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tv   Sec. Alex Azar on Health Human Services Policy  CSPAN  June 7, 2018 3:25am-5:26am EDT

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at 10:00 a.m.. live coverage here on c-span. the u.s.-north korea summit is set for tuesday. book tv will feature authors with books about the region. this sunday, with one book, a north korean girls journey to freedom. another author, and her book "undercover". watch on c-span2's book tv, sunday at 5:00 p.m. eastern. next, we have from health and human secretary alex azar. he testified yesterday morning. members focus their questions on the opium epidemic, mental
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health treatment, prescription drug prices and health insurance affordability. this is about two hours. >> 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.
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this committee's dedication to oversight and building working relationships with the various administrative departments are well-known and well-documented. 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.
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-- expect 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 workforce 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 it 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
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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 has -- that no one has been here before, but the fact is, we haven't heard from anyone from the department of health and human services. 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 the 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
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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 troubledhat t -- troubled at the administration's effort to erode civil rights protections under the guise 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
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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 that the department is accountable in faithfully executing the law. this is difficult when cabinet secretaries refuse to give the oversight committee their time. we look forward to your
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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. >> chairwoman 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
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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 -- be here 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
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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 arehard 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, the president's budget breeze underdevelopment in opioid addiction and overdose is stealing 100 american lives from us every single day. under president trump hhs has already disbursed unprecedented resources. budget would now address $3.5 billion in fy 2019 to address the opioid epidemic and serious mental illness. within that allocation, 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.
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recognizing 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 a historic transfer of resources and authority from the federal government back to the states, empowering those who are close -- closest to 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
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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 savepatients money on drugs and support fda's efforts to spur innovation and competition in drug 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.
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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 early education programs. the budget strongly supports headstart 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 futuregenerations. -- future generations. and it will make investments and reforms to strengthen our programs that serve families and communities, delivering on these goals. on these goals as the president's budget does is a
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sound vision for the department of healthand 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 asked 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 oneducators, local employers and communities. we have have introduced four bipartisan bills to target various areas impacted by opioids. mr. secretary, how is hhs working to combat the opioid epidemic as outlined in the fy
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2019 budget including engaging with educators and communities? >> thank you, madam chairwoman. as you mentioned, the opioid crisis is really one we can all work together on a bipartisan basis. i think we can all be very proud of how we have been doing that. 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 nonprescription, 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 of opioid addiction. those are a couple of things we're doing, madam chairwoman. >> thank you.
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the 2014 block grant added new requirements for criminal background checks. 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. to my knowledge, no state has fully implemented the background check requirement. 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? that weree with you expect to states to use the increased funding that has most recent appropriation to ensure that they get into compliance with all the requirements of that reauthorization.
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obvious, there are some technical issues with states and other issues we are working with them on and providing technical assistance. we do expect them to use the funding congress has provided to get there. i have a third question, but i will submit that in writing. recognize ranking member scott for his three minutes. indicated the importance of reducing prices of health insurance. are you aware that the elimination of the individual mandate will actually increase costs and premiums? aware that eliminating the mandate will increase the cost of health insurance? >> that would be one view. that is one estimate. >> it is a yes or no question. >> it is not a yes or no answer.
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aware that associated health plans will increase the cost for everybody else? >> they will actually bring down the cost of insurance for people left out. >> i take that as a no. >> the plants that do not cover the full benefit, the proliferation of those will increase the cost for everybody else. did you know that? >> we have a proposal to restore president obama's initial plan. >> that would increase costs for everybody else. >> that would actually lower costs by making plans affordable for those who can't afford it now. are you aware that the elimination of cost sharing reduction payments will increase the cost of health insurance premiums? >> congress is the one that did not appropriate the reductions, mr. scott. >> you are aware that the failure to make those payments
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increase the cost of insurance premiums? >> we were trying to work with congress on a bipartisan basis to appropriate the cost sharing reduction. but don't mean to be rude, with three minutes i'm trying to get several questions in an and is very difficult. shoulds of civil rights, strongly held religious believes be able to override other civil rights views and the civil rights protections. in the virginia case, the court band interracial marriages. the fact that he separated the races shows that he did not intend for the racist to mix. the foster care agency believes that, with a be able to deny
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interracial placements? >> we work to enforce the laws congress has put into place around nondiscrimination and we vigorously enforce that through our programs. we try to be extremely vigorous and the enforcement of .nti-discrimination >> nursed on sexual orientation. the agency have denied placements for same-sex? all laws to enforce congress has placed upon us. >> could your administration same-sex couples? >> thank you, mr. scott. >> just very quickly, i agree
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mission.aca's i was want to give an example, i take lipitor. i travel a lot, so i have the i will mention the pharmacy, but exact same prescription was $ 290. why was one of $290 and the other $12? i want to know where that money went because i don't think the pharmacy got it and another generic drug producer didn't get it. >> the issue you decided is one of the great challenges we have
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in our system and that is why we have already issued instructions out to our part d drug plans. about these so-called gag rules that would prevent pharmacist from telling you the beneficiary that you could actually pay cash sometimes for that generic drug cheaper than running it for your insurance. we have party told plans that we find that completely unacceptable. >> my question is what benefit benefit dong, what they provide? $275 of mycketed money that i paid cash for. >> i don't know enough particular circumstance whether the pharmacy was pocketing that money. somebody is getting the money and it is not you. >> one of the things i also want
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to bring up for the record is a medicare wage index. that is a huge problem cross country. live, medicare wage is .02. it makes it difficult for us to keep staff because we can't pay them. it is putting rural hospitals out of business. rural america is in trouble. , because commitment for people who don't know, their hospitals that have a wage index of 1.6 or 1.7. i would but a commitment from you to look at that issue because it is really harming rural america. thee totally agree that wage index imposes some real distortions geographically and there have been many studies on this very we look forward to working with congress on this. right now, administratively, there always has to be winners and losers. we look forward to working with
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congress because it really .resents the problem >> thank you. thank you, mr. secretary. madam chair, thank you. i yield back my time. the coversly, include 50 states and the district of columbia and doesn't include information about my district and the other nonstate areas. i understand in some jurisdictions do not have the resources needed to collect the data.
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could you make sure everyone can participate in government accountability and transparency. it is important everywhere in america. >> 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. on the second item, fewer of my people can be enrolled. the affordable care act did help us out.
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we're using up at acm money. 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 be willing to 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
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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 for three minutes. >> thank you, chairwoman foxx, thank you, secretary azar, for being here today. i understand that you are 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 years, 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
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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 providers, how will you work to resolve these concerns? >> thank you for raising --
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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 owned 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 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
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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 -- world 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,
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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 believe any of them were unable to comply. >> so 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 organizations or supporting, and subsidizing organizations that refer for or support abortions, that's how. >> can you tell us about the organizations and medical professionals you've spoken to about this?
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considering the fact that abortions rise by 20%. >> again, this is a matter of funding for 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.
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>> so the title x proposed regulation does not have a 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? you are recognized for three minutes. >> 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. -- there. one obviously is health care. as you know, the difference between a 45-minute hospital
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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 don't, 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
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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 on a 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. we do agree it needs to be addressed. >> 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
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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. 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 csr premium 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
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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 ofs because that impacts individuals in those plans also. i don't think it's actually a facile question how one addresses that.
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>> 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
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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.
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i yield back. >> thank you, mr. courtney. mr. lewis, you're recognize 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
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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 hadfof 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
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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.
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>> 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
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block grant. if your job is to promote the health and wellbeing of the american people, why are you cutting 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 -- why are you eliminating community service block grants, a program that specifically provides funds to alleviate causes and conditions of poverty? why are you eliminatingly 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
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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
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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.
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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.
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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
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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 overhestad 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. at the border, she came -- 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.
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she, her children and the mother, were crying and scared. those two children are now among the increased numbers of children placed in your custody following the administration's appalling decision to separate children at the border. mr. secretary 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
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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 incorrect. he actually didn't see the children because he requested to see a facility at 4 a.m. 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.
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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. that mandates conditions there so 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.
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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
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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 -- premium subsidy 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
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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. ? in addition -- >> in addition is the cadillac cost of it 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
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for three minutes. >> thank you, madam chair. mr. secretary, you said it was the mission of the department of health and human services to enhance 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
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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 care which prejudices in favor of able-bodied adults against children, the disability, and the aged, is exactly what will
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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. that 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
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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.
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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? -- affordable health insurance for workers? >> we believe it will greatly -- we want people with true choice. we are looking to collect -- cooperate with the labor department.
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as an option for individuals, the president wants to ensure the 28 million adopted men and women have affordable options they can choose from because the affordable care act is not giving them affordable options. i appreciate that. options are key. 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
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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.
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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
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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 -- put 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
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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
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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 it so training that is cuss customized, accessible and on demand and gets to what you're talk being. >> we have 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
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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. >> thank you mr. norcross, you are recognized for three minutes. >> thank you, madam chairwoman.
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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
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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
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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
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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 under 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 very important issue. the welfare reformtaniff was important at the time, but people have found ways around it and so that's why the president's budget was called enhanced workfor participation requirements,
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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
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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 structure that is effectively to --g, would help us would make a difference in opioid addictions. thatdered if you felt could advance under your strategy going back to the epidemic question mark -- epidemic? feel it is a plaintive and it is of all the properties that we could fund that is at the lower end of them. even if congress were to keep it in place, the issue you have around competition and accountability would be welcome to look at, anything that would
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help improve measures of performance there, where there are many. >> that is a time i would like to continue in my discussion. thank you. >> thank you. you're recognized for three minutes. 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 and the matter is just urgent, time sensitive, and especially we believe children come first. shifting gears, mr. secretary, i understand from your testimony
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that you support repealing and replacing the affordable care act and, in the interim, the administration has put into place some things that are destabilizing the system even more. so, delaware ian's could see an increase in premium as high as 19%. the affordable care act is the law of the land. today. so, what would be helpful is if you could share immediate steps that your agency is taking to stabilize the individual market please and lower the cost of premiums. land is the law of the that we worked to implement and we want affordable options for people. we do not want high premiums. the challenges are so many states only have one or two plans. the way the affordable care act is structured, if you only have those plans, assert -- this a premium -- that premium support goes up. there's no incentive for them to painting the cost increases.
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drug prices keep going up, and that is what drives so much. but, they are gaming the system that was created. >> can you give us what you are doing today to make an impact. we talked about the fact that open enrollment is coming. rate changes are coming. you have to take off some of the things your ministry's and is doing. your agency is doing. >> the biggest thing is making options available for folks. prices will go up and there is little we can do to stop the premium increase because subsidies chase those premiums. that is why we are trying to make other options available. >> we're going to have a follow-up meeting, i'm looking forward to it and i will yield the last 30 seconds to mr. scott. thank you so much. that some ofare the plans are not available because of the uncertainty
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injected by this administration. plans not aware of because, youle >> decided not to participate because of the uncertainty caused by this administration. >> i've not heard of that, nor do i believe it is accurate. there are major providers offering packages available and making a ton of money off of it, given the subsidies that we see in the system. >> thank you mr. scott. thank you madam chair. 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
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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
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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.
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>> 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 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 -- in this room are able to access primary care to lower ultimate healthcare costs in the long run by receiving preventive care. thank you very much. >> thank you, ms. stefanik. mr. desaulnier, you are recognized. >> thank you, mr. secretary for being here.
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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 terman 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
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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 and given your testimony about public/private partnerships and the abuses in
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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 -- are there any 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
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investment there so we do have to act and tread quite carefully in that place as we want that transitional science to work to deliver those kind of therapies that are helping 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
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improved knowledge of safety planning as a result of work done by fcpsa grantees and subgrantees. too often we legislate 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 so we can continue supporting states efforts to prevent domestic violence and provide shelter and support to >> 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.
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>> 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 streamlining 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
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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, secretary 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?
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>> 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 arrived with them? we have to get out of the business of macro -- micromanaging the how of health records. when the patient shows up, is the information there? do they own it? to the carry it with them and get the doctor's eyes off the screen and on the patient. would love to work with you on anyways we can support that vision because i think we are in complete agreement here. + i would love 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 around the patient and not those computer screens, which we all see when they go into the doctors offices. the question is, are you open to soliciting feedback from providers who are affected by
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these rule changes. i think that would be really important in basically refining the techniques that you are developing to streamline the electric -- electronic system. >> i would love any import them any source on how to make this work better for providers and the benefit of patients. i'm totally open-minded and would love input. i would love to work with you on this. >> thank you. mr. guthrie, you are recognized for three minutes. it is great to be here and i've really enjoyed working with you since you have been sworn in. you have been open and very accessible. matt and i worked in kentucky together and sarah runs a really good legislative shop. we are really pleased working with you guys.
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one thing i want to touch on. kentucky has been hit hard like everybody else on the opioid epidemic areas particularly everywhere, but the one issue i'm going to focus on here 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. neonatalsue of syndrome is such a novel issue. one of the things we need to do is build the evidence base around what is the right treatment for these children? bring them out of the addiction and what is the right way to care for them. we also have to make sure we get these syndrome places up and running. i've been privileged to see one in the dayton areas and the work that they're doing for these kids and their parents.
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in west virginia, the percent of kids born with it is shocking. i would love to work with rearrangen how we can our program with the money given to us. >> in the late 90's, welfare reform. these people are employers with open arms waiting for these people to come into the workforce. maybe it is a great opportunity to do so. could you evaluate the efforts, how could we invited the efforts of states to help participants move back into the workforce? + think part of the question is what percentage of the states --
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how many people are genuinely getting jobs and how many are they just offloading and paying with state money so that they can get credit for exiting the program? >> all the gaming that has been done in the last couple of decades and fixing that and working with congress. ? i know the farm bill and the big effort is putting job training into stacks of the thate can get job training leads to meaningful careers. look forward to working with you in this area as well as some of the others. i yield back my time. >> do wish to submit something for the record? + i ask unanimous consent to enter a letter signed by 86 numbers of congress.
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>> without objection. >> as you may know, there are thousands of children that are now in detention centers. told her have been separated from their families as they came into the united states without any documents. i've seen some images of where they are being held. these are very horrendous conditions in which they are in. , on the 2018 agreement, your department is now asking potential sponsors about their immigration status and their sharing that information with ice to read you and may be a green card holder or citizen and i may have an undocumented uncle -- and or uncle and my household and i have to share the information with you, i may not want to be underonsor of this child
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these very difficult conditions. what is your position on the? standard should be continued to be pursued? >> we work with the department of homeland security to ensure that -- our number one mission is to take care of these kids and get them with sponsors. one thing we have to do is work ensure that these are the people they say they are when they come in. identity verification and also ensuring background checks. of our the purpose information sharing agreement and working with dhs there. i think we share the goal of getting them with family members as sponsors. >> i think that that policy will discourage families from coming for and be willing to serve as sponsors.
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my second question is, i know that education is guaranteed to undocumented children by several court cases. , anou think that a child undocumented child use of chip should count against a parent immigration determination? >> i have not studied or look into that issue. i would be happy to get back to you in writing so i can give -- more and response thought and response. >> the whole aspect of this process is troubling and i think it will contribute to keeping these children in detention centers and will put their health and well-being in jeopardy. thank you, mr. secretary for your answers. >> thank you mr. secretary for
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joining us today. first question would be on the cost of health care as compared to other developed nations. in 1970, most developed nations 4% and 7% of gdp. the united states is proposing 20%. the next closest nation is below 15%, around 13% of gdp. $8,000e spending about and change. other countries are spending half that much. when you look at projections, our health care costs 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
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of health care? >> we get great health care in the united states. i personally had the benefit of that in a last couple of months. we are blessed to live in this country and have the quality of health care we have. is it twice as good as countries who it may have twice as much as go i'm not sure that is the case. we pay for procedures and sickness. i have four parts to that agenda. the first is generally an operable technology to release the power in this space. the second is the patient's making real choices. we are the biggest payers in the system, we have first mover advantage. we can ripple through the whole system by changing how we pay. it is on the radar and we are
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determined to make a material change here. side.the regulatory -- 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. physicians at least share with me the only way to bring down costs is to allow them to restore the patient/physician
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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 health care system. >> mr. allen. >> yes. >> we will -- >> mr. allen. >> yes. will ask the secretary to submit a response to you in writing. >> thank you.
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>> your time has expired. mr. grossthman, 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
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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
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prescribed. with medicaid, that is 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. obviously, 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,
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absolutely, for our drugs. >> thank you. >> thank you, mr. grothman. ms. grothman. handel, you're recognized three minutes. >> thank you very much, madam chairman and thank you, secretary, for being here. i -- 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 -- spur some interagency
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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. >> wonderful. 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 and what types of consumers might benefit from them? how does hhs went to make these plans broader in their offerings? >> thank you. it is important for people to , they were around.
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this is not some novel thing that even the previous administration was opposed to. waninganged it in the hours of the administration. but we are proposing is to restore the option to people. these are plans complete focused on people in transition. they have a gap and it can maybe be a bridge until they get to other types of care. people should go in with their eyes open. it may not be the right coverage for anyone and we want to ensure that. give just trying to options for people that are affordable for people who need it. we don't think that many people are going to leave subsidized individual market affordable care act coverage for this because they are not the same. they are regulated by states. .hey're able to choose air out of the aca australia
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regular play requirements for the most part. great. thank you so much, madam chairman. i yield back. >> thank you. ms. handel., 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 the 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
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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 also 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. because 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
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availability. thank you for your effort and work in that regard. >> -- 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
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held sincere religious believes. 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
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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 is 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
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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.
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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 headline 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 have
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-- about this. i have met with independent farmers in my district. this is a major issue and i hope that we will move expeditiously in this area and i will be following up on this issue myself. i also share the concern with rural hospitals, the comments that dr. rowe made and others and their deep concern. i have a couple of very rural areas where they are struggling very hard to hold onto the hospitals. we know that once those hospitals go, it very seriously damages the community. i appreciate also the comments -- tannif, innis that a job is really the best way to get people out of poverty. know the old saying of giving a person a fish incident to to the person how to fish.
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we want to do that. i think we need to own up to the fact that for many of our colleagues, it is extremely difficult, especially those who voted for the affordable care act or obamacare to admit that that legislation contained within it the seeds of its own destruction. unfortunately, and i really mean unfortunately, everything that we predicted that would go wrong with that legislation has gone wrong. all of us want to see people have access to affordable, effective healthcare, but putting washington in charge of that is simply not going to work. it doesn't work anywhere else. it doesn't take us long to understand that capitalism and free markets really do work. again, we don't have to look
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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 miserably. but it has. andl have to own up to it get on with our business and do everything we can to fix it. i appreciate what the administration is doing. we're doing everything that we 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 questions that were asked. i believe that that will help improve 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.
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>> 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
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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.
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>> by thursday on the c-span networks, the house returns at 10:00 a.m. for work on a revised spending bill. on c-span2, the senate returns for debate in both senate judiciary nominations and work defense department's bill. on c-span3 the house ways and means subcommittee on social
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security holds of meeting about the social security's solvency report. the chief actuary of the program testifies. the house foreign affairs committee considers ways to advance the u.s. investment and trade in the americas. journal" "washington live every day with the news and policy issues that impact do you. we are live in lansing, michigan for the next stop on the 50 capitals tour. democratic congressman will be on to talk about immigration policy. george mason university's house onlaw challenges facing social security funding. join the discussio


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