>> the appropriations subcommittee and related agencies will come to order. secretary, thank you for being here again this morning although it could always be better we will get you staffed up to a point this will no longer be the excuse so we will take the next reason it is not working the way it should but we encourage you to continue to do that. aobviously this is a difficult budget for us to talk about and frankly a difficult budget for you to defend forgot the budget control act has impact on this and in the case of the budget that you have been asked to submit, there is a reduction of 14 percent the budget control act would require an overallll reduction of nondefense discretionary spending of 9 percent so this budget even exceeds that but even for the 9 percent as i mentioned with the education secretary, present trump didn't sign the budget control act, president obama di did. you did not vote for it most of us did so there is some chair responsibility with that decision and where that has led us. but a number of concerns i imagine you have to share we made a top priority in c the years i have been a chairman of this committee that research has the resources that it needs at this particular time of breakthrough potential to do what it does in a way to save lives and benefits taxpayers as we find more solutions as an example if we could find a wayhe to identify alzheimer's we cut the projected cost by one third between now and 2050, the cuts you are proposing for nih would be overall you are proposing for nih would be overall or almost $5 billion i'm sure that will not happen but for that not tope happen we have to have the number to work with me will not eliminate anything that provides 6 million households with heating or cooling assistance, it cuts resources and training people for medical health and pediatric dentistry we will not do any of those things for quite understand you had to make difficult decisions i do appreciate two new initiatives that you propose i believe he will be supportive of those and one is to eliminate the transmissionta of hiv and phase one of the ten year plan hit the hardest hit states and missouri is one of those with additional a resources and diagnostic and treatment option options. i am pleased to see that is a neww proposal as the new pediatric cancer bill to provide $5 million over the next decade to launch a major data project on childhood cancer. that runs dramatically in the face of overall nih funding but i do think it gives us the opportunity to look even closer at pediatric cancer to factor that in as we continuero to hopefully improve nih funding. in addition to these new programs, i believe mental health treatment needs to be treated as any other health issue and that budget request includes funding missouri is one of the eight pilot states and those that tweet behavioral health like all other t health i was told just last week i cannot treat a person's diabetes until the schizophrenia is under control. i believe we will find if you do treat behavioral health you save more money on other health care cost then you spend to do the right thing with behavioral health. finally demonstrations commitmentmeo to end the opioid aid of it on - - epidemic the total economic cost of the opioid epidemic in 2017 was 684.$6 billion the cost to our economy and families into the hospital association this estimate suggests the epidemic cost the us nearly one.$6 billion every day every second of every day through 2017 the past four years the subcommittee has increased funding t to combat the epidemic by three.$5 billion with a great bipartisan leadership that understand this has impacted the states to forcefully make that case. i appreciate what you have to do to prioritize limited resources to make them more realistic and i'm glad you are here today and you bring all that expertise personally to this job and to turn to my partner and senator murray. >> thank you. people across the country made it clear they want us to fight for their health care and families get the care they need fighting for protections that allow with pre-existing conditions to get quality and affordable health care coverag coverage, bring down skyrocketing health care cos cost, fighting for public health investment to keep our communities safe. and fighting for investments in research. instead of fighting to defend the health care president trump is fightingids in court to take health care away from millions who are covered through the exchanges and medicaid and their parents plan. instead of fighting to bring down, he is fighting in court against protections for over 130 million people with pre-existing conditions to bring back annual and lifetime caps onn benefits even those who get their insurance through their own job and letting them not cover essential services like maternity care. and this is cut from the same cloth over the concerns of families with proposals to make it harder for people to get care and cuts to undermine families across the nation. over all the budget proposes a 12.7 billion-dollar cut to dhs slashing by 14 percent i always say budget is a function of your values this tells a very different story of the health care priorities and empty promises. despite claiming he would fight for people's healthle care and his recent claim republicans would be the party of health care he is continuing to push for harmful policiespa to weaken patient protections and take coverage away fromeo people and puts health care out of reach this includes trunk care which the cbo says tens of millions of people kicked off of health insurance with hiv opioid epidemic promising to fight the fire but the budget fans the flames to make this far worse by cutting over $1 trillion from medicaid over the next rid decade and to repel medicaid expansion it is the largest source of t insurance coverage with people with hiv covering four to one - - 40 percent. the 37 states that expanded medicaid show how we can play an important role to address the opioid crisis as well. four out of five people receiving treatment for opioid addiction are insured by medicaid. the cdc also plays an important role to address the public health crisis and many others. if it proposes cutting the budget by attempt and cuts immunization efforts even amid the measles outbreak in my home state and several others and cutting down on birth defects and disability by $44 million reduces infectious diseases despite the who say one of the biggest threats to global health. with w medical research this is a small step forward and a marathon sprint back i do applaud the call for more pediatric cancer research for every new penny he proposes he proposes cutting one dollar from nih. cutting medical research by 13 percent would slow the efforts to advance our understanding of alzheimer's disease, and deliver vaccines and treatments and cures for every other kind of cancer foror credit time when we have a health professional shortage in proposing to cut $800 million from training programs that support tuition assistance, loan forgiveness and training for several hundred thousand professionals annually. continues a harmful trend and the language specifically from planned parenthood is just one of the many steps backwards for women's health care. also the several qualified and despite thef proven record with cancer screenings and the gag rule which will push planned parenthood out of the program p altogether and then to learn about the full range of reproductive care options preventing people from across the country with the providers that they trust once again the proposals have critical assistance to millions of families like the low income low energy assistance program to help people afford heatingvi and cooling it is clear we are facing a child care crisis in this country as parents struggle to find high quality program we need investments and not cuts and this budget continues to show disregard with extreme poverty in central america. this proposes a 22 billion-dollare contingency fund for the unaccompaniedit children program with the discretionary program. want to make sure every child in hhs custody as well carry forward.dr on - - care - - cared for. while attempting to undermine protections and then to sound the alarm on family separation so they could target sponsors to rely heavily on temporary facilities which are three times as expensive that the office of refugee resettlement was tracking reproductive health and scott lloyd was personally interfering with decisions about their bodies. i am concerned of a recent letter to restructure the office that would impact programs to serve adolescence and women and low income communities and more and i'm very concerned that proposal what has a very little purpose over the health needs of families in this country. it is inaccurate to claim it requires the president to be at sequestration levels. i hope you don't look at those as excuse for the budgett schematic. >> you and i have talked i'm sorry, . >> thank you for inviting me to the president's budget for go it is an honor to have spent since i last appeared before the committee the men and women of hhs have remarkable results with new affordable t options and signs and with 87.$1 billion will moving to put the nation forced. hhs had the largest discretionary budget of any non- defense department in 2018 which means to stay within the cap set by congress has many difficult choices. to have strong investments that to appreciate the work over the years but i want to highlight how the president's budget supports a number of goals. first, the budget proposes reforms to deliver those of truly patient centered to a great personalized health care option that you as in control are treated like a human being and not like a number so that would make this possible to promote fiscal responsibility to maintain protections for people with pre-existing conditions. second the budget strengthens to help secure our promise to america's seniors in with the medicare trust fund over eight years while the budget grows at six.9 percent annual rate. is in three major ways that viewers cost for seniors to tackle the special interest of the medicare program and first to propose changes to require smaller practices and second to address those overpayments to acute providers and to take on drug companies that are profiting over seniors with a historic modica --dash to lower l out-of-pocket cost for go i believe there are many areas of common ground on drug pricing where we can work together with the best bipartisan legislation. the efforts we proposed around taking on special interest are so sensible and bipartisan even "the new york times" editorial board praised these ideas last week. and to the medical treasury funds all taxpayers not just seniors share these costs. to have the five-point strategy at the academic. treatment and recovery services and data on the epidemic with pain management practices. the appropriations major this committee in putting up money to these efforts including to the response program to be focused on access to medication assisted treatment, behavioral suppor support, and recovery services.cl and then including fighting infectious p disease $291 million of new funding for the first year of the trump plan to use the effective treatment and prevention tools we have today ending the hiv epidemic by 2030. other public health challenges including the use of e-cigarettes in fact, i'm pleased to announce today the fda is issuing warning letters to companies to make and sell or distribute liquids used for the e-cigarettes that have misleadingve the bullying loan - - labeling that resembles a cough syrup. and then toec close the on-ramp while allowing for the promise of the offramp of combustible tobacco products. to advance to help deliver on the promise we made and i look forward to your questions today. thank you very much. . >> in short time after 1145 if we do not recess there is a second round of questions. please stick within your time limit. and with the no liver allocation policy something we have been very interested in. we had one meeting with the oregon procurement transplant to group

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