HHS Secretary Tom Price Pressed on Budget Cuts CSPAN March 29, 2017 9:58am-12:08pm EDT
calculus. in recent days we saw syria launch missiles at israeli convoys. those missiles triggered israel's missile defense system for the first time since the conflict began. so my friends, this is not a time to be naive. iran's motives are no mystery. its goal to extend the influence of its government throughout the region remains unchanged. iran continues to support terrorist proxies like hezbollah, it continues its provocative testing of ballistic missiles and continues to disrega disregard its requirements. the united states can't let this aggressive behavior go unchecked. which is why i have worked with my colleagues, democrats and republicans those who supported
good morning, mr. secretary, it's genuinely my pleasure to welcome you to the subcommittee on labor, health and human services and education. we're looking forward to hearing your testimony. mr. secretary, your responsibilities are many. your department's responsible for insuring proper payment, overseeing medical search, helping families break the cycle of poverty and protecting our nation against bioterror and pandemic events. the cuts proposed in the budget blueprint
are extensive and span the reach of your agency. i believe there's always fat that can be trimmed and priorities that can be reordered. but i will ask you some questions this morning about whether this budget leaves america sufficiently prepared to respond to a pandemic, a new disease like zika or bioterrorism event. i'll ask questions about how you'll fulfill your mission of enhancing the health and well-being of americans at these levels of funding. i'll ask how you'll work to solve some of the challenges in your agency, including those related to the indian health service. ultimately, this subcommittee needs to know in detail what cuts you propose and what missions you're down grading or eliminating. some of the details will be forthcoming in the weeks ahead. we look forward to hearing what you're able to share with us today. we recognize our limitations in that regard. as a reminder, the subcommittee and our witness will abide by the five minute rule so everybody will have a chance to get their questions asked and
answered. now i'm going to go off script for a minute. i want to begin also welcoming you here as our former colleague, 12 years, and not only had the privilege of serving with you, and obviously, in congress, but in the same conference and on your committee which you chaired. and i couldn't have been more pleased with your selection by the president. i think you are not only a very good person and extraordinarily well-qualified for this job, i have no doubt you're going to do a brilliant job for the american people. having worked with you on the budget committee i know you know how to balance a budget and bring it into budget and make the tough decisions that have to be made for the country going forward. and, you know, we achieved that balance in the budgets that you were -- you crafted. in some cases, i think with appropriate balance between entitlement spending and discretionary spending. and i think that's probably one
of this committee's chief concerns. i think the president is absolutely correct that we need to spend more on defense. don't have any doubt about it at all. i think he's absolutely correct as well that it needs to be done in a fiscally responsible way with offsetting reductions else where in the budget. where we would disagree -- and i cut the administration considerably latitude because it's had little time to craft a budget. we may see something different in may and someway see something different in the years ahead. but in my personal view, these are focused too tightly on non-defense discretionary offsets, particularly with respect to your agency. i take considerable pride in the fact -- i know my colleagues on both sides of the aisle do -- that in the late 90s and early part of the 21st century, congress, a republican congress, frankly but with democratic support was able to double the budget at nih.
and our predecessors, speaker gingrich deserves considerable credit. we often point out they did a tremendous job i think for the american people. we then had about a dozen years of flat funding. i take considerable pride that it was a republican house and senate again in 2016 that restarted the cycle of increasing funding at the nih. and when i say flat funding, i know my colleagues would be the first to point out, flat funding means reduced funding because you obviously lose on account of inflation. i can give you the numbers in terms of number grants for research we were funding in 2003 versus what we were funding in 2015. we went down from one in three to one and six. that was a lot of good signs i think left on the table. so i'm pleased that we were able to restart that what i call
virtuous cycle. again, with the support of our friends on the other side of the aisle. and we did that again in a 2017 budget which i'm very hopeful you'll get to operate without a continuing resolution before the end of next month. and you'll see that will be another very substantial increase for the national institute of health. going forward -- also for the senator for disease control. and you've heard me say this before, but i really believe it. these two institutions in particular -- there's lots of good things in your budget. these two in particular are every bit as important for the national defense and national security of the american people as the pentagon is. frankly, you're much more likely to die in a pandemic than you are a terrorist attack. maintaining the ability to respond to terrorist attacks, to respond to unexpected things
like ebola and zika, extraordinarily important for the country. and i know you see it that way as well. again, you're in a tough position, you have to make tough decisions. and i respect that. this committee and me personally will be very hesitant about looking at cuts to the nature that we're talking about. frankly, pretty insistent on finding a way in the total budget to not only maintain the offsets that the president wants to, but spread them more broadly across the full budget. but do it in ways we can continue this investment in what i think is really cutting edge and important biomedical research and certainly at the center for disease control, what's literally the front line of defense. i'd much rather fight ebola in west africa than west dallas. i think you'd recognize the extraordinary contributions that were made by that agency and the
nih working together in that particular fight. so i just -- i say that out there just up front because we will have some differences, but i want to make it clear they're not differences in the basic thrust of what the president's trying to do. it's just doing what congress is supposed to do in trying to think maybe more broadly across the entire budget. i know you've done before. i've seen you do it. and try to make sure that we prioritize what's genuinely important and defense is genuinely important. these things are part of the defense to the country and its development, too. i really look forward to our discussion. i know it will be thoughtful. i know you will make good decisions on behalf of the american people going forward. because i know who you are. i've had the opportunity to serve with you. and this committee looks forward to working with you fully and openly and transparently. we had an excellent relationship
with your predecessor, someone i think very highly up. we'll have an excellent relationship with you. i know how you're serve the american people. this committee, republican and democrat alike looks forward to working with you to achieve a common goal. i know that's the president's goal. this is the beginning of a process. my hope is we'll get to an end of a process where we can take a great deal of satisfaction and we have achieved the objectives that i know we all share. and, frankly discharge the duties that we're all obligated to discharge. and with that i want to turn to the ranking member from connecticut for any opening remarks she cares to make. >> thank you very much mr. chairman. welcome mr. secretary. welcome to the subcommittee and your first appropriations committee. this is a place you know well. we meet during perilous times for the future of healthcare in our country. with the threat of rising premiums, rising deductibles, and the uninsured, americans
were protected last week when speaker ryan pulled a bill from the floor that would have repealed the affordable care act. the fate of their healthcare really now lies in your administration's hands. i have been deeply disturbed by president trump's recent threats to sabotage health insurance for the millions of americans that rely on the affordable care act every day. and last week, from the oval office he said and i quote, the best thing we can do politically speaking is let obamacare explode. end quote. on february 27th he told the national governor's association, let it be a disaster because we can blame the democrats. politically it would be a great solution. i find this speech to be insulting to the millions of workers, children and older americans whose futures are on the line. the healthcare of the american people is not a political
bargaining chip. the idea that the president of the united states would intentionally undermine the health and the financial security of millions of americans for personal and political gain, my view is malicious. mr. secretary, i hope that you will assure us today that you intend to use your position to strengthen the individual marketplace that's used by millions of americans. instead of sabotaging it for any political gain. i hope you'll tell us today that you concur with speaker ryan when he says that the affordable care act is the law of the land. and that there will be no further attempts to repeal it. but rather, take a look at the ways in which we can improve and strengthen the affordable care act. moving from the failed repeal of the affordable care act to the budget proposal. i think you know what my response is on the budget proposal. unfortunately, i do not have
anything complimentary to say about your budget request. in fact, i think it is a disaster that will have literal life and death consequences for american families. $15 billion in cuts to hhs is untenable. much like speaker ryan's healthcare bill that failed, the trump administration's budget request for the department of health and human services would eliminate critical resources and programs for low income and working families. it would also decimate the national institutes of health. the world's foremost biomedical research institution. severe negative consequences for public health departments across our country. to be clear, president trump is proposing to cut nih funding by $6 billion. this is really an understatement, since we just saw that the administration wants to cut an additional $1.2 billion from nih in 2017 as
well. and i hope you will tell us whether or not you agree or disagree with that additional cut. cutting billions from nih would be devastating, cancer research, alzheimer's research, hiv/aids research as well as research to prevent cure of any other disease that is causing misery for millions of americans and their families. make no mistake, this cut will turn back the clock on life saving biomedical research that you know and i know and the chairman knows and everyone on this committee knows has the power to save lives. mr. secretary, we know today, we need to know today do you agree that we should cut $6 billion from the nih. and i just might add it's $6 billion below what you voted for in the omnibus last december. we are choosing to hamper our
progressive as a nation. president trump is proposing to eliminate the low income home energy assistance program, which allocated $3.4 billion each year to help pay heating and cooling bills for nearly seven million low income households. earlier this week i heard from constituents who depend on it. let me just quote this from you. this was in derby connecticut. tears flowed, anguished creased faces and pleas for help filled the room. they came from people like amanda diaz who works 40 hours a week while taking care of two young children and a sick mother. chris, a former nurse left disabled. evan and her recently graduated from a griffin hospital training program. these programs are vital, amanda diaz said. she said people like me don't just stay home, i work. i have a 5-year-old daughter who has asthma and my mom has lupus.
she says minimal heating assistance she received kept her daughter and mother from getting 6 la last weekend. how does this government think we can cast people aside? she wiped tears from her eyes and said they are putting numbers down but we are talking about humans. these are the words of folks. they rely on this program to keep their kids healthy. to keep their families safe. and president trump is also proposing to eliminate the community service block grant program. a critical program that connects people with job training, nutrition programs and more. he would propose slashing funding for the centers for disease control, drastically reduces surveillance, epidemiology, laboratory testing as well as immunizations and emergency preparedness activities in the states. i was pleased to read in your
testimony about your commitment to emergency preparedness and how we need to foster that effort. in each of these cases, president trump is proposing to eliminate programs that help low income, working class families, often the same families that put their faith in him during last year's campaign. or he's proposing to cut programs like the nih, the cdc that benefit all americans. at the same time, he is preparing to introduce a massive tax cut for corporations and millionaires, just as he did in the failed healthcare bill last week. for decades, republicans have advocated massive cuts to health and education funding. such as with hr-1, the very first thing that republicans did when they took the majority. which proposed cutting the ni by $1.4 billion and cdc by 10%. it is showing the impact those cuts would have on our
communities. cuts to public health departments, cuts to home heating and cooling for low income families. cuts to meals on wheels, cuts to nurses training, cuts to family care givers and family planning service and the list goes on. my sincere hope is that the budget is dead on arrival. it's cynical, vindictive and will cause real harm to millions of american families. i look forward to finding out whether you support these reckless cuts, i sincerely and truly hope not. additionally i read your testimony, and i know that you do not have all the numbers yet. and i would ask the chairman, if we could have the secretary return in may to testify when we know the full extent of this budget when it comes around to may. i thank you and look forward to your testimony and to our discussion. >> thank the gentle lady.
we have the privilege of having the ranking member of the full committee here as well. just for the record, i want to say i was privileged last night to be with her when she received a lifetime award from the alzheimer's association for the distinguished work she's done over the course of her career. we have some of those folks associated with that effort here. we thank you for your good work and honoring our colleague and dear friend. the gentle lady is recognized for whatever remarks she cares to make. >> now, you're being so very gracious. but i think we should tell the group that i was honored to be honored with you, my friend. and i always want to say -- >> kind of hoping you'd bring it up. >> and i do want to say because i was glad you referenced it in your opening remarks, i was part of this committee when the republican, john porter doubled the money for the nih.
and i know of chairman cole's commitment to alzheimer's, to the whole range of diseases which we focus our efforts and find cures and prevent the terrible pain that these illnesses cause. i also remember, mr. chairman, when we used to say there are democrats, republicans and appropriaters and we have to get our work done. i'm very optimistic that at the end of this process we'll make major changes to the budgets. the skinny budgets that have been submitted to us. so with that, my friend, i want to join you in welcoming our guest today, secretary price. this really is a strange hearing. you come before us with a quote, a skinny budget, that doesn't contain many numbers. and the few clear details would have catastrophic results for americans. here's what we know about president trump's budget.
the nih would be cut by as much as $5.8 billion. resulting in 3,000 to 5,000 fewer annual research grants. nursing training programs would be eliminated. without liheap vulnerable americans would be left without heating assistance in the winter and cooling assistance in the scorching summer heat. and the department of health and human services would be cut by 18% putting critical priorities at risk. the 18% cut to hhs could endanger biosecurity, medical research, mental health counseling, substance abuse, early childhood development, combatting disease and epidemics, vaccine development -- i don't think i have enough time to list all the
cuts. you know how serious they are. there are no two ways about it, it's just not possible to make an 18% cut without decimating investments that americans rely on. so we should be honest with the american people. president trump's budget plans are nothing more than a broken promise. while special interests loopholes remain intact if you're working hard every day and still can't make ends meet. you're out of luck in trump's america. you also come before us days after trumpcare crashed and burned. with policy proposals constantly changing in an effort to appease the right wing in its final days. i'm not certain that any person in this room, perhaps including you, mr. secretary, could articulate the trump administration policy on healthcare other than repealing the affordable care act and taking healthcare away from 24
million people. i certainly hope, mr. secretary, that last week's failure of trumpcare has made clear that the american people want the aca to be strengthened. and i think working together, democrats and republicans, if we look at it with open eyes we can strengthen our healthcare system. especially in light of the news overnight that republicans are back at trying to repeal the bill. i don't understand that. instead of working together to improve to strengthen the affordable care act, without a plan in place, there's talk of repealing it again. and i want to make it very clear that we will call out any attempt by your department to undermine americans' health coverage.
i hope you're not inclined to seek a death by a thousand cuts approach to decimate the aca. i really do look forward to hearing from you about the administration pfls pla administration's plans for the department which you lead. i also hope this will not be your only visit and you'll return to testify on the full budget when it's released in may. again, i thank you for appearing before us, i thank the chairman for having this hearing. and i hope we can work together as we move forward, democrats and republicans, for the people of this country. those who were here talking to us about the impact of alzheimer's, for all those who have really suffered. we can make the bill better. rather than tear up the aca, let's work together to strengthen to improve it. thank you very much. >> thank you, gentle lady. i'm pleased to recognize my good
friend, our distinguished secretary of health and human services, again, secretary thank you for coming here before us. and we look forward to hearing whatever testimony you care to give. >> thank you so much, mr. chairman, chairman cole and ranking member thank you so much for the opportunity to be with you and discuss the president's budget blueprint for the department of health and human services for 2018. since i was sworn in as secretary i've had an opportunity to meet the employees at the headquarters across the street and at our many agencies around the country. i've been continually impressed with the myriad ways hhs supports local communities in times of emergency. often in ways that the american people never know about. when california's oroville dam was in danger of breaching, and when a natural disaster strikes
authorities rely on hhs data to know which households are in need oof assistance. this federal support rarely makes headlines. for the farmer who lives miles from any first responder or for the snowed in senior citizen, hhs can be a life saver. two weeks ago the president released his america first blueprint for 2018 spending. it requests $64 million for spending at hhs prioritizing critical programs and eliminating programs that were ineffective. it makes strategic efforts that will make us respond more efficiently and empower americans to make the best decisions for their healthcare needs and prevent waste fraud and abuse across the department, particularly within medicare and medicaid. the vision for hhs has been laid out in broad strokes, specific decisions on programs and account levels are still under
consideration. those details, as well as proposals on mandatory spending will be included in the president's full 2018 budget proposal which is expected in midmay. there are three priorities i'd like to highlight today. our nation's mental health and substance abuse crisis, the fight to end childhood obesity. over doses are at epidemic levels, 22,000 americans died of overdose in 2015. drugs are the leading cause of death from injury in america. this issue has hit home in any of your districts and communities. as a physician and as a american, it breaks my heart to see a deadly epidemic rage across our land. as secretary of health and human services, it's my responsibility to insure we're tackling it with all resources available. the budget blueprint reflects this commitment. hhs is investing efforts to
combat opioid misuse, increase availability of treatment and reduce deaths from overdoses, the investments include continuing the $500 million in funding. americans are struggling with substance abuse and mental illness. the administration plans on continued investment in high priority mental health issues inudcl ini. another function of the department is emergency preparedness. hhs office of the assistant secretary for preparedness and response coordinates the prepation for and response to public health disasters. the president's budget proposed to reform key emergency programs and create a new federal emergency response fund, which will allow hhs to rapidly respond to public health threats. with support from this subcommittee, hhs has played a key role in fighting the zika
virus, promoting vaccine development, advancing diagnostic and providing resources for pregnant women. the department continues to closely monitor the zika situation especially as we enter another mosquito season. hhs is monitoring and preparing for a range of threats, including viruses abroad like the avian flu virus in china. the problem of childhood obes y obesity, 20% of america's school children are obese. we owe it to them and their families to do better. and i look forward to working with you to augment the department's worthy efforts in this area. i want to thank again, chairman ranking member, and the members of this committee for the opportunity to testify today and for your continued support of the department, it's an incredible privilege for me to serve the american people as the secretary of health and human services. i appreciate the opportunity to be here today and i look forward
to our conversation. >> mr. secretary, whoever helped you with your opening remarks, keep them, they were 13 seconds, man, it was really good. let me begin, mr. secretary, as you know, the national institute of health is the primary funder of basic biomedical research in the country. it's the foundation upon which all treatments and cures are based. the nih supports transnational and clinical research on campuses at over 2,500 research institutions across the country. discoveries by nih researchers have resulted in new treatments and cures for diseases and have extended the life expectancy and quality of life for americans. congress has provided significant and steady increases in funding for the nih to help bring researchers closer to finding cures for diseases like cancer and alzheimer's, i'm extremely concerned about the impact of the 18% cut the administration has proposed at
the nhi. describe how your proposed budget would enable the united states to maintain the biomedical research enterprise and continue progress in developing new treatments and cures within this funding level. >> i appreciate the chairman's perspective. i share your accommodation for nih. i've had the privilege of visiting many of the staff divisions and operating divisions within the department. and i had a visit with nih and was incredibly impressed. have been always in my public service, incredibly impressed with work that they do. nih as you know is a part of large department. it comprises over a third of the discretionary budget at the department of health and human services. the funding level that's proposed of $25 billion remains over a third of the entire proposed budget for the department. i was struck by the need for efficiencies in decreasing duplication and the like within our entire department. i was struck by one thing at
nih. that is that about 30% of the grant money that goes out is used for indirect expenses, which as you know, means that that money goes for something other than the research that's being done. and i think what they -- the budget is trying to do is being the first step in this process -- is trying to bring focus to the kinds of things we ought to be able to do to get a greater -- bigger bank for our buck if you will. the research that's done at nih as you know is incredibly important. i support that. and want to make certain that uni young scientists and scientists who have been there for long know how much we value the work they do and want them to be able to continue. our goal is to fashion a budget that focuses on the things that work, that tries to decrease the areas where there are duplications or redundancies or waste or whether we can get a larger return for the investment
the american taxpayer in this area, which is vitally important. >> we look forward to working with you to find ways to stretch those dollars further as well. so we will be interested in your input as you go along and learn more. recent experiences with zika and ebola, other diseases highlight the importance of our investment in public health awareness. new threats can emerge at any time. the number of h 7 n 9 influenza virus infections have sky rocketed in china. if the virus becomes more easily transmittible, we could see an outbreak, particularly deadly flu strain in our country. congress recognizes the importance of public health and preparedness. in 2016 we provided additional funding for the cdc preparedness activities, project bioshield. we intend to continue these investments in fy 2017.
the fy 2018 request does not include much detail on the administration's plans to support public health and preparedness against biological threats. describe how you intend to maintain our preparedness. >> thank you, mr. chairman. in my opening remarks, i mentioned emergency preparedness and response is one of the absolute priorities. this is an area where as you know, the american people simply expect us to do our job and do it well so that they can rest assured at night that they're safe. i've been incredibly impressed with the people at the department who are in the preparedness response area, get a briefing almost daily on the work they're doing. an update on the h 7 n 9 situation in china, thankfully we haven't seen a transmission from avian source to humans at this point. and so our goal is to make certain that the resources are
available so that we can accomplish the mission that is to keep the american people safe. >> i appreciate that and before i yield to my good friend, the ranking member, as you present the fuller budget later, please take into account -- cdc plays an incredibly important role. we focus on nih. this ability to respond and protect, you know, is again, every bit as important as our ability to protect our fellow citizens against terrorists. very important that that agency remain robustly funded. because sadly, on your watch we can almost guarantee there will be a pandemic, there will be something. it's just going to happen. this is a place not to be penny wise and a pound foolish. with that admonition i want to yield to the good lady from connecticut. >> thank you very much, mr. chairman. mr. secretary, i'm going to ask a bunch of questions, and because i just have five minutes. i'd like to be able to get a yes
or no answer on these questions. will the administration commit to defending and continuing the cost sharing efforts for low income consumers the administration has done that so far, despite the house lawsuit against doing so. will you commit to defending and continuing these payments, yes or no? >> ranking member, as you know, the day that i was sworn it changed from house v burrwell to a house v price. i'm a party to that lawsuit and not able to comment. the clock running out, will the administration make a decision before the next court deadline of may 21st if not sooner. >> not able to comment. >> do you agree should the administration reject cost sharing payments as it's done for the past three years and a half, premiums will raise because of your decision. >> i'm a party to that suit -- >> but you're not a party to
whether or not -- whether it will -- if it -- if it stops, that's a judgment question. will premiums go up and will insurers drop out of the market. >> this side of the question is incredibly important because premiums have risen and it's the commitment of this administration to make certain that we are able to bring down costs for the american consumers so that they're able to afford the -- >> the question is about the cost sharing opportunities. that -- will that drive up the costs? >> that's what i'm not able to comment on. >> okay. let me then move to will you uphold the laws of the land even though you oppose? >> that's my sworn oath, yes. >> does that include enforcing the individual mandate? yes or no. >> so long -- >> yes or no. >> so long as the law is on the books we at the department are obliged to uphold the law. >> are you aware the cost of not enforcing the individual mandate, without the mandate,
premiums would jump by 20%. will you work to avoid such premium hikes by enforcing the current law? >> i think cbo has been -- puts a whole lot of stock in the individual mandate and we would suggest that the proof isn't there to suggest that the individual -- >> will you work to avoid such premium hikes by enforcing the current law? >> i beg your pardon? >> will you work to avoid premium hikes as has been projecting by enforcing law? >> what we're trying to do, the commitment of the administration is, is to make certain that every single american has access to affordable coverage. >> the office of the inspector general is investigating hhs's halting of advertising during open enrollment in january. do you intend to halt advertising again this year, yes or no? >> i haven't had any discussions about that. that was done prior to my erival. >> will you maintain the funding
provided during the 2017 open enrollment? >> we're committed to making certain that the american people have access to affordable coverage. >> will you maintain or expand the funding for the marketplace call center data services, h.u.b. and navigators, yes or no? >> those questions actually depend on the outcome of this process, this is the first step in the appropriations process. we'll see -- >> there's a judgment call about whether or not this is -- i don't know whether the decision was made to cut off the advertising during the open enrollment period in january. but that cutoff people's information about whether or not they should enroll or not. so are you -- will you continue that effort to disallow advertising to let people know about enrollment? >> that happened before my arrival. >> what will you do. >> we're committed to making certain that every american has access to afford -- >> you'll continue to do the advertising, you will do advertising. >> we're committed -- >> you'll do advertising --
>> i wouldn't commit to any specific entity because many of -- >> that's what we're concerned about, mr. secretary. let me talk about past four years every eligible person has at least one insurance company offering a number of health plans. that was because the secretary of hhs worked with insurance companies to insure access. have you engaged with these key partners to date? >> absolutely. we've met with many insurers across this country and what they tell us is that they are extremely concerned about the exchange market and the individual marketplace telling us that they aren't certain, given the current construct of the law how they're going to be able to continue to provide coverage for folks. that's what we're concerned about. that's why we believe it's imperative we move in a direction that allows individuals the greatest opportunity to have choices in the coverage they receive. >> does that include a public option? >> i think what we need to do is make certain that every single american has access to the coverage they want and it's
affordable. the sad point is the current law is making it so it's unaffordable for so many americans. >> i would assume that there will continue to be an attempt unlike what speaker ryan said about looking at repealing the affordable care act rather than looking at strengthening and improving it. >> is that a question? >> yeah, repeal or strengthen and improve? >> the department, the administration is committed to making certain the american people have access to affordable coverage -- >> does that include repeal? >> the lady -- >> i understand, mr. chairman. >> we believe the current law has harmed many individuals -- >> you will continue to move at repeal is what i gain from that conversation, thank you very much, mr. chairman. >> thank you. i know the demands on the ranking member's time are always great. i want to move, obviously, to her for whatever questions she cares to put. >> thank you very much, mr.
chairman. i do have some additional yes or no questions for you. does the trump administration believe women should pay more for health insurance than men? >> we believe that individuals ought to be able to have access to the kind of coverage they select for themselves and their -- >> yes or no when comparing men and women. >> i don't believe that's a yes or no question. what we believe is that you as a woman and my wife as a woman ought to be able to select the kind of coverage they want not the government forces -- >> i'll get to the next question. does the trump administration believe maternity care should be a covered benefit under federal law. >> again, individuals ought to be able to select the kind of coverage they want not that the government forces them to buy. >> how about preexisting conditions? does the administration believe federal law should prohibit price changes or allow people to be denied coverage based on a preexisting condition. >> the president has been clear about this, as have i.
nobody ought to be priced out of the market because of a preexisting illness or injury. it's imperative we have a system that works for patients. a system that doesn't work for patients isn't a system that works at all. >> i'll move on i'm not sure i understand that. i'd like to talk to you about title x family planning. they serve low income women and men every year offering contraceptive counseling, screening for hiv, screening for breast cancer, health education, primary healthcare services, 2/3 of title x patients have incomes below the federal poverty level. 60% of women who receive healthcare services from a title x funded clinic consider it their primary provider. in my home state of new york, more than 300,000 women and men are served each year by title x providers. in your state of georgia, almost
100,000 women and men are served each year by title x providers. mr. secretary, does your fy 2018 budget maintain funding for the title x family planning program? >> oftentimes as you mentioned, it's an individual's only line of opportunity to gain access to the kind of care that they need. one of the priorities of this administration and of this budget is to make certain that direct healthcare services are a priority. >> so is funding for title x providers included in your budget? >> i appreciate your input and look forward to have conversations. the large specific budget will come out -- >> i do look forward to that and i hope that we can agree on the funding of this program. because i'm not sure i got an answer to this question. are you eliminating funding for title x family planning services?
are you hesitant to tell this committee whether you want to cut funding for title x family planning or can we have a real discussion understanding that new york, georgia, many other places, men and women, depend on this for their healthcare services? >> well, i hope we have a real discussion and conversation. as i mentioned, the specifics of the budget for fy 18 will come out in i believe it's midmay. >> okay, i have a minute left. as you very well know, health insurance companies are required to cover contraceptive services without a copay. will you commit to insuring that policy continues while you are secretary of hhs, are women going to have to return to paying out of pocket for contraceptives? >> again, one of those areas where we believe individuals should have coverage they want
not what the government wants them to buy. we want to make sure the american people have coverage. >> if they choose to have the services covered, will you support it? >> if they choose to have those services covered. absolutely. that's the kind of program we envision. that's one where individuals are able to select the kind of coverage they want. not what washington thinks is best for them. that's one of the problems we think has occurred with the current system. >> it's clear that we have a lot of discussions ahead of us. because i think maybe, maybe it would be good for you to visit the title x services that are being provided in the clinics in georgia and you can come to new york, we could have a tour, too. >> i look forward to that visit. and i would just say to the gentle lady, that i visited many title x facilities in my capacity -- not just as a physician, but as a member of congress.
and know the importance as i said of those entities, oftentimes being the only avenue, only venue for care for many individuals across our land. >> i really appreciate that. and as i close i hope you can have that discussion with both democrats and republicans and that we understand how important these services are for people who couldn't afford to go other places to get those services. thank you. >> thank you. >> thank you, mr. chairman. >> thank you. i want to go next to my good friend, distinguished chairman of the subcommittee on energy and water appropations committee, mr. suimpson from idaho. >> thank you for being here, i want to congratulate the president on selecting you as chairman of hhs. oftentimes, you have sometimes secretaries appointed to various positions and we've all seen it where they're experts on policy and don't know politics. others that know politics but don't know policy. you know both of those. so i look forward to working
with you and i know you'll do a tremendous job. i get confused easily. by a lot of the questions that get answered in opening statements and those kind of things, i've got a few yes or no questions for you, also. do you want or believe all americans ought to have access to affordable healthcare regardless if they choose to purchase it? >> yes. >> do you believe healthcare consumers ought to have choices in healthcare coverage options? >> absolutely. >> do you believe that americans are smart enough to determine what is in their own best interest if given choices without the federal government mandating what is in their best interest? >> i do. >> thank you, i think we're on the same page. now, to something really important. a little parochial question. the cdc, nih and indian health services have dental divisions headed by dental directors.
unfortunately, hrsa has not followed suit. there is a bipartisan support on this committee and we've put it in a report language, the last two aappropriate priatioation. will you work with me to restore the position so we can appropriately prioritize oral health? >> i know your passion for this and comes from your history as a dentist. practicing dentist and i've and asked folks to look into it. i don't see any reason why we ought not been ail ble to accomplish that. >> nih is very important to this committee and congress. and we will look at the funding levels that come up, they do vitally important work. it's not only the work that they do, but they, with their biomedical research advances,
it's also they positively contribute to the economy. last year $2 billion increase, saw an increase of 27,122 jobs and more than $4 billion in economic activity. we all know the importance of nih. in the skinny budget -- this is the difficult part we can only talk about the skinny budget and not the full budget that comes out. it's a strange time. you -- the budget mentions a reorganization of nih. is that a reorganization in structure of nih or reorganization as you mentioned earlier of priorities and funding priorities and how we fund things? and if what you're looking at is trying to get more money into the actual research, i think that's important and that's something that this committee would support. >> yeah, i think it's both. we -- obviously, we're not -- we haven't made a presupposition about what the end point is in all this. understanding and appreciating that nih is a massive organization that does incredible work. as i mentioned previously, i think to the chairman, is
that -- again, i was struck by the indirect -- the amount of money, 30% of the money that goes out for grants is on indirect costs, which as you y haven't -- isn't for the specific research itself. we ought to be looking at that. that's an amount that actually would cover much more than the reduction that's being proposed. so if, in fact, there are greater efficiencies that can be had and to save money so that you can actually provide more grants for individuals to be able to study all sorts of array of diseases and challenges that we have, they do incredible work, and we need to support it. >> and i appreciate that. it is one of the things i've complained about over several years. i was told people that nih is probably the best-kept secret in washington, d.c. the good news is, they do great work. the bad news is, it's kind of a secret. once you get outside of washington, d.c., and outside of the medical community. and a lot of the research they do is in extra grants out to universities and hospitals and those types of things. and when they discover
something, it is, you know, johns hopkins university did this and stuff. what the taxpayers don't know, they're tax dollars that went through a grant to johns hopkins to discover that. and somehow, we have got to get the message out of the work that nih does to the average taxpayer, because when the average taxpayer sees what's being done with their tax dollars, i think they will be very supportive of what's going on at nih. >> i appreciate you saying that. that's been one of my charges to folks at the department. we've got to be trumpeting what it is we need to do. the american people need to know their tax dollars are being spent wisely. whether it's in preparedness and response or whether in discoveries, we need to make certain the american people know the incredible work that's being done on their behalf. >> thank you. >> thank you. we've moved to my good friend, the gentle lady from california. >> welcome, mr. secretary. >> thank you. >> mr. secretary, as was mentioned, your labor hhs budget summary recommends a reorganization of the national
institutes of health. this includes a proposal to consolidate the agency for health care research and quality into irh. at the same time, the president proposes nearly 20% reduction in nih's budget. making it nearly impossible for nih to fulfill its own core mission, let alone the mission of another agency. i strongly believe that our research portfolio is an essential part of the health research continuum, because it is the only federal agency whose entire mission is to generate evidence and how to improve health care quality, facilitate access to care, and control health care costs. given its important mission, how will your department operationalize moving into nih, and do you plan to make it an institute or a center within nih, or is this simply a way to
eliminate arc? >> i appreciate the question. as you know, this is the first step in this process, and i would love to have your feedback on this. but we envision the opportunity for the nih to assume the duties. the important duties of arc and then to decrease or reduce or eliminate the duplication and redundancies. some of the kinds of things being done at nih are also being done at arc so we look forward to the opportunity to fold arc into nih and gain those efficiencies, but also make certain we're continuing to fulfill the mission. >> well, i'm very concerned that arc's important health services research portfolio would take a back seat to basic science and clinical research within nih, especially when funding decisions are being made within a shrinking nih budget. but my other big concern about
subsuming arc into nih is the long tradition of congress being hands-off when it comes to directing research within niche. because in the case of arc, congress absolutely should be directing health services research since the federal government is paying for such a large percentage of health care in this country. so i really hope that you take a look at it, because -- and i repeat, it is the only agency that has the sole mission as -- as looking at health research, what are the safest and more accessible and affordable ways to provide that. >> yeah. and i appreciate that. and in my visit to nih and i suspect that many of the members of the committee have been there, i was really struck by the fact, and i knew this, but to walk the halls, you gain a different appreciation, that
down one hall is where the research, the scientific research, is being done, and the scientists -- the clinical scientists are working. and then -- on an adjacent hall is where patients are being seen, inpatients are being seen and cared for. so that's where we believe that there are some significant redundancies within the system itself. and obviously what we want is to make certain that the clinical perspective is gained, as well. and much of that is being -- is occurring currently at nih. >> but will there be a specific institute or center within nih? will it have its own -- >> we haven't answered that question yet. and that's part of the reorganization. but i look forward to your perspective, and input. >> i'm extremely concerned about your proposal to eliminate $403 million, approximately one half of the title 7 and title 8 health professions and nursing
training programs, current operating budget. in today's increasingly diverse operation, hrsa title 7, training programs have been invaluable as a tool in creating a pipeline of minority primary care professionals who overwhelmingly return to practice and diverse and underserved areas. additionally, over five decades of the title 8 work force programs have played a critical role in bolstering nursing education, as well as building the supply and distribution of qualified nurses for all health care settings, particularly in rural and underserved areas. your budget favors scholarships and loan programs for addressing shortages. while these are successful programs, do you have any compelling evidence that scholarship and loan repayment programs also build minority student pipelines, support retention and enhance the diversity of the health work force with the same success that
title 7 programs have shown? >> yeah, the work force issues are really pivotal, as you know. we're -- have the wrong trend in terms of work force, not just for nurses, but other health care providers. >> i was hoping for a yes or no answer here. >> one of the things we believe are important is to focus on those areas where there is a service component to the payment back of the loan or the moneys being provided for education. and that's where we have tried to put the -- the focus and the resources. >> but do you have -- >> the gentle lady's time has expired. >> title 7. >> we believe there is significant success in that area, yes, ma'am. >> okay. i would like to see that. >> thank you. now move to my good friend, distinguished vice chairman of the subcommittee, gentleman from arkansas, mr. womack. >> thank you, mr. chairman. and in -- thank -- i thank our witness this morning, and i join the chorus of people, particularly those with strong opinions on this side of the
dayis as we celebrate the secretary of health and human services. we are proud of you and look forward to your service. mr. secretary, i was pleased in your opening statement when you dedicated a portion of it to a problem that continues to challenge our country. and that's this opioid epidemic. a priority for this committee and specifically this subcommittee, and i know it's an issue that you and i have talked a lot about in your service in the house. and i'm pleased that, again, in your opening statement, that you're committed to doing whatever is necessary within the constraints of our budget and these sorts of things that we're going to do something about this. as you mentioned in your statement, cures -- the cures act, put $500 million to combat the opioid epidemic as part of
that endeavor. can you give us an update -- kind of do a little deeper dive, on how we are utilizing those funds and what the plans are of the agency to direct these funds so that we get specific outcomes? where we can actually move the needle on something that is -- seems to be moving away from us? >> yes, and i thank you for the question. because as mentioned, there are 52,000 deaths in overdose last year, 33,000 in opioid deaths -- related deaths. just a scourge that knows no bounds or no limits. every one of us know a family that's been just harmed significantly or communities that have been harmed by this crisis. you'll -- i hope that the committee members know the president today, this morning, i believe, is signing and having a ceremony to put in place or to identify a task force, a
commission, for opioid abuse, and drug addiction. and i'm pleased to be able to have the opportunity to serve on that. the 21st century cures was a remarkable commitment, evidence of a commitment by this congress to identify the challenges that we face and put resources, hard resources behind it. the grants that will go out on that will be going out in -- first of those grants will be going out in april. and will work through over the next number of months and make certain what we're trying to do is identify those areas, states and areas, that are having success in their treatment. how can -- how can we put the greatest amount of resources in an area that will -- that will demonstrate and will have the greatest amount of success and return. so that's the process that we're on. they haven't gone out yet. but we're in -- it's a work in progress. >> as you know, the knee-jerk reaction of the congress is throw money at the problem.
and sometimes we throw money at the problem without any real specific idea as to how it's going to be utilized, and there are many examples across the federal government spectrum, where money is just not -- money is important, money drives a lot of things, but at the end of the day, we -- because of constraint budgets, we need to make sure we're targeting money to the -- to the things that actually will work. and so i'm pleased to hear you say that the -- that you're looking at state programs, those that have had some beneficial results as a potential model for how a lot of this money is going to be utilized. that's good. we doubled down our efforts. section -- when we passed the comprehensive addiction and recovery act, section 303 of that act requires that practitioners and office-based opioid addiction treatment settings have the capacity to provide all fda-approved opioid medications, either directing or by referral. how will hhs implement this requirement to ensure patients
are provided with the range of options? >> this is another important area. as mentioned, we've got to make certain where the resources are going, they can actually be utilized in a way that will benefit the end user, the patient. i've shared with the department one of my perspectives, and that is we need to be thinking about people and patients and partnerships. and the partnership that is so important in this is to identify those areas in states, yes, but local communities, as well. who are actually able to accomplish the goal and the mission of mitigating the problem, getting people who have been hooked in this devastating challenge to be able to treat them in a way, treat -- provide treatment that increases the likelihood of them being able to concur this challenge that they have. and that's what we're looking at. >> mr. chairman, as you know, i'm on the defense subcommittee, and i have a european command brief i need to get to. so i won't be here for a second round of questionings, but i appreciate the time and i appreciate the service of dr. price. wish him the very best as i do the atlanta braves.
>> thank you, sir. go braves. >> we do miss the go braves, after every pledge of allegiance we give at republican conferences. we used to hear. but your fellow georgians are much more muted than you were, mr. secretary. with that, i want to go to my good friend, the gentle lady from california, ms. lead, and recognize her. >> thank you very much. good morning. >> good morning. >> thank you for being here. and, of course, i want to congratulate you, and say a couple of things before i ask you a couple of questions. as i look at your budget and the deep cuts, which disproportionately impact the poor, low-income, middle-income, people of color, really impact everyone except the very wealthy in our country. i see once again, and i just have to say this, mr. secretary. i see what steve bannon meant when he talked about deconstructing the administrative state.
as a secretary of the agency, the millions of people rely on -- it boggles my mind to know that you and your agency support this kind of a budget. it appears that you want and your agency wants to actually deconstruct the department that you are leading. the affordable care act is the law of the land. the president, however, cynically said that it was going to explode on its own. and i'm concerned that your agency, through this budget and its policies, really are trying to make it explode by some of these cuts. so a couple of questions. first, and, again, you can answer these yes or no. because they're pretty straight forward. are you planning to narrow the essential benefits that insurers are required to cover under the affordable care act, given it's the law of the land? >> as i mentioned before, what our goal is and mission is, to make certain that every american has access to affordable
coverage. whatever we can do to make that happen, we think is vital. >> that's an essential benefit under the law of the land. do you believe that insurers are required to cover pregnancy, maternity and newborn care? >> as i mentioned before, what we believe is that it's important for every single american to be able to choose the kind of coverage that they want as opposed to have the government force them to buy what's -- what the government believes is best. >> but this is the law of the land, mr. secretary. do you believe that -- >> also i also said, we will enforce the law of the land. >> okay. then you're going to make sure -- >> lay out the law of the land. >> essential benefits are covered. >> law of the land. >> insurers should be required to cover mental health services. >> if it's -- if it's aspirational, we believe, again, that every american ought to be able to purchase the kind of coverage. >> it's not. it's the law of the land, mr. secretary. it's not aspirational. >> it depends what your question is. what's the law, then we are committed to carrying out the law of the land. >> the law of the land, okay. and also insurers in terms of being required to cover prescription drugs. that's the law of the land.
do you believe that insurers should cover prescription drugs. >> we're committing -- we're committed to fulfilling the oath. i'm committed to fulfilling the oath i took, which is to carry out the law of the land. >> thank you, mr. secretary. now let me ask you about the cuts as it relates to hiv and aids. the overall budget. as you know, we've got a huge problem in america and throughout the world. and we're making some progress in a bipartisan way through rand white, through the minority aids initiative. yet your budget cuts, about $350 million from that. so i guess i just have to ask you. do you really believe that we need to continue in a bipartisan way to address hiv/aids crisis, both here and abroad, as we have done in the past? >> yeah, this is one of those, as you well know, one of the great success stories. ryan white, which started i think in 1990, and we have seen incredible progress in the treatment, detection and
treatment of hiv/aids. it's why we have -- we believe, and will continue to make as a priority, the direct services, direct care services in the ryan white area. >> mr. secretary, though, the -- do you agree with the proposed cuts in your budget to hiv and aids? >> as i said, what we are -- what we endeavor to do and what we will make as a priority is those direct services, whether it's through community health services, whether the ryan white program or other. >> so you agree with the cuts to the minority aids initiative, ryan white and all of the other programs, based on the $350 million cut that you appropriated. >> as i said, what we believe, and i'm -- i'm not sure where that number is coming from. the -- what the final numbers will be out in may. the specific priority that we have, as i say, is for direct services through community health centers and through the ryan white program. >> one of the issues we addressed in the affordable care act was -- were the issues as it relates to health equity, as it
relates to communities of color. now, in your budget, you propose an $11 million reduction for the office of minority health, which is focused on improving health outcomes for minority communities, low-income families and minority health training, minority health institutions. and with this $11 million cut, again, it's included as part of the affordable care act health equity. so how did this justify upholding the affordable care act? the law of the land with this cut? >> we're absolutely committed to looking at health disparities and the challenges that exist there. i've been incredibly struck by even in metropolitan areas, i used to represent a district outside atlanta. and in atlanta, there is a zip code that has -- >> mr. secretary, with an $11 million cut, how can you say that? >> because what we -- what we -- as i said, what we're trying to do is to make as a priority the community health centers, the kinds of direct services
available to individuals, and find efficiencies in the system. it's a tough budget area time to find efficiencies in the system. our goal is to make certain that those individuals that we concentrate on those individuals, and have it as a focus, higher health outcomes for them. >> you can't do that with an $11 million cut, mr. secretary. and, again, going back to the affordable care act, this is the law of the land, the office of minority health and expanding the initiatives under health equity. >> i think what i would say in response to that is that as i think mr. womack said, we -- we tend in this town to be -- we measure oftentimes the wrong things. and i would suggest that the amount of resources going into a problem, without measuring the outcomes, you mentioned yourself that the outcomes, the health disparities, dictate that the outcomes are as we believe they ought to be. yet we continue to believe that simply throwing money at the problem is the solution. we believe that it's important to look at that, identify what the metrics -- what we're actually measuring.
what's the data. and then move forward. >> the data shows it's beginning to work. >> the gentle lady's time is expired. >> thank you, mr. chairman. >> you're welcome. the chair reminds all of us, himself included, we're trying to enforce the five-minute rule here. so that everybody can ask their questions and the secretary has ample opportunity to provide a response. so with that, on the basis of order of arrival, mr. mullennar is recognized. >> thank you, mr. chairman. and mr. secretary, welcome. and also congratulations. and i just reflect that your lifetime of service as a physician, as a public servant and now in this role, i really believe you're at an important place to make a contribution to moving our country forward. so thank you for serving and it's great to see you again. i had a few questions. first i wanted to talk with you a little bit about some of the medicaid managed care issues, and perhaps you may be aware
that in some states, outstanding payments to medicaid-managed care organizations exceed $3 billion, and in fact there's one example of an individual managed care organization carrying unpaid receivables approaching -- even exceeding $500 million by states. and they have received little of their allocated federal match dollars. and i'm becoming worried that the instability this creates puts managed care organizations, medicaid providers and most importantly, millions of medicaid beneficiaries relying on these benefits at risk. and i just wondered if you could comment if the department has any plans or any tools in the tool box to address this issue. >> yeah, i appreciate the question, because this is really important. if you're -- as a formerly practicing physician, if i didn't know that income stream would be continuing, it wasn't clear for me whether i would be able to continue to care for
patients. whether it's hospitals or physicals or other providers. so what -- having been there short time, we're going to put significant focus on -- on how these payment streams can be much more predictable, much more certain. and if there is -- you can't -- you can't ask these folks to lay out there, stand out there for years at a time and not have some resolution. we're committed to working through that process. >> just as a quick followup on that, one of the issues that's been raised as the social security act has an anti factoring provision that prohibits medicaid payments to anyone other than a provider. and what this does is prohibits, you know, mcos from assigning their medicaid receivables to lenders who are not considered providers. i didn't know if there is anything that could be done to clarify some of the anti factoring provisions so that, you know, some of these
providers can access capital when states are having difficulty making payments. >> yeah. i'm not -- i'm not familiar with that specific item. but we're happy to work with you and see if there is a solution there. >> okay. okay. thank you. and then i appreciate your comments on the emergency response fund. wondered if you could offer some more information. would you as the secretary manage that fund? >> to what fund, do you -- >> the federal emergency response fund? >> that's the new -- the new task force? >> yes. >> yes. we would be controlling over that, and determine exactly what level and what kind of resources would be appropriate for that fund. but that's a work in progress, as well. i would love to have your feedback. >> okay. and then also wondered about your thoughts on barda and the development and counter measures at hhs. do you believe barda is going to have the resources it needs to continue its mission moving
forward? >> it's really important. this has to do with whether or not we're prepared in the event of a potential bio terror attack and the like. and the focus that we believe is important so to make certain that it is a priority, and that we have the resources available to accomplish the mission to keep the american people safe in the event. >> okay, thank you. and then one last question on poison control. i know in michigan, we have a poison control center, people can call, you know, the center in michigan received over 70,000 calls from citizens, hospitals, health care providers. pharmacists, nurses, ems providers. opioid situation, where people need to understand quickly how to respond. in the past, my understanding is they were funded at $18.8 million, and will you continue or do you envision continuing this kind of a structure or this kind of funding for poison control centers? >> yeah, we're working through the funding on all levels,
especially in the area of opioid abuse. and overdose. the numbers are staggering, as you well know. and as i mentioned before, we've all season remarkable challenges in our communities, far and wide. and so whether the greatest resource or the greatest venue for making certain that individuals are able to be resuscitated from a potential overdose, whether that's a poison center, poison control or elsewhere, we want to make certain we're doing the kinds of things that will affect the patient. >> right. well, again, thank you, mr. secretary. i work forward to working with you moving forward. >> thank you so much. >> next go to a new member of the committee, good friend, my gentleman from wisconsin, mr. bowcan. >> thank you. welcome, secretary price. great to work with you on the budget committee. let me try to follow up on a question. last week, president trump said that if the repeal failed, that
the affordable care act was the law of the land and he was going to move on. this week it looks like there's more attempts to repeal the affordable care act. what is the position of the administration at this point? is it to repeal the affordable care act? >> the position is that we find ourselves right now in a position where the current system is not working -- >> i got that answer before from you. i guess the question specifically, mr. secretary, is he said he was going to move on last week. this week it looks like they're still trying to repeal. is it just that -- are they not moving on, like the answer was last week, or is it that you are trying to still repeal the law? >> we have to fix the problem. there is a huge challenge out there for folks. they got one-third of the counties that only have one insurer. five states -- >> so the administration is still trying to repeal. maybe this is a better way of asking. >> we're trying to make sure that individuals have access to coverage and care. >> the failure of trumpcare, was it due to the democrats not voting for it, which we were never consulted, which is one tweet. was it due to the tea party, which was another tweet. or was it due to 18% of the
public supporting it? what was the reason? why did it fail last week, in your assessment? >> well, i'll let others make their conclusions about that. what -- what our department is focused on is to make certain that american people have access to care and coverage so that they have the highest quality. >> so you don't know necessarily why it failed last week. is that the -- you just don't -- i understand. i gotcha. i was just curious if you had an insight, programs, being on the inside. nih, you know, i think you're going to hear from many of us, very, very important in my state of wisconsin. there is a document yesterday that got some press. it looks like it came from omb, suggesting in the 17 budget to cut nih, i think $1.2 billion. was your office consulted on this document? >> there were conversations at a staff level about -- about that document coming forward. i don't know if there were conversations about the specific reduction. >> are you supportive of the $1.2 billion cut in the 2017 budget? >> as i mentioned before, i think what we need to do is to
identify savings so that we can provide the greatest amount of bang for the buck for the american people. and i support the priorities of the budget. >> so you support this document. >> support the priorities of the budget. >> in this specific document for 2017. >> well, that's a work in progress, as well. as you know -- >> i think we've got until the 28th of april which i believe also turns out to be ironically the 100th day of the trump administration. hopefully we don't have a shutdown on that day. so on nih, another question. you voted for the 21st century's cure act. we finally put some money in niche. i know you were in support of that, correct, when you were in congress. now there looks like a $5.8 billion cut for 2018, you're supporting. our problem is, you just mentioned the overhead and indirect costs. what are some of the those costs that are the indirect costs, the 30% you're trying to address? >> when a grant is let, many of those -- 30% of those monies go for the facility, they may go for administration, they may go
for all sorts of things at the -- either university or study center. research center. that don't have to deal with the specific research being done. >> so if i could, i would love to offer an invitation as well to come to wisconsin. you might want to wait another month or so, when the weather gets a little better. i'm sure senator johnson and senator baldwin would welcome this invite, as well. we're studying right now with a lot of nih money, everything from flu viruses to zika, diabetics, heart disease, colon and lung cancer, skin replacement, ebola, opioid abuse. we have a world-class research university. also you mentioned the need for new researchers. i think when i've talked to folks around some of these costs, they're afraid that no matter what, they're going to see less money going for the very cures that we just voted for, you and i, and the 21st century's cure act. i would like to extend that invitation, if you get a chance. we've got some amazing stuff happening in wisconsin and i would love for you to see that
firsthand. >> cheese, as well. >> amazing cheese, as well. drug importation. i talked to you on the phone yesterday about this. no so, again the president said he is going to remove barriers for entries into the country and talk about other concerns he had around the high costs of prescription drugs. you know, i guess if you look at the prices of drugs in other countries, and ireland, in particular, one i looked at very closely. canada, for example, you can pay $256 for an aurth rightis drug that in america costs $1126. and it's 28 times cheaper in ireland for the same drug. do you think that's fair? for the american people? >> i think you have to get to the root causes of why the costs are -- president is committed to this. >> i guess specifically, what's your department doing from negotiating drug prices or other issues, what's your department doing to try to address those concerns the president brought up? >> we're in the process with the
white house of formulating a strategy to address that. as i said, the president has on multiple occasions voiced his commitment to making certain that we do as a nation have a strategy to bring those prices down. >> i would volunteer to be one democrat to try to help on this side, if you're looking for some advice and suggestions along the way. >> there are a lot of folks on both sides of the aisle who have concerns about this, as you well know. >> thank you very much. >> thank you. >> just so the gentleman knows, the 28th of april is also the chairman's birthday. and i'm certain that my colleagues on both sides of the aisle and the president will not allow that to happen on my birthday. >> maybe they want you to take a holiday for that day. >> absolutely. and i will go to my good friend, the gentleman from maryland. who has considerable expertise in these areas, because of his professional background. the gentleman is recognized. >> thank you very much, mr. chairman. doctor, it's good to see you. it's good to be calling the
secretary of hhs doctor. we have someone who truly understands health policy in a way that is difficult to do if you haven't delivered care to patients. let me just dispense very quickly with something about the american health care act. the cvo scoring, and you -- you know, obviously -- it's -- a lot of it is unintelligible. they assumed all regulations stay in place. they assumed only the statutory change, is that correct? >> they just were scoring the first -- first piece of legislation. >> and, in fact, the secretary, and we know because thousands of times in the aca it said the secretary shall, the secretary will, whatever. that you have -- you do have -- and this could be a very short yes or no. you do have the ability to make regulatory changes that would dramatically lower the cost of insurance for americans. >> 1442 times, the aca said the secretary shall or the secretary may. >> and the cbo took no account of that at all in their scoring. >> i don't know their methodology, but i don't believe so. >> right. and that's what i thought. okay. let me get over to the --
obviously, we're all very interested in the nih, but you know, you bring up the issue of indirect costs, which is interesting. i have had nih grants. i know how it's done. are you aware that when the american lung association issues a grant, research grant, to a researcher at hopkins or somewhere else, they pay no indirect costs? they don't allow them? the american heart association, maximum, 10%. alzheimer's association, people in the room, 10%. bill and melinda gates foundation. 10%. that's it. robert woods johnson foundation. they are really generous, 12%. and yet the nih, on taxpayer dollars, are allowing grants to go out at much, much, higher indirect costs. you don't have to answer. i would just make the comment, it's very interesting that the private sector doesn't hold these indirect costs to be so valuable as to pay them.
but when the taxpayer dollar is involved, somehow we do. and you're right, the indirect cost total for last year was $6.4 billion. actually, if we just issued our grants with american lung association rules, we could actually fund more research than we do now. with the president's skinny budget proposal at $5.8 billion cut. anyway, let me move on. because you're also in charge of the medicaid program in hhs. and medicaid is a broken system. anybody who is in the practice of medicine knows, it's a broken system. in fact, you're aware, i assume, of the oregon experiment paper, published in "new england journal of medicine," this is the premier medical journal that showed when you enrolled people in these medicaid expansions in oregon on a lottery basis, lan dommized is great. you couldn't design a study that well. showed that there was actually no difference in outcome. with diabetics, hypertension, it
was pretty stunning, actually. it actually testified as to how broken our concept of medicaid -- as a solution for the american people is. beyond that, if you go to the omb website, i guess it's called the payment accuracy.gov. it shows that the improper payments in the medicaid program last year on total payments of $346 billion were $36 billion. almost -- $36 billion of improper payments in a program that scientifically shown, doesn't even help people. really doesn't help their health outcome very much. so i would hope -- i mean -- and medicaid -- medicare similarly, $41 billion improper payments. as secretary, we were promised when the affordable care act was patched. part of the payment, we're going to eliminate waste, fraud and medicare. and last year we had $41 billion in medicare. as secretary, do you commit to us that as we commit funds to
the department, the department is going to take a real hard look at how we -- just between those two programs, it's $77 billion. i'm sorry, it's -- medicaid -- if you could put medicare -- yeah, $77 billion. medicare advantage, $90 billion. commit to us that you're going to take a real hard look at those issues? >> absolutely. it's one of our priorities, is to try to find the waste and abuse that exists. and, in fact, as you well know, in the medicare program, for every dollar that's spent on trying to detect fraud and abuse, there's a $12 return on every single dollar that is spent. so this is an area where we believe there is some significant savings that can be had. >> it seems like a good idea. and just finally, i just hope that you -- you know, on the fda's side, the laboring rule is an issue. please take a look at it. small business owners come to me every day with issues. thank you very much. i yield back, mr. chairman. >> i thank the gentleman. and again, just want to remind the gentleman, i too am a
doctor, just not the kind of doctor that can help you. with that, i want to go to the gentle lady from massachusetts. before i do, i want to say she may be the smartest member of this committee. because she was kind enough to send me two extra tickets to the president's inauguration. so probably in higher demand in oklahoma than massachusetts. but the gesture was very much appreciated. >> we are always pleased to help you. and thank you, mr. chairman. thank you, ranking member, thank you, mr. price, for being here with us today. thank you for your call. i'm sorry i was unable to connect with you before this hearing. but i appreciate it. secretary, a topic that keeps coming up, and i was -- i share your characterization of the scourge of this opioid crisis as heart breaking. this is an issue that doesn't care if it's a red state, blue state, what level of education
you have, how much money is in your bank account. it's an equal opportunity killer. but it also ties into the affordable care act. and the mandates. because as you know, addiction treatment was one of the ten essential benefits that were covered by the affordable care act. that mandated that insurance companies cover treatment. and what has that meant? that has meant this provision has helped 2.8 million people with drug use disorders get the treatment that they need. and if we repeal that provision, that would take out at least 5.5 billion annually from the treatment of low-income people with mental and substance abuse disorders. the number that you used, 52,000 overdoses, is even higher than the numbers that i've seen of
32,000 deaths a year from overdoses. this is a staggering impact on our country. will you support mandated coverage for addiction treatment? >> just to clarify, the $52,000 is deaths from all overdoses, not just opioids, and 32,000 from opioids. and the numbers are -- it's an upward spike. this hasn't been flat. >> that's right. >> it's an awful scourge. this is -- this is remarkably important, to make certain we have treatment available for folks. and that's why we are going to make it a priority. i'm struck, however, by the 20 million individuals who don't have any coverage at all through the aca. and i believe that there are reasons for that. they're either -- they either took the penalty or asked for a waiver. and i would suggest respectfully that we ought to look at why that is. why is it that 20 million americans say no, thanks, i don't want that coverage, even though it's mandated, even though there is a penalty for
it. so i would hope we could work together and fashion a program that would attract those individuals to get the kind of coverage that they want for themselves and for their families. >> and i would be delighted to work with you on that. but i would like to know specifically, do you support a mandate for insurance coverage for treatment? >> what i believe and what we believe is that every single american needs access to the kind of coverage that they want for themselves. >> but do you support mandating it? that is the -- that is the law under the aca. do you support that mandate? >> we support the ability for every single american to have access -- >> can you answer me specifically? yes or no? do you support a mandate that insurance companies cover addiction treatment? >> it's not a yes or no question. >> it actually is. >> no. because the answer to it is that we believe that it's absolutely vital that every single american have access to the coverage that they want for themselves. >> so i'm going to take that as a no.
because if you -- you either support a mandate or you don't. and there are certainly ways that we can increase coverage. but if you don't support a mandate, and you're concerned about people who even, with mandated coverage, have chosen not to avail themselves of treatment, how would you -- how would you answer the question to the families at home who are ravaged by opioid addiction? that at that point in time, then they will go out and seek from a menu item of insurance treatment and try and buy themselves coverage? is that what you envision? >> there are certainly other ways to provide coverage and care for folks that don't require the federal government to dictate to people what they must purchase. >> so do you -- do you see the mandate -- the mandate for addiction treatment coverage as dictating to people what they must buy? do you see those as equivalences? >> when the federal government -- >> that's a yes or no. do you see that as an equivalency? >> what the federal government
decides exactly what coverage you must purchase, then it's deciding what coverage you may not purchase. >> so you would see that the mandate that we have under the current affordable care act, two insurance companies that they cover addiction treatment, that that is somehow limiting people's options. is that right? >> as i said, what we believe is that every single american needs to have the opportunity and be able to afford the kind of coverage that they seek for themselves and for their family. >> so will you protect access and medicaid funding levels to ensure that those people do not lose their access to substance abuse disorder treatment? >> substance abuse and addiction treatment is absolutely a priority. but as you heard from dr. harris, the medicaid program is woefully broken. when i talk to my former colleagues as a physician, they tell me that it's virtually impossible for them to care for individuals in the medicaid system. you've got a third of the physicians in this country who ought to be caring for medicaid patients who don't. and it's not because they don't want to see them. it's because the system is
terribly broken and making it so that they are -- they can't. >> i don't see how we are going to improve that system, but i do want to ask you one more question. >> the gentle lady's time has expired. >> all right. i will get you on the second round. thank you. >> i thank the gentle lady. next we go to the gentle lady from the state of washington. ms. herrera butler. >> thank you, mr. chairman. and thank you for being here. great to see you. and thank you for all of your work. i can only imagine. but even with your background as a physician, and your background in congress, and caring for folks, it's got to be a bit like drinking from a fire hose. we appreciate it very much. a couple of things. every year, about 4 million women in the u.s. give birth and more than 3 million breastfeed their infants. nearly all of these women take a medication or receive a vaccine while pregnant or breastfeeding. or it's recommended. pregnant women with chronic conditions such as asthma,
epilepsy, diabetics are faced with very difficult decisions. whether to take a med kaths occasion or they have no information or background on or whether to fight through what their condition is. i work with a number of folks to get included in the 21st century cures bill, language around a task force. and nih asking them to examine the gaps and knowledge around safe medications for pregnant and nursing women and the national institute of child and health development has begun implementing this task force. expect absent moms and health care providers need more data and information in order to make informed treatment decisions. and they need it yesterday. i just wanted to bring this to your attention, and ask for your help and prioritizing this as we move forward. >> absolutely. this is one of those areas where people assume that the data exists. but, in fact, it doesn't. and the kinds of studies that are so necessary to make certain that moms and families know that something is either safe or not. so that they can make an informed decision. >> thank you. on to a different one. every year, thousands of americans donate a kidney or a
portion of their lung or liver or pancreas or intestine to save a family member or friend or total strangers. organ donation does save lives. and i have introduced the living donor protection act with congressman adler. and it was remarkable to me as i sat and listened to stats. there is 118,000 people on the transplant wait list. 99,000 of them need a kidney. and everybody has two kidneys. well, almost everybody has two kidneys. it's one of those things that -- we could -- right now i think it's about 1 in 12 -- or 12 people die a day waiting for that. every ten minutes we add people to that list. and this is something that we're having -- part of the reason we introduced the living donor protection act, was because -- what we have seen in some instances is insurance companies will discriminate against someone who has given an organ when they don't realize in order to give an organ, you have to be the creme de will he creme.
the most healthy, tip top. everything has to be working well before you're allowed to be considered. yet companies will discriminate against them. we're trying to get some of those things fixed and addressed. i wanted to raise it to you. i think there is -- what i was looking at some of the numbers i've seen. kidney disease is the ninth leading cause of death in front of breast cancer and prostate cancer. 26 million americans have it, most of them don't even know. this is going to be a real challenge in our future. we want to encourage those folks who can donate to do so. and i just wanted to raise that to your level, as well. and one more thing, since i have a few more moments. and i'm going to read it fast. given the unprecedented advances in genetic testing, and screens and the rapid and widespread application across medicine, which is both exciting and terrifying, i'm concerned that folks we represent will be receiving genetic and genomic
tests like prenatal, dna screenings without the appropriate pre and post genetic counseling. oftentimes these tests can mean different things. even though they're advertised as one thing, the information that's given out isn't always given out accurately with all the drawbacks. and i wanted to ask, and i have a bill on this. but i wanted to ask your view on this issue, and the importance of making sure there's accurate genetic counselors to ensure that patients and physicians get the benefits of the genetic and genomic testing or screening. and they're aware of the pitfalls. people make decisions based on these tests. >> really important. and it's important that the individuals that are conveying the information are knowledgeable. because sometimes there are specific agencies that can be provided about the risks or the consequences of the results of the test. sometimes there is not. and you need to be able to treat that with compassion and knowledge, as well. >> absolutely. well, with that, i'll give back
the balance of my time. >> wow, you win gold stars. and you always do. again, just flamake sure everyb has an opportunity for questioning. the gentleman from texas. >> thank you, mr. chairman. secretary price, i know you'll appreciate this, having been a great member of this austere body. i was delayed this morning, because i was asked to preside as speaker pro tem at the last moment. so i apologize for being here a little bit later. but let me echo the plaudits of the people on this dias when i say congratulations on your appointment as secretary. thank you for your service, not only in this house, but to the administration, to our country. it's a very difficult time in this nation. health care is a very complex issue. you've got my full support. and, again, profound thanks are -- if i may begin, i
actually have a -- an unappropriations question to start off with. and it's regarding an issue for federal drug testing programs, sir. the department of transportation requires trucking companies to follow hhs guidelines when screening truck drivers for drug use. it's my understanding that samsha has been working on developing guidelines for hair testing as a federally accepted method for several years. and congress strongly endorsed and accelerated development of these guidelines in the fast act. it has been over a year, and samsha still has not produced these guidelines. i wanted to make sure that you were aware of this, sir. and as the completion of these guidelines will greatly improve truck safety, and secondly, would like to know if you might have any insight as to when we might expect them to be completed.
>> yeah, i appreciate the question. and i learned this yesterday. i wasn't aware that that work was going on. and i appreciate the focus on it. and we will get -- we will -- we're looking into that, and i'll get back to you on the specifics of when you might anticipate an answer. >> thank you, sir. earlier you were kind enough to answer a colleague for my dear friend and colleague, mr. monthlienour. i would like to revisit that, if i may. mr. secretary, as you know, hhs leads federal preparedness and response activities for public health emergencies, including the development, stockpiling and distribution of medical counter measures. like vaccines and treatments for national security threats. for the last decade, the biomedical advance research and development authority, barda, and project bio shield, srf, have successfully partnered with bio pharmaceutical manufacturers to develop and stockpile products to protect americans
from the most urgent threats we face. like anthrax, smallpox, ebola, and now zika. funding for barda and bio shield has been consistently supported by members on both sides of this committee. for more than a decade. i'm glad to see that you have been a long-time supporter of barda's critical mission. unfortunately, the previous administration, i would argue, did not prioritize barda and the development of medical counter measures at hhs. can you commit to ensuring barda has the resources it needs to continue this critical mission moving forward, sir? >> this is an absolute priority to make certain, as i mentioned before, the american people expect us to be prepared and be able to respond in the event of a challenge, especially in bio terror areas. so it is an absolute priority of the departments. >> thank you, sir. my final question, secretary price. the national academy of science has reported there is a declining number of research grants awarded to early
investigators, a rise in the age of grant recipients and the suggestion that there may be a research brain drain. last year, more than twice as many ro 1s, are awarded to principle investigators who are over 65 and those under 36. that is a total reversal from only 15 years ago. currently, the nih ro 1 grant applications work against young scientists, because they don't have the preliminary data to support their application. young researchers cannot get the preliminary data without significant funding creating a catch-22 for the young investigators. with these concerns in mind, do you have any input in how we can empower and encourage the next generation of researchers to keep their talents going toward american scientific innovation. >> this is really imperative. as -- there has been a flip, and in terms of the age of the grantee. and we need to get to the bottom of that.
i don't have an answer as to why that has occurred. but we're -- we are looking at that, and we'll continue to look at that. so that we can indeed address it. because these young scientists, we want them to remain here. we want them to be here and be able to use their talents for the benefit of all. >> thank you, mr. secretary. i believe my time is up. again, i wish you every success in your endeavor, sir. >> thank you very much. >> i thank the gentleman. the secretary has a hard stop at noon. he has another meeting that i know he has to attend. so i want to guarantee him -- he's free to get up before the middle of a question. but i won't let that happen. i know he's got to go at noon. to try and get in as many people as possible, we're going to move to a two-minute question, if we may. and i'm going to ask folks to adhere to that. the one exception i'll make is we have a member that was here, and when they get back, they'll get their five minutes in the same way all of us had an opportunity to ask five minutes. and i think i'm actually next up, right?
okay. so my two minutes. i will hold myself to this, mr. secretary. number one, thank you very much for taking the time yesterday to meet with chairman calvert and myself about the indian health service. not our direct responsibility in this subcommittee, bun it's part of your department and i do sit on the subcommittee at interior, as my friend, mr. calvert chairs. and, you know, that's important here, too. you're aware, american indians, alaska native, continue to live with health disparities greater than any other racial or ethnic group with a life expectancy, literally, four and a half years less than other americans. in fact, in some states like montana, american-indian men have a life expectancy of 20 years, less than their white counterparts. i know you haven't had an opportunity to flesh out your budget here. but i want to know how you expect your budget requests, hopefully, to help the indian health service, and other hhs operating divisions to address
health disparities in indian country. >> i at this that the chairman -- you have been such a champion on this. this is one of those areas where as i learn more and more, it is readily apparent to me that the kinds of work that we must do has to increase in the indian health service to make certain that we decrease those disparities, yes. but also are looking at the things that actually mean something. that is the outcomes. i was struck yesterday during our meeting with the graph that you all shared with the per capita amount of resources, federal tax resources that are going to the indian health service, as compared to medicare, medicaid and other federal health programs. and it just is very clear to me that this needs to be a focus. it is a focus. it's a priority of the department to make certain that we move in a positive way to address the real challenges that are in the indian community. >> i thank the gentleman. i look forward to working with him on that issue. with that, i go to my good friend, the ranking member.
>> thank you, mr. chairman. mr. secretary, quick, because i only have two minutes. yes or no answers. do you support the elimination of lihep, yes or no, move. i don't have time. do you support the elimination of lihep? yes or no? >> the responsibility of the department is to make certain that the needs of the american people are met. >> so you support the elimination of lihep. elimination of cspg, yes or no. >> what we're trying to do is to identify those -- >> yes or no? elimination of community services block grant. >> and where there are partnerships. >> no, okay. niche. the $1.2 billion, mr. poecan spoke about. do you support that, if the staff was looking at it, you must have been involved in that decision to go an additional $1.2 billion in a cut to the niche. in 2017. and in 2018 do you support the cut to the nih? >> it's clear in the remarks by me and others on the panel -- by others on the commit --
>> is a $6 billion cut to the nih, do you support it or no? >> there are efficiencies to be gained at nih. >> so you support a $6 billion cut in the nichh. have you divested yourself of all health care related investments? yes or no? >> as i said to the confirmation committee, that as we move through that process -- >> yes or no! >> the answer is yes. >> thank you. have you fulfilled the terms of the ethics agreement worked out with the office of government ethics? >> yes. >> okay. will you send the subcommittee a letter to fulfilling all of the elements of the ethics agreement? >> all of that is publicly available. >> can we get a copy of that? >> publicly available. >> so we will get it on our own. my last 17 seconds. it would appear, mr. secretary, that one fact for all of those who want to talk about the opioid crisis, that, in fact, if you voted to repeal the affordable care act, you would have voted to make the opioid crisis worse in this nation. you don't believe in insurers
covering maternity care, pregnancy, newborn care, mental health services, and substance abuse treatment. all of which come out of your department. mr. secretary, i think you're at the top of doing what mr. lee talked about, deconstructing an agency and dismantling health care in this country. >> i would respectfully dispute that. >> i'm sure you would. >> i want to now go to the gentle lady from alabama. she has a full five minutes, because this is her first opportunity to ask questions to the secretary. gentle lady is recognized. >> thank you, mr. chairman. so glad to have you here. >> good to see you. >> proud to call you mr. secretary. so we're real glad to have you in front of us today. i want to talk about wage in hospitals, now facing some acute financial pressure, because of this health care disparity created by the specific medicare regulation. and it's adversely impacting
alabama. the wage index doesn't get a lot of attention, although it should. it's a serious problem for a large number of states. and it needs to be addressed. it was created to account for geographic differences in wages. and many, including myself, believe that it's broken. hospitals in my home state have been punished for operating efficiently, receiving one of the lowest medicare reimbursements in the country, because of the flawed wage index system. so it creates this disparity that effectively punishes efficient hospitals in most rural states. in many of these states, these hospitals have seen the area wage index levels rapidly decreasing over the years, reducing the medicare reimbursements in order to subsidize increases to hospitals in a handful of states. so secretary price, i really just want to hear from you about whether or not you would be
willing to work with us to repeal this wage index and replace it with a more accurate and fair system that would help us with these financial placed on so many hospitals, including the ones in the great state of alabama. >> this is really important because i mentioned to another questioner there are folks who are providing care that aren't able to provide care for folks not just in the medicaid program but in the medicare program as well and oftentimes it's because of programs, policies, formulas that are just -- they've outlived their usefulness. it's a demonstration of the lack of ability of the federal government to be nimble and flexible and respond to changes in the market so that the patients can be cared for in a better way. we are absolutely committed to working with you and others to try to identify the most flexible, the most effective way to provide treatment for the patients of not just alabama but the entire nation. >> well, and i appreciate the work that the hospital
association, you know, at the national level, but certainly in our state as well the work that they have done to try to draw some more attention to this issue and so i'm grateful for any opportunity to work with you. i understand that this is not going to be necessarily a partisan issue as much as it is an issue amongst the states because there are winners and losers and i just -- i believe in fairness and i think that there are people that are un -- states, particularly rural states, that are being unnecessarily on the losing end of this. just real quickly i have spoken about in this committee many times the achievements of pre-k in my state and so i just want to touch on it really quickly. and i guess i can skip through some of this because my time is running out, but can you describe for us in as much detail as you can how the
president's fy '18 budget proposal can ensure that a new competition will take place under the preschool development grants program and your plan for that competition, how will the department support improved collaboration and coordination amongst early childhood programs at the state and local level through the preschool development grants program to better serve low income kids and families? >> yeah, this is really important as well and it is a work in progress and we look forward to working on you to make certain that the resources are there and available. there are programs that are effective, there are some that aren't effective and we need to make certain that we are providing the resources for those that are effective and that's a commitment that we have. >> great. thank you so much. thank you, mr. chairman. good to see you. i yield back. >> thank you for yielding back the extra time. the gentle lady from california is recognized for two minutes. >> given the two minute timeline
i've redrafted my questions so that you can answer it yes or no. and this has to do with lead poisoning and prevention in public health fund. the ongoing flint water crises and the exit contamination in my own district underscores the severity of public health crises posed by lead poisoning in many communities across the country. according to the best estimates available lead poisoning impacts approximately half a million u.s. children age one to five. cdcs national center for environmental health currently receives $50 million for lead poisoning made possible by the prevention and public health fund. cdc uses this relatively small amount to fund 29 states, d.c. and five u.s. cities to conduct lead poisoning prevention activities. if efforts to eliminate the prevention fund through aca repeal are successful cdc would lose 12% of their annual budget including all of the lead
poisoning prevention funds. given the serious impact of lead poisoning on our children, will you protect the prevention and public health fund and expand the cdc lead poisoning prevention program to all 50 states, d.c. and the territories? >> i will make sure that we address the issue without a doubt as flint demonstrate that had we need to make certain that water is safe to be consumed by the american people and the role that cdc has is significant. >> but will you protect the prevention fund? it's a simple yes or no and i have one more question and i have 28 or now 26 seconds to ask it. >> whatever way we're able to accomplish the goal and the mission to keep the american people safe in the area of this -- in this area we will do it. >> okay. will you ensure that the cdc has sufficient resources to maintain its critical surveillance and prevention activities across the country and around the globe? >> that's an absolute commitment that we have and a goal. >> is that a yes? >> it is our commitment to make
certain that the cdc can accomplish its core mission. >> okay. i'm afraid -- it's not a satisfactory answer. >> with that we will go to my good friend the gentleman from maryland, he is recognized for two minutes. >> thank you very much. again, pleasure having you here in front of the committee, dr. price. i'm going to go back to the medicaid issue because it's a huge issue, it's the most rapidly growing portion of the mandatory side of our budget as you know and, you know, again, that oregon study published in the new england journal, researcher from harvard and mitt, those are the two researchers that did the study showed there was no outcome difference. i will read you the letter because sometimes they publish these and the new england journal publishes letters to the authors. there are four letters, this is from a professor at the university of south carolina l.a. said remember these assignments are based on lottery, whether or not they got into the program or not, his conclusion was awarding lottery
winners equivalence of cash prizes worth $6,600 per year, you got $6,600 worth of medicaid, rather than medicaid might have improved their health outcomes and well being even more. if you go into the data in the study there are only four things that they showed a significant difference with less than 0% improvement, cholesterol screening and just having a screening, pap smear, mammogram and a psa test. added together that's $200 worth of value. we pay $6,600. the fact of the matter is one thing we should put on the table is actually looking at whether or not we should allow the people who we put on the medicaid system access to perhaps considering private insurance as an alternative. >> it's an important policy question because the medicaid program we believe is broken. there are individuals in our society who absolutely need to
have coverage and care, but if we are not accomplishing -- if we are not measuring the right things, if all we are looking at the medicaid program saying this is how much money we're putting into it but not measuring the kind of care being provided and whether or not folks are improving their health status within in a program we are not doing a service to the folks that are providing the resources but we are certainly not doing a service to those that are receiving the care. >> thank you very much. yield back. >> gentle lady from california is recognized for probably the last two minutes. >> thank you, mr. chairman. i will be very quick. >> if we can then i will. >> thank you, mr. chairman. as you move, mr. secretary, to deconstruct your agency do you support an increase of more than $54 billion for the pentagon by paying for it through cuts at your agency, health and human services? >> i think that it's important to address the premise -- >> mr. secretary, just yes or no. >> i'm the secretary of health and human services and i'm charged with a department of incredibly committed -- >> so your answer is no you
don't -- >> what i have and the opportunity to work with are 676,000 individuals who are as dedicated -- >> mr. secretary, do you support increase in the military budget by over $54 billion by cuts at your agency. >> deconstructing the department is not a goal. >> so you don't support it by paying for the increase in the pentagon budget? you don't support the cuts in your agency to pay for the $54 billion. >> i'm secretary of health and human services, if you'd like to ask a question about health and human services i would be pleased to answer. >> also as you move to deconstruct your agency do you believe that low income people deserve the same access to quality healthcare as upper income individuals, the same quality head care. >> that's been an absolute priority of mine since the day i entered -- no, since the day i went to medical school is that every single american needs to have the access to the highest quality of care and i must take issue with you, again, that it is not the goal of this secretary to deconstruct the
department -- >> mr. secretary, your budget is deconstructing your agency by -- >> this department effects every single american and it is my responsibility to make certain that we provide the services in the most -- >> but, mr. secretary, your budget does not say that. it is a roadmap to deconstructing the entire agency which you head. thank you. and i yield my time. >> gentle lady is recognized for what really will be the last question. >> thank you very much, mr. chairman. i want to go back to the budget and the opioid line item. it says in your budget there is an increase of $500 million from fy '16. so i want to be clear. that is level funding that you are proposing for fy '18 because we already -- we already have $500 million in there. >> i think the $500 million is the $500 million from the cures act, yes, ma'am. >> so there is no increase it's just level funding. that's correct. i want to follow up on the question about the defense
funding and nih. as we look at the alzheimer's folks who are here and we know the scourge that alzheimer's is and that it is taking one out of five medicare dollars, with whatever inefficiencies may be at nih and we can have a long discussion about how we fund our universities and the research partners they are and what indirect costs really go to, why would you decrease the budget overall? >> as i mentioned before i believe to others this is a tough budget year, there is no doubt about it and this is an opportunity to -- >> it returns $60 billion in our economy never mind the good that it can do as far as a win for patients, a win for science and a win for our bottom line. >> it's an opportunity to focus on those kinds of things that will allow us to accomplish the core mission and to actually get greater dollars, more dollars to the research that must be done in order for us to remain at the forefront of --
>> my final question is mr. self reno is now the head of the office of civil rights for hhs. he opposes the implementation of section 1557 of the aca which prohibits discrimination based on race, color, national origin, age, disability or sex in federally funded programs. do you support those prohibitions on discrimination in healthcare? >> as i've said before we will uphold the law of the land. >> thank you. >> thank you. >> i thank the panel. i very appreciative, mr. secretary, your time and frankly your accessibility to the members of this committee, your outreach to us before your testimony, your willingness to meet. i know a number of my colleagues certainly including me have had the opportunity to sit down with you and your staff and i very much appreciate the accessibility and as we work together trying to solve our common problems and again, i think i expressed the sentiment for this committee, certainly
morning, hillary clinton targeted president trump in her speech tuesday at the professional business women of california conference in san francisco. clinton who joked that she was thrilled to be out of the woods did not mention the president by name, but made it clear who she was referring to according to the associated press. there's no place i'd rather be than here with you, other than the white house. clinton referenced trump's characterization of americans in his inauguration speech and jabbed at his administration's policies. where some see a dark vision of darn analogy i see a light shining concrete tift and opportunity, she said. you can read more at the hill.com. and more live coverage today at 2:00 as military officials testify about the shortage of pilots in the military and efforts to retain them from leaving for commercial airlines. you can also watch on cspan.org and listen on c-span's free
radio app. >> sunday night on q & a. >> britain with as a dominant power in the middle east and it was everywhere in decline, nationalists were rising up. so the big strategic question that the u.s. faced was should it support britain against the rising nationalists or should it try to create a new order by mediating between the nationalists and the british. >> hudson institute senior fellow michael do you remember ran on his book "ike's gamble, america's rise to dominance in the middle east" about the 1958 crisis and it's aftermath. >> eisenhower's fear is the soviet union coming in aligning with the nationalists, undermining the british and taking control of the oil of the middle east. we cared about the oil because it was 100% of european oil came from the middle east. we wanted to make sure that we had friendly arab regimes that would if not align with the united states at least keep the soviet union out. that's the goal. >> sunday night at 8:00 eastern
on c-span's q & a. >> now portions of the apec conference held over the last couple days. speeches by nikki haley, steny hoyer, paul ryan and a panel on the 1967 six-day war. leading off representative nita lowey of new york. >> these days it's a rare sight to see a democrat and a republican standing next to each other, let alone sharing the stage.