Please come to order. ,odays hearing is on alex azar the nominee to serve as secretary of the department of health and Human Services. The committee will vote on the nomination. Senator murray and i will each have an Opening Statement and then the former secretary and governor of you call who we younge today, and senator who is a member of this committee, will introduce mr. Azar. Senators will each have five minutes of questions. We have a lot going on today in the senate but we already have a good turnout, so i anticipate a good, vigorous questioning. Hes confirmed to lead the department of health and Human Services, you will run a 1. 1 trillion organization, that almost signals the total of 12 Appropriations Bills that Congress Passes each year to find everything from National Parks to National Defense to national laboratories. You will be overseeing medicare and medicaid. Our nations government run Insurance Programs for the poor and elderly, Mental Health and substance abuse, or you will have to address the Opioid Crisis among many other issues. The National Institutes of health, where with francis leadership,llent the United States is leading efforts to develop a cure for alzheimers. Painkillerddictive to prevent opioid abuse and new treatments for cancer, the fda for Scott Gottlieb has gotten off to an excellent start for speeding up approval of generic drugs and working to spur innovation and access to regenerative medicines. You will be faced with skyrocketing premiums and individual Health Insurance market that are currently a nightmare for the 9 million americans who dont receive a government subsidy to help pay for their Health Insurance. We also have an opportunity to implement what the majority leader of the senate called the most important piece of legislation last year. Act whichentury cures senator murray and i and members of this committee agreed upon and gave broad new powers to the fda, the National Institutes of health included the first major organization, senator murphy specially worked on that, mental aslth programs in a decade well as significant new funding for the Opioid Crisis, which virtually all of us support. I believe you are an excellent nominees this job. You have been confirmed by the United States senate twice. You have offered to meet with every member of this committee and have met or spoken with 15 Committee Members. You have served in the Judicial Branch as law clerk for Supreme Court justice scalia. You know the executive branch, having been hhs general counsel for four years and deputy secretary for two years. And you know the private sector. You spent a decade in a leadership position at one of majoruntries pharmaceutical companies, so you know the system of how drugs get from the manufacturer to patients. With all these perspectives, you should need no onthejob training to lead this department and should be able to take advantage of this exciting time in Biomedical Research to speed safe drugs through the system to patients more rapidly. I see your broad experience as one of the principal assets. Experience in health care to me is an obvious asset for someone called upon to lead the nations most Important Health care agency. One reason dr. Gottlieb, the fda commissioner has done so well so rapidly is he knows the agent the. And everyn commissioner, and he knows the private sector well, having worked in it. Similarly, dr. Collins knowledge of nih and his experience leading the human genome project has made him an especially effective leader at the National Institutes of health. We plan to hold a third hearing on how the supply chain affects what patients pay for Prescription Drugs on december 12 two here from the national academies. Given your experience, i would welcome your input as we continue to examine the price patients pay when picking up their prescriptions. Health care is much broader than Health Insurance and only about 6 of the insured americans purchased their insurance in the individual market. But that is where we have had most of our debate and discussion. As i mentioned, 9 million individual markets dont qualify for subsidy. They are really getting hammered by skyrocketing prices. Intimacy, premiums have increased 176 in four years and in addition in tennessee, premiums have increased 176 . Senator murray and i and members this committee worked on an agreement cosponsored by 11 other republicans and 11 other democrats which the Congressional Budget Office says will prevent a 25 price 2020 by in premiums by paying all sharing subsidies, decreasing dollars spent on a sea of premiums, and as result, lower the deficit. It will give the states authority to use the waiver in the law to find other ways to lower premiums. For example, alaska created a Reinsurance Program and lower no newby 20 with federal spending. Yesterday the president said he supported the Alexander Murray agreement becoming law but into the year. Our agreement has so much in it that appeals to so Many Democrats and independents. Its hard to imagine our not passing something that prevents a 25 increase in premiums by 2020 and offers states electability to further lower rates. The democratic leader called it a good compromise and said it has the support of all 48 democrats. The chairman of the Democratic National committee tweeted last , Alexander Murray has widespread bipartisan support. As secretary, there are many other steps you can take to lower premiums and stabilize the market. The Opioid Crisis that is ravaging this country is a priority for the president and every member of this committee. We are having estate perspective on Opioid Crisis tomorrow. Drug Overdose Deaths in tennessee went up by 12 from 2016. O it dramatically increase 74 in 2015 to pledged tos streamline programs and provide funding to states and communities on the frontline of this crisis, imprudent and putting preventing the comprehensive addiction and recovery act. We have included 860 million in the fiscal year 2018 appropriations bill. We stand ready to work where additional tools and authority is needed. Some say that we need an opioid czar. In tellingll join me the president that this is a bad idea. Once confirmed you need to be the one to take charge in leading the federal government response and letting us know how to help. Exciting opportunity to implement the 21st century i hope you will work with us to includingtage president obamas precision initiative, the Vice President s cancer moonshot. Fda gave you and the authority to hire the scientists it needs. I hope that you use these authorities to make sure we take full advantage of this exciting time. They will also provide oversight on the drug quality act. We will also try to figure out how to Lower Health Care costs including the cost to patients who pay for Prescription Drugs. Next to the committee will have to reauthorize the hand gimmick pandemic and all hazards preparedness act. Making sure our nation is prepared for and able to respond to such emergencies such as hurricanes, diseases like zika, and bioterror attacks. There is a lot to do. I look forward to working with you on this and hearing more about your priorities today. Mr. Azar, thank you and your family for being here and for your willingness to serve. Because these were recent challenges are what this committee and the congress are discussing was supposed to be focused on, i will start my remarks with a few stories i have been told. My constituent julie is a fourtime cancer survivor. She has said she would not be able to afford her medical expenses or even stay alive without Affordable Care act protections. Kim from allensburg talked about her addiction to opioids and the ability to overcome it. From marysville said before going to planned parenthood that she struggled to get Birth Control regularly. Given her unpredictable schedule in the fast food industry. Those are just some stories. There are many others and so many pressing Health Problems this administration could be solving. It seems it has been determined to create problems. The department has not attempted to help people get highquality affordable coverage. They made it harder by stopping payments for outofpocket cost reductions. By letting insurers cover fewer benefits. By cutting the open Enrollment Period and slashing funding for Consumer Outreach and more. Rather than allowing women to make their own health care choices, the department has tried to prevent them from wentng care, even if they to a provider they trust. President trump went to states like New Hampshire and ohio and said he would confront the Opioid Epidemic had on and called it a tremendous problem. This administration and its Health Department did the opposite. It proposed gutting medicaid which officers critical wrap around services and Substance UseDisorder Treatment to people who otherwise could not afford it. Experts say it would cripple response efforts. All it took was a meeting with a few pharmaceutical executives for President Trump to go dark, despite from us is of bringing down. Ices the department has proposed using Public Health funds to close near term budget caps rather than to prevent costly illness and disease down the road. They have utterly failed to see the urgency of the Public Health crisis is still going on in the wake of hurricane maria. The administration is rolling back protections that that prevent discrimination against people who have historically been denied access to health care. It shouldnt have to be said but the absolute last thing our nations Health Department should be spending time on is encouraging more discrimination in our Health Care System. That is wrong. You and i do have stark disagreements, but your nomination could be an andrtunity for hhs to reset put aside the extreme politics and start focusing on the department as ignition instead of President Trumps ideological agenda. People across the country would be far better off if you took this opportunity. , myazar, i have to say review of your record leaves me with serious doubts that you will. Eli lily is currently working to currently under investigation for working with other Drug Companies to needlessly raise the price of insula insulin. You made it clear on questions of Womens Health. Ideology over science and rightwing politicians over women. Although conservative experts, governors, and some members of congress have reject rejected have rejected President Trumps attempts to sabotage health care, you said that this legislation would not spike premiums or undermine protections for people with preexisting conditions, gutted medicaid, cost tens of millions of people their health care, defunded planned parenthood and more. You said it didnt go far enough. This leaves me very concerned about whether you would faithfully implement the bipartisan agreement that the chairman just talked about with us. Of President Trumps profoundly underwhelming followthrough on his Campaign Promises about tackling the Opioid Epidemic, it is deeply appointing that another hasnt supported committing the new resources we need for this effort. So i worry about your professional history and statements that point to a continuation of some of the extreme damaging and political driven approaches we have seen so far from this administration. Let me return to the stories i mentioned at the beginning of my remarks to make my final point. Right now, julie is traveling around the country raising awareness about open enrollment to help more people sign up. Kim is pursuing a masters in social work and helping people in Central Washington to get the necessary treatment and services so they can overcome their addiction. Christina has become a vocal advocate for helping women in washington and nationwide to get care that works for their needs. Christina ared doing more than their part to keep our communities healthy and well. My question is why isnt our nations Health Department doing the same . People should have a secretary of health who will work for and with patients and families not against them. And who is committed to making policy based on science and not ideology. Im looking forward to your thoughts on the many serious concerns i have raised and how you would be an appropriate choice for this position. Im concerned that President Trump has yet sent us an extreme ideologicallydriven nominee to pick up where secretary price has left off and women and families deserve a lot better. So im interested in your responses today. I hope i am pleasantly surprised and i do want to say if you are confirmed, i want to make it very clear i have not and will not let this administrations approach so far lower my expectations for any of the department this committee oversees, and i will continue doing everything i can to hold hhs to the highest of ethics andards service for people in my state and across the country. With that, thank you very much. Welcome dr. Azar. We also welcome your family and friends. We thank them all for being here. Theres pretty good group of them and you may want to introduce them when you begin. Mr. Azar will first be introduced by governor mike leavitt. Governor leavitt served as president george w. Bushs secretary of the department of health and Human Services from 2005 to 2009. He worked closely with mr. Azar then while he served as deputy secretary. Then the nominee will be introduced by his home state senator and member of this committee todd young. Governor leavitt, please introduce mr. Azar. Leavitt thank you, members of the committee. Senator alexander and senator murray have very ably described the complexity and the importance of this role. And therefore, its my privilege to introduce and to recommend he alex azar. He is up to the task and supremely well qualified to carry out this important work. As mentioned during my service as secretary of hhs, mr. Azar was deputy secretary. Chiefence, he was the operating officer of this large and complex department. Prior to his service, he served as the general counsel under sec i secretary thompson whom believe later will also introduce and robustly recommend him to the finance committee. That, plus his experience leads me to conclude that there may not have been a nominee to this office of secretary better prepared to hit the ground running than alex azar. It was mentioned that hhs is a large and complex place. While deputy secretary, alex azar was the manager of the daytoday operations of 90,000 employees and 1. 1 trillion budget. Just a brief example of what i think would illustrate his capability. President bush had a management agenda that laid out a criteria of several dozen different objectives, and then had a dashboard of green, yellow, red. Alex had an objective to have every criteria green. He was the first equity secretary in the entire federal government to achieve that. He was also delegated oversight of much of the regulatory process. In a very skillful and lawyerly managed tohe processy adjudicate the which is robust. Hes a world class policy thinker. Youll see that today. I can assure you, if he is confirmed as secretary, you can expect good communication on both sides of the aisle. He is an experienced diplomat. Experienced is a word that i think will be underscored here. I have seen him under fire. 911, he was part of the response. There was a point in time when , andna, pandemic influenza the rollout of Medicare Part b was happening at the same time. This is a personal with great experience in a complex department. Say,important, can i just he is an extraordinarily good human being. Hes got the kind of compassionate heart that i believe is required to serve to lead the mission of this important department. I commend him to urge the confirmation of the secretary of health and humanservices. Thank you, governor. Thank you for joining us again as you have before. Senator young . Sen. Young thank you, chairman and Ranking Member murray. And fellow members of this com