tv Sec. Alex Azar on Health Human Services Policy CSPAN June 6, 2018 9:46am-11:45am EDT
a quorum being present, the committee on education and the work force will come together. good morning and welcome to today's hearing. we're pleased to welcome the honorable alex azar, secretary of the united states department of health and human services to his first hearing with the committee on education in the work force. i'm especially pleased to note this hearing comes just after secretary azar has celebrated his three-month anniversary in his new position. mr. secretary, we can't find another cabinet secretary in recent memory who has made an oversight hearing with this committee such an early priority. thank you. this committee's dedication to
oversight and building working relationships with the various administrative departments are well-known and well-documentsed. so far in this congress, we have been pleased to hear from secretary devos about their priorities for the management of those departments. the members of this committee are responsible for a wide legislative jurisdiction, meaning the work we do can impact americans in all stages and walks of life. in many cases, the department of health and human services is tasked with carrying out some of the laws that have their origins right here in this room, and that's why it's important that we hear from the secretary. i want to say at the outset that i've heard from some members, especially ranking member scott, that some congressional inquiries to your office have gone unanswered. i hope if you see here today any of those members who have written to you, then you can acknowledge those inquiries and provide some forecast as to when members can expect to a
response. we all know what a high volume of mail looks like. responding to constituent letters has kept me here many, many late nights over the years. but is one of the most important parts of this job. i'm sure you would agree the same is true for you. secretary azar, it's a pleasure to welcome you to the education work force committee. thank you again for making this hearing a priority. i understand that after this hearing was scheduled, president trump let you know that he had plans for you today, as well. every member of congress knows how to feels to have to be in two, sometimes three places at once. so we're going to try to make the most of our time together. i'll insert the remainder of my statement in the record, and i now yield to ranking member scott for his opening remarks. >> thank you, madam chair. madam chair, this is the first time an official from the department of health and human services has appeared before this committee since president trump took office. yet this opportunity to hear
from the department is long overdue, and i appreciate the secretary giving us time this morning. it may not be his fault that nobody has been here before, but the fact is, we haven't heard from anyone from the department of health and human services. d of health and human services. i'll also implore the majority and the administration to try to schedule this hearing at a time when gives us time for statements and questions. i understand his appearance is truncated so that members will not have a full five minutes, even after a year and a half of questions. it's impossible to do oversight if you don't have time to ask questions and follow up. the mission of department of health and human services to enhance health and the wellbeing of all americans. unfortunately this administration appears to be more focused on advancing an ideology than fulfilling that mission. despite congress's inability to
repeal the affordable care act and the public's resounding opposition to repealing and sabotaging the law, the administration continues to destabilize the health care system, for example its efforts to expand the sale of low quality health plans which do not offer coverage for people with preexisting conditions, will continue to increase health insurance costs and undermine patient protections for millions of americans. elimination of the individual mandate, although popular, will also increase the cost of insurance prices. i'm also deeply troubled that the administration's effort to erode civil rights protections under the guys of religious liberty. religious liberty is a fundamental american value but religion should not permit a person to cause harm or subvert the civil rights of others. lastly i am profoundly disappointed by the administration's efforts to weaken programs that help people meet their basic needs. in the wake of a $1.9 trillion
tax cut, overwhelmingly focused for corporations and the top 1%, the president's proposed cuts in basic services that support struggling individuals and families across the country is particularly difficult to justify. as the lead agency directed to improve america's health and wellbeing, i'm surprised that this department would support a budget that restricts families' access to essentials like health care, heating assistance, and food. while i appreciate the continued engagement in many areas where there may be some common ground such as doing more to address the opioid crisis, we must get clarity on the department's priorities and ensure the department is accountable in faithfully executing the law. this is difficult when secretaries refuse to give the oversight committee their time.
we look forward to your testimony and continued cooperation as we conduct this vital oversight. thank you and i yield back the balance of my time. >> thank you, mr. scott. pursuant to committee rule 7-c, all members will be permitted to submit written statements to be included in the permanent hearing record. without objection, the hearing record will remain open for 14 days to allow such statements and other extraneous material referenced during the hearing to be submitted for the official hearing record. it is now my pleasure to formally introduce our distinguished witness, the honorable alex m. azar, secretary for the u.s. department of health and human services. welcome, secretary azar. >> chairman foxx and ranking member scott. >> secretary azar, i ask you to raise your right hand. >> oh, yes. >> do you solemnly swear or affirm the testimony you are about to give will be the truth, the whole truth, and nothing but the truth? >> i do. >> let the record reflect
secretary azar answered in the affirmative. i think you understand the lighting system. i'm not going to read the script. it's a five-minute time. when one minute is left, the light will turn yellow. at the five-minute mark, the light will turn red. now, secretary azar, you are recognized. >> thank you, chairwoman foxx, ranking member scott, and members of the committee. thank you for inviting me to discuss the policies and priorities of the department of health and human services and the president's budget for this agency for fiscal year 2019. it's an honor to be and to serve as a secretary of hhs, whose mission is tone hands and protect the health and welcome back of all americans. it's a vital mission and the president's budget clearly recognizes that. the budget makes significant strange investments in hhs' work. among other targeted investments the budget requests $34.8 billion for the national institutes of health, $5.8 billion for the food and drug administration, $9.3 billion for head start, and $6.2 billion in
childcare funding. the president's budget especially supports four particular priorities that we have laid out for the department. issues that the men and women of hhs are hard at work on already. fighting the opioid crisis, increasing the affordability and accessibility of individual health insurance, tackling the high price of prescription drugs, and transforming our health system into one that pays for value. first, opioid addiction and overdose is stealing 100 american lives from us every single day. under president trump hhs has already disbursed unprecedented resources. the budget would now address $3.5 billion in fy 2019 to address the opioid epidemic and serious mental illness. the budget dedicates $1.2 billion to the state targeted response to the opioid crisis grants and invests $150 million
to confront the crisis in high risk rural communities. recognizes that we need new tools and private sector renovation to defeat the epidemic the budget proposes $500 million to launch the nih public/private partnership to develop new addiction treatments and nonaddictive approaches to pain. we at hhs are pleased that congress responded to the president's call for these investments, choosing to significantly boost hhs funding to confront the opioid crisis in the 2018 omnibus spending bill. the second priority i'll highlight is our commitment to bringing down the skyrocketing cost of health insurance, especially in the individual market. the budget proposes an historic transfer of resources and authority from the federal government back to the states, empowering those who are close toast the people and can best determine their needs while also bringing balance to the medicaid program. third, prescription drug costs in our country are too high. list prices are too high. seniors and government programs are overpaying due to lack of negotiating tools.
out of pocket costs are too high. and foreign governments are free riding off of our investment in innovation. to address these problems, the budget proposes a five part reform plan to further improve the already successful medicare part d program by straightening out incentives that too often serve middle men more than our seniors. we propose part b reforms to save patients money on drugs and support fda's efforts to spur innovation and competition in drunk markets. these priorities are expanded on in the recent blueprint for lower drug prices that hhs released last month. we also want medicare and medicaid and our entire system to pay for health and outcomes rather than procedures and sickness. our fourth departmental priority is to use the powers we have at hhs to drive value based transformation throughout the system. this budget lays the groundwork for the value based care vision that i laid out earlier this year.
our system may be working for entrenched interests and incumbents but it isn't working for patients and the taxpayer. and that simply has to change. finally, i want to highlight this budget's support for childcare and elderly education program -- and early education programs. the budget strongly supports head start and childcare through financial investments, reductions in regulatory burdens on providers and new incentives to reduce fraud. the president's budget will make the programs we run really work for the people they are meant to serve, including by making health care more affordable for all americans. it will make sure that our programs are on a sound fiscal footing that will allow them to serve future generations. and it will make investments and reforms to strengthen our programs that serve families and communities. delivering on these goals as the president's budget does is a sound vision for the department of health and human services and i'm proud to support it. thank you very much and i look forward to the committee's questions. >> thank you again, secretary
azar, for taking the time to testify before the committee. given our witness's need to head to the white house by noon and in agreement with our ranking member, members will each have three minutes to ask questions. i ask all members to keep their questions and answers within this time frame. i will begin with the questions. americans across our country are struggling with the opioid addiction, as the secretary said, hhs has been at the forefront of promoting access to treatment, reducing overprescribing and advocating for better pain management practices. our committee has hold three hearings in this congress on the impact on educators, local employers and communities. we have have introduced four bipartisan bills to target various areas aimpactimpacted b opioids. how is hhs working to combat the
opioid especialpidemic as outli the fy 2019 budget including engaging with educators and communities? >> thank you, madam chairwoman. i think we can all be very proud of how we've been doing the opioid funding in the 2018 omnibus, which is clear evidence of that. the $3.5 billion that we've requested in the 2019 budget will support the nih public/private partnerships to try to get the innovation of nonopioid treatments for pain, as well as research into nonprescriptio for instance, alternatives to treating pain, building the evidence base there. we're also putting grants out to states. so these are the state-targeted response grants. thanks to congress, even more flexibility to target those towards states that have the highest burden of opioid addiction. those are a couple of things we're doing, madam chair wherein
wom -- chairwoman. >> thank you. states and territories are required to come into compliance with requirements by september 30, 2017. all states applied for and received one year extensions as allowed under law because they could not meet that deadline. the new deadline, september 30, 2018, is fast approaching. and to my knowledge, no state has fully implemented background check requirements. mr. secretary, given that background checks play a significant role in keeping children safe, how does granting additional waivers protect these children? what is your agency doing to help states reach compliance as quickly as possible? >> so we agree with you that we expect states to use the increased funding that is provided in the most recent appropriation to ensure that they get into compliance with all of the requirements of that reauthorization. and so we're working with them on that.
obviously there are some technical issues with states, information technology and other issues that we're working with them on and providing technical assistance. we do expect them to get into compliance and use the funding congress has provided to get there. we agree with you on how important that is. >> thank you, i have a third question but i will submit that in writing. i now recognize ranking member scott for his three minutes. >> thank you. thank you, madam chair. mr. secretary, you indicated the importance of reducing prices of health insurance. are you aware that the elimination of the individual mandate will actually increase costs for premiums? >> so actually most of the people -- >> wait a minute. are you aware that eliminating the mandate will increase the costs of health insurance? >> that would be one view. most of the people that -- >> you don't -- >> -- are in the individual market right now -- >> it's a yes-or-no question. >> it's not a yes or no aware.
>> are you aware that health plans will increase the cost of insurance for everyone else? >> association health plans -- >> i take that as a no. the plans that do not cover full benefits, so-called junk plans, an increase in those will increase the costs for everybody else. do you know that? >> we have a proposal to restore president obama's initiative to have short term duration health plans. that's currently in the notice of comment period. >> that will increase costs for everybody else? >> that would actually lower costs by making plans affordable for the 28 million people who can't afford individual insurance now. >> the elimination of the cost sharing reduction payments, are you aware that will increase the costs of health insurance premiums? >> congress is the one that did not appropriate the cost sharing reductions, mr. scott. >> that means that you are aware that the failure to make those
payments increased the costs of health insurance premiums? >> there is an impact from congress's failure to appropriate money. we were trying to work with congress on a bipartisan basis to actually appropriate the cost sharing reduction monies. >> i don't mean to be rude. with three minutes, we're trying to get several questions in. it's very difficult. in terms of civil rights, should strongly held religious beliefs be able to override other civil rights views, civil rights protections? in the loving v. virginia case, a trial correlate justified the ban on interracial marriages by saying almighty god created races black, white, yellow, malayan, red, and but for this arrangement there would be no cause for such marriages. the fact that he separated the raises shows races shows that he did not
intend the races to be mixed. would a foster care agency be able to deny placements? >> as we know, we fully and vigorously enforce that through the office of civil rights as well as the acf and other other programs. we try to be extremely vigorous in the enforcement of all antidiscrimination provisions. >> the strongly held belief was against sexual orientation, would the agency deny placements for same-sex -- >> we enforce all laws that congress has entrusted us to enforce. >> i'm not sure i got an answer. could they deny placements for same-sex couples? >> we will enforce the laws vigorously. >> thank you, mr. scott. dr. roe, you're recognized for three minutes. >> thank you, madam chairman. thanks for being here, mr. secretary.
very quickly, i agree with the aca's premise of lowering cost and increasing access. it has not done that. one of the great drivers in medicare and the private sector are prescription drug costs. i'll give you an example, i take lipitor. i get it home, 90 days, a generic pharmaceutical. it's $12. i travel a lot so i have to put three pills, i had my doctor in d.c. call a prescription down the street, i won't mention the pharmacy, the exact same prescription was $290. exact same 12 pills. why was one 290, the other 12? and i think there's some money in between called a pbm or something, and i want to know where that money went, because i don't think the pharmacy got it. i know that the generic drug producer didn't get it. >> it's one of the great
challenges we have in our system. we have with already issued instructions to our part d drug plans, the pharmacy managers that you mention, about these so-called gag rules that would prevent pharmacists from telling you, the beneficiary, that you could pay cash sometimes for that generic drug cheaper than running it through your insurance. we've told plans we find that completely unacceptable. >> my question is, what benefit do they bring, what benefit to me as a physician writing the prescription and the patient actually getting their prescription filled, what benefit do they provide? i mean, somebody pocketed $275 of my money that i paid cash for. >> so i don't know in that particular circumstance whether that was the pharmacy or the pbm that was pocketing that money. it might be that that pharmacy was not in that pbm's network. somebody's getting the money and it's not you. it's coming out of your pocket. >> absolutely. and one of the things i also want to bring out for the record, and i know this is not
in our jurisdiction, but the medicare wage index. that is a huge problem across the country. in rural america where i live, our medicare wage index is .72. it makes it difficult to get physicians, difficult to pay staff. rural america is in trouble. we need a commitment to make a -- to write that, because for people that don't know, there are hospitals in california and massachusetts and new york have a medicare wage index of 1.6 or 7, those numbers. so i would like a commitment from you to look at that issue, because it is really harming rural america. >> so we totally agree that the wage index imposes some real distortions geographically. there have been many studies on this. we look forward to working with congress. right now administratively there always have to be winners and losers with any change on the
wage index. we look forward to working with congress, because it presents the problem you're talking about in so many areas. >> thank you, mr. secretary. i yield back. >> thank you, dr. roe. mr. sablan? >> thank you very much, madam chair. mr. secretary, welcome and thank you very much for your call yesterday. i don't want to blindside you, but after we spoke, i read the news report of the new medicaid scorecard your department is publishing. i certainly support the idea of measuring performance and letting the public know how government programs are working. but apparently the new scorecard covers, includes, the 50 states and the district of columbia and thus information about my district and the other non-state areas. i understand from cms that the data is submitted voluntarily and some jurisdictions, not just mine, do not have the resources needed to collect the data. so may i ask you, as you develop the scorecard, maybe 2.0-a
version, could you make sure everybody can participate in government accountability and transparency? it's important everywhere in america. >> thank you. i will certainly -- i will certainly work with the administrator to see what we can do to ensure that your constituents are included in the next generation of the scorecard. >> thank you, mr. secretary. on the second item, i think our absence from the new medicaid scorecard is a symptom of the problems. for americans living in the mariannas, people in the areas referred to as the outlying areas on this committee are not given the same level of medicaid assistance as americans living in other areas of the country. medicaid benefits are capped at $60 million of the year for the mariannas, that means benefits have to be limited. the affordable care act did help us out with additional funds over the $6 million actual cap.
we're using up that money, over $14 million in some years. the problem is the acm money runs out at the end of 2019. we will go from having upwards of $20 million for medicaid to just $6 million. we call it the medicaid cliff. my question for you, mr. secretary, what are your plans for making sure that people in the mariannas and other similar areas are given the same access to medicaid as other americans? would you support lifting the cap so we don't fall off the cliff? >> thank you for raising that important issue. after our phone call i already actually asked our team to ensure that we work with your office on legislative proposals to provide technical assistance and help on anything regarding the northern marianas medicaid caps. >> thank you, mr. secretary. i hope you would give me someone in your office, give me a name that we could get in touch with. >> our assistant secretary for legislation who is here with me
is the individual that we've asked to ensure coordination with your office on preparing that. >> thank you. thank you, mr. secretary. madam chair, thank you. i yield back my time. >> thank you, mr. sablan. mr. barletta, you're recognized foyer three minutes. >> thank you, chairwoman foxx, thank you, secretary azar, for being here today. i understand you born in johnstown, pennsylvania, the great state of pennsylvania. i know you're familiar with the layout of the state. i represent northeastern and south central pennsylvania which includes some very rural areas. one of the things i always here when i'm traveling through my district is the critical role that community pharmacies play in providing health care to those areas, especially our seniors. unfortunately, over the past few careers, community pharmacists have been burdened with post claim dir fees. at the time they dispense medication to the patient,
pharmacies receive information about what their reimbursement for the cost of the medication and professional services will be. however, weeks later, they can be notified that some of the reimbursement will be clawed back, otherwise referred to as pharmacy dir fees. this creates serious uncertainty for community pharmacists in terms of business operations and cash flow. and sometimes these fees are enough to actually put them out of business. in your own department, cms has recognized issues with dir fees, including how they are reported by part d plan sponsors, how these fees impact pharmacy business, and the resulting challenges they create for the part d beneficiaries. given the fact that these dir fees are detrimental to part d beneficiaries and part d pharmacy care provids,ow will you work to resolve these concerns?
>> thank you for raising -- that's a very important issue, the issue -- and it comes up in many contexts. one is the specialty pharmacy issue. i have long been concerned about this question of these retroactive dir fees being imposed on independent pharmacies to the detriment of them and to the benefit of ow d owned, pbm-owned pharmacies. i've asked our inspector general at hhs to look into this issue. i think it's important to ensure fair competition and beneficiary access. we want to make sure the pharmacy access is supported for beneficiaries. >> thank you, i yield back. >> thank you, mr. barletta. ms. davis, you're recognized for three minutes. >> thank you, madam chair. mr. secretary, over here. i know it's hard to see through my colleagues. mr. secretary, your agency is responsible for implementing the expanded global gag rule that we know is a mexico city policy. as you know, it prohibits
foreign organizations from providing information, referrals, and services for legal abortion or advocating for the legalization of abortion in their country. we know that the last time this policy was enacted, abortion rates actually rose by 20%. so when you restrict access to the full range of effective contraceptives or safe and legal abortion services, women do seek far more dangerous alternatives. the rule health organization has found such policies have negative impacts on women's mental health. so help me try to understand this, mr. secretary. what is the evidence that this decision would in any way reduce the rate of abortions or benefit women's comprehensive health? >> so the important principle that the administration is taking with this policy is to ensure that no federal monies are going to support in any way, directly or indirectly, the provision of abortion services abroad. the state department actually did a review earlier this year
to look at the implementation, practices, and for instance, no hhs grantees were unable to comply with the demands. i believe of 1,300 grantees across the u.s. government, 729 had received new funding and were subject to a -- i don't know any of them were unable to comply -- >> sir, are you saying that what it says then in terms of the rule that if people are describing just basically a referral for services, that that's okay under the rule? >> no, no. the referral for -- anything where abortion is used as a method of family planning, i believe, is the -- i believe is the terms of the restriction. >> how are you trying to get at the problem of reducing -- >> by not funding, supporting, and subsidizing organizations that referor abortions, that's w. >> can you tell us about the
organitions and medical professionals you've spoken to about this? considering the fact that abortions rise by 20%. >> again, this is a matter of funding organizations abroad with u.s. aid. the administration does not support the use of u.s. aid monies to organizations that support abortion. >> as you're thinking about this in terms of domestically, we've seen all the failures abroad. pursuing a domestic gag rule, what would that do to help american women feel that their health is being seen in a comprehensive way? because you're saying at the beginning that enhancing and protecting the wellbeing of american citizens. i'm struggling to see how you think that that's going to be better for them if you're putting these restrictions, even thinking about that in a domestic way. this includes referrals, this includes every kind of service that could be provided.
>> so the title x proposed regulation does not have a proposed gallon ru proposed gag rule in it. that is something from a past administration. that is not in the proposed rule. we allow counseling related abortion services in the proposal. >> thank you, ms. davis. mr. byrne? >> thank you, madam chairman. i'm bradley byrne, i represent the state of alabama. we have a crisis in rural america, particularly in my state of alabama, with regard to our small hospitals. we've lost 12, count them, 12 rural hospitals in alabama in the last few years. we lost the last one three weeks ago in jacksonville, alabama. i met with all of my hospitals last week. it is a crisis. we're going to lose more hospitals if we don't do something. there's two big problems this. one obviously is health care. as you know, the difference
between a 45-minute hospital ride and a 10-minute hospital ride is the difference between life and death in 'many cases. so losing a rural hospital puts the lives of people that live in those communities at risk. secondly, it is very difficult to bring some of these rural areas back if they don't have a local hospital. it's hard to track business and industry. the central problem we've got is this medicare wage index. i know you had a discussion about this over on the senate side with the chairman of the committee over there. this is not something -- we've got to have you in this with us in a big way. if you're not with us, we're going to lose a lot more hospitals. and there's nobody to blame but us because we've got the responsibility for doing it. so please tell me what you and i and other members of congress can do together about the medicare wage index so we don't continue to hemorrhage rural hospitals in america. >> so congressman, we understand the issue in alabama and so many
other states around the medicaid wage index, the impact on rural hospitals there. it's a statutory issue. and we will work with congress and the committees of jurisdiction that want to propose legislation. we think it needs to be addressed. and we want to work with you on addressing that. and i think oa bipartisan basis, it can and should be addressed. >> so you would support a legislative fix if we were able to put something here in congress? >> we will work with you. we believe the wage index needs to be addressed and fixed. it's been stuck in time. we would look forward to working with you on how to fix that. it's going to be winners and losers, unfortunately, among the congress, among states and areas. that will be difficult. we will work gladly with you on that. >> i don't think there are going to be losers. the losers to now are poor rural people. the winners are people in large urban wealthy areas. to me, that's not a hard choice. in fact, i think it is the absolute wrong choice we've made up to this point.
if we really care about poor people in america, if we really care about rural america, we will fix this problem and we can do it in a way to where everybody's a winner. yes, some other places have got too much money now, are going to lose a little bit of money. it's not going to strike them the way that the status quo is striking rural america. i appreciate your commitment and support. i look forward to working with you. and i yield back. >> thank you, mr. byrne. had cou mr. courtney, you're recognized for three minutes. >> thank you, madam chairwoman. we're weeks away from insurance regulators receiving rate requests for 2019's marketplace as well as nonmarketplace insurance plans. my conversations with regulators in connecticut is the department's inability to state what your intention is regarding broad loading of the cspremium cost is creating just a complete sort of question mark and instability, which you claim in your testimony is a goal to try and stabilize markets. so i'm asking you today, in an
oversight hearing, is your department going to federally mandate broad loading in terms of how the csr premium costs are going to be spread out in 2019, which will result in it large premium increases? >> so congressman, the issue you're raising is whether the impact of the so-called silver loading would be put across bronze and gold plans also, not just on silver plans. and the issue becomes one for 2019, man dating. you ask about mandating change. that couldn't be done in time for the 2019 period in any event. we're working at addressing -- it's not an easy question, whether one should attempt to force or even encourage the movement of that loading onto the bronze and gold s because that impacts individuals in those plans also. i don't think it's actually a facile question how one addresses that.
>> we're talking in real time right now. we're weeks away from the 2019 rate setting process. all i'm asking is just a clear answer from the department, because talking to my folks back in connecticut, and we've got a lot of actuaries out there, you right now occupy the decisionmaking position that is going to determine whether or not rates are going to go up double digit or not. >> well, again, even if you spread that, you're going to impact then your gold and bronze rates. >> i understand. the question is, is the department going to issue or are we just going to let 2019 move forward? we need an answer yes or no. >> we certainly aren't able to regulate in time -- >> i'm going to take that as a no. and hopefully that message will get out to regulators across the country. yesterday, again, we got the trustee's report that medicare lost three years in terms of the trust fund, the hospital fund.
i compliment the trustees in your department by identifying that the trump tax bill caused a lot of that deterioration in terms of lower revenue that was being collected as well as the individual mandate shifting more costs to hospitals. one way of restoring more solvency would be to follow what the congressional budget office has told us, if we allow for rate discounts to take place for prescription drugs for the folks who are on medicare and medicaid, the folks who, again, qualify for both programs, we would save $145 billion for the medicare program. so i would offer that to you as an immediate solution, using, again, the medicaid negotiating authority to save more money and help restore the solvency of that program. and again, given your background, we'll follow up with a letter, again, asking for your take on that, because, again, that's just sitting there as an opportunity for us to strengthen medicare's solvency. i yield back.
>> thank you, mr. courtney. mr. lewis, you're recognize coued for three minutes. >> thank you, secretary azar. the federal childcare and development block program aims to foster, as you know, quality development for low income families for childcare. it provides states with flexibility to meet these needs at the various states. programs include requirements for states to monitor providers that receive federal funds. now, unfortunately there has been a situation in my home state of minnesota where we've got a number of day-care providers that are openly violating federal and state laws and regulations, taking money for personal use, using the money to set up a fraudulent childcare client and providing a kickback has been reported. this is a major issue. there are allegations that not just several, you've got 23 childcare or day-care centers either closed or under
investigation. the fraud may go as high as $100 million. think about that in fiscal year 2018, minnesota received $120 million in federal funding. the state contributed about $50 million in matching and maintenance funds. and we may have a fraud case of nearly $100 million in this state with money then being transferred out of the country via msp airport. this is a big issue in my home state of hof minnesota. can you share with me what your agency is doing to investigate this? >> thank you for raising this important issue. we are integrated with the minnesota department of human services on these allegations of fraud committed by childcare providers. these do involve allegations that -- of childcare providers serving families that are receiving subsidies from the childcare development fund. the dhs, the minnesota dhs has agreed to provide us information as they conduct their work. after they've completed their work, and ongoing investigation, we'll be taking any steps necessary to protect the federal
side of this. thank you, we are very much connected with minnesota on this important issue. >> this latest occurrence is not the first. unfortunately there was another hhs program not long ago, the community service block grant federal program providing funds to something called community action agency in minnesota as well, and we find out that was used to pay for holiday trips to the bahamas, vegas, personal vehicles, rounds of golf and so forth. there's an old adage, secretary, that which the government subsidizes, it may regulate. i'm just wondering if we could not come up with some form of stricter enforcement to monitor the states that are receiving these funds to make certain that there's some sort of oversight here. this is happening with too great a frequency. >> and that's actually one of the reasons and the faults that we have with the community services block grant, is the tremendous flexibility given to states and grantees there. that's one of the reasons why, as we face a tough fiscal environment, we've suggested to congress that that program
should be eliminated. >> mr. secretary, thank you for your testimony today. i yield back. >> thank you very much, mr. lewis. ms. fudge, you're recognized for three minutes. >> thank you very much, madam chair. thank you so much, mr. secretary, for being here. since we've been limited to three minutes, i would really like to just ask you my questions and have you or someone in your office responding in writing. thank you so much. mr. secretary, you state in your testimony that the mission of hhs is to, and i quote, enhance and protect the health and wellbeing of the american people, end quote. yet the administration you represent has actively undermined the affordable care act and diminished access to care. you support the repeal of the aca and the policies that will increase the number of uninsured americans by millions. the president and the republican congress passed nearly $2 trillion in unfunded tax cuts, then have now turned around and
proposed a budget that cuts more than $1 trillion from medicaid and fundamentally undermines the program by turning it into a block grant. if your job is to promote the health and wellbeing of the american people, why are you cutt medicaid? why are you cutting billions of dollars from medicare despite the president's promise not to cut medicare? why are you cutting funding for preschool development programs? why result eliminating community service block grants, a program that specifically provides funds to alleviate causes and conditions of poverty? why are you eliminating liheap funding that helps people keep heat and air in their homes? hhs is required to uphold federal civil rights law. will you guarantee that hhs will not approve waivers that are racially biased? and i ask that question because your budget proposes a 20% cut
to the very office that oversees it. madam chair, those are my questions. i would request that you respond in writing, mr. ranking member, do you need more time? i yield the balance of my time to the ranking member. >> thank you. maybe i can get an answer to my question that i asked about religious freedom, whether or not strongly held beliefs give you a pass on the requirement to abide by civil rights laws. could a foster care agency religiously affiliated discriminate based on religion or sexual orientation? >> faith-based organizations that may be grantees of ours or of states that provide foster care have a long history of providing social services for the poor and underprivileged children as well, and families. if we take steps to exclude them from faith-based groups, from our programs, it will harm efforts to support them and
support our programs. we don't believe this is an either/or situation as you phrase it of this discrimination versus that discrimination, but how do we harmonize that and have states have the ability to use -- >> can the agency discriminate against a family based on race, religion, or sexual orientation? >> we have very clear prohibitions on elements of that in federal statute. those will obviously be enforced, as i said before. congress legislates, we enforce. >> thank you, mr. scott. mr. banks, you're recognized for three minutes. >> thank you, madam chair. thank you, secretary, for being here today. i want to start off by thanking you and the department's efforts regarding the title x funding for abortion providers as has already been mentioned in this hearing. i know i speak for millions of americans when i say that this life-affirming decision is long overdue and i'm grateful for this administration's courage in doing what's right. that being said, i understand the state of pennsylvania has already claimed you, we too claim you in the great state of
indiana. we appreciate your hoosier leadership in your new position. i think you would agree, after living and being a leader in indiana, that the state of indiana has a lot to offer the rest of the nation. and i want to talk for a moment, you mentioned in your opening remarks about head start and the department supporting funding for head start. but your department's own impact study also found that any benefits from the program were largely absent by the time the child was in first grade. and the followup report found similar negligible impacts by the end of the third grade. so my question to you is, is it time to empower the states to be more involved in developing their own early childhood education option, and specifically, do you agree that states are in the best position to design and implement early childhood education programs, and if we should block grant
those funds to the state rather than washington, d.c. designing them instead? >> congressman, i can't speak to form block granting or legislative change, the administration doesn't have any position on that. but doing things differently in our programs to achieve better results that they would like to experiment with, governor holcomb has ideas around head start and early childcare development, i'm happy to engage with him on those ideas and see what flexibilities we have or any other governor that would have good approaches. >> very good. let me shift gears, for the minute that i have left, my colleague, mr. byrne, talked about rural hospital issues. i want to talk for a minute about hospital consolidations and ask for your -- any brief comments you might have on the role that hospital consolidations have on the rising cost of health care in this nation. what can we do about it?
>> so many of the mandates that came from the affordable care act as well as other provisions have imposed such regulatory burden on providers that it has led to consolidation of providers to simply cover that overhead cost. we're working reducing that burden, we've reduced 4 million hours of regulatory compliance already. we have billions of dollars of regulations we hope to be coming out to relieve burdens on providers. i'm very concerned, any aspect on which our payment rules encourage integration and purchasing, that should be done as a matter of economics, not as a matter of our payment policies. >> thank you. my time has expired. i yield back. >> thank you. ms. bonamici, you're recognized for three minutes. >> thank you, madam chair. mr. secretary, a woman with the initials j.i.l. was severely beaten by a gang in el salvador. she left with her two young children and at the border they were ripped out of her arms.
she was seeking asylum in the united states. she, her children and the mother, were crying and scared. they are among the increased numbers of children placed in your custody following the administration's appalling decision to separate children at the border. i'm a mother, i know you're a father, many of us in this room are parents. your website, the office of refugee resettlement, states its primary consideration is the best interests in the children. is a policy of separating children from their parents in the best interests of those children? >> so individual children are separated from their parents only when those parents cross the border illegally and are arrested. we can't have children with parents who are in incarceration, so they're given to me. if one presents at an actual border crossing and presents a case to come into this country, one is not arrested and one's children are not separated from them. the best advice i have is actually present yourself at a legal border crossing and make
your case. cross illegally and get arrested and your children will be given to us. that's the simple fact, i'm afraid. nobody has a desire to separate children from their parents. i certainly don't. we will take as best care of them as humanly possible when entrusted with them. >> let me ask you about that. i know we have limited time, because there's been a large influx of additional children in your department's custody. does your department have adequate resources to fulfill their safety, health, and welfare needs? does every child have suitable shelter? medical care, other basic services? i know my senator, senator merkley, was just in texas and said it looks like a lot of these kids are in what look like cages. >> oh, that's completely correcting. -- incorrect. he actually didn't see the children because he requested to see a facility. these are minors, grantees returning a program. we accommodate requests from congress to inspect and look at our facilities. these children are provided full education, medical care, dental,
vision. they're provided athletics, meals. >> tell me how you're going to ensure the proper oversight of the conditions in which these children are kept in what steps you're taking if there are deficiencies. >> we're under a court consent called the flores case. we work diligently to work and ensure complete compliance with the court's consent decree. we take seriously our obligation to take care of these children very well. >> i join the millions of people across this country who are appalled at the policy of ripping children away from their parents. i'm very concerned about it and i hope that you as an adviser to the president will take that message from the people around this country. thank you. >> thank you, ms. bonamici. mr. wilson, you're recognized for three minutes. >> thank you, chairwoman foxx, for your leadership. thank you, secretary azar, for being here today and your service and testimony. i'm grateful to be a member of the bipartisan congressional
heroin and opioid task force. the key to attacking the opioid epidemic is addressing the overprescribing of substances. this is a gruesome problem in many places across the country including my home state of north carolina as well as, tragically, lifelong friends in rhode island and california. alan wilson has worked to fight the issue in south carolina. these pills can be misused, perpetuating the addiction problem. over 20 states have put in place laws promulgated by the cdc that note that 3 to seven days' worth of therapy is sufficient. we recently saw a similar policy for beneficiaries enrolled in medicare part d. what impact could expanding this
policy have on the misuse of opioids? >> i think you put your finger on a very important issue. we're committed to reducing by one-third prescriptions, that's the president's agenda, of these opioids. we've taken that action through part d in medicare and we encourage states to keep looking at the best practices, as you cited. >> thank you very much. and then as you know, obamacare exchange premium rates continue to rise, as we warned they would, because it's certainly a policy and a program that just is designed to fail. and the average premium subbed increased by 43% from 2017 to 2018. a recent gao study also found that hhs does not have an effective process to determine whether applicants are eligible to receive subsidies. of course it was the author, jonathan gruber of the obamacare, who said it was based
on the stupidity of the american people and the stupidity of the american media. what steps is hhs taking to ensure that only eligible applications are receiving subsidies? >> so i'm glad you asked that. i would like to get back to you on that, if i could, in writing. i want to make sure i inquire on the subsidy verification process. >> has the hhs analyzed how much impact this has had on employer sponsored coverage? >> i believe congress has delayed implementation on the cadillac tax in the current year. i don't know what prospective analysis has been done, probably by the treasury department, as a matter of tax policy. we would be glad to get back to you in writing with whatever
analytics were published. >> thank you very much. >> thank you. mr. takano, you're recognized for three minutes. >> thank you, madam chair. mr. secretary, you said it was the mission of the department of health and human services to enunanimous and protect the health and wellbeing of the american people. the president campaigned on the promise that he wouldn't cut medicare or medicaid. for instance, on may 7th, 2015, then-candidate trump boasted in a tweet, quote, i was the first and only gop candidate to state there will be no cuts to social security, medicare, and medicaid, end quote. mr. secretary, did the president keep that promise or are there cuts to medicare and medicaid in this budget? >> so actually these -- it's, again, washington-speak, that when programs continue to grow but they don't grow as quickly as they otherwise might grow, that's viewed as a cut. both -- >> excuse me. excuse me. excuse me, mr. secretary. according to the cbo, the
congressional budget office, the budget cuts $1.7 trillion from medicaid, the aca, and other health programs, and more than $200 billion from medicare over the next ten years. i would submit to you that this is a blatant departure from the president's campaign promises and it contradicts the mission of your department. let's move on. we're on the topic of medicaid. 1.75 million veterans and one in five children with disabilities have medicaid coverage. how does cutting more than a trillion dollars from medicaid and other health programs enhance the health of veterans and children? how does that meet your department's mission? >> actually restructuring the medicaid expansion and obama which prejudices in favor of able-bodied adults against children, the disability, and the aged, is exactly what will
allow the traditional medicaid program to restore its focus and states to restore their focus to those critical care populations that you just mentioned. >> mr. secretary, you and i both know, if you're making an argument on sustainability against expanded medicaid, the president signed a bill that was unpaid for, that gave $1.9 trillion in tax cuts to corporations and the wealthy. there was more than enough to cover the cuts that you're proposing. since day one, the administration has been working to sabotage the affordable care act. last year the uninsured rate rose for the first time since the enactment of aca. there are estimates that as many as 3.2 million americans lost coverage last year, and are in more danger of losing their coverage this year and next. how does that meet the department's mission? >> so obamacare is failing on its own weight. it was poorly designed. >> mr. secretary, with all due respect, that's a canard, and you use that as a means that you
use to distract from the fact that your department has been sabotaging enrollment. that's been driving costs up and that's also been causing people not to be able to get access to insurance. i yield back, madam. >> mr. walberg, you're recognized for three minutes. >> thank you, madam chairwoman. thank you for being here, mr. azar. i appreciate the fact. just an aside, words matter. and it is disappointing that when questions and assertions are given without then the opportunity for you to answer that, that's a problem. and i hope that that doesn't continue. also for the record, when assertions are made, for instance about your -- the administration's position on life, abortion, and the like, it should be noted that there is no safe abortion. there is no safe abortion. life always is taken. and i thank you and the administration for taking a
stand appropriately on that. as you know, this committee has had great concern, and ultimately support, on the issue of associated health plans. we've sent legislation out dealing with that. in january, the department of labor issued a proposed rule to expand access to hps under existing statutes. in your opinion, when finalized, will the department of labor's rule result in more or fewer coverage options for small employers and their employees, and secondarily, can you expand on how hhs and dol are working together to achieve unaffordable health insurance for workers? >> we believe it will greatly --
we want people with true choice. as i travel across michigan's seventh district, i hear about the rising cost of prescription medicine. that's come up already today. the president recently produced a plan to combat the rising cost of prescription drugs, a key priority identified in hhs' budget. what programs or policies does hhs plan to explore to implement in this area? >> thank you very much. we want to get list prices down. i can tell you every incentive in the system is based on a% of list price. every player except the patient has an incentive for prices to go up. we want congress to reverse
those incentives, to make sure when they increase list prices, it hurts, not helps. we want to overturn a 100 persian cap on rebates in the medicaid program. that would both bring in money, save money for the program, and dramatically change the financial incentives for pharma companies. >> from your lips to god's ears. i yield back. >> thank you very much. dr. adams, you're recognized for three minutes. >> thank you, madam chair. thank you very much, mr. ranking member and secretary, thank you for being here. mr. secretary, how do you reconcile your proposed repeal of the the aca and cuts to medicaid part 1 is with your strategy to improve access to prevention, treatment, and recovery services? >> so actually we think it helps by restoring, as i mentioned previously, by restoring the focus on those individuals who are disabled, aged, children, those really suffering from, for instance, substance use disorder, rather than the able
bodied. that's what the medicaid expansion goes to. it allows the states to focus on those who need the care the most and are very focused on this issue, as you raised. thank you. >> i want to flag that the cbo did an analysis and reported that the president's proposed budget cuts $1.7 million from medicaid, affordable care, and other programs, while earlier estimates of the graham/cassidy plan on which you base your proposal show that around 20 million will lose coverage over that same time period. so that $10 billion in the new hhs funding that you cite probably wouldn't even make a dent. as i cited before, millions have suffered from opioid abuse. treatment helps them find and keep jobs. illustrating that the department of food medicaid waivers with work requirements are not only
count productive but possibly unlawful. with that being the case, how can your department argue that these approved waivers promote the objectives of the medicaid program as the law requires? >> we absolutely believe that community engagement and supporting people getting to work is critical to one's health and firmly believe that. in terms of individuals suffering from substance use disorder, those are individuals who would not be subject to community engagement requirements under these waivers. we've tried to be very sensitive to both the categories of individuals the states would but the in that and the types of activities. this would involve study, training. we've tried to be very sensitive to the issues you've raised. >> thank you, mr. secretary. madam chair, i yield back. >> thank you very much, dr. adams. mr. ferguson, you're recognized for three minutes. >> thank you, chairwoman. mr. secretary, thank you for being here today. one of the things that i think we've watched recently in our society is how unfortunately we
see so many young people committing violent acts right now. and i look at the families around my district. you could say this about many parts of the economy is good, whether it's bad, you've got families that are working harder, spending less time in that particular family unit. and so i think one of the things that's happening with that all too often is that we may be missing some of the signs at home with children. there's one place that our children go every single day and that's to a school. we have these incredible educators that are out there working so hard every single day. they know our students, they are engaged with them. do you think that there is an opportunity to look at behavioral intervention, identify components with mental health in our school systems, not trying to overburden our teachers and give one more
responsibility to the teacher, but there is that unique framework there that may provide that. can you offer any insight into that? >> absolutely. i think you're completely correct there, and, in fact, the existing program that our substance abuse and mental health services agency had for educators was an in-person training that required school systems to take their teachers away from teaching, valuable time. we have actually rolled out a program from samsa online that is on demand that let's teachers learn the best ways to identify serious mental illness and report t training that is cu customized, accessible and on demand and gets to what you're lk being. >> whave good examples in our district, columbus state university, obviously it's a four-year college, but they've got some behavioral intervention programs that seem to be working very, very well. so you think that samsa is really a good spot to spearhead
some of this? >> absolutely. it is the mental health agency and this is as you said at the core so much is a serious mental health issue and requires that focus. i'm sure the doctor who runs samsa would be happy to talk with them to learn interventions that they have that may be more general. >> i think it's a unique opportunity. i think we're recognizing that as a society that we have in some cases let our children down. there's this unique place that i think, though, that we can really come together around our schools and around the safety of our children, but not just the safety, the overall benefit, overall wellness both physical and mental for our children. i'm glad to hear you say samsa would be a good place to spearhead some of that. i yield back. >> mr. norcross, you are recognized for three minutes. >> thank you, madam chairwoman. secretary, thank you for coming here today.
certainly listening to your views particularly on the disease and addiction are incredibly important, not only to the people in this room but to every member of our great country. i agree with you this is not a red or blue issue, this is not an economic issue, it's not a race issue. this is the disease of addiction and you certainly have seen, have heard just countless stories of people losing this battle. four hours in four years. four hours in four years. that's the average amount of time medical student is trained in the disease of addiction. some do much better, but unfortunately many are doing much worse. what is your department doing to ensure that these future doctors are being trained properly, as you said, 100 people each day are dying. how are you addressing this issue? >> i'm really glad you raised that. that's a passion of mine this
issue are we training our doctors adequately around how to identify addiction and treat those who do get sucked into that vortex. many states are starting to look at including that in their accreditation programs around that. i'd love to work with you on any ideas you have on ways that we can better support that at the federal level. i think it's really quite important. >> there's prevention, which is one of the issues, and this is multi-facetted. >> treatment. it's some of what we did on antibiotic resistance i think in terms of the medical profession of how we change a mentality culturally. >> the fact that we are having the conversation is helping that way, but unfortunately each of the medical profession, whether it's the schools or otherwise have very different opinions. i think this is an issue we can coalesce around and certainly we would appreciate it. so thank you. i yield the balance of my name to ms. bonamici. >> news reports indicate that
the administration is preparing a proposed regulation that would significantly expand the application of the public charged determination for individuals and families applying for green cards. the proposals being generated by the department of homeland security but it reaches into many hhs programs. have you and your department considered the full economic and social implications on families of such a change should, for example, a child's use of chip count against a parent's immigration determination? >> i have not seen a proposed rule on the issue that you raised. happy to look into that. of course, if it's in the deliberative process there's only so much i would be able to say, but i have not seen a proposed rule or content on that. >> thank you very much. i yield back. >> thank you, miss bonamici. mr. smucker, you're recognized for three minutes. >> thank you. hello, mr. secretary. you mentioned in your testimony that the most effective anti-poverty program is helping someone find a job and you talk about about the welfare to work
projects. i'd just like to hear what the department is doing in in regard specifically and you taniff, there is a certain percentage of individuals required to engage in some work-related activity. i'd like to hear how the department is supporting states implementing that. there's also a bill, of course, that moved out of the ways and means committee here that would increase the percentage of individuals that are subject to work requirements. so could you talk just a little bit about that? >> i think that's a ver important issue. the welfare refotaniff was impot at the time, but people have found ways around it and so that's why the president's budget was called for enhanced work participation requirements, training requirements, maintenance of efforts by states and really to get around some of the gaming that occurs. the amount of money and effort
devoted towards work training and workplacement is rather surprising at this point. >> what steps is the department taking to ensure there is accountability? >> so the biggest thing we can do is work with congress on a taniff reauthorization that would implement these ideas and ideas members of congress have about this because much is constrained by the existing statute that we have. we want to go in the exact direction you are talking about, increasing work and getting back to the spirit of welfare to work, empowerment, getting people on their own two feet. >> i have a minute so i want to switch topics. top priority you mentioned is fighting the opioid epidemic which obviously impacts all of our communities. i'm aware that hhs plays a role in administrating the community services block grant which, as you know, supports community action agencies. i introduced a bipartisan bill with my colleague representative mccolumn to establish a
competitive grant program for community action agencies to expand their efforts to combat the opioid misuse and addiction. of course, the grants would support a wide range of activities. in my community i believe leveraging that existing infrastructure that is effectively working would help to -- would make a difference in opioid addictions. just wondering if you feel the reforms in this bill would help the department advance its goals under your strategy to combat the epidemic. >> well, we have proposed actually eliminating as part of very difficult budget decisions we've proposed eliminating the community block services grant program in its entirety. we feel it is duplicative and of all the priorities that we could fund that that is at the lower end of them. if congress were to keep it in place, though, the idea is you have around competition and accountability certainly would be welcome to look at anything to help improve measures of
performance there where right now there aren't many. >> i'm out of time. i'd love to continue that discussion in my area of community service, block grants has been very, very effective. thank you. >> thank you, mr. smucker. ms. rochester, you're recognized for three minutes. >> thank you, madam chairwoman and ranking member scott. welcome, mr. secretary. first, thank you so much for the conversation we had yesterday. it gave me an opportunity to share my serious concerns about the impact of the administration's new immigration policy of separating children and their families as a deterrent and also the treatment of these children afterwards. you committed to continuing that dialogue as part of our congressional oversight role and the matter is just urgent, time sensitive and especially if we believe that children come first. shifting gears, mr. secretary, i understand from your written testimony that you support
repealing and replacing the affordable care act, and in the interim the administration has put into place some things that actually are destabilizing the system even more. so delaware southeaans could se increase by 40%. the affordable care act is the law of the land today. what would be helpful is if you could share immediate steps that your agency is taking to stabilize the individual marketplace and lower the cost of premiums. >> so it is the law of the land and we work to faithfully implement it. we want affordable options for people. we don't want high premium increas increases. so many states have only one or two plans. the way of the affordable care act is structured if you only have one or two plans the premium support that goes out chases that premium up. there is no incentive for the insurance company to in any way contain their cost increases.
it's like drug prices it just goes up, up, up. that's what drives so much of this. they may say there's other things. >> can you give us bullets of what are you doing today to make an impact? we talked about the fact that open enrollment is coming, we talked about the rate changes that are coming. can you just tick off some of the things that your administration is doing, your agency is doing. >> the biggest thing that we can do right now is make available other options for folks. the way that dynamic is those prices are going to go up and there's absent statutory change little we can do to stop that premium increase because the subsidies chase those premiums. that's why we're trying to make other options available for people. >> since we are going to have a follow-up meeting which i'm very much looking forward i'm going to yield the last 30 seconds to mr. scott. thank you so much. >> thank you. are you aware that some of the people that are -- some of the plans are not available because of the uncertainty injected by
this administration? >> i'm not aware of plans not being available and -- >> because they have decided not to participate because of the uncertainty caused by this administration? >> i have not heard that nor do i believe it's accurate. there are many major providers that are providing insurance packages and frankly making a ton of money off of providing in the obamacare markets given this subsidy abuse that we see in the system. >> thank you, mr. scott. ms. stefanik, you're recognized. >> thank you for being here this morning. according to the annual index report a family of four will pay on average a little over $28,000 in annual healthcare costs. as you know, costs are higher on average for rural americans. this is unacceptable particularly in a district like mine, i represent one of the most rural districts on the
yeast, new york's 21st district. one of my legislative goals has been to lower the cost of healthcare while maintaining the quality and accessibility. so two of my legislative initiatives i wanted to highlight today and then ask you what you're doing administratively to lower costs and ensure that healthcare is affordable for rural americans. the two issues i wanted to highlight are how we can increase access to preventive care. i co-introduced the primary care patient protection act of 2018 which creates a primary care benefit for all high deductible health plan holders allowing two deductible free primary care office visits per year. as we're seeing the increase of high deductible plans i think that investment for preventive care will help lower costs and also improve healthcare outcomes. and the second priority that i've focused on is ensuring that our community health centers are fully funded and have continuity over a period of years. i introduced the chime act which would reauthorize that program for five years, ultimately we
passed a two-year extension but i still want to focus on community health centers. what is your department doing administratively to specifically lower costs in rural communities like the ones i represent? >> so we fully support notions of telehealth, for instance, and alternative care providers and i want to make sure that we look and i would appreciate any recommendations you have of ways in which our regulations or our policies around payment get in the way of providing telehealth to rural areas as well as does the doctor always have to be present, does the doctor always have to be either on the phone or there? can we do this in a more modern way working with healthcare professionals to get appropriate quality care delivered throughout our communities. >> and then what is your feedback on the primary care patient protection act of 2018? again, that's bipartisan, i introduced it recently with brad schneider allowing the two deductible free primary care office visits her year. >> i don't believe we have an administration position on that legislation yet, but as you
describe t i'm not familiar with it, but as you describe it that certainly seems quite attract e attractive. notions of the types of behaviors we want to incent being excluded from deductibles, deductibles are largely to prevent you from doing things and so that's why preventive services are generally excluded from deductibles under the hsa regulations at the treasury department so it seems to be in the range of things that make sense, but i can't state a formal administration position on it. >> i'd like to hear follow-up from your office as you take the time to review that bill that we have introduced. again, it's bipartisan. as we're increasingly hearing about the high deductible plans i want to ensure that my constituents just like everyone's constituents in in room are able to access primary care to lower ultimate healthcare costs in the long run by receiving preventive care. >> thank you, ms. stefanik. mr. desaulnier, you are recognized. >> thank you, mr. secretary for being here. i come from a state, california,
where how we treat the disabled is important so we have some concerns with the administration in this regard. it's been a priority in california, say, conservative republican legislator ralph land ter man became a model to treat people with disabilities in a way that was respectful and efficient. there is one act you could do that would help. madam chair, i'd like to submit a letter for the record. >> without objection. >> thank you. a large group of disability rights advocates. we have known for some time that electric shock therapy is not good for -- and it is not effective. there is still one facility in the country in canton, massachusetts, i am told that the fda has had a ruling or a policy in place in front of you for a proposed rule for two years, so it goes beyond your time, and it's been four years since a panel of experts recommended that it be banned. i wanted to know if you were willing or anticipating signing
and authorizing the closure or the elimination of electric shock therapy at this facility, the last one in the country i'm told in canton, massachusetts? >> i will be happy to look into that issue. i am not aware that there is actually a proposed regulation awaiting at the department. i would need to check with our fda commissioner on what the status of that is. >> this letter is dated april 23rd. another category i appreciate your comments about the national institutes for health as being a crown jewel. we hope that you will advocate for more funding as we have in bipartisan efforts contributed more funding. so given your background, this is a personal issue to me, i have a medication in my pocket that keeps me alive, i am a survivor of cancer, i'm told it's a medical drug -- a miracle drug and it was developed with mostly at least in the beginning as i understand it in talking to the researchers at nih with public investments, but given your background one thing that i struggle with andiv your testimony about public/private
partnerships and the abuses in the private sector, from your perspective what's the right return on investment to get these public/private partnerships to continuing our public investment research that as you say is the envy of the world, but also from your position in the private sector, what's the right rate of return to get the investments knowing this is a very complex issue? and are there in i studies in the private sector, the public sector that you are aware of that would help congress understand how important these partnerships are, but also to avoid the abuses we have unfortunately seen? >> it's an important question. i think the market tends to determine from capital allocation what the right levels of course of return on investment would be. we do have to be careful with these public/private partnerships. the clinton administration tried something of actually imposing conditions on pricing afterwards and what we saw was the public/private interaction completely went away and they changed the policy.
because you need the capital investment there so we do have to act and tread quite carefully in that place as we want that transitional science to work to create those their piece that help you. >> it's important to not just me but millions of americans and shareholders. thank you, madam chair. >> thank you. mr. thompson, you are recognized for three minutes. >> thank you. mr. secretary, good to stee you again. thank you for taking the time to be here today. in april hhs released its fy 2019 annual performance plan and report. the report stated that, quote, data collected from the family violence prevention and services act grantees for fiscal years '12 through '15 show that more than 90% of domestic violence program clients reported improved knowledge of safety planning as a result of work done by fcpsa grantees and subgrantees. too often we legisla new program requirements without utilizing the data collected.
information let's us know that a program is achieving its intended purpose. today with my colleagues representative stefanik, rochester and moore i will introduce a bill to reauthorization the fvpsa at current funding levels to ensure states are able to continue to work to prevent domestic violence and offer support to victims. i would like to commend the department on your increased focus on prevention efforts and improvements that you have made to data quality. mr. secretary, do you agree it is important to reauthorize this program to we can continue supporting states efforts to prevent domestic violence and provide shelter and support to victims? >> we do, congressman. thank you. we fully support reauthorization of the family violence prevention and services act, as you stated, it serves an important purpose and we want to work with congress on getting that reauthorized. >> i appreciate that. in the interest of time, madam chair, i will yield back. >> thank you very much. mr. thompson.
mr. krishnamoorthi, you are recognized for three minutes. >> thank you, madam chair. ranking member scott, thank you secretary azar for coming in. i'd like to ask you a few questions about electronic health records and the meaningful use program. electronic health records were intended to improve patient outcomes by stream lining medical practices and making it easier for medical practices to communicate with each other. fundamentally they were supposed to ensure that patients were able to spend more time with their doctors and receiving better care. unfortunately a new study in the family medicine journal published earlier this year found that primary care physicians spend more than half their day interacting with electronic health records and not patients. and this statistic unfortunately is very disturbing because, as you know, we want physicians and providers spending as much time with patients and not with
electronic records. this is unfortunately an experience that has also been told to us by other physicians not just primary care physicians. i understand that cms is taking steps to reform the system. recently you and the department and cms have renamed meaningful use, quote/unquote, as advancing care information and now the merit-based incentive payment system also known as mips is promoting interoperability of different systems. i hope these changes are more than just cosmetic, sretary azar, and i hope that they are a sign of meaningful changes to come. so what i wanted to ask you was simply this, which is: what's going to be the practical impact of these changes and how are you going to measure whether they are going to be effective and, you know, basically improving patient outcomes and allowing physicians to spend more time with patients?
>> great question, congressman. thank you. the measure for us of interoperability and success with electronic health records is when the patient shows up does their data arrive with them? we have to get out of the business of micromanaging the how of health records and instead when the patient shows up is the information there? do they own it? do they have access to it? does it carry with them? and get the doctor's eyes off the screen and on the patient. i would love to work with you on anyways that we can support that vision because i think we are in complete agreement here. >> i would love that. you know, i think that it's refreshing to hear that you are trying to make sure that the information arrives with the patient and the eyeballs of the doctors are on the patient and not those computer screens, which we all see when we go into the doctor's offices. now, the corollary question is: are you open to soliciting feedback from providers who are
affected by these rule changes because i think that would be really important and basically refining the techniques that you are developing to streamline the electronic health record system? >> absolutely. i would love any input from any source on how to make this work better for providers and for the benefit of patients. i am totally open-minded how to approach this and would love input. >> okay. great. >> i will work with you on this. >> excellent. thank you. >> thank you, mr. krishnamoorthi. mr. guthrie, you are recognized for three minutes. >> thank you. thank you, madam chairwoman for putting this together. thank you, mr. secretary. it's great to be here. i've enjoyed working with you since you've been sworn in. you've been very accessible and i appreciate that. i think i got a call from you in the security line of the dca airport on drug pricing on another committee. i and matt bassett worked in kentucky together and sara runs a good legislative shop. we're pleased working with you guys. one thing i want to touch on and
some touches a couple committees that i'm on but for today, you know, kentucky has been hit hard like everywhere else on the opioid epidemic, particularly everywhere, but the one issue that i want to focus on is the infants that are born with addiction because of their parent. would you kind of explain what hhs is doing in terms of infant addiction? >> the issue of neonatal substance syndrome is a difficult one because it's such a novel issue. one of the things we need to do is build the evidence base around what is the right treatment pathway for these children? how do we help bring them out of that addiction? what's the right way to care for them. we have to build that evidence. we have to make sure we get these neonatal systems up and running. i've been privileged to visit one in the dayton area and see the miraculous work they're doing for these kids and
parents. west virginia the percent of kids born with nas is shocking and really we'd love to work with congress on the best approaches how we can reorient our programs with the help you've given at. >> in the late '90s welfare reform, people having to work, the ability and encouragement to go to work. kentucky has done the medicaid waiver, we are looking it through our snap program. these people that there are employers with open arms waiting for these people to come into the workforce like in the late 'the 0s where at a time it begins the economy is beginning to roar. maybe it's a great opportunity to do so. how can we evaluate the efforts of states to help taniff recipients move back into the workforce. >> some of the issues we have raised in the president's budget which is what percentage of money are states putting towards
workforce training. how many are just dumping off the taniff rolls so they can get credit for exiting the program. all the gaming that has occurred in the programs the last couple decades and fixing that working with congress. >> i know in the farm bill the big effort is putting job training money so people can get jobs that lead to fulfilling careers and meaningful moving forward. that's what we're looking for. look forward to working with you in this area as well as some of the others. i yield back my time. >> thank you, mr. guthrie. ms. blunt rochester, do you wish to submit something for the record? thank you. >> thank you, madam chair, i ask unanimous consent to enter a letter signed by 86 members of congress to the secretary of homeland security expressing significant concern with dhs -- >> without objection.
>> thank you, madam chair. mr. secretary, thank you for your patience to answer all of our questions. as you may know, mr. secretary, there are thousands of children that are now in detention centers, children that have been separated from their family as they came into the united states without any document. i've seen images of where they're being held. these are very horrendous conditions which they're in. yet in april 2018 agreement your department is now asking potential sponsors about their immigration status and they're sharing that information with i.c.e. so in essence even though i may be a green card holder or citizen and i may have an undocumented cousin or aunt or uncle in my household, if i now have to share that information with you, i just may not want to be the sponsor of this child as
detained under these very difficult conditions. what is your position on that? do you feel that that's a standard that should be continue to be if you are seed? >> so we work with the department of homeland security to ensure -- because our number one mission with these kids is to take care of them well and get them placed with sponsors, as you said, and preferably if they can be with family members. one thing we have to do is work with dhs to ensure these are the people they say they are when they come in. identity verification and also ensuring background checks on them to make sure there is not a reason that it would not be safe to place them in the custody of those individuals. so that's the purpose of our information sharing agreement and working with dhs there. i think we share the goal of, if we can, getting them with family members as sponsors. >> madam chair, i think that that policy will discourage families from coming forward and
be willing to serve as sponsors. my second question, mr. secretary, is i know that education is guaranteed to undocumented children by several court cases. do you think that a child -- an undocumented child's use of chip should count against a parent's immigration determination? do you think they should be eligible for chip if you are a child and you are undocumented? >> congressman, i have not studied or looked into that issue. i would be happy to get back to you in writing if i can give a more thoughtful response. i just have not looked at that precise question before. >> let me just conclude by saying that the public charge aspect of this whole process is very troubling. i think it will contribute to keeping these children in detention centers and i think it will put their health and well being in jeopardy. thank you, mr. secretary, for your answers. >> thank you, mr. espaillat. >> thank you, chairwoman fox. thank you, mr. secretary, for
joining us today. first question would be on the -- obviously the cost of healthcare as compared to other developed nations. in 1970, you know, most developed nations were between -- somewhere between 4% and 7% of gdp. today the united states is approaching 20%. the next closest nation is below 15%, around 13% of gdp. we're spending about $8,000 and change per patient, other countries spending about half that much. when you look at projections, our healthcare cost in this country are expected to grow exponentially if we don't do something about this. are you looking into this and what recommendations do you see forward on how to bring us at least competitive in the world of healthcare?
>> thank you. absolutely. listen, we get great healthcare in the united states. i personally have the benefit of that in the last couple months. we are blessed to live in this country, we're blessed to have the quality of healthcare that we have. is it twice as good as countries who pay half as much? i'm not sure that's the case. we pay for procedures, we pay for sickness. we have outlined an agtd to try to move towards paying for value and outcomes. i have four parts to that gd a, the first is genuinely interoperable health information technology to unleash the power of i.t. in this space, the second is transparency of price and quality, so the patient is in the driver seat making real choices, the third is using the power of medicare and medicaid to drive fundamental change in our system. we are the biggest payers in the system. the fourth is removing government barriers to coordination and integration of care delivery to deliver better quality more efficiently. it's absolutely on the radar and
we are determined to make a material change here. >> on the regulatory side and compliance side and, again, this has been going on since the '70s really ramped up in the 1990s and then of course it's exploded in the last ten years, but the government or hhs, health and human services intervening between the relationship of the patient and the physician. physicians in this country are well trained, well educated, do great residency programs. they know how to treat patients and, again, this gets back to electronic medical records and the checklist, if you will. but physicians at least share with me the only way to bring down costs is to allow them to restore the patient/physician
relationship. healthcare is a partnership, in other words, if i don't do what my doctor says to do, then that visit is useless and obviously he can't keep me healthy. so it is a partnership, it's not a checklist. anything you see that we can do to restore that relationship and really put the physicians in the game again and the patients aren't happy. i mean, i've talked to patients who are not happy with our current healthcare system. >> mr. allen. >> yes. >> we will ask the secretary to submit a response to you in writing. >> thank you. >> your time has expired. mr. grothman, you are recognized for three minutes. >> i know the criminal system, justice system in wisconsin. when we arrest an adult, we do not allow the children in the jail cell with them.
and i'm not aware of any state that does and i have heard no complaints in wisconsin even from the most left wing of democrats saying when we arrest somebody for breaking the law and putting them in jail that we tear apart families. that's the way they feel about it in wisconsin. i wanted to comment a little bit on the medicaid program. the seven states in 2015 the highest rates of opioid-related overdoses, west virginia, new hampshire, kentucky, ohio, rhode island, pennsylvania and massachusetts. all expanded medicaid programs under obamacare. obviously you get cause and effect all mixed up here is what's coming first, but way disproportionately people on medicaid are far more likely to die of an opioid overdose than people who are not on the
program. could you comment on that and is there anything we can do? do you feel the medicaid expansion made the opiate situation worse and is there anything we can do, again, remembering that, you know, kind of it's hard to tell in these things what the cause -- what's the cause, what's the effect, but can we do anything on the medicaid program to kind of cut off the supply here? >> so the ready availability of cheap accessible legal opioids, especially generic opioids was fundamental to this problem. the majority of people who get addicted on opioids start from a legal prescription for opioids making the financing and accessibility of those ready yer obviously contributes to it, how much i can't say, but it's quite clear that would be connected. what we've got to do is get at the issue at the state level and federal level of how often people are prescribed, why they are prescribed, how many they're
prescribed. with medicaid that's why we're asking for prescription drug monitoring programs as well as interoperable across states lines so you can't shop from west virginia into ohio, for instance, and go doc shopping. we're enforcing against pill mills from the inspector generals office and department of justice. it's a serious issue and you raised the right questions. >> good. good for me. one final question. overall prescription drug use in this country is way higher than any other industrialized nation. and observe very expensive. i wondered if you could comment on that in general, your opinion on the amount of prescription drugs prescribed in this country. >> too expensive but a lot of the major innovation we have had in healthcare delivery is from the availability of new facilities, not new procedures. we're paying too much, absolutely, for our drugs. >> thank you. >> thank you, mr. grothman.
ms. handel, you're recognized for three minutes. >> thank you very much, madam chairman and thank you, secretary, for being here. i wanted to go back to the topic of neonatal addiction syndrome that was brought up earlier in another committee. the acting director of dea and i had a conversation about a dea policy that actually says that in treating an addicted mother that she is under no circumstances should be allowed to experience any withdrawal symptoms, even going so far as increasing doses at the end of the pregnancy, which obviously then exacerbates and promotes and fosters fetal addiction syndrome. there has been a very interesting study out of an augusta medical facility in georgia, in augusta, georgia, that shows extraordinarily promising results and i wondered if i could send that to you and perhaps for some interagency
conversation about this issue because we should be doing everything that we can if this is going to deliver some results to keep babies being born without that fetal syndrome, it would seem to me that would be a positive. >> absolutely. i would be delighted to receive that information and ensure that all of the works who work on this in the department and dea are educated on that. thank you. >> i will get that over to your office this week. i wanted to ask you -- you had mentioned earlier about short term limited duration insurance and i wondered if you could briefly give a few more details around that since i think we are going to see a little bit of an uptick in that. what types of plans are they, what types of consumers might benefit from them and how does hhs plan to make these expanded plans successful and broader in their offerings? >> thank you. i think it's important for people to remember these plans were in existence the entirety of obamacare until the end of the obama administration when they were shortened from 12 months down to three months. so they were around. this is not some novel thing
that even the previous administration was opposed to. they changed it in the waning hours of the administration, what we are proposing is to restore that option to people. these are plans focused for people in transition, leaving one employer sponsored healthcare plan, they have a gap and it maybe can be a bridge until they get to other employer sponsored care. it may be for people who simply can't afford anything in the affordable care act market and don't qualify for medicaid and it's some coverage and option. it may not be the right coverage for anyone and we want to ensure that. we're just trying to present options for people that can be available that are affordable for those who need it. that's why, for instance, we don't think many people will leave subsidized individual insurance market affordable care act coverage for these because they are not the same. they are regulated by states. states are able to choose, they are out of the aca's regulatory requirements for the most part. >> great. thank you so much, madam chairman.
i yield back. >> thank you, ms. handel. mr. estes, you are recognized for three minutes. >> thank you, chairwoman. mr. secretary, i was a lead sponsor for a letter that got 153 signatures from our fellow members talking about requesting that you would affix the regulations for title x pertaining to what's commonly known as protect a life rule. i want to thank you for your effort in that regards. really it really wasn't a real change as soon as restoring the rules and regulations back to what the original legislative intent was that for so long have been accepted by the supreme court as the right ruling. one of the questions i guess i had for you is just, you know, how does that change with the protect a life rule actually help with accountability and integrity of the title x program and more specifically if you could talk a little bit about how does that help protect some
of the minor aged victims of sexual abuse? >> thank you for asking about that because various provisions of the proposed rule get more attention than others. one of the things we are doing in the proposed rule is bringing in a lot of the trafficking and abuse protections that have since -- that have developed since the last regulations were issued in title x. so really helping to ensure that grantees of title x organizations comply with state reporting requirements around trafficking and abuse and are properly trained to ensure they are able to identify that. we want to ensure we have a broad base of providers available and broad range of services for the men and women who take advantage of title x family planning services. >> that's great. i think what we set up as a legislative branch before i was here, was making sure we did have viable family planning capabilities provided through title x and wanted to make sure that that's the availability going forward for folks who have
that availability. thank you for your effort and work in that regards. madam chairman, i yield back. >> thank you, mr. estes. i'd now like to recognize mr. scott for his closing comments. >> thank you, madam chair and thank you, mr. secretary for being with us. i think we have both calculated if we had allowed four minutes we would have run over so we did the best we could with the time that we have available. we will have the opportunity for written questions and we expect them to be responded to and the secretary is indicating that he will and i will be asking the question unfortunately didn't get a straight answer from and that is can federally funded foster care programs discriminate against potential foster care parents based on race, religion or sexual orientation based on strongly
held sincere religious beliefs. mr. secretary, don't feel bad about not giving me a straight answer. i've been trying to get a straight answer, i couldn't get a straight answer from the two previous administrations. it's difficult to acknowledge to people that their agencies will tell people or won't deal with people based on race or religion. it's kind of hard to acknowledge that publicly, but that's what a religious exemption does. we will give you the opportunity to respond clearly and also to respond whether or not the health and human services is planning to inject a religious exemption in the healthcare rights law under section 1557 of the affordable care act which would allow -- which would, again, deny people the protection they have under those -- under that statute. you've gone to great lengths to talk about the opioid addiction and how hhs is dealing with that
from a public health perspective, which is obviously, i think, intelligent way to do it. we would hope that you would extend that strategy to other drugs where we are using the criminal justice system which everybody knows only loads up the prison, doesn't do anything to reduce opioid addiction. we had great back and forth on the separation of children by the department of homeland security. what's not clear, whether the health and human services has the capacity to care for all of the children or whether or not you could ever care properly for children that have been ripped away from their parents. so madam chair, i appreciate the opportunity to have the secretary here. we look forward to him coming back and other hhs officials coming so that we can perform our oversight responsibilities. thank you and i yield back. >> thank you, mr. scott. there have been a lot of --
there has been a lot of agreement today on the importance of oversight hearings and i really wish that more attention would be given to asking questions that would inform the members as opposed to so much time being given to attacking the secretary and what he's doing. i want to thank the secretary for being here. i think for someone who has been in such an important job that has so many technical aspects to it, to have come here with only three months in the job and be able to answer straightforwardly so many questions, i really commend you for that. i commend your staff for helping you be prepared for it also. we do take our responsibility of oversight very, very seriously.
in a world where the term fake news is of increasing concern for people of all political persuasions it's important that we hold hearings like this one with individuals in authority who can give us straight factual answers to questions that may have been sparked from a sensational head line or an old file photo. every member of this committee recognizes that immigration is a serious issue, it has been for a long time. so we appreciate the secretary's comments and clarification regarding the treatment of children and families and we share his concern. i want to add my emphasis to questions that were asked by members on the dir fees. i have special concerns about
again, we don't have to look very far, just look across to other countries who have tried to have management by the government at a central level, it hasn't worked anywhere. so i am sorry that it has failed so miss rerable blee, but it ha and we appreciate everything that the administration is doing. we're doing everything that we can to make it better. i want to thank you again, mr. secretary, for being here today, for answering our questions. i will join my colleague in saying we hope that we will get timely answers from the department to queions that were asked. i believe that that will help iro the relationship between the congress and the administration, but i think you have done a marvelous job here
today and i appreciate it and i appreciate all of our members and their patience. >> madam chairwoman. >> yes. >> can i have a request. >> without objection. >> i ask enormous consent to enter into the record documents that would show how the individual mandate repeal will increase prices, how the associated health plans will increase prices. >> without objection. >> and also junk plans and cost sharing reductions. and also i want to reiterate the fact that we haven't had a health and human service representative here before us in a year and a half is obviously not the fault of this secretary. >> well, it is not the fault of this secretary and we've had secretaries, acting secretaries and so, again, i like us to deal with the facts and we will always come back to that, mr. scott and we will make sure that people get the calendar.
i appreciate, again, the secretary jogging people's memories about certain things such as the different healthcare plans that were available under president obama and that were changed immediately before mr. -- president obama left office. anyway, we have facts and we have facts and then we have statistics. >> as long as they are not alternative facts. >> they are not alternative facts. we will make sure they are there. thank you again, mr. secretary. there being no further business, this meeting -- hearing is adjourned.
and that wraps up our coverage of this hearing with health and human services secretary alex azar. if you missed any of this live event, we will show you his testimony about the policies and priorities of his agency again tonight at 10:00 p.m. eastern on our companion network c-span. president trump is expected to sign a veterans healthcare bill later today. that's scheduled for 12:15 p.m. eastern in the rose garden and we will take you there live when it gets under way. later, white house economic adviser larry kudlow will preview the upcoming g-7 summit. that's supposed to start at 1:00 and we will have live coverage for you here on c-span 3 as well. in the meantime, here is a portion from this morning's washington journal.