Transcripts For CSPAN2 White House Domestic Policy Council D

You know. Its. Were live this morning for the alliance of Health Policy where trumps domestic policy director joe grogan will be talking about the Administrations Health Care policy. Live coverage here on cspan2. Were a Nonpartisan Organization convening the Health Policy through a balanced exchange of evidence and were see thankful to bill pierce and Apco Worldwide for putting on the series and with that support weve had the privilege are hosting many esteemed guests and Panel Discussions over the past years, including Joseph Grogan who im honored to welcome back today. I believe you have the distinction of being our first repeat guest. He joined us about a year ago when he was an associate director at omb so we look forward to hearing about your new role and Health Care Priorities as the director of the Domestic Policy Council. So thank you for being here again, mr. Grogan, and thank you for you being here and ill turn it over to bill to get it started. Threw, and welcome on behalf of apco, along with the alliance, we believe its an important thing to hold because we believe strongly that a wellinformed press is extremely important to the washington d. C. World, and that a dialog like this is extremely important so we really appreciate, joe, you willing to come in here and subject yourself to the questioning of this group of folks. So im senior director here at Apco Worldwide. Joe and i have known each other for a time, working in the Bush Administration. And we appreciate you coming here today. Joe has had a distinguished career in the private sector and Public Service and so were welcoming you back again. The only admonition i would make, when we turn it over to question and answers, that you state your name and what outlet youre for. Were live on cspan2 so welcome cspan2 viewers, so its mostly for their benefit, too, so they know who is asking the questions and where youre from, that would be greatly appreciated. With that id like to turn it over to joe. Take it away. Thanks for having me back and its good to see some of you reporters again and for those of you who i dont know, i look forward to the opportunity to be asked a few questions and share with you our views on health care on the Trump Administration, some of the function, some of the way the domestic policy functions and tell you maybe about some of the other issues were confronting as well. To start with the how the domestic policy functions and what it is we do on a daily basis, other administrations perhaps have had a more linear or defined area of responsibility for senior white house officials. This administration, this president has a very entrepreneurial style consistent with the way hes lived his life and he expects his Senior Leaders to pursue issues in an entrepreneurial manner and it requires us all to work in a very horizontal collaborative fashion. A lot of times there is there are stories in the d. C. Media about how theres tension in this white house or tension among Senior Leaders. First of all, tension is not a bad thing, but that there are overblown factions reported on, its widely overblown. The Senior Leadership in this administration gets along extremely well. I spend a lot of time walking the halls visiting Senior Leaders offices, getting alignment on issues before we go into the oval office. We have robust and open discussions in front of the preside president. I can tell you this week we had a meeting with the president and we had, i think, 14 people in there to brief him on an issue for which he had a make a decision. We couldnt find a Senior Leader of the team who disagreed so we went and found somebody else who could take the counter side so that the president would get the benefit of understanding a different side of the view and ultimately he made a decision. He works well when he watches people debate both sides of an issue and then hes able to make a decision. So, i love working in this white house. I think its a lot of fun. I like the Senior Leadership team. That doesnt mean we agree on everything, but thats fine. What i found is that a team of people that respect each other and works well together and has the best interests of the president and the American People first and foremost. Beyond that, id say my philosophy of Domestic Policy Council is there are certainly some issues of which we are lead, health care is one and thats what were going to talk about for the most today. Lead on other issues as well, labor issues, for instance, but where we arent lead, we want to support. So we want to be as helpful as possible to advance a policy agenda, for instance, larry kudlow at the National Economic council would be lead for tax policy. If there is something that crosses over into the domestic policies lane, say health care, for instance, big achievement of this administration intact policy and Health Care Policy is the fuel of the individual mandate. We would help with that. We would help make the argument to the president , look, this is something that should be repealed, it makes no sense, its onerous, its at odds with our values. There are a host of issues, i may not be lead on, but go with the other principal, look, this is in my opinion what we should do, it comports with what the other principal wants to do or here is knower take on it. So we lead when we have the baton and we support when somebody else does and its all to move the ball forward for the president and the American People. You know, one i think this that i think that people sometimes in this town struggle with because mr. Trump is is so different than the traditional politician is to say, well, what type of approach is he taking . Hes nonideological. He didnt come in with 50 years of Campaign Donations from particular vested interest and a defined philosophy except for this, he likes to solve problems and he will ask a gazillion questions to figure out the right answer to something. And hes not necessarily interested in somebodys opinion just because of their title or status, he wants to know from experts. And ive watched him look over cabinet officials and ask a question of a 20yearold or a 30yearold staffer who is sitting on the couch in the oval office and ask their opinion about an issue because he wants to know a variety of opinions and he really wants to know the opinion of people who are expert on any given subject. Hes told the story about being on the u. S. S. Jerry ford and asking the Maintenance Crew whether they whether their preference was for the magnetic launches for the aircraft on the Aircraft Carrier or the old steam launches and they said steam, and he said why . They said because when they break, we can fix it. And they went into a description how long it takes to load a plane into position and why the steam made more sense, and i can submit to you, i cant think of a president in my lifetime that would go over and ask the guys doing the actual work each and every day, what their opinion is. Now, that decision of a president to prefer steam, im sure, would anger a lot of defense contractors, it would anger a lot of procurement officers, it would anger a lot of project officers who were behind that, but this is a president who doesnt really care about defending special interests or people based upon title, he wants to get to the right answer for the American People and hes willing to talk to anybody who has expertise and real world experience in it. So i know this other impression that people who have been able to hack at the Administration Come in and wilt under the president s questioning. Tough to be frank with you. The president asks questions of a lot of people and he about uts puts them on the spot. A lot of people cant handle it. He wants to make sure you understand what youre talking about and you have the courage of your convictions and its an environment that i enjoy and a lot of other people enjoy. Some traditional d. C. Dwellers cant really handle it, but thats not this president s problem, thats their problem, and when they go out and they whine about it in the to the media or give anonymous quotes after the fact, you know, it should be taken with a grain of salt because theyve left for a reason. This president has is almost indefatiguable. The ive gotten calls, 7 00 and many of the people around him arent able to keep up. I think on health care, i think consistent with the president s view that there are a lot of problems that need fixing, this is and weve taken an approach thats not bound by any particular special interest. It would have been easy for the president to say, you know, im going to solve the drug pricing problem by throwing more taxpayer subsidies into the system and helping the people do out of pocket copays. Instead, hes challenged pbms, payers, manufacturers, all publicly, retorically and with serious policies, we have three major legislative agendas as we close out the year, drug pricing legislation is one of them. It would be easy to have gotten a deal to just appropriate more money and spend more taxpayer dollars to quote, unquote, solve the drug pricing problem, but thats not what he has wanted to do. He wants to lower list prices. Clear out a lot of the convoluted incentives that drive prices up and expose patients and the American People to excessive costs and consistently, across the health care agenda, youve watched him and his team confront issues that other administrations have ignored. I worked in this town during the Obama Administration. You could not get a meeting in the Obama Administration with a senior official on a health care subject that did not involve the aca and theres 13 Million People in the Affordable Care act. Theres 180 Million People in the employer sponsored market. There were drug pricing problems during the Obama Administration, you could not get them to address it. Hiv, what major hiv initiative occurred during the Obama Administration. If it occurred, i didnt see it. This is a president whos called on the state of the union for elimination of hiv transmission in ten years. Pediatric cancer, confronting the Opioid Epidemic exploded during the Obama Administration unconfronted and much of the Opioid Epidemic was fueled by taxpayer funded programs in medicaid and medicare and prescribing guidelines put out by c. D. C. That should have been addressed more quickly. You know, the list goes on and on. Transparency will have hopefully another announcement this month, maybe in december, but im hopeful this month, thats going to gore a lot of oxes. There are a lot of people who do not want customers and the American People to see where the money goes in the Health Care System. They thrive on opacity. They thrive on the arbitrage created by the lack of transparency in the health care market. Theres a lot of money flowing through the Health Care System and unless we get at confronting some of the vested interests that have been making a lot of money year over year on this, the American People are going to continue to be exposed. But other problems that Kidney Health initiative. That program had not been modernized since Richard Nixon created it. Modernizing the development of influenza vaccines is another example that were doing. Back to opioids, weve got year over year declines in opioid deaths, which is significant. On drug pricing we also have year over year declines in prices for medicines first time in 50 years. And thats a direct result of the president drawing so much attention to this issue and forcing companies and manufacturers to enforce more aggressively. Ive loved working on these issues with this president , its a wide open aperture. It isnt one issue. He hasnt concentrated on one problem. Give me a problem, you guys figure out how to solve it and ill back you. I dont care what special interest or lobby group we may offend, just Work Together and solve it. And on health care, last thing ill say before i open it up to questions, its probably the best integrated team of any subject that this administration confronts and when i say, best integrated, i also mean broadest. So on health care, when we have a meeting with the president , youll have a lot of people in the meeting. Sometimes we have to have them in the roosevelt room because a lot of people are interested in the subject, but Kellyanne Conway will show up, larry kudlow will show up, the white House Counsel will show up, russ vought will show up. And we work well together on the staff level and principals level, a lot of views and perspectives. Some issues well leave an alternative and larry kudlow or his team will say can you take the lead on this executive order or this particular issue because your person is ideally suited to move it forward. So its its a great team of people to work with that confronts hard problems, hard challenges, and its a pleasure to be a part of it. Thank you, joe. I think that was pretty good. Gives a good overview. Im going to ask two quick questions and then turn it over to you all for questions. And the two questions are, one flows right out of what you just said, which is how do you then, the Domestic Policy Council then in turn work with the departments . And then the second question is, are there one or two issues that you, the Domestic Policy Council works on, i dont need a detailed answer here, but one or two questions that you work on that the public doesnt know a lot about, but that you enjoy, that you think are important, you enjoy, that your staff works on . Just kind of give a brief, a little more depth to what the dpc does. We do a lot of issues, were not out, necessarily not outfront and and center on. Yesterday we had an event at the white house in the oval office with victims of communism, to highlight this is the first president to sign a proclamation to recognize the 100 Million People killed by communist regimes. We had a group of people who had suffer under communist regimes come in and tell their stories to the president. The Domestic Council sponsored that event and then they went out and they spoke to the press and some of them were on television today to make sure that the American People recognize the importance of fighting for freedom and the struggle against communism that still continues today. Religious freedom is another issue were involved in, a lot of people dont see. This is a president who respects religious institutions and isnt contemptuous of them and wants to make sure that people are free to practice their faith. Human trafficking is another issue that were working very hard on. Its an issue that has exploded with the rise of the internet, the dark web, some of the stories that are going that we hear are pretty awful. Its not just labor of trafficking, its also sexual trafficking. Its not just international, its domestic. Its not just, you know, International Criminal gangs, its domestic gangs and Family Members often and its a tragic situation. Work force development is another issue. I work closely with ivanka trump on that. Theres a whole host of issues, agriculture issues that we work on sometimes, and like i said, anything that we can be helpful on that we have bandwidth, we can we roll up our sleeves. How many staff is there at dpc . Were over 20 right now including details. So we take a lot of detailees from departments to come and help on a specific issue. Ive got somebody from the interior department who is a very talented attorney. Hes helping on some of the regulatory issues. We work very closely with the office of management and budget on regulatory issues, but the president s got a wonderfully refreshing view of regulation in that maybe we should pause on just constantly defaulting to regulation and solve every problem by regulation and clear out some of the underbrush and recognize that maybe some of these regulations are outdated or have created more harm than good and lets deregulate and this administration has been on that. And i hired someone from the department of justice, a talented attorney to help us work on that with the office of management and budget. So we and you asked also about our relationship with the departments. Weve got a great relationship with the departments. I mean, the white house drives policy, but we have an open door as far as people have good ideas, they can bring it to us. I mean, hhs, for instance, just unveiled a notice of proposed rule making to the stark kickback laws and that was not an idea that was generated at Health Policy<\/a> where trumps domestic policy director joe grogan will be talking about the Administrations Health Care<\/a> policy. Live coverage here on cspan2. Were a Nonpartisan Organization<\/a> convening the Health Policy<\/a> through a balanced exchange of evidence and were see thankful to bill pierce and Apco Worldwide<\/a> for putting on the series and with that support weve had the privilege are hosting many esteemed guests and Panel Discussions<\/a> over the past years, including Joseph Grogan<\/a> who im honored to welcome back today. I believe you have the distinction of being our first repeat guest. He joined us about a year ago when he was an associate director at omb so we look forward to hearing about your new role and Health Care Priorities<\/a> as the director of the Domestic Policy Council<\/a>. So thank you for being here again, mr. Grogan, and thank you for you being here and ill turn it over to bill to get it started. Threw, and welcome on behalf of apco, along with the alliance, we believe its an important thing to hold because we believe strongly that a wellinformed press is extremely important to the washington d. C. World, and that a dialog like this is extremely important so we really appreciate, joe, you willing to come in here and subject yourself to the questioning of this group of folks. So im senior director here at Apco Worldwide<\/a>. Joe and i have known each other for a time, working in the Bush Administration<\/a>. And we appreciate you coming here today. Joe has had a distinguished career in the private sector and Public Service<\/a> and so were welcoming you back again. The only admonition i would make, when we turn it over to question and answers, that you state your name and what outlet youre for. Were live on cspan2 so welcome cspan2 viewers, so its mostly for their benefit, too, so they know who is asking the questions and where youre from, that would be greatly appreciated. With that id like to turn it over to joe. Take it away. Thanks for having me back and its good to see some of you reporters again and for those of you who i dont know, i look forward to the opportunity to be asked a few questions and share with you our views on health care on the Trump Administration<\/a>, some of the function, some of the way the domestic policy functions and tell you maybe about some of the other issues were confronting as well. To start with the how the domestic policy functions and what it is we do on a daily basis, other administrations perhaps have had a more linear or defined area of responsibility for senior white house officials. This administration, this president has a very entrepreneurial style consistent with the way hes lived his life and he expects his Senior Leaders<\/a> to pursue issues in an entrepreneurial manner and it requires us all to work in a very horizontal collaborative fashion. A lot of times there is there are stories in the d. C. Media about how theres tension in this white house or tension among Senior Leaders<\/a>. First of all, tension is not a bad thing, but that there are overblown factions reported on, its widely overblown. The Senior Leaders<\/a>hip in this administration gets along extremely well. I spend a lot of time walking the halls visiting Senior Leaders<\/a> offices, getting alignment on issues before we go into the oval office. We have robust and open discussions in front of the preside president. I can tell you this week we had a meeting with the president and we had, i think, 14 people in there to brief him on an issue for which he had a make a decision. We couldnt find a Senior Leader<\/a> of the team who disagreed so we went and found somebody else who could take the counter side so that the president would get the benefit of understanding a different side of the view and ultimately he made a decision. He works well when he watches people debate both sides of an issue and then hes able to make a decision. So, i love working in this white house. I think its a lot of fun. I like the Senior Leaders<\/a>hip team. That doesnt mean we agree on everything, but thats fine. What i found is that a team of people that respect each other and works well together and has the best interests of the president and the American People<\/a> first and foremost. Beyond that, id say my philosophy of Domestic Policy Council<\/a> is there are certainly some issues of which we are lead, health care is one and thats what were going to talk about for the most today. Lead on other issues as well, labor issues, for instance, but where we arent lead, we want to support. So we want to be as helpful as possible to advance a policy agenda, for instance, larry kudlow at the National Economic<\/a> council would be lead for tax policy. If there is something that crosses over into the domestic policies lane, say health care, for instance, big achievement of this administration intact policy and Health Care Policy<\/a> is the fuel of the individual mandate. We would help with that. We would help make the argument to the president , look, this is something that should be repealed, it makes no sense, its onerous, its at odds with our values. There are a host of issues, i may not be lead on, but go with the other principal, look, this is in my opinion what we should do, it comports with what the other principal wants to do or here is knower take on it. So we lead when we have the baton and we support when somebody else does and its all to move the ball forward for the president and the American People<\/a>. You know, one i think this that i think that people sometimes in this town struggle with because mr. Trump is is so different than the traditional politician is to say, well, what type of approach is he taking . Hes nonideological. He didnt come in with 50 years of Campaign Donations<\/a> from particular vested interest and a defined philosophy except for this, he likes to solve problems and he will ask a gazillion questions to figure out the right answer to something. And hes not necessarily interested in somebodys opinion just because of their title or status, he wants to know from experts. And ive watched him look over cabinet officials and ask a question of a 20yearold or a 30yearold staffer who is sitting on the couch in the oval office and ask their opinion about an issue because he wants to know a variety of opinions and he really wants to know the opinion of people who are expert on any given subject. Hes told the story about being on the u. S. S. Jerry ford and asking the Maintenance Crew<\/a> whether they whether their preference was for the magnetic launches for the aircraft on the Aircraft Carrier<\/a> or the old steam launches and they said steam, and he said why . They said because when they break, we can fix it. And they went into a description how long it takes to load a plane into position and why the steam made more sense, and i can submit to you, i cant think of a president in my lifetime that would go over and ask the guys doing the actual work each and every day, what their opinion is. Now, that decision of a president to prefer steam, im sure, would anger a lot of defense contractors, it would anger a lot of procurement officers, it would anger a lot of project officers who were behind that, but this is a president who doesnt really care about defending special interests or people based upon title, he wants to get to the right answer for the American People<\/a> and hes willing to talk to anybody who has expertise and real world experience in it. So i know this other impression that people who have been able to hack at the Administration Come<\/a> in and wilt under the president s questioning. Tough to be frank with you. The president asks questions of a lot of people and he about uts puts them on the spot. A lot of people cant handle it. He wants to make sure you understand what youre talking about and you have the courage of your convictions and its an environment that i enjoy and a lot of other people enjoy. Some traditional d. C. Dwellers cant really handle it, but thats not this president s problem, thats their problem, and when they go out and they whine about it in the to the media or give anonymous quotes after the fact, you know, it should be taken with a grain of salt because theyve left for a reason. This president has is almost indefatiguable. The ive gotten calls, 7 00 and many of the people around him arent able to keep up. I think on health care, i think consistent with the president s view that there are a lot of problems that need fixing, this is and weve taken an approach thats not bound by any particular special interest. It would have been easy for the president to say, you know, im going to solve the drug pricing problem by throwing more taxpayer subsidies into the system and helping the people do out of pocket copays. Instead, hes challenged pbms, payers, manufacturers, all publicly, retorically and with serious policies, we have three major legislative agendas as we close out the year, drug pricing legislation is one of them. It would be easy to have gotten a deal to just appropriate more money and spend more taxpayer dollars to quote, unquote, solve the drug pricing problem, but thats not what he has wanted to do. He wants to lower list prices. Clear out a lot of the convoluted incentives that drive prices up and expose patients and the American People<\/a> to excessive costs and consistently, across the health care agenda, youve watched him and his team confront issues that other administrations have ignored. I worked in this town during the Obama Administration<\/a>. You could not get a meeting in the Obama Administration<\/a> with a senior official on a health care subject that did not involve the aca and theres 13 Million People<\/a> in the Affordable Care<\/a> act. Theres 180 Million People<\/a> in the employer sponsored market. There were drug pricing problems during the Obama Administration<\/a>, you could not get them to address it. Hiv, what major hiv initiative occurred during the Obama Administration<\/a>. If it occurred, i didnt see it. This is a president whos called on the state of the union for elimination of hiv transmission in ten years. Pediatric cancer, confronting the Opioid Epidemic<\/a> exploded during the Obama Administration<\/a> unconfronted and much of the Opioid Epidemic<\/a> was fueled by taxpayer funded programs in medicaid and medicare and prescribing guidelines put out by c. D. C. That should have been addressed more quickly. You know, the list goes on and on. Transparency will have hopefully another announcement this month, maybe in december, but im hopeful this month, thats going to gore a lot of oxes. There are a lot of people who do not want customers and the American People<\/a> to see where the money goes in the Health Care System<\/a>. They thrive on opacity. They thrive on the arbitrage created by the lack of transparency in the health care market. Theres a lot of money flowing through the Health Care System<\/a> and unless we get at confronting some of the vested interests that have been making a lot of money year over year on this, the American People<\/a> are going to continue to be exposed. But other problems that Kidney Health<\/a> initiative. That program had not been modernized since Richard Nixon<\/a> created it. Modernizing the development of influenza vaccines is another example that were doing. Back to opioids, weve got year over year declines in opioid deaths, which is significant. On drug pricing we also have year over year declines in prices for medicines first time in 50 years. And thats a direct result of the president drawing so much attention to this issue and forcing companies and manufacturers to enforce more aggressively. Ive loved working on these issues with this president , its a wide open aperture. It isnt one issue. He hasnt concentrated on one problem. Give me a problem, you guys figure out how to solve it and ill back you. I dont care what special interest or lobby group we may offend, just Work Together<\/a> and solve it. And on health care, last thing ill say before i open it up to questions, its probably the best integrated team of any subject that this administration confronts and when i say, best integrated, i also mean broadest. So on health care, when we have a meeting with the president , youll have a lot of people in the meeting. Sometimes we have to have them in the roosevelt room because a lot of people are interested in the subject, but Kellyanne Conway<\/a> will show up, larry kudlow will show up, the white House Counsel<\/a> will show up, russ vought will show up. And we work well together on the staff level and principals level, a lot of views and perspectives. Some issues well leave an alternative and larry kudlow or his team will say can you take the lead on this executive order or this particular issue because your person is ideally suited to move it forward. So its its a great team of people to work with that confronts hard problems, hard challenges, and its a pleasure to be a part of it. Thank you, joe. I think that was pretty good. Gives a good overview. Im going to ask two quick questions and then turn it over to you all for questions. And the two questions are, one flows right out of what you just said, which is how do you then, the Domestic Policy Council<\/a> then in turn work with the departments . And then the second question is, are there one or two issues that you, the Domestic Policy Council<\/a> works on, i dont need a detailed answer here, but one or two questions that you work on that the public doesnt know a lot about, but that you enjoy, that you think are important, you enjoy, that your staff works on . Just kind of give a brief, a little more depth to what the dpc does. We do a lot of issues, were not out, necessarily not outfront and and center on. Yesterday we had an event at the white house in the oval office with victims of communism, to highlight this is the first president to sign a proclamation to recognize the 100 Million People<\/a> killed by communist regimes. We had a group of people who had suffer under communist regimes come in and tell their stories to the president. The Domestic Council<\/a> sponsored that event and then they went out and they spoke to the press and some of them were on television today to make sure that the American People<\/a> recognize the importance of fighting for freedom and the struggle against communism that still continues today. Religious freedom is another issue were involved in, a lot of people dont see. This is a president who respects religious institutions and isnt contemptuous of them and wants to make sure that people are free to practice their faith. Human trafficking is another issue that were working very hard on. Its an issue that has exploded with the rise of the internet, the dark web, some of the stories that are going that we hear are pretty awful. Its not just labor of trafficking, its also sexual trafficking. Its not just international, its domestic. Its not just, you know, International Criminal<\/a> gangs, its domestic gangs and Family Member<\/a>s often and its a tragic situation. Work force development is another issue. I work closely with ivanka trump on that. Theres a whole host of issues, agriculture issues that we work on sometimes, and like i said, anything that we can be helpful on that we have bandwidth, we can we roll up our sleeves. How many staff is there at dpc . Were over 20 right now including details. So we take a lot of detailees from departments to come and help on a specific issue. Ive got somebody from the interior department who is a very talented attorney. Hes helping on some of the regulatory issues. We work very closely with the office of management and budget on regulatory issues, but the president s got a wonderfully refreshing view of regulation in that maybe we should pause on just constantly defaulting to regulation and solve every problem by regulation and clear out some of the underbrush and recognize that maybe some of these regulations are outdated or have created more harm than good and lets deregulate and this administration has been on that. And i hired someone from the department of justice, a talented attorney to help us work on that with the office of management and budget. So we and you asked also about our relationship with the departments. Weve got a great relationship with the departments. I mean, the white house drives policy, but we have an open door as far as people have good ideas, they can bring it to us. I mean, hhs, for instance, just unveiled a notice of proposed rule making to the stark kickback laws and that was not an idea that was generated at Domestic Council<\/a>ment council. It took over two years of really hard work that examples that another administration said too tough, not interested. Lets do something else, lets do something sexier, lets let industry continue to suffer under onerous regulations, but theyre outdated and prevented a lot of creative contract in the health care space, a lot that would benefit patients. Thats why we moved it. So we have a great relationship with the departments. Its a lot of back and forth each and every day, theres a member of my staff thats on the phone with any number of departments and anybody, you know, secretaries will call me up or swing by and say, hey, ive got an idea. Would you guys want to help . Do you think this is crazy . And we move it forward and its a great team, a great group, a great cabinet, too. All right. Well, lets open it up for questions and again, remind you to please state your name and where you work. Thank you. My name is emery and i work for my question involves [inaudible] the main holdup is the Senate Republicans<\/a> are not in favor of the provision. Does the white house support the inflation provision and widen the gap . So im glad you asked about it. Weve always wanted a bipartisan solution to drug pricing that even goes before the house of representatives was taken by the democrats. But its a its just a recognition of reality. Nancy pelosis the speaker of the house, youre going to need democrats to get something on the president s desk that he can sign. And you need 60 votes in the senate to get something that the president can sign. The republicans dont have 60 votes in the senate owe youve got to get democrats there. And youre right, we are very supportive of the grassleywyden compromise. Its a product of a really good bipartisan collaborative approach to solving drug pricing. The caps that and we continue to work with their staff each and every day, republican and democrat, on improving the package that came out of finance. Theres a number of Different Things<\/a> that were trying to accomplish there. Make sure that premiums are kept low as we align the incentive to drive drug prices down and give seniors a true catastrophic cap where they would pay zero after they hit the catastrophic cap ap right now its at 8,000. Wed lower that to 3,000 roughly. Thats a huge win for seniors, a huge win. As far as the inflation cap they are not the administrations proposal, but theyre a bipartisan compromise. Right now Nancy Pelosis<\/a> bill is not going to pass in its current form. The shortest route to a bipartisan solution that would be a real win for democrats, republicans, the president , and more importantly, the American People<\/a> is grassleywyden and were working very hard to get that done and get that moving. Ive been talking to pelosis people since they took the house, before they were before she was actually speaker. I got calls from her staff. I was at the Office Management<\/a> and budget at the time and they called me and said we want to work on drug pricing. I said absolutely. The door is open. We will work in a collaborative fashion and i said theres only one red line for us, and that is do not take savings and plow it into the Affordable Care<\/a> act for additional subsidies that will earn a president ial veto. And then the general directional approach is, we dont want to punish market successes, we want to address market failures. So there are clear instances where, you know, copays are way too high. Drugs are allowed to command a premium price far beyond the original vision and spirit of hatch waxman, and those are the things that should be addressed, not killing innovation or taking a product that somebody invented thats really valuable to a lot of people and you know, disappropriating the intellectual property or the value of it. So want to have new waves of innovation and we think were on the cusp of this country of a huge, huge push of medicines that would bring real value to people, genetic treatments that are coming online, that are in development right now are amazing. To watch that get killed would be a tragedy. Theres plenty of ways to save money for people payers, patients, companies and have them have a more rational system without killing innovation. Other here. Im sara hanson with bloomberg and the other one is on transparency, the administration transparency, consumers, insurers and hospitals come back, that wont he help. But a lot of employers would help analysts give information they need to know. Why not go with the Pilot Program<\/a> on that which is what some of the groups suggested. First, im not going to get into what the president decided. An example, but look, the transparency problem is not going to be solved in one step or one fell swoop. Well make a major push on it on a number of different fronts. Frankly, its implausible to believe that more opacity, more confusion, more lack of charity is going to help patients and drive costs down. We need to get one of the problems with addressing drug pricing and why its so hard is because these programs are really complicated. And every time you want to make a change, frequently congress or regulators make things worse. One of the reasons why the grassleywyden proposal is so important, because it would dramatically simplify the part d program. So transparency is a big it would be revolutionary if we had true transparency in our Health Care System<\/a>. I find it bewildering whenever i get a Health Care Bill<\/a> on a personal basis. Im one of the people that ignores my Health Care Bill<\/a> for a good 90 days because the first two are certainly not true, you know, they tell me i owe 40,000 for my most recent trip to the hospital and then turns out after three months, oh, we sorted it out, you owe 280. And that doesnt make any sense. Surprise medical billing that were working on on capitol hill, thats another element to get more transparency into the Health Care System<\/a>. Reforming part d is another effort. The grassleywyden proposal has a provision to require list prices to be attached to drugs, that is transparency. So, transparency should be first and foremost in everything we do in health care. Everything we do from a policy matter. As a government. Taxpayers, citizens should be able to see whats going on, should be able to understand these programs. We should get more data out there, generally speaking. Not just in health care, but in anything. So transparency is very much a broad ranging philosophical direction for this administration. We dont the government knows better than the private market or the american citizenry. In fact, the government knows less. So if we have data, lets get it out there. Yes, right on the and then right here. Do you have any announcements of what the Transparency Regulation<\/a> will say . No. No, i mean i think you know, we wont have i think bradley speaking its going to be unclear, but it could be huge. You look at the disparity in different areas, some hospitals will charge ten times as much with no improvable outcome from the procedure. And different sites of care. So i think the key focus of the transparency thing to think about is it would be revolutionary if we had true transparency in Health Care Pricing<\/a> and it would open up huge opportunities for innovation to bring costs down. We dont have costs coming down as much as they should in health care with all the innovation that weve gotten in computing, all of these computers you guys have, the amount of power in those systems that would have cost how much 10 years ago, 20 years ago, 30 years ago. Why arent we getting the same reduction in prices in health care with the same improvements in quality . A big part of that is government subsidy, lack of transparency and a misaligned incentive. We look at price increases, lasik surgery being the one thats constantly referred to and its a great example. So, transparency would be revolutionary and as with all, you know, disruptive innovations, unclear where it would end, but its got to be better than the current system. Theres no way that you can tell me that the level of confusion that exists in American Health<\/a> care is beneficial for taxpayers, patients, physicians. Im going to move around like this, so dont worry, im coming your way, just for the benefit of our audience. So, go ahead, next. Okay. Okay. Is the administration going through the pricing index, grassleywyden and also on grassleywyden since youve been talking with them so much what discussion has there been about adding rebates provision to the bill. The International Pricing<\/a> index regulation is currently under review so i cant get into a lot of detail on it. As i said, these are difficult issues. Were very focused on making sure that any policy that we roll out is solid. Making sure the data is right. Making sure that weve thought through potential unintended consequences. Drug pricing is a difficult issue. We continue to make sure across all of our Health Care Policies<\/a> and policy generally to make sure that theyre solid from a legal perspective, solid from a policy perspective and that we are not going to do something that were going to regret over time. Im sorry, the second question . Adding provisions to grassleywyden that would remove rebates or pass them through to patients . Well, there was a lot of talk about that when it was being voted on in committee. I am a skeptic of the rebates, i have been from the beginning. The first couple budgets that the president sent up to capitol hill and i worked on the drug pricing reform provisions in our first couple budgets, telegraphed a great deal of skepticism of the rebates and also had specific proposals for legislative changes to get at the rebate problem. Its really hard. Weve probably spent more man hours on rebates than any other particular issue in health care, to be honest with you. The amount of resources, national, economic, Councils Economic<\/a> advisors, contractors, cms, hhs, aspi trying to figure out the different modeling about what would happen under various scenarios. To be clear, the way the rebates are currently structured was set up in the Obama Administration<\/a> and this is another example of an issue that should have been confronted or another issue that weve inherited. If somebody has an easy legislative solution to the rebate problem, im all ears, but i think theyre not going to get there. Id much rather focus on simplification of part d and go direct at the enumeration issue that were willing to work with members on tweaking to make a stronger. Weve gotten a lot of good feedback from Senate Republicans<\/a> on the dir issue and i think that the transparency of some of this would help, too. I would say this, wialso, the restructuring to put taxpayers less on the hook and payers more on the hook would get at a lot of these rebates, to be honest with you and more aggressive negotiation in the private sector. So, just restructuring the benefit that weve got without directly calling it rebate reform will actually be rebate reform. Okay. Go ahead. Said that they are not a fan of having the u. S. Import drugs from canada. How is the president planning to address that importation plans and others say there are ways for the companies to contract around the potential importation regulation when we do see it. How is the Administration Planning<\/a> to address that . [inaudible] around the proposal. The president has been focused on this issue since he campaigned, the difference between u. S. Prices and international prices. Of course, many of both parties find it bewildering when they have citizens crossing the border to buy drugs in canada because its cheaper for them than it would be out of pocket here in the United States<\/a>. And governors have come to the president and asked for the ability to import drugs. Secretary azar has made it clear that his concerns around it can be alleviated because of the modernization of supply chain tools that can allow for importation through a mechanism like this to make sure that theres no adult ratiration. Were not talking importing drugs from thailand through canada. Were talking safe effective drugs that could be imported into the United States<\/a> provided a state wants to do that so weve been working very closely with states like florida and colorado and others on exactly how that could be achieved. But i think it is feasible. I think we can do it and well see. I mean, if its disruptive to the market and forces companies to contract around it, so be it. The Current Situation<\/a> is untenable and its objectively irrational and the president wants us to address it so were going to address it. I think it goes back to the president saying, oh, geez, its too hard, its difficult. Hes a disrupter, it makes some industries uncomfortable and vested Interest Groups<\/a> uncomfortable, but thats just the way it is and its refreshing, to be honest. [inaudible] operational to avoid widespread medical shortages. Is this on the radar of the administration and if so, are you encouraging secretary azar . Its on with your radar screen, but i dont want to get into deliberations and private discussions right now, but it is an issue. I dont want to rule anything out or in right now. Thank you. I just wanted to check on the administrator has said on multiple occasions public address said that the Health Care Industry<\/a> has a choice between moving in a different direction toward single payer or moving aggressively into valuebased qualitybased payments. The programs that you all have been moving on multiple paths initiative. One thing raising if the administration wants to aggressively push on that they could require all plans to adopt quality programs which would pull the commercial health plan into that role. Is that under consideration or more aggressive valuebased initiatives youre looking for . Were looking at for valuebased, and were looki looking to allow in a number of different contexts. Its a delicate balance. We doesnt want to force anybody necessarily into a valuebased arrangement that doesnt that when a patient doesnt choose to be there. So preserving Patient Choice<\/a> is front and center for everything that were doing. There are some patients that we believe would do better in a comprehensive care valuebased arrangement, others may choose not to. You know, to use an example, the Electronic Health<\/a> records debacle of the last eight, nine years is an example of what happens when we forget about where the patient is in all this. I mean, the Obama Administration<\/a> promised us when they put 36 billion, 46, whatever the astronomical insane number it was into the stimulus package to get ehr uptakes that it was going to improve quality, bring costs down, yadda, yadda, yadda, all of it fantasy, none of it happened. None of its interoperable and now were working on finalizing the interoperable rule to make sure that the systems can talk to one another. I dont know how many of you has been in the emergency room with a Family Member<\/a> or you, the doctor doesnt make eye contact. Theyre on the laptop asking questions. Its an example how the system is screwed up that weve allowed ourselves to not think of the Patient First<\/a> and foremost and think, oh, if we give the government enough power and with enough data were going to solve all our problems. Not true. These are human beings at the end of the day, these are human beings that need to be taken care of and we need to make sure that patients and physicians have the flexibility, have the choices they need to arrange their to make the Health Care Choice<\/a> thats going to make the patient healthier and weve been focused on that since weve issued an executive order in october 2017, asking for a report on choice and competition. Its allowed us to push out shortterm limited duration plans, ah ps hra. Health accounts for employers and employees to get more Health Care Arrangements<\/a> more economically viable for them. Were about choice and the patient being in control and the patient in the center of this. Anytime were talking about forcing arrangements, its something we would be very skeptical about. We would want there to be more transparency, more data out there for people to make the decisions that are best for th them. In the corner. Washington post, where do things stand with the vaping flavor ban . Do you have a sense of the timing and are there any concerns about vape shops politically or them being hurt economically . Well, the vaping issue, but more specifically ecigarettes is a complicated one and i dont know if you saw the l. A. Times story which was followed up with some other reporting about how this is an industry that was, again, first started to come onto the fore are regulators and policy makers during the Obama Administration<\/a>. And the decision was not to bring them into regulatory compliance. We have believed that ecigarettes are a viable alternative to combustible cigarettes. Everybody recognizes combustible cigarettes are a problem, they cause cancer, bad news, all sorts of other health problems, pulmonary and cardiac problems. However, the option for adults is complicated by the fact that weve now got about 5 million kids using these things and that is a Major Public Health<\/a> challenge. Again, consistent with my answer earlier, we really want to make sure that were datadriven on this and striking the right balance between adult choice and protecting kids, and that has been with our focus as weve looked to finalize our policy. Theres been late breaking data even over the past few weeks that we have been look at so i cant tell you exactly where were going to be or the timing, but we want to make sure that the data is solid and we strike the right balance between protecting kids and giving adults the choices they need to stay off combustibles. [inaudible] a flavor ban, how it could hurt them . Well, its important to recognize that, you know, the fda only has jurisdiction over nicotine. So you know, this is a world that i dont fully understand. I wasnt i was too old, i guess, when the vaping stuff started, but youd go into a vape shop and you can get flavored whatever and smoke it without nicotine and people do that. You can also go into a vape shop and you can buy nicotine separately and mix it with the flavor and thats fine, too. What were really focused on is the ecigarette devices that have the nicotine and the flavors mixed in and making sure that adults have options they need to get and stay off combustibles and that kids dont become addicted to something they otherwise wouldnt be addicted to. Nobody really knows how nicotine addiction plays out over the longterm. Anecdotally there are scary stories including personal stories ive heard from parents and older brothers, older sisters talking about whats happened to members of their family, but data is really, in many instances, early and thats what makes this complicated and a difficult issue to confront, but we are very focused on it and focused on making sure we do the right thing. Following up on that, is there any discussion about whether the plan would exclude menthol flavored or adultonly vaping shops. If the ban does exclude menthol would juul or others be able to reclassified the mint i dont want to get into it, and we need to do extensive q a on that. Its a difficult issue and fda regulation is complicated. On a personal issue i hate tobacco issues and always have. Fda shouldnt be regulating this in the first place. When this conversation started, this is a mornic idea. Fda regulates drugs that help people and balance whether or not theyre safe and effective. This stuff is awful. Tobacco has no redeeming qualities and it shouldnt be regulated by a Health Agency<\/a> like this. All the unintended consequences, sucking up of everybodys bandwidth on tobacco issues is a huge distraction. The fact that a fda commissioner like Scott Gottlieb<\/a> or Ned Sharpless<\/a> or whoever the next one is going to be has to spend all of this time on tobacco issues when they could be trying to figure out how to advance new therapies that are going to cure cancer. How to solve cystic fibrosis, get drugs approved more quickly and competition to bring prices down and theyre spending time trying to and a half evacuate this stuff. When i showed up at omb, i told my team, the door is open, any industry can come in in i Patient Group<\/a> anyone can come in with a problem bandwidth permitting. I dont want to do anything on tobacco. You know what . I got pinged all the time, tobacco. Tobacco, tobacco, traditional. Ecig, everything, they want to come in and explain were getting screwed by the fda. We dont understand the regulatory standards. This is not the way the law is intended. Im getting blown up by members of congress by tobacco. On and on and on it goes, its a huge waste of time for a Regulatory Agency<\/a> like food and Drug Administration<\/a> that should be helping us come up with the next wave of cures to be sucked in the mud on this all the time and its just the unintended consequences of this law are just mindboggling. You think about all the time that is spent on this issue. It sucks. [laughter] all right. Who should regulate tobacco then . I dont know. I mean, its not an official administration policy, its my personal opinion. I mean, i really i have never had this conversation with the president about who should regulate tobacco, but, you know it has no redeeming qualities. What the hell are we doing with fda doing this . I mean, its just awful that were wasting our time on this and youre wasting your time on it. [inaudible] from Mitch Mcconnell<\/a> on health care, an Election Year<\/a> how do you get around that . Look, the frustration level on the part of the American People<\/a> with the drug prices, the out of pockets that they pay and the high drug prices, the frustration on the part of employers, health plans, yeah, i dont think theres any issue that we confront thats more front and center. I mean, you poll the issue, its the Top Health Care<\/a> issue consistently of what people complain about. This is an issue that both republicans and democrats should be able to come together and get done. And unfortunately, you know, there are some current complications on that front. I think everything is set up to do it. This is the right president to do it. This is a once in a Generation Opportunity<\/a> to confront these issues in the nonideological fashion. We spent were in our third year here. Today is the anniversary of the election three years ago, he so i guess were starting our fourth year. Weve been spent a ton of bandwidth, pushing up policies to rationalize our system, protect patients and align the incentives, not have a bunch of Government Programs<\/a> that are set up to drive high prices. And i think its it would be a win for both democrats and republicans. I think there are a lot of members who want to do a deal. I get calls from democrat and republican members to want to help on the issue and if im hopeful we can get there. So, i dont actually see it the way you see it that its not in the best interest of either nancy pelosi or leader mcconnell to get a deal done. I think its in everybodys interest to get a deal done. Okay. Back row. Yeah, on the international. Name and on iti, you want to add retail drugs for part d medicare. On rebate reform, loud and clear, that the finance committee is trying to do something on it. Therefore, i would like to ask you, do you see any potential for point of sale rebates for insulin specifically and what do you think of using aggregate rebates instead of point of sale rebates . Like i said, ipi is under review so i dont want to get into any specific details on it. Were at a time for ideas. Somebodys got a rebate idea, that train left the station. We need solutions right here, right now. This package needs to be wrapped up in the next few weeks. Like i said, i spent over two years working on the rebate issue. Nobody has come up with an easy solution to it. Its one of the reasons why the pelosi faux negotiation because its not really negotiation what theyre proposing on the house side, why that thing has got to get jettisoned. Its not just that it has no chance of bipartisan support, its impractical, its unworkable. I dont know how that thing would work. It contemplates a whole new bureaucracy at hhs somehow is going to divine what a drugs value should be. Academics, payers, drug companies, consultants all invested in how much a drug should be valued. Theres no way that provision works. Thats why its not negotiation, its a price at the ends of the day, and no company could refuse. And why kill innovation. The opportunity to retool that is over. The opportunity to play around with the rebate stuff is over. Ive been talking with, as i said, pelosis team since last year, very open, collaborative, great conversations, wide open as far as ideas. Were done with ideas now. Weve got to get a solution and weve got to get it scored by congressional budget office, weve got to get a deal on the president s desk. Ive been hearing from, you know, frankly ive been hearing from the house side since january. Six weeks well have a bill, eight weeks well have a bill, four weeks well have a bill, two weeks a bill. They were supposed to have a cbo score, didnt happen. Theyve got to cut bait on things that arent going to end up on the president s desk and would sink this opportunity that is presenting itself. There is still work being done, so what areas, if its time to pull the trigger, what areas could still be tweaked before they do that . Wyden compromise was built. The money saved from the part d progr program, it was not a redirected into the benefit. I think if we redirect it into the benefit, you get an even bigger bang for your buck, frankly, and its a bigger benefit for seniors. Its a bigger win for seniors. So, those are the types of things that were working on. I dont want to and just making sure that its solid knew numberically. Were on the stage of a bipartisan basis of dialing in on the specifics for this. And other specifics as well, pay for delay piece. Getting creates done. Incentivizing biosimilars to get that industry moving better to bring down costs to the biologics market. There are a lot of pieces moving. Ways and means, bipartisan work there, Senate Judiciary<\/a> and senate help health have good enough there. And efforts around patent listing for biologics that would be helpful when you look at some of the biologics have the submarine patents or mystery patents that pop up long after and protect the Market Exclusivity<\/a> far beyond the original contemplation of what is rational. Her effort would be very well appreciated. So theres a lot of things that are moving that could be tied together and thats where we need to be concentrating, not on new ideas. Talk a little about the pending Court Decision<\/a> for the Affordable Care<\/a> act and if it were ruled unconstitutional, whats the next step from the administration on that . So the Affordable Care<\/a> act, recall, was rammed through in the middle of the night without any republican votes and its already been to the Supreme Court<\/a> twice. It doesnt work according to its original billing. It was supposed to give us universal coverage and it was supposed to allow people to keep their doctor. Both central concedes, both central promises of the aca have not born out. So we spent 50 billion a year to drive the individual market from over 10 billion to slightly over 13 billion. And we have 28 Million People<\/a> who are uninsured in this country. That is the failure of taca. So much so the democrats moved beyond the aca and see dominant medicare for all or medicare buyin. Everybody recognizes the aca is a failure. The central question at play in texas and administration thought it was important to stand up for the rule of law. Well be prepared after that decision comes down with the permtations that get decided. Its important to recognize nothing is going to happen immediately. The decision will be stayed pending supreme Court Decision<\/a>. This will surely go to the Supreme Court<\/a>, it may or may not be decided, probably not decided before the election, but even if it were, i would imagine the Supreme Court<\/a> would stay its decision. But we need bipartisan approaches to solving health care in america. And when we do things as Just One Party<\/a> ramming something through, bad things happen. As i started talking about in the beginning, we spent eight years talking about aca and avoiding all of these Health Care Issues<\/a> that were percolating and in some cases exploding, like the opioids, like the ecigarettes problem that was beginning to manifest itself. Ultimately, if democrats and republicans were to come together, we can solve the preexisting conditions problem in much the way that, you know, we solved medicare for seniors because theres a market failure. Everybody in the administration recognizes that preexisting conditions, people with preexisting conditions have a difficult time if not a possible time buying health care coverage. The problem is that the exchanges now are made up of people with preexisting conditions and people who are 100 subsidized. Thats it. So if thats what you want to accomplish, if you want to help the poor and you want to help people with preexisting conditions, you can do that far more effectively and far cheaper than the aca. We would be focused on protecting people with preexisting conditions and restoring the rest of the market to health and moving a lot of the other Health Care Initiatives<\/a> and addressing other problems in the system and not ignoring them by dumping more subsidies into the system. I actually believe that the protection of people with preexisting conditions will be the only lasting contribution of the aca. Thats what you have bipartisan concensus on now, the president campaigned on it, he said it consistently in our efforts to think through what should happen post aca, protecting people with protecting people with preexisting conditions is number one on the list and then we work down from there. So, i think regardless what happens, people with preexisting conditions will be protected and you know, if the democrats are in a position where they can prosecute a legislative effort to get medicare for all and wipe out Health Insurance<\/a> for 180 americans in the employer market, totally eviscerate the Medicare Program<\/a> for seniors, and disrupt the industry, it would be a disaster if they were ever in a position to do that. It wont work and shows how bankrupt their ideas are, to be perfectly frank with you. It would be a real disaster if it was ever to get moving. I wanted to ask you what you think a realistic chances given this november the appropriations, we have an election it sounds like [inaudible] a top priority. If we get drug pricing, we can get surprised billing. Even so, surprise billing has a lot of bipartisan support. I think there is an opportunity for compromise. We were in contact with the senate and the house. Its really down to just a couple, a few issues. I do hope that it can come together in the inn. Its an easy issue for the American People<\/a> understand and its an obvious one to address. People should be going into the emergency room expecting x price and they get with the understanding they have coverage, like they buy coverage for a reason and then they wind up sorry, this coverage doesnt apply in this instance, and heres your surprise. We are not in a position to bargain, not in a position to fully comprehend in many of these instances whats going on and they need help. Unfortunately, it hasnt already been addressed by think the opportunity is there to get it. I think were close and think it could come together with a bunch of healthcare legislation at the end of the year. [inaudible] it could be stand alone. I dont think it is necessarily has to be attached. I think there are a lot of healthcare pieces moving at the end of the year, drug pricing that this could get attached to. So theres going to be a lot of big bills at the end of the year your culturally, hopefully we wont just do flush usmca down the drain. Thats ridiculous if it hasnt already been done. That would be a clear bipartisan win, a big win for the American People<\/a>. The ndaa bill that has been passed every year for 57 just, that should be passed so that should get done. The Appropriations Bills<\/a> should get done and we should get a good healthcare package before the interview. Its just a question of ten these guys sit down and get it done. We have about ten ten minuts left, some going to ask a question and then will come back on the site after i ask the question. If you can think of your question, short answers. You might not be able to talk about this, joe, but one of the other big issues ive heard a lot about recent is the recent lawsuit against truvada i believe it is. Is that hiv aids issue part of your plan to address this issue but also have elements of drug pricing in as well . You talked about disruption, doing things differently. How should we look at that issue . The president called it in the still union the all the technology is to achieve this. The social side, the formal logical data, the testing data. Could all be done. Im a veteran of the hiv initiatives in the Bush Administration<\/a> as you are. I ran the president S Advisory Council<\/a> hiv aids and its an incredibly exciting time it youre a veteran of those policy fights to see the opportunity that presents us. And to the president s credit, he saw it as well and said lets go for it. He raises it repeatedly. He raises it in half an comments how excited he about this, how this is somebody who lived in new york city during the height of the hiv epidemic, and many people around him not live through height of the aids crisis. So the opportunity is there. Its a lot of weve deployed a lot of expertise. Look at bob rayfield down at the center for disease control, outstanding tony fauci, the team at hhs. Pick with a lot of great people working on this and it can be done if Congress Appropriates<\/a> the money. Thats another thing. We would like to see. They can be done relatively cost effectively and would be a huge win for Public Health<\/a> and for the American People<\/a>. As for the lawsuit itself ive not been involved in. I wasnt involved with it with my previous employer. I have not been anything on it since i been here and its in litigation now, so its up to somebody else to sort it out. Fair enough. [inaudible] could you expand on what you mention in your opening remarks, the view Medicaid Expansion<\/a> by the help for the Opioid Epidemic<\/a> . Will look, i mean, a lot of people who are addicted to opioids have been on Government Programs<\/a>, whether its medicare or medicaid. You know, this is something, and with treatment guidelines that encouraged and star ratings in medicare that encouraged aggressive Pain Management<\/a> with opioids. And, frankly, somebody wasnt minding the store. You look at some of his lawsuit that they can place at the state level about what occurred with some of the marketing, added to what he could to do specific litigation but it looks to me like people were allowed to engage in conduct that is inappropriate and got a lot of people hooked on opioids. I mean, the Opioid Epidemic<\/a>, i mean, it is an epidemic. I mean, youre talking that tens of thousands of americans getting killed every year by the epidemic. The president doesnt drink, doesnt smoke, doesnt do drugs. And to his credit he said lets confront it. Kellyanne conway has been upfront on this along with jim carroll at ondcp, and hhs, but to be frank, Kellyanne Conway<\/a> deserves a lot of credit for focusing on this like a laser beam when she came in the administration. We have yearoveryear declines in opioid deaths. So its an achievement of this president but we do have a larger addiction crisis in this country, and its important to recognize we cant just keep our eyes on one problem at any one time. We have two the open enough to confront problems that maybe we dont want to confront, you know. I dont know that anybody wakes up in morning super fired up to dive into the details of the tragedy that is occurring with addiction in this country, but you have got to because its important to the American People<\/a>. Its important, its important for our country and this is a president who has focus on fighting for people, who a lot of people havent thought about in a long time or havent had the front and center, whether American Workers<\/a> in the Manufacturing Sector<\/a> or people in flyover country or families that are struggling with addiction. So its, theres a long way to go but weve made a lot of progress so far. And changed a lot of the treatment guidelines at a lot of the incentives to drive opioid addiction. While the numbers, i have heard anecdotally again from people in specific practitioners in various parts of the country the said the opioid numbers will continue to trend down and which is seeing the beginning of the fruits of our efforts. Again from emergency room physicians, the nature is changing not anywhere and hugely but there is, they are seeing something different, which is good news. Go ahead. From the washington examiner. Dr. Scott gottlieb said the opposite this week. He said he expected deaths from opioids were actually start to climb again once the data comes in because of all the mixtures and opioids and cocaine opioids sometimes by users who dont know that the drug has been mixed together. I didnt see his comment. [inaudible] im talking prescription opioids specifically. But you start mixing, and we have a math problem that is starting to really take off thats going to be difficult to get arms rather the fentanyl issue meth mixed in inappropriate with prescription opioids or sold on the street. Its not easy but i would have to look at what hes talking about specifically. We sing yearoveryear declines. Thats the data i am looking at right now. [inaudible] with two court strike against the religious conscious rule in the past two days. Do you have any plans to more effectively implement some of those things . Ive talked to former director who said theres a possibility you guys could maybe get the religious conscious rule, addressing some of the judges issues with it. I dont know exactly what that approach would be. I mean, the president s agenda is oftentimes afforded by activist judges. Thats one of the reasons why we had as a celebration in the east wing this week, a point of over 150 federal judges who will interpret the constitution are not make up a policy to suit their own ends. We recognize the risk we run whenever we confront it these challenges but the president respects people of conscious and some judges are going to be skeptical of that. We spent time making sure that our rules and regulations are sound. But at the end of the day you do roll the dice in kind youre going to be disruptive that a liberal judge will come along. But we will prosecute and appeal any case on any policy that weve advanced because we believe in it and we spent a lot of time to make sure that it is solid. [inaudible] im just curious why the administration is continuing to pursue them, [inaudible] one is being appealed but curious whats the thinking on by pushing programs that event [inaudible] because the policy is solid and think we can win. We are not going to apologize for. If theres an instance where a judge is going, we will not get something done, at the very least highlight a legal change it should be made and we can go to cogs and say listen, the courts are sticking it to us here or there and you need to clarify the law because were on the right track your, heres the policy we are pursuing and its not going to be as robust as it could be without a legal change. If youre going to be aggressive in policymaking, if youre going to run a risk a court will hold you up but at least been you expose an opportunity for legislation to fix the problem. That goes in healthcare. Again, we could shrink from these fights and make life easier and i could leave at 4 00 everyday, but thats not the way we are approaching it. [inaudible] releasing private Nutrition Health<\/a> plan rates and they said that use the information in their own states to negotiate higher rates because they know they never got low rates because of the transparency law. Is there anything in the common rule to address that kind of unintended consequence . I dont want to get into what specific [inaudible] happy to have more conversations about it. [inaudible] we recognize any policy may have in the deadly consequences and work really hard to think them through. But you also the public, period for precisely that reason. I mean, the public as the opportunity to let us know hey, you are on track, your offtrack, make this improvement. Improvement. And we have consistently pursued sound regulatory policy procedures to give the public the opportunity to contribute and help us refine our rules. I cant stress enough how important it is for millers of the public to get involved in the regulatory process, to make sure the government is doing the right thing and make them respond to the approach that is proposed. It will glottis proposed and will solicit comment and we may make a change of time it is final. We are out of time. So joe, i would ask you, is there any subject, and hes covered a lot of subjects, but is anything else you would like to throw out that you didnt cover or wasnt asked . May be just some we saw jobs numbers come out last week revised upward of 303,000, about expectation on job creation. We are at record low unemployment in the africanamerican community. You know, 3. 5 nationally. We are in a robust economic period but healthcare specifically is an area that can contribute more to our gdp. If we get more inefficiencies out and align more insidious. The way to do that is not to put government more in control of the Health Care System<\/a>. Its to inject more choice, more competition. And again, stay focused on why we are in this business in the first place, which is the patient, the american citizen that needs healthcare and needs to be healthy. Director i want to thank everybody once again, great turnout. I think it demonstrates what you have to say is important and hope you come back again. Maybe a new job or maybe still in this job at some point in the future. You have moved, who knows whats next but in any event we love to have you back. We appreciate your willingness to sit and answer this question, so thank you very much. And you all. [inaudible conversations] thank you all. [inaudible conversations] [inaudible conversations] live coverage on cspan2 will continue this afternoon with acting National Counterterrorism<\/a> Center Director<\/a> russell trappers who will talk about the Trump Administration<\/a> counterterrorism policy. That is live from the Washington Institute<\/a> starting at 12 30 p. M. Eastern today. Also on cspan2 democratic president ial candidate joe biden holds a rally at the New Hampshire<\/a> state house after filing candidacy paperwork for the first in the nation primary. Watch at 1 p. M. Eastern again on cspan. President trump will deliver remarks at a black voices for trump rally in atlanta. Live at 3 p. M. Eastern on cspan and you could see all of our live events online at cspan. Org or listen. Org or listen live with the free cspan radio app. Watch the cspan networks life next week as the House Intelligence Committee<\/a> holds the first public impeachment hearings. The Committee Led<\/a> by chairman adam schiff will hear from three state department officials, starting wednesday at 10 a. M. Eastern on cspan3 top u. S. Diplomat in ukraine william taylor, a Deputy Assistant<\/a> secretary of state george kent will testify. And then on friday at 11 a. M. Eastern on cspan2, former u. S. Ambassador to ukraine Marie Yovanovitch<\/a> will appear before the committee. Follow the impeachment inquiry live on the cspan Networks Online<\/a> at cspan. Org or listen live with the free cspan radio app. At cspan. Org we are making it easier for you to watch cspans coverage of the impeachment inquiry and the administrations response. If you missed any of our live coverage go to our impeachment inquiry page at cspan. Org impeachment for video on demand. Weve added a tally from the associate press showing what each House Democrats<\/a> stands on the impeachment inquiry against president trump. Follow the impeachment inquiry on our webpage cspan. Org impeachment. It are fast and easy way to watch cspans unfiltered coverage anytime. Data secured expert shared their concerns over the chinese social media app ticktock as well as apples cooperation with the Chinese Government<\/a> regarding the storage of chinese customers of data. The witnesses were part of a hearing of the Senate Judiciary<\/a> subcommittee on crime and terrorism. 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