tv Sec. Alex Azar on Health Human Services Policy CSPAN June 7, 2018 4:07pm-6:09pm EDT
robert kennedy died from gunshot wounds. >> they quickly decided to transfer him to good samaritan hospital. mrs. kennedy was with him all the time riding in the ambulance with him from one hospital to the other. the suspect now identified as s sirhan sirhan was grabbed and load by police back through the ballroom in the hotel. some of the officers had to protect him from the crowd. there were several kennedy supporters who were close to his center hyster hysteria. health and human services secretary alex azar testified before a house committee on the policies and priorities of hhs,
including the opioid epidemic, mental health treatment, prescription drug prices and the affordability of health insurance. from wednesday, this is two hours. >> we're pleased to welcome alex azar. 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's made an oversight hearing with this
committee such an early priority. thank you. this committee's dead diagnosdi year sight a oversight is well known. the members of this committee are responsible for 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. that's why it's important that we hear from the secretary. i want to say at the outside 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 forecasts as to
when members can 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. it's one of the most important parts of this job. i'm sure you would agree the same is true for you. secretary azar, it's a pleasure to welcome you to the education work force committee. thanks 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. we're going to try to make the most of our time together. i'll insert the remainder of my statement in the record. i now yield to ranking member scott for his opening remarks. >> thank you, madam chair. madam chair, this is the first time an official from the department of health and human services has appeared before this committee since president
trump took office, yet this opportunity to hear from the department is long over due and i appreciate the secretary for giving us time this morning. it may not be his fougault that nobody's been here before, but the fact is we haven't heard from anyone from the department of health and human services. also employ the majority in the administration to try to schedule these hearings at a time that gives all members a full five minutes to ask questions. as i understand it, the conflict in the schedule will truncate his appearance here so that members will not have five minutes even after a year and a half worth of questions will not have a full five minutes. it's impossible to do oversight if you don't have time to ask questions and follow hup. the mission of the depth is to enhance and protect health and well-being of all americans. unfoshl this administration frequently appears to be more focused on advancing an ideology than fulfilling that mission. despite congress's inability to
repeal the affordable care act and the public's resounding opposition to both repealing and sab totaging the law, this administration continues to destabilize the health care system, for example the sale of low quality health plan which is do not offer the full comprehensive coverage or adequate protections for people with preexisting conditions, will continue to increase health insurance cost and undermine protections for millions of americans. the elimination of the individual mandate, although popular, will also increase the costs of insurance prices. also deeply troubled that 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'm profoundly disappointed by the administration's efforts to weaken programs that help people meet their basic needs.
in the wake of a $1.9 trillion tax cut overwhelmingly focused for corporations and the top 1%, the president's proposed cuts in basic services that support struggling individuals and families across the country is particularly difficult to justify. as the lead agency directed to improve america's health and well-being, i'm surprised that this department would support a budget that restricts families' access to essentials like health care, heating assistance and food. while i appreciate the continued engagement in many areas where there may be some common ground such as doing more to address the opioid crisis, we must get clarity on the department's priorities and ensure the department is accountable and faithfully executing the law. getting this clarity is difficult when cabinet secretaries refuse to fit the committee oversight hearing into their busy schedule so members can get the full five minutes of questioning they're entitled to.
i look forward to your testimony and for the continued cooperation as we conduct this vital oversight. >> pursuant to committee rules 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 material referenced during the hearing to be submitted for the official hearing record. it's now my pleasure to formally introduce our distinguished witness, the honorable alex m. azar is the secretary for the u.s. department of health and humanity services. welcome, secretary azar. >> chairwoman fox and ranking member scott -- >> secretary azar, i ask you to raise your right hand. do y do you swear the testimony you give will be the truth, the
whole truth and nothing but the truth? >> i do. >> let the record reflect secretary azar answered in the affirmative. i think you understand the lighting system. i'm not going to read the script. it's a five minute time. when one minute is left, the light will turn yellow. at the five-minute mark, the light will turn red. >> 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 here and to serve hhs. it's a vital mission and the president's budget clearly recognizes that. the budget makes significant strategic investments in hhs's work. among other targeted investments, the budget requests $34.8 billion for the national institutes of health, 5.8 for the food and drug
administration, 8.3 billion for head start and 6.2 in child care funding. the president's bunldget suppor four particular priorities that we've laid out, increasing the affordability and accessibility of individual health insurance, tackling the high price of prescription drugs and transforming our health care system into one that pays for value. first, the president's budget brings a new level of commitment to fighting the crisis of opioid addiction and joseoverdose. hhs has already disbursed unprecedented access to addiction treatment. the budget dedicates $1.2 billion to the state targeted response to the opioid crisis grants and invests $150 million specifically to confront the
crisis in high risk rural communities. recognizing that we need new tools and private sector ren nati renovation, the budget launches the nih public/private partnership. 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 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 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
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 improve the already successful medicare part d program by straightening out incentives that too often serve middlemen more than our seniors. the budget proposes medicaid and medicare part b reforms to save patients money on drugs and support innovation and competition in generic drug markets. these priorities are reflected and expanded upon in the recent blueprint for lower drug prices that hhs released last month. we also want medicare and medicaid to pay for outcome rather than sickness. this budget takes steps toward that shift, laying the dproungr
work for the value based care vision that i laid out earlier this year. our system may be working for entrenched interests, but it isn't working for the taxpayer and that has to change. i want to highlight this budget support for child care and elary education programs. the budget strongly supports head start amid child care through financial investments 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 sound fiscal footing that will allow them to serve future generations. and it will make investments and reforms to strengthen our programs that serve families and communities. delivering on those goals is a sound vision for the department of health and human services amand i'm proud to support it. thank you very much.
i look forward to the committee's questions. >> thank you again, secretary azar, for taking the time to testify before the committee. given our witness's need to head to the white house by noon and in agreement with our ranking member, members will each have three minutes to ask questions. i ask all members to keep their questions and answers within this time frame. 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 held three hearings during this congress. committee members 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 2019 budget, including engaging with educators, employers and local communities? >> thank you, chairwoman. as you mentioned, the opioid crisis is one we can all work together on a bipartisan basis. the opioid funding in the 2018 omnibus is clear evidence of that. the 3$3.5 billion we've requestd will support the nih to try to get the innovation of nonopioid treatments for pain as well as research into nonprescription for instance alternatives to treating pain. we're also putting grants out to states. these are the state targeted response grants. thanks to congress, even more flexibility to target those towards states that have the highest burden of opioid addiction. those are a couple of the things
we're doing. >> the 2014 reauthorization of the bloc grant adding new requirements for comprehensive criminal background checks, states and territories were required to come into compliance with these requirements by september 30, 2017. but all states applied for and received one-year extensions because they could not meet that deadline. the new deadline september 30, 2018 is fast approaching and to my knowledge no state has fully implemented background check requirement. given that background checks play a significant role in keeping children safe, how does granting a ining additional wai protect these children? what is your agency doing to help states reach compliance? >> we agree with you that we expect states to use the increased funding that is provided in the most recent appropriation to ensure they get into compliance with all of the requirements of that
reauthorization. we're working with them on that. obviously there are some technical issues with states and information technology and other issues. we do expect them to get into compliance. >> i have a third question, but i will submit that in writing. i now recognize ranking member scott for his three minutes. >> thank you, madam chair. mr. secretary, you indicated the importance of reducing prices of health insurance. are you aware that the elimination of the individual mandate will actually increase costs for premiums? >> so actually most of the people that are in the -- >> wait a minute. are you aware that eliminating the mandate will increase the costs of health insurance? >> that would be one view. most of the people in the individual market right now, that's one estimate. >> that's a yes or no question. >> it's not a yes or no answer. >> are you aware that associated
health plans, if adopted, will increase the cost of insurance for everybody else? >> association health plans will actually bring down the cost of insurance for the 28 million people left out. >> i take that as a no. the plans that do not cover full benefits, so-called junk plans, the proliferation of those will increase the costs for everybody else. did you know that? >> we have a proposal to restore president obama's initiative to have 12 month long limited duration health plans. >> that will increase costs for everybody else. >> that would actually lower costs by making plans affordable for the 28 million people who can't afford individual insurance now. >> the elimination of the cost sharing reduction payments, are you aware that the elimination of cost sharing reduction payments will increase the cost of health insurance premiums. >> congress is the one that did not appropriate the cost sharing reductions, mr. scott. >> that means that you are aware
that the failure to make those payments increased the costs of health insurance premiums? >> there's an impact from congress's failure to appropriate money. we were trying to work with congress on a bipartisan basis to appropriate the cost sharing reduction monies. >> i don't mean to to be rude. with three minutes we're trying to get several questions in. it's very difficult. in terms of civil rights, should strongly held religious beliefs be able to override over civil rights views, civil rights protections? in the loving v virginia case, the trial court justified the ban on interracial marriages by saying that al mighty god created races and placed them on separate continents and but for the intervention of this arra e arrangement, there would be no cause for such marriages. the fact that he separated the races shows he did not intend for the races to mix. if a foster care agency believes
that, would they be able to deny interracial placements? >> we work to enforce the laws congress has put in place around nondiscrimination. we fully enforce that through the office of civil rights and the acf and other programs. >> if a strongly held belief was against sexual orientation, would the agency deny placements. >> we work with all laws congress has trusted us to enforce. >> could they in your administration deny placements for same sex couples? >> if congress has placed anti-discrimination provisions in place in that regard, we will enforce them vigorously. >> thank you, mr. scott. dr. rowe, you're recognized for three minutes. >> thank you, madam chairwoman.
thanks for being here today. i agree with the aca's premise of lowering cost and increasing access. it has not done that. one of the great drivers both in medicare and the private sector are prescription drug costs. and i'll just give you an example myself. i take lipitor. i get it at home, 90 days generic. it's $12. i travel a lot, so i have to put three pills. if i got sick of it, i had my doctor in d.c. call a prescription down the street. i won't mention the pharmacy. the exact same prescription was $290. why was one 290, the other 12? i think there's some money in between called a pbm or something. i want to know where that money went. i don't think the pharmacy got it. i know the generic drug producer didn't get it. >> the issue that you just cite
is one of the great challenges that we have in our system. that's why we've already issued instructions out to our part d drug plans about these so-called gag rules that would prevent pharmacists from telling you, the beneficiary, that you could pay cash sometimes for that generic drug cheaper than running it through your insurance. we've told plans that we find that completely unacceptable. >> my question is, what benefit to me as a physician writing the prescription and the patient actually getting their prescription filled, what benefit do they provide? somebody pocketed $275 of my money that i paid cash for. >> i don't know in that particular circumstance whether that was the pharmacy or the pbm that was pocketing that money. it might be that that pharmacy was not in that pbm's network. somebody's getting the money and it's not you. >> absolutely. one of the things i also want to
bring up for the record and i know this is not under our jurisdiction, but the medicare wage index. that is a huge problem across the country. in rural medicare, our medicare wage index is.72. it makes it difficult for us to get physicians. it makes it difficult for us to keep staff and it's putting rural hospitals out of business. rural america is in trouble. we need a commitment to right that. for people that don't know, there are hospitals in california and massachusetts and new york who have medicare wage index of 1.6 or 7 or those numbers. i'd like a commitment from you to look at that issue, because it is really harming rural america. >> we totally agree that the wage index imposes some real distortions geographically. there have been many studies on this. we look forward to working with congress on addressing the wage index. right now administratively there always have to be winners and
losers with any change on the wage index. we look forward to working with congress because it really presents a problem that you're talking about in so many areas. >> mr. sublon you're recognized for three minutes. >> mr. secretary, welcome. thank you very much for your call yesterday. i don't want to blindside you, but after we spoke i read the news report of the new medicaid score card your department is publishing. i certainly support the idea of measuring performance and letting the public now how government programs are working. but apparently the new score card covers the 50 states and the district of colombia. it does not include my district and other areas, who do not have the resources needed to collect the data. as you develop this score card,
could you make sure everyone can participate government accountability and transparency is important everywhere in america. >> thank you. i will certainly work with the administrator to see what he what we can do to ensure that your constituents are included in the next generation of the score card. >> thank you. on the second item, i think our absence from the new medicaid score card is a symptom of the real problem. for americans living in the marianas -- people refer to the outlying areas are not given the same level of medicaid assistance as americans living everywhere else in our country. that means fewer of my people condition enrolled and their benefits have to be limited. the affordable care act did help
us out. we're using up that acm money, over 14 million in some years. the problem is the acm money runs out at the end of 2019. we go from having 20 million for medicaid to just 6 million. we call it the medicaid cliff. my question is what are your plans for making sure that people in the marianas and other non-state areas are given the same access to medicaid as other americans? and would you be willing to support lifting the cap so we don't fall off the cliff? >> thank you. after our phone call i asked our team to ensure that we work with your office on any legislative proposals to provide technical assistance and help on anything regarding the marianas medicaid caps. >> i hope you would give me someone in your office to work with, give me a name we could get in touch with.
>> our assistant secretary for legislation who's here with me is the individual that we've asked to ensure coordination with your office on preparing that. >> thank you. >> mr. barleta. >> thank you for being here today. i understand that you were born in johnstown, pennsylvania, the great state of pennsylvania. i know you're familiar with the layout of this state. i represent northeastern and south central pennsylvania, which includes some very rural areas. one of the things that i always hear 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 d.i.r. fees. at the time they dispense
medication to the patient, pharmacies receive information about what their reimbursement for the cost of the medication and professional services will be. however, weeks later they can be notified that some of the reimbursement will be clawed back, otherwise referred to as pharmacy d.i.r. 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 d.i.r. 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 beneficiariebene. given the fact that these d.i.r. fees are detrimental to part d beneficiaries and pharmacy care providers, how will you work to
resolve these concerns? >> thank you. that's a very important issue. it comes up in many contexts. one is the specialty pharmacy issue. i have actually long been concerned about this question of these retro active d.i.r. fees being imposed on independent pharmacies to the detriment of them and the benefit of pbm owned pharmacies. i have asked our inspector general to look into this issue. i think it's important to ensure full fair competition as well as accurate reporting in the program. we want to ensure beneficiary access and ensure pharmacy networks are supported. thank you for raising that. we are on that. >> thank you. >> 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 colleague. mr. secretary, your agency is responsible for implementing the expanded global gag rule that will we know is the mexico city
policy. as you know, it prohibits foreign organizations receiving u.s. global health funding from providing information, referrals and services for legal abortion or advocating for the legalization of abortion in their country. we know that the last time this policy was enacted, abortion rates actually rose by 20%. so when you restrict teaccess t the full range of contraceptives, women do seek far more dangerous alternatives. the world health organization has found that 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 is to ensure that no federal monies are going to support in any way the provision of abortion services abroad.
the state department actually did a review earlier this year to look at the implementation practices. for instance, no hhs grantees were unable to comply with the demands. i believe of 1300 grantees across the u.s. government, 729 received new funding and were subject to it. i don't believe any of them were unable to comply. >> 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 terms of the restriction. >> how are you trying to get at the problem of reducing? >> by not funding organizations and supporting and subsidizing organizations that refer for or support abortion. that's exactly how. >> medical professionals --
considering abortions rose by 20% -- >> 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 hope american women feel that their health is being seen in a comprehensive way? you're saying at the beginning that enhancing and protecting the well-being of american citizens, i'm struggling to see how you think 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 in this area. >> the title 10 proposed regulation does not have a proposed gag rule in it. that was something from a past administration. that is not in the proposed rule. we actually allow non-directive counselling related to abortion services in the proposal. >> mr. burn, you're recognized for three minutes. >> thank you. mr. secretary, thank you for being with us today. i'm over here. i'm bradley burn, 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. now, there's two big problems there. one obviously is health care.
as you know, the difference between a 45-minute hospital ride and 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 is this medicare wage index. i know you had a discussion about this over on the senate side with the chairman over there. this is not something -- we've got to have you in this with us in a big way. if you're not with us, we're going to lose a lot more hospitals. there's nobody to blame but us because we've got the responsibility for doing it. please tell me what you and i and other members of congress can do together about the medicare wage index so we don't continue to hemorrhage rural hospitals in america. >> so congressman, we understand
the issue in alabama and so many other states around the medicaid wage index on the impact on rural hospitals there. it's a statutory issue. 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. 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 together 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 look forward to working with you on how to fix that. it's going to be winners and lewandows losers unfortunately in the congress and among states. >> i don't think there are going to be losers if you change it. 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. i think it is the absolute wrong
choice we've made up until this point. if we really care about rural america, we will fix this problem. we can do it in a way to where everyone's a winner. some other places have got too much money now and are going to lose a little bit of money, but it's not going to strike them the way the status quo is striking rural america. i look forward to working with you and i yield back. >> thank you. mr. courtney, you're recognized for three minutes. >> thank you, madam chairwoman. we're weeks away from insurance regulators receiving rate requests for 2019's marketplace as well as non-marketplace insurance plans. my conversations with regulators in connecticut is that the department's inability to clearly state what your intention is regarding broad loading of the csr premium cost is creating a complete sort of question mark and instability, which you claim in your testimony is a goal to try and
stabilize markets. i'm asking you today, is your department going to federally mandate broad loading in terms of how the csr premium class are going to be spread out in 2019, which will result in large premium increases? >> so congressman, the issue you're raising is whether the impact of this so-called silver loading would be put across bronze and gold plans also, not just on silver plans. the issue becomes one for 2019 to mandate -- you asked about mandating any change there. that would require regulations which simply couldn't be done in time. it's not an easy question whether one should attempt to force or even encourage the movement of that loading onto the bronze and golds, because that impacts individuals who are in those plans also. i don't think it's actually a facile question how one
addresses that. >> we're talking in realtime 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 -- we've got a lot of actuaries out there. you right now occupy the decision making position that is going to determine whether or not rates are going to go up double digit or not. >> again, even if you spread that, you're going to impact then your gold and bronze rates. >> i understand how it all works. the question is, is the department going to issue or we going to let 2019 move forward -- we need an answer, yes or no. >> we certainly aren't able to regulate in time for the -- >> i'm going to take that as a no. 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 for the hospital fund.
again, i compliment the trustees by identifying that the trump tax bill caused a lot of that deterioration in terms of lower revenue 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 which is if we allow rate discounts to take place for prescription drugs, the folks who are on medicare and medicaid, the folks who qualify for both programs, we would save $145 billion for the medicare program. 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. again, given your background, we'll follow up with a letter again asking for your take on that. that's just sitting there as an opportunity for us to strengthen
medicare solvency. i yield back. >> mr. lewis? >> thank you, secretary azar. we appreciate your appearance here in front of the committee. the federal child care program aims to foster healthy childhood development by improving the access to low income families for child care. it provides states some flexibility to meet these needs. programs include requirements as well for states to monostore provipr -- monitor providers that receive federal funds. there's been a situation in my home state of minnesota where we've got a number of daycare providers that are openly violating state laws and regulations, taking money for personal use, using the money to set up a fraudulent child care client and providing a kickback has been reported. there are allegations that 23 child care or daycare 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. 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 minnesota. can you share with me what your agency is doing to investigate this? >> we are integrated with the minnesota department of human services on the issue you have raised regarding these allegations of fraud committed by child care providers. these do involve allegations of child care providers serving families that are serving subsidies from the child care development funds. the minnesota dhs has agreed to provide information after they conduct their work.
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 the community action agency in minnesota as well and 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 addage, that which the government subsidizes, it may regulate. i'm 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 there's some sort of oversight here. this is happening with too great a frequency. >> that's one of the reasons and faults we have with the community services block grant, is the tremendous flexibility goic given to states and grantee
there is. that's why we've suggested to congress that that program should be eliminated. >> i yield back. >> 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'd really like to ask you my questions and have someone, you or someone in your office respond in writing. thank you so much. mr. secretary, you state in your testimony that the commission of hhs is to -- and i quote -- enhance and protect the health and well-being 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 ropolicies that will increase the number of uninsured by millions. the president passed nearly $2
trillion in unfunded tax cuts and then have turned around and proposed a budget that cuts more than $1 trillion from medicaid. if your job is to promote why are you cutting billions of dollars from medicare despite the president's promise not to cut medicare? why are you cutting funding for preschool development programs? why result eliminating community service block grants, a program that specifically provides funds to alleviate causes and conditions of poverty? why are you eliminating liheap funding that helps people keep heat and air in their homes? hhs is required to uphold federal civil rights law. will you guarantee that hhs will not approve waivers that are racially biased? and i ask that question because your budget proposes a 20% cut to the very office that oversees
it. madam chair, those are my questions. i would request that you respond in writing, mr. ranking member, do you need more time? i yield the balance of my time to the ranking member. >> thank you. maybe i can get an answer to my question that i asked about religious freedom, whether or not strongly held beliefs give you a pass on the requirement to abide by civil rights laws. could a foster care agency religiously affiliated discriminate based on religion or sexual orientation? >> faith-based organizations that may be grantees of ours or of states that provide foster care have a long history of providing social services for the poor and underprivileged children as well, and families. if we take steps to exclude them from faith-based groups, from our programs, it will harm efforts to support them and support our programs.
we don't believe this is an either/or situation as you phrase it of this discrimination versus that discrimination, but how do we harmonize that and have states have the ability to use -- >> can the agency discriminate against a family based on race, religion, or sexual orientation? >> we have very clear prohibitions on elements of that in federal statute. those will obviously be enforced, as i said before. congress legislates, we enforce. >> thank you, mr. scott. mr. banks, you're recognized for three minutes. >> thank you, madam chair. thank you, secretary, for being here today. i want to start off by thanking you and the department's efforts regarding the title x funding for abortion providers as has already been mentioned in this hearing. i know i speak for millions of americans when i say that this life-affirming decision is long overdue and i'm grateful for this administration's courage in doing what's right. that being said, i understand
the state of pennsylvania has already claimed you, we too claim you in the great state of indiana. we appreciate your hoosier leadership in your new position. i think you would agree, after living and being a leader in indiana, that the state of indiana has a lot to offer the rest of the nation. and i want to talk for a moment, you mentioned in your opening remarks about head start and the department supporting funding for head start. but your department's own impact study also found that any benefits from the program were largely absent by the time the child was in first grade. and the followup report found similar negligible impacts by the end of the third grade. so my question to you is, is it time to empower the states to be more involved in developing their own early childhood education option, and specifically, do you agree that states are in the best position to design and implement early childhood education programs, and if we should block grant those funds to the state rather than washington, d.c. designing
them instead? >> congressman, i can't speak to form block granting or legislative change, the administration doesn't have any position on that. but doing things differently in our programs to achieve better results that they would like to experiment with, governor holcomb has ideas around head start and early childcare development, i'm happy to engage with him on those ideas and see what flexibilities we have or any other governor that would have good approaches. >> very good. let me shift gears, for the minute that i have left, my colleague, mr. byrne, talked about rural hospital issues. i want to talk for a minute about hospital consolidations and ask for your -- any brief comments you might have on the role that hospital consolidations have on the rising cost of health care in this nation.
what can we do about it? >> so many of the mandates that came from the affordable care act as well as other provisions have imposed such regulatory burden on providers that it has led to consolidation of providers to simply cover that overhead cost. we're working reducing that burden, we've reduced 4 million hours of regulatory compliance already. we have billions of dollars of regulations we hope to be coming out to relieve burdens on providers. i'm very concerned, any aspect on which our payment rules encourage integration and purchasing, that should be done as a matter of economics, not as a matter of our payment policies. >> thank you. my time has expired. i yield back. >> thank you. ms. bonamici, you're recognized for three minutes. >> thank you, madam chair. mr. secretary, a woman with the initials j.i.l. was severely beaten by a gang in el salvador. she left with her two young children and at the border they were ripped out of her arms. she was seeking asylum in the united states. she, her children and the mother, were crying and scared. they are among the increased numbers of children placed in
your custody following the administration's appalling decision to separate children at the border. i'm a mother, i know you're a father, many of us in this room are parents. your website, the office of refugee resettlement, states its primary consideration is the best interests in the children. is a policy of separating children from their parents in the best interests of those children? >> so individual children are separated from their parents only when those parents cross the border illegally and are arrested. we can't have children with parents who are in incarceration, so they're given to me. if one presents at an actual border crossing and presents a case to come into this country, one is not arrested and one's children are not separated from them. the best advice i have is
actually present yourself at a legal border crossing and make your case. cross illegally and get arrested and your children will be given to us. that's the simple fact, i'm afraid. nobody has a desire to separate children from their parents. i certainly don't. we will take as best care of them as humanly possible when entrusted with them. >> let me ask you about that. i know we have limited time, because there's been a large influx of additional children in your department's custody. does your department have adequate resources to fulfill their safety, health, and welfare needs? does every child have suitable shelter? medical care, other basic services? i know my senator, senator merkley, was just in texas and said it looks like a lot of these kids are in what look like cages. >> oh, that's completely incorrect. he actually didn't see the children because he requested to see a facility. these are minors, grantees returning a program. we accommodate requests from congress to inspect and look at our facilities. these children are provided full education, medical care, dental, vision. they're provided athletics, meals. >> tell me how you're going to
ensure the proper oversight of the conditions in which these children are kept in what steps you're taking if there are deficiencies. >> we're under a court consent called the flores case. we work diligently to work and ensure complete compliance with the court's consent decree. we take seriously our obligation to take care of these children very well. >> i join the millions of people across this country who are appalled at the policy of ripping children away from their parents. i'm very concerned about it and i hope that you as an adviser to the president will take that message from the people around this country. thank you. >> thank you, ms. bonamici. mr. wilson, you're recognized for three minutes. >> thank you, chairwoman foxx, for your leadership. thank you, secretary azar, for being here today and your service and testimony. i'm grateful to be a member of the bipartisan congressional heroin and opioid task force.
the key to attacking the opioid epidemic is addressing the overprescribing of substances. this is a gruesome problem in many places across the country including my home state of north carolina as well as, tragically, lifelong friends in rhode island and california. alan wilson has worked to fight the issue in south carolina. these pills can be misused, perpetuating the addiction problem. over 20 states have put in place laws promulgated by the cdc that note that three to seven days' worth of therapy is sufficient. we recently saw a similar policy for beneficiaries enrolled in medicare part d. what impact could expanding this policy have on the misuse of opioids?
>> i think you put your finger on a very important issue. we're committed to reducing by one-third prescriptions, that's the president's agenda, of these opioids. we've taken that action through part d in medicare and we encourage states to keep looking at the best practices, as you cited. >> thank you very much. and then as you know, obamacare exchange premium rates continue to rise, as we warned they would, because it's certainly a policy and a program that just is designed to fail. and the average premium subbed increased by 43% from 2017 to 2018. a recent gao study also found that hhs does not have an effective process to determine whether applicants are eligible to receive subsidies. of course it was the author, jonathan gruber of the obamacare, who said it was based on the stupidity of the american
people and the stupidity of the american media. what steps is hhs taking to ensure that only eligible applications are receiving subsidies? >> so i'm glad you asked that. i would like to get back to you on that, if i could, in writing. i want to make sure i inquire on the subsidy verification process. >> has the hhs analyzed how much impact this has had on employer sponsored coverage? >> i believe congress has delayed implementation on the cadillac tax in the current year. i don't know what prospective analysis has been done, probably by the treasury department, as a matter of tax policy. we would be glad to get back to you in writing with whatever analytics were published. >> thank you very much. >> thank you. mr. takano, you're recognized
for three minutes. >> thank you, madam chair. mr. secretary, you said it was the mission of the department of health and human services to enunanimous and protect the health and wellbeing of the american people. the president campaigned on the promise that he wouldn't cut medicare or medicaid. for instance, on may 7th, 2015, then-candidate trump boasted in a tweet, quote, i was the first and only gop candidate to state there will be no cuts to social security, medicare, and medicaid, end quote. mr. secretary, did the president keep that promise or are there cuts to medicare and medicaid in this budget? >> so actually these -- it's, again, washington-speak, that when programs continue to grow but they don't grow as quickly as they otherwise might grow, that's viewed as a cut. both -- >> excuse me. excuse me. excuse me, mr. secretary. according to the cbo, the congressional budget office, the
budget cuts $1.7 trillion from medicaid, the aca, and other health programs, and more than $200 billion from medicare over the next ten years. i would submit to you that this is a blatant departure from the president's campaign promises and it contradicts the mission of your department. let's move on. we're on the topic of medicaid. 1.75 million veterans and one in five children with disabilities have medicaid coverage. how does cutting more than a trillion dollars from medicaid and other health programs enhance the health of veterans and children? how does that meet your department's mission? >> actually restructuring the medicaid expansion and obama which prejudices in favor of
able-bodied adults against children, the disability, and the aged, is exactly what will allow the traditional medicaid program to restore its focus and states to restore their focus to those critical care populations that you just mentioned. >> mr. secretary, you and i both know, if you're making an argument on sustainability against expanded medicaid, the president signed a bill that was unpaid for, that gave $1.9 trillion in tax cuts to corporations and the wealthy. there was more than enough to cover the cuts that you're proposing. since day one, the administration has been working to sabotage the affordable care act. last year the uninsured rate rose for the first time since the enactment of aca. there are estimates that as many as 3.2 million americans lost coverage last year, and are in more danger of losing their coverage this year and next. how does that meet the department's mission? >> so obamacare is failing on its own weight. it was poorly designed. >> mr. secretary, with all due respect, that's a canard, and you use that as a means that you use to distract from the fact
that your department has been sabotaging enrollment. that's been driving costs up and that's also been causing people not to be able to get access to insurance. i yield back, madam. >> mr. walberg, you're recognized for three minutes. >> thank you, madam chairwoman. thank you for being here, mr. azar. i appreciate the fact. just an aside, words matter. and it is disappointing that when questions and assertions are given without then the opportunity for you to answer that, that's a problem. and i hope that that doesn't continue. also for the record, when assertions are made, for instance about your -- the administration's position on life, abortion, and the like, it should be noted that there is no safe abortion. there is no safe abortion. life always is taken. and i thank you and the administration for taking a stand appropriately on that.
as you know, this committee has had great concern, and ultimately support, on the issue of associated health plans. we've sent legislation out dealing with that. in january, the department of labor issued a proposed rule to expand access to hps under existing statutes. in your opinion, when finalized, will the department of labor's rule result in more or fewer coverage options for small employers and their employees, and secondarily, can you expand on how hhs and dol are working together to achieve unaffordable health insurance for workers? >> we believe it will greatly -- we want people with true choice. as i travel across michigan's seventh district, i hear about the rising cost of prescription medicine. that's come up already today. the president recently produced a plan to combat the rising cost of prescription drugs, a key
priority identified in hhs' budget. what programs or policies does hhs plan to explore to implement in this area? >> thank you very much. we want to get list prices down. i can tell you every incentive in the system is based on a% of list price. every player except the patient has an incentive for prices to go up. we want congress to reverse those incentives, to make sure
when they increase list prices, it hurts, not helps. we want to overturn a 100 persian cap on rebates in the medicaid program. that would both bring in money, save money for the program, and dramatically change the financial incentives for pharma companies. >> from your lips to god's ears. i yield back. >> thank you very much. dr. adams, you're recognized for three minutes. >> thank you, madam chair. thank you very much, mr. ranking member and secretary, thank you for being here. mr. secretary, how do you reconcile your proposed repeal of the the aca and cuts to medicaid part 1 is with your strategy to improve access to prevention, treatment, and recovery services? >> so actually we think it helps by restoring, as i mentioned previously, by restoring the focus on those individuals who are disabled, aged, children, those really suffering from, for instance, substance use disorder, rather than the able
bodied. that's what the medicaid expansion goes to. it allows the states to focus on those who need the care the most and are very focused on this issue, as you raised. thank you. >> i want to flag that the cbo did an analysis and reported that the president's proposed budget cuts $1.7 million from medicaid, affordable care, and other programs, while earlier estimates of the graham/cassidy plan on which you base your proposal show that around 20 million will lose coverage over that same time period. so that $10 billion in the new hhs funding that you cite probably wouldn't even make a dent. as i cited before, millions have suffered from opioid abuse. treatment helps them find and keep jobs. illustrating that the department of food medicaid waivers with work requirements are not only count productive but possibly unlawful.
with that being the case, how can your department argue that these approved waivers promote the objectives of the medicaid program as the law requires? >> we absolutely believe that community engagement and supporting people getting to work is critical to one's health and firmly believe that. in terms of individuals suffering from substance use disorder, those are individuals who would not be subject to community engagement requirements under these waivers. we've tried to be very sensitive to both the categories of individuals the states would 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 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 nation, whether the economy is good, whether it's bad. you've got families that are working harder, spending less time in that particular family unit. i think one of the things that's happening with that all too often is we may be some of the signs at home with children. there's one place that our children go every day and that's to a school. so we have these incredible educators that are out there working so hard every single day. they know our students they're engaged with them. do you, do you think that there's an opportunity to look at behavioral intervention, identify components with mental health in our school systems? not trying to overburden our
teachers and say, give one more responsibility to the teachers but there's the unique framework there that may provide that. can you offer any insight into that? >> i think you're completely correct there. in fact the existing program that our is your stance abuse and mental health services agency has for indicators was an in-person system that required teachers take their time away from teaching. we've enrled a program from samsa online that lets teachers learn and identify the best way to recognize mental illness. quite proud of that i think it gets at exactly what you're talking about. >> you've got some good examples of in our district, columbus state university. it's a four-year college. >> they've got some behavioral and intervention programs that seem to be looking very, very well. so you think that samsa is really a good spot to kind of
spearhead some of this? >> it is the mental health agency and this is as you said, not so much a serious mental illness issue and requires the focus. and i'm sure the doctor who runs samsa would be happy to talk and learn interventions that they have. >> i think it's a unique opportunity, i think recognizing that we're as a society, that we have in some cases let our children down. there's this unique place that i think 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 that sammsa would be a good place to spearhead some of that and i yield back. >> mr. norcross, you're recognized for three minutes. >> secretary, thank you for coming here today.
>> certainly listening to your views particularly on disease and addiction are incredibly important. >> not only to the people in this room. >> to every member of our great country, i agree with you, this is not a red or a blue issue. and this is not an economic issue. not a race issue. this is decent of addiction and you certainly have seen, heard of a 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 students is trained in the disease of addiction. some do much better, but unfortunately many are doing much worse. what is your department doing to insure that these future doctors are being trained properly as you said 100 people each day. how are you addressing this issue? >> i'm really glad you raise that that's a passion of mine.
are we training our doctors adequately about how to treat addiction. how to identify the rick of opioid addiction. many states are starting to look at that in their accreditation programs around that. i'd love to work with you on any ideas on ways we can better support that at the federal level. >> there's prevention which is one of the issues. >> treatment, just, it's some wlaf we did on antibiotic resistance. in terms of the medical profession, how we just change a mentality culturally. >> the fact that we're having the conversation is helping that way. but unfortunately, each of the medical profession, whether it's the schools or otherwise, had very different opinions. i think this is an issue we can coalesce around. so thank you. the balance of my time i yield to miss bonamucci.
>> news reports indicate that the administration is preparing a proposed regulation that would significantly expand the application of the public charge determination for individuals and families applying for green cards. the proposals being generated by the department of homeland security it reaches into many hhs programs, have you and your department considered the full economic and social implications on families of such change, should a for example a child's use of c.h.i.p. count against a parent's immigration determination. >> i'm not seeing a proposed rule on the issue that you raised, happy to look into that. if it's in the deliberative process, i have not seen a proposed rule or content on that. >> i yield back. >> thank you, ms. bonamicci. >> miss smucker, you're recognized for three minutes. mentioned your testimony that the most effective anti-poverty program is helping someone find
a job and you talk about welfare-to-work projects. i would like to hear what the department is doing in this regard specifically. there's a certain percentage of individuals that are 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 that moved out of the ways and means committee here that would increase the percentage of individuals that are subject, could you talk a little bit about that. >> i think that's a very important issue. the welfare reform was quite an important innovation at the time. over the last couple of decades, i think frankly states have enabled way around the workforce requirements in it and the work training requirements, that's why the president's budget has caused for enhanced participation requirements, training requirements, to get
around the gaming, the amount of money and effort devoted towards work training and work placement is rather surprising. at this point. >> what steps is the department taking to insure there's accountability? >> so the biggest thing we can do is work with congress on a tan i have reauthorization that would implement these ideas and ideas that members of congress have around that. so much of this is constrained by the existing statute. we want to go in the exact direction that you're 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 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 administratoring the community services block grant which as you know supports community action agencies. and introduced a bipartisan bill with my colleague,
representative mccullum to establish a competitive grant program for community action agencies to expand their efforts to combat the opioid misuse and addiction. the grants would support a wide range of activities, i just in my community i believe leveraging that existing infrastructure, that is effectively working would help to, would make a difference in opioid addictions. just wondering if you feel the reforms in this bill would help the apartment advance its goals on the strategy to combat the epidemic. >> we've proposed eliminating as part of difficult budget decisions, proposed eliminating the community block grant services program if its entirety that it's duplicating and all the programs that we could fund, that's the lower end of them. if congress were to keep it in place, the ideas you have around
competition and accountability, would be welcome to look at anything to help improve performance measures. >> i would love to continue that discussion in my area of community service block grants has been very effective. >> thank you, mr. smucker. ms. rochester. you are recognized for three minutes. >> ranking member scott, welcome, mr. secretary, first thank you so much for the conversation we had yesterday. it gave me an opportunity to share the serious concerns about the impact and the administration's new immigration policy of separating children and their families as a deterrent. and then also the treatment of these children afterwards. you committed to continuing that dialogue as part of our congressional oversight role. and the matter is just urgent, time-sensitive. and especially if we believe that children come first. shifting gears, mr. secretary, i
understand from your written testimony that you support repealing and replacing the affordable care act. and in the interim, the administration has put into place some things that actually are destabilizing the system, even more. so delawareans could see an increase in their premiums as high as 19%. the affordable care act is the law of the land today. what would be helpful is if you could share immediate steps, that your agency is taking to stabilize the individual marketplace and lower the cost of premiums. >> so we, it is the law of the land and we work to faithfully implement it we want affordable options for people, we don't want high premium increases. so many states have only one or two plans. the way of the affordable care act is structured, if you only have one or two plans, the premium support that goes out chases that premium up. there's no incentive for the
insurance company to any way contain their cost increases. like drug prices it just goes up, up, up. they may say it's other things, but they're gaming the system that was created. >> can you just give us, kind of some bullet the, what are you doing today to make an impact? we talked about the fact that open enrollment is coming, we talked about the rate changes that are coming. can you tick off some of the things that you're administration is doing. your agency is doing? >> the biggest thing we can do is make available other options for folks. the prices are going to go up and there's absent statutory change. there's little we can do to stop the premium increase, because the subsidies chase the premiums, that's why we're trying to make other options available for people. >> since we're going to have a follow-up meet chg i'm very much looking forward to. i'm going to yield the last 30 seconds i have to mr. scott. thank you so much. >> are you aware that some of the people that are, some of the plans are not available because
of the uncertainty injected by this administration? you're not -- >> i'm not aware of plans not being available and -- >> because decided not to participate because of the uncertainty caused by this administration. >> i've not heard that, nor do i believe it's accurate. there are many major providers that are providing insurance packages and frankly making a ton of money providing the obamacare markets, given the level of abuse we see in the system. >> thank you, mr. scott. miss steapick, you're recognized. >> according to the annual medical index report a family of four will pay on average a little over $28,000 in annual health care 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 east coast, new york's 21st district. one of my legislative goals has been to lower the cost of health care while maintaining the quality and accessibility. two of my legislative initiatives i want to highlight today and ask you what you're doing administratively to lower costs and insure that health care is affordable for rural americans. the two issues i want to highlight are how we can increase access to preventive care. i co-introduced the primary care patient act which creates primary care benefit for all the high deductible health plan holders allowing two free primary care office visits per year. as we're seeing the increase of high deductible plans. i think the investment for preventive care will help lower costs and improve health care outcomes. the second priority i've focused on is the community health centers are fully funded. i introduced the chime act,
which would re-authorize the program for five years. we passed a two-year extension, i want to focus on community health centers, what is your department doing administratively to specifically lower costs in rural communities like the ones i represent? >> we fully support notions of telehealth and alternative care providers and i with a tonight make sure that we look and appreciate ways in which our regulations, policies or 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 even on the phone. can we do this in a more modern way. working with health care professionals to get appropriate quality care delivered through our communities. >> what is our feedback on the primary care patient protection act of 2018? >> that's bipartisan, i introduced it recently with brad schneider, allowing the two deductive free primary care care office visits per year.
>> i don't believe we have an administration position on it yet. 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 from you doing things. that's why preventive services are generally excluded from deductibles under the hsa regulations and the treasury department it seems to be in the range of things that makes sense, i can't say to formal administration position on it. >> i would like to hear follow-up after this hearing from your office as you take the time to review that bill that we've introduced. again it's bipartisan, as we're increasingly hearing about these high-deductible plans. i want to insure that my constituents, like everyone's constituents in this room are able to access primary care to lower ultimate health care costs in the long run by receiving preventive care. >> thank you very much. >> thank you mr. desonnier, you're recognized for five
minutes. >> 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. conservative republican legislator, rafr lantropen, a national model to treat people with disabilities that was respectful and efficient. for madam chair, i would like to submit a letter for the record. >> without objection. >> a large group of disability rights advocates. we've known for some time that electric shock therapy is not good, and it is not effective. there is still one facility in the country in canton, massachusetts, i'm told that the fda has had a ruling or a policy in place in front of you, proposed rule for two years. so it goes beyond your time and it's been four years since the panel of experts recommended it
be banned. i want to know if you're willing anticipating signing or authorizing closure of the elimination of electro shock therapy. at this facility, the last one in canton, massachusetts. >> i'll be happy to look into that issue, i'm not aware that there's a proposed regulation awaiting at the department. i'll check with the fda commissioner what the status is. >> the 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 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'm a survivor of cancer, i'm told it was a miracle drug. it was developed with at least in the beginning, talking to the researchers at nih with, public investments. but given your background, one thing that i struggle with.
given your testimony about public/private partnerships and the abuses in the private sector, what's to you from your perspective, the right return on investment to get the 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 studies in the private sector or public sector that you're aware of that would help congress understand how important these partnerships are. but also to avoid the abuses we've unfortunately seen? >> it's an important question. i think the market tends to determine from capital allocation what the right levels 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 of pricing and what we saw was the public/private
interaction completely went away and they changed the policy. now you need the capital investment. we need to tread and act kwid carefully. >> loy would love to have further conversations, it's an area of importance not just to me, but to mains of americans and shareholders. >> thank you, mr. desonnier. mr. thompson, you're recognized for three minutes. >> thank you for taking the time to be here today. in april, hhs released its fy 201 performance plan and report. and the report stated that data collected from the family violence prevention act grantees for fiscal years 12-15 showed that more of 90% of nedomestic program reported knowledge by grantees and subgrantees. to afternoon we legislate new
requirements without utilizing data collected. programs like this lets the program know it's achieving it's intended purpose. i will introduce a bill to re-authorize the fvpsa, at current authorized funding levels to insure that states are able to continue to work to prevent domestic violence. >> i would like to commend the department. if you made to data quality. mr. second do you agree it is important to re-authorize this program so that we can continue supporting states' efforts to prevent domestic violence and provide shelter and support to victims? >> we do, congressman, thank you. we fully support reauthorization of the family violence and prevention services act. we want to work with congress on getting that re-authorized. >> i appreciate that. in the interest of time madam chair. i yield back.
>> thank you very much mr. thompson. mr. christian murthy, you're recognized for three minutes. >> thank you, madam chair. and ranking member scott. thaush thank you secretary azahra for coming in. >> i would like to 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 insure 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 is very disturbing. because as you know, we want
physicians and providers spending as much time with patients and not with electronic records. and this is unfortunately an experience that has 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 intraoperatability of different systems. i hope the changes are more than just cosmetic, secretary azahra and i hope they are a sign of meaningful changes to come. what i want to ask you is this, 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 basically improving patient
outcomes and allowing physicians to spend more time with patients. >> the measure for us of intraorpability and success with electronic health records, when the patient shows up, does the data arrive with them. we've got 0 get out of the business of micromanaging the how of medical health records. instead when the patient shows up, do they own it, do they have access to it and get the doctor's eyes off the screen and on the patient. and love to work with you any way we can to support that vision. think we're in complete agreement here. >> i would love that. i think that it's refreshing to hear that you are trying to make sure that the information arrives with the patient and the eyeballs of the doctors are on the patient and not those computer screens. which we all see when we go into the doctor's offices. now the corollary question is, are you open to soliciting
feedback from providers, who are affected by these rule changes. i think that would be really important in basically refining the techniques that you are developing to streamline the electronic health record system. >> absolutely. he would love any input from any source on how to make this look better for provides, and for the benefit of patients. totally open-minded and how to approach this and would love input. >> excellent. >> thank you, mr. christian murthy. mr. guthrie, you're recognized for three minutes. >> thank you for putting this together. >> i've really enjoyed working with you since you've been sworn in. you've been very accessible and i really appreciate that. drug pricing on another committee. matt and i worked in kentucky together and sarah run as really good legislative shop. we're pleased working with you
guys. one thing that i want to touch on and some of it touches a couple of committees that i'm on. for today, kentucky has been hit hard like everywhere else on the opioid epidemic. particularly everywhere. but the one issue that i want to focus on here is are the infants that are born with addiction because of their parent. would you kind of explain what hhs is doing in terms of infant addiction? >> the issue of neonay tall syndrome is quite a difficult one. it's such a novel issue. we one of the things we need to do is build the evidence base around what is the right treatment pathway for these children. how do we help bring them out of that addiction? what's the right way to care for them. we've got to build that evidence. we've got to make sure we get these neo-natal abstinence clinics up and running, i've been privileged to see one in the dayton area to see the great work they're doing for the kids and parents, we'd love to work
with you on ways we can address nas even better. west virginia, the percent of kids born with nas is shocking. and really we'd love to work with congress on the best approaches how we can reorient our programs with the money you've given us within nas. >> in the late '90s welfare reform. i wasn't here but a lot of it came through this committee. people having the work ability and the encouragement to go to work. kentucky medicaid waiver. we're look act it through our snap program. these people that are, their employers with open arms waiting for these people to come into the workforce, like in the late '90s, maybe it's a great opportunity to do so. could you evaluate the effort, how can we evaluate the efforts of states to help tanif recipients move back into the workforce? >> some of the issues we've raised in the president's budget which is what percent of money are states devoting to workforce
training and placement. how many of their people are getting jobs and how many of them are they offloading, paying the state money. dumping off the tanif rules so they can get credit for exiting the program. all the gaming that's occurred in the tanif program in the last couple of decades. working with congress. >> i know in the agriculture farm bill, the big effort is putting job training, money saved in snap to go into job training so people can get jobs that lead to fulfilling careers and that's what we're looking for and looking forward to working with you in this area as well as some of the others, i yield back my time. thank you very much. >> thank you, mr. guthrie. >> do you wish to submit something for the record. >> thank you. i would like, you're recognized for three minutes. >> madam chair, i ask unanimous consent to enter a letter signed by 86 members of congress to the secretary of homeland security expressing significant concern. which dhs.
>> without objection. >> thank you, madam chair. >> madam secretary, thank you for our patience to answer all of our questions. as you may know there are thousands of children that are now in detention centers. children that are intent separated from their family. as they came into the united states without any documents. i see in some images of where they've been held. these are very horrendous conditions which they're in. yet, under an april 2, 2018 agreement, your department is now asking potential sponsors about their immigration status. and they're sharing that information with i.c.e. so in essence, even though i may be a green card holder or citizen. may have an undocumented cousin or aunt or uncle in the household if i now have to share that information with you, i just may not want to be the sponsor of this child, as
detained under these very difficult conditions. what is your position on that? do you feel that that's a standard that should be continue to be pursued? >> we work with the department of homeland security to insure that, because our number one mission with these kids to take care of them well and get them placed with sponsors as you said and preferably if they can be with family members and one thing we have to do is work with dhs and to insure these are the people they say they are. when they come inside. identity verification and insuring background checks to make sure there's not a reason that it would not be safe to place them in the custody of those individuals. that's the purpose of our information sharing agreement and working with dhs there. but i think we share the goal of if we can getting them with family members as sponsors. >> madam chair, i think that that policy will discourage families from coming forward and
be willing to service sponsors. my second question is mr. secretary, is i know that education is guaranteed to undocumented children by several court cases, do you think that a child, an undocumented child's use of c.h.i.p. should count against a parent's immigration determination? do you think they should be eligible for c.h.i.p. if you're a child and you're undocumented? >> congressman, i have not studied or looked into that issue. i would be happy to get back to you in writing, give a more thoughtful response, i've not looked at that precise question before. >> let me just conclude by saying that the public charge aspect of this whole process is very troubling. i think it will -- contribute to keeping these children in detention centers and i think it will put their health and well-being in jeopardy. thank you, mr. secretary. >> thank you, mr. espi.
mr. allen you're recognized for five minutes. >> thank you for joining us today. first question would be on the obviously the cost of health care as compared to other developed nations. in 1970, you know, most developed nations were between somewhere between 4% and 7% of gdp. today the united states is approaching 20%. the next closest nation is below 15%, around 13% of gdp. we're spending about 88,000 and change for per patient and other countries spending about half that much. and when you look at projections, our health care cost in this country are expected to grow exponentially if we don't do something about this. what do you, do you have, are you looking into this? and what recommendations do you see forward on how to bring us
at least competitive in the world of health care? >> thank you. and absolutely. we get great health care in the united states. i personally have the benefit of that in the last couple of months so we're blessed to live in this country. we're blessed to have the quality of health care that we have. is it twice as good? as countries that pay half as much? i'm not sure that's the case. we pay for procedures, we pay for sickness. >> we've outlined an agenda to try to move towards paying for values and outcomes. the first is generally intraoperable. to unleash the power of i.t. the second is transparency of price and quality. so patients in the driver's seat making real choices. the third is using the power of medicare and medicaid. to drive fundamental change in our system. we're the biggest pairs in the system. we have first mover advantage. key wee can ripple through the whole system by changing how we pay and the fourth is removing government barriers to coordination and integration of care delivery to deliver better quality more efficiently.
so it's absolutely on the radar and we're determined to make, to make a material change here. >> on the relgtry side and compliance side, and again this has been going on since the '70s, when they ramped up in the 1990s. and then this exploded in the last ten years. the government, or hhs, health and human services, intervening between the relationship of the patient and the physician. the physicians in this country are well trained, well educated, to write residency programs, they know how to treat patients. and again this gets back to electronic medical records and the check list, if you will. but physicians at least share with me the only way to bring down costs is to allow them to
restore the patient/physician relationship. it's health care 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 check list. anything you see that we can do to restore that relationship and really put the physicians in the game again. and in the patients aren't happy. i talk to patients who are not happy with our current health care system. >> mr. allen we'll ask the secretary to submit a response to you in writing. your time has expired. >> you're recognized for three minutes. >> first of all. in case there's any self-doubt in your mind. i know the criminal 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 a law and putting them in jail that we're tearing apart families. that's the way they feel about it in wisconsin. i want 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. and obviously you get cause and effect all mixed up as to what's coming first. but way disproportionately people in medicaid are far more likely to die of opioid
overdose. than people who are not on the program. could you comment on that? and is there anything we can do? do you feel medicaid expansion made the opioid situation worse? is there anything we can do again, remembering that you know kind of it's hard to tell in these things, 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 generics 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 reddier. obviously contributes to it. how much i can't say. with you but it's quite clear that would be connected. what we've got to do is get at the issues, state level and federal level of how often people are prescribed, why
they're krib prooe described. how many they're prescribed. with medicaid, that's why we're asking for prescription drug monitoring programs as well as intraoperable state lines, i you can't shop from west virginia into ohio, for instance and go doc-shopping. we're enforcing against pill mills from our inspector general's office and the department of justice, it's a very serious issue. you raise the right questions. >> good for me. one final question. overall, prescription drug use in this country is way higher than any other industrialized nation. and obviously very expensive. i wonder if you could comment on that in general, your opinion on the amount of prescription drugs prescribed in this country. >> too expensive, i would say a lot of the major innovation we've had in health care delivery is from the availability of new therapies, not necessarily new procedures. so we need more reform on the other side. but we're paying too much, absolutely for our drugs.
>> thank you. >> thank you, mr. grossman. ms. handel, you're recognized for three minutes. >> thank you, madam chairman and thank you, secretary for being here. i wanted to go back to the topic of neo-natal addiction syndrome that was brought up earlier. in another committee. the acting director of dea and i had a conversation about it. 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 ex-as baits or promotes or fosters fetal addiction syndrome. there's 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 spur some interagency conversation about this issue. because we should be doing everything that we can, if this is going to deliver some results to keep babies being born without that fetal sin droel. it would seem to me that would be a would it seem to me that would be a positive. >> absolutely. i would be delighted to receive that information. i'm sure those folks are educated on that. >> wonderful. i will get that to your office. >> you had mentioned earlier about short term limited duration. i wonder if could you give a few more details around that. i think we'll see a little uptick in that. what types of plans are they? what types of consumers might benefit? and how do they plan to make the expanded man's successful and broader in their offerings? >> i think it is important to remember that they were, when they were shortened from 12
months to three months. it is not some novel thing that even the previous administration was opposed to. they changed it in the waning hours. these are plans particularly focused for people in transition. they're leaving one employer sponsored health care plan. they have a gap and it can maybe be a bridge. it may be for people who can't afford anything in the affordable care act market. they don't qualify for medicaid and it is some coverage. it may not be the right coverage for anyone. we're trying on present options for people can be available that are affordable for those who need it. that's why we don't think many people will leave. subsidized insurance market for these. they're not the same. they're regulated by states. straits able to choose. they're out of the regulatory
requirements. >> great. thank you so much. i yield back. >> thank you. you are recognized for three minutes. >> thank you. i was league sponsor for a letter that got 153 signatures for our fellow members requesting that you would fix the regulations for title ten pertaining to protect high of rule. i want to thank you for your effort in that regard. and really, really wasn't a rule change as much as restoring the rules and regulations back to what the original legislative intent was, that for so long had been accepted by the supreme court as the right ruling. one of the questions i had for you is, how does that change with the protect life rule? actually help with accountability and integrity of the title ten program, and more
specifically if you could talk about how does that help protect some of the minor aged victims of sexual abuse? >> thank you for asking about that. various provisions of the proposed rule get more attention than others. one of the things we're doing is bringing in a lot of trafficking and abuse protections that have developed since the last regulations. so really helping to ensure the grantees comply with state reporting protections, the way they're properly trained to identify that. we want to ensure we have a broad base of providers available. so a broad range of services for the men and women who take advantage of the family manning services. >> what we set up as a legislative branch is making sure that we have those viable family planning capabilities provided through title ten.
i want to make sure that's the availability going forward. thank you for your effort and work in that regard. i yield back. >> thank you. >> i would like to recognize mr. scott for his closing comments. >> thank you. i think we've both calculated if we had allowed four minutes we would have run over so we did the best we could with the time we have available. i'll be asking a question that we didn't get a straight answer from and that is, can federally funded foster care programs self-incrimination, based on
sexual orientation or religion, based on strongly held sincere religious beliefs. don't feel bad about not giving me a straight answer. i've been trying on get a straight answer. i couldn't from the two previous administrations. so it's difficult to acknowledge to people, their agencies will tell people, it is hard to acknowledge that publicly but that's what a religious exemptions does. we'll give you the opportunity to respond clearly and also to respond to health and human services is planning to inject a religious exemption in the health care rights law under section 1557 of the affordable care act which would not be under protection under that statute. you've quon to great lengths to
talk about the opioid situation and how public health is dealing with it which is the intelligent way to do it. we would hope that you would extend that strategy to other drugs, where we're using the criminal justice system, which everybody knows only loads up the prisons and doesn't help the opioid addiction. what's not clear is whether or not they have the capacity to care for the children or will ever care for the children who have been ripped away from their parents. i appreciate the opportunity to have the secretary here. we look forward to him coming back and other hhs officials so we can perform our oversight responsibilities. thank you.
i yield back. >> there's been a lot of agreement on the importance of oversight hearings. 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
oversight very, very seriously. in a world where the term fake news is of increasing concern for people of all political per situations, it is important that we hold hearings like this one with individuals with 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 this. i've met with independent pharmacists in my district and i can tell you this is a major issue. and i hope the ag will move expeditiously in this area and i will be following up on this issue myself. i also share the concern with rural hospitals. comments that dr. roe made and others. they are deep concerns of mine. i have a couple of very rural areas where they're struggling very hard to hold on to the hospitals. and we know once those hospitals go, it very seriously damages the community. i appreciate also the comments made about tanef and the fact a job is the best way to get people out of poverty. we know the old saying about give somebody a fish as opposed to teaching that person how to
fish. 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 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 health care. 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. and again, we don't have to look very far. just look across to other countries who have tried to have management by the government at a central level. it hasn't worked anywhere. so i am sorry that it has failed so miserably but it has. and we ought to own up to it and get on our business and do everything we can to fix it. and i appreciate what the administration is doing. we're doing everything that we can to make it better. so i want to thank you again, mr. secretary, for being here today. for answering my questions. i will join my colleague in saying we hope that we will get timely answers from the department to questions that we are asked. i believe that will help improve the relationship between the
congress and the administration. i think you've done a marvelous job. i appreciate what you've done and your patience. >> without objection. >> may i ask to enter into the record that would show how the individual mandate repeal, how the associated health plans will increase -- >> without objection. also we haven't had a health and human services person before us in a year and a half is obviously not the fault of this secretary. >> it is not the fault of this secretary and we've had secretaries, acting secretaries, and so again, i would like us to deal with the facts.
we'll always come back to that and make sure people get calendar. i appreciate again the secretary jogging people's memories about certain things such as the different health care plans that were available under president obama and were changed immediately before president obama left office. >> we have facts and we have facts. >> they're not alternative facts. thank you again. there being no further business, the hearing is adjourned.
anniversary of the assassination of robert f. kennedy. >> these last few weeks, robert f. kennedy was enjoying himself. he really enjoyed getting out among the people. he enjoyed the time. he said all people wanted to do was touch him, not hurt him. >> this weekend on real america, watch the cbs news special report from june 6, 1968. the night robert kennedy died from gunshot wounds. >> they quickly decided to transfer him to good samaritan hospital where the facilities were better for delicate brain surgeon. mrs. kennedy was with him all the time, riding in the ambulance. the suspect was grabbed by the two kennedy men. then he was led by police back through the ballroom and the hotel. some of the office hers to protect him from the crowd.
there were several by assistanters who were close to hysteria at this point and this was concern for the suspect's safety. >> watch real america. sunday. at 4:00 p.m. eastern on. c-span3. now deputy veterans affairs secretary thomas bowman talks about his department's efforts to ensure that homeless veterans are getting the services and help they need. he spoke at the annual coalition for homeless veterans. this is 45 minutes. >> good morning. it is a distinct pleasure for me to introduce our speaker. aid career here in d.c. i was on