The Proposed Fiscal Year 2021 Budget with Health and Human Services Secretary Azar

Transcript

you you you you you you you you you you you saying good things about you were gonna vent this morning oh gosh no I was actually I was waser means the Ways and Means Committee will now come to order good morning and welcome to Secretary a czar we want to thank you for joining us for this important hearing I think we all understand that you have had a very busy week with competing priorities including a number of hearings here on Capitol Hill I appreciate that you and your staff working with the committee to make the appearance today possible has occurred Americans including many of my constituents in Western Massachusetts have deep concerns about their ability to afford and access the health care they need they watch prescription prices continue to skyrocket and they worry that the administration will succeed in their court case to strike down protections for people with pre-existing conditions they also fear that at some point Medicare benefits that they earned won't be there for them this committee has been hard at work in 116th Congress trying to address these concerns and to strengthen our health care system so far we have tackled issues of lowering drug costs protecting Americans with pre-existing conditions putting it into surprise billing fighting the opiate epidemic reducing youth vaping and combating maternal mortality and the crisis that accompanies it we've also taken steps to increase opportunities for Americans to earn good jobs in health fields that talented workers are sorely needed president Trump's proposed budget is a direct contrast to this work his plan makes funding cuts designed to destabilize consumer protections under the affordable care act slashes funding for vital health care programs and creates more barriers to families trying to make ends meet the President's budget has proposed cuts 1.6 trillion dollars from health care programs over the next decade including Medicare Medicaid and programs that train doctors and support hospitals notably these proposals these proposed cuts in Medicare being on the chopping block cutting close to half a trillion dollars from vital programs that 10,000 baby boomers will join every day these proposals would lead to more Hospital closures in underserved communities like and urban areas and I am pleased with the tone you've taken because many members of our committee here today Republican and Democrat are very interested in providing more rural health care members of the committee are particularly attuned to these health care challenges in these underserved areas around the country to this end I hope the administration will support the bipartisan effort of rural and underserved task force work led by our colleagues Sewell Davis Arrington and winstram and I want to thank the colleagues that are here today for coming together to tackle these important issues the President's budget includes close to a trillion dollars of cuts to Medicaid that would be very harmful to families and individuals Medicaid has become a middle class benefit as long-term care becomes less and less affordable as the opioid crisis continues to ravage communities across our country it is unfathomable to cut nearly a trillion dollars from the biggest source for funding substance abuse services all of these sweeping cuts are being proposed the myths growing concern about corona virus the CDC has stated that it is not a question of if but when an outbreak will occur in the United States and that the corona virus could cause severe disruptions to American lives despite these efforts the president's press conference last night was not one that would inspire confidence we depend at this time in America on health experts and careerists to give us advice and guidance and the time used in front of our cameras today should not be used for any of us to try to score political points about the shocking advance of coronavirus and the public health and common illnesses that accompany it through the issues like the flu the president expressed an openness to accept additional funds from Congress I remain deeply concerned that the president's meager request for supplemental coronavirus funding needs to be upped we also need to work together to ensure that there are sufficient resources to prepare for and stem this tide health care is the number one issue on our constituents mind my objective here in Congress is to create policies that provide American workers and their families with high quality low cost health care the President's budget directly under minds that effort despite all of this I remain hopeful that we can come together to work for the good of the American people I must tell you that I've been very encouraged over your time with the words that you've had to say about lowering prescription drug costs that is a priority for all members of Congress and the committee here has put out a pretty good piece of legislation known as HR 3 that we passed earlier this transformative prescription drug pricing legislation provides close to 500 billion dollars in drug savings and expands Medicare to include dental vision and hearing coverage for beneficiaries Americans shouldn't pay more than patients in other countries for the same drugs I know that our Republican colleagues have ideas on this issue as well and the Senate also has a proposal but we need the president to weigh in and so secretary azar I hope that you can take back to the president we're ready to get to work on that issue we're ready to hear his proposal to get into the room and to hammer out a solution that will be well met by the American people and with that let me recognize the ranking member mr. Brady for an opening statement Thank You mr. chairman secretary azar thank you for joining us today I am I commend the Trump administration for its aggressive response to the corona virus I think the decisive actions administration took at the beginning the prudent travel restrictions are early containment strategy your leadership the current task force virus task force I think America has been able to stay ahead of the outbreak as it develops abroad we're going to explore that more today so mr. secretary we have quite a contrast before us in one hand and the leadership of President Trump in yourself with the support of congressional Republicans were making progress through creating a health care system that's truly patient focused rather than focused on the needs of Washington on the other hand we have the Democrats dangerous and controversial Medicare for all scheme embraced by leading Democrat presidential candidates and 118 House Democrats including many on this committee make no mistake Medicare for all guts quality health care in favor of glaze and long waiting lines gives Washington politicians unlimited control over your health care it cancels good health care planes for millions of workers children and seniors and so costly trillions of dollars you will bankrupt America imagine that you're one of the hundred and fifty eight million American workers whose two health care plan at work is canceled or the Union worker whose collectively bargained health benefits are eliminated with a single mom who relies on the Children's Health Insurance Program that disappears or the millions of seniors in Medicare Advantage thrown off your plane or the military family that counts on TRICARE that sees it ripped from your hands you used to have good dependable health care now you wait four weeks to see a doctor and get that test she says you need and since doctors and hospitals lose money on nearly every treatment they provide Medicare experts predict Medicare for all will cause a chronic shortage of doctors and nurses and increase closings of hospitals in underserved and rural communities while our American health care system does have problems we should focus on improving what's working and fix what's broken rather than starting over with a massive new socialized medicine scheme that will leave many of our families worse off as Republicans we are proud to be the party responsible for creating the crucial Children's Health Insurance Program Medicare Advantage for seniors the life-saving and popular Medicare prescription drug programs the Democrats have proposed in mass and every Democrat on this committee voted against at the time and we're proud to have approved America's first law establishing protections for people with pre-existing conditions we will not stand by let Democrats seize your health care your choices and your control over life and death health decisions with Medicare for all by contrast president Trump's leadership we've made great strides in health care including expanding health savings accounts repealing harmful of Affordable Care Act taxes pulling back the curtain on secret Hospital prices accelerating new cures and helping local businesses offer affordable insurance plans to their workers mr. secretary from drug pricing to surprise billing we believe there is a great deal progress that can be made this year to make health care better if as both parties in the white house work together our top priorities protect the vulnerable especially patients with pre-existing conditions under Republican Congress we approved America's first law establishing protections for people with pre-existing conditions through HIPAA it covers millions of Americans Republicans are proposed to do the same throughout this Congress represented and Walda and I introduced a House Resolution 281 administration work together to protect all Americans with pre-existing conditions to lower premiums to reduce dead prices strengthen Medicare and employer-provided coverage regrettably our Democrat friends blocked consideration of this bill last April I hope they will work with us and you to make sure that that is the law of the land for those not yet covered while the loss exchanges Affordable Care Act's exchanges have stabilized under this president while prices have fallen in many states after having doubled under President Obama and there are more choices for many families still too many Americans continue to suffer from the laws failure to lower premiums and offer better health care we ought to work together to bring down the high cost of health care something that Obama care promised but never delivered let's work on policies the president Trump can sign into law let's work together both parties to cap seniors drug costs in surprise medical bills regret to address the crisis of moms dying during birth to help rural and underserved communities in their struggle to retain and attract quality health care providers let's help more Americans get off the sidelines and into the workforce with that mr.

secretary and chairman Neal thank you Thank You mr. Brady welcome mr. secretary we certainly appreciate your presence here this morning we received your written testimony and it will be made part of the record in its entirety I ask you summarize your remarks in five minutes and we will then begin the questioning to help you at that time there is a timing light at your table when you have one minute left the light will switch from green to yellow and then finally to red when five minutes are up mr. secretary please proceed Chairman Neil and ranking member Brady thank you for inviting me to discuss the President's budget for fiscal year 2021 I'm honored to appear before this committee for budget testimony is HHS secretary for the second time especially after the remarkable year of results that the HHS team has produced with support from this committee this past year we saw the number of drug overdose deaths declined for the first time in decades another record year of generic drug approvals from the FDA and historic drops in Medicare Advantage Medicare Part D and Affordable Care Act exchange premiums the President's budget aims to move toward a future where HHS programs work better for the people we serve where our Human Services programs put people at the center and where America's health care system is affordable personalized puts patients in control and treats them like a human being and not like a number HHS has the largest discretionary budget of any non-defense department which means that difficult decisions must be made to put discretionary spending on a sustainable path the President's budget proposes to protect what works in health care and make it better I'll mention two ways we do it first facilitating patient-centered markets and second tackling key impact about health care challenges the budgets health care reforms aim to put the patient at the center it would for instance eliminate cost-sharing for colonoscopies a life-saving preventive service we would reduce patient's costs and promote competition by paying the same for certain services regardless of setting the budget endorses bipartisan bicameral drug pricing legislation and the overall reforms will improve Medicare and extend the life of the hospital insurance fund for at least 25 years we propose investing 116 million dollars in HHS's initiative to reduce maternal mortality and morbidity and we proposed reforms to tackle America's rural health crisis including telehealth expansions and new flexibility for rural hospitals I want to thank this committee for its attention to these issues today I'm pleased to announce I am appointing former Kansas governor Jeff Colyer as chairman of the National Advisory Committee on Rural Health and Human Services where he will work closely with me and senior HHS leaders on our rural health task force to develop creative responses for this challenge the budget increases investments to combat the opioid epidemic including SAMHSA's state opioid response program which we have focused on providing medication assisted treatment while working with Congress to give States flexibility to address stimulants like methamphetamines we request 716 million dollars for the president's initiative to end the HIV epidemic in America which we've already begun implementing with Congress's support the budget reflects how seriously we take the threat of other infectious diseases such as the novel coronavirus it prioritizes CDC's infectious disease programs raising spending by 135 million dollars from FY 2020 levels to 4.3 billion dollars and maintains 675 million dollars in state and local preparedness we have only 15 cases of the novel coronavirus detected here in the United States alongside three cases among Americans repatriated from Wuhan and 42 cases among American passengers repatriated from the diamond princess in Japan as president Trump vice president and I emphasized yesterday the immediate risk to the American public remains low in significant part because of the president's decisive action so far we're working closely with state local and private sector partners to prepare for mitigating the virus's potential spread in the United States because we expect to see more cases here in terms of identifying cases CDC has been able to test a 3625 specimens as of this morning at least 40 public health laboratories should now be able to test using modified existing CDC test kits in addition a newly manufactured CDC test can be sent to 93 public health labs as soon as Monday and there is a privately manufactured test based on the new CDC test that can be sent to those same labs as soon as tomorrow pending FDA clearance on Monday OMB sent a request to make funding available for preparedness and response including for therapeutics vaccines per little protective equipment state and local support and surveillance as the president made clear yesterday we are open to your views on what levels of spending may be appropriate and politics have no place in our mutual efforts to keep the American people safe as chairman of the president's coronavirus task force and working in conjunction with the administration's lead for the virus vice president pence I look forward to engaging with Congress on that this year's budget aims to protect and enhance Americans well-being and deliver Americans a more affordable personalized health care system that works better rather than just spends more I look forward to working with this committee to make that common-sense goal a reality Thank You mr. chairman Thank You mr.

secretary without objection each member will be recognized for four minutes today to question our witnesses so that we may ensure that all members have an opportunity to inquire before the Secretary's schedule requires that he leave yesterday as you know some of the questions ran over and I would encourage members to succinctly raise the questions that they have so that we can take advantage of the opportunity to question the secretary I want to recognize those members present at the time that the gavel came down by order of seniority and let me begin by recognizing myself the secretary the president's budget includes eight hundred and forty four billion dollars in unspecified cuts in the president's health care vision eight hundred and forty four billion dollars is a lot of money to cut particularly since the administration has a history of putting Americans with pre-existing conditions at risk could this vision include proposals that the Trump administration has made in the past like expanding use of short term limited duration plans so the allowance that we've put in the budget is the eight hundred and forty four billion dollars over ten year allowance to give us flexibility to work with Congress on reforms to the ACA structure that's a hundred billion dollars really around economies on the individual market exchange program and then 744 and Medicaid those would be ideas such as fixing the F map the federal matching rate to remove the distortion that prejudices Medicaid expansion into able-bodied adults in favor of them over the traditional pregnant women etc the program it also would give States greater flexibility on managing the long term spend in that program but these are flexible ideas really an allowance to open the door for us to work together the answer certainly does sound like yes and the problem with short term limited duration plans and other junk plans that the administration is allowed to Peru fellate and exclude maternity care cancer treatments hospital care and other needed services for conditions like coronavirus these plans discriminate against families because of pre-existing conditions and I hope that you will carefully proceed on that basis the administration is also supporting a lawsuit that would completely overturn the Affordable Care Act including the protections against pre-existing conditions and requirements for hospital and drug coverage that would be necessary amidst coronavirus and other public health crises mr. secretary you have said that there does not need to be a plan if the courts strike down this important law if the courts were to follow that advice and strike down the affordable care act how indeed with the administration handle the upheaval of Americans coverage and health care systems at large without a specific plan in in that rather remote eventualities of time and unpredictability of an eventual Supreme Court decision which at this point given the process in the courts could be years away from a final decision it would depend on how much the court strikes down is it all part or nothing of the affordable care act and also the composition of Congress and the political dynamic at the time of what we could work with the Congress to replace it with so it's very premature at this point but we would work obviously with Congress on a bipartisan basis the number-one thing would be to ensure pre-existing conditions are protected and that the ACA would be replaced in relevant part to ensure that we're providing affordable access to Americans to healthcare well as you know the house is very interested in cutting drug prices for the American people and we have certainly passed a bill that would save five hundred billion dollars from what is currently occurring most of these savings are from giving the secretary the power to negotiate prescription drug prices I certainly appreciate that you have said some very encouraging things and now we await the president to be consistent with the suggestions that you have made in fact you said and I'm going to quote here for far too long American patients have been paying exorbitant lehigh prices for prescription drugs that are made available to other countries at lower prices the Trump budget includes a number for drug pricing changes but not a policy does this vague drug policy budget number include prescription drug negotiating for the secretary and you probably can sum that up in one or two words so we are open to that it just has to be practical and implementable but most importantly it's got to be passable it's got to be bipartisan and get through the bicameral legislature so that's really the biggest thing we're the we're probably the most flexible party in the room on drug pricing if it gets list prices solved if it gets out of pockets down for seniors and if it gets the drug plans to the insurance companies to finally negotiate better against the drug companies we're open to working bipartisan bicameral with Congress to get that done let me now recognize mr. Brady the ranking member for five minutes Thank You mr. chairman thank you for being here mr. secretary let's start why I have a question about the corona virus start with debunking a few things we'll hear today so far from sabotaging Obama care the truth matter is after years of double-digit increases through the Affordable Care Act average benchmark premiums are actually down in most states certainly in Texas in our region there's far more competition and choices including in my home region and enrollment is stable you're often accused of somehow slashing Medicare Medicaid but under the president's budget Medicare gets another 25 years of solvency under this budget so crucial for that program way I see it Medicaid grows over 6% a year but it will look more like the families the elderly the poor in each state so it looks like the states that you're serving I know we have disagreement over short term duration plans for our constituents it's really crucial to have up to three or option for small business people in their workers for those in between jobs and those who are 62 and don't have health care until Medicare to have those short term duration plans for that coverage is really crucial for them and again Democrats don't have a budget so we can't really compare those two again this year but I think you've been very thoughtful in dressing some of these issues and debunking some of these myths I want to talk about coronavirus I think again the administration is clearly prepared for all possible outcomes you're taking every imaginal step to protect the health and safety the American people even John Hopkins University their global health security index shows the United States is a country most prepared to deal with the pandemic let me ask you about about medicines these are the times where you need life-saving medicines coming to the rescue I worry that under dangerous policies like Medicare for all or speaker Pelosi's drug plain that it would be harder to react to pandemics like this can you talk a little about what's happening in the pharmaceutical area my understanding is two companies Gilead and a V are working on medicines in this area NIH and others are working on the vaccines a red being and they will be ready for human testing somewhat shortly you talked about the CDC tests FDA working on other medical products can you tell us what you see in that regard of those medicine helps that could come to the rescue you bet so dr.

Fauci talked last night at the press conference about the vaccine that we invented at NIAID and now we're partnering with moderna in terms of the clinical testing on it a rather remarkably that should be in humans within three months of the initial specimen being provided from China that is just historic levels of progress and we will work to ensure because this is a joint venture that will be under contract with HHS we will work to ensure that there are appropriate protections to ensure the affordability of any vaccine produced out of joint venture work that taxpayers are funding as part of these cooperative cooperative ventures through our Barda so we have that we also have some purely private sector endeavors around vaccine candidates Gilead is doing clinic trials research on one of their antivirals that is not approved for anything yet REM de severe that's in clinical trial now in Japan China as well as at the University of Nebraska with patients so there is much promise but it will take time good thank you Thank You mr. secretary and I think you know this that our response to this virus is bipartisan so I know they'll be tired old political arguments about the funding but I think you know and expect Congress will come together to do whatever is necessary to support the response to this virus thank you thank the gentleman mr. Thompson from California is recognized for four minutes Thank You mr. chairman mr. secretary thank you very very much for being here I want to revisit some of the things that the Chairman I had mentioned it's it seems to me incongruent to be for protecting people with pre-existing conditions and to sue to do away with the protections for pre-existing conditions and the lawsuit that has been referenced are already today it would do more than just that it would it would preclude people from being able to keep their kids on their plan it would end health care for 20 million Americans and it would affect how we deal with people with mental illness and the issue of mental illness is so profound it's found in our addiction problems and our homeless problems in our law enforcement or jails were filled with are filled with people with mental illness and the Affordable Care Act was the first time that we ever put mental health on par with physical help and to sue to do away with this at the same time propose a budget with 844 billion dollars in cuts I find very difficult to believe that it's going to do anything but worsen our health care our health care problems and we've yet to see anything written that suggests that the administration has a plan to deal with health care is there a written proposal we were promised that this president was going to repeal the Affordable Care Act and replace it with something even better is there a written plan for them so we've put in the budget the eight hundred and forty four billion dollar allowance that would be for us to work together with Congress in a flexible way we're trying not to stake out an a firm demand around the approach that would replace the Affordable Care Act to there so that we have flexibility to work together we can see the composition of Congress but frankly right now it is so far off that we would see any Supreme Court decision and how it would rule it any any plan any document and eaten any notion like that would be so hypothetical and distant is today mainly Thank You mr.

secretary but if that's your position that the court case is going to take a long time to settle why don't you just work with Congress now to improve the Affordable Care Act so that's exactly what the 844 billion dollar allowance there for that would actually be reforming of Medicaid expansion reforming of the individual market approach so we are open to working with you on ways in which we can provide better health care for the American people well I don't know how you can improve healthcare at the same time you're proposing to cut it by 844 billion dollars on the issue of the coronavirus mr. secretary on one thing that I'm especially concerned about is that we're running out of isolation wards patients with coronavirus need to be held in isolation and right now they're being sent towards that acute care hospitals I know folks in my district are concerned what what are we doing about that I actually really appreciate you raising that question so we are right now in a very active containment mode and so that means an individual who test positive for coronavirus we're putting them into these types of Ebola like isolation units that will look very extreme that is not what's indicated medically for these individuals most individuals who get this corona virus will have mild to moderate symptoms will be able to stay home and treat it like the flu or a severe cold and present at a hospital only for urgent care comorbidities so it's really important we correct this impression that it will require this massive hospital isolation for normal patients we're in containment mode right now to stop any further spread but once if we end up having broader spread it will be a much more common approaches dr. shooked called it it will look and feel to the American people more like a severe flu season in terms of the interventions and approaches you see so thank you for helping me to clarify thank you folks thank the gentlemen let me recognize the gentleman from Florida mr. Buchanan to inquire for four minutes Thank You mr. chairman mr.

secretary good to see you appreciate you coming out I had an opportunity before the press conference last night did a telephone town hall with a lot of seniors I'm in Sarasota Tampa Bay area and it's all about the virus that was what the discussion is I want to give some of the questions I got asked last night and I didn't see the press conference but I've seen some of the highlights in terms of resources there's been discussion about the president mentioning two and a half billion some people four billion you know Chuck Schumer the Senators you know eight and a half billion what words were we add in terms of that and turn they want to make sure we're gonna have the resources if this thing really gets out it's more aggressive so I want to get your thoughts on it so we have proposed 2.5 billion dollars in spending in 2020 so in the next several months with openness around adjusting 2021 appropriation to fit needs as we see them over the next several months but the president has made it very clear on national TV last night that he is open to working with Congress to on a bipartisan basis to provide whatever the funding amounts that Congress feels it needs and the vice president's already been working with bicameral bipartisan leadership on this let me ask you of some misinformation mr. secretary is it fair to say that the president's funding of the agency has put over put our nation in danger by cutting life-saving programs like CDC and Barda know actually working with Congress the president during the president's tenure every part of our preparedness and infectious disease program activity has been enhanced and expanded CDC's budget is up 667 million during his tenure NIH up 7.3 billion dollars as per our preparedness and response function up 621 million global disease detection up a hundred and eighty three pandemic preparedness two hundred million net strategic national stockpile up a hundred and thirty million Barda and bio shield up a total of two hundred and seventy-five million dollars for procurement of countermeasures yeah watch the news this morning that's not that's not what a lot of Moore saying that's why it's kind of surprising with what they talk about is budgets but you know budgets are like the the first the first to move in a chess game with I'll be honest a fairly profligate Congress and the president starts that move with a budget knowing that we're gonna get a lot higher there as we work with Congress the other question that yeah interested myself just with the leadership going forward in vice president Pence what's the interface going to be with yourself mr. secretary between the two of you who's gonna do what and how do you see that working in terms of the task force so it'll be very it'll a lot of continuity with what we've already been doing I will remain the chairman of the task force the interagency task force what the vice president will do is actually a function that's been very similar what acting chief of staff Mick Mulvaney has been very Abele doing for me which is I'm in constant communication with him and he's able to clear barriers get alignment across cabinet departments and agencies and frankly deal with and coordinate areas that are outside of the health care expertise broader economic questions trade issues etc and the vice president's involvement and leadership across the whole of government brings just the weight of the office of the vice president to that task and then last question is just in terms of the China factor I know we've want to get people on the ground or maybe we have people on the ground do we feel like we're getting the real scoop there I mean the senses we're not want to get your thoughts on so we had an NIH and a CDC official two of them as part of the WH o--'s team and we're waiting for the final report out of that WH o team but the report I got from one of our individuals was they felt that they did get transparent access to data and had and saw very consistency in the information they were seeing as well as interaction that were productive with their Chinese colleagues so again with China I'm always in a wait-and-see mode but the report was very positive coming back on that in that room thank you and I yield back all right the gentlemen let me recognize the gentleman from Connecticut mr. Larson to inquire Thank You mr. chairman and thank you for holding this hearing and secretary airy Sarah thank you for your your service and the manner and the integrity you bring to approaching this current crisis that we face I think clearly this is something that has to be approached and will be approached in a non partisan nature a couple of the questions that I have relate to testing and you talked about getting I think Diagnostics is the key with respect to this both in terms of containment and also in terms of getting a handle on this but my understanding is only five states Labs have received tests so far kits my state hasn't in the state of Connecticut how soon can they expect to get those so CDC invented a diagnostic within I think a week of getting the sequence from China it has three steps to it they probably in retrospect may be over engineered in a bit we at CDC have done over 3600 tests there we have had no backlog we've added staff etc we ship to all of our labs the tests once it was approved by the FDA what we found was that in some labs the third step of that they were having trouble with getting a control quality control validation on that so it led to inconclusive results we now as of yesterday afternoon the FDA authorized the use of those tests by using just the first and second step provide a definitive diagnostic so 40 labs are qualified to already be doing that and then by this weekend all 93 labs around the country they get these will have either CDC or on Monday we'll have the private sector or on Monday a modified test that's even easier how about in the case of hospitals will hospitals be given the same a number of doctors and hospitals in our major cities have raised questions with respect to this how would you respond yes so that's the next step is working with the private sector and also CDC to develop a basically a bedside diagnostic so that that's really the next step we've got to get to and I thought part time line with respected I try not to make predictions about medical technology but we've got I think I've the Commissioner told me as many as 70 possible diagnostic makers are looking at how to get this up and running at the bedside well that's encouraging to hear but I know from talking to a number of the docs and the hospitals the sooner they're able to do this obviously the better but I thank you I just would add only as a as a a comment here and given that bipartisan nature our dear colleagues on the other side of the aisle when they for eight years at the ability to modify the Affordable Care Act but they said they were going to replace and repeal it and they did very little other than weaken it so it's heartening to hear that we're going to be pulling together to strengthen that in a way and especially in this time of crisis and thank you for your service the gentleman from Nebraska mr.

Smith is recognized to inquire Thank You mr. chairman Thank You secretary for sharing your expertise and insight these are important topics that we are discussing it it would seem to me that there's bipartisan agreement that there are a lot of problems with the so-called Affordable Care Act and that the question is what do we do about that and so I guess first of all can we get your commitment to working with us to to navigate through this and especially can you commit to the committee that the Trump administration would support for existing conditions protections no matter what happens in the courts president Trump has been adamant he will never approve any piece of legislation that doesn't protect pre-existing conditions in terms of replacing the ACA or fixing the ACA okay thank you I certainly appreciate that I know he stated that in this State of the Union speech we saw what the speaker's a response to that was but certainly the American people have have suffered greatly in in many ways the constituents of mine who are paying thirty and forty thousand dollars a year out of pocket when they were told they were promised that they would save twenty five hundred dollars per year per household so we can do a lot better than what is currently in place and we passed a bill here here in the house that would have actually reduced premiums it was roundly criticized and opposed by by folks who had supported the so-called Affordable Care Act but I think things are way too important for us to just dismiss and walk away from bipartisan concerns that we know exist in and that we want to address more specifically I've been working on a rural health clinic legislation and I know that this is important to a lot of Americans all across the country there is a proposed perspective payment system for rural health clinics that some of us are concerned might have some unintended consequences that would strain lower volume Hospital affiliated clinics and in pushed rural health clinics to prioritize volume over value in patient outcomes could you give us any detail on that about the proposed payment modernization and its expected impact on both independent and hospital affiliated rural health clinics so congressman I had not heard of those concerns around the rural rural rural clinic and a prospective payment system there and I'd love to learn more about that with you because of course we don't want to do anything that harms rural health care access in fact we're trying to do exactly the opposite with the budget proposal and the rural healthcare initiatives so please if offline if we could discuss the concerns there I'd love to hear them I certainly appreciate that I know that there is i'm impressed with many of the delivery systems in rural areas of course rural can mean different things in different parts of the country and and now you know nebraska my home state is a major player in coronavirus and i guess can you perhaps elaborate briefly as time is on quarantine efforts and how that can you know obviously prevent the spread of the virus and and we have quarantined folks in Nebraska right now can how can you assure that we can contain this in the units that do exist yes so the University of Nebraska of course is one of our finest institutions and partners with us on the Ebola treatment center that we have there absolutely and so this should really have no risk to any individuals in the community the these are highly contained controlled environments where if an individual tests positive even if they're not symptomatic they can't remain on military bases and so we move them into these treatment centers that are negative airflow appropriate containment units they're treated with protective equipment etc while they get better and so so this really is not a risk to anybody in the community and the visual may scare people but they should be reassured actually by the quality of containment very well thank you thank you gentlemen let me recognize the gentleman from Oregon mr. bloom and I were to inquire thank you Thank You mr. secretary the notion that visual may disturb some people but there are opportunities perhaps to be reassured I find reassuring that the administration is looking for two and a half billion dollars and may be open for Congress adding additional material among resources but I'm concerned about systemic cuts in this same area I mean the overall budget as I understand it is a nine percent cut to the Department of Health and Human Services twenty-six percent cut to the US Environmental Protection Agency 693 million dollars in cuts to the Centers for Disease Control and Prevention and seven hundred and forty two million dollars in cuts to health resources and services administration proposals you started in 2018 focusing on eliminating funding for the Obama era programs that for disease security programs the Admiral Ziemer I think who is tasked with managing pandemics quit and his global health security team was dissolved the CDC was forced to slash its efforts to prevent global disease by 80 percent it cut the complex crisis fund that was created in the Secretary of State's office by Secretary Clinton a 30 million dollar fund to be able to deal with that cutting global disease fighting budgets at CDC the National Security Council the Department of Homeland Security in the Department of Health and Human Services the budget cries out undermining the ability to respond on a global sense on the programs that were designed for situations like this how are we to take comfort with a notion that you'd accept two and a half billion dollars to try and deal with a problem that has been created yet over time this administration has been steadily attacking funding for the very programs that would help manage and perhaps prevent this outbreak care to give me some assurance absolutely so in this budget for instance we increase by 135 million dollars over what the administration has done since it took office in this area well that actually is an increase over existing funding so 135 million dollars over over over present funding for global health security disease infectious disease and preparedness and that gets to a total of four point three billion at CDC as I mentioned we've increased CDC over the president's term by six hundred and seventy million dollars of over that time its annual budget so it's been increased our budgets are an opening bid and interactions with you all because we know how that how the dance is going to work on budgets but where we get to has been consistent level increases in these priority program claiming my time I really would like to have some assurance in terms of the specific programs that were developed to deal with situations like a pandemic there have been flick tuitions up and down but armed 2017 on it appears to me that you have this administration has targeted the very programs that provided the sort of infrastructure that would help us respond and looking at modest adjustments in what you call an opening bid belies what this administration has done since it's been in charge and I would appreciate having an opportunity to flesh out comparing apples to oranges what's happened over the three years that we've watched this stewardship I appreciate your help thank the gentleman with that let me recognize the gentleman from New York mr. Reid to inquire for four minutes Thank You mr.

chairman and thank you to the secretary for being here today mr. secretary my questions are going to be focused on the area of innovation and what you're referring what you're doing in regards to the proposal and elsewhere so just taking innovation in regards to the coronavirus situation my colleagues on the other side of the aisle have passed a bill dealing with prescription drugs cost that acknowledge and concede will negatively impact the amount of cures coming to the marketplace for the American citizens as a result of that proposal so as we talk about budgetary cuts I also want to talk about the proposals that will limit innovation and so if we don't have innovation how are we going to get the treatments for things like the Korean coronavirus am I missing something and what the policies we should be promoting here and how it should be you're absolutely right wheat and we need the private sector to do this we can do basic research but to drive development across the finish line whether vaccines or therapeutics or Diagnostics it's gonna take partnership or even independent action by by companies and those companies are gonna have to be able to have a reward on their endeavors we propose at least a billion dollars of vaccine funding in the emergency supplemental but that's got to be in partnership with somebody so that if that partnership is not there and that innovative environment of America pharmaceutical research and treatment research is not vibrant issues like treatments for the corona virus and else are going to be at risk of being delivered to the American people is it they won't exist if we don't have a vibrant biopharmaceutical industry that's willing to that's willing to put significant amounts of capital up for very risky ventures we talk about vaccines and therapeutics as if they're a sure thing actually we're gonna have to put many bets out on the table to see what see what comes forward and see what works we don't know what off-target safety effects could be we don't know efficacy until we get in human clinical testing on these things so I appreciate that so following up on that one of the issues I've made a career of my career in Congress to dedicate it to his issue of diabetic care being the father of a type 1 diabetic myself working with Dinah to get in a bipartisan basis on the diabetes caucus we've had some really great successes in regards to working with the Department of Health in regards to continuous glucose monitors being covered at CMS issues like the omnipotent in the reimbursement policies we just got the phone application used with the desk um CGM technology approved through the system and so i was very intrigued with your budget proposal that looked at the issue of innovative alternatives to durable medical equipment for treatment and management of diabetes it's a specific provision in your proposal so I just want to give you the opportunity I applaud that innovative work I applaud what's going on in the diabetic research area and as we dealt with a letter recently that got 218 co-sponsors on the letter to deal with the issue of pricing and payment reimbursement for the artificial pancreas which is a great exciting technology and innovation in America's private marketplace could you tell us exactly what you're looking to do in regards to that innovation in regards to diabetic care sure as you know a Medicare durable medical equipment that program excludes coverage for non durable alternatives to DME so essentially we're stuck with durable what we would propose in the budget is allow coverage of these non durable alternatives to DME both to save money but also to enhance options for patients and it could come come about exactly as you say in the in the diabetic care arena I know your passion on insulins also I did want to say you know we're on a we're very close to a very important date when it comes to in March 2020 is when we could see the first filing of applications for insulin biosimilars which Congress has enabled and FDA has laid out a pathway for streamlined interchangeability and clinical information there so we could with insulin pricing be seeing within the next year to two years a radical radical transformation in every aspect of insulin and pricing and delivery for patients thank you very much mr. secretary I yield back thank you gentlemen let me recognize the gentleman from Wisconsin mr. kind thank you ma'am mr. chairman mr.

secretary thank you for your testimony here today mr. Burgess and I dr. Burgess have introduced an immunosuppressant bill and the administration has been favorable to it it would extend reimbursement coverage beyond a 36 month cutoff we think this is an important piece of legislation we encourage the administration's continued support I'm also co-chairing with representative cathy McMorris Rodgers the rural health caucus in Congress and we appreciate you know the focus that the administration is providing given the unique challenges that we face with our rural providers we certainly encourage continued support for critical access designation thinking out of the box when it comes to recruitment and retention challenges we have in rural areas at also a nationwide broadband deployment for 5g in order to really ramp up the potential of telemedicine that we have all these things that think with your leadership we can start moving aggressively forward on but like mr. Buchanan I too had a telephone town hall last night one out of every three caller in was talking about the corona virus so certainly the concern if not the fear is starting to permeate throughout our communities and throughout the country and we do face I think some unique challenges in the rural providers fear of how we address the spread of this virus how confident are you in regards the infectious disease protocols that we have in place with our rural providers right now that they're up to the task of what's appearing on our doorstep are ready with 47 countries the first known nonce or origin source detected here in the United States it's coming and I'm concerned whether we're we're ready for that I think it's a very question because and one of the bedrocks of our system is our great hospitals our great public health infrastructure and our providers that's how we're identifying these cases of the 15 cases that we've had here in the US that weren't imported from repatriation of all but one of them came from great doctors and nurses identifying symptoms and testing I worry about infection control protocols in rural in rural facilities just they don't see it as much and I I do think we're gonna and perhaps the funding through the emergency supplemental can help with that I think we have to up the game nationwide around immediate infection control on suspect cases so we don't get knows a comeall infection but I would also encourage the administration really take a forward stance on the protection of our frontline rural health providers the provider community overall because if they start getting infected and start going down then we are gonna be in a world of hurt and likewise how confident are you about the infectious disease protocols that we have in our schools I mean China now is shut down Japan just announced they're shutting their schools down South Korea soon we're probably gonna see it in Italy and sweeping through Europe are we ready at the school level to protect our children so at the school level it's like at the employment level the most important thing one can do is if you're symptomatic if you're not feeling well you need to stay home and not go to school you need to not go to work it's really doctor shook it spoke about this yesterday at the press conference it's the same basic public health protocols for the common cold and for the flu which is proper hygiene washing your hands covering your mouth not touching your face with unwashed hands and staying home if you're sick and we'll we need schools to enforce that we need employers to enforce that it's also poor we don't over scare and have people walking around masks on and that's that's not what we recommend that's not the safe way to deal with things well one thing I'd recommend that you take back the vice president Pence and the taskforce that's now formed is for us to start developing a strategy for online learning opportunities because man when this stuff starts spreading throughout the country the natural reaction of parents will be to bring the kids home and try to protect them and take them out of school and we can't afford as a nation to have them sitting at home without any course instruction in front of them for months at a time or however long it's going to take for us to get a grip on this so and then being uniquely concerned about those kids at home who don't have broadband access aren't going to have those same online opera two of these as as others children so that's one recommendation for the task force to look at Thank You mr. secretary thank you let me recognize the gentleman from Missouri mr.

Smith to inquire Thank You mr. chairman Thank You secretary azar for for being here today just last week I brought together a roundtable in Southeast Missouri with myself the governor of the state of Missouri Mike parson and also some members from the White House in regards to talking about opioids but also talking about access to rural health care and I know that that's been very important to you and that's been important to the president and I want to thank you for that being addressed within the budget for so for so long it's been overlooked by prior administrations in addressing access to rural health care and I'm glad that you're focusing on that I'd also like to applaud the administration's continued focus on advancing American Kidney health which has been a priority for myself and many other members of this committee American taxpayers spend more money on kidney disease annually than what we do on the departments of justice and energy and the State Department combined even more alarming of the more than a hundred thousand Americans who begin dialysis annually one in five will die within a year I think we can do a whole lot better I know there's members of this committee that I work with that believe that we can do better your department's work to ensure fewer patients develop kidney failure to increase rates of home dialysis and to increase the number of kidneys available for transplants have not gone on have not gone unnoticed the potential benefits for the more than 700,000 Americans who have in stage renal disease are immense for most Americans with kidney failure as you know the best treatment is a kidney transplant unfortunately the Medicare program we'll only cover the cost of immunosuppressive drugs for three years post transplant these drugs are vital much like what represent of kind had said earlier in preventing a patient's body from rejecting their new kidney congressman kine and I have introduced legislation along with some members in the E&C field to correct this misguided policy and I applaud the administration for including that proposal in its budget request this year so thank you very much I understand that HHS recently issued some data indicating that providing lifetime coverage for those drugs would lead to cost savings can you please talk about that data and the administration's perspective on this issue of lifetime immunosuppressive drug coverage and do you have any insights on the savings so I don't have the exact number on the savings but happy to get that to you but yes that's what we found is that by covering immunosuppressants we save the kidney by saving the kid the transplanted kidney it's a longer life a better health care for the individual and really appreciate your leadership and we're so delighted that that's in our budget it's very important to us and it's very important to so many patients across this country so thank you all so mr. secretary I hear there are still issues with organ procurement organization performance it's something that a lot of members of the Missouri delegation especially on the other side of the building my counterparts care about what will you do to move the ball on organ donation overall so we've got a proposed regulation out to enhance the accountability of the organ procurement organizations to bring them all up to the higher standard there's great variability in performance both on procuring organs and on securing live human transplantation of those organs successful transplantation we've got to up their game by real accountability I see my time is expired thank you for being here secretary like the gentlemen let me recognize the gentleman from New Jersey mr. Pascrell to inquire morning mr. chairman mr.

ranking member mr. Ezard were you aware were you told beforehand that the president was going to name mr. pence vice president pence to lead and lead to charge against the coronavirus did you know that of course I did yes you were told yes I was consulted and told yes but involved in it consulted discussed it worked on it and I'll be honest with you my reaction when I heard the idea that the vice president would be willing to help add his force of office to the so this effort I said I said quote that's genius mr. aids-related administration has proposed a 1.6 trillion dollar cut to health care programs and would destroy the safety net programs that millions of Americans my constituents rely on absolutely a nine percent cut for the entire Health and Human Services cannot and does not lower drug prices it doesn't protect pre-existing conditions and at defense and defend Social Security and Medicare doesn't do those things I'm not sure who you're trying to fool and presenting this budget or what you're trying to sell the FDA's budget request expresses unequivocal support for the adding that device identifiers to insurance claims adding identifiers to claims would provide better data to track the safety and quality of implants over time which in turn would improve the outcomes and reduce costs however CMS seems to disagree with the widespread agreement from across the health industry and the HHS Inspector General yes or no will you finalise adding device identifiers to claims as the President's budget request claims I wasn't I wasn't familiar with disagreement at CMS so I want to get back to you on a look at that I had not known of disagreement on the device identifier payment issue a critical issue mr. secretary was back several years now I agree on the important it will help us respond because this industry has gotten away with literally murder and if you know the court cases that were involved you'll see how important this is unworried this administration is not prepared for the global outbreak many of us are we're not going to sit back and simply say it's an somebody and somebody says we all have a responsibility here especially when we hear the news of the first person-to-person transmission on US soil the president is tweeting about the stock market senior officials are lying about containing it and I don't see a plan to manage the risk so we sent the letter last week highlighting the concerns about the risk to the medical supply chain due to global dependence on Chinese manufacturing you plan to ask Congress for additional appropriations as public health experts have suggested and what do you think about that supply change is in serious does it have serious problems as far as you perceive so we we do have a real issue in terms of the supply chain being bound up so much in China there is one bit of good news from our survey that FDA did there are 20 products that are either whole or with a single source active ingredient sourced out of China so 20 of them there's no alternative in that sense we're aggressively monitoring working with the industry we're not aware of any potential shortages yet but with device and pharmaceuticals we are we very much on the lookout for that and working to find alternative sites and supply chain Thank You secretary Thank You Jared Thank You mr.

Pascrell let me recognize the gentleman from Arizona mr. Schweikert I'm with you mr. chairman and just a reminder to everyone Medicare trust fund five budget years it's gone so anything we're doing here that can extend that or ideas are not laying on top of it so it's one thing to attack that but also to deal with the reality where the math is right now mr. secretary how familiar are you with Democrats HR 3 fairly familiar okay I there's something I've been passionately trying to get our brothers and sisters both in Republican Democrat side understand the cost savings from that piece of legislation comes from something in the connectors referred to as reference pricing so if you and I are in Great Britain a what is what's the formula a quality adjusted life year is worth $38,000 so if a pharmaceutical costs $40,000 but would give you an adjusted great year they don't buy it and it's that type of reinforce 'ti is how they save money on pharmaceuticals we are desperate both Republicans and Democrats as you've already spoken about to lower pharmaceutical prices my fear is the unintended consequence that by doing that that the high-risk high-reward small biologic small molecules even genomics that don't exist in those markets that scarcity is going to be really they're about to wipe out small pharma and functionally protect big pharma because if they just wiped out the capital stack for all the small pharma companies that are creating the disruptions am I wrong tell me am i seeing it the wrong way so I would be I would be a bit balanced on that in that as course the president and I have been very supportive of notions of reference pricing in Part B where we are a price fixer and price setter and we just do it pretty stupidly at a hundred and six percent of average sales price in Part D though where we actually have competitive marketplace that supply and demand curves are meeting to produce market competitive pricing for the most part except in some areas where they've been precluded from negotiating that system really does work and a system of reference pricing or price controls beyond that could lead to some real distortions in the system as you said and we also HR threes so-called negotiations it's not clear how implementable are practical those really could be as crafted want to work with Congress on the system to get prices down but it's got to be practical have the Democrats that care about pricing have they been reaching out to your office and trying to come up with a method that actually would work without killing people because of the future curative drugs that will disappear I'm not aware of that outreach with my office I know there's been White House interaction with the speaker's office but we want to work on a bicameral bipartisan basis you know we've got the the Grassley Wyden package in the Senate is one that has proven bipartisan that's one example of how we might move forward and real reform to Part D could bring huge benefit to our seniors I'm hopefully you're hearing we we all have the same goal some of us are very fearful that if we destroy those disruptive curative at 5% of our brothers and sisters that have chronic conditions that are the most of our health care spending we lose that cure that you know the single shot drug that cures hemophilia and these other things that are coming here um there's one other and this one's a little tougher like I have a series of alerts on just tracking testing for the for the virus here's a company out of Israel that just announced they think they have one that within twenty five minutes could do desktop analysis on the drug what do we as policy makers have to do to function legalize healthcare technology the thing you blow into that could tell you have the flu and order your antivirals except that technology today because it's an algorithm writing the prescription it's substantially illegal how do we how do we work with you to actually do the technologies that could crash the price of health care we work together thank you miss secretary thank the gentleman Jim with that let me recognize the gentleman from Texas mr. Doggett to inquire Thank You mr.

chairman Thank You mr. secretary coronavirus Kovan 19 is a respiratory disease is it not that's correct sir and after at the Center for Disease Control you have an expert who directs your respiratory disease section don't you yes what is her name dr. Nancy mess naa runs the the respiratory and influenza branch yes was it was it your decision yesterday to exclude her from the press conference on this issue no we actually had her boss the senior career official a doctor and shook it was at the press conference yet but not not the respiratory disease expert who was the truth teller not unlike dr. Lee in wuhan who spoke out on Tuesday apparently drawing the president's attention in saying we will see community spread in the United States it's not a question of if this will happen it is a question of win and how many people in this country will have severe illnesses do you agree with her statement first I know dr. masini extremely well over decades I have the highest respect for and yes we we believe all well no no no it's very good because if you agree with the public do you agree with her or not it there is context needed community spread could be in a town a locality or could be nationwide like that it could have begun yesterday or day before in north northern Calais let me ask you could be a community as you know and saying disruptions to everyday life may be severe but people might want to start thinking about this now do you agree with her on that that was a statement of a range of possibilities which is yes we're dealing with elementally the question is whether or not the administration is moving based on this serious concern are just on putting a happy face on all this that'll go away when the spring flowers come out that's a kind of misrepresentation but some of the specific things the administration is and is not doing in that regard beginning with the question of facemask I'm sure you saw this the story that the n95 mask that is important to those who are health care providers that many hospitals only had a week supply what is the administration doing to assure that there's an adequate supply of those masks we're asking you to fund us buying masks I see so we don't have them now and 60% of large chain pharmacies also say that they've had run out of masks for the public in general on the question of lab tests as you know last Friday the Association Public Health Laboratory said that only three states had the capacity to test people for the virus and in the case of what might be the first community spread in California it's taken four days to determine whether that person had coronavirus I've had this experience in San Antonio where any for anyone to determine whether those people that came off the ocean liner in Japan who are now at Lackland Air Force Base we have to send the tests off to Atlanta to get an answer on that a problem about not testing people on the base transporting them across town the congressman Castro and I wrote you about this back in on February the 13th despite numerous calls requests it's been difficult to get any answer about the specifics on that though my staff advises that finally in the midst of this hearing some message came through from you about that our localities even considering trying to put people in recreational vehicles to keep them separate if they have the corona virus in full the city of San Antonio has not received any reimbursement for these matters to date it's unclear to me whether the administration has in place a plan to send extra reimbursement to localities faced with a problem the ineptness with which the administration has approached this problem is not only serious it can be deadly if not changed in the approach thank the gentleman let me recognize the gentlelady from Indiana mr.

pilarsky to inquire Thank You mr. chairman Thank You secretary azar good to see you who's your face in front of this committee before I ask my question I just want to correct the record here to my good friend down there mr. Pascrell I've not seen or heard anything I've not seen any evidence that any senior official is lying about what's happening with corona virus so I would like to say that you know I think we need to be very factual when we talk about this and I think you have been secretary a czar I think it's a parent for the American people to know that this is Priority One at the administration I've not seen any evidence that there's anybody lying about what's happening with coronavirus but I just want to proceed by saying ten years ago Democrats rammed Obamacare through the Congress based on the slogan if you like your plan you can keep it if you like your doctor you'll be able to keep your doctor that slogan of course turned out to be a lie in fact it was rated as PolitiFact's lie of the year in 2013 fast forward to today in a majority of House Democrats have co-sponsored HR 1380 for the Medicare for All Act which would virtually outlaw all private insurance plans all the coverage enforce every American into a one-size-fits-all government plan so in just 10 years we went from if you like your plan you can keep it to if you like your plan too bad it's gone what a difference a decade makes contrary to what my colleagues on the other side of the aisle might say Americans do like their private insurance a recent Gallup poll found that 71% of Americans rate their private coverage as excellent or good the American people and the hard-working Hoosiers that I represent want that health insurance that they like they don't want that health insurance taken away and replaced with a massive new government program especially one that would require massive new taxes on workers and families secretary a czar can you talk about the financial impact for Medicare for all and what kind of impact it has potentially on seniors and middle-class Americans that I serve in Indiana second District it would be absolutely devastating we've got 180 million Americans who get their insurance through their employer or their more importantly their Union their insurance would be taken away collective bargaining rights that they have given up in exchange for insurance would be taken away without compensation and wages for 60 million seniors in Medicare a third of them depend on private insurance Medicare Advantage the ever more popular private option with added often dental vision benefits and pharmacy benefits for them taken away as part of this it would be devastating for America's seniors and let me ask you this the rising rate of maternal mortality across the country is something I've been extremely concerned about and I'm glad to see the Trump administration is actually tackling this head on your budget describes the improving maternal health in America initiative aimed at improving maternal health outcomes through evidence-based programs how do you see the maternal infant and early childhood home visiting program fitting into the department's maternal health initiative so that program gives pregnant women and families particularly those considered at risk necessary resources and skills to raise children who are physically socially and emotionally healthy and ready to learn so it's a very important part of our maternal health initiative I appreciate your efforts and let me just quickly bring to your attention here the administration's proposal to strengthen TANF focuses on work and families and direct from a direct alignment with the Republicans job for 6xs Act are you worried about a lack of accountability in TANF I absolutely I'm worried about the lack of accountability in TANF we've got dozens of states that are basically achieving their work participation rates without contribution to it it has been perverted from the original meaning of TANF which is to get people to work get them trained we've got to create real accountability again I appreciate it mr. Chairman I yield back back to gentlelady let me recognize the gentleman from Illinois mr. Davis to inquire Thank You mr.

chairman mr. secretary thank you for being here today and thank you for your testimony in January of 2019 you granted South Carolina a waiver of federal anti-discrimination regulations to allow mirror to heal ministries to reject Jews Catholics persons of other faiths non-religious persons and LGBTQ individuals from being members to are caretakers of foster youth stated mission of administration for children and families is to promote the well-being of vulnerable children and families and the directive of the children's viewer is to act in the best interests of the children in its care the crux of the wave of prioritizes the religious beliefs of an organization over the best interests of abused and neglected children contrary to the stated mission of the administration for children and families as Secretary your position is that it is acceptable form erica hill to use Health and Human Services provided funds to reject Jews Catholics persons of other faiths non-religious persons and LGBTQ individuals from being mentors to are caretakers of foster youth correct so first to clarify the Coalition for Jewish values as well as the Roman Catholic Diocese of Charleston are supportive of the approach we've taken which is that that we have to support the prompt placement of children and loving homes according to the best interest of the child and we need as many providers faith-based and non faithful to participate though they not be in the business of kicking out faith-based providers who are the backbone of so much of our foster care placement oh the answer is correct I'm your question isn't it is not an appropriate question it is the state you stated it as if we are as if we are encouraging that we are encouraging more providers not fewer providers because the priority is kids getting placed not who the providers are LMS as the chair of the subcommittee jurisdiction over programs critical to helping families and children in need this budget is deeply disturbing and destructive to the health of the most vulnerable members our nation at a time when the Republicans gave windfalls to the wealthiest corporations and individuals this budget slashes 200 billion dollars from Medicaid and the Children's Health Program cuts childcare assistance to working families takes nearly 2 billion dollars from the Temporary Assistance for Needy Families program our TANF eliminates the social service Block Grant undermines Adult Protective Services Meals on Wheels substance abuse programs programs in rural areas and mentoring could you assure that these cuts are not going to negatively impact or take away services from the most most vulnerable members of our society so to achieve our budget targets and the overall administration caps agreed with Congress we had to make some very difficult choices and we have to eliminate programs that are less effective invest in priority areas and support mostly those that provide direct services to individuals is your microphone on Dan so the answers we're cutting programs that are vital to the well-being of these vulnerable populations because we had to make some tough hard choices we're removing programs that are ineffective that are that have not proven results and also focusing on those that most deliver direct services instead of those that provide infrastructure support Thank You mr. chairman are you thank the gentleman after we recognize mr. LaHood we will then proceed with committee practice and we'll recognize on a 2 to 1 ratio members on the Democratic side gentleman from Illinois mr. LaHood is recognized Thank You mr.

chairman and mr. secretary welcome the country in our health care system is well served by your leadership I know you testified yesterday for almost seven hours you did the press conference last night and you're here today for three or four hours so thank you I just want to I want to talk about rural health care but before I do that I listened to mr. Doggett's comments and he must have watched a different press conference than I watched last night because I objectively watched that entire press conference and I think it couldn't have been more reassuring to the country the team of physicians researchers medical personnel that were put in place by this administration and under your leadership gave confidence to the country I know he mentioned talked a little bit about community spread I wonder if you could just comment on that for a second thank you because I do think that exchange could unnecessarily worry the American public when we say when the CDC says I say the president says that it is quite likely that we will see more cases and quite likely we will see communities spread that could be in one town a locality it could be in a neighborhood it could also be nationwide we say could could could we have to prepare for all eventualities and we have to educate the public about the potential for eventualities that does not mean they will happen it means we responsible stewards of prepare for them we have this fifteenth case in California that could be a potential first community spread in the United States we have to now do the epidemiology behind that we have been consistent from day one about this messaging across all levels of the government thank you for that thank you for clarifying that and I enjoyed hearing your comments at the beginning on your rural health care task force and putting the governor in charge of that appreciate that I am concerned about rural health care I have a district 19 counties I border Iowa and Missouri and very interested in this subject and I know as part of your four-part strategy to transform rural healthcare increasing rural access to healthcare as a priority in Illinois over the last five years frequent mental distress has increased by 14 percent in suicide now is the third leading cause of death for people ages 15 to 35 in Illinois health care providers in my district are focused on the need for increased behavioral health and mental illness services to address these troubling statistics and while there are many examples of innovative health approaches in my district I just want to point out one unitypoint health in Peoria Illinois is working on solutions to help broaden access to behavioral health providers through community organization partnerships they recently started a nonprofit organization called unity place that will work to better understand the unique mental health needs of rural communities in my district and how to transform our behavioral health system to ensure better delivery for these necessary health systems and services I wonder if you could discuss some of the successes you've seen from some of the programs and how the department plans to expand access to programs like the behavioral health workforce education and training program and the zero suicide initiatives absolutely and as you said we need better behavioral health and mental health care in rural America as well as all America we've got to have a sustainable business model they've got a work that they're economically viable we've got to make sure that we're focused on key activities like suicidality mental health prevention health promotion and then third we have to use telehealth so telehealth can be an important part of behavioral health delivery in rural America and of using technology and innovation and fourth we've got to get the next generation of providers whether nurse practitioners or or primary care or pas and let people practice to the maximum of their license especially in rural America we look forward to working with you on that Thank You mr. secretary thank the gentlemen let me recognize the gentlelady from California miss Sanchez Thank You mr. chairman and thank you mr.

secretary for being here I'm gonna be really honest with you the budgets that have come out of this administration in each year have been truly upsetting and the budget this year is no different I said this before and I'm gonna say it again that I think the president's budgets are out of touch with the needs and the concerns of everyday Americans once again the administration is putting the well-being of the ultra wealthy and corporations over that of hard-working American families and the people that I represent in here from everyday would suffer greatly under the devastating cuts that are in his budget proposal mr. secretary could you clarify if the administration thinks that children and adults should go hungry and a simple yes-or-no answer will do so the administration is fully funded in line with what the Congress did previously the headstart program the childhood question that I asked you is whether or not he's gonna set children an adult should go hungry because this administration's budget is cutting a hundred and eighty-one billion dollars from snap over the next 10 years there's also a 500 million dollar cut to the supplemental nutrition program for women infants and children otherwise known as WIC and in 2016 41% of WIC participants were Latino so the administration through these devastating cuts is actively making it harder for millions of Americans to receive receive help with something as simple as putting food on the table and I might remind you that one in every five snap recipients is a military family at that I'm not sure what your values are but back in the district that I represent we don't believe in letting kids go hungry or those that are in need go hungry a country as great and as rich as the United States of America should not see food insecurity among its population and slashing the budgets of vital programs that provide basic necessities to human beings in this country those programs should not be on the on the chopping block but I guess I shouldn't be surprised though because this is the same administration that puts children in cages so I could see how food might not be a priority for them where I come from people's actions are worth a lot more than what they say than what their lip service is President Trump in his State of the Union address said and I'm quoting him directly I've also made an ironclad pledge to American families we will always protect patients with pre-existing conditions and we will always protect your Medicare does president Trump's budget protect patients with pre-existing conditions people who have cancer or diabetes it absolutely does and will ensure the protection against pre-existing conditions the problem is the Affordable Care doesn't actually do what it says it does I'm gonna stop you right there because the president budget doesn't protect seniors or people with disabilities on Medicare it's fascinating that the president's vision for health care requires a eight hundred and forty four billion dollar cut to health care I'm gonna say that again eight hundred and forty four billion dollar cut to health care again actions speak louder louder than his empty words if he wants to protect people with pre-existing conditions why is this administration arguing in favor of a lawsuit that would do the exact opposite and that's take away protections for people with pre-existing conditions my district has over 300,000 non elderly people with a preexisting condition why is he trying to mess with their healthcare these sabotage attempts to our health care system and our immigration system are hurting and scaring millions from getting much-needed medical care so as much as you want to stand up here and defend the president this administration has made it more than clear on where they stand with the American public this budget is not fair for hardworking families in my district or for families across this nation and nothing that you can say reverses what the actions show Thank You mr. chairman gentleman recognize the gentleman from New York mr. Higgins to inquire Thank You mr. chairman mr.

secretary on Monday January 13th of this year President Trump in a tweet said and I quote that I was the person who saved pre-existing conditions in your health care end of quote how did he do that the president is going to ensure that any health care reforms protect pre-existing conditions unlike the Affordable Care Act where a 55 year old couple in Missouri making $70,000 a year and are unsubsidized would pay over $30,000 a year in premiums and have a deductible of over $12,000 that's a meaningless insurance card that's not actual protection of pre-existing conditions he's the one committed to actually doing that if Congress will work with and concurrently is trying to invalidate the only law that exists that protects people with pre-existing conditions so in other words before the enactment of the Affordable Care Act an insurance company could deny you coverage if you had a kid who was stuck with childhood cancer you can't do that anymore it's against the law there are a number of pre-existing conditions whereby an insurance company could jerk you around just because you were born into a predisposition a pre disposition chiu a pre-existing condition or a chronic illness there's a there was a lawsuit in the Fifth Circuit Court of Appeals challenging the constitutional constitutionality of the Affordable Care Act the only law the only law that protects people with pre-existing conditions and it was July of 2019 it was called Texas versus a czar that's you and there was a suit brought by 18 state attorneys general and endorsed by the administration to invalidate the individual mandate and thus the entire Affordable Care Act again the only law the only law in the books that protects people with pre-existing conditions how do you reconcile that first that's actually a false statement ERISA protects individuals with pre-existing conditions 180 million individuals who have insurance from the private-sector employers as well as well as their unions Medicare protects for 60 million Americans individuals with pre-existing conditions Medicaid protects individuals with pre-existing conditions and in the Affordable Care Act litigation this is a litigation position not a policy position and the president has made it clear that he will veto any piece of legislation that doesn't insure in the individual market actual effective and real Mr Justice Secretary Clinton back my time the replacement to the Affordable Care act that Congress tried to repeal and was defeated in the Senate had a provision as it relates to pre-existing conditions and that provision said that an insurance company could not deny someone coverage for a pre-existing condition but the coverage didn't have to include the treatment for the pre-existing condition that is fact and that is cynical and here's my concern with respect to what we're dealing with now well the flow in corvid 19 which is a disease caused by the corona virus may not be pre-existing conditions those with pre-existing conditions asthma chronic congestive heart failure young kids under the age of five the elderly are at greater risk because of their pre-existing conditions to become much worse triggered by this flu there were this Co vid 19 that we're dealing with and it is very clear to me and anybody that looks at this based on fact that the only law that exists that protects people with pre-existing conditions is the Affordable Care Act and you're trying to destroy that I yield back thank the gentleman let me recognize the gentleman from Ohio dr. winstram to inquire well thank you very much mr. chairman mr. secretary thank you for being here let me just lay the recent conversation one in the bill that we passed in the House of Representatives we were giving states the opportunity for a waiver if they had a high-risk or pre-existing condition program that actually functioned better than the federal program that was the purpose of that but also let me go again to the budget Medicare gets another 20 of the President's budget Medicare gets in 25 years of life under this budget and Medicaid grows year over year let me point out that this is there's more than one body in this government that we have and budgets aren't law they're a template and you can rant all you want but I find it interesting to complain about the President's budget when that there is no House budget present your house budget and that's what drives the conversation so I would be hesitant to be too critical of the President's budget if you don't have one yourself to make the recommendations it's easy to criticize but it's better if you have your own solutions mr. secretary I'm glad to see you here and and that you're gonna focus on rural health care that's very important to me as you are probably aware we have a nice bipartisan task force with representative Sewell Davis Arrington and and me we want to address workforce shortages reimbursement and payment schedules to have some flexibility especially for rural areas digital and telehealth and what we've come to call the social determinants of health which I know are valuable and important to you that we had it's that we address those issues another focus that I have in particular too is on Graduate Medical Education we can talk about health care all we want if we're not graduating enough physicians and we don't have residency programs for them none of this really makes much difference does it so I think that that's one of the things that I would like to work with the administration on along with these these priorities for rural health which I know are priorities of yours and you know we can do better residency programs in rural areas a lot of times people stay where they train that's very common in in medicine as we both know so how can the task force here on ways and means coordinate efforts with HHS to to really serve our rural communities better so we'd love to work together on improving rural health one of the ideas you just mentioned around Graduate Medical Education is in the budget which would merge Medicare Medicaid and Children's Graduate Medical Education take it off the books for Medicare put it on general tax revenue which is where it should be and allow flexibility so we get out of the structures that were frozen in place in the 90s and allow people to have GME in rural America have primary care psychiatrists that to have that flexibility to meet our underserved needs right now yeah I agree then it's not just rural we have urban underserved areas that would benefit from the same type of approach my district is southern Ohio as you're well aware that's great zero for our drug problem it's not just opioids heroin etcetera meth on and on can you tell me about the additional flexibility in the President's budget that would allow us to use tools at our disposal especially locally to fight the broader substance abuse epidemic absolutely so actually was I was delighted last year when Congress added to the state of hood response grant program the ability for states to use money for methamphetamine and other stimulants because in States and I know I've spoken with the governor in Ohio in some states methamphetamine is becoming more of an issue than then even opioids in some states that's always been we've got we've got 15 of the 36 states that report overdose deaths by drug type meth use was responsible for more deaths than synthetic opioids like fentanyl so that flexibility is critical for our state's well thank you my time is up I look forward to working with you and your team and with my colleagues from across the aisle thank the gentleman let me recognize the gentlelady from Alabama miss sue to inquire Thank You mr.

chairman mr. secretary in my Alabama district were always fortunate to get through each month without a hospital closure I found out yesterday that we would not be so fortunate this month as one of my rural hospitals is going under without finances to pay their staff one of our hospitals is set to close next week when it closes almost 150 people will do without a job and over 20,000 residents will lose their only hospital leaving them to we've to have to dry within an hour to get to another hospital sir I have a letter that I'll present to you at the end of the today asking for your emergency assistance and trying to keep this rural hospital open you know the stakes are high and I know that they're high and I know that this administration wants to focus on that but I saw that in the budget this year that there's a proposed cut to dish payments these disproportionate payments go for indigent care and I'm quite concerned that in addition to having a budget that doesn't reflect I think an emphasis on providing the health care needed especially for those indigent in rural America I was glad to hear that you are setting up a rural health initiative as dr. Woodruff said our Chairman chairman Neill set up a underserved and rural healthcare task force it's a bipartisan task force of which I'm co-chair along with dr. Winthrop mr. Arrington and mr.

Davis so we look forward to working with you and I think one of the things that we need to start working on is the fact that these dish payments which are so critically important for indigent care especially in rural America that we save those I saw in the President's budget that he wants to accelerate the cut of these dish payments to this May and what would happen is that the President's budget would cause a four billion dollar cut in FY 2020 and an eight billion dollar cut each year 2021 to 2025 this was not good for Alabama it's certainly not good for rural America sir my constituents and the health care providers in my district can't stand another cut and I look forward to working with you as well as with this rule task force that we've set up to try to address that I'd like to now turn to CMS administrator's proposal the CMS administrator called for a proposal in Medicaid fiscal accountability it is causing a lot of angst in Alabama and three of our major hospitals the CEOs have asked for the proposal to be withdrawn health care in Alabama would be decimated by this proposal it's a the CMS as administrators proposal is called the Medicaid fiscal accountability and mr. chairman I'd like to submit for the record the CEOs of three of our major hospitals in Alabama that's Children's Hospital of Alabama you of UAB as well as ascension or st. Vincent's hug a CMS post suggested that the comment letters like the letters I am going to submit were alarmist estimates about the rules impact on beneficiary access as being overblown I assure you mr. secretary that the fact that the CMS administrator is now this rule would change the way the imbalance the that we currently have between state and federal funding and it does so without having an analysis I'd like for your assurance that we would work with CMS to try to get either this rule withdrawn or actually have a adequate analysis of how this state and federal funding imbalance would occur and how it would impact beneficiaries in Alabama have you do you have any thoughts about this proposal I've been you work with us to try to make sure on that proposed regulation I've obviously been hearing a great deal from states and hospitals and we want to work with them on this yes thank you sir Thank You mr. chairman thank the gentlelady and the secretary I talked about that a couple of days ago as well thank you with that let me recognize the gentlelady from Washington State mr.

Bennie to inquire Thank You mr. chairman and thank you mr. secretary for being with us today I think you said earlier that we're in active containment mode when it comes to the corona virus and I know there's work happening on a vaccine and other medical countermeasures but right now I assume you'd agree that we're dependent on the ability of public health departments to identify quarantine and monitor those at risk of contacting the corona virus and that it's really state and local public health that are gonna do the lion's share of that work they're absolutely the backbone and in fact the state of Washington and in King County have been as always tremendous partners in public health measures and great wonderful to work with as we've been dealing with this thank you so after reviewing the supplemental request to address the corona virus there is light on details and in just a few weeks of managing the potential corona virus exposure in our state the Washington State Department of Health has spent over 1.7 million dollars I'm snohomish county in my district which had the first u.s. case of the corona virus they spent $200,000 just to manage and monitor individuals who came in contact with that one person and King County which you mentioned which is home to Seattle and the Tacoma International Airport which is doing screening now is spending fifty six thousand dollars a day to identify monitor and quarantine impossible possible patients so my question is can you give us a commitment that the administration is going to support backfilling state and local health departments for the work they're already doing on the corona virus as well as support them going forward so of course states are already receiving the 675 million dollar annual payment for the public health emergency preparedness I think Washington gets about 17 million dollars for that but the the supplemental proposal does in fact cover and want to and will work with Congress on what the appropriate amounts are we've got I think over 600 million in there for CDC but we'll work with you on if more is appropriate to support state and locals who are having to engage in added expense hiring contractors lab or contact tracing so there's no current mechanism for reimbursement like that but we'll work with you on what the appropriate mechanism in the sup would be for that in the zika supplemental back in 2016 they backfilled state and local public health departments did you know that site there's we're not opposed to doing that we'll happy to work with you as we work on a supplemental package of appropriate reimbursement for states if that's what Congress would like to do and that ended up being 44 million dollars to to those state and local governments this is critical these folks don't have lots of dollars to invest and so I think it's important that we backfill and I hope we have your commitment to do that the state and locals are the backbone of our public health response which is the core to everything we have to do here so I didn't get a yes there so I'm a little concerned but as I said we're in agreement we want to work on the Supplemental package to make sure the state and local governments are fully funded including if there's reimbursement needed we'll work with Congress if Congress wants to do that we're we're we want to make sure the needs are met okay also I just wanted to quickly ask you in the President's budget NIH has cut by 7 percent and given though there's been a bipartisan majority in the House to support increased funding for NIH because of the critical work they do and we've done that consistently now in fact this current fiscal year increase of two billion dollars and that would take that away how do you support making a supporting a decrease to NIH funding so Congress every year has been increasing the budget of NIH rates that of course exceed the growth of revenue for the United States it's 28% up since FY 2016 I believe Congress obviously will make the final decision on this I've got the largest non-defense discretionary budget if I've got a meet a 9% decrease NIH is the largest discretionary pocket of that obviously we know Congress will make different choices likely as they have Thank You mr. chairman let me recognize the gentleman from Texas mr.

Arrington to inquire Thank You mr. chairman and thank you mr. secretary for your leadership your good work to make our health care system more affordable to give greater access to maintain and even improve the quality of care I think you're doing a great job and I appreciate all your efforts your sense of urgency your commitment to taking on this very serious threat of the coronavirus I think I'm comforted that you're leveraging every tool and every resource public and private and my comment there is whatever we can do to help you please let us know and we're all in this together I represent hard-working farmers and ranchers that put the food on our tables and clothes on our backs and I'm proud to be their voice here I was with a good friend from my college days at Texas Tech Pat Green a famous Texas singer-songwriter one of his songs titled small-town family dream goes like this daddy was a farmer like his daddy was before it only seemed fitting I walked through the same door the only problem with it is too few of the next generation of farmers and ranchers are gonna walk through that door we don't do some very critical things with respect to sustainable health care now we got a farm bill Republicans led the effort but it was a bipartisan bill this president's working to hit Reese with China get fair and reciprocal trade relationships that put our producers first put America first we've reduced the tax burden we've removed some of the unfairness like with respect to the death tax people literally sell their family farms that are handed to them because they can't afford to pay the taxes we've reduced unnecessary and ridiculous regulations like the waters of the u.s. I could go on and on and I just appreciate all the good efforts but we have to give these young families that are going to be our Ag producers and provide the country with a safe affordable supply of food give us AG independence like energy independence strengthen our nation security that will only happen if they have access to basic care and you and I both know we've had great discussions and I appreciate your leadership in this effort in this area but half of the 2000 roughly rural community hospitals are operating at in that loss and and that's up 40% over the last three years so we're in a crisis mode we've lost over a hundred hospitals over the last several years a few of those are in my district I want to thank the Chairman and the ranking member for allowing me to be part of this leadership team this taskforce miss sue mr. Winthrop mr.

Davis we've met we're of one Accord and we are ready to tackle this and I believe our chairman and my colleagues on the Democrat side are going to solve this and we're not gonna let this get bogged down in the petty politics of this place we're gonna do something to give these guys some breathing room out there and we talked about telemedicine telehealth I ran a telehealth company where we were piping in specialty care to rural hospitals in Childress Texas it was saving lives and I appreciate your efforts around that I was reading about the virtual payment virtual care the payment code that you're changing to encourage and leverage technology revised the Medicare wage index so that we have greater fairness in low wage communities just want to say thank you and I'm wait to get to a place where we have that solution and we get it across both sides of the aisle both chambers and to the president so that we can give rural America a fighting chance to continue to bless this nation thank you thank you gentlemen let me recognize the gentlelady from California miss Chu to inquire secretary azar I would like to discuss how rumors and misinformation about the ongoing outbreak of corona virus is impacting Asian Americans throughout the country as a representative of a district with one of the highest Chinese American populations in the country in Los Angeles I believe it's our responsibility as public officials to stem misinformation and reassure our constituents not stoke fear in resentment this is critical because we've already seen examples of xenophobia directed at Asian Americans in this country a woman on the subway in New York City was attacked by someone calling her vile names because she wore a face mask in Indiana two Hmong guests checking in a hotel we're told that Asians were not welcome and in California a 16 year old high school student a boy was sent to the emergency room after being attacked at school by bullies who accused him of having the corona virus simply because of his ethnicity even just looking Asian has been enough to incite attackers to hurl insults and accuse the individuals of being disease carriers so yesterday I sent a Dear Colleague letter to my colleagues in the House and Senate urging them to refrain from repeating unfounded conspiracy theories and instead to commit to only sharing verifiable information from reliable sources like the CDC and local public health agencies secretary a czar as recently as Tuesday you referred to kovat 19 as the China corona virus which a reporter pointed out could further fuel these racist incidents secretaries are I've been listening to carefully all morning and I commend you because you have been using only the term corona virus and chyna coronavirus i thank you for that will you commit today to no longer referring to the virus by region but by the term coronavirus or the designated official name kovat 19 and yes or no is it sufficient yes I took that feedback to heart from that reporter absolutely it was a shorthand just for easy understanding it was not intended but you're absolutely right we must ensure nobody's discriminated against based on ethnicity ethnicity is not what causes the novel coronavirus in fact will you affirm that racial stereotyping is not an effective way to prevent the spread of kovat 19 that is absolutely correct thank you so much for that secretary is our another yes or no question on January 24th your Office of Civil Rights issued a Notice of Violation to my state of California erroneously claiming that California is in violation of the weld and amendment because we ensure that all healthcare coverage offers the full range of reproductive health care including abortion what's worse in this notice OCA OCR threatens to rescind hundreds of billions in federal funding for California but does not specify where this funding will come from secretary azar well this funding HHS is threatening to take from California come out of our CDC emergency preparedness funds to help combat the spread of corona virus again yes or no the state of California has refused to bring itself into compliance and I've referred that to our lawyers to look at what appropriate penalties would be that we would act upon but they should be proportionate and related to the nature of the program involved then I want to ask secretaries are again yes or no were you aware that there was a 2016 determination by the Office of Civil Rights that determined that California was in compliance with the Weldon amendment and that nothing has changed since then in California's approach yes or no I believe there was different leadership coming to that conclusion we believe it's a black-and-white straight answer of straight violation of the law black and white violation of law to force nuns to buy abortion coverage when the statute the Weldon amendment this Congress passed says you may not force an insurer or a plan sponsor to pay for abortion coverage for any reason I yield back let me recognize the gentlelady from Wisconsin Miss Moore to inquire well thank you so much mr. chairman and it's really four minutes certainly is not enough to cover all of the budgetary questions so I'll try to get through this as fast as possible thank you for a period mr. secretary the budget proposes to cut over the over the budget window 21 billion for Medicaid transportation and I guess a lot of arguments could be made for dynamic stores boring don't you think that missed appointments for cancer treatments dialysis people who have high blood pressure would increase the morbidity rate and thus really increase the costs of health care so the Medicaid transportation proposal would be to make that an optional benefit and that has been a source of tremendous fraud and abuse and so it would make it there's no evidence that there's a lot of fraud and abuse in the program I beg to disagree we believe there is evidence of the misuse of the program we will agree to disagree since I only have four minutes the Medicaid fiscal accountability rule which really changes the ability for states to to meet their maintenance of effort in various ways this will tremendously reduce the ability of states to meet their their commitment to Medicaid to what extent does the budget account for that and continue to provide Medicaid Services and needy populations so I don't know if the reform to the state intergovernmental transfers in the EM far proposed regulation is actually built into the administration the administrative budget there but I've told the chairman that I am hearing very clearly through this process the feedback of states and hospitals we're gonna take that feedback to heart as we look at thank you for taking the feedback because it's really necessary let me talk a little bit about the ten of proposals there's a slight increase in child care thank you for that but you also cut the social services Block Grant you zero out the health opportune he's a health worker opportunity program which might enable some welfare recipients to get meaningful employment how do you in this is a program that was stuck at 1994 levels so how do you justify a cut in welfare when we continue to see people the growing need and especially for child care actually in terms of TANF given the blooming economy the historic on a low unemployment rates we should see and are seeing a decline in rolls of well what we're kicking people officer well what I my question specifically is you're reducing opportunities for people to in fact get economic opportunities by zeroing out they the health worker training program somewhere where you know welfare recipients might logically go also child care by cutting out the social services Block Grant funds reducing TANF funding you're increasing the burden of by definition these are women with children to be able to receive child care even with that small uptick of child care funding it will tremendously reduce the ability for states to provide child care what's the what's the reasoning behind this sir we this has been a major investment area for us we actually proposed a 1.3 billion dollar increase in child care including a billion dollar mandatory investment but innovate ever has the child care pot been big enough they've always combined it with TANF funds with supplementary funds with social services black refers and you're cutting those other things do you understand my point I understand your point but the social services Block Grant is one that doesn't have discernible outcomes ghost' for it goes for basically it was elderly people it has indiscernible outcomes in our communities and I know you're glad my time is up thank the gentlelady let me recognize the gentleman from Georgia dr. Ferguson to inquire you mr. chairman mr.

secretary thank you for for being here first off I want to thank you for your service to America in this position it is an enormous branch of the federal government and I know it is an extreme challenge to manage all the moving parts though so thank you so much for your efforts there um I'd like to start with a couple of questions on antimicrobial resistance I think this is a good time to talk about giving what we've seen public health crisis that the potential health crisis that we have with dealing with the coronavirus it as you know the antimicrobial resistance letter that I on several of my caucus colleagues sent earlier this week in your where I hope that you're aware that that that came from us but this issue is critically important and now giving the fact that we have more emerging threats of Public Health it is it's going to be an important issue in the future as you're aware the letter focused on the marketplace challenges that are hindering the development of new antibiotics and I kind of want to get your thoughts along along those lines I also want you to comment on the challenges with the creation of new antibiotics to fight the superbugs you know how how are we gonna meet that demand can we do that domestically I think we've seen some exposure here that so much of our pharmaceutical pipeline is now comes from China and we've seen what happens there can you can you speak a little bit to that very quickly I've got another question but if you can if you could speak to that I would appreciate it absolutely so scientifically and technically we can and are making advances so Bardo which is funding development of antibiotics we have 16 novel antibiotic projects we've got 38 projects in car back from total of 54 our current portfolio we've dragged three new antibiotics across the finish line with FDA approval the bigger challenge is not scientific its market based and effectively we it looks like we're facing a market failure problem because we're asking companies and us to develop a antibiotic but then to use it sparingly which is not sustainable business model so I've asked my team want to work with you all how do we think about this maybe in the countermeasures approach of government government backing etc for a market failure situation so with that in mind would you be willing to continue to work with Congress to develop solutions to this problem absolute vital that we do so ok mr. chairman if I could if I could enter in the letter that we so ordered and also there's a there's a recent op-ed that was in The Washington Times that highlight says if I ordered if I could enter that as well and finally mr. secretary you know in talking about eliminating ineffective programs I believe the administration's budget does not propose reauthorizing the the health professional opportunity grants and correctly asserts that the program is duplicative of 4747 other training programs of that the federal government operates in addition it's been it's been shown to be completely ineffective at improving work outcomes in a recent long term evaluation analyzed impacts on participants using a three-year randomized trial and the evaluation confirmed that the program had no impact on employment or earnings and did not decrease the individual's public assistance use last year one of every one of my colleagues on the other side of the aisle voted to expand this program over 500% it's baffling to me that we continue to fund ineffective programs that wasting government taxpayer dollars and really if folks really cared about helping families and their poverty they would spend more time making sure the federal dollars go to those programs that actually work most importantly the best way out of out of poverty is a job and being prepared for those jobs and we need to have the most effective training layers so with that I will yield back but thank you the gentlemen let me recognize the gentleman from Michigan mr. Kildee to inquire Thank You mr. chairman and thank you mr.

secretary for for being here and in just a time if I could just we want I assume you have some awareness of the Flint Michigan water crisis generally aware of this yes of course eration there thank you I want to address that I was pleasantly surprised to see that the CDC's fiscal year 21 budget highlights the really good work done by dr. mona hanna-attisha and her team at the flint LED registry in response to the water crisis and if I could just read directly from the CDC's budget document quote CDC worked with local health departments to connect more than 90% of the children with elevated lead levels to follow-up services Medicaid expansion increased access to screening health care education and social services for affected children in the Flint community CDC support has enabled Michigan State University to implement an innovative one-of-a-kind lead exposure registry creating the model for the nation's first lead free city unquote so this budget document also correctly states that lead exposure harms a child's health we all know there's no safe level of lead it can affect growth and development hearing speech IQ academic achievement and behavior and we are really seeing this in terms of behavior so even though my hometown of Flint has made progress since the water crisis lead poisoning is still a problem for Flint's children and families and we'll be grappling with this for a long time Congress authorized the Flint LED registry in a bipartisan effort through my legislation which was signed into law in late 2016 and I'm now working with my colleagues on both sides of the aisle to reauthorize this program we do these things in five-year bites and we need to get it reauthorized so my first question is a simple one and that is whether of the Trump administration who obviously views this work as important and successful will commit to work with us to reauthorize the Flint lead registry we'll be happy to work with you on that I can't of course a statement of administration position but well it's a critical public health priority that we'll work with you on absolutely thank you I'm also pleased to note that the administration in this document hi the critical importance of Flint's Medicaid expansion waiver which was very much a part of the response to the lead crisis the expansion also expires next year and my office has been working with the state of Michigan and with officials in the city of Flint to get the expansion extended it was planned to be extended at the time that it was initiated but as we know these these waivers have a life span to them so secretaries secretary is I think more importantly because this does fall clearly within your jurisdiction and authority can I get a commitment from you to work with Michigan officials my office and with people representing the city of flint to to extend this expand the waiver and extend it so that children can continue to receive the critical services that the highly successful led registry makes them [Music] eligible for so I I don't have the details on that waiver but we'll be happy to work with you and the state to I'll check with the CMS administrator and see if there any issues and beef should happy to work with you on that thank you I will note that this is important this is the most important priority for me in terms of the work of your department at this moment and I want to make sure that we can continue to do this work and I am concerned that in an era where it appears that there's a there's a desire on the part of the administration to reduce expenditures in the in Medicaid that these very important programs will be difficult to continue and I just hope that we can reconcile those two I thank the gentleman let me recognize the gentleman from Pennsylvania mr. Boyle to inquire thank you first I would like to highlight serious concerns about a recently proposed change to Medicaid your Medicaid fiscal accountability rule I'm leading a bipartisan letter with my ways and means colleague from the other side of the diet of Kelly the dives into the impact this proposed rule would have on health care for some of the most vulnerable Pennsylvanians mostly children seen and low-income individuals seeing is the administration admitted to not knowing what the impact of this rule will be we are asking again on a bipartisan basis to work with all we're asking for you and this administration to work with all the stakeholders to ensure that this proposal does not place an insurmountable burden on our hospitals networks and providers now in the interest of the the brief amount of time I have I'll let our letter speak to the specifics but I just wanted for today to bring this letter to your attention and I look forward to your response second I did want to ask you about the the coronavirus happening literally at the same time as draconian cuts are being proposed by your administration's budget specifically I'm referencing the budget proposal to cut the Centers for Disease Control by 16% is it appropriate to stand by a 16 percent cut to CDC at the same time we are facing a unique worldwide health crisis so the changes at CDC are actually to chronic disease and prevention programs the increases we actually have a hundred and thirty five million dollar proposed increase on infectious disease global health security and preparedness so we already had in there increases and then of course the emergency supplemental undoubtedly there will be significant funding going to CDC well and what we're also seeing though is a certain to use a phrase robbing Peter to pay Paul in terms of directing some of this increased funding that you're shifting but in the interest of time let me just delve into another point of our response and coronavirus at a time like this making sure that the people can trust what government officials are saying is really paramount and we've seen that in in previous crises so I was concerned just yesterday the president called a press conference and he referred to only 15 cases of Crona virus and the CDC has confirmed that it's 60 the president said that Americans are not at risk to contract the disease but literally the same day the CDC confirmed that an American living in Northern California contracted the disease without traveling outside the us were apparently coming in contact with another patient - known to have the infection so I asked you who should Americans trust the President or the CDC your statements misrepresent what the president said he said they're 15 as I did in my opening statement there are 15 cases from individuals in the United States who traveled to Wuhan or their spouses there are 45 additional cases from individuals we repatriated from Wuhan or from the diamond princes and that's exactly what the president said that's our data that's the CDC's data and let me just reclaiming my time thank you and since I only have under a minute I do just want to reiterate something that went into at length a couple weeks ago when the OMB director was in front of the Budget Committee and focused at length on the scale of the proposed cuts to Medicare and Medicaid so I just want to briefly read into the record what not me but what the American Hospital Association has said about these this proposed 500 billion dollar cut from Medicare and 900 billion for Medicaid the eh-eh-eh-eh said quote this budget would result in hundreds of billions of dollars in cuts that sacrifice the health of the seniors the uninsured and low-income individuals we in Congress cannot allow these cuts from this administration to move forward I yield back I thank the gentleman let me recognize the gentleman from California mr. Nunez to inquire Thank You mr. chair as I follow-up to what I said yesterday and are trying to trade hearing I wanted to enter in the record piece from this morning's Wall Street Journal called Trump versus the coronavirus of note the author writes and I quote a medicare-for-all system in the US with minimal private hospitals or physicians would collapse beneath a real virus crisis Medicare for all would smother the public private infrastructure in the u.s.

that develops manufactures and distributes life-saving therapies for viruses or anything else unquote so ordered Thank You mr. there are several legislative proposals to address the high cost of prescription drugs some of them have no chance to be enacted into law like speaker Pelosi HR 3 which the president has already said he would veto however there is a broad bipartisan agreement that Medicare Part D needs to be reformed and modernized HR 9 the only bipartisan bicameral drug reform bill would cap seniors drug prices at no more than two hundred and fifty nine dollars per month that's real relief we can accomplish right now mr. secretary the administration's budget includes a Part D out-of-pocket cap and further policies to improve that benefit how are the Part D reforms in HR 19 consistent with the budget and how would it lower patient out-of-pocket costs thank you one quick clarification the case yesterday is unknown etymology but it is not from the repatriation as well to clarify that as to as to the HR 19 and Part D reform what we can do is limit seniors in out of pockets to no more than 3,100 dollars a year the first ever catastrophic cap on what people would pay seniors would pay for their drugs and we could allow them to opt into spreading that cap over the course of the year such that each month the senior would be guaranteed to never pay more than two hundred and fifty eight dollars a month for their drugs no matter what the cost of their drugs what a historic opportunity we have if we could just get our act together and work on a bipartisan bicameral basis to enact these reforms and bring that kind of savings to seniors from out your budget is matching up with the reforms in HR now that's consistent with the budget absolutely furthermore I mr. secretary we hear a lot of proposals that the federal government should step in and dictate drug prices to manufacturers when Congress created Medicare Part D it did so with the belief that private organizations which are already administering employer sponsored drug benefits could be used to administer a Medicare drug benefit and under Medicare Part D drug plans compete against each other to provide the lowest price to beneficiaries so I have one additional question do you think the government can negotiate a better deal than what the plans have been able to negotiate over the past 15 years as Peter Orszag who ran the Congressional Budget Office and OMB under in the Obama administration has made clear you can't get a better negotiation than these massive middlemen get unless you have a restricted formulary meaning unless the United States government for all seniors is willing to deny access to drugs and ration them to seniors you can't get a better deal then these middlemen do it's it's just it's basic economics they're not gonna hand you more money just because they like you thank you very much secretary and I know you have a real crisis on your hands and I want to be respectful of your time and with that I yield back the balance of my time I thank the gentleman let me recognize the gentleman from Pennsylvania mr. Evans to inquire thank you Thank You mr.

chairman mr. secretary I read over the mission statement the healthy human service mission of this department is to enhance the health and well-being of all Americans by providing for effective Health and Human Services fostering sound sustainable advances in science my understanding that's the mission statement but I want to talk about the healthcare environment back in my district and Philadelphia the city of brotherly love assist the affection now I know how many people don't notice the Philadelphia is the home of the nation's first hospital Pennsylvania Hospital it was founded by Ben Franklin in 1751 and was born I was born at the hospital a few years later since its founding Pennsylvania Hospital has become renowned for its innovation and patient care and treatment practice and medical research the city of Philadelphia has become one of the nation's most critical centers for health care health care research in the country and while we have seen so many growth and innovativeness in our city we've also seen my share of challenges over the last 20 years Philadelphia has experienced 20 Hospital 10 Hospital closures with the latest one being Harlem in hospital which made national news when the fire bankruptcy last summer when a hospital shudders his doors it does more and loss of a building it's the loss of hundreds if not thousands of jobs it's the loss of resources of patients families and have come to trust and rely on for generations somewhere for me they don't feel safe and for care if that loss of education is security for medical research it is either the increased burden on neighboring hospitals or the scrambling for patients to find new doctors who they have to travel far this is I've gone back home and they tell me I want my hospital back what is happening feel love it can happen anywhere Holloman is the canary in the coal mine the loss of this hospital in all the disruptions that came with it she served both as a warning and testimony to attention we must pay to this subject hospital closures are a lot of underlying issues and not you so I say to you mr. secretary that this is something that requires everybody the Congress and the executive branch of us working together there is no simple answer but the reason I read your mission statement is the budget inconsistent with your mission statement now I know you don't have full responsibility budget because there's the Budget Office but you make recommendations so taking your mission statement and taking what I read in the case Philadelphia but you can read anything throughout in your own judgment and maybe you will say it or maybe you will not see it but your mission statement and actually what you have heard please tell me that there's some inconsistency here with this statement we never have unlimited funds one could use that rationale for just unlimited expenditure on anything one has to pick programs that work and make sense I did want to say I want to thank you and I want to thank the chairman for arranging for the meeting that we're going to have to focus on hanaman hospital because you're right the hospitals are vital parts of our community whether in rural urban areas or underserved areas and your leadership has been very important there and I'm looking very much forward to our event together related to out of it I'd like to thank you and your staff along with the Chairman who came to the city of Philadelphia for having this discussion because it's not unique to where it all started in America keep reminding that to the chair me tells me Ben Franklin from the but the fact that matters we still do thank you I yield back mr. Ben Franklin of Massachusetts let me recognize the gentleman from Illinois mr. Schneider to inquire Thank You mr.

chair and Thank You secretaries are for coming before a committee today as you know my home state of Illinois had the second confirmed case of corona virus as well Chicago O'Hare directly adjacent to my district is one of us of the Select screening airports passengers for China that means that we have primary secondary and tertiary quarantine sites in and around my district these facts have sparked a fair degree of concern and worry among my constituents as it has across the country I am a strong believer in the axiom prepare for the worst hope for the best I wish I could with confidence simply ease my constituents fears by saying our administration is fully prepared and has the situation under control but right now I feel like saying so would be generously speaking a stretch of the truth the Trump's administration's response has been at best lethargic at worst and comprehensively short-sighted the budget you are presenting to our committee to committee today only stands further weaken the agencies like the CDC that are critical to the response to the corona virus outbreak on top of that the president in your department are requesting a mere two and a half billion in emergency funding you said it was a chess game to put in context how insufficient this funding is our Illinois state government projects a 15% decrease in GDP in the worst case scenario of a widespread outbreak that totals 231 billion dollars per year per month per year rather or ten point five billion dollars per month the state would need 1,000 state responders at the cost of seventy million dollars every 30 days Illinois alone will need 500,000 units of personal protective equipment gallons gloves mask face shields per month totaling 35 million dollars there and the cost of the current standard 14 days of quarantine including housing food medical support and law enforcement is estimated at 10,000 per individual that's just for one person these numbers are staggering and that is only one state representing a mere fraction of the national need you just said a few minutes ago that we need for all outcomes secre days are do you think the president in your agency's budget request is sufficient to be prepared for just the most likely let alone the worst-case scenario and if not to expect states communities and local hospitals will need to in fact be able to foot the rest of the bill so we do believe it is the appropriate response for the remaining months of 2020 but the president has made it very clear that we will work with Congress on a bipartisan bicameral basis to secure additional monies such the Congress sees fit I did want to mention it is not part of our doctrine for pandemic that we would be using mandatory institutional quarantine like we've dealt with in Chicago there that's unique circumstances of federal quarantine from these passengers coming in from out of the country in this active containment period so it would not be part of the expectation for Americans that you would see this - it would be home isolation is really much more the case in California is that person in quarantine whether because we are still at an active containment strategy which is to put people into mandatory mandatory quarantine at some point if we were in a mitigation mode people will stay at home just like with severe flu okay so um and just say good time my constituents in general would feel more confident if we were preparing to protect us against the worst case if we're asking for all the funding and never had to use it but you're not which is I believe unnecessarily putting our communities and our nation at risk when lives are at stake we also afternoon this may be the question you need to answer separately deal with the logistical issues like supply chain management with stockpiling we need to be dealing with today not tomorrow can you provide us with concrete examples of how the agency is preparing for shortages and supplies like gallons mass etc and what you've done so far what you plan to do in the future to make sure we have things placed where we need them when they need them as they need them so we're already using on the transfer and reprogramming money to do initiate contracts for gowns and as well as n95 masks and with the emergency supplemental funding that we hopefully will get we will acquire massively more amounts of that but we've started the seed contract so we can build on those quickly my time is up I yield back thank you gentlemen the gentleman from Texas Kansas I'm sorry mr. Estes is recognized Thank You mr. chairman and I wanna start with thanking secretary czar for being here I know it's a been a long morning already for you to work through this I no wonder under your leadership HHS has been refocused to address some of the major issues that impact many Americans including in my district and across across Kansas we've got to remain committed to protecting access to quality rural health care addressing the need for more transparency in our medical billing system and ensuring that we're helping families in need and I want to thank you for some of your policies that you put in a budget that would allow flexibility to combat substance abuse of any sign that it takes I know in our state methamphetamines still an issue as well as opioids and so wanting to ensure that the state opioid response grant program addresses all aspects of how to treat those those devastating addictions since last year I've been working closely with district attorneys and and health care providers in the state looking at how do we increase support against those addiction programs so I appreciate the support from the federal level and important that we make sure that we continue to make sure those federal resources get out to the states I do appreciate the minute the administration's collaboration with Congress and and want to continue to help improve our health care make sure that we keep prescription drug prices lower make sure we in surprise medical billing I also look forward to continuing all of this vital work with you I'm particularly here proud to hear about your announcement earlier today about former governor from Kansas Jeff Colyer to head up the HHS rural health initiatives our former governor and an a medical doctor Kansas know that dr. Collier is a dedicated to rural America and to patient well-being I can personally attest his qualifications and and know his that he's very fit for this initiative can you help talk through a little bit about how you want to make sure that there's a major focus on rural health care in America with this with this initiative absolutely so we really have four parts to our rural health care story which involves first we've got to get an economically sustainable model just as I was talking with congressman Evans about it's about we can't paper over facilities if the economic model doesn't work we've got to make them work so part of that was changing the way the wage index to redirect monies to rural hospitals but then how do we make them actually sustainable one of the budget proposals that I'm really excited about is to stop rural hospital closures is the critical access hospital plan that would let you switch to be an emergency room and outpatient and not have to be inpatient as well as get you supplemental payments to it to enhance that work so that for hospitals would be a great part of it so that's a part of it happy to go into more detail but I want to use up all your time okay great thank you because there are some different initiatives and and different hospitals that maybe have a different footprint in terms of how they were built and changes in the community over time and have had a major change I do want to follow up with one other one other comment well I still have some time is that we know you've been working a lot we've talked a lot this morning about the Cova 19 and and it's critical that those rural areas also have access to two protections against that and want to make sure that the funding gets out to that rural areas as well I mean maybe it needs to be as much as 25 percent or even more of the funding to help make sure that it covers those rural areas and not just the urban areas particularly I mean using it Tellem telemedicine being able to prepare for staff shortages being able to address overflows from some of the urban areas that are that are over critically hit in terms of when the crisis does hit so I don't know what if you've had some time to look through was you're working through this as what are you're looking at in terms of helping to make sure the rural hospitals and providers can help be part of this plan as we work together on an emergency sup on money that would go to states I think it's important that we make sure that gets out there because the states make so many decisions so it'll be quite eerie work on with you all thank you thank you thank you gentlemen let me recognize the gentleman from New York mr. sawasdee to inquire Thank You mr.

chairman Thank You mr. secretary for taking the time to be here today we appreciate it very much I'm gonna ask you to some very straightforward yes/no questions to try and just establish a clear record on certain things so mr. mr. secretary you're the former president of Eli Lilly USA is that correct yes that that's pretty clear mr. secretary is it true that Americans pay as much as four times as much for prescription drugs as people in other countries pay for the exact same drugs the numbers that we have in Medicare Part B would demonstrate about one point eight to two times what Europe and some Italy cz you could be much summonses is much higher it could depend on the drug but absolutely and that's why the president has made getting drug prices down such a critical priority Sarah are you aware that in January of 2016 candidate Trump said that Medicare could save hundreds of billions of dollars by negotiating drug prices with big pharma companies yes I am aware are you aware that the president in January of 2017 said of big pharma quote these guys are getting away with murder yes I am aware ease of them are you aware that in December the House of Representatives passed HR 3 the bipartisan drug costs now Act which would empower you as the secretary to negotiate lower drug prices on behalf of the American people I heard of that yes are you aware that the CBO the Congressional Budget Office estimates that just the negotiation aspect of HR 3 would save the federal government almost 500 billion dollars over the next decade it would also lead to dramatic reduction in new therapies for Alzheimer's cancer and understand that that's your position but do you know that the CBO says it'll save five hundred billion dollars I do okay has the Trump administration endorsed HR 3 no because we don't believe it can pass both chambers of Congress and understand we also don't believe it's it haven't endorsed it has the president endorsed any bill that allows the federal government to negotiate drug prices we have been supportive of the Grassley Wyden package which would have inflation have you endorsed that bill we are we have supportive of it as we're supportive of other options also that would be bipartisan and bicameral Thank You mr.

secretary are you aware that when a president Trump was running for president he tweeted quote I was the first and only potential GOP candidate to state that there will be no cuts to Social Security Medicare and Medicaid I'm worried though that are you aware that recently as this month he said quote he tweeted we will not be touching your Social Security or Medicare in the fiscal 2021 budget I don't remember that quote he did he did do that to see you know mr. chairman I asked that we have unanimous consent to insert into the record a statement from the American hospitals Association saying the following quote this budget would result in hundreds of billions of dollars of cuts that sacrifice the health of seniors the uninsured and low-income individuals soared thank you sir mr. secretary is it true that the budget proposal by the administration proposes to reduce Medicaid spending by 844 billion dollars over the next ten years through the allowance or the president's health reform vision we reduced the rate of growth from 5.4 percent per year to a 3.1 percent per year with growth in every single year of the budget period for the Medicaid program even with those changes is it true that the administration proposes to cut Medicare through reduced payments to hospitals for uncompensated care by eighty eight billion dollars over the next ten years we reduced the rate of growth of Medicare from 7.3 percent per year to 6.5 percent per year and extended the life of the program by over twenty five years mr. secretary is it true that your budget proposes to cut Medicare spending through reduced payments to on-campus on-campus hospital outpatient departments by 117 billion dollars over the next ten years we propose to require site neutral payments the hospital's can't game the system by where they locate providers and facilities and finally mr. secretary is it true that your budget proposes to cut Medicare spending through reduced payments for off-campus facilities that are hospital owned physician's office by 47 billion dollars over the next ten years again we do propose that we have site neutral payments so that you don't game the system by where you locate a facility Thank You mr.

secretary appreciate your time today thank you gentlemen let me recognize the gentleman from California mr. Panetta to inquire Thank You mr. chairman ranking member Brady appreciate both of you having this hearing secretary as her thanks for being here thank you for your service um last night's press conference press the president referenced a vaccine being rapidly developed a hearing earlier this week an administration official testified that one would be ready within 1.5 months you then today said three months where we add on that what is a timeline for actually being available to address kovat 19 plan I'm I'm sorry but you completely misrepresent what I said within three months I didn't I did not mean to do okay that's what I heard so no doctor foul she said within three months of the invention of the vaccine it would enter Phase one clinical trials within three months so that's that's what I referred to for the Acting Secretary of Homeland Security he wasn't he's not a doctor he was asked a question and said several months we were very clear last night doctor Falchi 12 8 12 to 18 months likely time for me to even that would be record speed for vaccine development understood understood in your role as secretary will you commit to us that any vaccine that is developed it developed will be provided at no cost are at a very low cost at least to the American public I've directed my teams that if we do any joint venture with a private enterprise that we're Co funding the research and development of the program that we would ensure that there's affordable access to the fruits of that whether vaccine or therapeutics and God forbid if a vaccine cannot be developed in a short period of time what's your public health strategy so our public health strategy is always based first and foremost on our state and local public health departments the blocking attacking of Public Health which is identify cases diagnose treat isolate and contact trace and that's where the emergency supplementals so important to make sure we have adequate funding out there to those frontline workers and frontline Public Health people moving on I you know obviously we're getting a lot of calls as you can tell our constituents are nervous and fearful not just because of this virus but I admit because of the way the administration is handling it and as you know one of the largest outbreaks of another virus HIV occurred in Indiana it was a result of critical testing sites title 10 clinics being closed through the cuts in state funding when it was determined that the cases were spiking due to needle sharing then governor pence failed to heed the advice of medical experts and really did slow walk the needed Public Health response now vice-president pence has been named to lead the nation's response to a virus experts know little about incubation period specific modes of transmission are short or long-term public health costs can you assure us mr. secretary that hhhh s will follow the advice of the nation's leading medical experts and not delay implementation of their recommendations so that the health of untold numbers of Americans aren't jeopardized I always follow the advice of my top public health career officials in these matters they these we we had them on stage last night these are the best people in the world and I I've known them for decades I've worked with them for decades I trust them completely and rep in a very proud to represent them ok thank you and in regards to how long the corona virus lasts on surfaces I mean we're hearing hours we're hearing over a week what is it how long does it last on we don't on a surface yeah we called that faux mite transmission we don't have firm data dr. Falchi is said if it's consistent with normal corona virus he would expect several hours but of course we do have other viruses that can last on surfaces longer we don't have study data on that yet okay and like influenza it is a corona virus affected by all change in the weather um normal the regular cold corona virus is affected by change of weather as is the flu that type of respiratory illness but SARS MERS for instance which are also modified corona viruses they do not seem to have the same impact of warm weather in terms of impeding the the transmissibility of it as a respiratory illness so we do not know with regard to the novel coronavirus is what will happen when we hit warmer seasons appreciate your candor thank you I yield back the gentleman let me recognize the gentleman from Texas mr.

Marsh on to inquire Thank You mr. chairman mr. secretary last November CMS proposed to Medicaid fiscal accountability regulation rmph are to improve accountability the Medicaid system we're very supportive of that job and very supportive of what you're trying to accomplish however our hospitals in texas are encountering some difficulty with the implementation of that and we would like to secure your commitment to sit down with them and see before the final policy is implemented see if you would be willing to sit down with them hear them out and either clarify our maintenance and we'll be happy to talk to them I've spoken with with many members senators about this issue especially with Texas we want to just make sure that we've got good integrity in the Medicaid system and we want to work with States in a productive way we don't we aren't looking for it to be penal we want to be prospective in our outlook and we want to even if they're if they're intergovernmental transfers that really are impermissible and not right work with states to restructure the funding so that it can be on a sound footing so that that's the intent of it and we want to work with States and if we go forward with the regulation so yes the regulation is not completely formulated you're not in a position to enforce it just yet oh no it's a proposal only it's only a proposal at this point so we're taking that feedback we're taking it to heart I'm hearing it quite vigorously today as I have throughout this week okay thank you very much and the other issue I'd like to discuss with you quickly is about home infusion and there's some confusion I know you've heard this from another the other committee in the House Energy and Commerce that Congress passed legislation and then the proposed implementation of it there is some concern among several congressmen I've got I've been working on legislation with some energy and commerce and I'm working on some legislation with Miss Sewell that there the congressional intent is not being followed can you comment on that so we certainly want to follow the language that Congress passed and I understand there's been concern about how the language was written we want to make sure that people can receive care in their home approp in the appropriate setting we believe in home based care and we actually implemented some temporary transitional payments for home infusion for 19 and 20 and finalized the permanent one we are trying as best we can to implement the congressional language passed but if Congress modifies that we will be very glad to implement also we've tried to come up with solutions to ensure adequate home-based infusion services thank you very much yield back Thank You mr. curry I want to compliment mr. Marshawn for the question on Medicaid if you can see talking to the ranking member and to talking to the others on the committee Ted this issue that Medicaid Waiver from Austin to Boston it's pretty consistent the apprehension that we all feel about that change so we take you at your word that you're going to give us ample time to review the proposal thank you absolutely we want to work with the we want to work with the committee this would be an important change and we want to make sure that if it happens if we do go forward with it and we're getting the comment on that that it's something that works for the system brings integrity but that doesn't bring undue harm to states or providers thank you let me recognize the gentleman from California mr.

Gomez to inquire Thank You mr. chairman mr. secretary thank you for being here I wanted to focus today on my concerns with administration's management of the note novel coronavirus including programs within this committees jurisdiction your overall supplemental funding request has been determined to be inadequate to the circumstances but I do see that you requested an increase from 1 million dollars to 10 million for the u.s. repatriation program within the administration for Children and Families ACF which I find interesting secretary Hayes are the ACF repatriation program is a Human Services program that provides temporary assistance to u.s. citizens returned to the United States is that correct yes it is thank you to you to your knowledge is the program typically used to respond to mass health events it's used whenever the State Department does a repatriation from abroad of American citizens to provide help for low income individuals to resettle and with transitory assistance we've had very few claims but just as part of the sup we thought it prudent as was done I think with Zika and some other situations to ask for an increase just so that it would be covered in the event we had low income individuals who needed assistance thank you so do these employees if they are used have any background in public health emergency response and this is this is funding this is for or in supporting if they need transit back home once they land in the United States if they have a Human Service need let me let me is it not a health issue this really let me rephrase my question were any ACF repatriation employees part of the teams deployed to Travis and March Air Force Base to receive the evacuees from Wuhan yes to us yes to assist with repatriation of American citizens which is anchor the program yeah so you what sort of health and safety training if any do these individuals receive of health and safety in terms of health needs of individuals well they would be protocol there they any a stroke widow because let me ask another question to your knowledge where any of these ACF employees exposed to high-risk evacuees from China for it was not Zika Haiti her in Hurricane Maria one your knowledge where any of the ACF employees exposed to high-risk evacuates from China they should never have been without appropriate PPE what's PP that's a personal protective equipment so that is one of the things that's required right to have equipment to wear suits if you were with anyone who's in quarantine to maintain quarantine that should be the case yes okay are you aware it is my understanding that you know there was a team as you just confirmed that was sent to the March and Travis Air Force bases and there was a lot of it was kind of chaotic on the ground to your knowledge where protocols followed at all times I would not accept your proposition that chaotic at all times um out of what I would want to get a report on my team I'm not aware of any violation of quarantine or isolation protocols so you're not aware okay may could there have been any protocols may have been broken given the perceived emergency and urgency of the situation on the ground they should not be urgency does not urgency does not compensate for violating isolation and quarantine protocols for personal protection no okay do you think that breaking product basic protocols and exposing untrained humans service employees to the coronavirus before allowing them to be dispersed around the country could have endanger the employees and other Americans I don't believe that has taken place and the isolation and quarantine protocols should always be followed according to whatever CDC or local state and local public health officials have recommended okay if they were not followed say they weren't followed what would be the steps to deal with those employees well I'd want to know what the full facts and we'd take appropriate remedial measures do you know the who the employees that were part of these teams that were deployed to Travis and March Air Force Base I don't know their names no obey 3,000 employees I apologize that all of their names do you guys know who they are of course yes okay well mr.

Chairman I thank you for your time I yield back thank you gentlemen let me recognize the gentleman from Nevada mr. horse first to inquire thank you so much mr. chairman and thank you secretary for your indulgence today the Trump budget proposal cuts the graduate medical education program by 52 billion dollars over the next 10 years this does not work for my home state of Nevada we need more doctors not cuts to the very program that trains them Nevada ranks 48th in the nation for primary care doctors there are just over a hundred and 80 full-time doctors for every 100,000 residents compared to 303 per 100,000 on average I literally have parts of my district in the rural areas that do not have ob/gyn services available and there are only 259 OBGYNs in the entire state of Nevada so how does the administration justify to Nevadans who desperately need to see a doctor but can of can't find one the cuts to the GME program so I actually hope you'll take another look at this because for Nevada with exactly the issues raised primary care OBGYN and rural what we propose doing is taking Medicare Medicaid and Children's GME putting it instead all on the general fund and creating a flexible more flexible fund that's not frozen and is that add money to the GME program would pull it down overall but it would actually allow refocusing on happy new wine and rural so it actually you might actually benefit I'm asked on that question secretary does it add no it removes as you said I think the proximate divert lien but you might actually your state might actually benefit from those changes no we won't because we need more resources not less the Trump budget also claims to improve access to rural healthcare but it eliminates the health profession opportunity grant again we have huge growth and demand for home health aides medical insurance coders medical assistants I introduced a bill HR 3340 to the health providers training act which was included in HR 3 the Elijah Cummings lower drug cost now act do you believe that eliminating the H pas training program will help the existing health care workforce shortage in the United States the Health Professions program funds institutions we believe in the Health Service Corps which actually gets us health care providers going to rural underserved areas as a tuition reimbursement program or forgiveness program each POG doesn't help to meet our we don't we don't believe it provides discernible results in terms of the shortages unlike the National Health Service Corps which we are very committed to lastly a number of my colleagues asked about the issue about drug pricing you said earlier that President Trump is willing to consider a bill that is brought forward through this process but then candidate Trump said that he was going to lead on this issue and force drug companies to negotiate what's changed well we have a Democratic House and a Republican Senate he doesn't believe that the leadership of the executive branch is important to come fulfilling his promise to lor he has but he has been leading this issue of drug pricing has been led by him but we do need the two sides the two chambers and the two parties to get together to pass something for the American people we've got and we leave it options out there we need the president's leadership to follow through on a campaign promise that he made to the American people to lower drug cost our committee has passed HR 3 the Elijah Cummings lowering drug cost Act now bill that is a bill that caps out-of-pocket expenses it allows Medicare to negotiate for the first time directly with drug companies which overwhelmingly Americans believe should be done and it makes sure that there's actually transparency in the process so I just would hope that the administration would follow through on its commitment I know you have prior affiliations with the drug manufacturer as my colleagues have pointed out but this is important to the American people and it's important that we follow through on our promise with that I yield back I thank the gentleman let me recognize the gentleman from Pennsylvania mr. Kelly to inquire thanks chairman and mr. secretary thanks for being here today my colleague mrs.

Weller skee mentioned that you're a Hoosier but I don't know that a lot of people know you actually got your start in Johnstown Pennsylvania so listen thank you for being here today and I and I know this you're taking time to be here it's really critical for all of us I just want if you could just repeat again and I mean it's hard to talk about the President's budget wouldn't and say it's not providing things and we don't have another budget to compare it to you made a statement about Medicare and you said it gets another 25 years of life under this budget that's something I think that needs to be repeated and repeated and repeated because we keep throwing out this other information that somehow it's tots that's right right now medic the Medicare Hospital trust fund which this can be as jurisdiction over will go bankrupt I believe in 2026 with the changes that we propose which are changes that really are for providers they make no change to beneficiary access or beneficiary benefits would extend the life of the trust fund by 25 years or more and still grow Medicare grow Medicare annually at six point five percent six point five percent growth throughout the period okay I really appreciate that and I think you know the longer in the ladder you say something the more it becomes true I think we need to talk more about what's really happening the truth as opposed to us trying to scare people there's one thing I do want to thank you for another there's a lot I want to thank you for I don't have time to do it we have a huge problem today with foster care funding and adoptive care funding and in mr. Evans city of brotherly love right now the Supreme Court's going to hear a case I find it almost incredibly hard to understand how we can say that the faith-based community which was the start of adoptive care in foster care no longer can receive federal funds because they discriminate against the lbgtq community and it seems to me that discrimination means look if you don't agree with me then then you're discriminating against me and it only goes one way it doesn't go both ways and so I want to thank you for HHS's position on that and pushing on pro-life issues and on this issue this is incredibly important this is about kids this is not about different parts of our society or or some some movement that yearns for all kind of spotlight on it it's about kids four hundred thousand they're looking for foster care and a hundred thousand looking for adoptive care and if we're gonna attack the very start of where this all began and that's it in the faith-based community that I think we better go back and actually take a look at history and how things work this I I guess as we keep going on and on and and one of the things that you you in referenced and I think dr. Davis brought this up is about insulin I'm a type 2 diabetic there's a there 7,000,000 type 1 diabetics and just as 30 million total diabetics but one of the things that bothers me as we can not develop a generic substitute I know we talked about biosimilars but when you talk about BIOS somewhere just concentrate on the similar of it not the exact replica which is a generic substitute that we need to develop on March 23rd of 2020 about 25 days from now that's gonna sunset under a provision that was put in the Affordable Care Act and for the life of me I can't understand why that was part of the Affordable Care Act why would we not encourage and try to develop a clear impermanent path for makers to go ahead and attempt to develop a generic substitute which would slash the cost of insulin I and I get to buy a similar part but I just don't understand why we can't have the generic substitute and I keep banging my head against the wall cause I can't find anybody that says you know what I agree with what you're saying but I can't be on that bill with you and the question is why the hell can't you I I do think that FDA would say the biosimilar pathway with the by with the interchangeable guidance we put out is actually the speedier path to a pharmacy level flipped insulin that would effectively genera size that industry so i we're happy to brief you on that i think it actually will do exactly what you want the pathway that we've got right now okay let's let's get the briefing because we're running out of time on this and honest to god this is something that just is bizarre to me when the cost of insulin since 2001 is going up over six hundred percent i can go to canada or i can go to the you go to the over to europe and buy it for a fraction of what what's being charged today so thank you so much for being here your time in your devotion gentleman recognize the gentlelady from Florida this Murphy to inquire Thank You mr. chairman and thank you secretaries are for your service and for being here before this committee today I really appreciate your leadership when it comes to reducing the cost of prescription drugs and I'm hopeful that between the House the Senate and the White House that we can get a good strong and bipartisan bill over the finish line this year because it's only bills that make it all the way through that can have a significant and immediate impact on the lives of my constituents and provide much-needed relief for them at the pharmacy counter but I I have to be honest if you want to understand why so many people are cynical about politics in this country you really need to look no further than the administration's budget request for HHS the administration is proposing draconian and dangerous cuts to keep uh blick health investments ranging from Medicaid to s SB G which helps prevent elder abuse and this includes deep cuts to accounts used to combat the corona virus which poses a growing threat to global health and global economy and the administration is recommending many of these cuts in the name of fiscal responsibility you know I'm sorry but the insincerity here is almost too much to bear you can't pass a partisan tax bill that primarily helps the very wealthy and explodes our deficits and then turn around and cite those very deficits as the basis for your proposals to severely cut critical accounts that protect the safety and well-being of everyday Americans and it's not principled nor is it even responsible it's really the height of hypocrisy excessive debts and deficits threaten our economy our security and our children's future policymakers must work to bring government revenues and spending into better alignment and it's hard to make bipartisan progress on this issue when Republicans approach our fiscal problem in such a cynical and imbalanced way turning to a little bit of substance you know there's been a lot of talk about coronavirus today and for good reason earlier this month I convened a roundtable of experts in my Central Florida district to give my constituents accurate information about coronavirus helping them separate fact from fiction and my goal is to ensure that people are vigilant not apathetic but not alarmist either I have some experience with pandemics in 2005 when I worked at the Department of Defense I helped to lead the Department's response to the threat posed by the avian flu working in coordination with other departments and agencies and that experience really taught me about the importance of public education of coordination of a whole-of-government approach of preparedness and finally proper funding and I'm confident Congress will do what the administration neglected to do which is to properly fund key accounts used to combat coronavirus at home and abroad in the coming fiscal year I'm also confident we'll work together to enact an emergency supplemental bill to fund essential anti coronavirus efforts that are needed right now I don't believe that there's any time to waste mr. secretary picking up on a theme raised by congresswoman Moore and others you proposed to eliminate s SB G the largest source of federal funding for child and adult protective services and this account helps state agencies prevent and punish acts of abuse and neglect against vulnerable people and in 2017 alone my home state of Florida received over 91 million dollars for this purpose in Florida is home to the largest percentage of seniors in the country and elder abuse and neglect occurs all too often can you explain to me why your agency wants to eliminate funding that protects vulnerable children and seniors so the SSP G is basically a large fund of money that goes out that doesn't have discernible measurable outcomes in an environment where we're focused on eliminating programs that proven ineffective or don't have discernible do you have a substitute program for how you do so we actually so the children so of course within our administration for community living we we funded actually increased by two million dollars the Adult Protective Services program wheeze flat fund the senior Medicare Patrol and the long-term care Ombudsman critical programs to ensure the protection of our seniors thank you and I yield back thank you miss Murphy with that the Secretary is acknowledged for his time with us today remember should be advised that they have two weeks to submit written questions to be answered later in writing those questions and your answers will be part of the formal hearing record Thank You mr.

secretary and with that the ways and means committee stands adjourned thanks