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tv   Inside Politics  CNN  January 18, 2017 9:00am-10:01am PST

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the irony is if diabetes gets out of control and those individuals end up having do have amputations or go blind, cms, medicare will pay for that, but it won't pay for that phone call to check on the individual that's helping to control their diabetes and keep them well. will you pledge to take a look at those kinds of policies and re-evaluate what we do pay for?
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>> absolutely. it's imperative that we're constantly looking and determining whether or not we're getting the outcomes that we want and the processes are either helping or obstructing those outcomes. >> and, finally, i want to touch on biomedical research, which is a passion of mine. i founded both the diabetes caucus in 1997, and i also am the founder of the alzheimer's task force in the senate, which senator warner is the co-chair. alzheimer's has become our nation's most expensive disease. it costs us $263 billion a year. $150 billion of that comes from medicare and medicaid. it's going to bankrupt those programs. it's devastating to families and the victims of the disease. diabetes consumes one out of
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three medicare dollars. if we invest in biomedical research, we have the possibility of not only improving lives for americans and curing or coming up with effective treatments for devastating diseases, but also actually lowering health care costs. do you support the increases for nih that we have passed in the last year and/or on track to pass this year as well? >> nih is a treasure for our country and the kinds of things that we should be doing to find cures for those diseases. one of the core -- i supported the increase. >> thank you. that goes along with your principle of innovation. >> absolutely. >> thank you, mr. chairman. >> thank you. >> we've been at this for about two hours. i'm going to take -- i'm going to suspend the operation for
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about five minutes and then we'll go to senator white house just so we can take a little break. committee is recessed for five minutes. >> all right. they're taking a break in this hearing. the u.s. on health, labor and pensions. they've been questioning tom price, who has been nominated to become the next secretary of health and human services. the democrats, jake, they really came forward with some serious important tough questions about his business deals, if you will, purchasing some stocks that they allege were inappropriate. >> that's right. especially senator al franken. very pointedly suggesting that he didn't believe some of the things that congressman price was claiming about what he knew and when he knew it in terms of the purchase of his stocks. tom price very firmly saying that everything he has ever done when it relates to stocks has
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been disclosed and transparent. nothing inappropriate happened. there are obviously also quite a few questions about obama care and the future of obama care. what might happen if obama care is ultimately repealed, what might replace it, what would happen to the individuals who have health insurance because of obama care, and you also heard from senator bernie sanders and this has been something bernie sanders has been trying to do for the last few weeks, to get tom price on the record backing up the comments that donald trump made during the -- his campaign for presidency, in which donald trump repeatedly said he did not want any cuts to medicare, any cuts to social security trying to get tom price to promise that he would abide by those pledges. >> let me play the exchange. this is senator bernie sanders questioning tom price. >> in canada, in other countries all people have the right to get health care. do you believe we should move in that direction? >> if you want to talk about
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other countries' health care systems, there are consequences to the decisions that they've made just as there are consequences to the decision that we've made. i believe, and i look forward to working with you, to make certain that every single american has access to the highest quality care and coverage that is possible. >> has access to does not mean that they are guaranteed health care. i have access to buying a $10 million home. i don't have the money to do that. >> that was an important exchange, and bernie sanders has been extremely consistent on this point going back to when he was obviously running for the democratic presidential nomination. >> we should point out that congressman price's response to bernie sanders when he said access to, i have access to buy a $10 million house, but i don't have the money to do it, congressman price did say that it was the position of the trump transition team and the soon to be trump administration to provide means for those who cannot afford insurance. now, says what the details are of such a promise we don't know. we have yet to see any sort of
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replacement, but that was a principle articulated by congressman price. >> sanjay gupta, you are a physician just like dr. price is a physician. in fact, you worked at the same hospital where he was an orthopedic surgeon. what was your immediate impression listening to the exchanges not just from the republicans, but the democrats as well? >> well, you know, tom price is somebody who has put out a plan, as you pointed out, almost every year since the affordable care act was put into place. we didn't hear a lot of those specific details, though. i thought that was a little bit surprising. there were a couple of areas that i think they drilled down on. one was very interesting. may go under the radar a little bit, but, again, with senator sanders saying specifically will you allow an organization like medicare to negotiate prices for drugs? it's a huge point. it's a huge point because right now they cannot negotiate prices for drugs. they are some of the biggest cost to our health care system, and many times what that particular issue as with other issues, there wasn't a straight response to this. i still don't know having
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listened to the last couple of hours exactly how he feels about that. i know what he has said in the past. i don't know what he is saying now, and i don't know how it translates going forward. there were certain issues like that. also, with regard to the continuity of coverage saying, look, if you keep your health care coverage for 18 months prior, you will not be discriminated against based on a preexisting condition, but he also lumps that in with high risk pools. something we talked about before the hearing started. high risk pools are difficult to administer. they're not great benefits for those who have chronic illness. i've seen that. it's very difficult for those patients who come in continuously with that sort of coverage for get good health care. >> one thing that's interesting is we see this with a lot of the confirmation hearings is president-elect trump articulating something and the cabinet nominees saying something that is more closely to conventional wisdom in washington, for better or for worse. one of those dynamics has to do with the support for the pharmaceutical industry in this country. pharmaceutical industry wields a lot of influence in this building behind me on capitol hill because of campaign
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donations, because of the good they do. many different reasons. donald trump has been out there saying tough things about the pharmaceutical -- >> they're getting away with murder. >> they're getting away with murder. >> and it's going to be interesting to see his words and how much they actually become policy among his cabinet officials. >> you heard bernie sanders saying the five largest pharmaceutical companies meremed with a $50 billion profit. >> one-fifth can't afford to get prescriptions. >> we were talking before the break that the relationship between physicians towards pharmaceutical companies versus physicians towards insurance companies. insurance companies are sort of like -- they're a third party interferer much in in the way that the government was, according to what tom price is describing, and pharmaceuticals, device makers, there's a cozier relationship. >> the chairman, lamar alexander, has just resumed the hearing. let's go back to it. >> and then at this time 2016 after the aca was in place, they
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took a look at the actual experience up to that point, and then they did a new projection going forward based on the affordable care act, and just in the following ten years this green period from 2016 to 2026, they're forecasti ining $2.9 trillion in federal health care savings that relate back to the affordable care act. this is where that came in. so we throw this thing out at our peril if you care about saving medicare the savings to which are a significant part of this $2.9 trillion, and we throw it out right now according to the republican plan with nothing to replace it. i've described that over the weekend at home. it's like being asked to jump
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out of an airplane without any parachute, but being told trust we'll build you a parachute before you touch the ground. he insisted not on just one parachute, but two. a spare. i think the american people are entitled to know what they're going to be offered as an alternative. there's been some conversation in this hearing about how there are republican ideas floating around, and sure there are republican ideas floating around, but there's no republican bill. there's no republican plan. there's no republican proposal. our cards are up on the table. it's obama care. you want to improve it? make suggestions. we've always been open to that. but on the other side of the table there's nothing. and it's really hard to negotiate with nothing, and i think the republicans have a responsibility to put a plan together. now, we talked about that, mr. price, when you and i met in my office, and my recollection
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of our conversation is that you told me that you would want to keep letting people stay on their parents' policies until they're 26. is that true? >> i think that they -- the insurance industry has included individuals up to the age of 26 on their parents' policies. virtually across the board. i don't see -- i don't see any reason that that would change. >> and you would want to keep, you told me, the donut hole closed to protect seniors against those pharmaceutical costs, is that also true? >> i think the discussion we had was about pharmaceutical costs and making certain we did all we could so that seniors were able to afford the kind of drugs that they need. >> i remember it more specifically than that. that you did not want to reopen the donut hole for seniors. are you saying now you're going to consider reopening the donut hole for seniors? >> that's not what i'm saying at all. i think it's important -- you know well that the reopening of the donut hole would be a legislative activity. not an administrative activity. >> you will be secretary of health and human services. you will be doing a lot of work to prepare this legislation and
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to do the technical work behind it for the administration. are you going to be proposing in that role something that reopens the donut hole? i have a lot of seniors who want to hear about that if that's your plan. >> i'm not aware of any discussions to do that. >> okay. finally, my recollection of that meeting in my notes that you told me you would not want to return to insurance company lifetime caps or insurance company denial of preexisting conditions or insurance companies going back and looking in the files for some little tiny discrepancy and then throwing somebody off their coverage when they come in with a significant claim. is that true? >> i think there are always ways we can improve coverage, and those are areas that are existent right now, and i think they need to be -- the issues need to be continued. >> when, as, and if we ever get a republican counter proposal to obama care, you would expect to see those things in it? >> i don't know whether they would be in it or whether they would be silent on it, but,
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again, that's a legislative question. >> they would leave it in place? >> it's a legislative question, not an administrative question. >> now, in one of your budgets you had a proposal that would allow states to throw what you called able-bodied people off of medicaid unless they were working or looking for work or in job training. people with addiction behavioral health, mental health issues, are they able-bodied in your definiti definition? >> well, we weren't as specific as what the definition was. the fact of the matter -- >> these words -- i'm asking you now. what did you mean when you said able-bodied in this provision. >> there are many individuals that have worked in this space for a long time who believe that providing for an opportunity for individuals who are able-bodied
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without children to seek or gain employment or to study to gain employment -- >> what do you mean by able-bodied. you just used that term again. >> that's what would be defined in the regulation itself. i don't know the -- >> you used a term without an idea of how you would define it? >> i think people have an understanding of what able-bodied is, and that's doesn't have the kinds of things that you described, i don't believe. >> that was a simple answer to my question. able-bodied does not include people who have addiction, mental health, and behavioral health issues? >> again, it's the work that would be done to develop the regulation. >> i mean, as you used the word. i'm not asking about in some future universe. as you used that term in your budget. >> i think individuals that demonstrated that they were, in fact, having challenges that would preclude them from being able to seek work or employment or education or the like that they ought to be attended to. >> now, i'm a fan of and think
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they do good work of the american academy of pediatrics. i'm a fan of and think they do good work of the american lung association, and i'm a fan of and think they do good work of the american public health association. all of those groups and many others have gone very clearly on record that climate change presents significant health issues. they signed a declaration on climate change and health which stated that the science is clear that this is happening. you, on the other hand, have said that the carbon pollution standards but the obama administration quote go against all commonsense and that there
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are obfiscation in the allegedly settled science of global warming. i'll pursue this with you through questions for the record because my time has expired, but if you could give a brief answer because it appears to every scientific organization in the country, all the legitimate major ones, and to really every american university that this actually is pretty darn settled science, and that the only people who disagree with it or people who have vast financial interests in preventing any work getting done, and it looks to me like in making this statement you have taken the side of those vast special interests against actually settled science. if we can't trust you on science that is as settled as climate science, how can we trust you on public health science issues where there's a big special interest on the other side? >> i don't agree with the premise of the insinuation, but i will say that the climate is obviously changing.
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it's continuously changing. the question from a scientific standpoint is what affect does human behavior and the human activity have on that and what we can do to mitigate that? i believe that's a question that needs to be studied and evaluated and get the best minds available to make -- >> start by finding the university that thinks the way you do. one. >> okay. we're running out of time. >> thank you, senator whitehouse. senator young, i believe you are next. i don't see him. senator roberts. >> well, thank you, mr. chairman. thank you for holding this anger management hearing. i truly hope my colleagues feel better at least for one day after purging themselves of their concern, their frustration, and their anger. i would like to note that i ask the technician here that is running the sound system, the
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audio system is working. i thought maybe senator bennett didn't know that, and he reminded me of my marine d.i. back in the good days where the d.i. would shout i can't hear you. so i just thought i would bring that up, the audio system is working. take care of yourselves. dr. price, congratulations on your nomination. thank you for being here today. >> thank you. >> as many of our colleagues have already noted, you will play a most important role if confirmed in helping to stabilize the individual market while congress does repeal the law and repair the damage it has caused. and enacts the reforms we believe -- i believe will put our health care system back on track. now, my home state of kansas we have three insurance carriers left. we feel very fortunate we have three. with each individual only having
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access to two of those and our premiums rose this past year over 30%. down the road it's going to be more difficult if we don't do something. there's no doubt with regard to uncertainty and angst among consumers. i think it's important to make clear that even if congress and the incoming administration were to do nothing, let it go, just like in "frozen," let it go, and saddaming or repeeling parts of the affordable health care act if the law is not working and we have to do something to meet that believe on relegation. the prices are affordable. the market is nearly nonexistent with several states and counties who are not as rural as wyoming, but we are rooirl in my state of kansas. i have a concern back in the day when we sat on this committee
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and wrote the first version of the affordable health care act. i don't know where that is. it's sitting on a shelf. we went day and night and day and night and is day and night. i worried about something i called the rationers. i'm talking about the independent payment advisory board, ipab, the center for -- simi, and the new coverage authorities given to the u.s. preventive services task force, and i would also mention the patient center outcomes research institute, which is called cori. not many people are aware of these. i even went to the floor of the senate and had four people riding a horse and called them the four horses of regulatory apocalyp apocalypse, but i'm worried about it, and the provisions which could interrupt the doctor-patient relationship allowing the government to district of columbia take what coverage you can receive. can you share some of any
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concerns that you have with regards to these -- what i would call -- four rationers with all due respect of what they're trying to do with good intent? >> yeah. i appreciate that, senator. i think that it's imperative that as we move forward that we recognize, again, that the patient ought to be at the center of this, and anything that gets in the way of the patient and their families and physicians making the decisions about what kind of health care they desire is -- we ought not go down that road, and so, for example, the c mmi, the center for medicare and medicaid innovation, i'm a strong proponent and odd sladvocate fo innovation. i've seen what's coming out of cmmi is a desire to require certain kinds of treatment for certain disease entities that may or may not be in the best interest of the patient. because it carries the full force of the federal government
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and the payment for those services, it means that we're answering the question who decides about what kind of care patients receive by saying that the answer to that ought to be washington d.c., and i simply reject that that's where those decisions ought to be made. >> i appreciate that answer. i have the privilege of being a member of this committee, the finance committee, and especially being chairman of the always powerful senate agriculture committee. i'm particularly interested in hhs and more importantly fda's work on food and nutrition policy. during the previous administration the fda issued numerous regulations with limited or delayed guidance and unrealistic compliance dates. this was the case with the implementation of the food safety modernization act called fsma and more recently with the nutrition facts panel revision. i know we all share the goal of a safe food supply and
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availability of accurate information for consumers, but i'm concerned the administration is not clearly or consistently communicated with the food and agriculture industry regarding new or changing requirements. will you commit to working with the secretary of agriculture and other relevant agencies, not to mention the committee i serve on and similar in the house, that your department is issuing science-based guidance and taking into consideration other regulatory burdens when establishing compliance and dates engaging in other regulatory actions? >> yes, i believe that's not only imperative, but the science that's relied upon ought to be transparent and available to the public so that people can see exactly what was the basis for the decisions that were being made. >> under the previous administration we had seen increased activity and regulatory action on nutrition policies such as issuing voluntary guidance. yet, the same administration continued to request additional resources from congress to
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comply with statutory requirements under the food safety modernization act. i'm concerned that the administration did not prioritize fda's mission to protect our nation's food supply instead focussing on nutrition policies. if confirmed, can you discuss how you will focus on the core fda duties such as implementing the law that congress passed rather than agenda-driven nutrition policy guidelines? >> this is really important, senator, and if i'm confirmed and given the privilege of leading, i would work specifically with the fda commissioner and make certain that we are relying on science. that it's science that is died guiding the decisions that we're making and, again, that the transparency is available for folks so that they can see what kind of decisions are made and how they're being made in addition to working with policy makers. you know best what's going on in your state and how it's being affected by the rules and regulations that are coming down from washington in so many areas, but certainly in the
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agricultural arena, and we ought to be having a dialogue with every single individual who has an interest to make certain that we're addressing the needs appropriately. >> thank you for your response. thank you, mr. chairman. >>. >> so in terms of -- the american people want to know, of course, when you get interviewed for potential conflicts of interest and your procedures with the office of government
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ethics is that in your role you're fighting for them and not biassed towards the poufrm companies that you have invested in and have invested in you, and you've taken some questions on that, but just let me follow-up a little bit to ask, first do you think drug price increases that we're seeing now, for example, the six-fold increase in the cost of an epipen is a problem for americans. >> i think there are certain areas where drug pricing -- it's important to note they've done some good things. whether it's in the generic arena where the prices have been held down significantly or -- >> let me continue down this
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path. trump supports medicare drug negotiation. will you work to repeal the prohibition on medicare in negotiating better drug prices on behalf of the american people if confirmed for this position? >> i understand that if i'm confirmed and if i have the privilege of serving as secretary, that the boss that i have will be the president of the united states. >> so you -- will you work to repeal the prohibition on medicare negotiating drug prices? >> following discussion and being informed by the individuals within the department and working with the president and then carrying out his wishes. >> was that a yes or a no? >> it depends on that tooit. >> he stated his position very recently, in fact, that he supports price negotiation, so that people on medicare can have
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the benefit of that. is that something that you would press congress to do? in other words, repeal the prohibition on that negotiation. >> i think we need to find solutions to the challenges of folks gaining access to medication, and it may be that one of those is changing the way that the negotiations -- as you know, the negotiations right now occur for seniors with the pbm's, with the privacy benefit managers where. >> you haven't said yes or no. you just talked about transparen transparency. would you support drug price transparency mandating that any drug price that wants to increase prices on their drugs, release public information on how they decide their prices because so many of these appear to be without classification, as you mentioned. >> i think there's a lot of merit in transparency in every area, and certainly in this area, and i look forward to exploring if i'm confirmed with
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you the ways to be able to make that work. >> thank you. >> i wanted to go back to the first round of questioning with the chairman who showed a chart, and it seemed like the -- what was implicit in the back and forth was the act of repeeling the affordable care act would only impact perhaps a very small part of the health care industry. you talked about 6% being covered by the markets. the protection type coverage on the coverage and premandating that people be covered even if they have a preexisting health condition. things like eliminating caps that let so many into medical
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bankruptcy. those apply across the health care system. repeal in no way limits us to a conversation percentage of our population. this is about serious impacts for all of america. would you agree? >> i think that the discussion about what our health policy for financing and delivery of health care to the american people is a very, very broad subject, and we need to discuss -- >> to repeal the affordable care act, the impact does not nar rely confine to medicaid and the individual market. it has impact on every american. medicare too. we are driving so much of our innovati innovation. it impacts medicare very, very significantly. so let me give one example. we in our office when you
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visited and thank you for your visit, but we talked about the opiod epidemic. one of the significant issues is treatment needed to overcome an addiction. if the affordable care act is repealed, there will no longer be a mandate for substance abuse treatment being covered. is that something you agree with? >> look, the opiod epidemic is rampant and is harming families and communities all across this nation. >> would you assure that treatment would be substance abuse treatment would be covered under a replacement plan that you would propose? >> i think it's absolutely vital that substance abuse and other kinds of things are able to be treated. >> do you think that's part of the -- >> that's a legislative decision, but i look forward to working with you to insure that people will be able to get the care they need. >> i want to make sure i heard the exchange because it sounded
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to me like you are saying you think insurers will continue to do it so there's no need for a mandate saying they must. with 5.7 million young people between the ages of 13 and 26 on their parents' health insurance, that's 5.7 million people who aren't in the individual market because they're in their first job after high school that doesn't have health insurance or in school without -- so is it just a wink and a promise or do you have in law that mandates that 18 to 25-year-olds be able to stay on their parents' health insurance? >> i think it's baked into the insurance programs that are out there right now. what i'm absolutely -- >> that they could -- >> i'm absolutely committed to making certain that every single american has access to the kind of coverage that they want and has the financial feasibility to be able to purchase that
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coverage. >> thank you, senator baldwin. senator young. >> i've enjoyed our service together. the last six years in the house of representatives, particularly the four years we spent on the weighs and means committee. i had a chance to get to know you personally there and to observe your quite impressive skill set. your depth of knowledge in the area of health care and health policy. your commitment, more importantly, to seeking alternative perspectives, to try to identify where bipartisan consensus could be realized, and ultimately forging consensus around some viable solutions. the one that i find most notable is your success on the sustainable growth rate, which is something members of this
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committee are familiar with. without your leadership over on the house side, i don't think we could have moved towards more valued based purchasing model. one area of the affordable care act, speaking of bipartisanship that members of my party -- of your party have periodically and quite vocally indicated their desire to repeal from time to time has been the center for medicare and medicaid innovation, and that's perhaps on account of the one size fits all prescriptive and mandatory demonstrations that occurred in recent years, and you have already indicated that you oppose the mandatory nature of demonstration projects. i strongly believe for one that there's innovating and experimenting across all layers of health care. further, i think cmmi and can
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continue to be a helpful laboratory for health care experimentation with respect to delivery models, payment models, and so forth. for medicare, for medicaid, the children's health insurance program. perhaps other areas. save taxpayer money, provide greater value. we see what doesn't work. we scale up what does work. dpor me it's commonsense. this is the way sort of scientists operate as they start with experiments and then they evaluate and then they scale up. i would like to know your intentions if you have strong feelings in this area. do you intend to keep this innovative center or create a new one, a varant of cmmi. speak to this please. >> as i mentioned i'm a strong advocate and supporter of innovation at every single level. it's only through innovation that we expand the possibilities
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for especially in the area of health care for increasing the quality of care. mmi entity has great possibiliti possibilities. i strongly support that i have adamantly opposed the mandatory nature with which cmmi has approached significant problems. let me also mention too, if i may, the first is the comprehensive joint replacement, the cjr program, which identified from cmmmi 68 geographic areas where if you were a patient and you received a lower extremity joint replacement for a variety of problems, then it was dictated to your doctor what kind of prosthesis, what kind of surgical procedure your doctor could do for you.
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regardless of what's in your best interest. they may be aligned, but they may not be aligned, and if they're not aligned, then your physician is incumbent upon doing what the government says to do. the other area that i think was even more egregious was covering 75% of the nation in the medicare part b drug demonstration model. in fact, not a demonstration model if it's 75% of the country. that would stipulate late what kind of medications your physician could use in an in patient setting. in a mandatory way. the problem that i've got with that is that really is an experiment. it's a demonstration to see whether or not it works. in every single experiment, health care experiment or medical experiment, or scientific experiment that deals with people, real people, we demand, we require that there be informed consent for the patient to participate in that experiment, and so you say to the patient, we're trying this to see if it works better. we would love to have you join us. with we think it may be to your
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benefit and the benefit of more individuals across this land, but if you don't want to do that, you don't have to. the federal government doesn't do that. they require individuals to participate, and oftentimes i suspect most oftentimes the patient doesn't even know it's an experiment that's going on. if either of these models were put in a small area, a pilot project somewhere and we saw that, in fact, they worked, then as you say, then you scale them up. >> i thank you for the response and the rationale behind how you've arrived at that position. i look forward to working with you to advance the next model of cmmi. i would be remiss in my remaining 90 seconds if i didn't mention indiana's what he with call healthy indiana plan 2.0. our vice president-elect pence showed a lot of leadership here, worked with our incoming cms administrator, seema verma, to develop a model for medicaid,
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which is unique to the state of indiana. it encourages recipients of medicare dollars to get some ownership over their health. it uses private market insurance concepts to prepare hoosiers for more self-sufficiency. i happen to believe that it will be replicated in other states if we can accommodate that as we continue to work on new health care legislation, but it's an important proof of concept that medicaid can be more efficient than a one size fits all approach. i just need some assurance from you that you will -- your load star will be state flexibility and innovation in the medicaid space so we can continue to accommodate plans like hip 2.0 as opposed to a one size fits all approach. >> i think you're absolutely right. the medicaid program is one
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where the states know best how to care for in the best way their medicaid population. >> you look forward to working with you. >> likewise. >> thank you, mr. chairman. representative price. i hope you can understand our frustration around trying to divine the nature of this replacement plan. we hear you and president trump praise all of these aspects of the affordable care act and lay out goals that sound eerily familiar to what we've been living with for the last six years. you've said that you don't want there to be a gap between the repeal and the replacement, that at least as many people will have coverage with the goal of
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more people having coverage. sick people won't face discrimination. young adults will get to stay on their plans until age 26. yet, we don't get any specifics as to how that is going to occur. it seems as if you and the president-elect want to do everything the affordable care act does, but just do it in a totally different way. and so i'm going to kind of give up on trying to get at the specifics of this secret replacement plan, and maybe ask you about metrics, about how we will measure whether what you propose as a replacement is meeting your benchmarks. for instance, the number of people covered. the cost of health care to individuals. the amount of money out of pocket that people have to pay. when you're at the end of your four years, how will you look back on this replacement plan to measure its success and to the extent you can give me specifics
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as to how you're going to measure the success of this replacement, i appreciate it. >> well, i thank you, and you identified some very specific areas that i think we need to be looking from a metric standpoint. what is the cost? is the out of pocket cost for individuals higher or lower than it was? right now i would suggest that the cost is higher than it was when the program began for many of those individuals in the individual and small group market. they were promised that the premiums would come down. the premiums have gone up. they were promised they would have access to their doctor. in fact, many of them have not had access to their doctor. >> imauto talking about from where we are today -- >> from where we are today if you look at the things that many of us believe have been harmed by the affordable care act, i hope that we're able to turn that around and decrease the out of pocket costs for individuals, increase choices for individuals, increase access to the doctors and the providers that the patients want as opposed what's happened. >> increase the number of people who have insurance. >> absolutely. as i mentioned over here, we
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still have 20 million individuals without coverage. i think as policymakers it's incumbent upon us to say what can we do to increase that coverage? the goal is to make certain that every single american has that access to coverage that they want for themselves and for their families. >> i just know those are two different things. having coverage and having access to coverage. i think we've gone through that a number of times. i want to come back to the question on some of the conflicts of interest issues that have been raised, and i raise it because i think there's a great concern on behalf of the american people that this whole administration is starting to being loo like a bit of a get rich quick scheme that we have a president who he won't divest himself from his business and could get rich off of him. we have a secretary of education that has a big -- and make a lot of money for his industry. i want to walk you through another set of facts, another timeline regarding some of your interactions and get your reaction to it.
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on march 8th of 2016 earlier last year cms announced a demonstration project to lower medicare reimbursements for part d drugs. that would have decreased incentives for physicians to prescribe expense i brand name medications and drug companies that were affected by this immediately organized a resistance campaign. two days later you announced europe zbligs for this demonstration project. one week later you invested as much as $90,000 in a total of six pharmaceutical companies. not five, not seven. six. all six, amazingly, made drugs that would have been impact by this demonstration project. there are a lot of companies, drug companies, that wouldn't have been affected, but you didn't invest in any of those. you invested in six specific companies that would be harmed by the demonstration project. you submitted financial disclosures indicating you knew that you owned these stocks and then two weeks after that you became the leader in the united
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states congress in opposition to this demonstration project. you wrote a letter with 242 members of congress opposing that demo. aye read those letters. i know that's not easy. that takes a lot of work to get 242 people to sign on. >> that's good staff work, senator. >> and then, guess what, within two weeks of you taking the lead on opposition to that demonstration project, the stock prices for four of those six companies went up. you didn't have to buy those stocks knowing that you were going to take a leadership role in the effort to inflate their value. as the american public take a look at that sequence of events, tell me how it can possibly be okay that you are championing positions on health care issues that have the affect of increasing your own personal wealth. that's a damning timeline, represe representative price.
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>> goes back years and years. the fact of the matter is i don't know whether you were here before, but the fact of the matter is i didn't know any of those trades were being made. i have a directed account -- broker directed account. those were all made without my knowledge. individuals on this panel have the same kinds of accounts. the reason that you know about them is because i appropriately reported them in an above board and ethical and appropriate manner as required by the house of representatives. >> do you direct your broker around ethical guidelines? do you tell him, for instance, not to invest in companies that are directly connected to your advocacy? it seems like a great deal as a broker. he can just sit back, take a look -- >> she. she can sit back. >> she can sit back in this case, look at the legislative positions you are taking, and invest in companies that she thinks are going to increase in value based on your legislative
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activities and you can claim separation from that because -- >> that's a nepharius arrangement that i'm really astounded by. the fact of the matter is that i have had no conversations about my broker about any political activity at all. >> why would you tell her -- >> other than her congratulating me on my election. >> why wouldn't you say, hey, listen, stay clear of any company says that are directly affected by my legislative work? >> because the agreement that we have is that she provide a diversified portfolio, which is exactly what virtually every one of you have in your investment opportunities, and make certain that in order to protect one's assets that there's a diversified arrangement for purchase of stocks. i knew nothing about those purchases. >> you have a diversified portfolio while staying clear of the six companies that were directly affected by your work on the issue. >> i didn't have any knowledge of those purchases. >> thank you, mr. chairman.
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>> thanks, senator murphy. senator merkowski. >> thank you, senator. there is added benefit to being one of the last in the chain here to ask questions because it certainly gives me a clear idea of where you're coming from, congressman, on some of these issues that are so important to us. we haven't had as much conversation about the rural aspects of health care, which, of course, are very important to me. we had a chance last night to hear from the nominee for education, and i pointed out to her, as i have pointed out to you, that alaska is a little bit unique. sometimes it's really unique and the challenges that we face allow us to be somewhat innovative, but we need some flexibility in order to implement some of the innovat n innovatio innovations. i had a chance to sit with a group of alaskaans on saturday in anchorage. they were from the -- everyone from the director of the
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division of insurance to our commissioner of health and social services, representative of the only provider on the individual market, representatives from small, rural hospitals, doctors. it was representatives from the tribal health organizations. it was a good mix of individuals. obviously we got different views and opinions about where we go with this replacement of the aca and what that would need to look like to help address the needs and issues in a very rural, very fronti frontier, very high cost -- the highest cost insurance, the highest cost health care costs. we're down to one provider on the individual market, so we've got all the demographics that would tell you that this is -- this is a difficult place to be
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operating right now. we as a state moved forward with medicaid expansion a couple of years ago. some 27,000 alaskans have coverage that didn't see that before. there was also good discussion about making sure so recognize iing that there is certain exemptions that were included as part of the aca, exemptions for medicare cost savings provisions, federal match for american indians and alaska native enroll e lees when they receive their care through an ihs facility, including the tribal prauting facilities. we have seen extraordinary collaboration that's going on
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between our ent ities with our tribal health organizations that have allowed for increased efficiency, improved health access and so a great deal of the discussion was focused on what will happen to those who have gained access through med kaud expansion and what can we do to ensure that coverage options are provided for those in this new era of health care reform. then b a further question to that is should a block grant approach be considered. what efforts, then, would be made to ensure that this very unique trust responsibility for american indians and alaskan natives are continued to be fulfilled. these were concerns raised in this meeting and folks would hope i'd have a chance to ask. >> i appreciate it.
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we had a wonderful discussion about alaska and learned much about your state. medicaid system is one that absolutely imperative and vital for members of our polllation who receive their care through the medicaid program. it's a federal and state partnership, as you well know. it's one that we absolutely must ensure that individuals don't fall through the cracks in whatever transition occurs. so whether it's retaining the same level of medicaid participation or providing an option for something else that allows them coverage that suits their needs, we are committed and adamant that that coverage be able to be continued. so they have assurance we will work with you. >> what about the concerns expressed by the health organizations that perhaps if there's a block grant approach that is utilized that that it could impact some of the assurances and benefits that the
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tribal health organizations have seen. >> this is in its early stage, obviously. it's a legislative decision that occurs. it's not a department decision that o occurs. it's a legislative decision, but we'd look forward to working with you to ensure that individuals in the indian health service which have had some real challenges and need to make certain this the metrics we're looking at are clinical correlated metrics that we're looking at what actually makes a difference to the people receiving the care and it's one of those promises that we have to make certain that the indian health service works and i think we can do a lot better in that. >> i look forward to more conversation on that. let me ask about some of the efforts that alaska has made relatively innovative as we have attempt to stabilize our individual health care market. the state moved forward with some reforms. they created a reinsurance
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program for high risk individuals. we have submitted a 1332 state innovation waiver. again, all with the hope that we're going to be able to somehow provide for some level of stabilization. what sort of considerations or state-based reinsurance programs will you consider? >> i think the whole array of opportunities that are available to make certain that nobody falls through the cracks. the 32 paver program is one that's just beginning, but it's one that holds significant promise in making certain that we're able to ensure that things like reinsurance, high risk pools mauk it so that individuals do not lose their opportunity to gain access to the highest quality care. >> and then finally on our small rural hospitals, one of the concerns that i heard repeatedly was the level of regulatory burden that particularly our
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smaller hospitals are just feeling stifled by some of the innovative things that one of oush hospitals on the peninsula is looking at advancing. they kind of feel that it's too risky roigt now to move forward with any level of innovation that they it had hoped to take on because they are facing some of the regulatory burden. you can do things min strauadm e administratively early on should you be confirmed to this position. what regulatory issues could be addressed to help reduce some of the regulatory u burden particularly to some of these small, rural hospitals. >> not specifically, but i share with you the concern that i have about the burden of regulatory guidelines and regulatory schemes that i come out of washington, d.c.
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especially for the rural area. it's not just the hospital. it's the providers and the dock who is are providing the care. most of the folks in the rural area tend not to have margin to cover the cost of this regulation. i heard from more than a few physicians who because of the r regular story schemes said they can't do it anymore. they are having to close their doors and one of them where they are having real challenges in providing the services. when that happens, those individuals have no care. that's unacceptable to me. >> i have remaining senator warren, hassett and kane. >> more than 10 million americans now receive their
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health care through medicare and medicaid programs. these are seniors, people with parents in nursing homes. countless number of young children and they all benefit from these programs. so i want to understand the changes to medicare and medicaid that you have already proposed. the budget that you recently authored as chair of the house budget committee would have cut spending on medicare by $449 over the next decade. is that right? >> i don't have the numbers in front of me. i assume you're correct. >> so you'd cut medicare by $449 billion. your 2017 budget proposal would have cut medicaid funding that goes to the state governments by more than $1 trillion. is that correct? >> i think senator, senator, the
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metrics that we use for the success of these programs -- >> i'm just asking, yes or no. did you propose to cut a a trillion dollars from medicaid? >> what e we believe -- i'm sure you're correct. what we believe of is appropriate is to make sure the individuals receiving the care are receiving the care. >> i understand why you think you're right to cut it. i'm just asking the question. did you propose to cut more than a trillion dollars from medicaid over the next ten years. >> you have the numbers before you. >> is that a yes? i'll take it as a yes. so i'm sure you're aware during his campaign for president, president-elect trump was very clear about his views on medicare and medicaid u. as senators sanders has quoted, president-elect trump said i'm not going to cut medicare or medicaid. when president-elect trump said i'm not going to cut medicare or medicaid, do you believe he was telling the truth? >> i believe so, yes. >> given your record of
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proposing massive cuts to these programs along with several other members of this committee, i sent the president-elect a letter in december asking him to clarify his position. and he hasn't responded yet. so i was hoping you could clear this up. can you guarantee to this committee that you will safeguard president-elect trump's promise and while you are hhs secretary you will not use your authority to carry out a single dollar of cuts to medicare or medicaid eligibility or benefits? >> what the question presumes is that money is the metric. in my belief from a scientific standpoint, if patients aren't receiving care even though we're providing the resources, it doesn't work for patients. >> we're very limited on time. the metric is money. and the quote from the president-elect of the united states was not along this course.
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he said he would not cut dollars from this program. so that's the question i'm asking you. can you assure this committee you will not cut one dollar from medicare or medicaid should you be confirmed to this position? >> i believe that the metric ought to be the care that the patients are receiving. >> i'll take that as a a no. >> that's the wrong metric. e we ought to be putting forth the resources. >> i'm asking you a question about dollars. . yes or no? >> we should put forward the resources to take care of the patient. >> frankly, the millions of americans who rely on medicare and medicaid today are not going to be very reassured by your notion that you have metric other than the dollars that they need to provide these services. you might want to print out president-elect trump's statement. i am not going to cut medicare or medicaid a


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