be worst off without medicaid. The Program Needs a trillion dollars in cuts. Public opinion is very clear. Two out of three enrollees are very happy. Seven out of ten americans say congress ought to leave it as it is. No block grants. No per capita cuts. Fortunately the Budget Proposal hit the wall here in congress and theres a lot of debate to be had on trump care. Right now the administration is causing turmoil in the Insurance Markets and its already having disastrous effects for millions of families. The president issued a one day executive order undermining the Affordable Care act and nobody on the trump team can give a straight answer about whether the administration will continue making cost sharing reduction payments that are key to making insurance affordable for working families. Because of this sabotage, insurers are pulling out of the market and people are left without plans to choose from. You dont have to take my word for it, the insurers are very clear about why theyre making these decisions. Furthermore, on the campaign trail the president said he wouldnt cut medicare. The trump bill shrinks the life of medicare. The Budget Proposal expands the mandatory cuts under the budget sequester by more than 30 billion. The food and Drug Administration, the centers for disease control, the National Institutes of health all slashed in the budget. The same is true in programs aimed at basic human needs, programs that fund meals on wheels, child care, foster care. This is the budget you write if you think seniors and working families have it too easy. I want to thank the secretary for joining the committee. I apologize again for the hectic schedule. Its never an easy appointment for the cabinet secretary and i think he knows theres going to be some vigorous discussion this morning. I also again want to express my thanks to the chairman for his very gracious and ongoing courtesies on these kinds of matters. Thanks, senator stabineau for being willing to return in. I thank the chair. Thank you, senator. Let me just say im grateful that the president and hhs are in essence working on this effort. And are in essence willing to work with congress to fix our health care in order to make sure americans can access Affordable Health care coverage. This may not be something that is going to be that easy to do. And as we know, time is of the essence in regard to this effort. Earlier this week we received word that anthem is pulling out of ohios marketplace, potentially leaving 10,000 patients and consumers in 20 counties without any Insurance Options on ohios exchange for 2018. This news is particularly frightening as we expect to hear similar notices from anthem as they reevaluate their participation in Obamacare Exchanges throughout the United States, our whole country. Now this recent story is just the latest in a long line of failures that my colleagues on the other side seem to want to continue under the guise that this is working. Its not working. All of this demonstrates the need to move forward with repealing obamacare and replacing it with a more workable approach, one that will take serious that we can take seriously the blooming ballooning Health Care Costs impacting every american family. Let me talk for a few minutes about the specifics of the president s budget. The budget assumes 250 billion in total savings from the repeal and the replacement of obamacare and despite some insinuations to the contrary, the budget does not incorporate the specific legislative proposal. The American Health care act that is before congress right now, therefore, it is not accurate to associate the specific medicaid savings the cbo has estimated from enactment of the ahca from the president s budget. To do so would assume a level of specificity that for obvious reasons is just not there. Moreover, the president s budget does not cut 1. 5 trillion dollars from medicaid nor does it assume that the specific medicaid reform proposals from the ahca will be enacted into law. Im quite certain well hear a lot about that today but any attempt to make that connection is simply unfounded and any senator who harps on the ahca medicaid numbers here today either does not understand the explicit language and estimates provided in the president s budget or they are simply attempting to muddy the waters in order to scare americans who rely on medicaid for health care coverage. Ultimately, the president s budget appears to accept the reality that the senate will need to come up with its own Health Care Proposal that includes a fundamental fix to medicaid which is, quite frankly, long overdue. Anybody who doesnt agree with that isnt living in the real world. In addition to the savings assumed from the repeal of obamacare, the budget also explicitly assumes 610 billion in savings from putting medicare on a sustainable fiscal path by capping funding in fiscal year 2020 through per capita caps or block grants at the state option. All told, most of the budgets overall medicaid savings would be achieved by returning the focus of medicaid to serving those with the greatest needs, the elderly, disabled and needy mothers and children. By giving states more flexibility to run their own Medicaid Program. Any senator who would like to argue that the federal government should spend more medicaid dollars to provide coverage for nondisabled childless adults at the expense of disabled patients who remain on waiting lists should explain why. Furthermore, any senator who would like to argue that the states are ill equipped to handle their Medicaid Programs should explain why that is the case given that the overwhelming consensus weve heard from governors nationwide over the last few years is that states want more independence and flexibility to tailor the Medicaid Program. Washington needs to stop measuring the success of a federal program by how much money it spends or how many other programs are a part of it. Instead, washington needs to focus on how well a federal Program Helps those it is intended to serve and how efficient the program is at fulfilling its mandate. Long story short, we need to stop focusing on spending and pay more attention to outcome because we may not be able to spend more. It doesnt appear that were going to be able to. The rate things are going right now under the current system, its a national tragedy. I think the president s budget while it is by no means flawless largely recognizes this reality and the president and the administration deserve credit for that. I look forward to having an open and frank discussion with secretary price about his thoughts on these and other matters. Before we get to that, let me just say that id like to say today that we have the pleasure of being joined by secretary thomas e. Price. Secretary price, we want to thank you for coming. Secretary price is sworn in as the 23rd secretary of health and Human Services on february 10th, 2017, as a policymaker and as a physician, surgeon in particular, he brings to the department a lifetime of service and dedication to advancing the quality of health care in america. Secretary price first began his career in care for patients as an orthopaedic surgeon. He followed in the footsteps of his father and grandfather and began a solo medical practice in atlanta, georgia. That has grown to be one of the largest nonacademic orthopaedic practices in the country hoping to make a different impact on health care secretary price ran for public office. Was elected to four terms in the Georgia State senate and i believe would have continued on forever if he wanted to. During his tenure there, secretary price served as minority whip and later as the first Republican Senate majority leader in the history of georgia. Most recently secretary price served as u. S. Representative for georgias sixth Congressional District from 2005 to 2017. During his time in the house, secretary price served in various roles including chairman of the house budget committee, chairman of the House Republican policy committee and chairman of the republican study committee. Secretary price received his bachelor and doctorate of medicine degrees from the university of michigan after which he completed his orthopaedic surgery residency at emory university. Secretary price, were grateful to have you here. Well be happy to have you proceed with your testimony here today. Thank you so much, mr. Chairman. Ranking member stabineau and members i want to thank you for inviting me today to discus the president s budget for the health and Fiscal Services for 2018. It is an honor to be with you. Whenever a budget is released, the most common question in this town, in washington, is how much . How much does the budget spend on this program . How much does it cut from the other programs . As a former legislator, i understand the importance of this question, but too often its treated as the only question thats worth asking as it relates to the budget as if how much a program spends is more important or somehow more indicative of whether the Program Actually works. President trumps budget request does not confuse Government Spending with government success. The president understands that setting a budget is about more than establishing top line spending levels. Done properly, the budgeting process is an exercise in reforming our federal programs to make sure that they do their job and use tax dollars wisely. The problem with many of our federal programs is not that theyre too expensive or too under funded. The real problem is many of them simply dont work. Fixing a broken Government Program requires redesigning its structure and refocusing taxpayer resources to better serve most in need. Thats exactly what President Trumps budget will do in hhs and across the government. Consider medicaid thats been discussed. The primary source of medical coverage for millions of low income families and seniors facing Challenging Health circumstances. If the amount of Government Spending were truly a measure of success, medicaid would be haled as one of the most successful programs in history. 20 years ago actual spending on medicaid was less than 200 billion. Within the next decade its estimated to top 1 trillion a year. Despite these significant investments, onethird of physicians who ought to be seeing new medicaid patients dont and some Research Shows that enrolling in medicaid doesnt necessarily improve your Health Outcomes for the newly eligible medicaid population. This suggests we need Structural Reforms to power states to serve their unique medicaid populations in a way thats compassionate and sustainable. Federal rules prevent states from focusing on their most vulnerable communities to improve Health Outcomes and access to chair. This budget changes that. Hsss mission of protecting the health involves far for than overseeing the health care and insurance programs. Hss is the world leader in helping the Health Care Sector prepare for Cyber Threats and responding to and protecting against Public Health emergencies, recently i witnessed this important work first hand visiting ebola survivors in liberia and representing the United States at the g20 in berlin and the World Health Assembly in geneva. To support hsss unique role, the president s budget provides 4. 3 billion for Disaster Services coordination and response planning, biodefense and Infectious Disease research and developing and stockpiling of critical countermeasures. America faces a new set of Public Health crisis that have been far less successful if resolving. Those are serious mental illness, Opioid Crisis and childhood obesity. And the president s budget calls for investments in policy reforms that will enable to do just that. The budget calls for investments in high priority Mental Health initiatives for Psychiatric Care and suicide and homeless prevention and childrens Mental Health focusing especially on those suffering from severe mental illness. Over 52,000 americans died in over dose from opioids. This budget calls for 811 million to support the departments five part strategy to fight this epidemic. To invest in the health of the next generation and help nearly the 20 of School Aged Children who are obese, lead healthy and happier lives the president s budget establishes a new 500 Million Health block grant. The president s budget prioritizes Womens Health by investing in research and increasing funding for the maternal and Child Health Block grant and healthy start. Across hss funding is maintained for vital programs serving women including Community Health centers, Domestic Violence programs, womens cancer screenings and support mother and infant programs in the office of Womens Health. This budget demands tough choices and in this challenging fiscal environment there are no easy answer. With this budget however the new administration charts a path toward a sustainable fiscal future and ensures the dedicated resources provided enhance and protect the health and wellbeing of the American People. I want to thank you for the opportunity to be with you today and your continued support of the department of health and Human Services. Its my privilege to serve as its secretary. We know that youre excellent member of the house and so far it looks to me like youre getting on top of what these problems are, although you were pretty well on top of them before as a member of the house. The Opioid Crisis seems to be spreading across the country effecting families and communities in unprecedented ways. In fact, the the New York Times reported earlier this week that Overdose Deaths are at an all time high. Tackling this crisis is a priority for you and for President Trump. So can you describe the efforts hss is undertaking to discourage this across the United States. This is one scourges across the nation that just tears your heart out. 52,000 as i mentioned in 2015 fellow americans died of an overdose, 33,000 of those of opioid overdose. We hear day after day. What the departments done is put in place a five part strategy to make certain that were identifying the kind of treatment and Recovery Efforts that work in assisting the states. I want to make certain we have the overdose reversing drugs available wherever they need to be available and know that were trying to survey and make certain that we know strong drugs getting to the streets from a Law Enforcement aspect. Theres a Public Health aspect to this obviously to try to determine what the heck is going on. Why is this scourge as large as it is and were putting resources into that . In addition we want to make certain were doing the highest level of research to try to identify those pain treatments that are able to make it so that theres not a need for individuals to seek it for its euphoric effect. Finally, its important to look at how we manage pain in this nation. 20 years ago we started down this road of measuring pain as a fifth vital sign. Let me suggest to you that that has resulted in significantly greater use of opioids and Prescription Medication than wouldve otherwise been the case. So weve got this five part strategy. You have been incredibly helpful and congress has been incredibly helpful to make through 21st century cures and resources so we can allow the states to identify, again, those evidence based programs that theyve got in place that can help mitigate this challenge. We continue to move in the wrong direction, mr. Chairman and we will not rest at the department or in the administration until we bend that curve in the other direction. Thank you so much. Hss recently published a report using the previous administrations data showing just how much Health Insurance premiums in the individual market have increased since 2013. Could you tell us what are the principal findings of that report . Thank you so much. I know that when i visited with folks in my previous position and since ive been privileged to serve as secretary, i hear over and over again how folks are just so terribly concerned about the cost of Health Coverage for them and their family. And there was this disconnect, you have this the individuals talking about the wonders of the program that was in place and that you had all then you had all of these individuals who were so concerned because they didnt have the ability to afford the coverage or get the care. This study that we undertook that was undertaken at the aspy group within hss identified that the average premium increase over the last four years has been over 100 . It was 105 , so more than doubled across the country. In fact, three states the increases were tripled, in alaska, alabama and oklahoma. And what that means is that theyre individuals who one, cant afford the coverage and two, even when they can afford the coverage, the deductibles have increased to a significant degree so that they may have an insurance card but they dont have any care because they cant afford the deductible. Thats the challenge were trying to address and make certain that Congress Addresses so that individuals are able to afford the kind of coverage that folks want for themselves and for their families. Well, as you may be aware this committee has for several years been keenly interested in the large backlog of medicare claims under hss. The most report the backlog has reduced of nearly 1 million claims to a current number closer to 750,000 claims. That number is still unacceptably high. Can you tell me what hss is doing to address the unnecessary backlog of medicare claims . These are appeals that providers have said that they dont believe the federal government is providing the kind of resources necessary for them to be able to care for their patients and as you mentioned the numbers are staggering. Nearly 1 million claims, down to 700,000 now. We can take care of around 20,000 up until recently. What weve done is met with the individuals and there high quality folks. These are folks just trying to get these appeals through the process and make the right decision. We put a focus on that. We talked to weve encouraged them to talk to the stakeholders and individuals out there about why we have this increase in claims. Theres a problem there. It means that the system isnt working to the degree that it should to allow those individuals to care for those patients and be compensated for that care. Weve identified the opportunity for the Administrative Law judges to be able to review higher claims and move in the direction of having magistrate judges review lower claims so we can get through a larger volume of claims on an annual basis. Then we tried to decrease the burden of reporting. Were working on trying to reduce the burden of reporting for the providers so that there is less likely a possibility that they would need to feel the need or desire to file a claim. This is a major problem. Were working through it and were committed to getting that number down to a reasonable number. Im happy to have to listen to you. Youve inherited a tremendous number of problems and i know that youre fully capable of solving those problems and i think youre well on your way. The distinguished Ranking Member has agreed with me. Ill allow senator isakson to go next. Thank you, mr. Chairman. Dr. Price, welcome back. Last time you were here we were here confirming you and now youre getting lecture from all the georgians are very proud of you. You just returned from your first trip overseas as secretary and that began in liberia. I did. What did you learn particularly with regard to our response to the ebola which ground zero i think was liberia. It was indeed. Thank you so much. I appreciate your support and your service to our great state. My first trip overseas was we stopped first in liberia and i wanted to do that because i wanted to express our appreciation to the americans who were working over there especially during that ebola crisis and to also demonstrate our continued commitment for Global Health security and to thank the liberian government for what they had done to elevate an increase in their ability in the area of Infectious Disease. What i saw was incredibly inspiring. And you all would be so remarkably proud of the American People who are Forward Deployed if you will in Global Health, individuals from the cdc, from nih, who are doing all that they can to make certain that we address the Health Challenges that exist around the world especially in the area of Infectious Disease. It paid off in absolute remarkable benefit and we saw that because of the most recent outbreak of meningitis that occurred and that outbreak the surveillance that was done, the detection that was done the prevention of spread that was done and the treatment was only possible because of the work that had been done in liberia since the Ebola Outbreak and since that challenge was resolved. So i was i was just uplifted and inspired by the incredible work of the American People who are dedicating their lives to assisting the health of individuals overseas. Cdc did a phenomenal job as did hhs. The president s budget is cut by 136 million the Preparedness Fund a lot of which went to the initial response to ebola and africa to have the first place we could bring some of those victims. So we need to work to see to it that funding is there so it can have the same type of response the next time an outbreak take place. Were the worlds clinic if you will for emergencies and disasters like that. Yes. Secondly, you had a partner by the name of john knox. I did. You may remember, john operated on my son kevin 30 years ago and saved his leg from a terrible injury and a terrible accident. It took him nine months to recover. Eight of those months he recovered at home. My wife and i went to school, we took lessons in how to clean ports and put down drips into him so he could fight infection in his bone marrow while he recovered at home. Since 1989 when that accident took place over time reimbursement for antibiotics and Home Infusion went away. There was a drive to drive everybody in the hospital to recover. Not as much reimbursement to stay at home. Fortunately senator warner worked closely with us to get reimbursement for Durable Medical Equipment. I hope youll work to it we can expand coverage to get Home Infusion wherever practical and possible covered as a benefit so we can have more people recovering in a less expensive more hospitable environment. This is really important, senator. What we find health care and medicine is dynamic. It changes all the time. So what used to be able to be done only in a hospital now can oftentimes be done as an out patient or in the instance of recovery oftentimes at home and home and Community Based services are absolutely imperative for us to have the flexibility to be able to do that. Its one of the things that were trying to concentrate on from a waiver standpoint in many different programs as well as trying to incent the flexibility within existing programs so we can cover those kinds of treatments in not necessarily in the venue that was previously selected when that was the standard of care, but in a new venue because it works better for the patient. Lastly, i want to underscore what you said about experimenting to see how medicaid coverage available and robust for our citizens. Your state and my state, georgia we have 1. 9 Million People on medicaid, 1. 3 of them are children. 50 of all the live births in georgia are paid for my medicaid. So as we go through the reforms are necessary, we got to remember were talking about first and foremost children who benefit from those programs being robust or hurt if their theyre cut. I look forward to working with you to see to provide the coverage thats necessary and experiment with ways to incentivize the care. Thank you very much, mr. Chairman. Thank you, mr. Secretary. Thank you, mr. Chairman. Welcome, secretary price. Theres so many things i would like to talk to you about and debate you in terms of what has been said and the positions of the administration, but i want to start with i think a very important basic assumption that you have made and that is that Affordable Care act is falling apart, oh, my gosh, look whats happening. We have to dismantle it. We do Something Different because its falling apart and yet we know, to me its like pulling the rug out from under somebody and then going oh, my gosh they fell down. We have seen consistent moves by the Administration Whether its cutting in half the number of days that citizens have to sign up for insurance, whether its no longer aggressively doing outreach to younger, Healthy People making sure everybodys in the pool so that costs dont go up or whether its doing whats been done to take away the commitments made to the Insurance Industry to make sure that they would be covering preexisting conditions and having no caps on services and its laid out this morning in the Washington Post when we look at the question of whether or not the white house is going to let the Health Care System die and i want to just quote a little bit in there because this is coming from the industry, the biggest source of industry anxiety right now is whether the administration and congress will continue to fund cost sharing subsidies that help 7 million americans with aca plans, afford deductibles and copay. Absent that funding i dont know if well have much participation in the Exchange Market in 2018 said tennessee insurance commissioner julie mcpeek a republican who has also serves as president elect of the National Association of insurance commissioners. The uncertainty, the uncertainty is one of the top reasons insurers have cited when explaining why they are posting higher rates for the next year or withdrawing from markets all together. Two weeks ago Blue Cross Blue Shield of North Carolina filed a rate increase of 22. 9 . It they said it would have been 8. 8 , not 22. 9 if the administration had committed to paying basically keeping the commitments that were passed as part of Health Reform and finally on tuesday, Anthem Blue Cross and blue shield announced it was pulling out of the federal exchange. The president seemed to cheer that yesterday. I dont know why were cheering that people are going to have less opportunity to have health care if we spent a 10th of time as been spent undermining the Health Care System working to make it better we would be making terrific strides to lower cost for people. But heres what was said by the North Carolina chief executive brad wilson of Blue Cross Blue Shield. We have to take a snapshot in time which is right now, a lack of action, a lack of action by the administration, he added, yields a result we are currently seeing. Higher premiums rather than lower premiums and so my question, mr. Secretary, is why do you believe its in the best interest of American Families to sabotage the Health Care System that is today allowing American Parents to take their children to the doctor . Thanks, senator. Let me just correct a few statements. Nobody is interested in the system dying. What were interested is making sure the system works for patients and families. Then why excuse me. Why are you not willing then to indicate that as long as we have the system we have youre going to keep the commitments and reimburse the Insurance Companies so they have certainty . Nobody is interested in sabotaging the system. Nobody is interested nobody is cheering the challenges we have in this system. In your state alone, premiums were up 90 before this president came into office. The number of insurers were down before this president came into office in your state. But i can assure you after meeting with the head of blue cross and blue shield of michigan theyre going to file two rates. One, if the administration keeps their commitments and one if they dont. And if they dont, theyre going to be much higher and so i think the question is why wouldnt you keep the commitments made. I understand you have a different view in terms of what this system should look like which i disagree with, but in the meantime, you have insurers, insurers that are saying the reason the rates are going up is because of uncertainty and instability created by the administration. Actually why is that a good idea . If you read further in that article it talks about the increasing cost and decreasing insurance availability for individuals across this country before this administration came into office. So what were trying to do is to fix the challenge that we have lets start by keeping our commitments. I have more questions for another round. Lets start by making sure that the administration is keeping the current commitments following the current law while we debate what should happen next. Thank you, mr. Chairman. Did you have enough time to answer that question . Yes, sir. If you need more time. Im fine, thanks. Well turn now to senator cassidy. Hey, dr. Price. Hey. Couple things im encouraged by in your budget, senator and i put in a bill regarding direct primary care and for those unfamiliar with it but as physicians you and i know the way you lower cost is empower the patient physician relationship so that if the patient has a problem instead of going to the er she can call her physician and her physician can give her the advice. Direct primary care is a contractual relationship so theres more investment perhaps than the other relationships that are out there, say in Urgent Care Center where you might see the person once, never see them again. So i like it because it can decrease utilization and by decreasing utilization decrease Health Care Cost and we dont decrease the cost of insurance unless we decrease both utilization and the cost of health care. Absolutely. Any comments on that direct primary care model. This its an helpful program and it gets to the point of the health care. The opportunity that individuals may have to be able to have a personal physician, a primary care physician in all settings across our Health System would be i think absolutely beneficial to the ability for that patient, that individual patient to get the care that he or she needs. Right now you cant do that and so what we want to do is to move toward a system that allows for more Personalized Care and the dpc model is one that i think holds great promise. If you would, and let me talk about the per capita cap or the per beneficial payment and just a little history for those who may not know, but it was first introduced by president clinton as a concept and senators phil graham and rick sanatorium simultaneously as a way to align incentives between the patient, the state and the federal government and i think were actually seeing almost a modified version of that as states are now going to Medicaid Managed Care aligning the incentive between the state as a payor with the Medicaid Managed Care company and the patient, i guess the way i look at the per benefit payment as you know i introduced a bill in 2020 2010 i dont know when it was 112 congress which brushed off the phil graham bill clinton proposal and updated it if you will. Your line between the federal and the state government. Exactly. Its so important because as you know, having taken care of as i did medicaid patients in our practices, the medicaid population is not a monolithic population. There are individuals healthy moms and kids. Theyre also individual in the medicaid population who are seniors, low income seniors and disabled, blind and disabled individuals and all those individuals need to be treated uniquely because theyre unique individuals and what we do as a system by and large is say youve got to take care of every one of those people exactly the same way which doesnt allow for that flexibility in the program so states can tailer their Medicaid Programs to suit their medicaid population. I dont know if this is in the house bill because the way we do the per beneficiary payments but as an example of aligning the incentives, if states recover waste, fraud and abuse they have to give back the federal government the portion the federal taxpayer put in so if its a 60 state, 40 state, 60 of that recovery goes back to the federal government, that works to disincentivize the state to go after waste, fraud and abuse because they have to kick it back under the per beneficiary model that we put forward the state would keep 100 of waste, fraud and abuse if you will aligning the incentive for them to ring out that waste, fraud and abuse. Its those kinds of modifications and improvements to a system that i believe we ought to be all embracing because its those kinds of things that would allow us to align the incentives but make certain that every individual in that interaction is working for the benefit of the patient, making certain theres not the fraud and abuse, making certain the patient is able to see the physician that he or she wants to see, making certain the patient is able to have the kind of treatment that he or she desires. Under the mac act which i introduced weve Incorporated States like california actually get more money. Umhum. And so some big blue states actually do well. Florida does better. So in terms of having more dollars for certain categories of patients in order to improve health care, so when i hear folks condemn it without understanding it, i feel like this could be an incredible missed opportunity to align those incentives, to improve patient care but also to protect the federal and state taxpayer. I look forward to working with you. Hopefully well have folks on the other side of the aisle. I yield back. I want to take a moment just to begin if i could to commend you and senator grassley for something you did, gosh, i want to say 24 years ago and what you did is you cosponsored legislation authored by senator john chasy that called for creating in every state marketplaces, exchanges. You called for not only establish and exchanges in marketplace in every state but to also say that in order to make sure that the Insurance Companies had a healthy pull of people to insure that there would be an individual mandate that people had to get coverage. You cant force people to get coverage. Fine them if they didnt. Incentivize them to get the coverage. I will want to congratulate you on cosponsoring legislation that provided for an employer mandate and that also provided for the idea that insurance cannot, you know, deny coverage to people who had a preexisting condition. All that is all those ideas are part of romney care in massachusetts and frankly all those ideas are part of the Affordable Care act. And the part of the Affordable Care act that republican colleagues seem to like the least are those ideas. I think theres a real irony in all of this and i like those ideas. I like Market Forces. I like trying to harness Market Forces and make them work. Yall came up with a good idea in 1993 and i just wish to heck that you would work with us to try to make sure that those good ideas have a chance of working. And the reason why the marketplaces are failing in places like you mentioned in ohio in your statement, mr. Chairman, the reason why theyre not working is basically undermine the individual mandate so that people dont have to get coverage. Young people arent. Weve taken off the training wheels so to stabilize the marketplaces and Insurance Companies they lost their shirts in 2014 because of it. They lost less money in 2015, it got better. They raised their premiums and their copays and deductibles and they did better. Standard and poors tell us rather than the marketplaces being a dust pile at the end of 2016, theyre actually recovering. Until a new administration came in and said were not sure if well enforce the individual mandate and, by the way, we dont know for sure whether well extend the cost sharing arrangements. That provides unpredictability, lack of certainty for the Insurance Companies, what do they do, well raise our premiums more. Youre destabilizing the very idea that these guys came up with 24 years ago. If i can just interrupt for a second. Those were ideas that were against it was part of the antihillary care bill. They were good ideas. I commend you for them. I couldnt tell you. I know what your bill did and frankly they were good ideas. And now were undermining, undercutting them. Why . Dr. Price, why . Senator, i appreciate the observation. I would add to that that there are significant challenges out there and there were so before this administration started. In your state alone premiums were up 108 before this administration started. In your state alone there were fewer Insurance Companies offering coverage on the exchange before this administration started. So what were trying to do is to address especially that individual and Small Group Market that is seeing significant increases in premiums, increases in deduction. How are you stabilizing the marketplaces . The three rs. What are you doing on those . Reinsurance, risk adjustment. We put in place a market stabilization rule earlier this year that identified the special enrollment periods and the grace periods to make certain they were more workable for both individuals and for Insurance Companies. We allowed the states greater flexibility in determining what a qualified health plan was to provide greater stability for the market. Weve put out word to all governors across this nation on both 1115 and 1332 waivers and suggestions regarding what they can do to allow for greater market stabilization in their states and we look forward to working with you and other senators to try to make certain that all those individuals, not just in the individual and small working with you and other senators to try to make certain that all those individuals, not just in the individual and Small Group Market but every single american has the opportunity to gain access to the kind of coverage that works for them and their families. Let me mention medicaid. When i came to the congress a long time ago before i was governor, i used to think that medicaid waS Health Care coverage for mostly women with children, poor women and children. You know where we spend most of our money, most of the money we spend in medicaid today is for old people in their Nursing Homes and a bunch of them have dementia and when we talk about cutting 800 million its not just poor women and children, its those old people getting hurt. Its a lot of people between the age of 50 and 65 white males, a lot of veterans their only hope and getting access to medical care because they cant qualify for va coverage is through medicaid. Mr. Chairman, heres an idea. I extend this idea with good intent. I spent eight years as a governor. I loved being a governor. I loved being part of the National Governors association the governor of michigan used to come here and the ways and means committee, were used to testifying on welfare reform. These are the views of the governors, democratic and republican. This is an issue that cries out for getting governors to sit at this table and say, heres how this is going to affect. This is why the waiver system works or why it doesnt work. This is why we like the idea of per capita caps and why it doesnt work. Thats what we ought to be doing. The 13 folks that have been picked to pick up a republican alternative to the house passed a mess. It would be a lot better informed if you can have this kind of hearing. This is fine. Thats something that may be move us toward a principal compromise. People want us to get stuff done. Thank you for joining us. Mr. Chairman, if i may just comment on that. I think its important for people to appreciate what the work the departments doing and we met with the National Governors association, met with governors on both sides of the aisle to solicit their input into the suggestions that they would have regarding 1115 and 1332 waivers those that affect the Medicare Program and individual market. Were doing were doing all that we can to make certain that states are able to address the challenges that they have. Dr. Price, just to be clear. When barack obama left office, was it a perfect administration, no. When he left office, there was an insurer in every county of every state in this country. Thank you. Senator carden. Thank you very much. Ive heard your commitment to make sure that youll do everything you can to help all people in this country get access to Quality Health care and thats something we all agree on, thats what we want to get done. I want to get to some of the practical problems here. I was in federalsburg on monday. Closer to where senator carper lives than i live. Very Rural Community. They dont have the same access to Health Care Providers that we have in our urban centers and i visited Federalsburg Elementary School Wellness Center where we have the qualified center that provides direct services to our children within the Elementary School and their capable of doing that and this is for many of these children their only real ability to get access to primary care and to have someone who can check up on their health and theyre able to do that under current law but they tell me as the legislations passing from the house to the senate, that that direct reimbursement would be cut off. They also tell me that if they cannot continue their flows through the Medicaid Program, that they will clearly not be able to continue the services that theyre providing today in Caroline County. My question to you, i understand your commitment to help all areas. Today our qualified senators are providing lifelines in many communities. They rely upon creative ways in rural areas to provide care including within School Settings and they depend greatly on the reduced numbers of uninsured and those covered under the Medicaid Program for comprehensive reimbursement to be able to maintain their presence. So how do we insure that as we go through this transition that the administration is talking about, that the children in Caroline County are going to be able to continue to get their Health Care Needs met . I appreciate that. There are significant challenges in the rural areas of our nation for the provision of Health Services and those have been present for a long, long time and theres a strong commitment on the part of our department and certainly on the part of the president to make certain that rural Health Services are available. So whether its through grants to the states, whether its through an opportunity for various Health Programs within school or elsewhere to make certain that children have the kind of health care and not just coverage that they need, then were absolutely committed. One of the things our budget includes is something called a new American Health block grant which would provide resources to states to do just this sort of thing, to make certain that folks in rural areas of states have the opportunity to gain the kind of coverage and care that they need. I look forward to working with you to make certain that were able to make that happen. The other area i want to cover that you and i talked about it in my office during the confirmation process and ill bring up again today is i want to know your commitment to deal with Minority Health and health disparities. We have separate agencies today to deal with it. We have an institute at nih. As i go around and look at some of the historic discriminations within our health care and recognize that health care is not equally available and our focus is not been to all communities equally and were trying to compensate for that today, i worry about what youre doing in medicaid particularly. Every Minority Community i go to they mention to me medicaid and that there is no capacity at the state level to pick up the slack if the federal government withdraws its commitment either in the numbers of people who are covered or in the benefits that are reimbursed. So how do you how do you square commitment to continue down the path to reduce Minority Health disparities in this country and the not only the reduction and the bill that passed the house but also the president s budget with such a large cut in medicaid . This is incredibly important and i cant remember whether i mentioned in this committee for my confirmation hearing or in the other one, in the health committee. But the disparities are in Health Outcomes are absolutely unacceptable to all because what we see and its not just necessarily rural versus urban area. There are areas within urban centers. I know of one in atlanta where there is a zip code where the Health Outcomes, the disparities are absolutely astounding in terms of the mortality that exists, the addiction that exists, the chronic disease that exists and thats not because of lack of Services Close by because its in the center of the city. But imagine if you would please a system that allowed for the Medicaid Program in the state of georgia to provide increasing resources to that zip code to provide a case manager if you will for every single individual in that zip code who has a chronic disease within the Medicaid Program, thats now not possible. You cant do that. Thats the kind of waiver and partnership that i think is so incredibly important to make it so that we actually identify those folks that need greater assistance because there are if were going to end the disparities that are out there which you and i both have a commitment to ending. Im all for flexible of the states. I appreciate that, but i also know the pressures on state budgets and i know in my state of maryland where our legislatures been aggressive, they cant pick up the slack. The waiver wont give them what they need in order to be able to make the type of commitments to underserved areas. Thank you, mr. Chairman. Okay. Were going to turn to let me just see here, senator casey. Thank you, mr. Chairman. Secretary price, good to be with you this morning. Wanted to start by referencing a letter that i and i guess 14 other senators sent to you recently about the house bill hr 1628 but in particular wanted to reference the Congressional Budget Office report that just came out on the 24th of may. This is a nonpartisan report by both the Congressional Budget Office assisted by the joint committee on taxation. And i just delivered to the table next to you there a copy of the cbo report so you could go to the page. I direct your attention to page 17 of the cbo report. On that page the following statement is set forth there, quote, Medicaid Enrollment would be lower throughout the coming decade culminating in 14 million fewer medicaid enrollees by 2026, a reduction of about 17 from current numbers. It then references this chart which you see on page 19 showing the numbers going down for medicaid over that time period between 2018 and 2026, all bars going down. I reference that in the context of what you said on cnn on may the 7th, quote, im quoting you now and the transcript is right in front of you, quote, there are no cuts to the Medicaid Program, unquote. Thats what you said. Do you still stand by that statement that you made on cnn . The Medicaid Program under the president s budget would increase by let me just yes or no. You can explain after that but yes or no. Do you stand by that statement you made on may the 7th on cnn . What i stand by is the statement that the president s do you stand by that statement . I think there are whats the baseline . There are no cuts to the Medicaid Program, do you stand by that statement . Whats the baseline. If there are no cuts yes, i stand by that statement. Its relative to something. Go ahead. The baseline, if the baseline is todays amount of money being spent on medicaid, the president s budget provides for an increase, cpi medical or cpi medical plus one in the increase in medicaid spending for the programs are you saying the statement on the cbo report on page 17 is not accurate . Im saying that the statement on that the cbo made doesnt include the constellation of activities within the administration regarding how we would move forward on health care. Cbo says 14 million fewer medicaid enrollees so thats one. Do you have the cbo report on the aca when it was proposed in 2010, because what they said then, 25 million individuals talking about the House Republican bill that was passed. Im talking about the cbo did they had a similar graph about the number of individuals that are covered now and, in fact, they were let me direct your attention to the same cbo report you have in front of you page 13. The top of that page, it says the following, the introductory sentence is, a reduction quote, the total deficit reduction includes the following amounts shown in table 3, the first bullet under that is quote, a reduction of 834 billion in federal outlays for medicaid. So do you still assert in light of that and in light of the previous cbo statement you still assert that there are no cuts to the Medicaid Program . It depends all im asking you to do secretary is to tell us whether you stand by that statement. I stand by that statement. Okay. Finally, let me go to a statement that was made in the cbo report now im going to page 19 and 20 you have in front of you. At the bottom of page 19 the following is set forth, quote, under the act meaning under the republican bill passed in the house, under the act premium for older people could be five times larger than for those younger people in many states but the size of the tax credits for older people would only be twice the size of credits for younger people. As a result, and heres the first bullet point for older people with lower income, net premiums would be much larger than under current law on average. Then it refers to table five at the end of the report. So i ask you that in the context of another statement you made. Now this is meet the press in march, the 12th, you said that nobody will be worse off financially as a result of the bill. Do you stand by that statement . I dont believe that statement was in reference to the bill it was in reference to the Health Care Plan that weve put forward and i stand by that statement. Senator, your time is up. I hope that you focus more on not just the proposed reforms you talk about for medicaid, i hope you focus on people like the 15 million americans that get medicaid because they have a disability. Were all for discussion about making programs better, but i think you should focus more intensively on those people and be truthful when youre commenting about something as important to american lives as the Medicaid Program and i would argue, sir, you have been deliberately misleading based upon those statements. Senator, with respect, thats precisely what were focusing on. The American People have understand an appreciate that the Health Care System that we currently have for many of them is not working. Many of them in the Medicaid Program its not working and what were trying to do and wed love to have your support, what were trying to do is to make certain that we have a system that responds to the wishes and the needs and the Health Care Needs of all americans. We all agree on that but i think you have to start being straight with people about what will happen. These are major cuts, the cbo said it in more ways than one. I think you should be truthful about that. Let me start by saying, mr. Chairman, you and senator grassley i have a great deal of respect and admiration for so my first question that i would make of the chair is, will we have a hearing on the Health Care Proposal . Will we . Yes. I think weve already had one. No. I mean the proposal that youre planning to bring to the floor, will there be a hearing . Well, i dont know that theres going to be another hearing but weve invited you to participate. Thats not true, mr. Chairman. Let me just say, i watched carefully all of the hearings that went on the Affordable Care act. I was not a member of this committee at the time although i wouldve liked to be. Senator grassley was the Ranking Member. Dozens of republican amendments were offered and accepted in that hearing process and when you say that youre inviting us and i heard you, mr. Secretary, just say wed love your support, for what . We dont even know. We have no idea whats being proposed. Theres a group of guys in a back room somewhere that are making these decisions. There were no hearings in the house. Listen, this is hard to take, because i know we made mistakes on the Affordable Care act, mr. Secretary. And one of the criticisms we got over and over again was the vote that was bipartisan. You couldnt have a more partisan exercise that what youre and gauged in now. Were not even going to have a hearing on a bill that impacts one sixth of our economy . It is all being done with an eye to try to get it by with 50 votes and the vice president. I am stunned that that is what leader mcconnell would call regular order which he sanctimoniously said would be the order of the day when the republicans took the senate over. We are now so far from regular order, the new members dont even know what it looks like. And i know that doesnt make you happy, mr. Chairman or senator grassley because you have been in the senate so long you know the value of the hearing process and the amendment process and even though the vote ended up being partisan, just as yours will be, the amendment process wasnt. Both of you had amendments that were put into that bill. As did other members of this committee. I want that opportunity. Give me that opportunity. Give me an opportunity to work with you. Thats what is so discouraging about this process. So, mr. Secretary, i want to ask you theres a 17yearold a 27yearold young man that lives in Jefferson County and hes finally making enough money that he can do one of two things, he can either buy a Health Insurance or buy a new harley and which do you think hes going to buy . You tell me. I think hes going to buy the new harley because he feels young and invincible and hes wanted a harley his whole life. He buys the new harley. He lays it on the pavement on the interstate an 18wheeler cuts him off and hes lifeflighted to the hospital do you believe that hospital should treat him. Of course. In america we treat you whether youre insured or not, correct . And theres a mandate that he buy insurance right now. Youre going to do away with that so were now in your scenario, is it working . Thats not my question. Im saying under your scenario, he does not have to buy insurance, he buys the harley, its lifeflighted to the hospital and we deliver 3 million worth of care for him. My simple question to you, mr. Secretary, is who pays for it . Sadly, it spreads among the entire system and frankly nobody pays for it from the federal government standpoint. Correct. So people pay for it . Well, or people provide the Services Without any compensation. They have to make it work at the end of the year so what the hospital does they call the Insurance Company and say we had x amount of uninsured care this year well have to raise your prices for labor and delivery or angioplasty and that Insurance Company calls the Small Business down the road. Well have to raise your premiums because the hospital is charging us more because we have to cover the uninsured care. And in your state premiums were up 145 between 2013 and 2017. Thats not true. Yes, maam. Would be glad to show you the numbers. Glad to debate you the numbers. The point is that when we add 24 million more uninsured, who is going to pay those bills . We wont be adding 24 million uninsured. You disagree with the cbo scores . Absolutely. If anyones kicked off medicaid who pays those bills . I want to make sure everybody understands were just passing along these costs to people that have insurance policies. Theres 20 million that dont have insurance under the current system. We are paying their bills so were going to reverse that and create even more uninsured. Your time is up. Senator grassley has one question, hes been waiting here patiently and well i was only over by 35 seconds, mr. Chairman. I think i did okay. Youve done so much better than the rest of your colleagues. I was very proud of you. Mr. Secretary, i only have one question because i have to run to another meeting. So im going to im going to ask you this one question and submit other questions for you to answer in writing. The Rural Community hospital Demonstration Program was established in a bipartisan manner to protect patients access to health care, these hospitals are collectively called, quote unquote, tweeners and other piece of legislation the 24 century cures act extended that program. The language was very clear. The program was to be extended beginning on the date immediately following the last day of the initial five year period. Despite this clear language, cms proposes to begin implementation of this extension on or after october 1st, 2017. This gap in implementation is inconsistent with congressional intent which requires a seamless extension of this critical program. Furthermore, it is inconsistent with the way the agency implemented the first five year extension of this program. I have a bipartisan letter to administrator vurma asking her to look at the alternative payment timing that was included in the proposed rule. I would like to submit a letter to the for the record, mr. Chairman, and by way without objection. You mr. Secretary were ccd on this letter so dr. Price, very simple question, i hope you can give consideration to this request in this letter because in several states many states, this is an issue particularly rural states one of them is alaska as an example and i hope you can help us make sure that we have a seamless implementation of this program. Absolutely, senator. And well get back with you because my understanding in looking into this is that as it was extended the rule was the proposed rule was put out in april of this year and allowed for rural hospitals to apply to this program literally as we speak and i think the deadline was the latter part of may. We have a commitment to it and it is so incredibly important for rural areas and well get back with you and look forward to working with you on it. I yield back my time. Senator brown . Thank you mr. Chairman, mr. Secretary, thank you for joining us. You called the Opioid Epidemic a key Public Health priority and you highlight how this years budget proposes a 50 million increase in funding over previous levels, up to 811 million. That might seem like a lot of money and it is but you know whats a bigger number, 939 million, 939 million is the amount of money one state, my home state of ohio spent on fighting the Opioid Epidemic last year alone. 939 million, my state spent. This chart came from Ohio Department of medicaids website, governor republican kasichs website. In 2016 ohio invested 939 million in fighting this Opioid Epidemic. 70 of that total 939 million came from . 650 million came from medicaid. 650,200,000 came from medicaid, despite this investment, despite governor kasich investing nearly a billion dollars in prevention, education, medication assisted therapy and other treatment, eight people if todays like most days, eight people in my state will die from an opioid overdose. 4,000 ohioans died from overdose last year. Were on track to go far exceed that number in some counties weve already exceeded the number of the year before and this is only june. 43 people died in Cuyahoga County, the states largest or second largest county in the state. 43 people since memorial day. This epidemic continues to devastate communities in my state. I know you know that. I agree with what you wrote in your testimony. Were not winning this fight. But im confident we lose far more people, far more lives, far more families turned upside down if we werent spending this money, if medicaid werent spending this 650 million, dont take my word for it. Two weeks ago, my colleague both members of this committee, senator portman, my ohio friend republican, senator carper my delaware friend held an important meeting about this epidemic to discuss proposals. I want to quote from a couple people. The witnesses on the second panel of that hearing, a doctor and a police chief from newtown, ohio, one of the most conservative parts of our state. He was the former head of drug control policy and a coroner from Cuyahoga County, all have voiced opposition to either ending the Medicaid Expansion or cutting the program. These four experts brought by senator portman to his committee all said dont cut medicaid, dont either dont dont cut it or dont end the expansion. The Cuyahoga County coroner noted anything like Medicaid Expansion being limited that limits peoples access to health care. I cant see any good coming from this crisis, from that i cant see any good coming from that in this crisis, especially with the high rates in mortality. Police chief from newtown, ohio, little town near cincinnati, hes in the front lines of this fight, he said, we should not be decreasing medicaid. He talked about one of the programs that his teams are doing in the Hamilton County area signing people up for medicaid, then getting them into treatment. Right now 200,000 families in ohio are getting opioid Addiction Treatment who have insurance because of medicaid, yet your administration continues to talk down to criticize Medicaid Expansion and to suggest cuts in medicaid. He went on to say taking away medicaid would make this fight more difficult. I dont even want to imagine the number of Overdose Deaths we wouldve had in ohio if our republican governor, im proud of what he did and hes gotten a lot of criticism from President Trump and a lot of criticism from your party if he had not expanded medicaid to those 700,000 families. The Budget Proposal, thats thats in addition to the house medicaid covers a third of all Substance Abuse treatments and communities across ohio and it covers 50 of all medication assisted therapy or treatment. You sit in front of us. You have taxpayer funded Health Insurance. We have taxpayer funded Health Insurance. The 200 republican plus republican members of the house who have taxpayer subsidized Health Insurance are all willing to take it away from these 200,000 ohioans getting only opoid treatment. Your policy proposals, you say you your interested in fighting the epidemic, your policies proposals tell a youve confirmed we can do all a kinds of things with grants. No, you cant. Compare to the size. Maybe you dont know me, but i dont want to to go 24r. I think probably senators dont meet enough people that are in these programs. But you said increasing Substance Abuse treatment pan of your plans to on addre s ts to d crisis. What you are not telling the West Virginia readers, Donald Trumps second best state in the country, youre not telling them what you are really doing. And sorry for the preface, but how do you plan to increase access to treatment when cut the single biggest source of funding for treatment by 600 billion . How does that possibly add up . Senator, youve visited victims in your state and i talked to a mother whose son died in the bath room of a mace is hes from an overdose. What we have is unsebl taccepta you, to me, to the president. Our commit. Is to make certain that when we put in place is a program that actually works. Youve seen the graphs. The numbers continue to go in the wrong direction. So thats not a system i want to be married to. What i commit to you and what i look forward to working with you on is a system that actually works for the parent who are suffering today because they have lost a loved one. I commit to working on a system that works for those addicted who want to gain recovery are and treatment. Imagine is system that focuses on resources. What it would do for the ability to treat folks and also to thrive in a better way physical kelly elsewhere. If there is any treatment, they are not all successful. It often takes three, four, five times. Abo but if you cut medicaid, you can talk about a Grant Program and all this good talk and i know you mean it in terms of wanting to take care of people. Youre a physician. I know that. But how does this possibly work if you will cut the biggest revenue treatment that takes care of these families and putting them in these programs . Youre way over your time. Ill allow him to answer that. Thats quh im trying to encourage us to look at. Is a system that actually work for the individuals who are suffering from this addiction. A system that focuses attention and treatment on it. We need to turn the curve down. We continue to tolerate a system that allows for addiction and Overdose Deaths. Its sun acceptable to me. I have a couple questions. This report that the department is working on a rule that would deny Birth Control for employees, are you aware of this . There is a current rule on the concept mandate. Youre proposing that you allow employers to discriminate against women in having Birth Control be part of an insurance policy provided by employers . What is currentlys occurring is solicitation of input and in that process i cant make any comment. You cant comment whether it should be part of health plan . For women that desire Birth Control, it should be available. Are you promulgating the rule . There is a rule that has been proposed. So you want it should be enough to just say on a c conscientious fwhafs they dont believe in providing it . Women who desire Birth Control should desire that access should have access to Birth Control. Women cannot be discriminated against by their employer who wants to cherry pick various aspects Womens Health. So this is the intent of this rule, i guarantee you there will be a big fight on this issue. Sfwh i wanted to ask you about proposed medicare cuts. My understanding is that the budget include as two year extension of mandatory sequestration which would impose a 2 cut on medicare providers such as hospitals and rural hospitals. Does your budget through that . I think are referring to the current law and i think the budget reflects current law. So youre saying that the extension of the mandatory sequester is not a cut to medicare . If its current law, then there should be no reductions. So you believe we should be making the reductions to Rural Health Care facilities . I think we should make certain that we have a Health Care System that is financial feasible and make sure that the American People have access to the kind of care that they need. Okay, ill take it as a yes that you were behind this particular cut and ill say that our rural hospitals are struggling are struggling to make this care. And i have a question on rebalancing of the medicaid budget. I dont know if youve had more time to look at that. That is something that we wrote into Affordable Care act that the states are doing and its a huge savings to the budget. Is that something that you think the administration can get further behind . As i mentioned to a couple other questions, the dine michl of the Health Care Market is so important to embrace because we should be allowing and accommodating in our system for individuals to receive care where it suits them and their providers. So youve identified an area where we should be able to accommodate that and the system should allow for it. Thank you senator nelson. Thank you, mr. Chairman. Good morning, mr. Secretary. I just want to ask you for things in your proposed budget. Something that weve heard a lot about are the cost sharing reduction subsidies. 72 of floridas Affordable Care act consumers benefit from these. And thats why where im asking. Now, its hard to get a clearance on this. The private market the providing under the exchanges, i cant take the uncertainty of knowing whether or not the subsidies are going to be there. Insurers have confirmed this to my questions when proposing rit hikes or even pulling out of the markets. Because of the uncertainty. So can you confirm that the administration will continue to reimburse insurers for these subsidies that help so many of my constituents see a doctor . And i notice its in your budget through fiscal year 2018, what should we believe. Sfwh answer may not prove of aing to you, but the Current Court case is now house v price. So im the defendant in florida case. So what i kell tell you is just what you said, and that is that the budget reflects the payment of the csr payments through 2018. So does that answer mean if the court case went in the favor of the administration, that basically those subsidies would be cut . What i can tell you, and again, id like to be able to share more, but as the defendant in the case, im not able to do so. But i can tell you that the budget reflects csr payments through 2018. And unfortunate dilemma, mr. Chairman, that because of the uncertainty, it predicts an outcome that the aca, the Affordable Care act, is in the exchanges which is bringing Health Insurance to millions and millions of people that otherwise could not afford it, the uncertainty of whether or not those subsidies will be there in the future in fact is undermining the ability ever insurers to be able to project what their premiums are going to be and therefore to proiskt themselves what they are do is being is jacking up premiums which is undercutting the whole reason for having the subsidies in the first place. Let me shift to the zika virus, mr. Secretary you know there are a bunch of cases, 1400, in florida alone. And your administration 2018 budget states, and i quote, outbreaks like zika will not be a one time event, Capacity Building at all levels as well as innovation in dyiiagnostics needed to prevent and control these outbreaks and understand more about these vectors. End of quote. Yet the administration slashes the very programs designed to bolster capacity at all levels. So does your budget cut can more than 7. 2 billion from nih . I cant tell you how proud i am of the wok being done at nih to work on a vaccinvaccine. Were in the phase two trial of. The cdc is doing phenomenal work to make certain that surveillance and detection i understand all that. I believe the budget accommodates for handling any challenge that may exist from the zika threat. I understand. But the question is does it cut 7. 2 billion from nih . The proposed budget identifies reductions that we believe can be accomplished at nih and savings that accomplish by increasing efficiencies and making certain that we have a core mission of nih accomplished through the resources that are made available. Efficiencies are great. But i just want to know black or white. Does it cut 7. 2 billion from nih . The deductions i think your number is accurate. It depends again what the baseline is. But i think your number is accurate. Mr. Chairman, ive got a couple other questions. Just are simple. Yes or no questions. Go ahead, but your time is up. I understand, but i tried to get a yes with or no question. Go ahead. Thank you. Good does it cut more than 600 billion from the Medicaid Program . No. Your budget does not be. Okay. Does it cut more than 1. 3 billion from the cd krchc . 10 through appropriate priorities and id if iing deficiency, we believe strongly that the cdc budget is what is needed to continue to protect not just the United States but the world. So is that a yes, it cut s 1. 3 billion from cdc . What it is is a statement that affirms the president s desire to get pofolks that you dont measure success of a program by the amount of money that is going into it, you depend on whether or not the outcome and mission is accomplished. And if we can accomplish the mission, the appropriate mission of cdc, with less resources than one would think that that would be something to celebrate. Mr. Chairman, i understand al the reasoning behind it. I just want to know does it cut 1. 3 billion from cdc. As i said, there is about a 10 reduction in resources going to cdc. Does that equate to 1. 3 . I think your number is accurate. As it cuts 850 million from the food and Drug Administration . I dont believe so. What we envision in the fda is to shirt the resourft the resou. I think there is about a 500 million resources to fda through a modification and improvement in the user fee process. Youre way over your time. Senator bennett. If its okay with you, i think i would yield to senator roberts who has been here waiting and then id like to go after him. That is gracious of you. Well go to senator roberts. I want to get in the weeds a little bit. Welcome back, doctor. Thank you. Good to be black. There are statements that you are responsible for people dieing in ohio, all of the problems in the Affordable Care act, regukss in funding in rural areas which of course im very much interested in. The entire budget by the president , to be more accurate, omb. And the chairman has been chided for not having regular order where what we have is closure and delay. That is not regular order. And then i sort of lost oh, the shih came virus. Are you enjoying yourself . The job is a great challenge and im joining the challenge, yes, sir. In your prior life, i know you shared my frustration with the implementation of the Competitive Bidding program pi wont go too much further into this except we dont have the providers that we used to have and people are having to drive 150 miles with regards to Durable Medical Equipment and access to it. Last year we passed the 21st se century act to reduce temporarily the impact. So preserve the intent of the program, does the agency need to provide additional regulatory changes . Im trying to get a sense of whether legislation is needed. Legislation would be welcome to loi a greater opportunity to provide services to their clients, to the patients across the land we believe strongly that the Previous Program is limiting the access to to appropriate services especially in rural areas. I appreciate that. Ive been listening to my friends across the aisle with regard to their concerns, and i have a question that would be repetitive to the chairmans and you have talked about what is happening with our premiums. Blue cross saying that they are pulling out last year. There will be less options. Premiums have doubled in three states, tripled. And yet i hear my colleagues saying stay the course, full steam ahead, keep funding what is not working. Trying to pin it on you is amazing. This is like blaming cassidy and sun dance kid for jumping off the cliff or to be more accurate we are in the obama car and its a lot of hyping in the same car with thelma and louise and were going into the canyon. We have to get out of the car. I think that is what you are try doing. I dont think you are responsible for the entire budget proposed by omb. Im not favor with some of the things with regard to ag gli culture. But i dont know of anytime that the senate has considered any budget that came from a president seriously since reagan. And then this other business of regular order with regard to the chair plan during that whole episode of when we put obama care together and days and nights and days and nights. It started in the health committee. That is gathering dusz. It failed on a party line vote. I came here are and i had the same amendment on rationing and it failed on a party line vote. And then the product went to the floor of the house. And behind closed doors and leaders office. And sort of like charlie rich singing behind closed doors and out came obamacare. And weve had eight years of this now. And i just think for all of these decisions where you said we are trying to correct on a bipartisan basis has been over the top. 567bd my time has expired. Secretary, great to see you again. I wanted to start by understanding the medicaid cuts, however you want to characterize them. Characterize them. But the numbers as i understand them are that there is about 834 billion of cuts in the house bill, the House Health Care bill. And there is about 610 billion in savings or cuts to the Medicaid Program in the budget. Is it right too add those together, is there over4rlap . I dont believe its correct to add them together. My understanding is the budget doesnt seem passage of the house bill. My understanding is that it absolutely does assume passage of the house bill. It assumes as it relates to medicaid that what is put in place is a per cappa block Grant Program that will reflect over a ten year period of time a savings of 610 billion. If we could workipa block Grant Program that will reflect over a ten year period of time a savings of 610 billion. If we could worktpa block Grant Program that will reflect over a ten year period of time a savings of 610 billion. If we could worka block Grant Program that will reflect over a ten year period of time a savings of 610 billion. If we could work i probably with the opportunity to see whether were talking about 834 billion or 1. 4 trillion. In either case, its a huge cut to the Medicaid Program. I asked the governor yous office to tell me who is on medicaid in my state and heres what they said and i want to ask whether you dispute any of this. They said when you look at who is on medicaid in colorado, nearly half the program are children. Does that strike you as probably right . That is the ballpark for most states. And more than 40 of our medicaid spending supports the disabled and senior, plane many whom in Long Term Care facilities. So these are people who have spent down their life savings for the privilege of being in a nursing home funded by medicaid. Would you agree that that is right . Sounds a little higher than most states, but probably in the ballpark. And then they said of the remaining adults on medicaid, the vast majority work but still cant afford Health Insurance on their own. Sound familiar to you in terms of colorado or other states . There are certainly individuals who have medicaid coverage who are employed. Well, and what they would say is that there is a tiny residual percentage of people that are arent the children or he wield that dont work and on medicaid. Is colorado different. We can get you the numbers for your state im sure. That would be great. But go you see any reason to dispute what i just said . So here we have the i appreciate your condor. Dgo you dispute what i just said . So here we have the i appreciate your condor. Ogo you dispute what i just said . So here we have the i appreciate your condor. You see dispute what i just said . So here we have the i appreciate your condor. Candor. Medicate id is not surpting a we lot of people that should be working but arent. Would you agree . I think it varies from state to state. There are certainly individuals who are able bodied without kids on medicaid who arent working. But that is a very small percentage of people. I think weve agreed that havent we . So hes not saying that there are people lazy who dont want to work. It doesnt comport with the evidence. And certainly not true in my state. So if we were with going cut it by 25 pr and i have a story fr the denver post, front page story about the 700 million a year by 2023 that the state will have to come up with to compensate for the withdrawal of the federal government, the medicaid reductions that are in that, just the house passed bill, not your budget, but the house passed bill, what is your advice to us in our state about how we should handle the cuts . When i you ever poor children, a whole bunch of people in Nursing Homes, a whole bunch of people working but cant afford private insurance, what is my state supposed to do . I think again the constellation of programs that we would envision that would provide for greater opportunity for individuals to get Health Coverage as opposed to less right now i would remind folks again there are 20 million americans without Health Coverage, i dont know what the number specifically is in colorado, but there is a significant number of individuals that dont have Health Coverage. And what he woulwe would envisi system that responds to those folk and those who find that it is not better to be covered on on the medicaid system because system that is more responsive and my time is up. And with respect, and i do respect you a lot for your service in the house and the fact that youre a doctor, to believe what you just said, you would have to first reject the findings of the Congressional Budget Office that it throws 23 Million People off insurance, creates 23 Million People more that dont have insurance. Youd have to believe that and youd have to believe that a 25 cut to medicaid in a covethat cr children, people in Nursing Homes and people that are already work, and cant afford insurance will somehow magically be able to afford insurance. Thats what were being asked to believe. And i can tell you this, because the republicans in the senate have not yet taken up the bill and i hope that we will, if you set out to design a bill less responsive to thehe critics of obamacare in colorado, to republican critics of obamacare, you could not write a bill less responsive than the house bill. So my hope is that in the senate you could not do it, my hope is that in the senate we will not do this in a partisan way but we will come together as democrats and republicans and address the Health Care System in a way that is actually believable to the people that i represent. What yyou just are said is not believable in any respect. And im talking about republicans. Thank you, senator. Senator heller, you are the last one. Thank you. Thank you for being here and taking some of our questions. I want to talk about nevada and the aca. Our lenlggislature just finishe monday. So as of two or three days ago, it adjourned for the next two years. And one of the questions and comments being made is that if the aca in its current form what came out of the house were to parks then it wouldle put a 250 million annual hole in the nevada budget. And these numbers then an budge and these numbers are an indication. Im getting out of the Governors Office also from the state of nevada. I like your reflection on that. If its 250 million a year, thats the bien yuneium, and th would have to have a special session in order to correct that budget offset. Do those figures sound accurate to you . I dont think so because and again, the house bill doesnt anticipate, as i understand, doesnt anticipate any significant changes until 2019, so and 2019 is when the changes would come into place and wed be happy to review the genesis of those numbers and see whether or not theyre accurate and if so, how we can address that. Have you had the opportunity to do research on nevada . The reason i asked this question is we had delegation on the house side and we had a conversation with the director with you and cms and these numbers perhaps arent as accurate or as dreadful as they come out of the Governors Office. Thats correct. What kind of reflection did you have . Do you recall what kind of conversation you had . Yeah. In fact, i think there was specific language that accommodated that concern which is why i say i dont believe that any changes would occur over the ensuing two years, but again, i would be happy to talk with you and work with you and the governor and your state and see where they believe those numbers are coming from and determine their accuracy or not. What do you anticipate being the growth rate of healthcare costs over the next ten years . What have you calculated . It depends what population youre talking about. The medicaid population and annual growth rate has been in the range of 2. 6 and 2. 8, as i recall, annually . No. Thats historic. What do you guys anticipate over the next ten years . I can get back to that on the on the specific amount. I think its increasing a little bit, and i can get you the exact number. Are you washging with leadership on our side as we go through the changes . Im going to guess that leadership on our side has had discussions with you and cms and some of the particular changes that were looking at. Including grow the rates and i dont know what the growth rates going to be if it will be cpi medical plus one as it did in the ahca whether its cpi medical or inflation, for that matter . Have you had any discussions and im trying to find an answer to these questions and i cant get it out of our meetings and im wondering if you have insight into what the rate may be in the cpo. The proposal in the budget is a cp1 medical for those disabled medical and the others. Do you still endorse that . If it was anything below that, would you support it . In other words, if they went to inflation, right, would you support that . I think it depends what the entire program looks like. If were accommodating anybody that would have challenges in a supplemental manner then i would have to look at that, but what i support and what i think is important is to make sure that every single american has coverage that they need. Cpi plus one. Cpi medical plus one. And what was the other . Aged. If that were to change to cpi medical or just inflation, would you oppose that . As i say, it depends on what the entire program looks like. In isolation that might be a challenge, but that doesnt that doesnt address what the entire constellation of whatever the plan or program is, because there are other ways to accommodate individuals who need Financial Assistance and where we are committed to making certain that that happens. Over the next ten years, what is the rate increase overall . Over the next ten years. Well get that to you. I dont have it on the tip of my tongue. If its below that, would you have a problem with it . In other words, we figure it out and you tell me what it is, and if we have a proposal thats less than that, would you oppose it . I think whats important in this conversation is to make certain that we accomplish the goals that we have set out and that is to make certain that every single american has access to the coverage that they want and when you have that as your goal then it requires that you provide resources in an array of different ways to make sure that that is an accomplishment. I just want to make sure that medical inflation, and the funding isnt below that because if it is then we dont meet your goals. In isolation, i would agree. Okay. Okay. Thank you. Thank you, mr. Chairman. And your time is up, senator thune. Secretary price, thanks for being here today. I appreciate the budgets attention to the need to repeal and replace the collapsing Affordable Care act, the need for medical Liability Reform as well as the Budget Programs and integrity provisions and we have a number of important issues to tackle in the health care space. I want to thank you for your work. I discussed this with you at your confirmation hearing, but i have serious concerns about the health service. Yeah. We ton to see two facilities entered south dakota after they enter with the the center for medicaid and cma services. Cmr is finding emergencies unannounced visit from cms. These systemic problems over the years is what prompted the senators and i to restore the accountability in the ihs act. The bill would give ihs the flexibility to terminate poorly performing employees and streamline the hiring process so ihs can recruit, talented, medical professionals more quickly and create incentives so those folks will stay on the job longer. My question is will the department commit to working with us on this legislation and other reforms to improve the quality of care at ihs. Absolutely, senator. Ive been impressed with the commitment of individuals in ihs and the resources that we are trying to identify for new facilities and one of them, as you know, is in south dakota to make sure were living up to our responsibility and the commitment that we have as a nation in the ihs arena. Wed love to give you more tools to create the kind of act ability that we need. Ly we look for to working with us, but last we address the an mriing of competitive bid rates and ultimately the and provideded a delay and itty r yeared them to report you on payment adjumpu justments affect the access and that was supposed to have been done by january of this year. I wonder if you can provide an update on the report on the status for the committee . It remains in process and we have a significant commitment to make certain that the dme program is functional and works for folks all across this land especially in the rural area. I guess i would say additionally, as you discuss regulatory relief which i know is a priority for the administration and something that we very much agree with, maybe what the departments approach might be for addressing these beneficiary access challenges that are posed by the current reimbursement structure. Is there something you can do in the interim that would help bring us some relief . Absolutely. You cant have a system that awards, as you well know, awards contracts to entities that have never provided services in a geographic area, and thats the system that we currently have. Or awards contracts to servicers or providers that have never demonstrated the capability to provide that service, and sadly, thats the system that we have in place right now. So what were looking at is the entire array of the dma system and the goal is to make certain that all americans regardless of where they live have access to the kind of services whether its hospital beds, whether its wheelchairs, home oxygen and whatever it may be in the dme space. These are quality of life issues for so many, many people and from my perspective, we have failed to date in making certain that we ensure the accessiblity that folks need. We discussed the 2009 rule requiring that services being required under direct supervision which has been delayed annually since then in small and rural hospitals and you expressed an interest on working on a permanent extension on the nonenforcement of this policy, and im wondering if you have an update on where things stand from the departments perspective. The i think, the permanent nonreinforcement is part of a bill that we have out there and weve been trying to weve kicked this down the can this year and im hoping we can get a permanent solution and im hoping where you see things from your departments standpoint. Senator, its an area of significant interest, and i can tell you that its a work in progress. All right. We hope we can get permanent relief there and we look forward to working with you going forward. Thank you, mr. Chairman. Thank you, senator thune. We have a question or two and well wrap this up. I want to the thank you for your courtesies this morning in allowing us to have thorough opportunities to ask questions and secretary price, again, thank you for being here. There are so many issues that i continue to have great concerns about, but certainly when we look at this budget that in practicality cuts medicaid and Nursing Home Services and Children Healthcare and research and lifesaving drugs. I can go on and on. One type of cut that i know we need is not in this budget and thats a cut in the cost of Prescription Drugs. President trump repeatedly said he wanted to drastically bring down Prescription Drug prices through medicare negotiation saying pharmaceutical companies were getting away with murder. I support medicare negotiation and had for a long time and 90 of americans support that, but this budget doesnt include any major proposals to bring down the cost of Prescription Drugs whether its medicare negotiating and safe importation of Prescription Drugs, transparency or any other policy, for that matter, even though the prices of the most popular drugs have increased by 208 . 208 in the last ten years. However, the House Republican Health Care Plan and i assume the senate one does give Drug Companies a huge their 25 billion tax cut paid for by the people who are seeing their Prescription Drug prices go up. Middleclass families and seniors. Given that this budget is the major policy document from the administration, is it fair to say that lowering Prescription Drug prices is not a priority in the. No. Absolutely not, senator. In fact, at the department and the president has made this an absolute priority and has charged us with reducing drug prices and over the past six week, eight weeks weve had half dozen to eight stake holder meetings with individuals and weve charged hrsa and the fda to make certain we can provide the president with the most effective way to be able to reduce the increase in drug prices. So, no, its an absolute priority and we look forward to working with anybody who is interested in holding down or bringing down drug prices for the American People. Should a family have to pay 700 for epipens for their child . Well, regarding the epipen, what has occurred in the past is that the ability for competition to bring hold down those prices or to bring down those prices was prevented by a previous decision through the previous administration. So were looking through the fda at exactly those kinds of things because to our goal is to make certain that the American People have access to the kind of medication that they need at a price that they can afford. Which i wish was in this budget, but its not in the budget at this point, but should someone who learned has hepatitis c have to pay 80,000 to get the drug they need to be cured . Youre identifying a drug thats saving lives. 80,000 in ord for someone to have the opportunity to save their life . There is a right price. Is that the right price . How do we make certain that we incentivize innovation and make it so that, in fact, companies are able to identify these these remarkable cures that are out there. I dont know what the right price is, but i know how you figure out what the right price is. I would be anxious to know what you think the right price is. If you have Cystic Fibrosis and need the latest drug to improve lung function should you have to pay 300,000 . I think we ought to be celebrating the incredible invention and work individuals are doing to save lives in neuroCystic Fibrosis. I celebrate that. Its difficult if someone cannot afford what is put forward on the market. So we certainly celebrate innovation. That innovation needs to be affordable so people have access to treatment, and that can save their life. I would agree. Is it appropriate to give pharmaceutical companies a 25 billion tax cut in the Health Care Reform bill when there is nothing to bring down the cost of Prescription Drugs in that bill . Well, i regarding whats in that bill as it relates to drug pricing im not sure that im talking about the tax cut. Do you think its appropriate to give a 25 billion tax cut to the pharmaceutical industry in a bill thats actually taking away healthcare from people and does nothing about lowering the cost of Prescription Drugs. I dont know thats what it does. I do know thats what it does. Well, then you do. Its imperative that we have a system in place that incentivizes innovation so that we can realize the remarkable, remarkable productivity and entrepreneurialship and innovative spirit of the american scientists at nih and elsewhere who are discovering these wonderful kinds of drugs to save lives. I totally agree with that. Do you think the industry should be spending more on rnd today than they spend on advertising drugs to us . I think that i think that again issue the system needs to be such that it incentivizes innovation so that we can realize the benefit of wonderful inventions. Okay. Just for the record, all those ads are written off and we pay for them as taxpayers. Id love to be helping them write off much more on rnd and mr. Chairman, as i close, let me just say just for the record, we dont have to debate it today, but mr. Secretary, youve talked about a study over and over again about prices, and i just want for the record, to say this is highly disputed study that youve been talking about that compares two different kinds of systems, doesnt include the tax credits that have substantially brought down costs out of pocket costs for real people and so at another day i look forward to debating you what i believe are in michigan very flawed numbers. Thank you. Let me just say that i ive been in thiS Health Care business for 41 years, and every year we demand more and more money, more and more spending, more and more federal government and more and more intrusion and we wonder why it costs us so much. All i can say is weve never had a better secretary than you, nor have we had anybody more patient in are answering all these questions, and i want to thank you for participating the way you have especially want to thank you, secretary price, for attending today. I think we can all agree this is certainly not the most enjoyable activity that you could have participated in today, but it is nevertheless, extremely important, and my colleagues, these are important questions theyve asked and as ive said many times before id like to work with anyone, republican or democrat who would like to resolve these important and pressing issues. Health care is no joke to any american and to those with diminishing access, it means the world. I look forward to hearing from each of you in the coming week, and i hope we can find ways to work together. For any of my colleagues who have written questions, i urge that they submit them by june 15th. Im sorry. I dont mean to interrupt. Im not going to this will have to be it. I dont have any more time. Do you have to have questions, senator . Ive only been waiting for two hours, mr. Chairman. Thats okay. Use ten minutes before. Nine. Nine. Well, you can he came in large part so he can answer one of my questions and its not really a question. I just want to say one thing if i could and ill be very, very brief. Sure. Mr. Chairman, i mentioned earlier, dr. Price heard me described myself as a recovering governor, but i am. Ive sat right where youre sitting and trying to provide a governors perspective on issues just like this one, just like this one and one of the things that we asked for, for welfare reform, give us the opportunity to have waivers and give us the opportunity to apply for a waiver on how well do on welfare reform and that was granted. We asked when we did the race to the top, the education reform stuff in the last administration. Lets make sure the states could apply for waivers in the federal law and we do. As it turn out with medicaid, if im not mistaken, states can apply for waivers and maybe every state has one or more waivers with medicaid. There are some cases in the law that states cannot get a waiver and we can have a good discussion with governors about whether that makes sense and there should be further governing. I always like to have some flexibility. Find out what works best in my state and works well with us and maybe not, but that could be a healthy thick to do. The other thing i want to the ask for the request, bluecross, blueshield of North Carolina, premiums to rise in 2018 for health care acts and the single biggest reason this is bluecross, blueshield North Carolina and the sharp increase in rates is a lot, is a lack of federal funding for cost sharing reductions beginning in 2018 and you know this is the program weve been talking about earlier and the administrations budget to the credit fund, cost sharing and the president keeps talking it back and he sdvsht want to do this, raising questions and its a lack of predictability for the Insurance Companies that drive up the prices. So lets just keep that in mind. Thank you, senator. You always add a great deal of understanding to these issue, and i appreciate you doing that. In that case, can i have a couple of more minutes, mr. Chairman . No. Im going to kill you if you keep this up. I will die happy. No. Youre doing a great job. Mr. Secretary, youve been very patient, and i personally really admire you. I know you know this field very, very well. I know you know the problems. I know you know how difficult it is to solve these problems, and i know you know theres no quick answers to some of these questions that have been asked. You handled these very well today, and i just want to the personally thank you and with that, well adjourn this meeting. Thank you mr. Chairman. Thank you, mr. Chairman. On wednesday, former Homeland Security secretary jeh johnson will testify in the russian interference on the 2016 president ial elections and hell be speaking before the house Intelligence Committee. Youll be able to watch tp live at 10 00 a. M. Eastern on cspan3 and watch it online at cspan. Org or stream on the cspan radio app. Recently on cspan. New orleans mayor Mitch Landrieu on the removal of a robert e. Lee staff you. To lay out the reason yes the statues were erected in the first place and what we can do to recover from the ageold battles that have divided us for so long and because of new orleans role in that dark period of our history, we were, after all, one of the countrys largest slave market, i felt that i and Little People in the city had a special responsibility to help our nation continue to move through racial discord. Actress Mariska Hargitay at a Bipartisan Task force aimed at ending sexual violence. To hear these stories and to hear words like you said, dehumanizing, these lives derailed, the way that life goes off track. These are not kits sitting on a shelf. These are peoples lives sitting on a shelf. Getting derailed. Children getting derailed of what is this life supposed to be . I was on this track, i cant even make sense of whats happened to me and we have been letting perpetrators go by not testing these kits and saying we dont care about this issue. And senator rand paul on the proposed arms sale to saudi arabia. We will discuss something even more important than an arms sale. We will discuss whether we should be actively involved and should the United States be actively involved with refueling the saudi planes, with picking targets, with having advisers on the ground. Should we be at war in yemen . Cspan programs are available at cspan. Org. Right on our home page or by searching the video library. Cspan where history unfolds daily. In 1979 cspan was created as a Public Service by americas Cable Television companies, and is brought to you today by your cable or satellite provider. Last week, several senators questioned Deputy Attorney general Rob Rosenstein about the