[Senate Hearing 115-229]
[From the U.S. Government Publishing Office]
S. Hrg. 115-229
NOMINATION OF THOMAS PRICE
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON FINANCE
UNITED STATES SENATE
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
on the
NOMINATION OF
THOMAS PRICE, TO BE SECRETARY,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
__________
JANUARY 24, 2017
__________
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Printed for the use of the Committee on Finance
__________
U.S. GOVERNMENT PUBLISHING OFFICE
30-005 PDF WASHINGTON : 2018
----------------------------------------------------------------------------------------
For sale by the Superintendent of Documents, U.S. Government Publishing Office,
http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,
U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free).
E-mail, [email protected].
COMMITTEE ON FINANCE
ORRIN G. HATCH, Utah, Chairman
CHUCK GRASSLEY, Iowa RON WYDEN, Oregon
MIKE CRAPO, Idaho DEBBIE STABENOW, Michigan
PAT ROBERTS, Kansas MARIA CANTWELL, Washington
MICHAEL B. ENZI, Wyoming BILL NELSON, Florida
JOHN CORNYN, Texas ROBERT MENENDEZ, New Jersey
JOHN THUNE, South Dakota THOMAS R. CARPER, Delaware
RICHARD BURR, North Carolina BENJAMIN L. CARDIN, Maryland
JOHNNY ISAKSON, Georgia SHERROD BROWN, Ohio
ROB PORTMAN, Ohio MICHAEL F. BENNET, Colorado
PATRICK J. TOOMEY, Pennsylvania ROBERT P. CASEY, Jr., Pennsylvania
DEAN HELLER, Nevada MARK R. WARNER, Virginia
TIM SCOTT, South Carolina CLAIRE McCASKILL, Missouri
BILL CASSIDY, Louisiana
Chris Campbell, Staff Director
Joshua Sheinkman, Democratic Staff Director
(ii)
C O N T E N T S
----------
OPENING STATEMENTS
Page
Hatch, Hon. Orrin G., a U.S. Senator from Utah, chairman,
Committee on Finance........................................... 1
Wyden, Hon. Ron, a U.S. Senator from Oregon...................... 4
Isakson, Hon. Johnny, a U.S. Senator from Georgia................ 6
ADMINISTRATION NOMINEE
Price, Hon. Thomas, M.D., nominated to be Secretary, Department
of Health and Human Services, Washington, DC................... 9
ALPHABETICAL LISTING AND APPENDIX MATERIAL
Grassley, Hon. Chuck:
``Grassley Says Emory Psychiatrist Didn't Report $500,000 in
Payments,'' by Jacob Goldstein, The Wall Street Journal,
October 3, 2008............................................ 77
``Top Psychiatrist Didn't Report Drug Makers' Pay,'' by
Gardiner Harris, Money and Policy, October 3, 2008......... 78
Hatch, Hon. Orrin G.:
Opening statement............................................ 1
Prepared statement with attachments.......................... 80
Heller, Hon. Dean:
Letter From Hon. Aaron D. Ford and Hon. Jason Frierson to
Senator Heller, January 10, 2017........................... 89
Isakson, Hon. Johnny:
Opening statement............................................ 6
McCaskill, Hon. Claire:
Distribution of Federal Tax Change by Expanded Cash Income
Level, 2017, Summary Table, Tax Policy Center, December 15,
2016....................................................... 91
Nelson, Hon. Bill:
``A Premium Support System for Medicare: Analysis of
Illustrative Options,'' Congressional Budget Office,
September 2013............................................. 92
``GOP Split on Reforming Health Care,'' by Jennifer
Haberkorn, Politico, April 30, 2012........................ 138
Price, Hon. Thomas, M.D.:
Testimony.................................................... 9
Prepared statement........................................... 139
Biographical information..................................... 141
Responses to questions from committee members................ 171
Stabenow, Hon. Debbie:
Statements and testimonials.................................. 253
Wyden, Hon. Ron:
Opening statement............................................ 4
Prepared statement with attachments.......................... 281
Communications
American Association of Hip and Knee Surgeons (AAHKS)............ 289
Association of Web-Based Health Insurance Brokers (AWHIB)........ 289
Brasch, Steven P., M.D........................................... 292
Choat, Lesli, MT (ASCP).......................................... 293
Claybour, Richard and Jill....................................... 294
Darrow, Robert K................................................. 294
Gyetvan, Angela Wilson........................................... 295
Human Rights Campaign............................................ 296
LeadingAge....................................................... 298
Murzyn, Debbie................................................... 299
National Center for Lesbian Rights (NCLR)........................ 300
Quinn, Marilyn D................................................. 303
Ravanesi, Stacey................................................. 304
Subaiya, Indu, M.D., MBA......................................... 305
Treatment Action Group (TAG)..................................... 307
Vallance, Elizabeth.............................................. 309
NOMINATION OF THOMAS PRICE,
TO BE SECRETARY, DEPARTMENT OF
HEALTH AND HUMAN SERVICES
----------
THURSDAY, JANUARY 24, 2017
U.S. Senate,
Committee on Finance,
Washington, DC.
The hearing was convened, pursuant to notice, at 10:02
a.m., in room SD-215, Dirksen Senate Office Building, Hon.
Orrin G. Hatch (chairman of the committee) presiding.
Present: Senators Grassley, Crapo, Roberts, Enzi, Cornyn,
Thune, Burr, Isakson, Portman, Toomey, Heller, Scott, Cassidy,
Wyden, Stabenow, Cantwell, Nelson, Menendez, Carper, Cardin,
Brown, Bennet, Casey, Warner, and McCaskill.
Also present: Republican Staff: Chris Campbell, Staff
Director; Nicholas Wyatt, Tax and Nominations Professional
Staff Member; Jay Khosla, Chief Health Counsel and Policy
Director; Kimberly Brandt, Chief Health-care Investigative
Counsel; Brett Baker, Health Policy Advisor; and Erin Dempsey,
Health-care Policy Advisor. Democratic Staff: Joshua Sheinkman,
Staff Director; Michael Evans, General Counsel; Elizabeth
Jurinka, Chief Health Advisor; David Berick, Chief
Investigator; Laura Berntsen, Senior Advisor for Health and
Human Services; Beth Vrabel, Senior Health Counsel; Adam
Carasso, Senior Tax and Economic Advisor; Matt Kazan, Health
Policy Advisor; Anne Dwyer, Health-care Counsel; and Ryan
Carey, Press Secretary and Speech Writer.
OPENING STATEMENT OF HON. ORRIN G. HATCH, A U.S. SENATOR FROM
UTAH, CHAIRMAN, COMMITTEE ON FINANCE
The Chairman. The committee will come to order. I would
like to welcome everyone to this morning's hearing. Today we
will consider the nomination of Dr. Tom Price to be the
Secretary of the Department of Health and Human Services.
I want to welcome Dr. Price to the Finance Committee. And I
appreciate his willingness to serve in a position of this
magnitude, especially at this particularly crucial time.
When Obamacare was pushed through on a series of party-line
votes, Republicans in Congress warned that the new health-care
law basically would harm patients, families, and businesses.
Not to put too fine a point on it, but we were right. And the
next HHS Secretary will play a pivotal role as we work to
repeal Obamacare and replace it with patient-centered reforms
that will actually address costs, among other things. This will
be an important endeavor, one that will and should get a lot of
attention here today, but it should not be the sole focus of
the next HHS Secretary.
HHS has an annual budget of well over $1 trillion. Let me
repeat that: one department, $1 trillion. HHS encompasses the
Centers for Medicare and Medicaid Services, the Centers for
Disease Control and Prevention, the National Institutes of
Health, the Food and Drug Administration, and many others. It
is no exaggeration to say that HHS touches more of the U.S.
economy and affects the daily lives of more Americans than any
other part of the U.S. Government.
I firmly believe that Dr. Price has the experience and
qualifications necessary to effectively lead this large and
diverse set of agencies, and many people share that view. He
has had a wealth of experience in the practice of medicine,
understands these problems, and has been a great member of the
House of Representatives.
For example, past HHS Secretaries Mike Leavitt and Tommy
Thompson strongly support his nomination. Physician
organizations that know Dr. Price's work, including the
American Medical Association and most surgical specialty
groups, enthusiastically support him. The American Hospital
Association and other health-care stakeholder groups do as
well.
Perhaps the Healthcare Leadership Council, representing the
broad swath of health-care providers, said it best in stating
that, quote, ``It is difficult to imagine anyone more capable
of serving this Nation as the Secretary of HHS than Congressman
Tom Price.''
Unfortunately, in the current political environment,
qualifications, experience, and endorsements from experts and
key stakeholders sometimes do not seem to matter to some of our
colleagues. At least that appears to be the case, since none of
those who say they oppose Dr. Price's nomination seem to be
talking about whether he is qualified. Instead, we have heard
grossly exaggerated and distorted attacks on his views and his
ethics. On top of that, we have heard complaints and a series
of unreasonable demands regarding the confirmation process
itself. Of course, these tactics have not been limited to Dr.
Price.
My Democratic friends have taken this approach with almost
all of President Trump's Cabinet nominees, as Senate Democrats'
unprecedented efforts to delay and derail the confirmation
process and apply a radically new set of confirmation standards
has continued unabated.
To that point, let me say this. I have been in the Senate
for 40 years, and I think my record for being willing to reach
across the aisle is beyond any reasonable dispute. And I have
certainly done it with my fellow Democrats here on this
committee. In fact, from time to time I have taken lumps in
some conservative circles for working closely with my
Democratic colleagues. I have, on some occasions, voted against
confirming executive branch nominees, but far more often than
not I have opted to defer to the occupants of the White House
and allowed them to choose who serves in their administrations.
I have taken some lumps for that too.
I am not bringing any of this up to brag or to solicit
praise from anyone in the audience. I raise all of this today
so that people can know I am serious when I say that I am
worried about what my colleagues on the minority side are doing
to the Senate as an institution. While the overriding sense of
comity and courtesy among Senators has admittedly been in
decline in recent years, I have never seen this level of
partisan rancor when it comes to dealing with a President from
an opposing party. I have never seen a party in the Senate,
from its leaders on down, publicly commit to not only opposing
virtually every nomination, but to attacking and maligning
virtually every single nominee.
Now, let me be clear. I am not suggesting that the Senate
start rubber-stamping nominees, nor am I suggesting that any
member of the Senate should vote against their conscience or
preferences simply out of respect for tradition or deference.
What I am saying is that the same rules, processes, courtesies,
and assumptions of good faith that have long been the hallmark
of the Senate confirmation process, especially in this
committee, should continue to apply regardless of who is
President. If what we are seeing now is the new normal for
every time control of the White House changes hands, the
Senate, quite frankly, will be a much lesser institution.
Unfortunately, our committee has not been entirely immune
to the hyper-politicization of the nomination process. We saw
that last week with the Mnuchin hearing. And I regret to say
that I think we are likely to see more of it today. I hope not.
Case in point: I expect that during today's hearing, we are
going to hear quite a bit about process and claims that Dr.
Price's nomination is being rushed and that the nominee has not
been fully vetted. These allegations are simply untrue.
President Trump announced his intent to nominate Dr. Price
just 3 weeks after the election. Dr. Price submitted the
required tax returns and completed questionnaire on December
21st. That was 35 days ago. And by any reasonable standard,
that is sufficient time for a full and fair examination of the
nominee's record and disclosures.
By comparison, the committee held a hearing on the
nomination of Secretary Sebelius, the Democrat nominee, 16 days
after she submitted her paperwork. For Secretary Burwell, it
was 17 days. In other words, the time between the completion of
Dr. Price's file and his hearing has been more than that of the
last two HHS Secretaries combined. And by the way, both of
those nominees received at least a few Republican votes in this
committee and on the floor.
Outside of extraordinary process demands, Dr. Price has
faced a number of unfair attacks on both his record as a
legislator and his finances. On the question surrounding
finances, I will defer on any substantive discussion and first
allow Dr. Price to defend himself from what are, by and large,
specious and distorted attacks. For now I will just say that I
hope that my colleagues do not invent new standards for
finances, ethics, and disclosure that are different from those
that have generally applied in the past. There is a saying
involving both stones and glass houses that might be applicable
as well.
With regard to Dr. Price's views and voting record, I will
simply say that virtually all the attempts I have witnessed to
characterize Dr. Price's views as being, quote, ``outside of
the mainstream'' have been patently absurd unless, of course,
the only ideas that are in the, quote, ``mainstream'' are those
that endorse the status quo on health care and our entitlement
programs.
In conclusion, I just want to note that the overly partisan
treatment of nominees and distortions of their records is a
relatively new development on this committee. My hope is that
we can begin to set a new standard here that we can all be
proud of, and that we will work to reverse recent trends and
have a fair and open discussion of the nominee and his
qualifications.
So with that, I will turn to our distinguished ranking
member, Senator Wyden.
[The prepared statement of Chairman Hatch appears in the
appendix.]
OPENING STATEMENT OF HON. RON WYDEN,
A U.S. SENATOR FROM OREGON
Senator Wyden. Thank you very much, Mr. Chairman.
Colleagues, the American public heard many promises about
health care from the new administration. No cuts to Medicare or
Medicaid. Nobody hurt by ACA repeal. ``Insurance for everybody
. . . much less expensive and much better.'' Congressman
Price's own record undercuts these promises.
I am going to start with ethics and undisclosed assets.
Congressman Price owns stock in an Australian biomedical firm
called Innate Immunotherapeutics. His first stock purchase came
in 2015 after consulting Representative Chris Collins, the
company's top shareholder and a member of its board. In 2016,
the Congressman was invited to participate in a special stock
sale called a private placement. The company offered the
private placement to raise funds for testing on an experimental
treatment it intends to put up for FDA approval. Through this
private placement, the Congressman increased his stake in the
company more than 500 percent. He has said he was unaware he
paid a price below market value.
It is hard to see how this claim passes the smell test.
Company filings with the Australia Stock Exchange clearly state
that this specific private placement would be made at below-
market prices. The Treasury Department handbook on private
placements states, and I will quote: ``They are offered only to
sophisticated investors in a nonpublic manner.'' The
Congressman also said last week he directed this stock purchase
himself, departing from what he said was his typical practice.
Then there is the matter of what was omitted from the
Congressman's notarized disclosures. The Congressman's stake in
Innate is more than five times larger than the figure he
reported to ethics officials when he became a nominee. He
disclosed owning less than $50,000 of Innate stock. At the time
the disclosure was filed, by my calculation, his shares had a
value of more than $250,000. Today his stake is valued at more
than a half-million dollars. Based on the math, it appears that
the private placement was excluded entirely from the
Congressman's financial disclosure. This company's fortunes
could be affected directly by legislation and treaties that
come before Congress.
It also appears the Congressman failed to consult the House
Ethics Committee following other trades of health-care stocks.
That was required, as they are directly related to two bills he
introduced and promoted. Even if some of those trades were not
made at his direction, he would have been made aware of them
when he filed his Periodic Transaction Reports with the House
of Representatives.
Set aside the legal issues. It is hard to see this as
anything but a conflict of interest and an abuse of position.
Another key question on the Finance Committee's
biographical questionnaire is whether nominees have been
investigated for ethics violations. The Congressman has been
the subject of two investigations stemming from fundraising
practices. This too was not disclosed. The committee needs to
look into these matters before moving the nomination forward.
Now to policy. On the Affordable Care Act specifically, and
the scheme known as ``repeal and run,'' the secret replacement
plan is still hidden away, but already the administration
charges ahead with a broad executive order that endangers
Americans' health.
As the Budget chairman, Congressman Price is the architect
of repeal and run. If his repeal bill became law, 18 million
Americans would lose their health care in less than 2 years. In
1 decade, you would go from 26 million uninsured to 59 million.
Repeal and run raises premiums 50 percent in less than 2 years.
Costs skyrocket from there. The market for individuals to buy
health insurance collapses. No-cost contraceptive coverage for
millions of women, gone. By defunding Planned Parenthood,
nearly 400,000 women would lose access to care almost
immediately, hundreds of thousands more would lose their choice
to see the doctors they trust. The Price plan takes America
back to the dark days when health care was for the healthy and
the wealthy.
His other proposals do not offer much hope that the damage
will be undone. There is a big gap between the Trump pledge of
``insurance for everybody and great health care'' and the
Congressman's proposals.
In another bill, the Empowering Patients First Act, the
Congressman brings back discrimination against people with
preexisting conditions such as pregnancy or heart disease. He
gives insurers the power to deny care and raise costs on those
with preexisting conditions if they did not maintain coverage.
In effect, the bill said insurance companies could take
patients' money and skip out on paying for the care they need.
The Price bill also gave insurers the okay to reinstate
lifetime limits on coverage and charge women higher rates
because they are women. It gutted the tax benefits that help
working people afford high-quality coverage. It slashed the
minimum standards that protect patients by defining exactly
what health plans have to cover. All this from a bill called
Empowering Patients First. I have seen a lot of bills with
ironic titles. This one, colleagues, takes the cake.
Here's the constant. The Congressman's proposals push new
costs onto patients. Massive cuts to Medicare were proposed in
the Price budget, as another example. In my view, the Congress
has a duty to uphold the promise of Medicare. It is a promise
of guaranteed benefits.
The Congressman advocated privatizing Medicare, cutting it
almost a half-trillion dollars. After his nomination, he said
he wanted to turn the program into one with vouchers within the
first 6 to 8 months of the administration. He supports
``balance billing'' so seniors would have to cover extra
charges above what Medicare pays when they go to the doctor.
More extra costs for seniors on a tight budget. In addition,
the Congressman calls for block-granting and capping Medicaid,
which would shred a vital safety net for our most vulnerable.
Medicaid insures 74 million people. More Americans rely on
Medicaid to pay for nursing home care and home-based care than
any other program. The program pays for nearly half of all
births and covers millions of children. It is a critical source
of mental health coverage and substance abuse treatment, vital
at a time when our communities are battling the opioid
epidemic.
I will close with just two additional points. If confirmed,
the head of HHS, the Health and Human Services Department, is
the captain of the Trump health-care team. Now the Congressman
says patients should be at the center of care. I agree with
that. When I look, however, at the Congressman's proposals, I
do not see the patient at the center of health care. I see
money and I see special interests at the center of health care.
Now finally, let me just make a point with respect to the
process and the comments of my good friend, Chairman Hatch.
Colleagues, the process here is exactly the same process to
a ``t'' that this committee has used for 20 years. It is the
process that applied, for example, to Tom Daschle; it applied
to Ron Kirk.
I will enter into the record a specific set of details
about how this is the process that is exactly what was done on
a bipartisan basis for 20 years. And I will make that a part of
the record.
[The information appears in the appendix on p. 278.]
Senator Wyden. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
[The prepared statement of Senator Wyden appears in the
appendix.]
The Chairman. I am pleased to hand over my normal witness
introduction duties today to our colleague, the distinguished
Senator from Georgia, Senator Isakson, who will introduce Dr.
Price.
And so, Senator Isakson, please proceed.
OPENING STATEMENT OF HON. JOHNNY ISAKSON,
A U.S. SENATOR FROM GEORGIA
Senator Isakson. Well, thank you, Chairman Hatch, Ranking
Member Wyden, and fellow members of the committee. I am proud
to have a seat right up there on this committee and enjoy being
a part of it.
And I could not be prouder than to introduce Tom Price to
you today. This is the second time I have had the occasion to
introduce Tom in the last week. The first time I was called, it
was to introduce him at the HELP Committee, which I also serve
on, and I was proud to do that. And I gave what I hope was the
best introduction I could possibly give for a man whom I have
known for 30 years. I have known him as a family man, as a
legislator, as a member of our community, as a great physician,
and a great friend.
And it was easy to do that one. But since that last week,
things have changed. I feel like I have been asked to be a
character witness in a felony trial in the sentencing phase of
a conviction.
There are things that have been said the last week or so,
just to me, that need to be refuted. So I am going to take all
the positive things and say them at the end, but try and begin
by saying there are a few things out there that need a
perspective all the way around.
I am very proud that Tom has submitted his income tax
returns. A couple of things that the ranking member mentioned
came from those submissions. Some of the things that came out
in a memo last night about property taxes, those were de
minimis items that came out, one late tax payment in Nashville,
TN, one late tax payment in Washington, DC. Late, not unpaid--
just late, and I have done that myself a couple of times.
On Innate Immunotherapeutics, that was a disclosure that he
made, and the valuation difference on a private placement is a
normal thing. It is an eyes-of-the-beholder placement in terms
of what you assess it at. And this was merely an assessment as
to what you disclose in terms of its worth, not whether you
disclose it or not.
Tom is a good man. He is a family man. He is a physician.
He is an honorable man. And I am proud to be here today, not to
defend him, because he does not need defending, but to praise
him for the things that he has done.
You know, I think it is important for all of us to look at
a Secretary nomination, whether it is Secretary of Defense,
whether it is Health and Human Services, and say, ``What am I
really looking for in terms of this person?''
Well, first and foremost, I am looking for a person who
understands the American family. Tom is a great family man. In
fact, his wife Betty is here. Raise your hand, Betty.
Last week I told her to stand up, and she was in a crowd
and I could not get her to do it, so I am going to get her to
raise her hand this time around. Betty is a great lady and a
great wife. Their son Robert, I guess, is still in Nashville,
TN singing country music. Is that right? So he could not be
here today, but Lamar Alexander appreciates that part very
well.
Tom is active in his church, active in his community,
understands the needs of families, and understands the
relationship of health care to a good family.
Secondly, who would I ask to spend $1.1 trillion of my
money? I do not have that much, of course, but that is how much
Tom will oversee at HHS. What would I look for in a person to
handle that much money?
I would look for a little bit of experience. And Tom has it
in terms of being a legislator. I would look for somebody who
understood where that cost was going and what he needed to do
to manage it. And Tom is that type of person. I would look for
somebody I would trust with that amount of money, even though I
do not have it, but if it were mine.
Third, does he understand health care? Let me tell you a
little bit about Tom and his medical practice. It is called
Resurgens Orthopaedics. Resurgens Orthopaedics is the
consolidation of a number of small orthopaedics firms around
the State of Georgia into the largest orthopaedic provider in
our State.
Tom was one of the leading persons who pulled that together
and, in fact, ran the practice for a while himself. They are my
doctors. In fact, 26 years ago Resurgens saved my young son
Kevin's right leg after a terrible automobile accident. And I
have never forgotten what they did for him in a terrible crisis
that we had in our family.
But they are a great medical firm. He understands medicine.
And he has run a comprehensive medical program.
Fourth, I would want to understand if he knew the
legislative process. You know, when the President calls Tom in
and says, okay, we are going to go to the Senate and the House,
we are going to sell our package, Tom has to have the ability
to convince 535 people that the President is right or that the
administration is right. You do not want somebody going up
there who has not walked into a legislative meeting before,
somebody who has not been in the political process before. Tom
has been there and done that. And he is the type of guy you
could trust to make the sale and represent the administration
and the people.
Fifth, I would want somebody who is accountable. Tom is an
accountable type of guy. In fact, I joked last week and said he
is one of those rare ones of us who actually reads the bills.
In fact, when I have a big question, I will usually come talk
to Tom late at night and say, ``Tom, what do you know about
House Resolution 3742?'' and he will tell me.
He is not exciting. He is sometimes boring, but he is
always right, because he is always prepared. But he understands
you need to be accountable in this business. You need to be
responsible for what you do and responsible for what you say.
Now, there is a rumor that has been spread around by some
people that Tom does not support the saving of Social Security.
Let me tell you a little story. A few weeks ago, in fact at the
end of the campaign in October, I was called by AARP and Tom
was called by AARP. They said, will you two go on the road for
us and do presentations around the State in your congressional
districts about how you are going to save Social Security?
And I guess Alpharetta, GA was the first place. Tom and I
went one night and spent the whole night before a room full of
seniors defending saving Social Security. So anybody who is
passing that rumor around, hey, go ask AARP who is going to
save Social Security, go ask the people who are active in that
business who is going to do it. Tom Price understands the value
of Social Security and the value of Medicare. And being
eligible for both, I would not be up here promoting somebody
who is going to take it away from me, I guarantee you that.
Now, let me tell you one other thing. Four years ago, I sat
in this committee room and in the HELP Committee and I
questioned and I asked all that I could of Sylvia Burwell. And
when it came time for a vote, I voted for her because she was
the right person at the right time for the administration to
put in as head of HHS.
Dr. Tom Price is the right man at the right time for the
right job. He is my friend. He is a man I have known for 30
years. He has unquestioned character and unquestioned ability.
And he will be a great Secretary of HHS.
I thank all of you for taking my calls earlier when I
called before this meeting. I urge you to give him the courtesy
of your time to listen to what he has to say, ask your thorough
questions, and I hope you will see fit to nominate an honorable
man, an accountable man, and a good man to be the next
Secretary of Health and Human Services.
And I yield back, Mr. Chairman.
The Chairman. Well, thank you, Senator Isakson.
I tell you, Tom, you could not have a better introducer
than Senator Isakson. I mean, he is not only highly respected
by all of us in the Senate, Democrats and Republicans, but he
is very, very articulate, as you can see. And I think he did a
very good job talking about you and your future here in this
committee.
Now, I have some obligatory questions for the nominee.
First, is there anything that you are aware of in your
background that might present a conflict of interest with the
duties of the office to which you have been nominated?
Dr. Price. I am not.
The Chairman. Do you know of any reason, personal or
otherwise, that would in any way prevent you from fully and
honorably fulfilling this responsibility?
Dr. Price. I do not.
The Chairman. Do you agree, without reservation, to respond
to any reasonable summons to appear and testify before any duly
constituted committee of the Congress, if you are confirmed?
Dr. Price. I look forward to that.
The Chairman. Finally, do you commit to provide a prompt
response in writing to any questions that may be submitted to
you or addressed to you by any Senator of this committee?
Dr. Price. I do.
The Chairman. Well, thank you. Those are the obligatory
questions that we ask of everybody.
Let us turn the time over to you, Dr. Price, Congressman
Price, to state whatever you would like to state here for the
committee this morning.
STATEMENT OF HON. THOMAS PRICE, M.D., NOMINATED TO BE
SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON,
DC
Dr. Price. Thank you so much, Chairman Hatch and Ranking
Member Wyden, and to all the members of this committee, for the
opportunity to speak with you today and to engage in a
discussion about the road ahead for our great Nation.
I want to thank Senator Johnny Isakson so much for his
incredibly gracious introduction. As he mentioned, we have
known each other for 30 years or so. I am so grateful for his
friendship and his kindness. Our State is so grateful for his
leadership and his service. And we are blessed to have had it.
I wish also to especially thank my wife Betty, of 33 years,
who joins me here today. Her support and her encouragement and
her advice--which I will remind you is always correct--and her
love that she has given me over those past 33 years, I am more
grateful for that than I could ever say.
Over the past couple of weeks and months, I have met with
many of you individually and gained a real appreciation for the
passion that you all have for the critical work that is done at
the Department of Health and Human Services. Please know that I
share that passion, which is why I am here today and why I am
honored to have been nominated to serve as the next Secretary
of Health and Human Services.
We all come to public service in our own unique ways that
inform who we are and why we serve. My first professional
calling was to care for patients. That experience as a
physician and later as a legislator has provided me a holistic
view of the complex interactions that take place every single
day across our communities. And today I hope to share with you
how my experience has helped shape my understanding of and
appreciation for the Department of Health and Human Services.
From an early age, I had an interest in medicine. My
earliest memories, though, were of growing up on a farm in
Michigan, where I lived until I was 5 years old when our family
moved to suburban Detroit.
I spent most of my formative years being raised by a single
mom. Some of my fondest memories as a child were those spent
with my grandfather, who was a physician, and I would
occasionally spend some weekends with him when he would make
rounds, which meant that we got in a car and went to people's
homes and made house calls. And I will never forget the warmth
and the love with which he was greeted at every single door.
Those impressions are seared in my memory.
After graduating from medical school from the University of
Michigan, I moved to Atlanta, which I have called home for
nearly 40 years. It is where I met my wife Betty. It is where
we raised our son. I did my residency at Emory University and
Grady Memorial Hospital, where I would later return in my
career to serve as the medical director of the orthopaedic
clinic.
Throughout my professional career, I cared for and treated
patients from all walks of life, including many, many children.
And anyone who has ever had the privilege of treating a child
knows how fulfilling it is to look into the eyes of a mom or a
dad and say how we helped heal their son or their daughter. My
memories of Grady are filled with the gracious comments of
parents and of patients for the team of health-care specialists
with whom I had the privilege of working.
After 25 years of school and training, I started a solo
orthopaedic practice. Over the years, this practice grew, as
Senator Isakson mentioned, and it eventually became one of the
largest non-
academic group practices of orthopaedics in the country, for
which I eventually served as chairman of the board. During 20
years as a practicing physician, I learned a good bit about not
just treating patients, but about the broader health-care
system and where it intersects with government.
A couple of vivid memories stand out. One is the number of
times when patients were remarkably angry about the individuals
figuratively, not literally, standing between themselves and
their physician in the clinic room, making it so that what the
physician was recommending might or might not be possible,
whether it was from insurance or regulators or government or
the like.
And then there was the day that I remember vividly when I
realized there were more people in the office behind the door
where we saw patients in the front clinic area trying to fight
with insurance and regulators and government than there were in
front of the door actually caring and treating patients. And it
became clear to me that our health-care system was losing focus
on its number-one priority, and that is the patient.
As a result, I felt compelled to broaden my role in public
service and help solve the issues harming the delivery of
medicine, and so I ran for the Georgia State Senate.
I found Georgia's State Senate to oftentimes be a
remarkably bipartisan place where collegial relationships were
the norm. This is the environment in which I learned to
legislate, reaching across the aisle to get work done.
In Congress, I have been fortunate to have been part of a
collaboration that broke through party lines as well to solve
problems. Just this past Congress, as you will recall, it was a
bipartisan effort that succeeded in ridding Medicare of a
broken physician payment system and which has now begun the
creation of a system that, if implemented properly, will help
ensure that seniors have access to higher-quality care.
If confirmed, my obligation will be to carry to the
Department of Health and Human Services an appreciation for the
bipartisan, team-driven policymaking in what has been a
lifetime of commitment to improving the health and well-being
of the American people. That commitment extends to what I call
the six principles of health care: affordability,
accessibility, quality, responsiveness, innovation, and
choices.
But Health and Human Services is more than health care.
There are real heroes at this department doing incredible work
to keep our food safe and to develop drugs and treatment
options driven by scientists conducting truly remarkable
research. There are heroes among the talented, dedicated men
and women working to provide critical social services, helping
families and particularly children have a higher quality of
living and the opportunity to rise up and achieve their
American dream.
The role of the Health and Human Services Department in
improving lives means it must carry out its responsibilities
with compassion. It also must be efficient and effective and
accountable as well as willing to partner with those in our
communities already doing remarkable work. Across the spectrum
of issues and services this department handles, there endures a
promise that has been made to the American people. And we must
strengthen our resolve to keep the promises our society has
made to senior citizens and to those most in need of care and
support.
That means saving and strengthening and securing Medicare
for today's beneficiaries and future generations. It means
ensuring that our Nation's Medicaid population has access to
quality care. It means maintaining and expanding America's
leading role in medical innovation and of the treatment and
eradication of disease.
So I share your passion for these issues, having spent my
life in service to them. And yet, there is no doubt that we do
not all share the same point of view when it comes to
addressing each and every one of these issues. Our approaches
to policies may differ, but surely there exists a common
commitment to public service and compassion for those whom we
serve.
We all hope to improve the lives of the American people, to
help heal individuals and whole communities. So with a healthy
dose of humility and an appreciation for the scope of the
challenges before us, with your assistance and with God's will,
we can make it happen. And I look forward to working with you
to do just that.
Mr. Chairman, I thank you for the opportunity to be with
you today.
[The prepared statement of Dr. Price appears in the
appendix.]
The Chairman. Well, thank you, Dr. Price. I cannot think of
anybody who could give a better analysis of why this position
is so important to them.
Let me start with this question. The Department of Health
and Human Services is one of the largest departments in
government, employing, I think, nearly 80,000 employees and
encompassing over 100 programs covering a large range of
complex and diverse issues.
Now, you have described to a degree, but if you could
elaborate a little bit more, can you describe how you will
prioritize and oversee the large array of issues for which you
will be responsible? And tell us, what in your history has
prepared you to lead the Department of Health and Human
Services, such a multifaceted department?
Dr. Price. Thank you, Mr. Chairman. As you and members
know, the mission of the Department of Health and Human
Services is to improve the health and the safety and the well-
being of the American people. I am committed to that mission,
but in order to do that, you have to put together teams of
individuals in each sector of health and human services. And my
history, wherever I was--whether it was in my clinical practice
or in the State legislature or Congress or the work that I did
in communities--was just to bring forward the greatest quality
of talent that we could assemble.
Second is to understand the scope and the issues. And
clearly, having the experience both in the clinical arena as
well as in the legislative arena, I understand the scope and
the issues.
And then finally, focusing on results. I think oftentimes
it gets kind of muddy up here in Washington, what we do. We
name the programs, we make certain that the resources are there
to be able to provide money for the programs to be run, but
oftentimes I think we drop the ball on whether or not we are
actually accomplishing the mission. Are we truly improving the
health and the safety and the well-being of the American
people?
So one of the major goals that I have is to look at the
metrics that we are looking at at the department to make
certain that we are accomplishing that mission and that goal.
The Chairman. Thank you. The Center for Medicare and
Medicaid innovation, CMMI, has begun numerous initiatives over
the past few years, some of which have generated much
controversy. Could you tell us your position on the work in
CMMI and how it should or should not be continued in the
future?
Dr. Price. Thank you, Mr. Chairman. Innovation is so
incredibly important to health care and the vibrant quality of
health care that we need to be able to provide to our citizens.
Innovation, in fact, is what leads quality health care. It is
what expands the ability of health-care professionals to be
able to treat patients. So I am a strong supporter of
innovation, and I think one of the roles that we as
policymakers have is to incentivize innovation.
The Center for Medicare and Medicaid Innovation is a
vehicle that might do just that. I think, however, that CMMI
has gotten off track a bit. I think that what it has done is
defined areas where it is mandatorily dictating to physicians
and other providers in this country, in certain areas, how they
must practice. So whether it is a geographic area that includes
67 or 68 areas in our country that have to perform a certain
procedure in a certain way and use a certain implant in a
certain way because the government says they have to
mandatorily, without exception, or whether it is 75 percent of
the Part B Medicare drug demo, what is called a demonstration
project, which dictates to physicians and other providers they
must use an in-patient setting, that, to me, is no longer a
trial, that is no longer an experiment, that is no longer a
pilot project to determine whether or not an innovative
solution might work. That is changing the way that American
medicine is practiced by folks making decisions here in
Washington as opposed to patients and families and doctors
making those decisions.
So I am a strong supporter of innovation, but I hope that
we can move CMMI in a direction that actually makes sense for
patients.
The Chairman. Well, thank you so much. Medicare has lost
more than $130 billion--that is with a ``b''--to improper
payments over the past 3 years. The program has also been above
the legal billing error rate threshold of 10 percent for the
past 4 years.
Given that Medicare trustees have issued grave concerns
about looming Medicare insolvency if we stay at the current
spending levels, will your administration actively champion our
Medicare Integrity Program so that we can recover a much higher
percentage of the billions of taxpayer dollars lost each year
to billing mistakes and ensure that Medicare will be in place
for future American seniors?
And also, as a former practicing physician who has
experience with Medicare and Medicaid programs, do you have any
insights into steps you think should be taken to address the
multi-billion-dollar problem of waste, fraud, and abuse in
these programs?
Dr. Price. Yes, thanks, Mr. Chairman. Nobody supports care
being billed that is not needed or has not been provided. And
this is one of those areas that I think we need to be very,
very focused on.
I am certain that there are some bad actors out there. I
think they are a minority, but there are some bad actors out
there. And I am certain that if we were to focus specifically
on those bad actors in real time--which is what happens in
every other industry in our country where that real-time
information is available and acted upon--instead of trying to
determine whether every single incident of care is necessary,
if we were to focus on those individuals who were the bad
actors specifically, then I think we could do a much better job
of not just identifying the fraud that exists out there, but
ending that fraud.
The Chairman. Well, thank you.
Senator Wyden, we will turn to you now.
Senator Wyden. Thank you, Mr. Chairman.
Congressman, I am going to start with the trading in
health-care stocks. Your position is that the trading was legal
because, in your view, it complied with House rules. I think
there are debatable legal questions, but there are other
matters.
Innate Immunotherapeutics is an obscure Australian company
that develops a treatment for immune system disorders and plans
to seek FDA approval. Innate's fortunes are affected by
congressional action.
Today, the total value of your shares exceeds a half-
million dollars. Yet on the Office of Government Ethics
disclosure form you filed as a nominee, you significantly
undervalued the stock. You failed to include the value of more
than 400,000 shares you bought at a significant discount during
a private stock sale made available to specially chosen
investors around Labor Day. You also significantly
underreported the value of this purchase to the committee. It
is worth more than twice what you reported.
You heard about the stock from a House colleague who is a
board director of this Australian drug company and the largest
shareholder. You got in on private placements not available to
the public. In these private placements, you bought over
400,000 shares at discounts that were as much as 40 percent
cheaper than the price on the Australian Stock Exchange. And
you were sitting at the time on committees that have
jurisdiction over major health-care programs and trade policy.
``Yes'' or ``no,'' does this not show bad judgment?
Dr. Price. Well, if what you said was true it might. But
the fact of the matter is, that is not the case.
Senator Wyden. We have a paper trail, Congressman. We have
a paper trail for every comment I have made. ``Yes'' or ``no,''
does this not show bad judgment?
Dr. Price. No.
Senator Wyden. Well, I just----
The Chairman. Well, let him answer the question too. I
mean, you have kind of indicated he did something wrong. Let
him explain why it was not wrong.
Senator Wyden. It was a ``yes'' or ``no'' answer.
The Chairman. No, I want him to be able to handle that
problem.
Dr. Price. Maybe it would be helpful if you laid out the
accusation, sir.
The Chairman. Be fair.
Senator Wyden. Well, you purchased stock in an Australian
company through private offerings at discounts not available to
the public.
Dr. Price. If I may, they were available to every single
individual who was an investor at the time.
Senator Wyden. Well, that is not what we learned from
company filings. Company filings with the Australian Stock
Exchange state that this specific private placement would be
made at below-
market rates. The Treasury Department says it is only offered
to sophisticated investors in a non-public manner. We have a
paper trail for every one of the statements that I have gone
into. And trading in stocks while you sit on two committees
introducing legislation that directly impacts the value of the
stocks----
Dr. Price. What legislation would that be, Senator?
Senator Wyden. We will take you through the various bills.
But the reality is, this has been cited on a number of
occasions.
Dr. Price. The reality is that everything that I did was
ethical, above-board, legal, and transparent. The reason that
you know about these things is because we have made that
information available in real time as required by the House
Ethics Committee.
So there is not anything that you have divulged here that
has not been public knowledge.
Senator Wyden. Your stake in Innate is more than five times
larger than the figure you reported to ethics officials when
you became a nominee.
Dr. Price. And if you had listened to your committee staff,
I believe you would know that our belief is that that was a
clerical error at the time that the 278E was filed. We do not
know where it happened, whether it was on our end, whether it
was on the end of the individuals of OGE. But there was not any
malicious intent at all.
Senator Wyden. Congressman, you also reported it in the
questionnaire to the committee, and you had to revise it
yesterday because it was wrong.
Dr. Price. And the reason for that is because I, when asked
about the value, thought it meant the value at the time that I
purchased the stock, not the value at some nebulous time when
we supposedly made a specific gain.
Senator Wyden. I want to get in one other question, if I
might. This weekend, the President issued an executive order
instructing the Department and other agencies to do everything
possible to roll back the Affordable Care Act. If confirmed,
you will be the captain of the health team and in charge of
implementing the order.
``Yes'' or ``no,'' under the executive order, will you
commit that no one will be worse off?
Dr. Price. What I commit to, Senator, is working with you
and every single member of Congress to make certain that we
have the highest-quality health care and that every single
American has access to affordable coverage.
Senator Wyden. That is not what I asked. I asked, will you
commit that no one will be worse off under the executive order?
You ducked the question. Will you guarantee that no one will
lose coverage under the executive order?
Dr. Price. I guarantee you that the individuals who lost
coverage under the Affordable Care Act, we will commit to
making certain that they do not lose coverage under whatever
replacement plan comes forward. That is the commitment that I
provide to you.
Senator Wyden. The question again is, will anyone lose
coverage, and you answered something I did not ask.
I will wrap up this round by saying, will you commit to not
implementing the order until the replacement plan is in place?
Dr. Price. As I mentioned, Senator, what I commit to you
and what I commit to the American people is to keep patients at
the center of health care. And what that means to me is making
certain that every single American has access to affordable
health coverage that will provide the highest-quality health
care that the world can provide.
Senator Wyden. I am going to close by way of saying that
what the Congressman is saying is that the order could go into
effect before there is a replacement plan. And independent
experts say that this is going to destroy the market on which
millions of working families buy health coverage. And on the
questions that I asked, will the Congressman commit that nobody
will be worse off, nobody will lose coverage, we did not get an
answer.
Thank you, Mr. Chairman.
The Chairman. Well, how can anybody commit to that?
[Laughter.]
Let me just say, Dr. Price, you have been accused here of
investing in securities that you had a direct effect over in
Congress and you disclosed the wrong value of shares you owned
in Innate Immunotherapeutics.
Now Dr. Price, let me just say this, has a diversified
portfolio with Morgan Stanley in a broker-directed account.
Correct me if I am wrong on any of this, Doctor. The portfolio
includes both health-care and non-health-care stocks. His
financial adviser designed the portfolio and directed all
trades in the account. The advisers and not Dr. Price have the
discretion to decide which securities to buy and sell.
On March 17, 2016 in a rebalancing of the portfolio, the
financial adviser directed the purchase of 26 shares in Zimmer
Biomet worth under $3,000. The adviser notified Dr. Price of
the purchase on April 4, 2016, and Dr. Price disclosed them on
his House periodic transaction report on April 15th.
Now, Dr. Price began his legislative effort related to the
comprehensive joint replacement demonstration project in 2015.
With one exception, all of Dr. Price's stocks are held in three
broker-
directed accounts. Neither he nor his wife direct or provide
input regarding investments in these accounts. Innate
Immunotherapeutics is the one exception.
Now, Dr. Price decided to invest based on public
information regarding his work on multiple sclerosis treatments
as a disease. He has been intimately involved in treating for
years. He directed the investments based on his own research
into the company. He invested $10,000 in the company in January
2015 and reported the investments to House Ethics in February
of that year. He made an additional investment in September
2016 and also disclosed that investment.
He has corrected his filing regarding the value of his
shares. He has agreed to divest all shares in the company. Is
that a correct set of remarks?
Dr. Price. I think your summation is correct, sir. And I
just would point out that anybody who knows me well knows that
I would never violate their trust. And I know the environment
that we are in here--you mentioned it in your opening
statement--but I appreciate you correcting the record.
The Chairman. Well, thank you.
Senator Carper. Mr. Chairman?
The Chairman. Yes, sir?
Senator Carper. Just an inquiry. You just consumed about 2
minutes beyond your opening statement. And in the interest of
fair play, is it appropriate for someone to note that 2 minutes
is also owed to Senator Wyden or somebody on our side?
The Chairman. Well, he already did go over 2 minutes, so it
is no problem.
Senator Carper. Okay. But as we go forward in this process,
I would just ask you to keep that in mind.
The Chairman. Well, I am not going to relinquish my role as
chairman----
Senator Carper. No, I understand.
The Chairman [continuing]. To correct errors that are
promulgated here. But I have always been good about giving time
that you need, so I will try to do that.
Senator Carper. Thank you.
The Chairman. But I am also not going to allow things that
are false to go forward without some sort of comment.
Senator Carper. All right.
The Chairman. We just cannot allow this to happen.
Senator Wyden. Mr. Chairman, just a unanimous consent
request.
The Chairman. Yes.
Senator Wyden. I have a bipartisan disclosure memo I would
like to ask be made a part of the record, because it will
document what I have stated.
The Chairman. Without objection.
[The memorandum appears in the appendix on p. 283.]
The Chairman. Senator Roberts?
Senator Roberts. Did you really wink at me and smile? Bless
your heart, thank you. [Laughter.]
Good Doctor, thank you for coming. I think it is important
to make clear right off the bat that, even if Congress and the
incoming administration were to do nothing, absolutely nothing
amending or repealing parts of the Affordable Care Act, the law
is not working.
Dr. Price. Right.
Senator Roberts. It is collapsing. The prices are
unaffordable, the market is nearly nonexistent, with few
options in several States and counties. This year, one out of
every three counties in this country only has one insurer
offering coverage on the exchange.
What tools do you have, or will you have when you are
confirmed, which could be utilized over the next couple of
months to provide stability and improve the individual
insurance markets, make them more appealing so that insurance
carriers will want to come back and provide more coverage
options as we transition away from the Affordable Care Act?
Dr. Price. Well, thank you, Senator. I think it is
incredibly important for us to admit here what the American
people know, and that is that this law is not working. It
certainly is not working for folks in the individual and small-
group market.
You have premiums that are up significantly; they were
supposed to go down by 2,500 bucks; now they are up more than
2,500 bucks on average. You have deductibles that have
escalated to $6,000 to $12,000. You have, as you mentioned,
States where there is only one insurance provider. You have
one-third of the counties in this country where there is only
one insurance carrier.
This is maybe working for government, maybe working for
insurance companies, but it is not working for patients. And so
what we need to do is make an effort to try to reconstitute the
individual and small-group market. And that begins, I believe,
by providing stability in our conversation and in our tone.
And one of the goals that I have is to lower the
temperature in this debate, to say to those providing the
insurance products across this country, we understand; we heard
the challenges that you have.
They are already exiting the market. What we need to do is
to say, there is help on the way to allow us to reconstitute
the individual and small-group market and allow for folks to
gain the kind of coverage that they want for themselves and for
their family--not what the government forces them to buy--that
allows them to purchase coverage at a reasonable amount, that
makes it so that they do not have deductibles through the roof,
where they have the ability to pay the premiums and the
deductible as well.
So there are so many things that we ought to be focusing on
to make certain, again, that the American people have access to
the highest-quality care that is affordable for them.
Senator Roberts. Doctor, I have 84 critical access
hospitals in my State. They are all part of the rural health-
care delivery system, which is under great stress. As we have
seen when I visit with hospital administrators all throughout
Kansas--there was a time I knew every one of them--they are
scratching their heads over regulations coming out of HHS, CMS,
and all the other agencies that you will oversee when you are
confirmed.
I mention the meaningful use program for electronic health
care records. Doctors used to spend, what, 10 to 15 minutes
with patients. It is now down to about 2 or 3, and then they
have to report immediately on what was going on.
The 96-hour rule for critical access hospitals, numerous
other documentation requirements--it seems to me there is a
lack of understanding of our provider shortages in our rural
areas. We are just hanging on by a thread, and these one-size
regulations from Washington simply do not translate to rural
Kansas or any other rural area as far as population----
My question is, how will you work to ensure an effective
but smarter, less-burdensome rulemaking process?
Dr. Price. Well, this is really critical, Senator, because,
as you mentioned, in the rural areas--Georgia is the largest
State geographically east of the Mississippi, and we have a
large rural population, and critical access hospitals are so
important to communities around our State and truly around this
Nation.
But the regulatory scheme that has been put in place is
choking the individuals who are actually trying to provide the
care, so much so that you have physicians and other providers
who are leaving the practice, who are leaving the caring for
patients, not because they have forgotten how to do it or they
have grown tired of it, but because of the onerous nature of
the regulatory scheme coming out of Washington, DC.
The meaningful use project that you mentioned makes it that
much more difficult. We have turned physicians into data-entry
clerks. And you just have to ask them what they are doing. And
if you talk to patients, what they recognize is that, when they
go in to see their doctor, they see the top of his or her head
as they are punching the information, the data into a computer,
as opposed to that sharing of information that is so vital and
necessary between the physician and the patient for quality
health care.
So, one, a recognition of the problem is incredibly
important, a recognition of the importance of rural health care
in our Nation and how it needs to be bolstered up, and then
looking at the consequences of what we do as government.
As I mentioned earlier, oftentimes I do not think we look
at the consequences. We pass the rule, we pass the regulation,
we institute it, we think it is the greatest thing since sliced
bread, but in fact what it is doing is harming the very
individuals who are trying to provide the care. You do not get
that information unless you ask.
Senator Roberts. All right, I appreciate that. My time is
up.
Thank you, Mr. Chairman.
The Chairman. Senator Nelson?
Senator Nelson. Thank you, Mr. Chairman.
Congressman, I enjoyed our visit yesterday. We had a
discussion, when you were kind enough to come visit me, about
the fact that I have in the State of Florida 4 million-plus
seniors on Medicare, and they are petrified of the idea of
privatized Medicare.
And I talked to you about this. And you talked about the
premium support system that you are advocating. And you pointed
to a study that was done by CBO. You mentioned that you would
send me a copy, and we have not gotten it. So what I did, I
went and got the copy myself, and it is from September of 2013.
And what it concludes is opposite of what you said with regard
to high-cost States like Florida.
Medicare is going to be spending 4 percent less under the
proposal that you were talking about in this CBO report, lower
than current law, and beneficiary costs will decrease by 6
percent on the average, which is what you said yesterday. But
in high-cost regions like Florida, you are going to have a
higher beneficiary cost than current law under your premium
support proposal.
Annual premiums in Florida would increase 125 percent
according to the CBO chart on page 71. CBO says that the annual
premium in a high-cost region like Florida would be $3,600
compared to the current law of $1,600. That is a 125-percent
increase. So please help clarify what you were saying yesterday
as it applies to Florida.
Dr. Price. Yes, thank you, Senator. And I enjoyed our time
together as well.
When we talk about Medicare, it is important for everybody
to appreciate, as I know that you and your colleagues do, that
the Medicare trustees, not Republicans or Democrats, the
Medicare trustees have told all of us that Medicare in a very
short period of time, less than 10 years, is going to be out of
the kind of resources that will allow us as a society to keep
the promise to beneficiaries in the Medicare program.
What that means is--and it is important to appreciate what
that means--it means that we will not be able to provide the
services to Medicare patients at that time, which is very, very
close, if nothing is done.
So my goal is to work with each and every one of you to
make certain that we save and strengthen and secure Medicare. I
think it is irresponsible of us as policymakers to allow a
program to continue, knowing--knowing--that in a few short
years it is not going to be able to cover the services that we
are providing. So that is the first point, that the current
Medicare program, if nothing is done, as some have described
it, goes broke.
The second point is that my role, if I am confirmed and
have the privilege of serving as the Secretary of Health and
Human Services, my role will be one of carrying out the law
that you all in Congress pass. It is not the role of a
legislator, which I had when I was working to try to formulate
ideas to hopefully generate discussion and get to a solution--
--
Senator Nelson. Okay. Let me be so rude as to stop you,
because I am running out of time. Remember that Donald Trump in
the campaign said that he was not going to cut Medicare
spending.
And I would also point out to you a legislative solution--
one of the greatest examples on Medicare is 1983, when we were
just about to go bust and it took two old Irishmen, Reagan and
O'Neill, to agree to come to an agreement that made, in this
case it was not Medicare, it was Social Security, actuarily
sound for the next half-century.
Let me ask you, Representative Price: you had made a
statement that it was a terrible idea for people who had
preexisting conditions to have the protection of insurance
against those preexisting conditions.
And what I would like to ask you is, if you please, in
light of President Trump expressing his desire to retain this
basic protection, do you think his proposal to continue the ban
on discriminating against people with preexisting conditions is
a terrible idea?
Dr. Price. No, and I am not certain where you are getting
that quote from. What I have always----
Senator Nelson. It came from a Politico talking points
memo, May 1, 2012.
Dr. Price. Well now, there is a reliable source.
[Laughter.]
What I have always said, Senator, is that nobody--nobody--
--
Senator Nelson. So you did not say it is a terrible idea?
Dr. Price. I do not believe I ever made that statement.
What I have always said about preexisting conditions is that
nobody, in a system that pays attention to patients, nobody
ought to be priced out of the market for having a bad
diagnosis. Nobody. That is a system, again, that may work for
insurance companies, may work for government, but it does not
work for patients.
So I believe firmly that what we need is a system that
recognizes that preexisting conditions do indeed exist and that
we need to accommodate them and make certain that nobody loses
their insurance or is unable to gain insurance because of a
preexisting condition.
Senator Nelson. Mr. Chairman, as I close, I would like to
insert in the record the September 2013 Congressional Budget
Office analysis of premium support systems for Medicare.
[The analysis appears in the appendix on p. 92.]
Senator Nelson. And I would invite you, Congressman, to
please respond with the CBO report that you said yesterday
supports your position, because this one does not.
Dr. Price. I look forward to that. Thank you, sir.
The Chairman. Senator Menendez?
Senator Menendez. Well, thank you, Mr. Chairman.
Congratulations, Congressman Price.
Let me ask you a series of questions. Given your medical
training and time spent as a practicing physician, I have a
couple of simple ``yes'' or ``no'' questions to start off with.
In your medical opinion, does HIV cause AIDS?
Dr. Price. I think that the scientific evidence is clear
that HIV and AIDS are clinically, directly related.
Senator Menendez. In your medical opinion, have immigrants
led to outbreaks of leprosy in the United States?
Dr. Price. I do not know what you are referring to, but I
suspect that there are instances where individuals have an
infectious disease, and they come to the United States and that
that----
Senator Menendez. I am not asking about an infectious
disease. I am asking specifically about immigrants in the
United States causing leprosy in the United States, in your
medical opinion and scientific background.
Dr. Price. Again, I do not know the incident to which you
refer. Are you referring to a specific incident?
Senator Menendez. There are statements that have been made
in the public domain that immigrants have led to outbreaks of
leprosy in the United States. As the person who is going to be
designated as the director of Health and Human Services, that
is not only the national, but the world's health epicenter, I
want to know, in your medical opinion, is there such a
causation?
Dr. Price. Any time you get two individuals together in any
relationship whatsoever, whether it is an immigrant or a
visitor, and one individual has an infectious disease, then it
is possible that that individual transmits that infectious
disease----
Senator Menendez. Including leprosy?
Dr. Price [continuing]. Whether it is the flu or a cold.
Senator Menendez. Including leprosy? Including leprosy?
Dr. Price. Any infectious disease whatsoever.
Senator Menendez. In your medical opinion, do abortions
cause breast cancer?
Dr. Price. I think the science is relatively clear that
that is not the case.
Senator Menendez. In your medical opinion, do vaccines
cause autism?
Dr. Price. Again, I think the science in that instance is
that they do not, but there are individuals across our country
who are very----
Senator Menendez. I am not asking about individuals; I am
talking about science, because you are going to head a
department in which science, not alternate universes of
people's views, is going to be central to a trillion-dollar
budget and the health of the Nation.
Can you commit to this committee and the American people
today that, should you be confirmed, you will swiftly and
unequivocally debunk false claims to protect the public health?
Dr. Price. What I will commit to doing is doing the due
diligence that the Department is known for and must do to make
certain that the factual information is conveyed to, obviously,
the President and to the American people.
Senator Menendez. And that factual information will be
dictated by science, I would hope?
Dr. Price. Without a doubt.
Senator Menendez. Okay. So let me ask you about Medicaid
specifically. And let me just say I am a little taken back
about your answer on the question of immigrants and leprosy. I
think the science is pretty well dictated in that regard too.
Let me ask you this. One of the most beneficial components
of the Affordable Care Act was the expansion of the Medicaid
program that resulted in 11 million people nationwide and over
half a million in New Jersey gaining coverage, many for the
first time. It is one of the biggest programs on the Republican
chopping block with proposals to not only repeal the Affordable
Care Act's Medicaid expansion, but going further and gutting
billions in Federal funding to the States.
There is no doubt that this would result in catastrophic
loss of coverage for tens of millions of low-income families
and lead to tens of billions in losses to safety-net and other
health-care providers.
Do you recognize Medicaid to be a valuable program and
consider the coverage it provides to 74 million Americans to be
comprehensive?
Dr. Price. Medicaid is a vital program for health care for
many individuals in this country, but one that has significant
challenges. There is one out of every three physicians who
should be seeing Medicaid patients who are not taking any
Medicaid patients. There is a reason for that.
If we are honest with ourselves, we would be asking the
question, why?
Senator Menendez. Well, if that is the case that one in
three does not treat Medicaid patients, you have to ask
yourself, is that because Medicaid reimbursements are so low?
And since provider reimbursements are set at a State level,
will not cutting Federal funding and hitting States with higher
costs only lead to lower provider rates? And how many doctors
would actually treat former Medicaid beneficiaries when they no
longer have any coverage or ability to pay?
So, even if there is only one of three, there are still two
of three who are providing the services; imagine if you do not
have coverage.
Which goes to my next question. You have advocated to, in
essence, block-grant Medicaid. Now, the essence of Medicaid is
an entitlement, which under the law means, if I meet these
criteria, I have the right to have that coverage under the law.
When you move to a block grant, you remove the right and you
make it a possibility subject to whatever funding there is
going to be.
Do you recognize that in doing so you risk the potential of
millions of Americans who presently enjoy health-care coverage
through Medicaid no longer having that right?
Dr. Price. I think that it is important to appreciate that
no system that the President has supported or that I have
supported would leave anybody without the opportunity to gain
coverage. Nobody.
Senator Menendez. Well, that is not my question, so let me
reiterate my question. Medicaid, under the law as it exists
today, is a right. Is that not the case, ``yes'' or ``no''?
Dr. Price. It is an entitlement program----
Senator Menendez. And as an entitlement, does that not
mean, if you meet the criteria, that you are entitled to the
services?
Dr. Price. If one is eligible, that is correct.
Senator Menendez. One is eligible, meaning you have a
right. When you move to a block grant, do you still have the
right?
Dr. Price. No. I think it would be determined by how that
was set up if, in fact, that was what Congress did. Again, the
role of the Department of Health and Human Services is to
administer the laws that you pass, not to make the law.
Senator Menendez. Yes, but I would just simply say to you,
I know in our private conversation--and I appreciate you coming
by to visit me--you suggested that your role is that of an
administrator of a large department. Well, that is not even
what the Vice President said when you were nominated. He said
he expected your experience, both medically and legislatively,
to help drive policy. And even beyond the expectations of the
Vice President in that regard, when we have the ability of the
Secretary to dictate regulation, that is policy.
So please do not say to me, I am here just to do what
Congress says. I respect that you will follow the law and do
whatever Congress says. But you will have an enormous impact.
And based upon your previous opinion as it relates to Medicaid,
ultimately block-granting means a loss of a right. And then it
is just a question of funding, and then we will have a bigger
problem with a number of providers' will to provide.
And so I hope we can get to a better understanding of your
commitment to Medicaid as it is, as an entitlement, as a right.
Dr. Price. Thank you, sir.
The Chairman. Senator, your time is up.
We will go to Senator Carper now.
Senator Carper. Congressman Price, welcome to you and to
your wife.
There is a verse of scripture--you mentioned earlier that
you are active in your church--in the New Testament, in Matthew
25, which speaks to the ``least of these.'' When I was hungry,
did you feed me? When I was naked, did you clothe me? When I
was thirsty, did you give me to drink? When I was sick and in
prison, did you visit me? When I was a stranger in your land,
did you take me in? It says nothing about, when my only access
to health-care coverage was going into the emergency room of a
hospital, did you do anything about it?
What we sought to do with the ACA was to do something about
it. And we did not, in this room, invent the Affordable Care
Act. The genesis of the Affordable Care Act goes back to 1993
when Hillary Clinton, first lady, was working on what was
called Hillarycare. And a group of Senators, led by Senator
John Chafee, a Republican from Rhode Island, developed
legislation co-sponsored by, I think, 23 Senators, including,
as I recall, Senator Orrin Hatch and Senator Grassley.
And what he did in his legislation, what he proposed in his
legislation, was to use really five major concepts. One, to
create large purchasing pools for folks who otherwise may not
have access to health-care coverage. He called them exchanges
or marketplaces.
He also proposed that there be a sliding scale tax credit
to buy down the cost of people getting coverage in those
exchanges within the different States.
The third thing he proposed was the notion that there
should be an individual mandate. He wanted to make sure people
got covered, and he realized if they did not mandate coverage
or people getting coverage, then you would end up with
insurance pools that health insurance companies could not begin
to cover; it just would be unworkable.
He proposed, as well, employer mandates. And he proposed,
as well, the notion that people should not lose their coverage
because of preexisting conditions.
Those are not Democratic ideas. Those were proposed by
Republican leadership actually in the Congress at the time. And
when Governor Romney developed his own plan in Massachusetts, I
do not know, a decade or so later, he borrowed liberally from
those ideas.
When they instituted it, as you may recall--they instituted
what I call, what others call, Romneycare--they found they were
doing a pretty good job on covering people, but not such a good
job on affordability. And what took place over time was, they
found out they had insurance pools where a lot of the people
were not young, they were not very healthy, they were older,
and they needed more health care. And as a result, the
insurance companies, in order to be able to stay in business,
had to raise the premiums.
I do not know if any of this sounds familiar to you, but it
sure sounds similar to what we have seen in the last 6 years or
so with the Affordable Care Act.
To the ideas of Senator Chafee and the ideas of Governor
Romney, we have added some things. We have encouraged States to
increase the number of people they cover under Medicaid by
raising to about 135 percent of the poverty level the
eligibility under which people can receive health care. We have
encouraged a focus on prevention and wellness: not just
treating people when they are sick, but also trying to make
sure that people stay healthy in the first place. We provide
funding for contraception. We provide funding for programs that
are intended to reduce obesity. We have programs that are
intended to reduce smoking, the use of tobacco.
This is not a ``yes'' or ``no'' question. What was wrong
with that approach? What is wrong with that approach?
And the last thing I will say is this, before you answer.
The health insurance companies found it difficult to stay in
business in the State group exchanges across the country. One
of the reasons why they were unable to is because, I think--
really we learned this from Massachusetts--we did not raise the
fine or, if you will, we did not have the incentive high enough
to get young, healthy people, like my sons, into the exchanges
across the country.
S&P, I am told, has just put out, about a month ago, an
update looking at the financial health of the health insurance
companies in this country as they have tried to figure out how
to price this product. And it seems like, according to S&P,
believe it or not, they seem to have sort of figured it out,
because the financial health of the health insurance companies
has begun to stabilize. Your reaction to this, please?
Dr. Price. Well, as I mentioned either in my opening or in
response to a question, the principles of health care that all
of us hold dear--affordability and accessibility and quality
and choices for patients--I think are the things that we all
embrace.
The next step, how we get to accomplish and meet those
goals and those principles, is where it takes working together
to do so.
The program that you outline has much merit, whether it is
making sure that individuals with preexisting illness and
disease are able to access coverage, whether it is the pooling
mechanisms which I have actively and aggressively supported for
years, there is a lot of merit there.
So again, what I am hopeful that we are able to do is to,
in a collegial, bipartisan way, work together to solve the
remarkable challenges that we have.
One of my physician colleagues used to tell me that he
never operated on a Democrat patient or a Republican patient,
he operated on a patient. And that is the way that I view the
system. It is not a Republican system, it is not a Democrat
system, it is a system where hopefully we are focusing on the
patients to, again, make certain that they have the access to
the highest-quality care possible.
Senator Carper. Thank you for that. Let me just conclude,
Mr. Chairman, by saying I will use an analogy. There is a large
building, and there are people in the large building. And there
is a fire in the large building, but for some reason they
cannot use the stairways and they cannot use the elevators. And
they look out the windows and there are firefighters down in
the street saying, ``Go ahead and jump, we will save you,'' but
they do not have any safety nets.
And my fear is, if we repeal what I have described, the
system that I described, that we put in place, the Affordable
Care Act, largely founded on Republican ideas which I think
were good ideas, and we do not have something at least as good
in place to catch those people as they fall from the building,
we will have done a disservice to them and to our country.
Thank you.
Dr. Price. Thank you.
The Chairman. Thanks, Senator. Your time is up.
Senator Burr?
Senator Burr. Thank you, Mr. Chairman.
And a quick reminder that the Affordable Care Act was
passed with not one Republican vote in the House or the Senate.
So, Dr. Price, a couple of questions just to cut to the
chase. Are all of your assets currently disclosed publicly?
Dr. Price. They are now and they always have been.
Senator Burr. Okay. Are you covered by the STOCK Act
legislation passed by Congress that requires you and every
other member to publicly disclose all sales and purchases of
assets within 30 days?
Dr. Price. Yes, sir.
Senator Burr. Now, you have been accused of not providing
the committee information related to your tax and financial
records that were required of you. Are there any records you
have been asked to provide that you have refused to provide?
Dr. Price. None whatsoever.
Senator Burr. So all of your records are in?
Dr. Price. Absolutely.
Senator Burr. Now, I have to ask you, does it trouble you
at all that, as a nominee to serve in this administration, some
want to hold you to a different standard than you were held to
as a member of Congress, and I might say the same standard that
they currently buy and sell and trade assets on? Does it burn
you that they want to hold you to a different standard now that
you are a nominee than they are held to as a member?
Dr. Price. Well, we know what is going on here.
Senator Burr. Well, we do. We do.
Dr. Price. And I understand. And as my wife tells me, I
volunteered for this.
Senator Burr. So let us go to substance. You and I have a
lot in common. We both spoke out in opposition to Obamacare
early. We predicted massive premium increases. When the
President promised, if you like your doctors, you can keep
them, if you like your plan, you can keep it, we both said
these promises would be broken, and, in fact, they were.
Over the last 7 years, you and I, Senator Hatch,
Congressman Upton, and others have actually written our own
health-care plans because we were, I think, brave enough to say
that, if you are going to be critical of something, then put
your ideas on the table.
In your opinion, was it clear to the American people that
repeal of Obamacare was a promise that Donald Trump made before
he was elected president?
Dr. Price. Well, I have no doubt that it played a very
prominent role in this past election and that the President is
committed to fulfilling that promise.
Senator Burr. And as the nominee and hopefully--and I think
you will be--the Secretary of HHS, what are the main goals of
an Obamacare replacement plan?
Dr. Price. The main goals, as I mentioned, are outlined in
those principles. That it is imperative that we have a system
that is accessible for every single American, that is
affordable for every single American, that incentivizes and
provides the highest-quality health care that the world knows,
and provides choices to patients so that they are the ones
selecting who is treating them, when, where, and the like.
So it is complicated to do, but it is pretty simple stuff.
Senator Burr. I want to thank you for not only testifying
here, but testifying in front of the HELP Committee when Johnny
and I both had you over there. You are brave to go through
this, but the country will be much better off with your
guidance and your knowledge in this slot.
Mr. Chairman, I yield back.
Dr. Price. Thank you, sir.
The Chairman. Thank you.
Senator Cardin?
Senator Cardin. Thank you, Mr. Chairman.
Dr. Price, again, thank you for your willingness to serve
in this position. And we also thank your family for being
willing to put up with your voluntary choices.
I want to talk about a few issues in the time that I have.
One, yesterday the President by executive order reinstituted
the global gag rule, but he also did it in a way that is more
comprehensive than the previous. The new policy would prohibit
any Federal aid to foreign organizations that provide or
promote abortion.
In the past, the policy only applied to organizations that
got family planning funding; now it will apply to organizations
that get global health funding, potentially including maternal
health programs, anti-Zika efforts, and expansion of PEPFAR to
stop HIV/AIDS.
My question to you is this: if confirmed, how will you make
sure that the U.S. can fully participate in these global health
efforts to help with maternal health, to help in stopping of
the spread of and ending HIV/AIDS, to make sure that the next
Zika virus is contained so it does not cause catastrophic
effects, if the global gag rule is enforced in a way that
prevents us from participating in international health
organizations?
Dr. Price. Okay. This is really important, Senator, and I
appreciate the question. The Department is full of all sorts of
heroes, as you well know, and incredibly talented individuals.
And my goal, if I am confirmed and given the privilege of
serving as the Secretary of Health and Human Services, is to
gather the best minds and the best talent that we have within
the Department and without and determine what is the wisest
policy for this Nation to have as it relates to, in this
instance, infectious disease.
Germs no know geographic boundaries. And we do incredible
work, the work that the CDC does and the work that is done by
others in our Nation, to try to work to prevent infectious
disease, work to detect the spread of infectious disease. And
then providing a logical and methodical and aggressive response
to the outbreak of any infectious disease is absolutely vital
to protect the American people, and we are committed to doing
so.
Senator Cardin. And I agree with that. I just hope that you
will look at perhaps unintended consequences from these
executive orders that could compromise our ability to be as
effective as we need to, using all tools at our disposal.
I want to get to tobacco regulation for one moment, an area
that I think is now clear within the medical community, the
impact that tobacco has, the fact that the Family Smoking
Prevention and Tobacco Control Act of 2009 authorizes the HHS
Secretary, through FDA, to regulate tobacco products, including
restricting the sale of tobacco products to minors. It also has
been expanded to include the selling of e-cigarettes, et
cetera.
I know initially you did not support that legislation. If
confirmed, can you commit to us that you would rigorously
enforce that act to make sure particularly our children are not
subjected to the new forms of tobacco products?
Dr. Price. If I am confirmed, the responsibility that we
will have is to enforce the law of the land, and we will do so.
Senator Cardin. It also requires keeping up with new
technologies that are being used by the industry that may
require modifications, as we see with e-cigarettes. Are you
prepared to not only enforce the law, but to enforce our intent
to make sure our children are protected?
Dr. Price. Yes, I look forward to working with you,
Senator, on just that.
Senator Cardin. I was listening to some of the exchanges
related to the Affordable Care Act, and we will continue to
debate the merits of the Affordable Care Act. I am a strong
supporter of it. I think millions of people have coverage who
did not have it before, the quality of coverage that Americans
now have did not exist before, and the rate of growth of our
health-care premiums is far lower than it would have been but
for the Act. We will debate that later.
The question is, what is coming along? I mean, we have
heard you say several times the principles that the President
has articulated as to what would be in place of the Affordable
Care Act.
I would like just to drill down a little bit, if I could,
on essential health benefits. We have talked about preventive
care now being available. We know that we have now mental
health and addiction services that are available. We also know
we have oral health, pediatric dental, that is now available,
which is particularly important in my State because of the
tragic loss of Deamonte Driver in 2007.
Can you assure us that, as you look at what will be the
health-care system moving forward, you are prepared to make
sure that Americans have quality insurance coverage to deal
with issues such as preventive care, mental health services,
addiction services, and pediatric dental?
Dr. Price. What I can commit to you, Senator, is that we
will do all that we can within the Department with the
incredible knowledge and expertise that is there to define
whether or not the program is actually working as intended or
not, if coverage equals care. In many instances, I would
suggest that many individuals right now have ``coverage.'' They
have a card, but they do not have any care, because they cannot
afford the deductible that allows them to get the care.
So we are committed to making certain that the program
works, not just for government, not just for the insurance
companies, but for the patients.
Senator Cardin. And as you know, we eliminated any copays
on preventive care. But we can talk about the specifics going
forward. I look forward to those discussions. Thank you, Mr.
Chairman.
Dr. Price. Thank you.
The Chairman. Thank you, Senator.
Senator Isakson?
Senator Isakson. Thank you, Mr. Chairman.
Tom, as Secretary-to-be, let me ask you a few ``yes'' or
``no'' questions. You have been asked a lot of them with the
intent of trying to get you to say ``yes'' that you are going
to cut Medicare when you are not going to cut Medicare; you are
going to try to improve it and reform it.
But ``yes'' or ``no'' to these questions. Question number
one: we have been hearing about the joint replacement program
that Secretary Burwell launched in 2015. You and many others
have raised concerns about this program saving money, that it
could actually harm the quality of patient care. So in other
words, was this an administrative action by HHS that actually
cut a Medicare benefit?
Dr. Price. Potentially, yes.
Senator Isakson. Second: last year, HHS proposed a new way
of paying for cancer drugs so as to reduce Medicare spending on
these drugs. Many of us opposed this from our side of the aisle
as well as the other. We were concerned it would cut cancer
patients' benefits and, more often, it would be a cut to the
Medicare benefit to seniors. Is that correct?
Dr. Price. I believe that is correct. Yes.
Senator Isakson. Last one: what about all the recent
changes HHS has made to cut Medicare payments to Medicare
Advantage? Nearly one-third of all Medicare beneficiaries are
on Medicare Advantage. Would these cuts not also break the
pledge of not cutting Medicare?
Dr. Price. I believe so.
Senator Isakson. My point being, any one of us can sit at
this dais and say give me ``yes'' or ``no'' answers and
demonstrate the point we want to make, but that all of us,
Republican and Democrat alike, are interested in saving Social
Security for our seniors, making Medicare work, and saving the
taxpayers' money in the United States of America. Is that not
true?
Dr. Price. Absolutely.
Senator Isakson. And one other point. Any one of us can
take a financial disclosure, using something called disparate
impact, where you take two facts, one over here and one over
there, to make a wrong. Any one of us could do it to disrupt or
misdirect people's thoughts on somebody. It has been happening
to you a lot because people have taken things that you have
disclosed and tried to extrapolate some evil that would keep
you from being Secretary of HHS when, in fact, it should not be
true.
For example, if you go to Senator Wyden's annual report, he
owns an interest in BlackRock Floating Rate Income Fund. The
major holding of that fund is Valeant Pharmaceuticals. They are
the people we jumped all over for 2,700-percent increases last
year in pharmaceutical products. But we are not accusing the
ranking member of being for raising pharmaceutical prices, but
you could take that extrapolation out of that and then indict
somebody and accuse them. Is that not true?
Dr. Price. I think that is correct, yes, sir.
Senator Isakson. So the point of that is, we ought to in
the end be looking for the best person, man or woman, for the
job and not trying to trick them into agreeing to something
that is wrong, but in fact let them execute the programs that
improve Medicare for the American people.
Dr. Price. Yes, sir.
Senator Isakson. I thank you for your time. And I reserve
the rest of my time.
Senator Wyden. A point of personal privilege, Mr. Chairman.
The Chairman. Senator Wyden?
Senator Wyden. I do not trade in health-care stocks.
The Chairman. Okay. Did you care to----
Senator Isakson. My only point to the Senator from Oregon
is, you do have mutual funds like most of us have. The mutual
funds have holdings in pharmaceuticals, many of them, one of
them you own. But nobody should accuse somebody of holding
pharmaceutical stocks if they have a mutual fund by pulling----
Senator Wyden. Mr. Chairman, to continue on this point of
personal privilege. Mutual funds in particular, by independent
experts, ethics experts, are considered in a completely
different category than personal trading in stocks. Even past
Republican ethics experts make that same point, and they have
never seen anything like what the Congressman has engaged in.
Thank you, Mr. Chairman.
The Chairman. Senator Brown?
Senator Brown. Thank you, Mr. Chairman.
And welcome, Congressman Price.
Dr. Price. Thank you, Senator.
Senator Brown. I was troubled by your response to Senator
Wyden when he asked the question, if you repeal the Affordable
Care Act, will you commit that no one will lose insurance? That
is 22 million Americans, almost 1 million in my State.
He asked, will you commit that no one will lose their
insurance? And you ignored the question and responded that no
one who lost their insurance under the Affordable Care Act--and
to my knowledge that is 2 million to 4 million people, and
almost all of them ended up getting reinsured--you said that no
one who lost their insurance under the Affordable Care Act will
basically lose it after they have been reinstated.
So you pretty much ignored the 22 million, and that is the
problem we all face. But I want to ask you about something
else.
If you are confirmed, obviously you will play a role in the
repeal of the Affordable Care Act. I would like to ask you
``yes'' or ``no'' questions, and they really are ``yes'' or
``no'' questions; they are not meant as a trap.
Marguerite is from Lyndhurst, OH. She suffers from a
chronic condition. She was turned down by insurance companies
for 25 years before the ACA. She will lose her insurance if the
ban against discrimination based on existing conditions is
weakened.
My question is, if you are confirmed, will you maintain the
current scope of the law and continue to vigorously enforce the
law's ban against discriminating against individuals with
preexisting conditions, ``yes'' or ``no''?
Dr. Price. I commit to you that we will not abandon
individuals with preexisting illness or disease.
Senator Brown. Thank you. Victoria is from Buckeye Lake,
OH. As a senior on Medicare, she relies on free preventive
services provided by the ACA. Will you commit to ensuring
seniors like Victoria, who rely on Medicare, continue to get
their preventive care--no copays, no deductibles, no out-of-
pocket costs, ``yes'' or ``no''?
Dr. Price. Preventive care and wellness care are absolutely
vital for so many members of our population.
Senator Brown. That is part of ACA. You will commit to
that?
Dr. Price. And I believe it is a part of health care and
health coverage, and it ought to be a priority.
Senator Brown. Yes, and we did that. Okay, I do not mean to
be rude. We did that under the ACA.
Grace is from Westlake, OH. She is 24. She was diagnosed
with stage four metastatic melanoma in 2015. She is still on
her parent's health insurance, which was purchased through the
ACA marketplace, and she benefits from the ACA's ban on annual
lifetime coverage maximums. Her first 3 months of treatment
cost $800,000. As Secretary of HHS, if an insurer asks you for
an exception to the current ban on out-of-pocket maximums as
provided in Friday's executive order, will you commit to stand
up for patients like Grace and refuse to grant any insurer this
exception?
Dr. Price. As I mentioned, I think patients ought to be at
the center, and our goal is to make certain that every single
patient has access to the highest-quality care.
Senator Brown. I do not want it as your goal, I want you to
commit that you will stand firm, as the ACA does, on this
provision of canceling care, canceling insurance, because
patients are too expensive.
Dr. Price. As I said, nobody ought to lose their insurance
because they get a bad diagnosis.
Senator Brown. Okay. Alice is from Bethel, OH. Prior to the
ACA, she could not afford her preferred method of birth
control. Now thanks to the law, she benefits from covered
contraceptive coverage. Are you able to set aside any personal
political views and protect the doctor/patient relationship by
committing to ensure every woman's right to access the form of
contraception deemed best for her by her doctor at no cost, as
currently provided in the ACA?
Dr. Price. I think that contraception is absolutely
imperative for many, many women. And the system that we ought
to have in place is one that allows women to be able to
purchase the kind of contraception that they desire, between
their doctor and themselves.
Senator Brown. As the law is now with the ACA. Thank you.
President Trump said he is working with you on a
replacement plan for the ACA, which is nearly finished and will
be revealed after your confirmation. Is that true?
Dr. Price. It is true that he said that, yes. [Laughter.]
Senator Brown. So not that he has ever done this before,
but did the President lie? Did the President lie about this,
that he is working with you? He said he is working with you. I
know we do not use the word ``lie'' here because we are polite
when Presidents say statements that are not true. But did he
lie to the public about working with you?
Dr. Price. I have had conversations with the President
about health care, yes.
Senator Brown. Which is not quite an answer, so will you
commit, with this President's plan, to maintaining the
protections for those Ohioans you just committed to in the
replacement plan?
Dr. Price. Our commitment is to make certain that every
single American has access to the highest-quality coverage and
care possible.
Senator Brown. I am still not sure if the President lied,
not to you, but to us, the public, about whether he is actually
working with you. It sounds like he did.
Last series of questions briefly, Mr. Chairman.
I want to find out about the Children's Health Insurance
Program. You said last week to staff that it has been a
remarkably successful program. You once earlier had said it
sounds like socialized medicine to you. I do not quite know
what that means.
Ninety-five percent of children in America are currently
insured. I know about the chairman's interest in CHIP, the
Children's Health Insurance Program. Ninety-five percent of
American children are insured now, partly because of Medicaid
expansion, partly because of CHIP.
You discussed the importance of using the right metrics, so
my question is this. Funding for CHIP, I think you know, is set
to expire in September. If confirmed, would you advise the
President to support an extension of CHIP and the Pediatric
Quality Measures Program beyond September of this year?
Dr. Price. Absolutely, but I want to expand a little bit
because, after last week's hearing in the HELP Committee, the
same question was asked, quoting me as saying that CHIP was
socialized medicine. And so I went back and looked at that
article, and as so often happens, as you well know, though this
may have never happened to you, it was a characterization in
the article by the author of the article to push a political
point of view.
And I knew that was the case because I rarely, if ever, use
that word. I talk about patients as being the focus. I do not
talk about government being the focus.
Senator Brown. Okay. I am sorry. That is fine. I want to
ask you specifically on CHIP. Last week, MACPAC submitted a
report to Congress advising we extend the current CHIP program
and the Quality Measures Program for 5 more years. Do you agree
with this?
Dr. Price. I think the CHIP program, with policymakers, has
to be looked at, and I believe it ought to be extended.
Senator Brown. For 5 years?
Dr. Price. Well, if we could extend it for 8, it would
probably be better than 5.
Senator Brown. Okay. Thank you, Mr. Chairman.
The Chairman. Well, thank you, Senator.
Let us go to Senator Portman.
Senator Portman. Thank you, Mr. Chairman.
I have a lot of questions, so I am glad you are letting
people go a couple of minutes over, because I may need that
time.
Dr. Price. I am not. [Laughter.]
The Chairman. We have been letting the other side go a
couple of minutes over. We are not going to let our side go a
couple of minutes over.
Senator Portman. Okay, well I would like that time back.
[Laughter.]
First of all, Dr. Price, thank you very much for your
willingness to serve. We need you.
As you know, a couple of weeks ago Congress passed a budget
resolution to set up a process that gives us the possibility of
replacing the Affordable Care Act with policies that work
better, particularly to reduce skyrocketing health-care costs
that affect my constituents in Ohio. It is not just premiums.
It is deductibles and copays, and also, people need more
choices in health care.
I did join with four of my colleagues, as you know--we
talked about this--introducing an amendment that would have
ensured we had enough time for the next step in the process.
And I believe we got assurances for that to ensure that we have
time to work with you, frankly. We need somebody at HHS in
place who can work with us to be sure that the legislative and
the administrative policies are working together and that this
is done carefully.
Prior to the Affordable Care Act, we had a very competitive
insurance market in Ohio; now we do not. In fact, if you look
at what has happened due to the increased regulations and
mandates, we have a dramatically decreased competitive market.
We went from having 17 insurers offering plans last year on the
exchanges to 11 now. We have 20 counties now in Ohio, over one-
quarter of our counties, that only have one health-care
insurance company offering plans. We used to have no counties
in that situation.
I know we are doing better than the rest of the country,
actually, because about a third of the counties only have one
insurer, and some of them have only one insurer in the entire
State.
Now that we have begun this process of replacement and the
President has issued his executive order, what can we do,
briefly? What actions can you take through your authority as
Secretary to ensure that my constituents in Ohio have access to
affordable health-care coverage with a healthy insurance
market?
Dr. Price. Well, what you laid out is the challenge that we
have all across the Nation. And Ohio is doing better than other
States, as you noted.
But it is important to appreciate that things have gotten
worse for the individual and small-group market, and we
believe, I believe, that it is a direct result of policies that
have come from Washington, DC, directly from the Affordable
Care Act.
So if we are honest with ourselves and honest with our
constituents about trying to solve the challenges that they
have to gain access to coverage that they want, then we ought
to look at that and say, how do we fix that? And the way that
you fix that is to make it so that individuals have the
choices--one of the principles I mentioned--that we allow for
pooling mechanisms that provide for individuals to have
opportunities to recreate and reconstitute that individual and
small-group market, which now does not exist.
Senator Portman. And by the way, I appreciate your response
to my colleague from Ohio about protecting people who have
preexisting conditions. And one way you do that, obviously, is
through those risk pools, and, again, many States had good risk
pools that were working before the Affordable Care Act to help
in that regard.
As you know, Congress recently passed legislation authored
with Senator Whitehouse called CARA, our Comprehensive
Addiction and Recovery Act. And it is meant to address this
opioid crisis we face--heroin, prescription drugs.
We are now working to both fully fund--and the funding is
there in place for this new program--and now to implement it.
And a lot of the implementation goes through SAMHSA; almost
half of the funding under new grant programs goes through HHS
and SAMHSA.
What should be done to ensure access to addiction treatment
for those individuals currently getting insurance coverage
through the exchanges or Medicaid expansion? And do you commit
to us today to fully implement and implement promptly the new
legislation?
Dr. Price. Without a doubt. As you know, Senator, this is a
scourge that has gone all across the country, and it is in
communities large and small, destroying lives, destroying
families, harming communities. And it is growing.
And so what we must do is absolutely commit to carrying out
the law as it was passed, but also--as I have talked about with
some other challenges--make certain that we have the right
metrics in place. Are we actually helping with what we are
doing?
There may be better things to do there, maybe things that
we think we ought to do that in fact do not help, and we ought
to be identifying those as much in real time as possible so
that we can bring about a program that is actually making it
work for the patients, for the individuals who are actually
being harmed.
Senator Portman. One example of that, quickly. You are
aware, I think, of the Institution for Mental Disease rule that
says if you have an inpatient treatment center, it has to be
limited to 16 beds. Would you be willing to look at that rule
to see if we can get that number up to be able to provide more
of this treatment?
Dr. Price. I think that is one of the rules that has to be
looked at. I think the 3-day stay rule in facilities is
another, where oftentimes many of these individuals have some
mental illness as well, and the limitation on being able to
keep folks on an inpatient basis when all of the health-care
professionals involved in their care say they ought to, but in
fact that is not what is covered, makes no sense. And
therefore, they are put back out on the street, and the
challenge is, we just get in this revolving door.
Senator Portman. A final question, and maybe you could
respond to this in writing, because my time is expiring based
on the allocation here.
With regard to the waivers, you know, Ohio applied for a
waiver, and this was an 1115 waiver for Medicaid, to be able to
better cover people under Medicaid. We were rejected by CMS. I
know you have Seema Verma coming in who has worked on these
over time.
Do you believe that during this replacement time we should
cover people under Medicaid expansion but then move to a
program that is more flexible to provide better care under
Medicaid?
Dr. Price. I think there have to be better ways to provide
care to the Medicaid population, because there are huge
challenges right now, as I mentioned before. And the people
whom we need to be listening to are the Governors and the State
insurance commissioners and the folks on the ground actually
providing the care. And if we listen to them, I think they will
guide us in the right direction in terms of policy.
The Chairman. Senator, your time is up.
Senator Portman. Thank you, Mr. Chairman.
The Chairman. Senator Bennet?
Senator Bennet. Thank you, Mr. Chairman.
I want to thank my colleague from Ohio for his graciousness
in not going too over.
Congressman Price, you have said a couple of times--I may
misquote you a little, I hope not--that the goal here is access
to the highest-quality coverage and the highest-quality health
care for all Americans. Is that roughly where you would like to
head? And I think that is a worthy goal.
Dr. Price. Yes.
Senator Bennet. And just piggybacking on what Senator
Portman was asking you about, I am worried today--whether it is
the Affordable Care Act or not the Affordable Care Act, whether
it is the insurance market--that people, especially in rural
parts of this country, in rural parts of my State, are not
getting the access they need to high-quality health care, are
not getting the access they need to high-quality choices in
terms of insurance.
I worry a little bit, and whether we are trying to repeal
the Affordable Care Act or we are trying to fix the Affordable
Care Act, I think it is incumbent on all of us not to make
matters worse for rural America in doing what we are doing. And
I know you share that goal.
Dr. Price. Absolutely.
Senator Bennet. And you talked about pooling as one
solution. I wanted to talk a little bit or ask you a little bit
about your projected quality of insurance in these markets,
because one answer that I have heard from folks, including
yourself, over the weeks has been making sure that people have
the opportunity to buy coverage for catastrophic care.
I wonder whether you also believe that it is essential that
there be a floor for insurance providers. You know, some of the
things that the Affordable Care Act requires for coverage
include outpatient care, emergency services, hospitalization,
maternity and newborn care, prescription drugs, rehab services,
lab services, preventative care such as birth control and
mammograms, pediatric services like vaccines, and routine
dental exams for children younger than 19.
I am not going to ask you to go through each one of those.
But directionally, are we headed to a world where people in
rural America have to settle for coverage for catastrophic
care? Are we headed to a place where there is regulation of
insurance providers that says if you are going to be in the
insurance market, particularly if we are in a world where you
are selling across State lines, there has to be a floor on the
services you are willing to pay for?
Dr. Price. I think there has to be absolutely credible
coverage. And I think that it is important that individuals
ought to be able to purchase the coverage that they want.
Senator Bennet. I just do not want us to get to a place
where people in America have to settle for something that no
one else in the industrialized world has to settle for. Why
should they have to pay out of pocket month after month after
month for something that is not going to cover something as
basic as a hospitalization or maternity services or, you know,
the rest of this list? There may be certain things on the list
we disagree with.
But I am worried that we are heading toward a place where
somehow that choice is accepting a world that no one else in
the industrialized world has to accept. And I applaud your
goal, and I hope we can work together to make it so.
Dr. Price. As do I.
Senator Bennet. You mentioned that we should listen to the
Governors, which brings me to my second question and your
answer to Senator Portman.
In Colorado--you may have heard of this--we have something
called the Accountable Care Collaborative that is a unique
approach to Medicaid. It connects members with coordinated
primary care providers while reducing barriers to access. It
also provides coordinated care for those with dual eligibility
for Medicare and Medicaid. I do not have it today, but I could
show you that the cost curve there is really starting to turn
around because of the coordinated care that is happening out
there.
When asked about the need for more State flexibility, which
is an argument that is made to carry out innovative programs
like the one in Colorado, our Governor said that, quote,
``Greater flexibility cannot make up for the lack of funding.
Should the Federal Government pull back its financial
commitments, we simply cannot afford to make up the
difference.''
So I would ask you whether you agree with our Governor's
assessment that while flexibility is helpful, it is not a
replacement for critical funding needs.
Dr. Price. I think so. And the decision for funding
obviously is a legislative decision.
Senator Bennet. But that is a very fundamental component of
the Affordable Care Act, the expansion of Medicaid, would you
not agree?
Dr. Price. And that decision whether or not to change that
is a decision that you and every member of the committee and
Congress will be involved in. And if I am fortunate enough to
serve as the Secretary of Health and Human Services, we will
carry out the law that you pass.
Senator Bennet. I appreciate that. In your mind, though,
does the repeal of the Affordable Care Act include a repeal of
the expansion of Medicaid that was part of the passage of the
Affordable Care Act?
Dr. Price. Any reform or improvement that I would envision
for any portion of the Affordable Care Act would be one that
would include an opportunity for individuals to gain coverage,
the kind of coverage, again, that they want, the highest-
quality health care.
Senator Bennet. But that is not the question I asked.
And I am sorry, Mr. Chairman; I realize I am at the end of
my time.
Do you believe that a repeal--I mean, this is what the
President ran on--of the Affordable Care Act includes the
repeal of the expansion of Medicaid that was a fundamental part
of the Affordable Care Act?
Dr. Price. Again, that is a decision that you all would
make.
Senator Bennet. That is true.
Dr. Price. What I believe is that any reform or improvement
must include a coverage option and opportunity for every single
American, including those who are either currently in or close
to joining the Medicaid population in a given State, which
changes depending on the State.
Senator Bennet. Okay.
Thank you, Mr. Chairman.
The Chairman. Well, thank you, Senator Bennet.
Let us go to Senator Toomey.
Senator Toomey. Thank you, Mr. Chairman.
Congressman Price, thank you for joining us.
Dr. Price. Thank you.
Senator Toomey. Thanks for the great work you have done in
the House and your willingness to serve in this extremely
important post. I appreciate it, and I enjoyed the conversation
that we had a little while back.
I do think it bears reminding everyone as we talk about
Obamacare that certainly the individual market is in a classic
death spiral. The adverse selection is destroying that market.
It is in a freefall. In Pennsylvania, 40 percent of all
Pennsylvanians in the Obamacare exchanges have a grand total of
one choice, and that very typically does not include whatever
they had before and were promised they could keep, which, of
course, was never true.
So we have a system that is in collapse. And what we are
trying to do is figure out what is a better way to go forward.
Now, when we talk about repeal, sometimes I hear people say,
well, but we have to keep coverage of preexisting conditions
because, you know, we have to keep that. And when I hear that,
I think that we are missing something here.
And here is what I am getting at. There are obviously a
number of Americans who suffer from chronic, expensive health-
care needs. They have had these conditions sometimes all their
lives, sometimes for some other period of time. And for many of
them, the proper care for those conditions is unaffordable.
I think we agree that we want to make sure those people get
the health care they need. Now, one way to force it is to force
insurance companies to provide health insurance coverage for
someone as soon as they show up, regardless of what condition
they have, which is kind of like asking the property casualty
company to rebuild the house after it has burned down. But that
is only one way to deal with this.
And so am I correct, is it your view that there are other,
perhaps more effective ways, since, after all, Obamacare is in
a collapse, to make sure that people with these preexisting,
chronic conditions get the health care that they need at an
affordable price without necessarily having the guaranteed
issue mandate in the general population?
Dr. Price. I think there are other options. And I think it
is important, again, to appreciate that the position that we
currently find ourselves in with policy in this Nation is that
those folks, in a very short period of time, are going to have
nothing because of the collapse of the market.
Senator Toomey. Right. The second topic is, I think you and
I share a goal of having health care that is much, much more
driven by individuals, families, patients, consumers--consumer-
centric rather than bureaucrat-centric, which is what Obamacare
is.
Do you agree with me that to get there we need to do more
about the transparency of health-care outcomes so that informed
consumers can evaluate among different physicians, different
hospitals that really get the best outcomes? Do we need to do
more there?
Dr. Price. Absolutely. And this is an important point. And
it is not just in outcomes. Outcomes are important, and we need
to be measuring what actually makes sense from a quality
standpoint and allow patients and others to see what those
outcomes are.
But it is transparency in pricing as well, and right now we
do not have that. So if you are individual out there and you,
in fact, want to know what something costs, it is virtually
impossible to find out what that is. There are all sorts of
reasons for that.
But if we are honest with ourselves as policymakers and we
want to make the system patient-friendly, not insurance-
friendly or
government-friendly, but patient-friendly, then we would make
that a priority. And if I am confirmed, I hope to do so.
Senator Toomey. I think Medicare and Medicaid, CMS, can
play a big role in advancing that. Ultimately, I think the more
we diminish dependence on third-party payers and allow the
evolution of a market that responds to individuals, individuals
will demand that information the way they do in every other
market.
Dr. Price. Right.
Senator Toomey. The last point I want to touch on, if I
could, has to do with NIH research and specifically Alzheimers.
It is my view that we ought to think of Alzheimers as a disease
in a category of its own. And I say that because there is no
disease like it that we know of that afflicts Americans today.
There are 5.2 million Americans with the disease right now. It
is 100-percent fatal. It is the sixth-leading cause of death.
There is no cure, there is no treatment; there is nothing.
And yet, for fiscal year 2016, NIH spending is a grand
total of $168 per diagnosed patient. It seems to me that the
expenditures are wildly out of line with the severity and the
breadth and the scope of this disease. And I wonder if you
would commit to working with me and others who share this view
to ensure that we have a better proportionality in terms of the
allocation of resources in the breadth and severity of
illnesses.
Dr. Price. I think it is absolutely imperative, Senator,
and I look forward to working with you.
Senator Toomey. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
Senator Thune?
Senator Thune. Thank you, Mr. Chairman.
Dr. Price, welcome, and thank you for your willingness to
serve in this very important capacity. We have a lot of
challenges ahead that we need to take on.
As I met with you a couple of weeks ago, one of the issues
that is of particular interest to me, which I conveyed to you,
is this issue of Indian Health Service. In 2010, there were
some systemic problems that were uncovered in South Dakota. And
an administrative action plan was set in motion to help remedy
many of these findings. Similar issues popped up again
throughout South Dakota in 2015, and they continue to this day.
And after oversight hearings, it became abundantly clear that,
time and again, there was a lack of follow-through by the
agency.
And my question is, will you commit to follow up with me in
writing that you will designate someone at HHS to be the point
person that my staff and I can contact to ensure, one, that
reforms are being implemented, and two, that we continue to
collaborate on reform in the IHS?
Dr. Price. Absolutely, Senator. This is an area that is of
significant concern, because it appears to me, as I know you
shared with me, that in the Indian Health Service there are so
many areas where we are not meeting the goal of the highest-
quality care being provided to individuals accessing that
system.
And so we are not doing what we ought to do in that system.
And I am committed to making certain, should I be confirmed, to
turn that system around.
Senator Thune. And as I shared with you, Senator Barrasso
and I introduced a bill last year called the IHS Accountability
Act which we believe will bring about a lot of structural
changes within the IHS. And as I have said many times, that
act, although we think it addresses a lot of the problems that
have cropped up--and it was based upon consultation that we
received from the tribes--really is merely a first step in the
process that is necessary to improve that agency.
If confirmed, what types of reforms could you see yourself
supporting when it comes to the IHS and, obviously, starting
perhaps with our legislation? I do not know, you probably have
not had a chance to look carefully at that yet, so I will not
ask you to comment specifically on it. But are there thoughts
that you have with respect to the IHS when it comes to reforms
that you could work with us on?
Dr. Price. Yes, I appreciate that. I have had the privilege
of visiting some IHS facilities in the State of Wisconsin and a
couple of facilities that were doing remarkable work. And it
appears to me that what we have not done--and if I am
confirmed, I look forward to getting into this area within the
Department itself--is identified best practices within the IHS
system itself and shared those and incentivized the ability to
move that kind of activity that is providing high-quality care
for individuals in that system in certain areas to make certain
that we are able to extend that across the country in the IHS.
Senator Thune. Okay. Well, we look forward to working with
you on that. I think best practices is a good place to start.
And obviously, those have not been employed in a lot of
facilities in our State.
In 2009, CMS issued a final rule that required all
outpatient therapeutic services to be provided under direct
supervision. Every year since then, the rule has been delayed,
either administratively or legislatively, for critical access
and small and rural hospitals.
And I shared this with you as well. In my State, obviously,
we have a lot of critical access hospitals, a lot of very rural
areas, big geography to cover, and it is sometimes difficult to
get providers out to these areas. So the question is, if
confirmed, will you work to permanently extend the
nonenforcement of this regulation of these hospitals in order
to remove this regulatory burden?
Dr. Price. Yes, I look forward to working with you on it,
Senator. I think there are areas, from a technological
standpoint, where we are missing the boat, especially in our
rural areas and the critical access hospitals. In every other
industry out there, the information technology age has arrived
and is moving across the land with rapid speed and has done so.
However, it seems that in health care we have put
roadblocks up to the expansion of technology, especially into
the rural areas. And we ought to be incentivizing that so that,
again, the patients are able to receive the highest-quality
care.
It is possible now, for example, in our State, if you are
an individual who is suspected of having a stroke, you go to a
critical access hospital in a rural area, it is possible by
telemedicine to be able to access one of the world's foremost
specialists in stroke treatment by telemedicine at the
university health center. So that is improving the lives and
care of patients across our State.
And I think there are so many things that we could do that
would mirror that kind of technological expansion.
Senator Thune. Thank you. There is one final point I will
make, because my time is expiring. But I know you have probably
been questioned already a good amount about what happens next
with respect to replacing Obamacare. I would simply say that I
hope we can work with you in beginning to shift a lot of the--
giving the States, I guess I would say, more flexibility when
it comes to designing plans that work in our States.
I think one of the problems that we have had with this is
there is just too much dictation from Washington, DC and too
much one-size-fits-all. And that is something I think that most
States would probably agree with, and certainly, I think, most
providers would agree with as well.
So we look forward to working with you and designing
programs that get that flexibility to our States and put them
more in charge of some of these issues in a way that removes
that power from Washington, DC, where I think too many of the
problems have been happening.
Thank you, Mr. Chairman.
Dr. Price. Yes, sir. I look forward to it.
The Chairman. Senator Casey?
Senator Casey. Thank you, Mr. Chairman.
Dr. Price, good to be with you again.
Dr. Price. Thank you.
Senator Casey. I want to ask you a couple of questions that
center principally on children and individuals with
disabilities.
First, with regard to children, I think if we are doing the
right thing, not only as a government, but as a society, if we
are really about the business of justice and if we are really
about the business of growing the economy, we should invest a
lot and spend a lot of time making sure that every child has
health care. The good news is, despite a lot of years of not
getting to that point, not moving in the right direction, we
have made a lot of progress.
The Urban Institute in an April 2016 report--I will not ask
the report to be made part of the record, but I will read a
line from this Urban Institute report ``Uninsurance Among
Children, 1997 to 2015,'' dated April 2016. It said as follows
on page 3: the ``decline in children's uninsurance rate
occurred at a relatively steady pace and includes a significant
drop following implementation of the Affordable Care Act's key
coverage provisions from 7.1 percent in 2013 to 4.8 percent in
2015.''
So that is a significant drop, 7.1 percent to 4.8. Millions
of kids have health insurance today who would not have it
absent the Affordable Care Act and including the Medicaid
provisions as well. That 4.8-percent uninsured rate for kids is
an all-time low. That means we are at a 95-percent insured rate
across the country for children.
Kaiser Foundation, a separate authority, tells us that even
with that, even with all that progress made in the last couple
of years and even some progress before that, we still have more
than 4.1 million children uninsured.
Would you agree with me, first of all, that we should get
that number down, the number of uninsured children?
Dr. Price. I think that throughout our population we ought
to identify individuals who are uninsured and strive to make
certain that they gain coverage.
Senator Casey. Right. And you would agree with me with
regard to children especially?
Dr. Price. Everybody in the population. Children are
precious and are our future.
Senator Casey. Great. And just with regard to children, now
that we have that number, we know the number that we have
arrived at, we know the percentage, will you commit, if you are
successful in your confirmation, to maintain or to even reduce
that uninsured number even further--in other words, that you
will be able to commit to us today that the number of uninsured
children will not increase during your time as Secretary, were
you to be confirmed, and the percentage of uninsured would not
increase while you are Secretary?
Dr. Price. Our goal is to decrease the number of uninsured
individuals in the population under age 18 and over 18.
Senator Casey. Well, I hope you maintain that, because I
think that is going to be critically important.
The reason I ask that question is not just to validate that
as a critically important goal for the Nation, but your answer
seems to be contrary or in conflict with what you have
advocated for as a member of the House of Representatives, not
only in your individual capacity, but as chairman of the Budget
Committee.
Looking at now for reference an op-ed by Gene Sperling--you
know who Gene Sperling is. He was head of the Council of
Economic Advisers to two Presidents, both President Clinton and
President Obama--Chair of that National Economic Council, I
should say, is the proper title.
In an op-ed on Christmas Day, the fifth paragraph, here is
what he said in a pertinent part referencing you and your
budget proposals. He said, quote, ``Together,'' meaning the two
areas of policy that you have a long record on, full repeal of
ACA and block-granting of Medicaid, which we now know is Trump
administration policy, ``they would cut Medicaid and the
Children's Health Insurance Program funding by about $2.1
trillion over the next 10 years, a 40-percent cut.''
How can you answer the questions that I just asked you
about making sure that that number of uninsured children does
not get worse under your tenure if that is the case with regard
to your policies, the effect of what your policies would be--
and now apparently, contrary to what was said during the
campaign, it is now the policy of the Trump administration to
block-grant Medicaid?
Dr. Price. Yes. With respect to both you and to Mr.
Sperling, it is because you all are looking at this in a silo.
We do not look at it in a silo. We believe that it is possible
to imagine, in fact put in place, a system that allows for
greater coverage for individuals, in fact coverage that
actually equals care.
Right now, many of those individuals--the ACA actually
increased coverage in this country. It is one of the things
that it actually did. The problem is that a lot of folks have
coverage, but they do not have care. So they have the insurance
card, they go to the doctor, the doctor says, ``This is what we
believe you need,'' and they say, ``I am sorry, I cannot afford
that.''
Senator Casey. A cut of a trillion dollars, a combined cut
of a trillion dollars that would adversely impact the
Children's Health Insurance Program and the Medicaid program,
is totally unacceptable, I think, to most Americans, Democrat,
Republican, or otherwise.
Dr. Price. And you are looking at that in a silo. You are
not looking at what the reform and improvement would be.
Senator Casey. We will see the rebuttal to what not only
Gene Sperling has said, but a whole long line of public policy
advocates and experts. And I think the burden for you, sir, is
to make sure that you fulfill your commitment to make sure that
no children will lose health insurance coverage while you are
Secretary.
Dr. Price. I look forward to working with you.
The Chairman. Okay. Senator Heller?
Senator Heller. Thank you, Mr. Chairman.
And, Dr. Price, thank you for being here today. And thanks
for your patience in working with us throughout this
confirmation process.
Mr. Chairman, as you can imagine, I am committed to
ensuring that all Nevadans have access to high-quality and
affordable health insurance.
I have a letter here that came to my attention January 10th
from the Nevada legislature. The letter comes directly from our
majority leader of the State Senate and our Speaker of the
Assembly. And they are good questions, five questions.
Obviously, they want to get the same answers that all of us
want here.
We have about 88,000 Nevadans who have health insurance
through the health exchange, 77,000 Nevadans who are eligible
for Federal tax credits, 217,000 Nevadans who receive health-
care coverage under Medicaid expansion. Basic questions.
Mr. Chairman, if I may, can I submit this letter for the
record, and also, if I may, ask Dr. Price if he would respond
to this particular letter, to these legislators? Again, I think
they are very good questions.
The Chairman. Without objection.
[The letter appears in the appendix on p. 89.]
Senator Heller. Also, if I may add, if you could CC the
Governor also. I think the Governor also would like answers to
these questions. And I think you are in a great position to
answer these particular questions.
Dr. Price. Thank you, sir.
Senator Heller. Thank you.
If I may, can I get your opinion on the Cadillac tax?
Dr. Price. I think the Cadillac tax is one that has made it
such that individuals who are gaining their coverage through
their employer--there may be a better way to make it so that
individuals gaining their coverage through their employer are
able to gain access to the kind of coverage that they desire.
Senator Heller. The Cadillac tax would affect about 1.3
million Nevadans: school teachers, union members, senior
citizens. And there is some disagreement as to whether or not
these individuals are wealthy or not. There are some on this
committee who believe that the $1.1-trillion tax increase in
Obamacare does not affect the middle class. Do you agree with
that?
Dr. Price. I think it does affect the middle class.
Senator Heller. I do too. Do you believe that school
teachers are wealthy?
Dr. Price. Everybody has their own metric of what wealthy
is, and some people use things to determine wealth that are not
the greenbacks in----
Senator Heller. I would argue that most school teachers do
not think they are wealthy.
Do you think most union members are wealthy?
Dr. Price. I doubt that they think they are wealthy.
Senator Heller. Yes, I would agree with that.
Do you think most senior citizens are wealthy?
Dr. Price. Most senior citizens are on a fixed income.
Senator Heller. They would argue that they are not wealthy.
And that is my argument on this particular tax. In fact,
Obamacare as a whole is just another middle-class tax increase
of $1.1 trillion.
I guess my request and question for you is if I can get
your commitment to work with this committee and work with
myself and the Treasury Secretary to repeal the Cadillac tax.
Dr. Price. Well, we will certainly work to make certain
that those who gain their coverage through their employer have
the access to the highest-quality care and coverage possible in
a way that makes the most sense for individuals from a
financial standpoint as well.
Senator Heller. Does the Cadillac tax make the most sense?
Dr. Price. As I mentioned, I think there are other options
that may work better.
Senator Heller. And do you believe it is an increase, a
health insurance increase, to middle-class America?
Dr. Price. I do.
Senator Heller. Okay. I want to go to Medicaid expansion
for just a minute. Nevada was one of 36 States that chose to
expand eligibility for Medicaid. We went from--I think the
enrollment went from 350,000 to over 600,000.
And I guess the concern, and I think it is part of the
letter that I gave to the chairman, is whether or not that will
have an impact and what we are going to do to see that those
individuals are not impacted. Probably the biggest question
that we have here for you today is, what are we going to do
about those who are part of the Medicaid expansion and how that
is going to impact them?
Dr. Price. Yes. Again, as I mentioned to a question on the
other side, I believe this is a policy question that needs to
be worked out through both the House and the Senate. We look
forward to working with you and others, if I am able to be
confirmed, on making certain that individuals who are currently
covered through Medicaid expansion either retain that coverage
or in some way have coverage through a different vehicle. But
every single individual ought to be able to have access to
coverage.
Senator Heller. Dr. Price, thank you. Thank you for being
here.
Mr. Chairman, thank you.
Dr. Price. Thanks, Senator.
The Chairman. Thank you.
Senator Warner?
Senator Warner. Thank you, Mr. Chairman.
Good to see you again, Dr. Price.
Dr. Price. Thank you.
Senator Warner. Let me start on something we discussed in
my office. One of the issues I have been working on since I
have been Governor, that I have been working on very closely
with your friend, Senator Isakson, is the issue of how we as
Americans address the end of life and sort through those
issues. I think we both shared personal stories on that
subject.
Senator Isakson and I have legislation that we call the
Care Planning Act that does not remove anyone's choices, it
simply allows families to have those discussions with their
health-care provider and religious faith leader if needed or
desired in a way to prepare for that stage of life.
This year, CMS took a step by introducing a payment code
into the fee schedule to provide initial reimbursement for
providers to have these conversations with, as mentioned, a
multidisciplinary case team. It also ran a pilot program that
allowed hospice-type benefits to be given to individuals who
were still receiving some level of curative services, called
the Medicare Care Choices.
I believe it is very important that we do not go backwards
on these issues. And as I think we talked about, we are maybe
the only industrial nation in the world that has not had this
kind of adult conversation about this part of life. Again, it
is not about limiting anyone's choices.
But would you, if you are confirmed, continue to work with
Senator Isakson and me and others on this very important issue?
Dr. Price. I look forward to doing so----
Senator Warner [continuing]. And not be part of any effort
to kind of roll back those efforts that CMS has already taken?
Dr. Price. I think it is important to look at the broad
array of issues here. And one of the issues is liability. And I
cannot remember whether we discussed that in your office. But
the whole issue of liability surrounding these conversations is
real. We need to be talking about it openly and honestly and
working together to try to find a solution to just that.
Senator Warner. I would concur with that, but I also think
this is something that more families need to take advantage of.
On Friday, January 20th, President Trump issued an
executive order that says Federal agencies, especially HHS,
should do everything they can to, quote, ``eliminate any fiscal
burden on any State or any cost, fee, tax penalty, or
regulatory burden on individuals and providers.''
Dr. Price, if you are confirmed in this position, will you
use this executive order in any way to try to cut back on
implementation or follow the individual mandate before there is
a replacement plan in place?
Dr. Price. Well, I think that, if I am confirmed, then I am
humble enough to appreciate and understand that I do not have
all the answers and that the people at the Department have
incredible knowledge and expertise, and that my first action
within the Department itself as it relates to this is to gain
that insight, gain that information, so that whatever decisions
we can make with you and with Governors and others can be the
most informed and intelligence decisions possible.
Senator Warner. I am not sure you answered my question.
What I would not want to see happen as we take--I understand
your concerns with the Cadillac tax. I know there are concerns
you and others have raised about the individual mandate. There
are some who are concerned about the income tax surcharges.
It is just remarkable to me--and this is one of the reasons
why I think so many of us are anxious to see your replacement
plan--that the President has said he wants insurance for
everybody, he wants to keep the prohibitions on preexisting
conditions, he wants to keep young people on their parents'
policies until 26, and it seems like there is at the same time
a rush to eliminate all of the things that pay for the ability
of Americans to have those kind of services.
And I would just want your assurance that you would not use
this executive order prior to a legal replacement to eliminate
the individual mandate, which I believe helps actually shore up
the cost coverage and the shifting of costs that are required
in an insurance system.
Dr. Price. Yes. No, a replacement, a reform, an improvement
of the program, I believe is imperative to be instituted
simultaneously or at a time----
Senator Warner. But you will not use this executive order
as a reason to kind of, in effect, bypass the law prior to a
replacement being in place?
Dr. Price. Our commitment is to carry out the law of the
land.
Senator Warner. I want to, in these last couple of minutes,
go on. I know you have been in the past a strong critic of the
Center for Medicare and Medicaid Innovation, CMMI. I believe in
your testimony last week you saw great promise in it.
To me, if we are going to move towards a system that
emphasizes quality of care rather than simply quantity of care,
we have to have this kind of experimentation. There is one such
program, the Diabetes Prevention Program, that last year CMS
certified saved money on a per-beneficiary basis.
And I know my time is running out, so let me just ask these
questions. I think they can probably be answered ``yes'' or
``no.''
Do you support CMMI delivery system reform demonstrations
that have the potential to reduce spending without harming the
quality of care?
Dr. Price. The second clause is the most important one. I
support making certain that we deliver care in a cost-effective
manner. But we absolutely must not do things that harm the
quality of care being provided to patients.
Senator Warner. But if part of that quality of care--and I
would agree with you--would mean bundled and episodic payment
models that actually move us towards quality over volume, would
you support those efforts?
Dr. Price. For certain patient populations, bundled
payments make a lot of sense.
Senator Warner. And if these experiments are successful,
would you allow the expansion of these across the whole system?
Dr. Price. I think that what we ought to do is allow for
all sorts of innovation, not just in this area. There are
things I am certain that have not been thought up yet, that
would actually improve quality and delivery of health care in
our country, and we ought to be incentivizing that kind of
innovation.
Senator Warner. Well, I would simply say, Mr. Chairman,
that CMMI seems to be one of the areas where I would like to
have seen more, but I think it is a model and a tool we ought
not to discard. Thank you.
The Chairman. Well, thank you, Senator.
Senator Scott?
Senator Scott. Thank you, Mr. Chairman.
Dr. Price, good to see you again.
Dr. Price. Tim.
Senator Scott. South Carolina launched the Nation's first
statewide pay-for-success project with Nurse Family Partnership
with the use of Medicaid funds. Twenty percent of the babies
born in South Carolina are born to first-time, low-income
mothers. We also have a much higher than average infant
mortality rate.
Nurse Family Partnership is evidence-based and has already
shown real results, both in the health of the mother and the
babies, but also in other aspects of the mother's life, such as
high school graduation rates for teen moms and unemployment
rates.
What are your thoughts on incorporating a pay-for-success
model to achieve success metrics?
Dr. Price. Well, it sounds like a great program that
actually has the right metric, and that is the quality of care
and the improvement of lives. And as you state, if it is having
that kind of success, it probably ought to be put out there
again as a best practice for other States to look at and try to
model.
Senator Scott. Yes, sir. Thank you.
I believe you were the director of the orthopaedic clinic
at Grady Memorial Hospital in Atlanta.
Dr. Price. I was.
Senator Scott. You just mentioned something that I think is
very important. I believe Grady Hospital had the highest level
of uninsured Georgians. You talked about having coverage, but
really not access. Can you elaborate on how your experience at
Grady may help inform you and direct you as it relates to the
uninsured population?
Dr. Price. Well, it was an incredible privilege to work at
Grady for the number of years that I did. And we saw patients
from all walks of life and many, many uninsured individuals.
And they come with the same kinds of concerns, the same kinds
of challenges that every other individual has. And they have an
additional concern, and that is, is somebody going to be caring
for me? Is somebody going to be able to help me?
And that is why it was so incredibly fulfilling to be able
to have the privilege of working at Grady and assisting people
at a time when they were not only challenged from a health-care
standpoint, but challenged from a concern about whether or not
people were going to be there to help them.
Senator Scott. Yes, sir. I know that you are aware of title
I of the Every Student Succeeds Act. It allows for the
population of Head Start to have access to resources. It seems
to me that it would be imperative for the Secretary of HHS and
the Secretary of Education to look at ways to synergize your
efforts to help the underprivileged student, the
underprivileged child.
Can I get your commitment that you will look for ways to
work with the Secretary of Education where it makes sense to
help those students? You know, we have Head Start under you and
other programs under ESSA. It would be wonderful for us to take
the taxpayer in one hand, the child in the other hand, and look
for ways to make sure that they both win.
Dr. Price. Yes, you have identified an area that is a pet
peeve of many of us, and that is that we do not seem to
collaborate across jurisdictional lines, not just in Congress,
but certainly on the administrative side. And so I look forward
to doing just that and having as a metric how the kids are
doing.
Senator Scott. Yes.
Dr. Price. Are they actually getting the kind of service
and education that they need? Are they improving? Are we just
being custodians? Are we just parking kids in a spot, or are we
actually assisting and improving their lives? And are we able
to demonstrate that?
And if we are not asking the right questions, if we are not
looking at the right metrics, then we will not get the right
answer that allows us to either expand what is actually working
or to modify it and move it in a better direction.
Senator Scott. Thank you. I think that is one of the more
important parts of your opportunity in this position: looking
at those kids. I know that you know as well as anyone who is a
doctor that those ages, before you ever get into pre-K or
Kindergarten, the development of the child between those first
3 or 4 years is a powerful opportunity for us to direct a
child's potential so that they maximize it.
And sometimes we are missing those opportunities. We think
that somehow the education system will help that child catch
up. But there are things that have to happen before they ever
get in the education system. So I thank you for your
willingness to work in that direction.
And my last question has to do with the employer-sponsored
health-care system that we are so accustomed to in this country
that provides about 175 million Americans with their insurance.
In my home State of South Carolina, of course, we have about
2.5 million people covered by their employer coverage.
If confirmed as HHS Secretary, how would you support
American employers in their effort to provide effective family
health coverage in a consistent and affordable manner? Said
differently, there has been some conversation about looking for
ways to decouple having health insurance through your employer.
Dr. Price. I think the employer system has been absolutely
a remarkable success in allowing individuals to gain coverage
that they otherwise might not gain. I think that preserving the
employer system is imperative.
That being said, I think that there may be ways in which
employers--I have heard from employers who say, if you just
give me an opportunity to provide my employee the kind of
resources so that he or she is able to select the coverage that
they want, then that makes more sense to them. And if that
works from a voluntary standpoint for employers and for
employees, then it may be something to look at.
Senator Scott. That would be more like the HRA approach
where the employer funds an account and the employee chooses
health insurance, not necessarily under the umbrella of the
employer specifically.
Dr. Price. Exactly--and gains the same tax benefit.
Senator Scott. Yes.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
Senator McCaskill?
Senator McCaskill. At the risk, Mr. Chairman, of being way,
way away from you and you being someone I have worked with and
respected greatly, I do want to gently correct something in
your opening statement.
The first nominee of President Trump that this Senate
considered was confirmed by a vote of 98 to one. I would not
consider that a partisan vote.
The second nominee of President Trump was confirmed by a
vote of 88 to 11. Once again, I would not consider that a
partisan vote.
So I really do think we are all trying to look at each
nominee individually. And I have had a chance to review
Congressman Price's questioning of Secretary Sebelius, and I
can assure you, Mr. Chairman, it was no beanbag. It was tough
stuff.
So I think all of this looks different depending on where
we are sitting. And I wanted to make that point.
And as to passing Obamacare without one Republican vote, we
are about to repeal Obamacare without one Democratic vote. This
will be a partisan exercise under reconciliation. It will not
be a bipartisan effort. And what we have after the repeal is
Trumpcare. Whatever is left after the dust settles is
Trumpcare.
Now, I know the President likes to pay close attention to
what he puts his name on. And I have a feeling, Congressman,
that even though you keep saying today that Congress will
decide, you are not really believing, are you, that your new
boss is not going to weigh in on what he wants Congress to
pass? We are not going to have a plan from him?
Dr. Price. Well, I think we look forward to working with
you and other members of the House and Senate.
Senator McCaskill. No, my question is, are we going to have
a plan from the President? Will he have a plan?
Dr. Price. If I have the privilege to be confirmed, I look
forward to working with the President and brining a plan to
you.
Senator McCaskill. Great. So the plan will come from
President Trump and you will have the most important role in
shaping that plan as his Secretary of Health and Human
Services, correct?
Dr. Price. I hope I have input, yes, ma'am.
Senator McCaskill. Yes. Okay. So whatever Trumpcare ends up
being, you will have a role in it. And I think it is really
important to get that on the record.
Now, when we repeal Obamacare, we are going to do a tax
cut. Does anybody in America who makes less than $200,000--are
any of them going to benefit from that tax cut?
Dr. Price. It's a hypothetical, and you all are the ones
who are going to----
Senator McCaskill. No, no, no, no, it's not a hypothetical.
When we repeal Obamacare, there are taxes in Obamacare. And
when it is repealed, there is no question the taxes are going
to be repealed. I promise you the taxes are going to be
repealed. When those taxes are repealed, will anyone in America
who makes less than $200,000 benefit from the repeal of those
taxes?
Dr. Price. I look forward to working with you on that plan,
and hopefully that will be the case.
Senator McCaskill. No, no, no, no, no. I am asking, the
taxes that are in there now, does anybody who makes less than
$200,000 pay those taxes now?
Dr. Price. It depends how you define the taxes. There are
many individuals who are paying much more than they did prior
to that point. The ACA----
Senator McCaskill. No, I am talking about taxes.
Dr. Price. I understand.
Senator McCaskill. Taxes, you know--the Cadillac tax has
not been implemented, so that does not affect anybody. I am
trying to get at the very simple question--and I do not think
you want to answer it--that, in fact, when Obamacare is
repealed, no one in America who makes less than $200,000 is
going to enjoy the benefit of that.
Dr. Price. As I say, I look forward, if I am confirmed, to
working with you to make certain that that is the case.
Senator McCaskill. That is not an answer, but we will go
on.
Okay. We talked in my office. Ending Medicare as we know
it, your plan that you have worked on for years is converting
Medicare to private insurance markets with government
subsidies. Correct?
Dr. Price. Not correct.
Senator McCaskill. Well, we talked yesterday, and we kind
of went through this in my office. And by the end of our
conversation, you admitted to me, and I am going to quote you,
that your plan for Medicare in terms of people getting either
tax credits or subsidies or however you are going to pay for
the Medicare recipients would be them having choices on a
private market. And you said yes, it was pretty similar to
Obamacare with the exception of the mandate. Did you not say
that to me yesterday?
Dr. Price. That's a fairly significant exception.
Senator McCaskill. Well, but these people are old. They do
not need to be mandated to get insurance. It is not like a 27-
year old who does not think he is going to get sick. You do not
need a mandate for people who are elderly; they have to have
health insurance. So the mandate is not as relevant. But did
you not admit to me that Obamacare and the private markets are
very similar to what you are envisioning for Medicare? Did you
not use the phrase ``pretty similar?''
Dr. Price. There are some similarities. I think what I
said, though, was that the mandate was significant.
Senator McCaskill. Well, the mandate I get in Obamacare is
significant. But we do not need a mandate for seniors. Would
you agree with that, that you do not have to tell seniors they
need health insurance?
Dr. Price. What I hope is that we do not need a mandate for
anybody so that they are able to purchase the kind of coverage
that they want, not that the government forces them to buy.
Senator McCaskill. Okay. Finally, you want to block-grant
Medicaid for State flexibility and efficiency. Correct?
Dr. Price. I believe that Medicaid is a system that is now
not responding necessarily to the needs of the recipients, and
consequently, it is incumbent upon all of us as policymakers to
look for a better way to solve that challenge.
Senator McCaskill. Are you in favor of block-granting
Medicaid?
Dr. Price. I am in favor of a system that is more
responsive to patients in the Medicaid system.
Senator McCaskill. Are you in favor of block-granting
Medicaid? It is a really simple question, Congressman. I mean,
you are at your confirmation hearing for the most powerful job
in health care in the country. I do not know why you would not
be willing to answer whether or not you are in favor of block-
granting Medicaid. That is not complicated.
Dr. Price. I am in favor of making certain that Medicaid is
a system that responds to patients, not the government.
Senator McCaskill. Okay. I do not understand why you will
not answer that. And I do not have time. I know I am over. I
will probably--I do not know if we are going to get another
round, Mr. Chairman. Should I ask my last question, or are we
going to get another chance?
The Chairman. I am going to allow additional questions. I
hope that not everybody will take the opportunity. [Laughter.]
Senator McCaskill. Okay. I will disappoint you; I am sorry.
The Chairman. I will not call it a second round, however.
Senator McCaskill. Not many, I just have one more.
The Chairman. Let me just on that point say that Obamacare
raised taxes on millions of American families across income
levels. The nonpartisan Joint Committee on Taxation analysis in
May 2010 identified significant, widespread tax increases on
taxpayers earning under $200,000 contained in the ACA.
And then, for example, for 2017, 13.8 million taxpayers
with incomes below $200,000 will be hit with more than $3.7
billion--with a ``b''--in Obamacare tax hikes from an increase
in the income floor for the medical expense deductions.
Obamacare has led to middle-class tax hikes, without
question. It has led to fewer insurance options, higher
deductibles and higher premiums.
So I think those are facts that cannot be denied.
Senator McCaskill. I will look forward to looking at those
facts, because somewhere in this mix we have alternative facts.
[Laughter.]
Senator Wyden. Well, and just on that----
The Chairman. Well, I think these are right, I can tell you
that.
Senator McCaskill. Well, I think mine are right.
Senator Wyden. Mr. Chairman, just a point of privilege to
respond.
The Chairman. Yes, sir. Yes, sir.
Senator Wyden. On this point, no alternative facts. The
Republicans in last year's reconciliation bill cut taxes for
one group of people. They cut taxes for the most fortunate in
the country. That is a matter of public record. It is not an
alternative fact or universe. People making $200,000 and up got
their taxes cut. That was in the reconciliation bill of the
Republicans last year.
The Chairman. Well, let us see who is next here. I do not
agree with that, but we will see who is next.
Senator Cassidy and then Senator Grassley.
Senator Cassidy. Thank you, Mr. Chairman.
Dr. Price, how are you?
Dr. Price. I am well, Senator.
Senator Cassidy. Let us talk a little about Medicaid,
because we are getting this kind of rosy scenario of Obamacare
and of the Republican attempt to replace it. It does seem a
little bit odd.
First, I want to note for the record that President Trump
has said in various ways that he does not want people to lose
coverage. He actually would like to cover as many people as
under Obamacare. He wishes to take care of those with
preexisting conditions and to do it without mandates and lower
cost. Those will be your marching orders. Fair statement?
Dr. Price. Absolutely.
Senator Cassidy. Now let us go to--you and I, we talked at
a previous meeting. We have both worked in public hospitals for
the uninsured and for the poorly insured, folks on Medicaid.
Now, let us just talk a little bit about Medicaid. Why
would we see patients on Medicaid at a hospital for the
uninsured? If they wanted to see an orthopaedist in private
practice, does Medicaid pay a provider well enough to cover the
cost of seeing an orthopaedic patient?
Dr. Price. Oftentimes it does not. And in fact, as you well
know and as mentioned before, one out of three physicians who
ought to be able to see Medicaid patients in this Nation does
not take any Medicaid patients. And there is a reason for that,
whether it is reimbursement or whether it is the hassle factor
or whether it is regulations or the like.
But that is a system that is not working for those
patients. And we ought to be honest about that and look at that
and answer the question ``why?'' and then address that.
Senator Cassidy. I will note that when the House version of
the ACA passed, Robert Pear in The New York Times wrote an
article about a Michigan physician, an oncologist, who had so
many Medicaid patients from Michigan Medicaid that she was
going bankrupt. And she had to discharge patients from her
practice.
Now, the ranking member said we cannot have alternative
facts. I agree with that. We also know that a New England
Journal of Medicine article spoke about Medicaid expansion in
Oregon, about how when they expanded Medicaid in Oregon
outcomes did not improve. So I suppose that kind of informs
you--as you say, we need to make Medicaid something that works
better for patients.
Dr. Price. Absolutely. And we need to look at the right
metrics. Just gaining coverage for individuals is an admirable
goal, but it ought not be the only goal. And we must have a
goal in health care especially to keep the patient at the
center and realize what kind of care and coverage we are
providing for people on the ground, for real people in real
lives, and whether or not we are affecting them in a positive
way or a negative way.
If we are affecting them in a negative way, then, again, we
need to be honest with ourselves and say, how can we improve
that?
Senator Cassidy. Now, a lot of times there is this kind of
conflation of per-beneficiary payments to the States per
Medicaid enrollee and block grants, which to me is a
conflation.
I will note that Bill Clinton on the left and Phil Gramm
and Rick Santorum on the right proposed per-beneficiary payment
some time ago. And that is actually how, would you agree with
this, how the Federal Employees Health Benefits Program pays
for these Federal employees? They pay a per-beneficiary payment
to an insurer. Fair statement?
Dr. Price. Correct.
Senator Cassidy. Would it not be great if Medicaid worked
as well as the Federal Employees Health Benefits Program in
terms of improved outcomes?
Dr. Price. It would indeed. In fact, when you talk about
the Medicaid population, it is not a monolithic population, as
you well know. There are four different demographic groups
within it: seniors, disabled, and then healthy moms, and kids,
by and large. And we treat each one of those folks exactly the
same under the Medicaid rules.
Senator Cassidy. So when you are pressed on whether, by
golly, you believe in block grants, is there any nuance? I do
not hear any of the nuances that we are discussing offered in
that question.
Dr. Price. Not at all.
Senator Cassidy. But frankly, you cannot address that. Are
you speaking about a per-beneficiary payment? Are you speaking
about each of those four, one of those four? How do you dice
that? New York is an older State, demographically. Utah is a
very young State. Fair statement?
Dr. Price. Absolutely. And those are the things that I
think we tend not to look at, because they are more difficult
to measure. They are more difficult to look at. But when we are
talking about people's lives, when we are talking about
people's health care, then it is imperative that we do the
extra work that needs to be done to determine whether or not,
yes, indeed, the public policy that we are putting forward is
going to help you and not harm you.
Senator Cassidy. Now, let me ask, because there is also
some criticism of your proposal about Health Savings Accounts.
I love them because they activate the patient. I think we are
both familiar with the Healthy Indiana Plan where, on a waiver,
they gave folks of a lower income Health Savings Accounts and
had better outcomes, decreased ER usage. Can you comment on
that?
Dr. Price. Just that when people do engage in their health
care, they tend to demand more, they tend to demand better
services. And individuals who have greater opportunity for
choices of who they see, where they are treated, when they are
treated, and the like have greater opportunity to gain better
health care.
Senator Cassidy. So going back to not wanting to have
alternative facts, if we contrast the experience in Healthy
Indiana with the experience in Oregon where the National Bureau
of Economic Research--I think, if I got that acronym correct--
published in the New England Journal of Medicine that they
found no difference in outcomes in those who are fulfilled
through a Medicaid expansion program in Oregon, contrast that
absence of good effect, if you will, in outcomes with that in
which Indiana attempted to engage patients to become activated
in their own care. ER usage actually fell, but outcomes
improved.
I think in our world of standard facts, I kind of like your
position. Thanks for bringing a nuanced, informed view to the
health-care reform debate, Dr. Price.
Dr. Price. Thank you, sir.
The Chairman. Thanks, Senator.
Senator Grassley?
Senator Grassley. Two statements before I ask a couple of
questions. One is, it is kind of a welcome relief to have
somebody of your profession in this very important role,
particularly knowing the importance of the doctor/patient
relationship. Because in my dealing with CMS and HHS over a
long period of time, I think that the bureaucracy has been
short of a lot of that hands-on information that people ought
to have.
And secondly, when you were in my office, we discussed the
necessity of your responding to congressional inquiries. And
you very definitely said you would. I tongue-in-cheek said
maybe you ought to say ``maybe'' because a lot of times
nominees do not do it. But since you said you would, I will
hold you to that and appreciate anything you can do to help us
do our oversight.
As a result of oversight, I got legislation passed a few
years ago called the Physicians Payment Sunshine Act. And the
only reason I bring this up is because it took Senator Wyden
and me, last December, working hard to stop the House of
Representatives from gutting that legislation in the Cures Act
that passed.
And I want to make very clear that the legislation I am
talking about does not prohibit anything. It only has reporting
requirements because it makes it very, very--well, it brings
about the principle of transparency, brings accountability.
And I have some studies here that we did and some newspaper
reports on them, particularly one about a psychiatrist at Emory
University who was not reporting everything that he should
report, and even the president of Emory University came to my
office and said, ``Thank you for making us aware of this
stuff.''
I want to put those in the record.
[The studies and reports appear in the appendix beginning
on p. 77.]
Senator Grassley. But since you are administering this
legislation and since Senator Blumenthal and I will think about
expanding this legislation to include nurse practitioners and
physician assistants, I hope that I could get your commitment
that you will enforce this act the way it was intended to be
enforced, because even under the Obama administration, after we
got it passed, it was 3 years getting these regulations,
getting it carried out. So effectively, it has only been
working for about 2 or maybe 2\1/2\ years.
So I would like to know, if you are confirmed, would you
and the Department of Health and Human Services work with me to
ensure that this transparency initiative is not weakened?
Dr. Price. We look forward to working with you, sir. I
think transparency in this area and so many others is vital,
again, not just in outcomes or in pricing, but in so many
areas, so that patients are able to understand what is going on
in the health-care system.
Senator Grassley. Thank you. Now, the last question deals
with vaccine safety. You are a physician. I believe you would
agree that immunization is very important for modern medicine
and that we have been able to get rid of small pox way back in
1977, worldwide polio I think in 1991, at least in the Western
Hemisphere, and all that.
So as a physician, would you recommend that families follow
the recommended vaccine schedule that has been established by
experts and is constantly reviewed?
Dr. Price. I think that science and health care have
identified a very important aspect of public health, and that
is the role of vaccinations.
Senator Grassley. Thank you very much.
I yield back my time.
The Chairman. Thank you, Senator.
Senator Stabenow?
Senator Stabenow. Thank you, Mr. Chairman.
First, I would ask unanimous consent that a series of
stories from individuals at a public forum that was held last
week with my colleagues--people concerned about policies that
our nominee has authored and about issues we are talking about
today--be included in the record.
The Chairman. Without objection.
[The information appears in the appendix beginning on p.
253.]
Senator Stabenow. Thank you very much.
Welcome, Congressman Price.
Dr. Price. Senator.
Senator Stabenow. And I appreciate our private discussion
as well as the discussion this morning. I want to start right
out--lots of questions--to see if we can move through some
things quickly.
You have said this morning that you would not abandon
people with preexisting conditions. Is that basically what you
are talking about with high-risk pools? Is that one of the
strategies that you are thinking about? I have heard that
talked about this morning.
Dr. Price. I think high-risk pools can be incredibly
helpful in making certain that individuals who have preexisting
illness are able to be cared for in the highest-quality manner
possible.
I think there are other methods as well. We have talked
about other pooling mechanisms. The destruction of the
individual and small-group market has made it such that folks
cannot find coverage that is affordable for them. And one of
the ways to solve that challenge is to allow folks in the
individual and small-group market to pull together. In fact, I
think we talked about this in your office, with the Blue Shield
model being the template for it----
Senator Stabenow. Yes, right.
Dr. Price [continuing]. Where individuals who are not
economically aligned are able to pool together their resources
solely for the purpose of purchasing coverage.
Senator Stabenow. But let me just stress that, for about 35
years, we have tried high-risk pools. Thirty-five States had
them before the Affordable Care Act. And frankly, they did not
produce great results.
In 2011, .2 percent of the people with preexisting
conditions--.2 percent--were actually in a high-risk pool. And
the premiums were 150- to 200-percent higher than standard
rates for healthy individuals, and they had lifetime and annual
limits on coverage and cost States money. So that was the
reality before we passed the Affordable Care Act.
So let me also ask you, when President Trump said last
weekend that insurance was going to be much better, do you
think that insurance without protections for those preexisting
conditions or without maternity coverage or without mental
health coverage or insurance that would reinstate caps on
cancer treatments is better?
Dr. Price. Well, I do not know that that is what he was
referring to. I think that----
Senator Stabenow. Well, he said that it would be better.
And if we in fact took away, if we went to high-risk pools
instead of covering people with preexisting conditions, or if
we stop the other coverage we have now, I am just wondering if
you define that as better.
Dr. Price. Well, I mean, you would have to give me a
specific instance. What is better for you may not be better for
me or somebody else. And that is the important thing that I am
trying to get across, and that is that patients need to be at
the center of this, not government.
Should government be deciding these things, or should
patients be deciding things?
Senator Stabenow. Prior to the Affordable Care Act, about
70 percent of the private plans that a woman could purchase in
a marketplace did not cover basic maternity care. Do you think
that it is better not to cover basic maternity care?
Dr. Price. And I presume that she would purchase that
coverage if she needed it then.
Senator Stabenow. She would have to pay more, just as in
general for many women. Just being a woman was a preexisting
condition. That is the reason why we have a basic set of
services covered under health care. So it is just a different
way of looking at this.
This is something where, sure, if a woman wanted to pay a
premium, wanted to pay more, she could find maternity care. We
said in the Affordable Care Act, that is pretty basic. And for
over half the population who are women, maternity care ought to
be covered.
Let me go to another one. Do you believe that mental health
services should be a guaranteed benefit in all health insurance
plans?
Dr. Price. I have been a supporter of mental health parity
inclusion, yes.
Senator Stabenow. So mental health should be a defined
benefit under health insurance plans?
Dr. Price. I think that mental health illnesses ought to be
treated with the same model as other physical illnesses.
Senator Stabenow. I agree with you. On Medicare, there has
been a lot of discussion--and I have to say also, with the
nominee for the Office of Management Budget talking today about
Medicare and Social Security, I personally believe people on
Medicare should be very worried right now in terms of what we
are hearing overall.
But I did want--and my time is up--I did want, Congressman,
just to relay a message from my mom who is 90 years old, who
said she does not want more choices, she just wants to be able
to see her doctor and get the medical care that she needs. She
is not at all supportive of the idea of Medicare in some way
being changed into premium support, into a voucher.
So I am conveying to you this is somebody who is getting
great care right now and is not interested in more choices, she
just wants to keep her care.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator.
Dr. Price. Well, if I may, Mr. Chairman, I would just
convey to the Medicare population in this Nation that they do
not have reason to be concerned. We look forward to assisting
them in gaining the care and coverage that they need.
Senator Stabenow. Thank you.
The Chairman. Thank you.
Senator Cantwell?
Senator Cantwell. Thank you, Mr. Chairman.
Congressman Price, sorry we have not had a chance to talk.
Dr. Price. I apologize.
Senator Cantwell. No, I think both of us have tried, and it
is just a myriad of consequences.
Dr. Price. Weather.
Senator Cantwell. But I wanted to ask you broadly, I know a
lot of my colleagues have been asking you about Medicaid, but
what do you think is behind the rise in Medicaid costs? What is
it due to?
Dr. Price. Well, I think it is multifactorial. I think that
we have a system that has many, many controls that are creating
greater costs to the provision of the care that is being
provided.
I think that, oftentimes, we are not identifying the best
practices in the Medicaid system so that patients move through
the system in a way that is much more economical and much more
efficient and effective, not just from a cost standpoint, but
from a patient standpoint. There are so many things that could
be done for, especially the sickest of the sick in the Medicaid
population, where we could put greater resources and greater
individual attention to individual patients.
As you know, in a bell curve of patients in any population,
there are those who are the outliers on the high side, where
the resources spent to be able to provide their care is
significant. And if you focus on those individuals
specifically, then you oftentimes can provide a higher level of
care and a higher quality of care for those folks and a more
responsive care for those folks at a lower cost to move them
down into the mainstream of the bell curve.
Senator Cantwell. Okay. Well, you have brought up a couple
of interesting points, and I want to follow up on them. But
specifically, if I started that conversation, I would start
with two big phenomena: one, people living longer, because the
longer they live, the more Medicaid they are going to consume.
If they are living 10 or 15 years longer than we have had in
the past, they are going to consume more health care. And
second, the baby boomer population is reaching retirement age.
Those two things are ballooning the cost of health care in
general, and specifically for the Medicaid population.
And I want to make sure I understand where you are, because
I feel like the administration is creating a war on Medicaid.
You are saying that you want to cap and control the cost. And
what we have already established in the Affordable Care Act are
best practice incentives and ways to give the Medicaid
population leverage in getting affordable health care. So I
want to understand if you are for these things.
For example, we provided resources in the Affordable Care
Act to rebalance Medicaid patients out of nursing home care
into
community-based care. Why? Because it is more affordable.
So, do you support that rebalancing effort?
Dr. Price. I would respectfully, Senator, take issue with
your description of a war on Medicaid. What we desire and want
to do is to make certain that the Medicaid population is able
to receive the highest-quality care.
I have cared for thousands of Medicaid patients. The last
thing that we want is to decrease the quality of care that they
have access to. And clearly, the system is not working right
now. So moving toward home-based care is something that is, if
it is right for the patient, a wonderful thing to be able to
do, and we ought to incentivize that.
There are so many things we could do in Medicaid that would
provide greater quality of care that we do not incentivize
right now.
Senator Cantwell. We did incentivize it in the Affordable
Care Act, and your State and about 20 other States actually did
it. They took the money from the Affordable Care Act. In fact,
Georgia was approved for $57 million to make sure Medicaid
beneficiaries got care in community-based care, and it has been
able to shift 10 percent of its long-term costs from
institutional care to that community-based care. So it is
working. So are you for repealing that part of the Affordable
Care Act?
Dr. Price. What I am for is making certain, again, that the
Medicaid population has access to the highest-quality care
possible. And we will do everything to improve that, because
right now so many in the Medicaid population do not have access
to the highest-quality care.
Senator Cantwell. I would hope you would look at this model
and you would also look at the Basic Health Plan model. Again,
what I think you are proposing and what the administration is
refusing to refute is, when the President said, ``I am going to
protect these things,'' and my colleague, Senator Sanders,
brought this up and asked, ``Are you going to protect this?''
and then senior White House staff are now saying, ``No, no, no,
we are going to basically cap Medicaid spending,'' it is a
problem.
What we want to do is, we want to give these individuals
leverage in the marketplace. That is what the Basic Health Plan
does. That is what the community-based care plan does. It gives
them the ability to get more affordable care and better
outcomes, and it is saving us money.
So if you could give us a response--I see my time is
expired--look at those two programs and tell me whether you
support those delivery system reforms in the Affordable Care
Act.
Dr. Price. I would be happy to.
Senator Cantwell. Thank you.
The Chairman. Well, thank you, Senator.
That would end our first round. I would like to not go
through a full second round, but we have some additional
Senators here who would like to ask some more questions, so I
guess we will start with Senator Wyden.
Senator Wyden. Thank you, Mr. Chairman.
Congressman, I have several ideas on how to lower the price
of medicine. But I would like to set those aside and start with
the President's idea: lower drug prices through bidding or
negotiation.
If confirmed, you are going to be the captain of the
President's health team, and you are going to have to persuade
Republicans to change the law so that the President can fulfill
his pledge: more affordable prices for medicine through
bidding.
As captain of the health team, will you do that?
Dr. Price. As you know, Senator, we are committed to making
certain that drug prices are affordable for individuals so they
can have access to the high-quality care. Right now, that
negotiation from a Part D standpoint, which I would remind
folks is a real success story--the cost for medications for
seniors is about half of what it was projected to be when Part
D passed--the Pharmacy Benefit Managers are doing that
negotiation right now.
I think it is important to have a conversation about
whether or not----
Senator Wyden. Congressman, I am asking about a specific
idea, and it is not mine, it is the President's.
Dr. Price. I was going----
Senator Wyden. And the question is, will you advocate to
Republicans for authority to negotiate? It is ``yes'' or
``no.''
Dr. Price. What I was going to respond, Senator, if you
will allow me, is to say right now the PBMs are doing that
negotiation. I think it is important to have the conversation
and look at whether or not there is a better way to do that.
And if there is, then I am certainly open to it.
Senator Wyden. On Saturday, hundreds of thousands of women
of all ages and backgrounds came to Washington to speak out in
support of policies that you have opposed. This includes the
Violence Against Women Act, provisions in the Affordable Care
Act to prevent insurance companies from charging them more
because they are women, access to no-cost contraceptive
coverage, and the choice to see the provider they trust.
Now, Speaker Ryan has publicly stated that no one will be
worse off if the Affordable Care Act is repealed. But the
nonpartisan Congressional Budget Office does not share that
view. They have indicated nearly 400,000 women would lose
access to care, including lifesaving cancer screenings, in the
first year if Planned Parenthood is defunded and cut off from
Medicaid.
So again, Congressman, this is not my opinion as Democrat
or Republican, this is the nonpartisan Congressional Budget
Office.
You are going to be the point person for health. Will you
advise the President to reject any proposal that cuts coverage
for or otherwise limits a woman's ability to see the provider
she trusts?
Dr. Price. Well, there were multiple inaccuracies in your
premise, Senator, and I would take significant issue with the
Congressional Budget Office conclusion because, again, as I
mentioned to a question over here, it looks at it in a silo,
looks at it as saying, this is what you are doing without doing
anything else to provide coverage for individuals. And that is
simply--that is not anybody's plan.
Senator Wyden. Well, again, this is what is in the bill you
wrote. And these silos--you know, we keep hearing all kinds of
happy talk about silos and dreams and the like. What we want to
know is one thing above everything else: is there going to be a
replacement before there is repeal?
And you have been asked this now by a whole host of
members. We have not been able to get any answers on it. It
seems to me that your own bill is out of step with what the new
President has said. The new President said the two were going
to be intertwined. Your own bill was repeal and run, repeal it
now, come back some other time.
So I want to let my other colleagues have a chance to ask
their questions. But when you talk about silos, that is the
view of someone--I respect your right to state it--who would
like to be confirmed.
The nonpartisan Congressional Budget Office says women, who
were speaking out in communities across this country, women are
going to lose access to those vital cancer screenings. And that
is not a partisan statement. That is from a nonpartisan agency.
Dr. Price. I respect----
Senator Wyden. I hope you will reconsider your position.
Dr. Price. I respectfully disagree with the conclusion.
The Chairman. Okay, hopefully we can finish in the next 20
minutes.
Senator Cardin?
Senator Cardin. Thank you, Mr. Chairman.
Again, thank you, Dr. Price, for your response to our
questions.
One of the major objectives of the Affordable Care Act was
to deal with the historic discrimination against minority
communities in our health-care system. And we can give you
chapter and verse--the medical research that was done was very
much not directed towards the priorities in the minority
community. The access to providers was always challenging in
minority communities. The affordability and quality of
insurance products were not the same in minority communities.
So there were various provisions included in the Affordable
Care Act to deal with that. One was an amendment that I offered
that elevated the National Institute for Minority Health and
Health Disparities to a full institute, as well as creating
offices for minority health and health disparities within the
health-related agencies.
Are you committed to continuing progress so that we have a
focal point, so that we draw attention to the needs of minority
communities?
Dr. Price. Senator, this is a really important question,
because there are many in our society in the minority community
who, if you look at the right metrics, are not having the same
outcomes or same quality of health that others in society are.
And I believe that it is incumbent upon us as individuals
administering these programs to ask the question why, why is
that, and then reach a plan, a strategic plan, to be able to
help correct that. Whether that is through the current offices
or a different mechanism, you have my commitment to look at
that and make certain----
Senator Cardin. I appreciate that. The National Institute
for Minority Health and Health Disparities funded a program in
Maryland, in Baltimore, to show disparities, and that has been
extremely helpful. And I would just encourage you to look at
that institute as a real, valuable resource to you to carry out
that commitment.
The Affordable Care Act also increased dramatically the
funding for Qualified Health Centers that allow access to care
in minority communities. Are you committed to maintaining the
support for Qualified Health Centers?
Dr. Price. Qualified Health Centers play a vital role in
our Nation's health-care delivery system right now. And so I
think it is imperative that we retain them or improve the
delivery of care in that area.
Senator Cardin. So now I am going to get to the subject
that has been talked about by many members: Medicaid. And the
reason I mention Medicaid--and I appreciate your response that
you do not want to disadvantage anyone who is currently on the
Medicaid system--is blacks, Latinos, American Indians, and
Native Alaskans are almost twice as likely to be in Medicaid
than the white population. In my State, 70 percent of our
Medicaid population are people of color, so it is by far the
dominant population that relies on Medicaid.
So I hope you understand our concern, that when we talk
about changing Medicaid, talk about block-granting Medicaid,
talk about new approaches to Medicaid, it sends a signal that
what we are going to do is cut the Federal Government's
commitment to access for minorities. And it is a major area of
concern.
We have seen budget rounds where cuts to Medicaid dollar-
for-dollar would have reduced access to minority communities
for their health-care needs. We know States have challenged
budgets, and the more you put on the State, the more likely it
is that many States will not be able to meet their full
commitments to the Medicaid population.
Can you just share with me a little bit more your vision.
When you look at the resources we are putting into health
care--everybody wants to do it more efficiently--but if you
just look at the Medicaid population, what you are doing is
taking resources away from minority communities and making the
problem even worse.
How can you give me a comfort level that you are committed
to the minority communities that depend so heavily on the
Medicaid program?
Dr. Price. Well, Senator, let me try to assuage your
concerns. I think, of the individuals at the dais and at this
table, I am the only one who has ever treated a patient in the
Medicaid system, in fact treated thousands of patients in the
Medicaid system.
And when we as a society use as the only major metric for
determining whether or not we are providing care for
individuals in the Medicaid system, the amount of money that we
are putting into the system instead of the outcome, whether or
not people are getting covered, whether they are able to see
the doctor they want to see, whether they are able to get the
kind of care that they want----
Senator Cardin. And I agree with that. I agree with what
you are saying, but I would just make this point----
Dr. Price [continuing]. Then we are measuring the wrong
thing.
So my commitment to you is to make certain that we measure
the right things.
Senator Cardin. I agree with you, but if you look at the
relative resources that are going into the Medicaid population
versus the general population, you will find in many cases it
is less resources. And as we said on quality education, money
is not the only thing, but it is part of the problem.
I just really urge us to recognize, yes, we want a better
outcome, we all want a better outcome in our health-care
system. But you do not do that by taking money away from our
most vulnerable.
Dr. Price. Thank you.
Senator Cardin. Thank you, Mr. Chairman.
The Chairman. Senator Nelson?
Senator Nelson. Thank you, Mr. Chairman.
Congressman, just to follow up our last conversation, you
said that you did not recall having said it is a terrible idea.
I quoted the source, Politico, and that was ``Most Republicans
support''--and I am quoting from the Politico article of 2002,
April the 30th, ``Most Republicans----''
Dr. Price. 2002?
Senator Nelson. 2012.
Dr. Price. 2012.
Senator Nelson. April 30th. ``Most Republicans support the
health law's requirement that insurance companies accept all
applicants. But the replacement plan on preexisting conditions
put forth by the most prominent Republican ignores the idea''--
talking about preexisting conditions.
Dr. Price. Yes, I would disagree.
Senator Nelson. Quote, `` `It is a terrible idea,'
Representative Tom Price, the sponsor of the plan, told
Politico.''
So, Mr. Chairman, I would like to insert that Politico
article into the record for clarification.
The Chairman. Without objection.
[The article appears in the appendix on p. 138.]
Senator Nelson. You and I had the opportunity yesterday to
talk about Puerto Rico. We do not know the origin of this, but
they are not treated like the States where the poorer of the
population that you have, the more Federal assistance for
Medicaid that you get. Instead it is a block grant, and the
block grant is going to run out this year. And they are in a
heck of problem, not only financially on the island, but now
with a third of the population, according to the CDC, being
infected with the Zika virus.
Do you want to comment on what you might do going forward?
Dr. Price. Well, as we talked about in your office
yesterday, Senator, we absolutely need to find the resources to
be able to make certain that they have access to the care that
they need. These are American citizens, and it is incumbent
upon us to take that responsibility seriously.
Senator Nelson. I mentioned earlier, and I did so
yesterday, that senior citizens--we have 4 million in Florida
on Medicare, but there are almost 2 million people in Florida
who now get their health care through the ACA.
And on Medicare Part D, the drugs, what we have tried to do
is close the amount of money that seniors have to pull out of
their own pocket, otherwise known as the doughnut hole.
Do you want to comment, Congressman, about whether or not
seniors should have retained that Federal ability to purchase
their drugs?
Dr. Price. Well, in view of the fact that two of those
senior citizens in your State are my mother-in-law and my
father-in-law, I need to tread very carefully here.
One of the concerns that I have about drugs being available
for seniors is the accessibility of the drugs that they need
and desire. So we need to make certain that formularies are not
limited, that we are not decreasing the access and availability
of medications that seniors have available to them for the care
that they receive.
Senator Nelson. And so, the part of the ACA that closed
that doughnut hole for senior citizens, you would support that
part?
Dr. Price. As I say, I think it is imperative that we
provide the greatest amount of opportunity for individual
seniors to be able to gain access to the drugs that they need.
So oftentimes in these discussions, we think that whatever
we are doing right now is the only solution that is possible.
And I just, again, I am humble enough to believe that there are
better ideas out there. And if we find a better idea that
actually provides greater coverage at a lower cost more
efficiently and is more responsive to patients, then we ought
to be able to admit to ourselves that we would embrace that if
it were to come along.
Senator Nelson. Congressman, as their Senator and as their
protector of senior citizens in Florida, I cannot get away with
an answer like that. I have to tell them that I am going to
support their right to get drugs under Medicare Part D just
like they are getting them now and not take that away from
them.
Dr. Price. And I understand that. And I would respectfully
suggest that if we used, as a society, the line, we are going
to maintain the kind of quality coverage that we have right now
unless we are able to improve it, then we might just be able to
do that for you.
Senator Nelson. And if I gave them that answer, I would get
run out of the room by a group of senior citizens.
Thank you, Mr. Chairman.
The Chairman. Senator Menendez?
Senator Menendez. Thank you, Mr. Chairman.
Congressman Price, one of the main policy priorities that
you share with Speaker Ryan is to radically reform or alter, I
should say, Medicare from its current structure to one where
seniors would, in essence, receive a coupon to buy coverage.
Now, despite the fact that President Trump has made repeated
promises throughout the campaign that he will not touch
Medicare, it seems that it is still one of your top agenda
items.
I have heard serious concerns about privatizing Medicare,
not only from seniors worried about increased costs and
decreased coverage, but also from providers in my State
concerned about the serious negative impacts such underfunding
will have on their ability to continue caring for Medicare
seniors.
So if the stated goal of Medicare privatization is to
reduce Federal expenditures on health care for seniors, then
does it not stand to reason that every dollar the Federal
Government saves is going to have to come out of the pocket of
seniors on Medicare?
Dr. Price. Well, I disagree with the characterization of
the program as you described it. I think it is inaccurate.
Senator Menendez. Okay. So let us go through the specifics.
Do you not seek to privatize Medicare?
Dr. Price. No.
Senator Menendez. Do you not seek to ultimately offer a
voucher as your way of creating greater affordability?
Dr. Price. No.
Senator Menendez. Well, it is interesting you say that,
because studies that have been done on your and Speaker Ryan's
Medicare privatization plans have shown that an average 65-year
old will pay more than twice what they pay now since the
vouchers that you would give out are, by design, far short of
what the current Medicare program covers.
Dr. Price. Well, Senator, with respect, I have no reason to
believe that the President, in his statement that he is not
interested in modifying Medicare, that that position of the
President has changed.
If you want to talk about what my role as a legislator was
in fashioning legislation and trying to solve the challenges
that we have in Medicare, I am happy to do that. But that is
not the role that I would play if I am given the privilege of
being confirmed to serve as the Secretary of Health and Human
Services; that would be to administer the changes that you all
come up with in the Congress of the United States and the
programs that are----
Senator Menendez. Well, let me respond to that, because I
know I have heard you at various times, both here and before
the HELP Committee, say that you are going to have more of an
administrative role, not a legislative role. And I said to you
privately, I think that that is a little disingenuous.
I noticed last week, the day of the hearing before the HELP
Committee, Vice President Pence was on TV, and he said, quote,
``I could not be more enthusiastic that someone with his
background,'' referring to yourself, ``in medicine, but also
his understanding of the President-elect's vision for health-
care reform and his ability to help us shape what that replace
bill looks like once we repeal Obamacare. . . .''
Clearly, they think, the President and the Vice President,
that you are going to be playing a policy development role, not
just simply the administration of whatever the Congress
decides.
So in your advocacy with the President as he deals with his
desire to replace Obamacare, the reality is, you are going to
have more than an administrative role; you are going to have a
policy role. And if past is prologue, then your views as a
legislator as to what you think is best for the American people
is of concern to me because that, in essence, is a plan towards
privatizing Medicare.
So if that is not the case, would you commit to ensuring
that, under your watch, Medicare will not increase costs or
limit the coverage to current or future beneficiaries as a
result of a change in the plan?
Dr. Price. Senator, a couple of things. One, the comments
that you referenced, I think, were related to the ACA, not to
Medicare.
Second, as I mentioned to you yesterday in our conversation
in your office and as I have said before here, I am humble
enough to understand and appreciate that the work that I did as
a legislator is not necessarily the work that I would promote
as Secretary of Health and Human Services.
The work that has been done within the Department--the
experts within the Department have significant knowledge and
expertise in the work that they have done----
Senator Menendez. Well, I appreciate that. But the essence
of my question, then, if you dispute that your past views are
going to be your future views, that your past views and
legislative activity are not going to be your advocacy with the
presidency, then I would ask you to go to the core of my
question. Are you willing to commit that we will not see
increased costs or less coverage for seniors under a revision
of Medicare as you might advocate or the President might
pursue?
Dr. Price. What I can commit to you and will commit to you
and have committed to you, sir, and others on this committee
and in other conversations, is that our goal is to make certain
that seniors have access to the highest-quality health care
possible at an affordable price.
Senator Menendez. Well, access without the ability to
afford it--and I will end on this.
Dr. Price. That is what I said: affordable price.
Senator Menendez. Well, affordability, still a question, is
not just an affordable price; it is your ability to have the
wherewithal even to access an affordable price.
Medicare guarantees as a right, it guarantees care for
seniors, like my late mother who worked in the factories of New
Jersey as a seamstress, was not in a unionized factory, did not
have private insurance. After working a lifetime of hard work
to help her family achieve what they did, she faced an enormous
struggle with Alzheimer's that ultimately took her life. For
her, her health-care security was Medicare. And without it, she
would not have lived with the dignity that she deserved in the
twilight of her life.
So changing Medicare from a commitment and an entitlement
to vouchers that might hope to create affordability but do not
guarantee it, that is a fundamental shift in the nature of how
we take care of seniors in this country. And that is why I am
so passionate about it.
I said this to you privately, and I just wanted to explore
it with you publicly, but your answer does not assuage me that,
in fact, you are committed to Medicare as we know it today in
terms of the guarantee. Can we improve? I am always open to
improving it, but the guarantee is what I am concerned about.
Dr. Price. I share those concerns as well, but I disagree
with your characterization and can also share with you a story
of my mom, who, in the twilight of her years, had an illness
that took her from us. And she enjoyed the benefits of Medicare
and, without that, would not have been able to have the care
that she received.
Senator Menendez. Well, I hope that will be compelling to
you in the days ahead, that it will instruct you as to how we
should pursue Medicare.
Thank you, Mr. Chairman.
The Chairman. Senator Brown?
Senator Brown. Thank you, Mr. Chairman.
I began with the comments of Congressman Price about not
using the word ``socialized medicine,'' the term. In 2007 in
the Congressional Record, debating CHIP, he talked about being
eligible for government-run socialized medicine, referring to
CHIP. But I do not want to debate that, I just want to point
that out. You may have forgotten--it has been 10 years--I
certainly understand that.
I want to follow up on what Senator Menendez said about
Medicare, with a slightly different twist. In December, you
said you expected lawmakers to push forward an overhaul of
Medicare, and I quote, ``in the first 6 to 8 months of the
Trump presidency.''
Today, Congressman Mulvaney, the Budget Director designee,
said that he would support raising the eligibility age for
Social Security. He seemed to be open to raising the
eligibility age for Medicare too, in his comments. And like
you, he supported efforts to raise it in legislation, in
Speaker Ryan's so-called A Better Way plan.
That is in exact contradiction, I understand, of what
President Trump has said; he said he opposes both cuts and
raising the eligibility age.
I would like you to--I asked you to clarify your position
in a letter. I have not received a response yet. I know you are
busy. But my question is this: if Congress passes legislation
to raise the eligibility age for Medicare, as laid out in
Speaker Ryan's A Better Way plan, will you advise President
Trump to veto that legislation?
Dr. Price. I do not anticipate a single piece of
legislation related to just that. So we would have to look at
the constellation, if I am confirmed.
Senator Brown. So if something else is part of it, you
would consider supporting raising the eligibility age? If you
are not willing to say, no matter what else is in it--you stand
firm on that?
Dr. Price. If I am confirmed, it would be my responsibility
to talk with the President about the various aspects of any
piece of legislation, lay out the pros and cons and the
consequences of the decisions that would be made by the
Congress of the United States and make a recommendation.
Senator Brown. When I think about a barber in Warren, OH or
a factory worker in Logan, OH or a woman who works in a diner
in Mansfield, OH or someone working construction in Troy, OH
and saying to them, you know, I know that you think Medicare's
eligibility age is 65, you have worked all your life, you do
not have these jobs where we can work to older ages--you and I
are close to the same age; unfortunately I am a bit older--but
I just cannot imagine the morality of telling these people who
have worked all their lives and their bodies have broken down
more than ours do in these jobs, that we would even consider
the possibility, as you all did in Congressman Ryan's bill, you
did, Budget Director Mulvaney did, raising the eligibility age
for Medicare. It is just stunning to me.
Let me talk about something----
Dr. Price. Senator, if I may, I struggle with the morality
of a system that looks at Medicare, which is broken and is----
Senator Brown. Yes, I know. I know what you are going to
say. You have said that already. I appreciate that. I do not
agree with that. I do not agree that Medicare is broken the way
you say.
Let me talk about something else. You said good things
about innovation. I want to bring up one really quick issue and
ask you to continue to work with us on it.
Last summer, Secretary Burwell visited my hometown of
Mansfield, OH to witness firsthand the effective and cost-
efficient role of community health workers in reducing infant
mortality rates. I will talk to you more privately--and thank
you for trying to get together in the last few days--about
working to ensure that community health workers are recognized
and included in new payment and delivery system reforms. They
have been very effective at bringing down the low birth weight
baby rate and cutting back the rate of infant mortality.
My State is, unfortunately, maybe last in black infant
mortality and pretty bad overall in infant mortality. I just
want a commitment from you to at least sit and work with us on
what Secretary Burwell and I began for dealing with community
health workers.
Dr. Price. Absolutely.
Senator Brown. Okay, thank you.
Last question--and thank you for your indulgence, Mr.
Chairman, on this second round.
Do you support guaranteed health care for our Nation's
veterans?
Dr. Price. I think the commitment that has been made by
this Nation is that veterans should receive health care, yes.
Senator Brown. But we do not. I mean, not all veterans
qualify for care through the VA. On Tricare they do and there
are a lot of them in your State as in my State. But because of
these gaps, additional coverage options, like those provided
through the ACA, are critical to ensure that they are covered.
So what is the answer? The VA does not do it alone; the ACA
complements the VA. So if we repeal the ACA, how do you
guarantee health care for my State's thousands, your State's
thousands of veterans who served their country, but do not have
real health care?
Dr. Price. Right. Well, currently, as you know, Senator,
there are real challenges in the VA system. Again, I think I am
the only individual on the dais here who has ever taken care of
a patient in a VA hospital. And I know the challenges. And I
know----
Senator Brown. Well, but you want to repeal--thank you--but
you want to repeal the Affordable Care Act, and we have used
the Affordable Care Act in such a way that these veterans now
have guaranteed health care. Almost all veterans have
guaranteed health care, yet you are going to repeal the
Affordable Care Act with no plans that anybody has seen yet to
make sure these veterans have guaranteed health care.
Dr. Price. I understand and appreciate the promise that has
been made to veterans. And sadly, in many instances, we are not
keeping that promise right now.
Senator Brown. So is that part of your----
Dr. Price. And I look forward to working with you to put
together a better system that will----
Senator Brown. Well, I appreciate that. I appreciate that,
Congressman.
Dr. Price [continuing]. Allow us to care for veterans in
the way that we should.
Senator Brown. Now, you had said when I asked you about
President Trump saying he has been working with you on this
repeal and replace plan, you said he has not really been
working with you. So, I mean, you did not call the President a
liar, but, you know, putting two and two together is pretty
easy; it adds up to four.
What does that mean? If you and he are working together,
are you going to suggest to him that we find a way in repeal
and replace to make sure there is guaranteed health care for
our Nation's veterans?
Dr. Price. Well, I think it is vital, again, as I have
mentioned before, that every single American have access to
affordable coverage that is of high quality. And that is our
goal, and that is our commitment.
Senator Brown. And so when we replace the Affordable Care
Act after your party repeals it in this Congress, you will find
a way for all 22 million Americans, including a lot of those
who are veterans, to have health insurance, so they do not lose
it with the replace part of repeal and replace?
Dr. Price. I look forward to working with you to make that
happen, sir.
Senator Brown. That is not quite a ``yes,'' Congressman.
Dr. Price. That is my answer.
Senator Brown. Okay. Inadequate, but thank you.
The Chairman. Okay. Thank you.
Senator Casey?
Senator Casey. Thank you, Mr. Chairman. Thanks for the
additional round of questioning.
Representative Price, I want to move to the topic I hoped I
would have gotten to in the first round, which is individuals
with disabilities, many of whom, I do not have the exact
number, but many of whom rely upon Medicaid.
One of them is actually a young child whom I just got a
letter from his mother about--Pam Simpson, who is from
Coatesville, PA, which is in southeastern Pennsylvania--talking
about her son, Rowan Simpson, who was diagnosed in 2015 with
autism. And among the things she said about the great care they
get, that he gets in their family benefits from Medicaid, she
says, without Medicaid, quote, ``we would be bankrupt or my son
would go without the therapies he sincerely needs.''
Can you guarantee today that his family is going to benefit
from and he, Rowan Simpson, will have that kind of coverage and
protection that Medicaid provides, that he will have that if
you are Secretary of Health and Human Services?
Dr. Price. We are absolutely committed to making certain
that that child and every other child and every other
individual in this Nation has access to the highest-quality
care possible.
Senator Casey. Okay, not access, he will have the medical
care that he has right now, or better. If you can come up with
a better level of care, that is fine. But he will have at least
the coverage of Medicaid and all that that entails that he has
right now? And that is either ``yes'' or ``no,'' that is not--
--
Dr. Price. No, it is not a ``yes'' or ``no,'' because the
fact of the matter is that, in order for the current law to
change, you all have to change it. If I am given the privilege
of leading at the Department of Health and Human Services----
Senator Casey. Yes. Here is why it is ``yes''----
Dr. Price [continuing]. And I am responsible for----
Senator Casey. Look, you should stop talking around this.
You have led the fight in the House, backed up by Speaker Ryan,
for years----
Dr. Price. To improve Medicaid.
Senator Casey [continuing]. To block-grant Medicaid, okay?
Dr. Price. To improve Medicaid.
Senator Casey. To block-grant Medicaid. What that means is,
States will have to decide whether or not this child gets the
Medicaid that he deserves. That is what happens. So you push it
back to the States and hope it works out.
One estimate by the Center on Budget and Policy Priorities,
long before you were named, said that--here is the headline of
a chart: ``House budget chair's plan would slash Medicaid by
one-third by 2026.'' This was not developed because you are now
in front of this committee. That is what they were saying, that
Medicaid would be cut by a third and by a trillion dollars.
So let me ask you this question.
Dr. Price. May I respond?
Senator Casey. Let me just get this question in. Can you
commit to us right now that no person with a disability who is
currently covered by Medicaid, so that is everyone--that is
Rowan and that is everyone else--that no person with a
disability who is currently covered by Medicaid will lose
health-care coverage, not access but coverage, under the block-
granting plan that the administration now embraces as of
Sunday?
Dr. Price. What I can commit to you is that in our Medicaid
system, if I am given the privilege of service, working with
CMS administrators, the metrics that we will use for Rowan and
every single other patient are the quality of care that they
are receiving----
Senator Casey. That is fine----
Dr. Price [continuing]. And whether or not they are
receiving that care. The metric that you want to use----
Senator Casey. Metrics are fine. What I am asking you again
is, will you commit to ensure that Rowan and every other person
in the country who has a disability, who benefits from Medicaid
today, will they have that same coverage and the same health
care and coverage they have today?
Dr. Price. Our commitment is to make it so that they have
that coverage or greater.
Senator Casey. That is a commitment you are making.
Dr. Price. That is a commitment.
Senator Casey. For every person with a disability who
benefits from Medicaid.
Dr. Price. As I said, the goal is and our desire is to make
sure that people have better health care, not less health care.
And it is astounding to me----
Senator Casey. Well, here is the problem with that. Here is
the problem with your answer. Until Sunday, there was a
question as to whether or not President Trump or his
administration would fully embrace block-granting of Medicaid,
because he said when he was campaigning that he would not cut
Medicare and Medicaid and Social Security. As of Sunday, the
administration has said on the record, in at least one and
maybe two interviews, that they are going to pursue a block-
granting policy with regard to Medicaid.
What flows from that are the following: he has a majority
in both houses, so what you have been working on in the House
for years that you could vote for now may become the law of the
land. So this is a live issue; this is not theory or some
policy among House Republicans. This is a potential enactment
of law to block-grant Medicaid.
And I hope you can keep your promise to make sure that no
one with a disability suffers any diminution of care or
coverage. That is the promise you just made, and I hope you can
keep that in light of a trillion-dollar cut in Medicaid
pursuant to block-granting.
The Chairman. Senator McCaskill, you are the last one.
Senator McCaskill. Thank you. And thank you for your
patience in letting us have another round of questions, Mr.
Chairman. We sincerely appreciate it.
I would like to put in the record a table prepared by the
Tax Policy Center on December 15, 2016 that lays out what
happens with a repeal of all ACA taxes, including premium
credits based on income level, if I could make that part of the
record.
The Chairman. Without objection, it will be placed in the
record.
[The table appears in the appendix on p. 91.]
Senator McCaskill. You were chairman of the Budget
Committee. I am going to try not to be--I get frustrated when
people will not answer, especially when your record is so clear
on this, Congressman. I do not really understand why you want
to divorce yourself from your record.
You were chairman of the Budget Committee, correct?
Dr. Price. Yes.
Senator McCaskill. And in that role, you had the most
important--we all know the power of the chairman around here.
You had incredible power to influence what was in that
document, correct?
Dr. Price. Which document do you refer to?
Senator McCaskill. The budget that you prepared for 2017.
Dr. Price. Absolutely, along with my colleagues.
Senator McCaskill. Along with your colleagues. Was there
anything in that document that you disagreed with on principle
when you supported it?
Dr. Price. Oh, absolutely.
Senator McCaskill. Okay. What was in the document you
disagreed with on principle when you supported it?
Dr. Price. I would have to go back and look.
Senator McCaskill. All right.
Dr. Price. But it was a combined effort. But again, you
know, as I mentioned before, if I am given the privilege of
serving as Secretary of Health and Human Services, I appreciate
and understand that that is a completely different role than as
a legislator.
Senator McCaskill. I know it is a completely different
role. That is not what I am asking you, Congressman. I am not
asking you about the difference.
Dr. Price. Each of your questions refers to that role.
Senator McCaskill. I am not asking you about the difference
in your roles. What I am asking you is, what do you believe in?
What do you believe in? You have been respected around these
halls for a man of integrity because you believed in certain
principles. And one of those was the principle that you
embraced as chairman of the Budget Committee to block-grant
Medicaid.
Dr. Price. No, on the contrary. What I believe in is this
great country and the people of this great country and the
principles of health care that I defined earlier. And those are
the principles that we all share, I believe, and they are that
we need a system that is affordable for everybody, we need a
system that is accessible for everybody.
Senator McCaskill. I get that.
Dr. Price. We need a system that is of the highest
quality----
Senator McCaskill. You have said that over and over again--
--
Dr. Price [continuing]. That is responsive to patients, not
to insurance companies and government.
Senator McCaskill. I am just trying to figure out----
Dr. Price. We need a system that incentivizes innovation,
and a system that provides choices to patients. That is what I
believe.
Senator McCaskill. I understand. I understand the
aspirational goal you have. But there is a record, Congressman.
That is on record. And the record is that as chairman of the
Budget Committee, controlled by your party, you put out a
budget document, and you said over and over again that you
favored block-granting Medicaid.
In fact, your budget in 2017 when you were the chairman,
you want to run away from that today as if it never happened,
and I cannot figure out why. You are going to be influential.
What you really believe matters. And you want to run away from
that.
You cut Medicaid by a trillion dollars in your 2017 budget.
And yet today, you want to stand on some notion that, well,
whatever you guys do is fine. And that is just not reality,
Congressman.
What is reality is, you have been chosen because of your
beliefs, and your beliefs are reflected in your budget that you
wrote as chairman of the Budget Committee. And that is the
point I am trying to make.
Dr. Price. Can I respond?
Senator McCaskill. And I have a hard time understanding why
you will not say, listen, it may not turn out the way I
believe, but yes, I favored block grants to Medicaid.
Dr. Price. What I believe in is a Medicaid system that is
responsive to the patients and provides the highest-quality
care possible.
And I would respectfully suggest to you that that is not
the Medicaid system that we currently have. So it is incumbent
upon you, it is incumbent upon me, if I am given the privilege
of serving in this capacity, to work together to find the
solution so that we provide the highest-quality care for
Medicaid patients and everybody else in this country.
Senator McCaskill. And I understand. And by the way, the
argument being made in favor of block grants is, they give more
flexibility and efficiency to the States. That is the argument
you have made before, that is the argument that was made around
the budget that you crafted, that when you block-grant things
to States, it gives them more efficiency.
So I want to turn to a block grant that we have now, which
is the Social Services Block Grant, which you have voted
repeatedly to repeal. You have said that you wanted to zero it
out. And you have voted that way as a member of Congress. And I
want to make sure that you understand that that efficiency and
effectiveness that you say you get with a block grant of
Medicaid is what is happening in my State with the Social
Services Block Grants, which, by the way, came about with
Ronald Reagan.
They are deciding where to use that money. And right now,
just so you know where it is being used--in case you want to
advise the President, the same way you voted--it is being used
for residential treatment for detoxing off heroin, it is being
used for daycare for seniors to keep them in their home so we
are not paying the bill on Medicaid in a nursing home, it is
being used for adoption services, and it is being used for case
management to save money so that the cases are being managed
effectively and efficiently in terms of accessing Federal
safety net programs.
Will you continue to advocate, as you have in Congress, for
a repeal of the Social Services Block Grants?
Dr. Price. Senator, with respect, I think there is likely a
better way to provide those services in a much more efficient,
effective, and economical way for the individuals receiving the
care. And I would also respectfully suggest to you that another
State flexibility model that is held up by many is the TANF
program that has been extremely successful, and so there are
different ways to do things.
And again, it ought to be a collegial conversation that we
have to lay out what the challenges are before us, working
together to solve those challenges. And that is what I would
like to do.
Senator McCaskill. I just was trying to point out the
inconsistency of saying block grants to Medicaid are good
because of flexibility and efficiency and block grants to
States on social services are bad. And that has been your
record in Congress, Congressman, and that is why I brought it
up.
Dr. Price. And with respect, for individuals to say that
State flexibility for Medicaid is bad, but State flexibility
for TANF is fine, again, is a little bit inconsistent as well.
Senator McCaskill. I understand.
Thank you, Mr. Chairman.
The Chairman. Well, thank you.
Now, we are going to close this, Senator Wyden and myself,
so we will just ask Senator Wyden to make his closing remarks,
and then I will make mine.
Senator Wyden. Thank you very much, Mr. Chairman.
As we wrap up another quiet, subdued hearing in the Finance
Committee [laughter], I just have a couple of thoughts. And the
first is for you, Congressman. Despite our policy differences,
I want you to know I very much respect your willingness to
serve. As you know--we have talked about it--you and I have a
lot of mutual friends, and I know they are very supportive of
your career. And I want you to know I respect your willingness
to serve.
Here is where we are in terms of the substance. Several
hours ago, I asked you, with respect to the executive order on
the Affordable Care Act, will you commit that no one will be
worse off? And you ducked it. I asked you, will you guarantee
that no one will lose coverage? You ducked that. I asked you,
would there be a replacement before all of this went into
effect to avoid hurting working families? And that was ducked
as well.
And it just seems to me there is a big gap between the
answers you have given on the executive order with respect to
repealing the Affordable Care Act and what the new President
said all through the campaign. Everybody was going to be okay,
nobody would be worse off, there would be no gap between repeal
and replace.
My colleagues have gone through in great length the debate
about the Medicaid block grant. Prediction? I think some of
your biggest critics are going to be Republican Governors on
this, because I think Republican Governors--and they will be
probably more diplomatic than I--are going to see this as a
Trojan horse to cut spending. And that is why a lot of us are
concerned about shredding the safety net.
I asked you about women's health care, and here the concern
is that women all across the country are going to lose the
choice of providers that they want and they have today and
coverage. And you just said, ``Hey, I disagree with the
Congressional Budget Office.''
I asked about drugs and how we are going to lower these
pharmaceutical prices, and you told me about pharmaceutical
benefit managers. You told me about Part D--I voted for Part D,
one of the relatively few Democrats who did--but you did not
answer the question about whether you would get Republicans to
help you fulfill the President's pledge on bargaining. So that
is what concerns me about all of this.
On the ethics questions, we want to correct one key point
that was said earlier in the hearing, that the Congressman does
not have control over his brokered accounts. First, the
Congressman has not provided copies of the agreements that
would clarify his level of control.
Second, last week the Congressman told Senator Murray
regarding the purchase of Innate, quote, ``I did it through a
broker, I directed the broker to purchase the stock, but I did
it through a broker.''
And third on this point, these are not blind trusts. I just
want the record to reflect that.
I am also going to put an article in the record, Mr.
Chairman, that ran this morning about investments in other
health-care stocks, specifically in four companies that
manufacture products in Puerto Rico.
The Chairman. Without objection.
[The article appears in the appendix on p. 286.]
Senator Wyden. And so, Mr. Chairman, I will wrap up with
just one last point. Ever since I was director of the Gray
Panthers, the Oregon Gray Panthers--I did it for almost 7
years--I was interested in one thing: changing a system that
was largely for the healthy and the wealthy.
And as you and I have talked about, I had eight Democrats
and eight Republicans on a bipartisan bill that would do that.
I did not get my way. But the Affordable Care Act had many,
many good features, and one of them was, it made clear all
across this country we were not going to go back to the days
when health care was for the healthy and wealthy.
And I am especially troubled as we wrap up this morning--we
have been at it close to 4 hours--that when you take all of
these policies together that you have described this morning,
that is really where we are headed, that is where we are going
to be. And that is why I am so strongly opposed to these
positions.
My hope is--we still have some additional questions to look
at with the ethics issues. I can just tell the Congressman that
George W. Bush's ethics lawyer was in the paper this morning
talking about your stock trades, and he said ``I have not seen
anything like this before, and I have been practicing and
teaching about securities law for 30 years.''
So I think there are very troubling questions that remain,
Mr. Chairman, with respect to this. I know that we are being
told that members have to get any written questions in by this
evening. But with respect to what we have heard this morning
and the lodestar that I see, that America will end up with
health care that works for the healthy and wealthy, I am going
to oppose it. I am very troubled by what we have heard today.
And I appreciate the chance to make these closing remarks.
The Chairman. Well, thank you, Senator.
If we keep going the way we are going, there will not be
any health care for anybody. We will not be able to afford it;
we will not be able to provide for it. There are so many things
that are wrong with the current system, but it is just
pathetic, and it is gradually eating up the whole doggone
Federal budget.
Now, I have been around here only 40 years, but I will tell
you I have never had a witness for any position in government
who has performed as well as you have, who has an impeccable
reputation in medicine and in the Congress. And to be treated
like, if you do not agree with some concepts that some of my
colleagues do, there is something wrong with you, is just
beyond the pale.
Like I say, you not only have a great deal of experience in
medicine, but you have been a great Congressman, and you have
been trying to get things under control around here. And you
have found that it is almost impossible, because we have all
these people saying we have to do everything in the world, and
they do not care what the costs are. And that is why this
country is broke.
We have to find some way of delivering all these health-
care benefits to people without totally ruining the country so
nobody gets any health-care benefits, which is where we are
headed. I do not know how in the world we can continue to buy
into this liberal claptrap that you do not have to pay the
piper.
Now, what you have said is, we are going to try, within
this current system, to make it work and to cover everybody and
to help people, whether they be poor or whether they be rich.
Now, I do not know if you can say much more than that. But
I get a kick out of how many of these people are constantly
blathering about, we have to do everything for everybody when
we know we are $20 trillion in debt. And this money does not
grow on trees, and yet every one of us wants to make sure
health care works, every one of us wants to make sure every
deserving person in our society is cared for.
And I say that as a person who, over the last 40 years,
almost every health-care bill that works has my name on it,
starting with the Orphan Drug Act. How about Hatch-Waxman that
created the modern generic drug industry? Name it all.
The fact of the matter is that you have been very
forthright, very honest, and you have indicated that, in spite
of all the problems of trying to fund health care and all the
problems around health care, you are going to do your doggone
level best to make sure health care is delivered to our
American people.
You know, I wonder how many of my colleagues on the other
side are going to vote for you. And if they do not, it kind of
says something about what is happening in this country.
Now, I want to thank you for being here today. You know, I
do not think you ducked any questions. You answered them
forthrightly. It might not have pleased the individual
Senators, but you did. And I look forward to Dr. Price being
confirmed and assuming his position so he can begin working
with us here in Congress to improve the Nation's health and the
whole health-care system and to ensure that taxpayer dollars
are used efficiently and effectively.
Now, we owe that to the dedicated taxpayers and citizens of
this great country. And to that end, several groups and
individuals have submitted letters of support for Dr. Price.
And I would like to ask that those be entered into the record
at this point, without objection.
[The letters appear in the appendix beginning on p. 82.]
The Chairman. In closing, this committee takes its
responsibilities very seriously. As you can see, this is a very
intelligent committee. We have a lot of really great people on
both sides on this committee, and they are serious about what
goes on. But that is why we have such a thorough review process
for nominees. This is why the committee is following and will
continue to follow our longstanding process in the future.
Now, I would ask that any written questions for the record
be submitted by 8 p.m. tonight, which is 2 hours more than what
the Democrats gave us. This is a timeline that is consistent
with the committee's consideration of previous nominees for HHS
Secretary. And that's a direct quote, by the way.
Now, I want to thank you and your family for sitting
through this and for answering these questions. I think this
was the best I have ever heard them answered, understanding
that there are no answers to some of these problems.
And I just want to personally thank you. My gosh, you could
have such a great life without doing this kind of stuff, and
you are willing to give your life to working for the American
people and in trying to do what really needs to be done in the
area of health care. And I want to commend you for it, because
I just do not think there is a justifiable reason to vote
against you.
Dr. Price. Thank you, sir.
The Chairman. Well, with that----
Senator Wyden. Mr. Chairman, just a unanimous consent
request.
The Chairman. Yes, sir.
Senator Wyden. I would just like to put in a statement by
me under this unanimous consent request----
The Chairman. That would be fine.
Senator Wyden [continuing]. On how important it is that
Congressman Price respond to the questions he has been asked by
the HELP Committee. It is a different committee, but it is
something of great importance to me. And I appreciate it.
The Chairman. Well, that is fine. But see, in my
estimation, the HELP Committee should not have held a hearing
to begin with. This is the committee of jurisdiction. This is
the committee that has to stand up and vote on whether or not
our congressional friend is going to serve this country in this
great capacity. And I believe we will vote for him and get him
out of here. And by getting him out of here, I do not mean out
of this room, okay, we have to get him out of the Congress and
get him up there where he can really help with all this medical
expertise that he has.
And it is apparent that you have it. I mean, there is no
question about that in my mind. And it is hard for me to
understand why anybody would give you a rough time. It is good
to ask tough questions, and we have had a lot of tough
questions here today, but you have answered them very, very
well, as far as I am concerned, much better than a lot of other
people who have held this position.
Many of the others, even recently, could not answer these
questions that you have been asked. And it is wonderful that we
have a doctor who has had a long life in medical practice
willing to give up that life, give up the freedoms that you
have to have to repeatedly come up here and justify everything
you do down there. I think it is a wonderful thing, and I just
personally want to congratulate you and your wife and family
for giving so much to this country.
With that, we will recess, and we will reconvene again to
vote on you promptly.
[Whereupon, at 1:54 p.m., the hearing was adjourned.]
A P P E N D I X
Additional Material Submitted for the Record
----------
Submitted by Hon. Chuck Grassley
The Wall Street Journal, October 3, 2008
Grassley Says Emory Psychiatrist Didn't Report $500,000 in Payments
By Jacob Goldstein
For a while now, Senator Chuck Grassley has been writing to
universities around the country to ask about ties between high-profile
doctors and the drug industry--an interest related to a bill he's
sponsoring that would require drug makers to report payments to
doctors.
In the latest letter, Grassley says a prominent Emory psychiatrist
failed to disclose a half-million dollars in payments from
GlaxoSmithKline.
Charles Nemeroff, the chair of Emory's psychiatry department, was paid
by Glaxo to give speeches to doctors around the country, the Grassley
letter said. Nemeroff was also the main investigator on a federally
funded trial of Glaxo drugs.
Emory requires its doctors to disclose potential conflicts of interest
when they receive payments of over $10,000. In a statement to the WSJ,
Emory said the allegations made by Senator Grassley are ``serious'' and
that the university is ``working diligently to determine whether our
policies have been observed consistently with regard to the matters
cited'' by Grassley.
The New York Times posted a copy of a 2004 letter from Emory to
Nemeroff telling him that he had to limit his Glaxo consulting fees to
less than $10,000 a year to avoid a conflict that would violate federal
regulations. This week's letter from Grassley says Glaxo paid Nemeroff
more than $70,000 in 2005 and more than $30,000 in 2006, according to
reports from the company.
Nemeroff didn't return a call from the WSJ, but the university said
Nemerov told Emory officials that ``to the best of my knowledge, I have
followed the appropriate university regulations concerning financial
disclosures.'' Glaxo said it has ``rigorous guidelines governing our
interaction with healthcare professionals who participate in GSK-
supported speaking events,'' and that it requires them to disclose
those relationships.
Grassley has previously investigated similar issues regarding
psychiatrists at Harvard, Stanford, the University of Cincinnati and
the University of Texas Medical Branch. For more on Grassley's
investigations, check out the recent interview from the HealthCare
Channel.
The Physician Payment Sunshine Act, which Grassley sponsors, would
require drug makers to report payments to doctors. The industry
supports the bill--finding it preferable to a patchwork of state laws--
which has been working its way through Congress for a while now.
______
Money and Policy, October 3, 2008
Top Psychiatrist Didn't Report Drug Makers' Pay
By Gardiner Harris
One of the nation's most influential psychiatrists earned more than
$2.8 million in consulting arrangements with drug makers from 2000 to
2007, failed to report at least $1.2 million of that income to his
university and violated federal research rules, according to documents
provided to Congressional investigators.
The psychiatrist, Dr. Charles B. Nemeroff of Emory University, is the
most prominent figure to date in a series of disclosures that is
shaking the world of academic medicine and seems likely to force broad
changes in the relationships between doctors and drug makers.
In one telling example, Dr. Nemeroff signed a letter dated July 15,
2004, promising Emory administrators that he would earn less than
$10,000 a year from GlaxoSmithKline to comply with federal rules. But
on that day, he was at the Four Seasons Resort in Jackson Hole, WY,
earning $3,000 of what would become $170,000 in income that year from
that company--17 times the figure he had agreed on.
The Congressional inquiry, led by Senator Charles E. Grassley,
Republican of Iowa, is systematically asking some of the nation's
leading researchers to provide their conflict-of-interest disclosures,
and Mr. Grassley is comparing those documents with records of actual
payments from drug companies. The records often conflict, sometimes
starkly.
``After questioning about 20 doctors and research institutions, it
looks like problems with transparency are everywhere,'' Mr. Grassley
said. ``The current system for tracking financial relationships isn't
working.'' The findings suggest that universities are all but incapable
of policing their faculty's conflicts of interest. Almost every major
medical school and medical society is now reassessing its relationships
with drug and device makers.
``Everyone is concerned,'' said Dr. James H. Scully Jr., the president-
elect of the Council of Medical Specialty Societies, whose 30 members
represent more than 500,000 doctors.
Dr. Nemeroff is a charismatic speaker and a widely admired scientist
who has written more than 850 research reports and reviews. He was
editor-in-chief of the influential journal Neuropsychopharmacology. His
research has focused on the long-term mental health risks associated
with child abuse as well as the relationship between depression and
cardiovascular disease.
Dr. Nemeroff did not respond to calls and e-mail messages seeking
comment. Jeffrey L. Molter, an Emory spokesman, wrote in an e-mail
statement that the university was ``working diligently to determine
whether our policies have been observed consistently with regard to the
matters cited by Senator Grassley.''
The statement continued: ``Dr. Nemeroff has assured us that: `To the
best of my knowledge, I have followed the appropriate university
regulations concerning financial disclosures.' '' On Friday night,
Emory announced that Dr. Nemeroff would ``voluntarily step down as
chairman of the department, effective immediately, pending resolution
of these issues.''
Mr. Grassley began his investigation in the spring by questioning Dr.
Melissa P. DelBello of the University of Cincinnati after The New York
Times reported her connections to drug makers. Dr. DelBello told
university officials that she earned about $100,000 from 2005 to 2007
from eight drug makers, but AstraZeneca alone paid her $238,000 during
the period, Mr. Grassley found.
Then in early June, the Senator reported to Congress that Dr. Joseph
Biederman, a renowned child psychiatrist at Harvard Medical School, and
a colleague, Dr. Timothy E. Wilens, had reported to university
officials earning several hundred thousand dollars each in consulting
fees from drug makers from 2000 to 2007, when in fact they had earned
at least $1.6 million each.
Then the Senator focused on Dr. Alan F. Schatzberg of Stanford,
president-elect of the American Psychiatric Association, whose $4.8
million in stock holdings in a drug development company raised
concerns.
Mr. Grassley has sponsored legislation called the Physician Payment
Sunshine Act, which would require drug and device companies to publicly
list payments to doctors that exceed $500. Several states already
require such disclosures.
As revelations from Mr. Grassley's investigation have dribbled out,
trade organizations for the pharmaceutical industry and medical
colleges have agreed to support the bill. Eli Lilly and Merck have
announced that they would list doctor payments next year even without
legislation.
The National Institutes of Health have strict rules regarding conflicts
of interest among grantees, but the institutes rely on universities for
oversight. If a university fails, the agency has the power to suspend
its entire portfolio of grants, which for Emory amounted to $190
million in 2005, although the agency rarely takes such drastic
measures.
Dr. Nemeroff was the principal investigator for a 5-year $3.9 million
grant financed by the National Institute of Mental Health for which
GlaxoSmithKline provided drugs.
Income of $10,000 or more from the company in any year of the grant--a
threshold Dr. Nemeroff crossed in 2003, 2004, 2005 and 2006, records
show--would have required Emory to inform the institutes and take steps
to deal with the conflict or to remove Dr. Nemeroff as the
investigator.
Repeatedly assured by Dr. Nemeroff that he had not exceeded the limit,
Emory did nothing.
``Results from N.I.H.-funded research must not be biased by any
conflicting financial interests,'' John Burklow, a spokesman for the
health institutes, said in the kind of tough statement that in the past
has rarely been followed by real sanctions. ``Officials at Emory are
investigating the concerns.''
``Failure to follow N.I.H. standards'' on conflict of interest, Mr.
Burklow continued, ``is very serious, and N.I.H. will take all
appropriate action to ensure compliance.''
In 2004, Emory investigated Dr. Nemeroff's outside consulting
arrangements. In a 14-page report, Emory's conflict of interest
committee detailed multiple ``serious'' and ``significant'' violations
of university procedures intended to protect patients.
But the university apparently took little action against Dr. Nemeroff
and made no effort to independently audit his consulting income,
documents show.
Universities, too, can benefit from the fame and money the deals can
bring--a point Dr. Nemeroff made in a May 2000 letter stamped
``confidential'' that he sent to the dean of Emory's medical school.
The letter, which was part of a record from a Congressional hearing,
addressed Dr. Nemeroff's membership on a dozen corporate advisory
boards (some of the companies' names have since changed).
``Surely you remember that Smith-Kline Beecham Pharmaceuticals donated
an endowed chair to the department and that there is some reasonable
likelihood that Janssen Pharmaceuticals will do so as well,'' he wrote.
``In addition, Wyeth-Ayerst Pharmaceuticals has funded a Research
Career Development Award program in the department, and I have asked
both AstraZeneca Pharmaceuticals and Bristol-Meyers [sic] Squibb to do
the same. Part of the rationale for their funding our faculty in such a
manner would be my service on these boards.''
Universities once looked askance at professors who consulted for more
than one or two drug companies, but that changed after a 1980 law gave
the universities ownership of patents discovered with federal money.
The law helped give birth to the biotechnology industry and led to the
discovery of dozens of life-saving medicines. Consulting arrangements
soon proliferated at medical schools, and Dr. Nemeroff--who at one
point consulted for 21 drug and device companies simultaneously--became
a national model.
He may now become a model for a broad reassessment of industry
relationships. Many medical schools, societies and groups are
considering barring doctors from giving lectures on drug or device
marketing.
For all his fame in the world of psychiatry, Dr. Nemeroff has faced
ethics troubles before. In 2006, he blamed a clerical mix-up for his
failing to disclose that he and his co-authors had financial ties to
Cyberonics, the maker of a controversial device that they reviewed
favorably in a journal he edited.
The Cyberonics paper led to a bitter e-mail exchange between Dr.
Nemeroff and Claudia R. Adkison, an associate dean at Emory, according
to Congressional records. Dr. Adkison noted that Cyberonics had not
only paid Dr. Nemeroff and his co-
authors but had also given an unrestricted educational grant to Dr.
Nemeroff's department.
``I can't believe that anyone in the public or in academia would
believe anything except that this paper was a piece of paid
marketing,'' Dr. Adkison wrote on July 20, 2006.
Two years earlier, unknown to the public, Emory's conflict of interest
committee discovered that Dr. Nemeroff had made more serious blunders,
including failing to disclose conflicts of interest in trials of drugs
from Merck, Eli Lilly and Johnson and Johnson.
His continuing oversight of a federally financed trial using
GlaxoSmithKline medicines led Dr. Adkison to write Dr. Nemeroff on July
15, 2004, that ``you must clearly certify on your annual disclosure
form that you do not receive more than $10,000 from GSK.''
In a reply dated August 4, Dr. Nemeroff wrote that he had already done
so but promised again that ``my consulting fees from GSK will be less
than $10,000 per year throughout the period of this N.I.H. grant.''
When he sent that letter, Dr. Nemeroff had already earned more than
$98,000 that year from GlaxoSmithKline. Three weeks later, he received
another $3,844.56 for giving a marketing talk at the Passion Fish
Restaurant in Woodbury, NY.
From 2000 through 2006, Dr. Nemeroff earned more than $960,000 from
GlaxoSmithKline but listed earnings of less than $35,000 for the period
on his university disclosure forms, according to Congressional
documents.
Sarah Alspach, a GlaxoSmithKline spokeswoman, said via e-mail that
``Dr. Nemeroff is a recognized world leader in the field of
psychiatry,'' and that the company requires its paid speakers to
``proactively disclose their financial relationship with GSK, and we
believe that healthcare professionals are responsible for making those
disclosures.''
http://www.nytimes.com/2008/10/04/health/policy/04drug.html
______
Prepared Statement of Hon. Orrin G. Hatch,
a U.S. Senator From Utah
WASHINGTON--Senate Finance Committee Chairman Orrin G. Hatch (R-Utah)
today delivered the following opening statement at a hearing to
consider the nomination of Rep. Tom Price (R-Georgia) to head the
Health and Human Services (HHS) Department:
Today we will consider the nomination of Dr. Tom Price to be the
Secretary of the Department of Health and Human Services.
I want to welcome Dr. Price to the Finance Committee. I appreciate
his willingness to serve in a position of this magnitude, especially at
this crucial time.
When Obamacare was pushed through on a series of party-line votes,
Republicans in Congress warned that the new health law would harm
patients, families, and businesses.
Not to put too fine a point on it, but, we were right. And, the
next HHS Secretary will play a pivotal role as we work to repeal
Obamacare and replace it with patient-centered reforms that will
actually address cost. This will be an important endeavor, one that
will and should get a lot of attention here today, but it should not be
the sole focus of the next HHS Secretary.
HHS has an annual budget of well over $1 trillion. Let me repeat
that: One department, $1 trillion.
HHS encompasses the Centers for Medicare and Medicaid Services, the
Centers for Disease Control and Prevention, the National Institutes of
Health, the Food and Drug Administration, and many others. It is no
exaggeration to say that HHS touches more of the U.S. economy and
affects the daily lives of more Americans than any other part of the
U.S. Government.
I firmly believe that Dr. Price has the experience and
qualifications necessary to effectively lead this large and diverse set
of agencies, and many people share that view.
For example, past HHS Secretaries Mike Leavitt and Tommie Thompson
strongly support his nomination.
Physician organizations that know Dr. Price's work--including the
American Medical Association and most surgical specialty groups--
enthusiastically support him. The American Hospital Association and
other health-care stakeholder groups do as well.
Perhaps the Healthcare Leadership Council, representing the broad
swath of health-care providers, said it best in stating that, ``It is
difficult to imagine anyone more capable of serving this Nation as the
Secretary of HHS than Congressman Tom Price.''
Unfortunately, in the current political environment,
qualifications, experience, and endorsements from experts and key
stakeholders don't seem to matter to some of our colleagues. At least,
that appears to be the case, as none of those who say they oppose Dr.
Price's nomination seem to be talking about whether he is qualified.
Instead, we've heard grossly exaggerated and distorted attacks on
his views and his ethics. On top of that, we've heard complaints and a
series of unreasonable demands regarding the confirmation process
itself.
Of course, these tactics haven't been limited to Dr. Price. My
Democratic friends have taken this approach with almost all of
President Trump's cabinet nominees as Senate Democrats' unprecedented
efforts to delay and derail the confirmation process and apply a
radically new set of confirmation standards has continued unabated.
To that point, let me say this: I have been in the Senate for 40
years and I think my record for being willing to reach across the aisle
is beyond any reasonable dispute. In fact, from time to time, I've
taken lumps in some conservative circles for working closely with my
Democrat colleagues.
I have, on some occasions, voted against confirming executive
branch nominees, but far more often than not, I have opted to defer to
the occupants of the White House and allow them to choose who serves in
their administrations. I've taken some lumps for that too.
I'm not bringing any of this up to brag or to solicit praise from
anyone in the audience. I raise all of this today so that people can
know I'm serious when I say that I am worried about what my colleagues
on the minority side are doing to the Senate as an institution. While
the overriding sense of comity and courtesy among Senators has
admittedly been in decline in recent years, I have never seen this
level of partisan rancor when it comes to dealing with a President from
an opposing party. I have never seen a party in the Senate--from its
leaders on down--publicly commit to not only opposing virtually every
nomination, but to attacking and maligning virtually every single
nominee.
Let me be clear: I'm not suggesting that the Senate start rubber-
stamping nominees. Nor am I suggesting that any member of the Senate
should vote against their conscience or preferences simply out of
respect for tradition or deference. What I am saying is that the same
rules, processes, courtesies, and assumptions of good faith that have
long been the hallmark of the Senate confirmation process should
continue to apply regardless of who is President. If what we're seeing
now is the new normal for every time control of the White House changes
hands, the Senate, quite frankly, will be a much lesser institution.
Unfortunately, our committee has not been entirely immune to the
hyper-politicization of the nomination process. We saw that last week
with the Mnuchin hearing, and I regret to say that I think we're likely
to see more of it today.
Case in point: I expect that, during today's hearing, we're going
hear quite a bit about process, with claims that Dr. Price's nomination
is being rushed and that the nominee hasn't been fully vetted.
This is simply untrue.
President Trump announced his intent to nominate Dr. Price just 3
weeks after the election. Dr. Price submitted the required tax returns
and completed questionnaire on December 21st. That was 35 days ago,
and, by any reasonable standard, that is sufficient time for a full and
fair examination of the nominee's record and disclosures.
By comparison, the committee held a hearing on the nomination of
Secretary Sebelius 16 days after she submitted her paperwork. For
Secretary Burwell, it was 17 days. In other words, the time between the
completion of Dr. Price's file and his hearing has been more than that
of the last two HHS Secretaries combined. And, by the way, both of
those nominees received at least a few Republican votes on this
committee and on the floor.
Outside of extraordinary process demands, Dr. Price has faced a
number of unfair attacks on both his record as a legislator and his
finances.
On the questions surrounding finances, I'll defer on any
substantive discussion and first allow Dr. Price to defend himself from
what are, by and large, specious and distorted attacks. For now, I'll
just say that I hope that my colleagues don't invent new standards for
finances, ethics, and disclosure that are different from those that
have generally applied in the past.
There is a saying involving both stones and glass houses that might
be applicable as well.
With regard to Dr. Price's views and voting record, I'll simply say
that virtually all the attempts I've witnessed to characterize Dr.
Price's views as being ``outside of the mainstream'' have been absurd,
unless, of course, the only ideas that are in the ``mainstream'' are
those that endorse the status quo on healthcare and our entitlement
programs.
In conclusion, I just want to note that the overly partisan
treatment of nominees and distortions of their records is a relatively
new development on this committee. My hope is that we can begin today
to reverse recent trends and have a fair and open discussion of the
nominee and his qualifications.
______
American Academy of Dermatology Association
1445 New York Avenue, NW, Suite 800
Washington, DC 20005-2134
Main: 202-842-3555
Fax: 202-842-4355
Website: www.aad.org
January 30, 2017
The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Finance
104 Hart Senate Office Building 221 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
Dear Chairman Hatch and Ranking Member Wyden:
The American Academy of Dermatology Association (Academy), which
represents more than 13,500 dermatologists nationwide, wishes to
express its support for the nomination of Representative Tom Price,
M.D., for the position of U.S. Secretary of the Department of Health
and Human Services (HHS).
Dr. Price, in his active role in health care policy in Congress as well
as his years of service at the state level of government, has
demonstrated a proven understanding of the intricate complexities of
our nation's health care system. Additionally, as someone who has
worked as a practicing physician, Dr. Price would bring to the position
of Secretary a personal understanding of how the policies enacted in
Washington impact the practice of medicine and delivery of care to
patients across the country.
Specifically, Dr. Price understands the importance of the physician-
patient relationship and recognizes the critical role that physicians
play in the delivery of care to their patients. He has often supported
dermatology's position on integrated electronic health care records and
the challenges of meaningful use. Dr. Price has also been a leading
voice to reduce burdensome regulations which have limited the time
physicians can devote to caring for and treating patients.
During his time in Congress, Dr. Price worked with colleagues on both
sides of the aisle to enact a new Medicare physician payment system
that streamlines multiple reporting requirements for physician
practices within Medicare. More recently, with the roll out of the new
Medicare Quality Payment Program (QPP), Dr. Price sought input
regarding proposed regulations and their potential impact on physicians
and patients, working with stakeholders and advocating with the Centers
for Medicare and Medicaid Services (CMS), to help provide flexibility
for physician practices both small and large.
The Academy appreciates your consideration of Dr. Price's nomination as
Secretary of Health and Human Services, and supports his nomination as
Secretary. At this important time in health care for our nation, Dr.
Price's experience as a physician and his in-depth understanding of
health care policy will provide HHS and our nation the direction needed
to guide our health care system as it addresses the needs of a growing
and diversifying patient population. Should you have any questions or
need additional information, please contact Shawn Friesen, the
Academy's Director, Legislative, Political and Grassroots Advocacy at
[email protected] or (202) 712- 2601.
Sincerely,
Abel Torres, M.D., JD, FAAD
President, American Academy of Dermatology Association
______
American Association of Neurological Surgeons
Kathleen T. Craig, Executive Director
5550 Meadowbrook Drive
Rolling Meadows, IL 60008
Phone: 888-566-AANS
Fax: 847-378-0600
[email protected]
and
Congress of Neurological Surgeons
Regina Shupak, CEO
10 North Martingale Road, Suite 190
Schaumburg, IL 60173
Phone: 877-517-1CNS
FAX: 847-240-0804
[email protected]
January 4, 2017
The Honorable Orrin Hatch
Chairman
Committee on Finance
U.S. Senate
Washington, DC 20510
SUBJECT: Rep. Tom Price Nomination for HHS Secretary
Dear Chairman Hatch:
On behalf of the American Association of Neurological Surgeons (AANS)
and Congress of Neurological Surgeons (CNS), representing more than
4,000 practicing neurosurgeons in the United States, we are writing in
strong support of Representative Tom Price, M.D. (R-GA) to become the
next Secretary of the U.S. Department of Health and Human Services
(HHS).
Throughout his time in Congress, Dr. Price, an orthopaedic surgeon, has
been a staunch advocate for the preservation of the doctor-patient
relationship, a fierce protector of private practice, and a stalwart
supporter of academic medicine. As a practicing physician, and because
of his work on key congressional committees with jurisdiction over
health care issues, he understands all aspects of the health care
system, which is essential to run HHS effectively.
We have every confidence that Dr. Price will work tirelessly to create
a health care delivery system that promotes high-quality, high-value,
and better-coordinated care for our nation's patients. We, therefore,
urge the Senate Finance Committee to favorably report Dr. Price's
nomination to the full Senate vote swiftly.
Thank you for considering our views.
Sincerely,
Frederick A. Boop, M.D., President Alan M. Scarrow, M.D., President
American Association of
Neurological Surgeons Congress of Neurological Surgeons
Staff Contact:
Katie O. Orrico, Director
AANS/CNS Washington Office
725 15th Street, NW, Suite 500
Washington, DC 20005
Direct: 202-446-2024
Email: [email protected]
______
American Podiatric Medical Association (APMA)
9312 Old Georgetown Road
Bethesda, Maryland 20814-1621
Tel: 301-581-9200
Fax: 301-530-2752
https://www.apma.org/
January 11, 2017
The Honorable Orrin Hatch
Chairman
Committee on Finance
U.S. Senate
219 Dirksen Senate Office Building
Washington, DC 20510
The Honorable Ron Wyden
Ranking Member
Committee on Finance
U.S. Senate
219 Dirksen Senate Office Building
Washington, DC 20510
Dear Chairman Hatch and Ranking Member Wyden:
The American Podiatric Medical Association (APMA) respectfully requests
your Committee affirmatively recommend Representative Thomas Price,
M.D., to the full Senate for Secretary of Health and Human Services
(HHS). Founded in 1912, the APMA is the leading organization and
represents the majority of the estimated 15,000 podiatrists in the
country.
Dr. Price is highly qualified for this position and brings years of
experience as a physician and the leading health policy expert in
Congress. Dr. Price has been supportive of policies that will free
providers of overly burdensome regulations which hinder the delivery of
care to patients and has encouraged additional pathways for providers
to play a more significant role in regulatory decision-making. He has
consistently provided healthcare solutions that are patient-centered
and emphasize consumer choice, which will be critical as Congress moves
forward with changes to the Patient Protection and Affordable Care Act.
Again, we support the nomination of Congressman Tom Price as HHS
Secretary and ask for your favorable consideration.
Sincerely,
R. Dan Davis, DPM
President
______
Corinthian Medical IPA
5030 Broadway, Suite 821
New York, NY 10034
T 212-740-8294
F 212-740-8246
www.corinthianmedicalipa.com
January 16, 2017
The Honorable Lamar Alexander
Chairman,
Committee on Health, Education, Labor, and Pensions
U.S. Senate
Washington, DC 20510
Re: Letter in support of Dr. Tom Price
Dear Honorable Lamar Alexander:
I have practiced medicine in the United States for 25 years. Throughout
that time, I have focused my practices exclusively on improving
outcomes for lower-income communities, who face extreme health
disparities in our current system. Many of my patients are immigrants;
and I am proudly an immigrant myself.
Today, I head a nonprofit network, Advocate Community Providers. We
consist of over 2,000 physicians and healthcare providers and are
responsible for over 700,000 lives across four boroughs in New York
City. To put this population in perspective, this is larger than the
populations of all but the seventeen largest cities in the country.
Nearly all of our patients are Medicaid recipients; most are
concentrated in the Hispanic and Asian communities. Our network came
together as a result of New York's transformative Delivery System
Reform Incentive Payment program, or DSRIP, which uses state and
federal dollars to cut costs stemming from unnecessary hospital usage
by lower-income patients by switching to a community-based preventative
care system as opposed to one that depends on emergency room visits,
and switching a value-based system instead of one based on exorbitant
fee-for-service.
I have had the opportunity to meet with Congressman Tom Price last year
in New York; Dr. Price was particularly interested in knowing about
health-care issues and care-enhancing, cost-saving methods that are
showing promise in lower-income communities in New York, especially
regarding the DSRIP initiative.
I sincerely support his nomination and I hope that after his
confirmation as Secretary of Health and Human Services, he will look
closely at our work and this model and that we can work together to
discuss support and scalability. The reforms that my network and the 24
other similar networks in New York are pioneering can and should be
thoughtfully considered in urban areas and rural states alike with
heavy Medicaid populations. We stand ready to work with him.
There is no question that a new Administration taking office presents a
key opportunity. Hopefully, it will be a historic moment for a renewed
national dialogue on health-care reform that is apolitical and places
patients first. The eventual outcome is uncertain, but there is no
doubt that the Affordable Care Act will undergo significant changes. No
matter the changes, I hope that Dr. Price and President-Elect Trump
will be as committed to raising outcomes and creating healthier,
stronger and more prosperous communities through better quality care
and lower expenditures as the previous administration. I trust that
they share that goal, and as a doctor who has worked in the Medicaid
network, I can confirm that using this system as the place to make
change is where the strongest potential exists.
I look forward to welcoming Dr. Price back to New York this year and
convening a round table of providers who are leading on care-enhancing,
cost-saving reforms that can flourish anywhere. I hope to serve as a
laboratory for results that will have positive national implications
and that Dr. Price and the Department of Health and Human Services will
take every advantage of under his leadership.
With regards,
Dr. Ramon Tallaj
Chairman, Corinthian Medical IPA (CMIPA) (ACP)
______
State of Georgia
Office of the Governor
Atlanta 30334-0090
Nathan Deal
Governor
The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
Committee on Finance Committee on Finance
U.S. Senate U.S. Senate
Washington, DC 20510 Washington, DC 20510
January 23, 2017
Dear Chairman Hatch and Senator Wyden:
It is with great pride that I write to you to support the
nomination of Congressman Tom Price, M.D. as the Secretary of Health
and Human Services. As an orthopaedic surgeon, in private practice for
twenty years, Rep. Price knows firsthand the intricacies of the
healthcare landscape. Representative Price has served in both the State
Senate and as a Representative for Georgia's 6th District. During this
time, he has become a champion for healthcare. As such, he is uniquely
situated to serve as the Secretary for Health and Human Services.
Representative Price has been working for the past several years to
craft a solution to the many woes of the Affordable Care Act, passed
and signed into law in 2010.
As a Governor, charged with balancing a state budget, I know the
many challenges that the Affordable Care Act has brought to states like
Georgia. Since taking office, we have seen the portion of our state
budget consumed by health expenses continue to grow. Continued growth
in healthcare expenses means that other critical spending areas like
education, transportation, and public safety are put at risk.
I look forward to the confirmation of Representative Price so that
Georgia can craft a Medicaid program that is sustainable and best
suited to fit the needs of our unique population.
Sincerely,
Nathan Deal
______
Grady Health System
80 Jesse Hill Jr. Drive, SE
Atlanta. GA 30303
(404) 616-1000
www.gradyhealth.org
January 20, 2017
The Honorable Orrin Hatch
Chairman
Committee on Finance
U.S. Senate
Washington, DC 20510
The Honorable Ron Wyden
Ranking Member
Committee on Finance
U.S. Senate
Washington, DC 20510
Dear Chairman Hatch and Ranking Member Wyden:
It is an honor to submit these comments as you deliberate the
confirmation of Dr. Tom Price, M.D. as this country's next Secretary of
Health and Human Services. I am Chairman of the Grady Health System
Board of Directors (Grady Memorial Hospital) in Atlanta, Georgia, one
of the largest, essential safety net health systems in the country.
Grady has a vital stake in the future of this Nation's healthcare
policy.
Grady was founded with a mission to care for the underserved and is
celebrating its 125th anniversary this year. Our health system consists
of the 953-bed Grady Memorial Hospital, 6 neighborhood health centers,
Crestview Health and Rehabilitation Center, and Children's Healthcare
of Atlanta at Hughes Spalding, which is operated as a Children's
affiliate. In 2016, Grady had over 620,000 patient visits, including
more than 130,000 emergency room visits. Over 28% of our patients are
uninsured, 28% are covered by Medicaid, and 24% are enrolled in
Medicare. The remainder have other forms of coverage, including
commercial insurance.
With its nationally acclaimed emergency medical services, Grady has the
premier level I trauma center in all of North Georgia and serves as the
911 ambulance provider for the city of Atlanta and six rural counties.
Grady's American Burn Association /American College of Surgeons
verified Burn Center is one of only two in the State. And the Marcus
Stroke and Neuroscience Center is a Joint Commission designated
Advanced Comprehensive Stroke Center.
Other key services include Grady's Regional Perinatal Center with its
Neonatal Intensive Care Unit, Georgia's first Cancer Center for
Excellence, The Avon Breast Health Center, the Georgia Comprehensive
Sickle Cell Center, and the Ponce de Leon Center--one of the top three
HIV/AIDS outpatient clinics in the country.
As the cornerstone of healthcare in Atlanta, Grady serves Americans
from every walk of life in every possible circumstance and does it with
limited resources. Grady's funding, like other safety net hospitals in
the country, is often determined by the changing priorities of
government--local, State or Federal. And it's the place where changes
in public policy can have an immediate and direct impact on the lives
of our patients and the hospital's ability to meet the demand for
services.
Dr. Price completed his residency program in orthopedics at Grady and
later returned to serve as Medical Director of the Orthopedics Clinic.
We believe there is no better training or opportunity to gain personal
perspective on the health-care needs of all Americans than working at a
safety net institution like Grady. While at Grady, Dr. Price trained
the next generation of clinicians and provided care to the vulnerable--
particularly the uninsured and Georgia's Medicaid recipients.
No clinician has been in charge of our Nation's health-care system
since Dr. Louis Sullivan, a former board member of Grady. With so much
change being contemplated and considered in both houses of Congress, it
reassures us to know that Dr. Price will view changes in policy with
Grady and the community we serve in mind.
As our Nation continues to discuss how best to deliver health care to
all Americans, but especially to the indigent and uninsured, we believe
Dr. Price's experience as a physician at Grady will serve him well. We
are grateful for Dr. Price's work with us throughout his time in public
office. We look forward to working with him in this important role to
improve access to care for all Americans.
Sincerely,
Francis S. Blake
Chairman
______
National Confectioners Association (NCA)
1101 30th Street NW, Suite 200
Washington, DC 20007
(202) 534-1440
https://www.candyusa.com/
January 13, 2017
The Honorable Orrin G. Hatch The Honorable Ron Wyden
Chairman Ranking Member
Committee on Finance Committee on Finance
U.S. Senate U.S. Senate
219 Dirksen Senate Office Building 219 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
The Honorable Lamar Alexander The Honorable Patty Murray
Chairman Ranking Member
Committee on Health, Education,
Labor, and Pensions Committee on Health, Education,
Labor, and Pensions
U.S. Senate U.S. Senate
428 Dirksen Senate Office Building 428 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
Dear Chairmen Hatch and Alexander, Senator Wyden, and Senator Murray:
I am writing to you to express support from the National Confectioners
Association in regard to the nomination of Representative Tom Price as
Secretary of the Department of Health and Human Services.
The National Confectioners Association is the trade organization
representing the $35 billion U.S. chocolate, candy, gum and mints
industry. Confectionery is manufactured in all 50 states, directly
employing 55,000 workers in more than 1,000 facilities. In addition to
these jobs in manufacturing, the industry supports an additional
410,000 U.S. jobs in fields like retail, transportation and
agriculture. The confectionery industry generates more than $10 billion
in U.S. taxes and more than $2 billion in exports annually.
Dr. Price's experiences as a surgeon and his significant legislative
background at the state and federal levels have uniquely positioned him
to lead the Department. His considerable experience will also have a
positive influence on the Food and Drug Administration, an agency with
significant oversight on regulations that impact the confectionery
industry. Dr. Price is a principled man and strong leader who will
underscore the importance of making policy using the best science
available after thorough and practical deliberation.
NCA respectfully asks for Dr. Price's prompt consideration by both of
your committees and confirmation by the United States Senate as our
next Secretary of the Department of Health and Human Services.
Sincerely,
John H. Downs, Jr.
President and CEO
______
Small Business and Entrepreneurship Council (SBE Council)
301 Maple Avenue West, Suite 100
Vienna, VA 22180
(703) 242-5840
January 23, 2017
The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
Committee on Finance Committee on Finance
U.S. Senate U.S. Senate
The Honorable Lamar Alexander The Honorable Patty Murray
Chairman Ranking Member
Committee on Health, Education,
Labor, and Pensions Committee on Health, Education,
Labor, and Pensions
U.S. Senate U.S. Senate
Dear Chairmen Hatch and Alexander, and Ranking Members Wyden and
Murray:
On behalf of the Small Business and Entrepreneurship Council (SBE
Council) and our more than 100,000 members nationwide, I am writing to
express our strong support for the confirmation of U.S. Representative
Tom Price, M.D. as Secretary of the U.S. Department of Health and Human
Services (HHS).
Congressman Price is a serious and successful physician, legislator,
and policy thought leader who naturally transferred his Hippocratic
Oath to policymaking and legislative initiatives across many areas.
Over the course of his career in Congress, he has worked hard to
propose and fight for policies that empower and help all Americans,
while warning against those that do harm and undermine opportunity.
Congressman Price is a great friend of entrepreneurs and small business
America, and understands that government policies and actions--if not
carefully thought through--can take a disproportionate toll on the
ability of small businesses to compete, grow, innovate and create jobs.
Regarding health care policy, his insights and experience have been
invaluable in developing positive solutions, while also correctly
warning about the unintended consequences of poor policy or actions.
Congressman Price has been a leader on common sense reforms to lower
health costs, improve quality, drive more choice and innovation in the
market, and create true access for all health care consumers. His ``do
no harm'' ethic is extraordinarily important now as the Congress and
policymakers carefully unwind a health care law that has undermined
people's health, access to health coverage, as well as their personal
finances. Small businesses and the self-employed have especially been
burdened by the higher costs and limited choices that have resulted
from the Affordable Care Act.
Congressman Price is the right person, with the precise set of skills,
experience and temperament to guide us to a system where all people
have access to high quality, affordable care, and a system that is
innovating for the future. This is a system--a market--that desperately
needs more entrepreneurial ideas, but excessive regulation and
government control are barriers that prevent the type of rapid
innovation we are benefitting from in other industries and sectors.
SBE Council strongly supports Congressman Price's confirmation, and we
urge the Senate to move quickly on a full vote to ensure HHS has the
leadership it needs in many important areas, including navigating the
type of reforms we need to make health coverage more affordable and
competitive for the self-employed, small businesses and their
employees. Please do not hesitate to contact me if you have questions
about SBE Council's support for Congressman Price's confirmation as HHS
Secretary.
Sincerely,
Karen Kerrigan
President and CEO
______
Scott Walker
Office of the Governor
State of Wisconsin
P.O. Box 7863
Madison, WI 53707
www.wisgov.state.wi.us
(608) 266-1212
Fax: (608) 267-8983
January 17, 2017
The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
Committee on Finance Committee on Finance
U.S. Senate U.S. Senate
The Honorable Lamar Alexander The Honorable Patty Murray
Chairman Ranking Member
Committee on Health, Education,
Labor, and Pensions Committee on Health, Education,
Labor, and Pensions
U.S. Senate U.S. Senate
Dear Chairmen Hatch and Alexander, and Ranking Members Wyden and
Murray:
I write today in support of President-elect Trump's nomination for
Secretary of the U.S. Department of Health and Human Services, Dr. Tom
Price.
Secretary-designee Price is uniquely positioned to work with Wisconsin
and other states to reform health care and help curb years of federal
overreach. In addition to his leadership roles in congress, he spent
more than 20 years caring for patients in Georgia as an orthopaedic
surgeon and medical professional. If confirmed, Dr. Price will bring
years of medical knowledge and federal lawmaking experience to the
department.
In Wisconsin, we share Dr. Price's commitment to quality healthcare as
we rank one of the best states in the nation for health insurance
coverage and our reforms allowed us to cover everyone living in poverty
under Medicaid. His decades of medical knowledge and firsthand
experience as a licensed physician and orthopaedic surgeon, combined
with his years as a lawmaker make him the perfect candidate to begin
tackling critical reforms to empower the states.
Again, I strongly support the confirmation of Dr. Price as the next
U.S. Health and Human Services Secretary. I look forward to working
with him in this new role.
Sincerely,
Scott Walker
Governor of Wisconsin
______
Submitted by Hon. Dean Heller, a U.S. Senator From Nevada
Nevada Legislature
January 10, 2017
The Honorable Dean Heller
324 Hart Senate Office Building
Washington, DC 20510
Dear Senator Heller:
We are writing to express our concern regarding plans to repeal the
Affordable Care Act. Specifically, we are concerned that Republicans in
Congress are pushing ahead with a repeal of the Affordable Care Act
despite having no viable replacement legislation ready to enact.
Failure to immediately enact replacement legislation risks creating
uncertainty in the insurance marketplace. Such uncertainty will likely
result in higher out-of-
pocket costs and fewer insurance options for Nevada's families while
simultaneously placing an increased burden on our State budget.
As you are aware, Governor Sandoval worked closely with the Legislature
and ultimately signed legislation creating the Silver State Health
Exchange in 2011. Subsequently, more than 300,000 Nevadans have gained
access to health care coverage, either by purchasing it on the exchange
or by meeting the expanded Medicaid eligibility requirements.
In light of these facts, we hope that you will address the following
questions regarding the planned repeal of the Affordable Care Act:
1. What steps do you plan to take to ensure that the more than
88,000 Nevadans who have purchased health insurance through the Silver
State Health Exchange continue to have the ability to purchase health
insurance with adequate coverage in a transparent marketplace?
2. What steps do you plan to take to ensure that the more than
77,000 Nevadans who are eligible for Federal tax credits under the
Affordable Care Act to help purchase private insurance will continue to
have access to affordable health insurance options with adequate
coverage?
3. What steps do you plan to take to ensure that the 217,000
Nevadans who are receiving health care under the Medicaid expansion
remain covered?
4. The Affordable Care Act guarantees coverage vital to
preventative services for women, including cancer screenings and birth
control. What steps do you plan to take to ensure that the Affordable
Care Act's coverage guarantees remain intact for women's health?
5. The Affordable Care Act guarantees that Nevadans with pre-
existing conditions will not be denied health care and ends lifetime
minimums on coverage. It also allows younger people, many of whom are
saddled with college debt and cannot afford insurance, to stay on their
parents' insurance until they are 26. What steps do you plan to take to
preserve those coverage guarantees?
The lack of clarity regarding viable alternatives to the Affordable
Care Act from the incoming administration and Republican congressional
leadership is troubling. While Congress has expended considerable time
and energy over the past several years talking about the law, hundreds
of thousands of Nevadans have relied in good faith on the Affordable
Care Act to obtain health insurance. Repealing the law without
implementing an adequate replacement will put those Nevadans' health
and well-being at risk.
Further, any congressional action that creates a large gap in insurance
coverage will likely result in more Nevadans relying on state-funded
social service programs. Most of these programs are already under
resourced. Nevada cannot afford to shoulder this new financial burden
created by politicians in Washington failing to live up to guarantees
that the Federal Government previously made to our citizens.
We hope you will use your position as Nevada's senior U.S. Senator and
a member of the majority party to protect the thousands of Nevada
families who are now at risk of losing their health insurance. We also
hope you will take steps to ensure that our State does not bear any
unfair and unnecessary costs of caring for people who stand to lose
that coverage in the near future.
We look forward to your prompt reply.
Sincerely,
Aaron D. Ford Jason Frierson
Majority Leader Speaker
Nevada State Senate Nevada State Assembly
______
Submitted by Hon. Claire McCaskill, a U.S. Senator From Missouri
Table T16-0285
Repeal all ACA Taxes, Including Premium Credits
Baseline: Current Law
Distribution of Federal Tax Change by Expanded Cash Income Level, 2017 \1\
Summary Table
http://www.taxpolicycenter.org/
--------------------------------------------------------------------------------------------------------------------------------------------------------
Tax Units with Tax Increase or Cut \3\ Average Federal Tax Rate
-------------------------------------------------------- Percent Share of \5\
Expanded Cash Income Level With Tax Cut With Tax Increase Change in Total Average ---------------------------
\2\ -------------------------------------------------------- After-Tax Federal Tax Federal Tax
Pct. of Tax Pct. of Tax Avg. Tax Income \4\ Change Change ($) Change (% Under the
Units Avg. Tax Cut Units Increase Points) Proposal
--------------------------------------------------------------------------------------------------------------------------------------------------------
Less than 10 7.3 -1,150 0.0 7,140 1.6 3.5 -80 -1.5 5.3
10-20 6.6 -1,210 4.2 3,850 -0.5 -5.8 80 0.5 2.6
20-30 7.2 -960 9.9 4,020 -1.3 -22.1 320 1.3 4.4
30-40 41.6 -170 9.2 4,600 -1.1 -18.2 350 1.0 7.7
40-50 83.9 -90 6.1 5,630 -0.6 -11.2 260 0.6 10.4
50-75 93.6 -100 3.1 6,400 -0.2 -8.3 100 0.2 13.1
75-100 97.3 -140 1.3 5,840 0.1 3.1 -60 -0.1 15.6
100-200 98.8 -190 0.4 6,540 0.1 14.8 -160 -0.1 18.8
200-500 99.8 -540 0.0 8,320 0.2 18.0 -540 -0.2 23.0
500-1,000 99.9 -4,590 0.0 0 0.9 17.9 -4,580 -0.7 28.0
More than 1,000 99.9 -50,200 0.0 0 2.2 108.4 -50,130 -1.5 32.6
All 60.0 -600 3.8 4,720 0.3 100.0 -180 -0.2 19.6
--------------------------------------------------------------------------------------------------------------------------------------------------------
Source: Urban-Brookings Tax Policy Center Microsimulation Model (version 0516-2).
Number of AMT taxpayers (millions). Baseline: 5.5; proposal: 5.5.
* Non-zero value rounded to zero; ** Insufficient data.
\1\ Calendar year. Baseline is current law. Proposal would repeal all ACA taxes: the 3.8 percent Net Invest Income Tax, the 0.9 percent additional HI
tax, the Cadillac Tax, the excise tax on employers offering inadequate health insurance coverage, the excise tax on individuals without adequate
health insurance, the increase in threshold for medical expense deductions, and the excise taxes on health insurance providers, pharmaceutical
manufacturers and importers, and medical device manufacturers and importers. Analysis includes the Premium Tax Credit which is not treated as a tax in
the TPC baseline due to its similarity to a spending program. Simulations of Premium Tax Credit calibrated to match results from Urban Institute's
Health Insurance Policy Simulation Model (HIPSM). For a description of TPC's current law baseline, see http://www.taxpolicycenter.org/taxtopics/
Baseline-Definitions.cfm.
\2\ Includes both filing and non-filing units but excludes those that are dependents of other tax units. Tax units with negative adjusted gross income
are excluded from their respective income class but are included in the totals. For a description of expanded cash income, see http://
www.taxpolicycenter.org/TaxModel/income.cfm.
\3\ Includes tax units with a change in federal tax burden of $10 or more in absolute value.
\4\ After-tax income is expanded cash income less: individual income tax net of refundable credits, corporate income tax, payroll taxes (Social Security
and Medicare), estate tax, and excise taxes.
\5\ Average federal tax (includes individual and corporate income tax, payroll taxes for Social Security and Medicare, the estate tax, and excise taxes)
as a percentage of average expanded cash income.
Submitted by Hon. Bill Nelson, a U.S. Senator From Florida
_______________________________________________________________________
Congressional Budget Office
September 2013
A Premium Support System for Medicare:
Analysis of Illustrative Options
Summary
Over the past two decades, numerous proposals have been advanced for
the establishment of a premium support system for Medicare. Under such
a program, beneficiaries would purchase health insurance from one of a
number of competing plans, and the federal government would pay part of
the cost of the coverage. The various proposals have differed in many
respects, including the way in which the federal contribution would be
set and how that contribution might change over time.
This Congressional Budget Office (CBO) report presents a preliminary
analysis of the ways two illustrative options for a premium support
system would affect federal spending and beneficiaries' choices and
payments. The agency has developed significant new tools to analyze
such a system in greater depth than in the past; the specifications of
the options examined here also differ from those CBO analyzed
previously. As the agency refines its modeling approach and considers
alternative options for a premium support system, its findings could
change. CBO's analysis to date indicates the following:
Both options for premium support considered here would reduce
federal spending for Medicare net of beneficiaries' premiums and other
offsetting receipts.
Under the second-lowest-bid option, the option with the greater
reduction in net federal spending, beneficiaries' premiums and total
payments for Medicare's Part A and Part B benefits would each be higher
on average than they would be under current law. (Total payments
consist of premiums and out-of-pocket costs for deductibles,
copayments, and coinsurance.) Under the average-bid option, the option
with the smaller reduction in net federal spending, those amounts would
each be lower on average than they would be under current law.
---------------------------------------------------------------------------
Notes: Unless otherwise indicated, the years referred to in this
report are calendar years. The estimates for the next 10 years were
generated using the Congressional Budget Office's March 2012 baseline
projections of Medicare spending, and the analysis of longer-term
effects was based on the agency's June 2012 long-term projections of
Medicare spending. (Those were the most recent projections available
when much of the analysis was performed.)
Numbers in the text, figures, and tables may not add up to totals
because of rounding.
Under both options, combined spending by the federal government
and by beneficiaries (that is, premiums and out-of-pocket costs) would
---------------------------------------------------------------------------
be less than that if current law remained in place.
Under both options, effects on premiums and total payments for
some beneficiaries would differ greatly from the national averages. In
particular, in most regions, the premiums and total payments of
beneficiaries enrolled in the fee-for-service (FFS) program would be
higher than they would be under current law.
Alternative specifications for key features of a premium support
system would yield different results.
What Premium Support Options Did CBO Analyze?
The two premium support options analyzed in this report differ in terms
of the formula by which the federal contribution would be determined.
Otherwise, they are very similar. The nation would be divided into
regions within which competing private insurers would submit bids
indicating the amounts they would accept to provide Medicare benefits
to a beneficiary of average health. The FFS program would be part of
the system as a competing plan, and its ``bid'' would be based on the
projected FFS spending for an enrollee of average health in a given
region. Insurers would bid to provide a benefit package that would
encompass the same services covered by Part A (Hospital Insurance) and
Part B (Medical Insurance) of Medicare under current law and that would
have the same actuarial value as Parts A and B combined (that is, each
package would cover the same percentage of total expenses for a given
population that Medicare's FFS program would cover under current law).
Beneficiaries who were eligible for the premium support system would
not be permitted to enroll in Part C (the current Medicare Advantage
system, offered by private insurers that contract with Medicare to
provide Part A and Part B benefits). Part D (Medicare's prescription
drug benefit program), which is now delivered through a competitive
system, would continue as it is under current law and would be
administered separately from the new program.
The federal government would pay insurers for each enrollee who was in
average health an amount that was equal to a ``benchmark'' set for that
region minus the standard premium paid by enrollees; insurers would
receive larger or smaller government payments for beneficiaries whose
health was worse or better than average. Beneficiaries who enrolled in
a plan with a bid that equaled the benchmark would pay the plan a
standard premium, which would equal one-quarter of the estimated cost
of providing the Part B portion of benefits and would be the same
across the nation (set by the same formula as that used under current
law for the Part B premium). Beneficiaries who chose a plan with a bid
less than the benchmark would pay a premium that was lower by the full
amount of the difference between the bid and the benchmark, and those
who chose a more expensive plan would pay a premium that was
correspondingly higher.
The benchmarks that would be used to set the federal contribution are
the defining features of the two options CBO examined:
Under the second-lowest-bid option, the benchmark in a region
would be the lower of a pair of bids--the region's second-lowest bid
submitted by a private insurer and Medicare's FFS bid.
Under the average-bid option, the benchmark in a region would be
the weighted average of all bids, including the FFS bid. Each bid would
be weighted by the proportion of beneficiaries enrolled in that plan in
the year immediately preceding.
CBO assumed that no cap would be imposed on the amount or the rate of
growth of the federal contribution and that insurers would be required
to provide coverage to all beneficiaries who selected a particular
plan.
The agency made detailed assumptions about many other specifications of
the premium support system. Some were chosen to illustrate the
potential for savings from a highly competitive system; others were
chosen for feasibility of implementation or to simplify the analytical
process. The specifications adopted for this analysis are not
recommendations, and many alternative specifications are possible.
For this analysis, CBO assumed that dual-eligible beneficiaries--people
who are simultaneously enrolled in Medicare and Medicaid--would be
excluded from the premium support system and that federal spending for
their health care would continue as it would under current law. Anyone
else who was enrolled in Medicare when the premium support system was
implemented (assumed to be 2018 for this report) would enter the system
immediately, and anyone other than dual-eligible beneficiaries who
became eligible subsequently would enroll in the new system. (See below
for a brief discussion of policy alternatives that would exclude
certain other Medicare beneficiaries from a premium support system.)
The starting date of 2018 was chosen to allow for a period during which
the federal government could develop the necessary administrative
structures and beneficiaries and insurers could learn about and prepare
for the new system.
How Would the Premium Support Options Affect Federal Spending?
CBO estimates that the second-lowest-bid option would reduce net
federal spending for Medicare by about $45 billion in 2020 and that the
average-bid option would reduce such spending in that year by about $15
billion (see Table 1). For this analysis, CBO reports those effects as
a percentage of two different measures of spending projected under
current law: net federal spending on Medicare as a whole and net
federal spending on Medicare's Part A and B benefits for beneficiaries
who would be affected by the options (that is, everyone other than
dual-eligible beneficiaries who would have enrolled in Medicare under
current law).
Net federal spending for Medicare is total Medicare spending,
including spending on dual-eligible beneficiaries and prescription
drugs covered by Part D, minus beneficiaries' premiums and other
offsetting receipts. The second-lowest-bid option would reduce that
spending in 2020 by 6 percent and the average-bid option would reduce
that spending by 2 percent, CBO estimates.
Net federal spending on Medicare Part A and B benefits for
affected beneficiaries includes amounts that would be paid for hospital
and medical benefits provided by the FFS program and private plans
under current law and the premium support options, but excludes net
spending for dual-eligible beneficiaries, Part D benefits, and certain
items and services that are not covered by the bids of Medicare
Advantage plans under current law. Beneficiaries' premiums and other
offsetting receipts are subtracted from that amount to arrive at net
spending. The second-lowest-bid option would reduce such spending in
2020 by 11 percent and the average-bid option would reduce such
spending by 4 percent, CBO estimates. Those percentages are larger than
the percentages for total Medicare spending because the savings are
measured relative to the portion of Medicare spending that would be for
the beneficiaries who are directly affected by the premium support
system rather than to total Medicare spending.
Federal savings under either option would be substantially lower over
an extended period if all current beneficiaries stayed in the existing
Medicare system and only new enrollees participated in the premium
support system.
The savings to the federal government would stem, in part, from greater
price competition. Because all plans would offer a basic benefit
package covering the same services and having the same actuarial value
and because the government's contribution within a region would not
vary from plan to plan (except to adjust for differences in the health
status of enrollees), the full difference between plans' bids would be
reflected in the premiums that enrollees would pay. Thus, the two
options would generate more price competition among private insurers
than would be the case under current law, which would induce insurers
to offer plans with lower premiums as a way to attract more enrollees.
To reduce premiums, private insurers could, for example, strengthen
utilization management (which insurers use to control costs by
influencing the quantity and type of services provided) or tighten
provider networks (that is, limit the number of providers to be covered
by a plan). In most regions, the benchmark would be lower under the
second-lowest-bid option than under the average-bid option, so the
federal contribution for a plan with a given bid would be lower, and
the premium would be higher under the second-
lowest-bid option.
Heightened price competition would probably restrain the growth of
Medicare spending over the long term by curtailing demand for costly
new technologies and treatments and by boosting demand for technologies
that reduced costs--although the magnitude of any such changes is
highly uncertain. Those effects on the growth of spending would be
larger under the second-lowest-bid option than under the average-bid
option, CBO anticipates, because the higher premiums under the second-
lowest-bid option would cause a larger fraction of beneficiaries to
choose private plans with lower bids.
Under current law, the growth of Medicare spending will be restrained
in other ways during the next two decades, thus limiting the potential
for the government to realize further savings from a premium support
system. For example, updates to Medicare's payment rates for most
providers in the FFS program are generally scheduled to be smaller than
the increases in the costs of their inputs (such as labor and
equipment), and the federal government has broad authority under
current law to make regulatory changes to expand demonstration projects
that successfully reduce spending for Medicare. How effective the
various incentives and possible administrative actions under current
law ultimately will be at restraining growth in spending, however, is
not known.
CBO estimates that the rate of growth in Medicare spending in the 2020s
under the two premium support options would be similar overall to the
rate under current law. Thus, the estimated savings relative to current
law would be roughly the same in percentage terms throughout that
period as in 2020, although the dollar amount of the savings would
increase. That estimate is subject to considerable uncertainty but, in
CBO's judgment, lies in the middle of the distribution of possible
outcomes. Beyond the next two decades, the federal savings from the
premium support system would probably increase slightly in percentage
terms, but CBO has not quantified the amounts because the uncertainties
are even greater for that longer period.
How Would the Premium Support Options Affect Beneficiaries' Premiums?
CBO estimates that the premiums that affected beneficiaries would pay
for Medicare Part A and B benefits under the second-lowest-bid option
in 2020 would be about 30 percent higher, on average, than the current-
law Part B premium projected for that year. CBO expects that much of
the increase would occur because many beneficiaries would remain in the
FFS program and pay much higher premiums than would be the case under
current law. Two-fifths of the beneficiaries who chose the FFS program
would spend at least 6 percent of their household income on premiums
for each beneficiary, CBO estimates. (For comparison, CBO estimates
that under current law about one-fifth of FFS enrollees would do so.)
In contrast, under the average-bid option, affected beneficiaries would
pay premiums that were 6 percent lower, on average, than the current-
law Part B premium in 2020. Because of the higher federal contribution,
premiums would be substantially lower under the average-bid option than
they would be under the second-
lowest-bid option. The impact of either option on premiums would vary
geographically, depending on regional differences in plans' bids.
Because CBO estimates that total Medicare spending would be reduced
under either option, and the standard premium would equal the same
share of spending that the Part B premium equals under current law, the
standard premium under either premium support option would be lower
than the current-law Part B premium. In each region, beneficiaries
would be offered at least one plan at or below the standard premium
(given the manner in which the regional benchmarks would be
calculated), and in most cases, at least one plan with a premium that
is below (not just at) the standard premium would be offered, CBO
anticipates. Beneficiaries who chose such a low-cost plan would pay a
lower premium than they would under current law. (Beneficiaries subject
to the income-related premium under current law--that is, the
additional Part B premium required of beneficiaries whose income
exceeds specified thresholds--would still be required to pay that
additional amount.)
Under both options, most beneficiaries who wanted to remain in the FFS
program would face higher premiums than they would for private plans.
In addition, in many regions, the bid for the FFS program would exceed
the benchmark, so beneficiaries who chose to remain in the FFS program
would pay higher premiums than they would under current law. Although
many beneficiaries would switch to lower-
bidding private plans, CBO estimates, a substantial proportion of
beneficiaries would still prefer to remain in the FFS program.
How Would the Premium Support Options Affect Beneficiaries' Total
Payments for Medicare Services?
CBO's analysis of beneficiaries' total payments focuses on premiums and
out-of-pocket costs for deductibles, copayments, and coinsurance for
Medicare's Part A and B benefits for affected beneficiaries. The
analysis accounts for the loss of the federally subsidized supplemental
benefits that enrollees in Medicare Advantage plans would receive under
current law (projected to average about $400 per enrollee annually in
2020), which would not be available under the options analyzed here. In
2020, beneficiaries' total payments would be about 11 percent higher,
on average, under the second-lowest-bid option and about 6 percent
lower, on average, under the average-bid option than they would be
under current law (see Table 2).
Under the second-lowest-bid option, the premiums that beneficiaries
would pay generally would be higher than current-law premiums, but out-
of-pocket costs generally would be lower than under current law because
more beneficiaries would enroll in lower-bidding private plans, which
would tend to reduce the total costs of care while maintaining the
required actuarial value. The lower out-of-pocket costs would offset
part, but not all, of the increase in premiums. (On average, according
to CBO's estimates, out-of-pocket costs would account for a higher
share of beneficiaries' total payments than premiums would, but under
the second-lowest-bid option, they would decline by a smaller
percentage than premiums would increase relative to amounts under
current law.)
Under the average-bid option, the estimated reduction in beneficiaries'
total payments results from the combination of lower average premiums
and lower out-of-pocket costs. As with the second-lowest-bid option,
the difference in out-of-pocket costs would be attributable primarily
to increased enrollment in lower-bidding private plans.
Under both options, the change in total payments for particular
beneficiaries could differ markedly from the national average. For
example, those who chose to remain in the FFS program would generally
face higher premiums and would not see a reduction in out-of-pocket
costs.
How Would the Premium Support System Affect Combined Spending by the
Government and by Beneficiaries?
The sum of net federal spending for Medicare and beneficiaries' total
payments as discussed above would be about 5 percent lower in 2020
under the second-lowest-bid option than under current law, CBO
estimates. Under the average-bid option, combined payments would be
about 4 percent lower than under current law. The estimated effects
under both options are measured as a percentage of projected net
federal spending and beneficiaries' total payments for benefits covered
by Parts A and B, in each case focusing on the beneficiaries who would
be affected by the premium support system. The second-lowest-bid option
would yield slightly more savings overall than would accrue from the
average-bid option because the smaller federal contribution under the
second-lowest-bid option would increase competitive pressure. The
federal savings under the second-lowest-bid option would be much larger
than those under the average-bid option, but beneficiaries' payments
would be higher.
What Are the Implications of a ``Grandfathering'' Provision in a
Premium Support System?
Under some premium support proposals, all beneficiaries who became
eligible for Medicare before the system took effect would remain in the
current-law Medicare program and only those who became eligible after
that time would enroll in the premium support system. Such an
arrangement would substantially reduce federal savings relative to a
system without a grandfathering provision--for an extended period--
because, in the early years, only a small portion of the Medicare
population would be covered under the new system. Moreover, because
newly eligible beneficiaries entering the system would have health care
costs that were lower than the average for Medicare beneficiaries as a
group, the potential savings would be limited even more.
CBO estimates that if a premium support system began in 2018 and
existing Medicare beneficiaries remained in the current system, only
about 25 percent of the Medicare population would be covered under the
new system after five years (assuming dual-eligible beneficiaries were
excluded), and those beneficiaries would account for only about 15
percent of net Medicare spending in total for that year under current
law (including spending for dual-eligible beneficiaries and for Part
D). After 10 years, about 45 percent of the Medicare population would
be covered, accounting for about 30 percent of net Medicare spending in
total.
Although in order to simplify the modeling, CBO decided for this
analysis not to consider grandfathering provisions, the agency expects
to complete such a study soon. A very rough approximation (made on the
basis of the estimated share of Medicare spending that would be covered
each year) suggests that federal savings after five years of operation
under a system with grandfathering would be about 15 percent of the
savings achieved if all beneficiaries other than those with dual
eligibility entered the new system in 2018; after a decade, about 30
percent of those savings would be realized.
Thus, the cumulative savings would be substantially less than would be
possible if all beneficiaries entered a premium support system
immediately. Grandfathering also would reduce, for an extended period,
the incentives to modify the development and adoption of new
technologies, so the restraint in the growth of Medicare spending that
would probably occur under a premium support system would be
substantially smaller for many years.
What Key Specifications of a Premium Support System Would Affect
Federal Spending and Beneficiaries' Payments?
On the basis of its preliminary analysis, CBO identified several
important features of premium support proposals that would
significantly affect federal spending and beneficiaries' payments:
A smaller federal contribution would yield greater federal
budgetary savings; on average, beneficiaries' premiums would be higher,
however.
Including the FFS program as a competing plan would boost
federal savings, both because the rates the program pays providers
(which generally are below rates paid by commercial plans) would serve
to hold down the rates paid by competing private insurers and because
in some regions the FFS program would be the
lowest-bidding plan and therefore could lower the benchmark relative to
what it would be otherwise.
Excluding some groups of beneficiaries from the premium support
system--say, people born before a particular year or dual-eligible
beneficiaries--would reduce federal savings; however, including certain
groups could pose additional challenges for administering the system
and could have unintended consequences for members of those groups.
(Dual-eligible beneficiaries, for example, might face limited provider
networks and complex issues of care coordination.)
Features that make beneficiaries more responsive to differences
in premiums would boost enrollment in plans with lower bids and thus
increase the incentive for plans to submit lower bids.
Many other aspects of a premium support system also would significantly
affect federal spending and enrollees' payments. CBO will continue to
develop its capacity to estimate the effects of varying those features.
Two Illustrative Options for a Premium Support System for Medicare
In designing a premium support system for Medicare, lawmakers would
confront many choices affecting federal costs, beneficiaries' payments,
and, perhaps, beneficiaries' access to care and the quality and nature
of the care that they would receive--both in the short term and over
the longer term. To project the potential effects of such a system, CBO
developed detailed illustrative specifications regarding eligibility
for the program and the timing of its implementation, the structure of
the market for Medicare benefits, and the determination of federal
contributions and beneficiaries' payments.
CBO analyzed two illustrative options, both of which would require
insurers to submit bids specifying the payment they would accept to
provide a basic package of Medicare benefits for an enrollee of average
health. Under each option, the federal contribution toward
beneficiaries' health care costs would be determined on the basis of a
benchmark set for each region of the country. The two options differ in
that under the first, determination of the benchmark would involve the
second-
lowest bid in each region; under the second, the benchmark would be set
on the basis of a weighted average of bids in the region. For this
analysis, CBO adopted a variant of the second-lowest-bid approach that
is similar to those included in several recent proposals.\1\ Under such
an approach, the benchmark would equal the lower of two bids: the
second-lowest bid from a private insurer and Medicare's FFS bid. Thus,
in any region, the benchmark could be no higher than the bid of the FFS
program. (For a summary of the program's operations under the second-
lowest-bid option, see Figure 1. The operations under the average-bid
option would be the same except for the determination of the
benchmark.)
---------------------------------------------------------------------------
\1\ See House Committee on the Budget, The Path to Prosperity: A
Responsible Balanced Budget: Fiscal Year 2014 Budget Resolution (March
2013), http://go.usa.gov/bAAV (PDF, 7 MB); Pete Domenici and Alice
Rivlin, Domenici-Rivlin Protect Medicare Act (Bipartisan Policy Center,
June 2012), http://tinyurl.com/nherwb4; and Ron Wyden and Paul Ryan,
Guaranteed Choices to Strengthen Medicare and Health Security for All:
Bipartisan Options for the Future (House Committee on the Budget,
December 15, 2011), http://go.usa.gov/bAsz.
Medicare would continue to be divided into Parts A, B, and D under both
options, and financing for federal outlays would come mostly from the
---------------------------------------------------------------------------
same sources as under current law (see Box 1).
The specifications outlined in this report are not recommendations.
Some were chosen to illustrate the potential for savings from a premium
support framework; others were chosen for feasibility of implementation
or to simplify the modeling approach. Many other variants of these
options are possible. (For additional discussion, see the section
``Implications of Key Specifications and Alternatives.'')
Eligibility and Timing
CBO assumed that dual-eligible beneficiaries would be excluded from the
premium support system and that gross federal spending for their health
care would continue as it would if current law remained in place. (In
2009, those beneficiaries made up 19 percent of the Medicare population
and accounted for 29 percent of total spending for Medicare's Part A
and Part B benefits.) \2\ CBO made that assumption because of the
additional complexity of specifying how the system would work if such
beneficiaries were included, although alternative systems could be
designed to include them. CBO did not make any explicit assumptions
about the system of care that would be in place for dual-eligible
beneficiaries, and it assumed that their exclusion from the premium
support system would not affect the number of Medicare beneficiaries
who enrolled simultaneously in Medicaid.
---------------------------------------------------------------------------
\2\ See Congressional Budget Office, Dual-Eligible Beneficiaries of
Medicare and Medicaid: Characteristics, Health Care Spending, and
Evolving Policies (June 2013), www.cbo.gov/publication/44308.
Everyone else who was enrolled in Medicare when the premium support
program took effect in 2018 would enter the new system at once, and
people who reached eligibility after 2018 (other than dual-eligible
beneficiaries) would enter the new system when they became eligible.
The Medicare Advantage program would not be available as an option
after 2017 for beneficiaries in the premium support system.
The Structure of the Market for Medicare Benefits
CBO made several assumptions about the structure of the market for
Medicare coverage, including the required scope of benefits, the
bidding process, and the process by which beneficiaries would choose a
plan.
Scope of Benefits. Under each premium support option, insurers would
offer a basic package of benefits with services and an actuarial value
that matched those provided by Medicare's FFS program under Parts A and
B. CBO assumed that hospice services and certain services provided to
beneficiaries with end-stage renal disease would not be included in the
basic benefit package and that spending for those services would
continue as it would under current law. Those services were excluded so
that the plans' benefits would be identical to those that are included
in the bids of Medicare Advantage plans under current law. That
assumption simplified CBO's modeling.
Insurers would be permitted to offer an additional package with
enhanced benefits, however, and would submit separate bids for
providing prescription drug benefits through Medicare's Part D, as
under current law. Enrollment in Part D would remain voluntary.
Bids. To simplify the choices for beneficiaries (and thereby heighten
competition based on differences in premiums), private insurers would
be allowed to submit bids for just one or two plans for the basic
Medicare package in each region. (The two plans could have different
features--offering a larger or smaller provider network, for example--
but both would need to have the same actuarial value.) Insurers would
submit bids reflecting their costs for a combined package of Part A and
Part B benefits (as insurers do for Medicare Advantage) and not
separate bids for Parts A and B. Bids would be the amount that insurers
would charge to provide care for a beneficiary of average health.
Insurers also could offer one package of enhanced benefits (with a
single, fixed higher actuarial value that would be the same for all
insurers) to go along with each basic package offered. Enrollees would
pay the full additional cost of the enhanced packages through higher
premiums. Under such rules regarding packages with enhanced benefits,
beneficiaries would find it easier to compare plans, and thus
competition would be heightened.
Bidding Regions. Regional boundaries would be determined by the
government and designed to coincide with health care markets within
states. Regions would be the same for all prospective bidders, and
insurers would be required to serve the entire regions for which they
submitted bids.
Fee-for-Service Medicare. Medicare's FFS program would act as a
competing plan. Its bid in each region would be based on the amount it
would cost the program in that region to provide care for a beneficiary
with average health as projected by the Medicare program. Support for
disproportionate-share hospitals (whose share of low-income patients
exceeds a specified threshold) and spending for medical education,
hospice benefits, and certain benefits for patients with end-stage
renal disease would be excluded from that projection. CBO assumed that
such spending would continue outside the premium support system at the
amounts projected under current law. The government's administrative
costs for the FFS program, however, would be included in the bid. The
FFS program would be required to maintain a contingency reserve fund
equal to a specified percentage of projected expenses, and if the
program's actual expenses differed from its projected expenses, future
bids would be adjusted to maintain adequate reserves. CBO assumed that
there would be no changes to current law concerning either the
mechanisms for setting the rates paid to providers or the tools
available to the FFS program to help it contain costs. As under current
law, enrollees in the program could purchase supplemental (medigap)
coverage from private insurers. CBO assumed that the same standard
medigap plans that are currently available would be available under the
two premium support options.
Coverage for Retirees. CBO assumed that employers and unions that
provide coverage for retirees who are Medicare beneficiaries would make
cash payments to their retirees to be applied toward the purchase of a
basic package offered in the bidding region, an enhanced-benefit
package (on top of a basic package) from any of the private plans in
that region, or supplemental coverage for the FFS program. In that way,
the choices of beneficiaries with retiree coverage would be the same as
those of other beneficiaries, and they would have no additional
incentives to select a particular plan (as typically occurs now when
employers pay part of the premium if retirees enroll in a plan offered
by the employer). CBO assumed that the premium support system would be
implemented so as to not affect the percentage of beneficiaries with
retiree coverage. Those assumptions simplified CBO's modeling.
Requirement Regarding Issuance. Insurers would be required to issue
insurance to all Medicare beneficiaries who applied and to charge the
same premium for all enrollees in a particular plan within a bidding
region.
Plan Selection. Beneficiaries would receive information about premiums,
cost sharing, and other plan attributes to help them compare plans.
Enrollees would choose a plan during an annual enrollment period and
would be required to remain in that plan for a year. Once beneficiaries
chose a plan, they would automatically remain in that plan in
subsequent years unless they chose a different one.
Initial Choice. Beneficiaries would not automatically remain in their
current plan when the premium support system began in 2018. In 2018 and
later years, beneficiaries who entered the premium support system and
did not make an affirmative choice for enrollment would be assigned
(with equal probability) to plans that presented bids at or below the
benchmark, including the FFS program if it met that criterion. (If more
than four plans in a region did so, beneficiaries would be assigned to
one of the four lowest-bidding plans.) After their first year in the
system, beneficiaries who were initially assigned to a plan would
remain in that plan unless they chose a different plan during a future
enrollment period or the plan to which they were assigned was no longer
one of the lowest-bidding plans in their region (in that case, the
beneficiaries would be assigned to one of the new low-bidding plans in
their region). Beneficiaries who had been assigned to a plan and then
subsequently chose another plan, as well as beneficiaries who
affirmatively chose a plan when they entered the premium support
system, would remain in that plan in subsequent years unless they chose
a different one.
Enrollment in Part A and Part B. For this analysis, CBO assumed that
enrollment in Part B would remain voluntary and that beneficiaries with
coverage under Part A or Part B (or both) could enroll in any plan
within a bidding region. Federal payments to plans for enrollees with
Part A coverage only would be reduced proportionately on the basis of
the share of total Medicare spending nationally for Part A services,
and federal payments to plans for people covered under Part B only
would be reduced in a similar manner.\3\
---------------------------------------------------------------------------
\3\ That approach to enrollment of beneficiaries who are not
enrolled in both Parts A and B of Medicare was adopted to simplify the
modeling for this analysis. In fact, including such beneficiaries in a
premium support system would raise complex issues that are not
addressed in this report.
---------------------------------------------------------------------------
Federal Contributions and Beneficiaries' Payments
CBO also made assumptions about the determination of the amounts the
federal government would pay insurers for providing Medicare coverage
and the amounts beneficiaries would pay for that coverage under the
illustrative premium support options.
Federal Contributions and Risk Adjustment. The benchmarks for setting
the federal contribution would be based on the bids for the basic
package of benefits. A benchmark would be calculated in each bidding
region for a beneficiary of average expected health. For each enrollee
of average health, the federal government would pay insurers an amount
that was equal to the regional benchmark minus the standard premium. To
compensate for a higher or lower cost implied by an individual
beneficiary's ``risk score,'' insurers would receive a larger or
smaller payment for a beneficiary whose health was worse or better than
average--as is the case under current law for Medicare Advantage and
Part D.\4\ Neither the amount nor the rate of growth in federal
payments would be capped.
---------------------------------------------------------------------------
\4\ CBO assumed that a risk adjustment mechanism comparable to that
used for the Medicare Advantage program would be used for a premium
support system. That mechanism assigns each beneficiary a risk score,
based on the person's medical conditions and demographic
characteristics, that represents the expected spending in the FFS
program relative to the national average for the Medicare population. A
beneficiary with a risk score of 1.0 has average expected spending. To
simplify the discussion, this report refers to beneficiaries with risk
scores that are less than or greater than 1 as being in better or worse
than average health--although personal characteristics other than
health also influence spending for Medicare services.
Beneficiaries' Payments. Medicare beneficiaries who joined plans with
bids that equaled the regional benchmark and were enrolled in Parts A
and B would pay the insurer a standard premium, which would be set at
25 percent of total costs for covered services in Part B (physicians'
services, hospital outpatient care, durable medical equipment, and
other services, including some home health care)--using the same
formula as that for the standard Part B premium under current law. The
premium for beneficiaries with Part A coverage only would be
proportionately smaller than the standard premium based on the share of
total Medicare spending nationally for Part A services (about half); a
similar calculation would be used to set the premium for enrollees in
---------------------------------------------------------------------------
Part B only.
Beneficiaries who joined plans with bids that were higher than the
benchmark would pay the insurers the standard premium plus the
difference between the bid and the benchmark. Those who selected plans
below the benchmark would pay the insurers the standard premium minus
the difference between the benchmark and the bid. In contrast to the
rules for the current Medicare Advantage program, insurers with bids
below the benchmark could not use such differences to enhance benefits
or reduce premiums for Part D prescription drug insurance and the
result would be heightened competition based on differences in premiums
for the basic benefit package.
For the most part, premiums would be paid directly to insurers, as is
generally the case for Part D, rather than withheld from Social
Security benefits, as is generally the case under current law for Parts
A and B. Income-related premiums for Part B specified in current law
would continue and would be withheld from Social Security benefits.
Hypothetical Examples of Determining Premiums
Several examples show how premiums would be determined under the
illustrative premium support options considered here. The hypothetical
bids for regions with high and low levels of FFS spending per
beneficiary are roughly consistent with the bids CBO has projected for
such regions under the two options. In regions where FFS spending is
high, premiums under the second-lowest-bid option would generally be
higher than those under the average-bid option because the benchmark
would be set at a low bid rather than at the average bid, and low bids
would be much lower than the average bid. In regions where FFS spending
is low, the low bids and the average bid would be closer and premiums
under the two options would be more similar.
The Second-Lowest-Bid Option. Consider a region with high FFS spending
in which the FFS program's bid in 2020 was $14,000 and the bids from
the region's five private plans were in the range of $11,000 to $11,800
(see Table 3). Under the second-lowest-bid option, the regional
benchmark would be $11,200, equal to the bid of the second-lowest-
bidding private plan. The annual premium for enrollees in that plan
would be $1,500, the standard premium nationwide. Premiums for the
other plans would differ from that amount depending on how the bids
compared with the benchmark. Because the FFS bid would be $2,800 more
than the benchmark, the premium for FFS enrollees would be $4,300
($1,500 plus $2,800). The annual premium for the lowest-bidding private
plan would be $1,300.
Next, consider a low-spending region in which the FFS program's bid was
$9,900 and the bids of the five private plans ranged from $9,300 to
$10,100. The regional benchmark would equal that of the second-lowest-
bidding private plan ($9,500), and enrollees in that plan would pay the
standard premium of $1,500. Because the bid of the FFS program would be
$400 more than the benchmark, FFS enrollees would pay an annual premium
of $1,900.
The Average-Bid Option. Consider again the high-spending region in
which the FFS bid was $14,000. The private plans' bids would be
slightly higher in this region--ranging from $11,200 to $12,000--
because the share of income that beneficiaries would spend on premiums
would be lower, on average, thus reducing the sensitivity of
beneficiaries' choice to differences in premiums and reducing
competition among plans to lower bids. As a simple example, assume
that, in the previous year, 25 percent of the people in the region
enrolled in the FFS program and 75 percent enrolled in private plans,
with an equal number enrolled in each private plan. Then the benchmark
(the enrollment-weighted average bid) would be $12,200. Under this
option, the standard premium would be $1,500 nationwide. Because the
FFS program's bid would be $1,800 more than the benchmark, the FFS
premium would be $3,300. The annual premium for the lowest-bidding
private plan would be $500 because that plan's bid would be $1,000 less
than the benchmark.
Finally, consider the low-spending region in which the FFS program's
bid would be $9,900. The bids of private plans would be about the same
as that for the second-lowest-bid option in this region, ranging from
$9,500 to $10,300. Assume that, because FFS spending is low, in the
previous year 75 percent of the region's beneficiaries enrolled in the
FFS program and 25 percent enrolled in private plans, with an equal
number enrolled in each private plan. The benchmark would be the
enrollment-weighted average bid of $9,900. Because the FFS bid would be
the same as the benchmark, the FFS premium would be the standard
premium of $1,500. The annual premium for the lowest-bidding private
plan would be $1,100.
Comparison With the Current Medicare Program
Although some aspects of a premium support system would make it similar
to the current Medicare program, there also would be significant
differences. Under both illustrative options analyzed here, insurers
would be required to provide a benefit package that encompassed the
same services that were covered under Parts A and B of Medicare (with
the few exceptions noted above) and that had the same actuarial value
as Parts A and B combined. However, under both options, the federal
contribution per beneficiary in each bidding region would be determined
prospectively each year on the basis of the bids submitted by
participating insurers. In contrast, except for Part D, federal
spending for Medicare under current law is either on a fee-for-service
basis or, in the case of Medicare Advantage enrollees, is tied to
spending in the FFS program.
Under current law, the premium paid by enrollees in the FFS program is
the same regardless of where a beneficiary lives. That premium has two
components, both for enrollment in Part B: the standard amount
(referred to in this report as the Part B premium), and the income-
related amount. Under either illustrative option, by contrast, the FFS
program would be one of the bidders, and its premium would vary by
region depending on how its bid compared with the benchmark.
Although the current Medicare Advantage program is similar in some ways
to a premium support system, several features limit the extent of price
competition among private insurers, and the FFS program is not a bidder
in Medicare Advantage. For example, benchmarks for Medicare Advantage
(which determine the maximum federal payment for an enrollee) are set
by law as a specified percentage of the average FFS spending in a given
county and are announced before insurers submit bids (see Box 1).\5\ In
contrast, benchmarks for the premium support options would be
determined from plans' bids. Another difference concerns the incentives
offered to beneficiaries to enroll in plans with lower bids. Under
Medicare Advantage, beneficiaries who enroll in a plan with a bid below
the benchmark receive some of the difference between the two, generally
in the form of additional benefits. Under the two premium support
options, by contrast, beneficiaries who enrolled in a plan with a bid
below the benchmark would receive the entire difference between the two
in the form of a lower premium.
---------------------------------------------------------------------------
\5\ This description reflects the method of determining Medicare
Advantage benchmarks that will be fully phased in by 2017. The
benchmark for each county will be set at a specified share (ranging
from 95 percent to 115 percent) of local FFS costs.
---------------------------------------------------------------------------
Effects on Federal Spending
Projecting the effects of a premium support system in the first several
years after implementation is difficult, given the substantial changes
to the Medicare program that such a system would entail, the lack of
historical experience with similar systems, the rapid evolution of
health care and health insurance, and the significant changes in the
Medicare program occurring under current law. (For additional details
about the methods used in the analysis, see Appendix A.) Projections
are even more uncertain for the period following the first several
years of implementation. One reason is that growth in Medicare
spending--and for health care more generally--has slowed markedly over
the past several years, although it is not clear how much of the
slowdown is attributable to persistent changes in the health care
system.\6\ Moreover, spending for Medicare is projected to be
restrained by provisions of the Affordable Care Act that will change
the ways and amounts that health care providers and insurers are
paid.\7\ The implications of those changes for long-term growth in
Medicare spending are difficult to assess, thus adding to the
uncertainty concerning the difference in spending that might occur as a
result of policy changes--including the adoption of a premium support
system.
---------------------------------------------------------------------------
\6\ See Michael Levine and Melinda Buntin, Why Has Growth in
Spending for Fee-for-Service Medicare Slowed? Working Paper 2013-06
(Congressional Budget Office, August 2013), www.cbo.gov/publication/
44513.
\7\ The Affordable Care Act comprises the Patient Protection and
Affordable Care Act and the health care provisions of the Health Care
and Education Reconciliation Act of 2010.
---------------------------------------------------------------------------
Effects in the First Several Years
CBO assumed that the premium support system would be implemented in
2018. This analysis reflects the assumption that dual-eligible
beneficiaries would be excluded from the premium support system and
that federal spending for their health care would continue as projected
under current law. Everyone else enrolled in Medicare in 2018 would
enter the new system in that year, and people who became eligible for
Medicare subsequently (other than dual-eligible beneficiaries) would
enter the new system. For this analysis, CBO chose 2020 as an
illustrative year shortly after implementation for which to report
results about federal spending. Additional information--both about the
bids of private plans and about the uncertainty in the estimates--
provides context for understanding those results.
In 2020, the second-lowest-bid option would reduce net federal spending
for Medicare by about $45 billion, or 6 percent, from the approximately
$700 billion projected under current law, CBO estimates (see Figure 2).
The average-bid option would reduce net spending in that year by about
$15 billion, or 2 percent, the agency estimates.\8\ Those percentage
savings were estimated relative to net federal spending on all services
covered by Parts A, B, and D, including spending on benefits for dual-
eligible beneficiaries. (The estimated savings in percentage terms were
generated using CBO's March 2012 baseline projections of Medicare
spending--because the agency's work on the estimates in this report
began in earnest in early 2012--and the estimated savings in dollar
terms were obtained by applying the percentages to the agency's latest
baseline projections of Medicare spending, which were released in May
2013.) \9\
---------------------------------------------------------------------------
\8\ This analysis presents estimated changes in net federal
spending because the allocation of financial flows to the budget
categories of gross outlays and offsetting receipts would differ from
those under current law in complicated ways. The two options would
eliminate withholding of basic premiums from Social Security benefits;
instead, beneficiaries would pay the basic premium directly to a plan.
The reduction in gross spending attributable to that change in the way
premiums were collected would be accompanied by a corresponding
reduction in the government's collections of offsetting receipts.
However, the proposals also would establish a new source of offsetting
receipts consisting of the premiums paid by beneficiaries who enrolled
in the FFS program--that is, the basic premiums plus the amount by
which the FFS program's bid exceeded the benchmark (or minus the amount
by which the benchmark exceeded the FFS program's bid).
\9\ See Congressional Budget Office, ``Medicare--March 2012
Baseline'' (March 13, 2012), www.cbo.gov/publication/43060, and
``Medicare--May 2013 Baseline'' (May 14, 2013), www.cbo.gov/
publication/44205.
The second-lowest-bid option would reduce net federal spending on Parts
A and B of Medicare in 2020 by about 11 percent for beneficiaries who
would be affected and the average-bid option would reduce such spending
by about 4 percent, CBO estimates. Those savings are larger than the
savings for net federal spending on all of Medicare because the amount
of spending to which the savings are compared is restricted here to
include only the beneficiaries and the portions of Medicare that would
be covered by the new system. (The ratios of the two estimates for each
premium support option are nearly identical, and the difference
reported here is attributable primarily to rounding.) \10\
---------------------------------------------------------------------------
\10\ The ratios also differ because of small effects on net
spending for dual-eligible beneficiaries. Although CBO assumed that
gross federal spending for dual-eligible beneficiaries would not
change, net spending would increase by a small amount relative to that
under current law because premiums for dual-eligible beneficiaries
would decrease. Those premiums would be linked to total Part B spending
in Medicare, which would decline under the premium support options.
For either option, during the first several years of a premium support
system, Medicare savings would be similar in percentage terms to the
savings estimated for 2020, with one main exception. Under the average-
bid option, the federal savings estimated for 2018 would be much
smaller than the amount estimated for 2020 in percentage terms because
the FFS bid would receive a greater weight in constructing benchmarks
in the first year of the new system than it would in later years. (CBO
assumed that the weight would equal the proportion of enrollment in the
FFS program under current law in 2017.) Thus, under the average-bid
option, most regions would have higher benchmarks in 2018 than they
---------------------------------------------------------------------------
would later.
Federal savings would be greater under the second-lowest-bid option
than under the average-bid option because the benchmarks that determine
the federal contribution would be lower. Under either option, CBO
projects, the benchmarks in most regions would be lower than the FFS
program's bid.
Although federal costs would decrease if more people declined Medicare
coverage under either option than did so under current law, CBO
projects that few people would do so. Beneficiaries would have plans
available that cost less than, or about the same as, Medicare under
current law. Also, beneficiaries who did not actively choose a plan
would be assigned to one, and CBO expects that few would choose to drop
out of the Medicare program rather than remain in an assigned plan for
the required one-year period.
Effects on Private Plans' Bids. The options' effects on federal
spending would be determined in part by how they influenced the bids of
private plans. Various factors, such as competition and the reduced
importance of the administratively determined payment rates of the FFS
program, would affect the bids that determined the benchmarks. CBO used
its projection of the bids that Medicare Advantage plans would submit
under current law as a starting point in estimating the bids of private
insurers under premium support. On net, CBO's analysis indicates that
private insurers' bids in 2020 under the two options would be below the
current-law bids for Medicare Advantage by about 4 percent, on average,
and that the differences between those types of bids would vary
regionally. That outcome would be the net result of different types of
downward and upward pressures on bids.
On the one hand, CBO expects, both options would create more
competitive pressure than the Medicare Advantage program, encouraging
insurers to reduce their costs (primarily by constraining the volume
and intensity of health care services provided and to a lesser extent
by reducing administrative costs and profits) and thus to be able to
lower their bids. The greater competition relative to the current
Medicare program would arise because insurers with lower bids would
expect to achieve larger increases in enrollment, because more Medicare
beneficiaries would choose plans affirmatively and those beneficiaries
would face larger differences in premiums among different plans. The
specification adopted for this report that insurers could submit no
more than two bids for the basic benefit package per bidding region
also would increase competitive pressure to submit lower bids, in CBO's
view. (Under the Medicare Advantage program, insurers often submit more
than two bids in their service areas.) Given the competitive structure
of the two premium support options, CBO expects that restricting
insurers to a maximum of two bids would cause insurers to eliminate
some of the higher-bidding plans that would exist under the current-law
Medicare Advantage program. Another smaller but notable force also
would tend to lower private plans' bids: The enrollees in private plans
would be healthier (on average, after accounting for characteristics
included in the risk adjustment mechanism) than enrollees in the FFS
program, and such ``favorable selection'' would occur to a greater
extent in a premium support system than under current law, CBO expects.
That relatively greater favorable selection would occur because private
plans would face greater pressure under premium support to contain
costs (for example, by narrowing provider networks), and as a result,
they would be less attractive to beneficiaries who use more health care
services than do other beneficiaries with the same risk score.
On the other hand, reductions in the share of Medicare beneficiaries
enrolled in the FFS program would cause private insurers participating
in a premium support system to pay higher rates to health care
providers. Two main mechanisms would be at work. First, although the
rates private insurers pay now under the Medicare Advantage program are
similar to those for Medicare's FFS program, CBO expects that a lower
FFS market share would reduce the importance of the FFS program's rates
in determining how much private insurers would pay providers for
treating Medicare enrollees. Second, to accommodate an influx of
enrollees, some private plans might need to expand their networks to
include health care providers who would be more costly, on average.
(CBO assumed in this preliminary analysis that all plans would be
required to serve all beneficiaries who wished to enroll.) The
resulting payment rates negotiated between insurers and health care
providers would probably rise toward commercial rates for people under
age 65 (which, adjusted for differences in average health status by
age, are generally higher than Medicare's rates), especially where the
market share of the FFS program declined substantially. However, even
in areas where the FFS market share would be very low, CBO expects, the
rates private insurers paid providers for their premium support
enrollees would be somewhat lower than the rates they would pay for
commercial enrollees under current law for several reasons: The FFS
provider payment rates would serve as a reference point for
negotiations, the competitive structure of a premium support system
would tend to constrain rates, and the commercial rates existing
alongside a premium support system would be lower because the extent to
which relatively low Medicare FFS rates led providers to charge more to
treat privately insured enrollees would abate as the FFS market share
declined.
Although CBO projects that bids would be similar under the two premium
support options, the agency expects that they would be just slightly
lower under the second-lowest-bid option than under the average-bid
option because private insurers would have a stronger incentive to bid
low under the former. However, factors that would tend to increase
private plans' bids--the reduced importance of the provider payment
rates in the FFS program and the broadening of provider networks--also
would be stronger under the second-lowest-bid option than under the
average-bid option and would partially offset the stronger incentive to
bid low.
Uncertainty in the Estimates. CBO's estimates of the effects on
Medicare spending of the two illustrative premium support options
depend on numerous parameters and other factors used in predicting the
responses of insurers, health care providers, and beneficiaries--all of
which are subject to considerable uncertainty. To characterize that
uncertainty, the agency specified ranges of values for five key
parameters in its analysis and determined the effects of varying those
parameters, focusing on estimates for 2020.\11\ The ranges for the
parameters' values were chosen to represent CBO's judgment that,
accounting not only for uncertainty about those parameters but for many
other sources of uncertainty, there would be about a two-thirds chance
that the effect on federal spending would be within the range reported
(under an assumption that the premium support system was implemented as
specified here).
---------------------------------------------------------------------------
\11\ CBO varied the following parameters to construct the ranges:
bids of Medicare Advantage plans relative to FFS spending as projected
under current law, the amount by which private insurers would reduce
their bids relative to Medicare Advantage bids under current law in
response to the increased competitive pressure created by the premium
support system, the higher rates that private insurers would need to
pay providers (with corresponding increases in bids) that CBO projects
would result if the market share of the FFS program fell significantly,
the responsiveness of beneficiaries to differences in premiums when
choosing among plans, and the percentage of beneficiaries who would not
actively choose a plan in the first year of premium support and that
therefore would be assigned to a plan with a bid at or below the
benchmark.
The results indicate that for the second-lowest-bid option, net federal
spending in 2020 on Parts A and B for beneficiaries who would be
covered under the premium support system analyzed would probably be
reduced by between 9 percent and 14 percent (CBO's central estimate is
11 percent), and for the average-bid option, federal spending would
probably be reduced by some amount between 1 percent and 7 percent (the
central estimate is 4 percent). (See Table 2.) \12\ The range is
smaller for the second-lowest-bid option mainly because a higher or
lower proportion of beneficiaries enrolled in lower-bidding plans under
that option would not directly affect the benchmarks that determined
the federal contribution. By contrast, spending under the average-bid
option would be directly sensitive to the fraction enrolled in lower-
bidding plans, and the range of estimates incorporates the greater
uncertainty from that additional factor. (For additional discussion of
factors affecting the ranges, see Appendix B.)
---------------------------------------------------------------------------
\12\ For the second-lowest-bid option, the reported range is not
symmetric about the central estimate because of rounding.
---------------------------------------------------------------------------
Effects After the First Several Years
After the initial years of a premium support system, the percentage
savings from either illustrative option would remain roughly constant
for about a decade, CBO estimates. At that point, heightened price
competition would probably reduce the growth of Medicare spending over
the long term relative to that under current law, and that effect would
probably be larger under the second-lowest-bid option than under the
average-bid option. However, the longer-term effects are even more
uncertain than are the short-term effects of a premium support system
on Medicare spending. And if other health care or health insurance
policies changed as well, the effects of such a system on spending
could differ significantly from those presented here.
Effects of the Two Illustrative Options. During the decade following
the first several years of implementation, CBO expects that the growth
in bids of private plans under either option would be close to the
growth in per capita costs in the FFS program under current law,
contributing to the roughly constant percentage savings over that
period. Over the longer term, CBO expects that the growth in Medicare
spending under the options would probably be somewhat less than the
growth of Medicare spending under current law.
The increased competition created by either option would tend to
restrain growth in Medicare spending by reducing demand for costly new
technologies and treatments and by increasing demand for cost-reducing
technologies. A crucial factor underlying the rise in spending for
health care in recent decades has been the emergence, adoption, and
widespread diffusion of new medical technologies and services.\13\
Although such advances can sometimes reduce costs, in medicine they and
the accompanying changes in clinical practice have generally had the
opposite effect. By strengthening price-based competition in Medicare,
a premium support system could change that dynamic within the program
and perhaps in the broader health care system. Moreover, relative to
outcomes under current law, the potential for cost savings from
managing utilization and limiting provider networks would be greater
under a premium support system with a larger share of Medicare
beneficiaries enrolled in private plans that have the flexibility to
manage care. The magnitude of that effect is highly uncertain, however,
and it would take a number of years before it became fully apparent.
CBO anticipates that the effect on spending would be larger under the
second-lowest-bid option--because of greater competitive pressure--than
under the average-bid option.
---------------------------------------------------------------------------
\13\ See Congressional Budget Office, Technological Change and the
Growth of Health Care Spending (January 2008), www.cbo.gov/publication/
41665.
However, the provisions of current law that will restrain growth in
Medicare spending limit the potential for additional savings to result
from a premium support system. In particular, CBO anticipates, private
insurers would not be able to hold down payments to health care
providers to the extent required in the FFS program under the
sustainable growth rate mechanism for physicians or under the
provisions of the Affordable Care Act that apply to other providers
(the consequences of those provisions are discussed below). More
generally, current law offers incentives to providers and beneficiaries
to help reduce growth in federal spending, and it allows some
flexibility for the Centers for Medicare and Medicaid Services in
managing the program. Beneficiaries' demand for Medicare services will
be constrained as the program's premiums and cost sharing consume a
larger portion of their income. For providers, whose updates to
Medicare's payment rates are generally scheduled to be smaller than the
increases in the costs of inputs, the pressure to adopt cost-reducing
procedures and technologies will be significant. Other changes in the
structure of Medicare payments to providers--such as financial
incentives to reduce hospital-
acquired infections and readmissions--also might help to constrain
federal spending.\14\ The Centers for Medicare and Medicaid Innovation,
like many state Medicaid agencies and private insurance companies and
providers, is hoping to achieve cost savings by testing promising ideas
for modifying rules and payment methods and by expanding the use of
ideas that prove effective.\15\ Whether any of the several
demonstrations currently in process will succeed and be applied more
widely is still uncertain.
---------------------------------------------------------------------------
\14\ For example, see Sarah L. Krein and others, ``Preventing
Hospital-Acquired Infections: A National Survey of Practices Reported
by U.S. Hospitals in 2005 and 2009,'' Journal of General Internal
Medicine, vol. 27, no. 7 (July 2012), pp. 773-779, http://go.usa.gov/
DbQC; and Centers for Medicare and Medicaid Services, ``Readmissions
Reduction Program,'' http://go.usa.gov/DbQW.
\15\ A list of ongoing demonstration projects is available at
Centers for Medicare and Medicaid Services, ``Innovation Models,''
http://go.usa.gov/DbQd.
Another factor limiting the potential for cost savings under a premium
support system is that the Medicare program is required by law to cover
items and services that are judged to be medically necessary and
reasonable. Private insurers participating in the premium support
options analyzed for this report would be required to cover the same
services as those covered by the FFS program. The options would cause
less restraint on the development of costly new technologies than would
be the case if private insurers (or the Medicare program as a whole)
had the authority to refuse coverage for certain services if, for
example, less costly alternatives were available that were at least as
effective. Under the options analyzed in this report, however, private
insurers would have some flexibility to reduce beneficiaries' use of
costly services through tools such as utilization management, higher
cost sharing, and exclusion of providers from an insurer's network on
the basis of practice style. By contrast, the FFS program does not have
the authority to apply such methods to influence beneficiaries' use of
services but, rather, must pay for any services that are used as long
as they meet Medicare's criteria for coverage. That feature of the FFS
program would remain in place under the two premium support options and
might limit the extent to which either option could reduce the growth
in Medicare spending. (Removing the FFS program as a competitor in the
premium support system would tend to push up Medicare spending in other
---------------------------------------------------------------------------
ways, as discussed earlier.)
In quantifying the effects of the illustrative premium support options
relative to outcomes under current law, CBO recognized that current law
provides for three approaches to restraining cost growth in Medicare
that could be difficult to sustain over the long term: the ongoing
reductions in payment updates for most providers in the FFS program,
the sustainable growth rate mechanism for payment rates for physicians,
and the process associated with the Independent Payment Advisory
Board.\16\ It is unclear whether the long-term restraint of Medicare
spending envisioned to occur through those provisions can be
accomplished through greater efficiency in the delivery of health care
or whether it would lead to reductions in beneficiaries' access to care
or the quality of care they received. Accordingly, CBO's extended
baseline reflects the assumption that the growth rate of Medicare
spending after 2029 will not be affected by those provisions but that
the percentage reduction in Medicare spending in 2029 achieved through
those provisions will continue in later years.\17\ In the analysis in
this report, CBO anticipates that beneficiaries will respond to
concerns regarding access and quality in the FFS program by showing
some additional preference for private plans relative to the FFS
program when payment rates for providers in private plans increase
relative to those paid by the FFS system.
---------------------------------------------------------------------------
\16\ Before the enactment of the Affordable Care Act, payment
updates for most providers (except for physicians, whose payments have
been controlled by the sustainable growth rate mechanism since 1998)
generally were set to equal the estimated percentage change in the
average cost of providers' inputs. Under current law, however, the
updates will equal those percentage changes in costs minus the 10-year
moving average of growth in productivity in the economy overall--a
measure that seeks to capture, for the economy as a whole, how much
more output is produced from a given amount of inputs. Under current
law, payment rates for physicians' services in Medicare will be reduced
by about 25 percent in January 2014 and, CBO projects, will be
increased by small amounts in most subsequent years. The Independent
Payment Advisory Board will be required to submit a proposal to reduce
Medicare spending in certain years if the rate of growth in spending
per enrollee is projected to exceed specified targets.
\17\ For more discussion, see Congressional Budget Office, The 2012
Long-Term Budget Outlook (June 2012), pp. 56-57, www.cbo.gov/
publication/43288.
Under the assumptions of its extended baseline, CBO anticipates that
growth in Medicare spending per beneficiary (after removing the effects
of demographic changes on health care spending--in particular, changes
in the population's age distribution) would exceed growth in spending
per beneficiary for all forms of private health insurance combined
because the private sector has more flexibility to respond to the
pressures created by rising health care spending than administrators of
Medicare have under current law. The growth rate of federal spending
for Medicare under the two illustrative premium support options--which
involve a mixture of features of Medicare and private health
insurance--would probably be lower than that for the existing Medicare
---------------------------------------------------------------------------
program but above that for private health insurance.
Uncertainty in the Estimates. Estimates of the longer-term effects of
the premium support options on Medicare spending are subject to the
same sources of uncertainty that are described above for the shorter-
term effects, but the magnitude of the uncertainty is increased by the
longer time horizon. Uncertainty in projecting federal spending for
Medicare over the long term under current law adds to the uncertainty
of such estimates.
In particular, CBO's assessment--that the growth rate of federal
spending for Medicare under the two options would probably be lower
than that for the existing Medicare program but above that for private
health insurance--is highly uncertain. It is possible, for instance,
that over the long term, the bargaining power of health care providers
relative to private insurers could increase to such an extent that
spending growth under the options would exceed that for the existing
Medicare program. Alternatively, private health insurers could be more
successful than CBO projects in developing processes for delivering
care in ways that would reduce costs, in which case spending growth
under the options could be further below that for the existing Medicare
program than CBO anticipates.
Effects of Modifying the Illustrative Premium Support Options or of
Combining a Premium Support System With Other Changes to Medicare. The
longer-term effects of the two illustrative options on Medicare
spending could differ significantly from the estimates presented here
if either option was modified or if policies for setting payment rates
in the FFS program were revised. For example, imposing a cap on federal
contributions under a premium support system could have an important
effect on federal savings, and changes in the way provider payment
rates in the FFS program were set could have complex interactions with
a premium support system. Although CBO has not estimated the
consequences of such policies, the following observations provide some
relevant information.
Effects of a Cap on Federal Contributions. The effects of a cap on
federal contributions under a premium support system would depend in
part on how the cap was specified. CBO expects that if a premium
support system limited the growth rate of federal contributions per
beneficiary to match the growth of gross domestic product (GDP) per
capita plus, say, 1.5 percentage points per year, in most years such a
cap probably would not be binding. Under last year's extended baseline,
which largely follows current law and which CBO used for the analysis
in this report, the agency projected that the growth rate of Medicare
spending per beneficiary between 2020 and 2032 (after adjusting for
demographic changes) would be, on average, 0.8 percentage points
greater than the growth rate of GDP per capita.\18\ As a result of the
offsetting factors just described, CBO estimates that the growth rate
for Medicare spending during those years under both premium support
options would be similar to that under current law.
---------------------------------------------------------------------------
\18\ See Congressional Budget Office, The 2012 Long-Term Budget
Outlook (June 2012), www.cbo.gov/publication/43288.
A cap of per capita GDP plus 1.5 percentage points could be binding
regularly, however, if CBO's long-term projection underestimates growth
in Medicare spending. And that cap could be binding in some years but
not in others even if the projection is generally accurate because of
volatility in the growth of health care costs and GDP. Moreover, the
prospect of a cap's taking effect could alter the behavior of insurers
in any year, thus increasing or decreasing the likelihood that such a
cap would take effect. The effects of a cap would also depend on the
details of how it was specified and enforced. For the current report,
CBO has not attempted to estimate the effects of imposing a cap on
---------------------------------------------------------------------------
federal contributions.
Effects of Alternative Policies for Setting Payment Rates for Providers
in Fee-for-Service Medicare. Under CBO's extended alternative fiscal
scenario (included in The 2012 Long-Term Budget Outlook), the reduced
payment updates would expire and the Independent Payment Advisory Board
process would cease to be effective after 2022, and payments to
physicians would be maintained at 2012 rates rather than declining as
scheduled. Under that scenario, CBO projected, net Medicare spending in
2030 would be about 0.5 percent of GDP higher than it would be under
CBO's extended baseline. CBO has not estimated the effects of combining
a premium support system with the changes to current law that are
assumed under its extended alternative fiscal scenario.
Instead, if current-law policies restraining cost growth were retained
through the 2030s or longer, then spending in the existing Medicare
program would be below that projected under CBO's extended baseline.
CBO has not estimated the long-term effects of a premium support system
under such restraints either.
Effects on Beneficiaries' Premiums
The premiums that beneficiaries would pay under the two premium support
options would depend on the premiums charged by the plans in their
region and on the beneficiaries' choice of plan. Under each option, at
least one plan would be available in every region that charged the
standard premium or less, and in most regions other plans would be
available that charged premiums that were higher or lower than that
amount (depending on whether the bid was above or below the benchmark).
For each option, CBO estimated the premiums that would be charged by
the array of plans offered, and the agency summarized that information
by estimating the average premiums charged by three plans--the second-
lowest-bidding private plan in the region, the median-bidding private
plan (that is, the plan with a bid in the middle of the distribution
among private plans), and the FFS program. To arrive at the average
premium charged by each plan, CBO computed a weighted average of
region-specific premiums, with each region weighted by the proportion
of affected beneficiaries.
CBO next estimated the premiums that beneficiaries would pay under each
option by estimating their choice of plan, based on the differences in
the premiums charged and on beneficiaries' sensitivity to those
differences. For that analysis, CBO computed a weighted average of the
premiums charged, weighting plans by the number of beneficiaries each
one enrolled. CBO compared average premiums charged by plans and
average premiums paid by beneficiaries with the Part B premium under
current law.
Background on Premium Determination
Under either premium support option analyzed in this report,
beneficiaries would pay the standard premium if they chose a plan with
a bid that was equal to the regional benchmark. That premium would be
the same everywhere in the country and would be determined by the same
formula used under current law for the Part B premium: The federal
government allocates spending under Medicare Advantage to Parts A and B
on the basis of the share of total spending in the FFS program for Part
B services and then sets the Part B premium equal to 25 percent of all
Part B spending, divided by the number of beneficiaries. In this
report, the standard premium equals 25 percent of the estimated amount
of total Medicare spending attributable to Part B services under a
premium support system.
Under current law, the Part B premium will be $1,600 in 2020, CBO
projects. Because total Medicare spending would be slightly less than
it would be under current law under either premium support option, CBO
estimates, the standard premium for each would be slightly lower than
the Part B premium under current law--$1,500 per year under either
option. (All estimates of annual premiums in this report are rounded to
the nearest $100; although CBO projects that the standard premium under
the average-bid option would be higher than that under the second-
lowest-bid option, those amounts round to the same number.)
If a beneficiary chose a plan with a bid that differed from the
regional benchmark, the premium would depend on the plan chosen.
Someone who enrolled in a plan with a bid above the benchmark would pay
the standard premium plus the amount by which the plan's bid exceeded
the benchmark, and someone who enrolled in a plan with a bid below the
benchmark would pay a correspondingly lower premium. CBO expects that,
depending on how bidding regions were defined, there might be some
sparsely populated regions in which no private plans would participate
under either option. In those regions, the FFS program would be the
only plan available, and beneficiaries who enrolled in the program
would pay the standard premium.
CBO focused on standard premium amounts that did not include income-
related adjustments. In addition, the agency analyzed premiums only for
the basic package of Medicare benefits, excluding additional amounts
that enrollees in private plans might pay for enhanced benefits or that
enrollees in the FFS program might pay for supplemental coverage.
Enrollees in private plans under the options would forgo the federal
subsidies for supplemental benefits that would be provided by many
Medicare Advantage plans under current law. CBO estimates that the
annual value of those supplemental benefits (under current law) will be
about $400, on average, per Medicare Advantage enrollee in 2020. The
loss of those subsidies would make private plans less attractive under
the options, all else being equal. For this analysis, CBO compared
premiums for both options with the $1,600 current-law premium projected
for Part B. The agency did not make any adjustment in that analysis for
the loss of supplemental benefits under the Medicare Advantage program.
Those forgone benefits are included in the analysis presented below
concerning the effects of the two options on beneficiaries' total
payments.
Premiums by Region. The range of premiums around the standard premium
would vary geographically. CBO's analysis focused on four groups of
regions--ranked from highest to lowest average FFS spending--with equal
numbers of beneficiaries in each group. In regions with high FFS
spending, CBO estimates, the bid for the FFS program would be higher
than the private plans' bids and higher than the benchmark under either
option. Medicare beneficiaries enrolled in the FFS program in such
regions tend to use certain health care services at a higher-than-
average rate, so private plans would have greater potential to achieve
savings relative to the FFS program by reducing that use. In contrast,
CBO estimates, the FFS program's bid would be similar to or lower than
the bids of private plans in many regions with low FFS spending. People
enrolled in the FFS program in those regions tend to use less care, so
private plans would have less potential to achieve savings by reducing
the quantity of care; savings from reducing the price of care also
would be difficult to achieve because of the restraints in provider
payment rates that are scheduled for the FFS system under current law.
Thus, the range of premiums would be narrower in regions with low FFS
spending.
Premiums for Beneficiaries Who Do Not Actively Choose a Plan. CBO
projects that many beneficiaries would not actively choose a plan in
the first year of a premium support system--perhaps because they were
unaware of the new system, did not understand how to enroll, were
hampered by a health problem, or for some other reason. Under the
options considered for this report, beneficiaries who did not choose a
plan would be assigned to a plan with a bid at or below the benchmark.
CBO projects that about 15 percent of beneficiaries would not choose a
plan in the first year of premium support under the second-lowest-bid
option and about 20 percent would not choose a plan in the first year
under the average-bid option.\19\ Those beneficiaries would pay
premiums less than or equal to the standard premium, but there would be
no guarantee that the assigned plan would include all of their current
providers.
---------------------------------------------------------------------------
\19\ CBO expects that some beneficiaries who were assigned to a
low-bidding plan in the first year would later switch to the FFS
program or to another plan that would have, on average, a higher
premium.
Under an alternative approach, which CBO has not yet analyzed,
beneficiaries who did not make a choice would remain in the plan most
similar to their current plan (or be transferred to the FFS program if
a similar plan was no longer available). In particular, beneficiaries
who had been in the FFS program when the premium support system began
would remain in that program unless they chose a private plan. In that
sort of system, FFS beneficiaries would retain access to their current
providers but, depending on the region, their premiums could be
substantially higher. In addition, insurers would have less incentive
to reduce their bids because they would anticipate that being a lower-
bidding plan would result in a smaller gain in enrollment than they
would achieve if all beneficiaries were required to affirmatively
choose a plan.
Premiums Charged by Plans in 2020
Under either illustrative premium support option, CBO anticipates,
beneficiaries would be offered at least one plan at or below the
standard premium and most people would have access to at least one
other plan with a premium below that amount. In most regions, the plans
with premiums at or below the standard amount would be private.
Overall, CBO estimates, the premiums charged by plans would generally
be lower under the average-bid option than under the second-lowest-bid
option because the benchmarks would be higher under the average-bid
option, so the federal government would contribute more for each plan.
The Second-Lowest-Bid Option. Under this option, CBO estimates, the
average premium for the second-lowest-bidding private plan across all
regions would be about $1,500 per year in 2020, or 6 percent below the
Part B premium projected under current law for that year (see Table 4).
In regions with low FFS spending, however, the premium for the second-
lowest-bidding private plan would tend to be higher than in other
regions because of the role of FFS spending in determining the
benchmark. Specifically, in some regions with low FFS spending, the bid
for the FFS program would be lower than that of the second-lowest-
bidding private plan, so the FFS program's bid would become the
benchmark, and the premium for the second-lowest-bidding private plan
would be above the standard amount. CBO estimates that the average
premium for the second-lowest-bidding private plan would be $1,600 in
regions with the lowest FFS spending (see Figure 3).
The average premium for the median-bidding private plan available would
be $1,800 in 2020 under the second-lowest-bid option, CBO estimates.
That amount would be 13 percent above the current-law Part B premium.
The average premium for the FFS program under the second-lowest-bid
option would be about $3,100, or almost twice the projected Part B
premium under current law, CBO estimates. That increase would occur
because, in most regions, the FFS program's bid would be substantially
above that of the second-lowest-bidding private plan, and thus the bid
for the latter would become the benchmark. The premium for the FFS
program would be highest in regions with the highest average FFS
spending. CBO estimates that in those regions, the average premium for
the FFS program would be $4,600, or almost triple the projected
current-law Part B premium. Even in regions with the lowest FFS
spending, the average FFS premium would be $1,900, or almost 20 percent
above the projected current-law Part B premium. (In some regions, the
FFS program's bid would be lower than that of the second-lowest-bidding
private plan, and the premium would equal the standard premium.)
The Average-Bid Option. Premiums would generally be lower under the
average-bid option than under the second-lowest-bid option. For the
second-lowest-bidding private plan, the national average premium in
2020 would be $900 under the average-bid option, CBO estimates--more
than 40 percent below the projected current-law Part B premium for that
year. That amount would be less than the premium for that plan under
the second-lowest-bid option because, in most areas, the benchmark
would be higher and the plan's bid would be below the benchmark, which
determines the government's contribution. Under the average-bid option,
the average premium of the second-lowest-bidding private plan would be
the smallest (at $600) in regions with the highest FFS spending because
that plan's bid would be lower relative to the benchmark (which would
be influenced by the bids of the FFS program and the higher-bidding
private plans). The average premium of the second-lowest-bidding
private plan would be substantially greater (at $1,400) in regions
where FFS spending is lowest because, in most of those areas, that
plan's bid would be close to the bid of the FFS program.
For the median-bidding private plan, CBO estimates that the average
premium would be $1,200. That amount would be 25 percent below the
current-law Part B premium in 2020.
The FFS program's bid under the average-bid option would be above the
benchmark in most areas. CBO estimates that the national average
premium for the FFS program would be $2,400, 50 percent higher than the
projected current-law Part B premium.
Premiums Paid in 2020
The average premiums that beneficiaries would pay under a premium
support system would depend not only on the premiums charged by plans
as just discussed, but also on the plans beneficiaries chose to enroll
in. Under the second-lowest-bid option, CBO estimates, the average
annual premium paid by beneficiaries in 2020 would be $2,100--about 30
percent higher than the current-law Part B premium for that year (see
Figure 4). Under the average-bid option, CBO estimates, the average
premium paid by beneficiaries in 2020 would be $1,500, or 6 percent
below the
current-law Part B premium.
The Second-Lowest-Bid Option. CBO estimates that about half of the
beneficiaries included in the premium support system would enroll in
private plans under the second-lowest-bid option and about half would
enroll in the FFS program. The average premium paid by beneficiaries
for private plans across all regions would be $1,800 and the average
premium paid for the FFS program would be $2,500. The percentage of
household income that beneficiaries would spend on the premium for the
FFS program would vary substantially. The premium for the FFS program
would amount to less than 2 percent of household income for about one-
fourth of enrollees in that plan and to 6 percent or more for about
two-fifths of the plan's enrollees. In comparison, under current law
that premium would amount to less than 2 percent of household income
for about two-fifths of beneficiaries in the FFS program and to 6
percent or more of household income for about one-fifth of
beneficiaries in that program. (Those estimates focus on the standard
premium and, in the case of premium support, on any reduction or
increase in that premium that would result when a beneficiary enrolled
in a plan with a bid below or above the benchmark. The estimates do not
include amounts paid for the income-related premium.)
Under the second-lowest-bid option, average premiums would vary
regionally. Beneficiaries in regions with the highest FFS spending
would pay an average of $2,300 (compared with the nationwide average of
$2,100). The higher average premium estimated for the regions with
highest FFS spending is largely a reflection of CBO's estimate that
about one-fifth of the beneficiaries would enroll in the FFS program.
In those regions, roughly half of all beneficiaries enrolled in the FFS
program would spend at least 6 percent of their household income on the
FFS premium. Beneficiaries in regions with the lowest FFS spending
would pay an average premium of $1,800, according to CBO's estimates.
About 80 percent of beneficiaries in regions with the lowest FFS
spending would enroll in the FFS program.
The Average-Bid Option. CBO estimates that slightly fewer than half of
all beneficiaries would enroll in private plans under the average-bid
option in 2020 and slightly more than half would enroll in the FFS
program--proportions that are similar to those CBO projects for the
second-lowest-bid option.\20\ For all regions combined, the average
premium paid by beneficiaries in the FFS program would be $2,000 and
the average premium paid by enrollees in private plans would be $1,000,
compared with $2,500 and $1,800, respectively, under the second-lowest-
bid option.
---------------------------------------------------------------------------
\20\ Two opposing considerations led CBO to project similar--but
not identical--enrollment patterns for the two options. In most
regions, the FFS premium would be higher relative to private plans'
premiums under the second-lowest-bid option than under the average-bid
option. That difference would arise because the second-lowest bid would
be lower than the average bid, resulting in a larger gap between the
federal contribution and FFS costs under the second-lowest-bid option.
As a result, enrollment would tend to be higher in private plans under
the second-lowest-bid option. CBO expects, however, that the prospect
of paying higher premiums under the second-lowest-bid option would
prompt more beneficiaries to choose a plan in the first year of the
program. Thus, a smaller proportion of beneficiaries would be assigned
to a plan at or below the benchmark, and that would tend to decrease
enrollment in private plans under the second-lowest-bid option.
Under the average-bid option, the average premium would be
approximately equal for beneficiaries in all four groups of regions
classified by FFS spending, CBO estimates. Where FFS spending is
highest, the estimated $1,500 average premium reflects the anticipated
choice of some beneficiaries to enroll in private plans with bids below
the benchmark (about three-fourths of that group; their average premium
would be less than $1,500) and of others to enroll in the higher-
bidding FFS program (about one-fourth; their average premium would be
more than $1,500). In areas with the lowest FFS spending, the $1,500
average premium reflects much smaller differences between the bids of
private plans and the FFS program. In those regions, about three-
fourths of beneficiaries would enroll in the FFS program, by CBO's
estimate.
Effects on Beneficiaries' Total Payments
CBO has estimated the effects of the two illustrative premium support
options on beneficiaries' total payments for covered services. The
total consists of premiums and out-of-pocket payments for deductibles,
coinsurance, and copayments. In this analysis, out-of-pocket payments
include all such obligations for beneficiaries, whether paid directly
by beneficiaries or covered by supplemental insurance.\21\ The premiums
included in CBO's estimates are the average premiums that beneficiaries
would pay as presented above and are based on CBO's projections of the
distribution of beneficiaries among plans. Income-related premiums for
Part B also were included in the total payments the agency estimates
under current law and for both options. In addition, the estimates
account for the value of the forgone federally subsidized supplemental
benefits that would have been available to enrollees in Medicare
Advantage plans under current law but that would not be available under
the two options. As discussed below, the estimated effects of the two
premium support options on beneficiaries' total payments are subject to
considerably greater uncertainty than are the estimated effects on
federal spending and the premiums charged by plans.
---------------------------------------------------------------------------
\21\ This report does not provide estimates of the total effects of
the premium support options on beneficiaries' payments for Medicare
services because the analysis did not include premiums that
beneficiaries would pay for supplemental coverage. (CBO has not yet
modeled such coverage as part of a premium support system.) However, by
including total out-of-pocket costs for Medicare services, whether paid
by the beneficiary or by supplemental insurance, the analysis captures,
in the aggregate, most of the costs beneficiaries would incur for
premiums for supplemental insurance.
---------------------------------------------------------------------------
Effects in 2020
CBO estimates that beneficiaries' total payments in 2020 would be about
11 percent higher, on average, under the second-lowest-bid option than
they would be under current law. The premiums paid by beneficiaries
would be higher, on average, than under current law, but beneficiaries'
out-of-pocket costs would be lower--even though the actuarial value of
the Medicare benefit would be unchanged--because of a decline in the
total cost of covered services, which would be a result primarily of
greater enrollment in lower-bidding private plans.\22\ (On average, a
larger share of beneficiaries' total payments is in out-of-pocket costs
than in premiums, so, in the calculations of the change in total
payments, the percentage change in out-of-pocket costs receives a
greater weight than the corresponding change in premiums.) The
projected savings in out-of-pocket costs would offset part, but not
all, of the increase in premiums.
---------------------------------------------------------------------------
\22\ CBO expects that lower-bidding plans would generally have
lower rates of health care utilization. As a result, enrollees would
pay less out of pocket than they would with higher-bidding plans. Under
the options in this report, the actuarial value of all plans would
match the value of current-law Medicare; that is, every plan would
cover the same percentage of the total expenses of a given population
that is covered by the current Medicare benefit package. For general
information on the actuarial value of health plans, see Chris L.
Peterson, Setting and Valuing Health Insurance Benefits, Report for
Congress R40491 (Congressional Research Service, April 6, 2009).
CBO's analysis implies that beneficiaries' total payments would be
about 6 percent lower, on average, under the average-bid option than
under current law. That reduction results from the combination of the
lower average premiums paid discussed above and a reduction in average
out-of-pocket costs, which would result primarily from higher
---------------------------------------------------------------------------
enrollment in lower-bidding private plans.
Under both options, the effect on total payments for particular
beneficiaries could differ greatly from the nationwide average and
would depend partly on the region and the choice of plan. In
particular, beneficiaries who chose to remain in the FFS program would
generally face higher premiums and would not experience a reduction in
out-ofpocket costs.
Uncertainty in the Estimates
To characterize the uncertainty of the estimated effects of the options
on beneficiaries' total payments, CBO applied the same type of analysis
reported above for the effects of the premium support options on
federal spending. Specifically, it varied the same five parameters,
with ranges chosen to generate lower and higher estimates of the
effects on beneficiaries' payments for each option. In CBO's judgment,
there is a two-thirds chance under the second-lowest-bid option that
beneficiaries' total payments in 2020 would, on average, be within a
range extending from a reduction of 2 percent to an increase of 24
percent relative to payments under current law (CBO's central estimate
is that total payments would increase by 11 percent). For the average-
bid option, the corresponding range of likely average effects on
beneficiaries' total payments extends from no effect to a reduction of
12 percent (the central estimate is a reduction of 6 percent.) (See
Table 2.) The range under the average-bid option is narrower than that
under the second-lowest-bid option mainly because the changes in
beneficiaries' premiums from varying those parameters are smaller under
the average-bid option and because the variation in responsiveness to
smaller changes in premiums results in a smaller range of effects on
total payments. (For additional discussion of factors affecting the
ranges, see Appendix B.)
Beneficiaries' total payments would be unlikely to rise, on average,
under the
average-bid option relative to those under current law, for two main
reasons. First, because use of health care services tends to be higher
for enrollees in the FFS program than for those in private plans, out-
of-pocket costs would probably be lower under the average-bid option
than they would be under current law as long as the percentage of
beneficiaries in the FFS program did not increase. According to CBO's
central estimates, the share of beneficiaries in private plans would be
about 20 percentage points greater than under current law, and a
reduction in that share would be unlikely. Second, average premiums
paid under the option would be closely tied to the standard premium,
which would be set using the same formula as the Part B premium under
current law, so those average premiums would not differ greatly from
the Part B premium. And even if premiums were slightly higher under the
average-bid option than under current law, the effect probably would
not offset the decline in out-of-pocket costs.
Effects on Combined Federal Spending and Beneficiaries' Total Payments
The combined payments of the federal government and beneficiaries
constitute the total amount paid for health care services covered by
Medicare. They consist of the federal government's payments to plans,
beneficiaries' premiums, and beneficiaries' out-of-pocket payments. CBO
estimates that those payments would be about 5 percent lower under the
second-lowest-bid option and about 4 percent lower under the average-
bid option than they would be under current law. Those percentages are
a combination of the effects on net Medicare spending and on
beneficiaries' total payments discussed above.
CBO expects that the decrease in combined payments would probably be
slightly larger under the second-lowest-bid option than under the
average-bid option mainly because the former would result in lower bids
by private plans and a larger share of beneficiaries enrolled in those
plans. CBO did not quantify the uncertainty of those estimates but it
did reach two conclusions about ranges that would cover two-thirds of
the possible outcomes for the two options: First, such ranges would
clearly overlap; that is, CBO is not confident that combined payments
under the second-lowest-bid option would be lower than combined
payments under the average-bid option. Second, based on the separate
ranges for federal spending and for beneficiaries' total spending,
ranges for combined payments would extend only over reductions in
payments; that is, it is likely that either option would result in
reductions in combined federal spending and beneficiaries' total
payments.
The sum of federal spending and beneficiaries' payments examined here
is a significant component of total national spending on health care,
and this analysis suggests that total national spending would probably
decline under either of the two illustrative premium support options.
However, a premium support system would interact with other parts of
the health care system in complex ways that CBO has not quantified.
Comparison With CBO's Previous Analyses of a Premium Support System
CBO has previously estimated the budgetary effects of revamping
Medicare as a premium support system.\23\ But those earlier analyses
were limited in at least two key respects: They did not include
detailed modeling of beneficiaries' choices among alternative insurance
plans, and they did not include detailed modeling of insurers' behavior
regarding bids or payments to health care providers. Thus, none of
those analyses captured the full effects of a competitive system on
federal spending or payments by beneficiaries. The analysis in this
report incorporates such modeling. In addition, this report differs
from some previous analyses by CBO in considering different
illustrative options for a premium support system instead of a specific
proposal.
---------------------------------------------------------------------------
\23\ For example, see Congressional Budget Office, The Long-Term
Budgetary Impact of Paths for Federal Revenues and Spending Specified
by Chairman Ryan (March 2012), www.cbo.gov/publication/43023; Long-Term
Analysis of a Budget Proposal by Chairman Ryan (attachment to a letter
to the Honorable Paul Ryan, April 5, 2011), www.cbo.gov/publication/
22085; Budget Options, Volume 1: Health Care (December 2008), pp. 120-
121, www.cbo.gov/publication/41747; and Designing a Premium Support
System for Medicare (December 2006), www.cbo.gov/publication/18258.
The treatment in this report is substantially different from the rough
analysis of a specific premium support proposal published by CBO in
April 2011. Not only have there been substantial improvements in CBO's
modeling of the behavior of beneficiaries and insurers, but the options
examined in this report differ in important ways from that earlier
proposal. For example, the earlier proposal included a grandfathering
provision, and CBO estimated that only 4 percent of Medicare spending
in 2022 would be accounted for by premium support payments under that
proposal. The proposal also specified a federal contribution that was
initially fixed (rather than determined through bidding) and that would
keep pace with the consumer price index for all urban consumers (at a
rate that CBO estimated would be substantially slower than the rate of
growth in Medicare spending under current law). Moreover, because of
the simple formula for determining federal spending in that proposal,
CBO projected such spending over a longer period than it does in this
---------------------------------------------------------------------------
report.
CBO's estimates of the total payments by beneficiaries and of combined
federal spending and beneficiaries' payments for the 2011 proposal were
much higher than the estimates for the two options in this report
primarily because CBO projected for that earlier report that health
care spending covered by private plans would be much higher initially
and would grow faster than the agency currently estimates. The
difference arose from two main factors: First, the earlier proposal did
not include the Medicare FFS program as a bidding plan in the premium
support system. Because that program was not present to put downward
pressure on the rates paid to providers by private insurers, CBO
projected, the premiums of private plans would be substantially higher
than they would be under the premium support options discussed in this
report. Second, more recent information has led CBO to make a downward
revision in its projections of the future growth rate of private health
insurance premiums.\24\
---------------------------------------------------------------------------
\24\ See Congressional Budget Office, Updated Estimates for the
Insurance Coverage Provisions of the Affordable Care Act (March 2012),
www.cbo.gov/publication/43076.
---------------------------------------------------------------------------
Implications of Key Specifications and Alternatives
Although policymakers would need to determine many specific
characteristics of a premium support system, several choices would be
particularly important from a federal budgetary perspective: setting
the formula for the government's contributions, determining whether the
traditional FFS program would be included as a competing plan, setting
rules of eligibility for the system, delineating bidding regions, and
designing the program features that would influence beneficiaries'
choice of a plan. Policymakers would also need to address many other
design and operational issues to implement such a system.
Note again that the illustrative premium support options analyzed here
are anchored in basic features of the current Medicare system: Both
would guarantee insurance for all beneficiaries; adjust payments to
private insurers to account for the health of their enrollees (that is,
use risk adjustment); and, under what is called community rating,
require that insurers charge everyone in a region the same premium for
the same coverage. Changes to those features also could have important
consequences for a premium support system.
In addition, changes in the broader health care and health financing
systems would affect a premium support system and change the way it
affected federal spending and beneficiaries' payments. For example, if
more people outside of the Medicare market purchased health insurance
plans with narrower networks of providers and lower premiums than CBO
expects under current law, the willingness of Medicare beneficiaries to
purchase similar plans in a premium support system would probably
increase--although the opposite could occur if people's experiences
with those plans left them dissatisfied. Legislative changes affecting
the broader health care market also could have consequences for the
effects of a premium support system in Medicare. For instance,
repealing the tax exclusion for employment-based health insurance would
heighten pressure to restrain the growth of health care costs outside
of Medicare. The resulting changes in practice patterns of health care
providers would probably decrease private plans' bids under a premium
support system, although CBO has no basis for estimating the magnitude
of such an effect.
Federal Contributions
In this analysis, CBO focused on two possible approaches to determining
federal contributions, but many other methods could be used. For
example, capping the growth rate of federal contributions could
generate additional federal savings relative to an uncapped proposal,
although CBO has not yet estimated the effects of such a cap. In
general, federal budgetary savings would increase as federal
contributions declined, but beneficiaries' premiums would be higher.
The Fee-for-Service Program
CBO assumed that Medicare's FFS program would continue to be offered
within the premium support options analyzed here. If, instead, the FFS
program was eliminated, the savings produced for the government under a
premium support system would be less (or federal spending could be even
more than under current law) because the rates that private insurers
would pay health care providers for treating Medicare enrollees would
probably be higher than CBO estimates for either premium support
option. In general, the rates that private insurers now pay providers
for Medicare Advantage enrollees are similar to those Medicare pays
under the FFS program but substantially below the rates paid for
enrollees who are in commercial plans and are not Medicare
beneficiaries.
CBO anticipates that competition from the FFS program within a premium
support system would constrain the rates that private insurers paid for
premium support enrollees in the same way that the FFS program now
appears to constrain the rates that insurers pay for Medicare Advantage
enrollees. If a system did not offer the FFS program as a choice, the
result probably would be higher payment rates, higher bids, and higher
costs for the government. CBO also expects that, under the options
analyzed here, in some regions the FFS program would submit the lowest
bid, so eliminating the program would directly reduce federal savings
by raising the benchmark in those regions.
Eligibility
If fewer people were included in a premium support system, federal
savings generally would be lower, all else being equal. For this
analysis, CBO assumed that the premium support systems would not
include a grandfathering provision (thus including more beneficiaries
than if such a provision were part of the system) and would exclude
dual-eligible beneficiaries.
A Grandfathering Provision. Under some premium support proposals, all
beneficiaries who became eligible for Medicare before the system took
effect would remain in the current-law Medicare program and only those
who became eligible after that time would enroll in the premium support
system. Several important questions would arise about the structure of
such a program (see Box 2). Clearly, however, grandfathering some
beneficiaries would limit the savings that could be achieved over an
extended period because only a subset of the Medicare population would
enroll in the new system and (because the grandfathered beneficiaries
would be older) the cost of health care for the eligible population
would tend to be lower than average.
CBO estimates that if a premium support system implemented in 2018
excluded beneficiaries who entered the program before 2018 and dual-
eligible beneficiaries, only about 25 percent of the Medicare
population would be covered under the new system after 5 years, and
spending for those beneficiaries would represent only about 15 percent
of net Medicare spending in total in that year under current law (where
such spending includes that for dual-eligible beneficiaries and for
Part D). After a decade, approximately 45 percent of the Medicare
population would be covered, and spending for that group would
represent about 30 percent of net Medicare spending in total under
current law.
Because the share of the Medicare population and the share of Medicare
spending covered would rise gradually under a grandfathering provision,
federal savings would be substantially smaller over an extended period
than would be the case if all beneficiaries entered the new system
immediately. A very rough approximation (made on the basis of the
estimated share of Medicare spending covered each year) for a system
that also excluded dual-eligible beneficiaries suggests that of the
total savings achieved if all eligible beneficiaries entered in 2018,
federal savings would be about 15 percent as much after 5 years and
about 30 percent as much after 10 years.
Moreover, the savings under a grandfathering provision could be
slightly smaller than the rough estimates would suggest, for two
reasons. First, CBO anticipates that the gradual rise in the proportion
of Medicare beneficiaries and Medicare spending covered under such a
system would give private insurers less incentive to reduce their bids,
over an extended period, than would be the case if all eligible
beneficiaries entered the system immediately. Second, the reduction in
the growth of Medicare spending likely to occur under a premium support
system as a result of changes in the demand for new technologies would
be substantially smaller for many years if that system included a
grandfathering provision.
Dual-Eligible Beneficiaries. Medicare covers some services for dual-
eligible beneficiaries and Medicaid covers others, thus creating
conflicting financial incentives for the federal and state governments
and for health care providers.\25\ Recent federal and state efforts
have focused on integrating the Medicare and Medicaid funding streams
and coordinating the often-complex care of many of those
beneficiaries--and including that group in a premium support system
would pose substantial additional challenges. For instance, it would be
difficult to give dual-eligible beneficiaries incentives to choose low-
bidding plans in a premium support system while also minimizing their
total payments for medical services. Despite that, excluding such
beneficiaries would reduce the potential savings that could be achieved
from a premium support system. In addition, that exclusion might create
incentives for private plans to encourage lower-income beneficiaries
with higher health care costs than predicted by their risk scores to
seek Medicaid eligibility and thereby leave the plan.\26\
---------------------------------------------------------------------------
\25\ See Congressional Budget Office, Dual-Eligible Beneficiaries
of Medicare and Medicaid: Characteristics, Health Care Spending, and
Evolving Policies (June 2013), www.cbo.gov/publication/44308.
\26\ Such effects are not included in CBO's estimates in this
report.
Bidding Regions
CBO assumed that bidding regions for both options would reflect health
care markets within states. The precise definition of those markets
would involve trade-offs. For example, defining regions to include
large numbers of beneficiaries would make insurers' projections of
average spending within the region more reliable. However, regions that
included areas that varied greatly in their spending would make it more
difficult for insurers to project spending for their enrollees because
those enrollees could be concentrated in certain areas within the
region. As another example, because CBO assumed that a premium support
system would require any insurer that submitted a bid for a region to
serve the entire region, some local and regional insurers might decline
to participate if a region included areas they could not serve
effectively, thus reducing competition. And in some regions, those
firms could be among the insurers offering the lowest-cost health care,
the highest-quality health care, or both. However, if regions were
small, some insurers might decline to participate even though they
would have served those same areas if they had been included in larger
regions. That result could occur, say, if the costs to carriers of
developing networks of providers in those areas were higher than in
nearby areas and if those costs would have been worth incurring to
serve a larger region.
Features of a System That Could Influence Enrollment
Features of a premium support system that made beneficiaries more
sensitive to differences in plans' premiums would tend to reward plans
that bid low with higher enrollment and thus encourage more plans to
submit lower bids.
In the illustrative premium support options analyzed here, CBO assumed
that differences in bids would be translated dollar for dollar into
differences in premiums. If, instead, the government retained some of
the difference between the benchmark and bids below that amount, two
effects would occur: First, the government would reduce its spending by
the amount retained, all else being equal. Second, however, by
retaining some of the difference between the benchmark and the bids,
the government would reduce the incentive for beneficiaries to enroll
in low-bidding plans and thus reduce the incentive for plans to submit
low bids--which would increase the benchmark and federal spending. The
net effect of those two factors on government spending would depend
partly on beneficiaries' responsiveness to premiums and partly on the
extent to which private insurers raised their bids. Moreover, if the
difference between the benchmark and bids below that amount was
provided as additional benefits rather than as cash, beneficiaries
would tend to have more difficulty comparing plans.
CBO assumed that beneficiaries who did not choose a plan when they
entered the premium support system would be assigned to a plan that
submitted a bid that was at or below the benchmark (or assigned to one
of the four lowest-bidding plans if more than four were at or below the
benchmark). If, instead, beneficiaries were automatically placed into
their original plan (if they had already been enrolled in Medicare) or
into the FFS program, insurers would probably have less incentive to
submit low bids, and beneficiaries' total payments would be higher
because low-bidding plans would have lower enrollment. Conversely, if
those beneficiaries were assigned to plans that had especially low bids
(rather than being assigned equally to all plans bidding at or below
the benchmark), insurers would probably have a greater incentive to
submit low bids, and beneficiaries' total payments would be lower.
Alternatively, if beneficiaries were required to choose a plan if they
wished to enroll in the premium support system and thus to maintain or
obtain Medicare coverage, some would not do so and the fraction of the
eligible population not covered by Medicare would increase--
particularly in the first few years after implementation.
In this analysis, CBO assumed that the basic packages that plans would
be required to offer would consist of health care services and an
actuarial value that matched those provided by Medicare's FFS program
under Parts A and B--although the plans could vary in other dimensions,
such as the breadth of provider networks or the structure of
coinsurance. If that basic package was only a minimum requirement and
plans could supplement a package in unrestricted ways without offering
the basic package itself, comparisons would be more difficult for
beneficiaries, enrollment in low-bidding plans would be reduced, and
plans' bids would rise. Conversely, if the deductibles and copayments
of the basic package were made standard, comparisons would be simpler.
The drawback of standardization, however, is that it could dampen the
ability of insurers and providers to develop more cost-effective
approaches to providing health care and for beneficiaries to choose
those approaches rather than more expensive ones.
______
Appendix A:
Basis for CBO's Findings
The preliminary findings presented in this report regarding the effects
of two illustrative options for a premium support system for Medicare
(one called the second-lowest-bid option and the other called the
average-bid option) are based on detailed modeling of the behavior of
buyers and sellers of health insurance policies. In its analysis, the
Congressional Budget Office (CBO) focused particular effort on
estimating private insurers' bids under those options.
CBO reviewed the research literature and consulted a variety of experts
who represented a broad span of views about premium support systems. In
addition, some insights about the potential responses of beneficiaries
and insurers are possible from observing current experience with the
Medicare Advantage program (which provides benefits through private
insurance), Medicare Part D (the prescription drug program), the
Federal Employees Health Benefits program, and various employment-based
insurance plans. The usefulness of those systems to inform the analysis
of a premium support system is limited, however, because the
competitive structure of a premium support system would be quite
different from that of Medicare Advantage or the federal employees'
program, and the array of health care services covered would be broader
than that under Part D. Moreover, information about the small number of
employers whose experiences with similar systems have been studied in
depth may not be broadly generalizable--particularly to the Medicare
population, which is likely to be less responsive than the nonelderly
population to differences in health insurance premiums. Finally, the
changes that are occurring in private health care and in health
insurance could affect federal spending on Medicare in complicated and
unpredictable ways--either under current law or under a premium support
system. And the adoption of a premium support system for Medicare could
have spillover effects on private health care and health insurance
systems.
The current analysis incorporates a range of significant improvements
in the modeling of a premium support system for Medicare compared with
CBO's earlier analyses of such systems.\27\ The agency has devoted
considerable time and effort to strengthening its analytical
capabilities in this area. Nonetheless, it is extremely difficult to
know how beneficiaries or insurers would respond to a premium support
system for Medicare, and the actual outcomes would surely differ from
the estimates presented in this report--which, according to CBO's
current judgment, represent the middle of the distribution of possible
outcomes. The agency's modeling effort is not complete; further
analysis and additional consultation with outside experts may alter the
findings, perhaps in significant ways. One potential area of inquiry
that CBO has not analyzed concerns the ways a premium support system
might affect the coordination of care or the quality of care that
beneficiaries receive; the agency does not currently have the tools
necessary to study such effects, nor does it anticipate having them in
the near future.
---------------------------------------------------------------------------
\27\ For examples of earlier analyses, see Congressional Budget
Office, Long-Term Analysis of a Budget Proposal by Chairman Ryan
(attachment to a letter to the Honorable Paul Ryan, April 5, 2011),
www.cbo.gov/publication/22085, and Designing a Premium Support System
for Medicare (December 2006), www.cbo.gov/publication/18258.
---------------------------------------------------------------------------
Estimating Private Insurers' Bids
To estimate the bids that private insurers would submit in 2020 under
the two illustrative premium support options considered in this report,
CBO analyzed insurers' 2012 bids for Medicare Advantage, projected
those bids to 2020, and adjusted them to account for the differences in
competition that CBO anticipates private insurers would face under the
two options as compared with the current Medicare Advantage program.
In adjusting the projected Medicare Advantage bids to develop estimates
of what private insurers would bid under a premium support system, CBO
concluded that some factors would tend to lower bids and others would
tend to raise them (see Figure A-1). The net effect is that the
projected bids under the two premium support options considered in this
report are lower, by an average of about 4 percent under each option,
than those projected for the current-law Medicare Advantage program.
(Bids would be slightly lower under the second-lowest-bid option than
under the average-bid option, but the differences relative to bids
under the Medicare Advantage program are rounded to the nearest
percentage point.) The difference between private insurers' bids under
the two options and average spending in Medicare's fee-for-service
(FFS) program would remain fairly constant in the decade after the
first few years of implementation, CBO anticipates.
Projecting Medicare Advantage Bids
Under current law, each Medicare Advantage plan generally can define
its service area as consisting of one or more counties.\28\ CBO based
its estimates on the bids submitted by insurers for their service
areas, using the county as the unit of analysis. The agency developed
simulated distributions of bids for counties based on the view that
insurers would participate in a premium support system and would offer
insurance plans with a range of prices, just as is the case for the
current Medicare Advantage program.
---------------------------------------------------------------------------
\28\ This discussion applies to local Medicare Advantage plans,
which account for the bulk of enrollment in the Medicare Advantage
program. By contrast, the federal government defines service areas for
regional preferred provider organizations--or PPOs--as consisting of
one or more states; each PPO must serve one or more of those designated
service areas.
CBO estimated benchmarks for counties under the two premium support
options on the basis of the agency's projected distributions of private
insurers' bids, which were combined with projected per capita Medicare
FFS spending for each county. The use of the county as the unit of
analysis simplified the modeling and provides a foundation for
subsequent analyses of a system with other types of bidding regions.
The results of the analysis could change if different types of regions
---------------------------------------------------------------------------
were specified.
Under current law, Medicare Advantage insurers submit a bid for a
beneficiary in average health (defined as a beneficiary with a risk
score of 1.0). CBO projects that the average bid from current-law
Medicare Advantage plans in 2020 will be 6 percent below the average
FFS spending for a beneficiary with the same reported risk score. For
the one-quarter of the nation's counties with the highest average FFS
spending, CBO estimates, the average Medicare Advantage bid will be 12
percent below that amount.\29\ For the one-quarter of counties with the
lowest average FFS spending, CBO projects that the average Medicare
Advantage bid will be 6 percent above that amount.\30\
---------------------------------------------------------------------------
\29\ For this analysis, CBO divided counties into quartiles on the
basis of average FFS spending in the county, with the same number of
counties in each quartile. This differs from the approach elsewhere in
the report for the analysis of beneficiaries' premiums, which divides
groups of regions into quartiles constructed such that the same number
of beneficiaries is in each quartile.
\30\ Those estimates incorporate factors affecting bids that are
related to the risk adjustment mechanism, discussed below. For this
analysis, CBO excluded three types of Medicare Advantage plans that
differ substantially from plans that would probably be offered under a
premium support system: private FFS plans, special needs plans, and
employment-based group plans. The FFS program's costs used for the
comparisons in this report exclude certain types of spending because it
is not covered by the bids that Medicare Advantage plans submit under
current law--namely, the additional payments to disproportionate-share
hospitals (whose share of low-income patients exceeds a specified
threshold) and spending for medical education, hospice benefits, and
certain benefits for patients with end-stage renal disease. CBO
included in its calculations the government's cost of administering the
FFS program. The analysis was based on CBO's projections of Medicare
expenditures and Medicare Advantage enrollments in March 2012. See
Congressional Budget Office, ``Medicare--March 2012 Baseline'' (March
13, 2012), www.cbo.gov/publication/43060.
CBO expects that Medicare Advantage bids will be higher relative to
average FFS spending in the same areas in 2020 than in 2012 because
Medicare Advantage plans will be able to achieve some--but not all--of
the restraint in provider payment rates that is scheduled for the FFS
system under current law. As a result, the agency projects higher
growth in the bids of Medicare Advantage plans than it does for growth
in per capita spending under the FFS system.
Factors That Would Tend to Reduce Bids
CBO anticipates that two main mechanisms would tend to lower bids under
either option relative to Medicare Advantage bids under current law:
increased competition that would result from stronger incentives for
beneficiaries and insurers to focus on reducing health care costs and
the slightly greater favorable selection for private plans than exists
under the Medicare Advantage program.
Increased Competition. Differences in the plans' bids under either
option would translate directly into differences in beneficiaries'
premiums. Under current law, a Medicare Advantage plan with a bid below
the benchmark receives a federal payment that equals the bid plus a
rebate that is a percentage of the difference between the bid and the
benchmark. (Beginning in 2014, the rebate will range from 50 percent to
70 percent, depending on the plan's performance on certain measures of
quality.) Plans now return most of that difference in the form of
supplemental benefits (rather than as reduced premiums), which
consumers generally find harder to evaluate than a cash amount. Under
the illustrative premium support options, plans with bids below the
benchmark would return the entire difference between the two in the
form of lower premiums. Beneficiaries would therefore be more sensitive
to differences in plans' bids in deciding on a plan than they would be
under the Medicare Advantage program, so the insurers would have more
incentive to lower their bids under the two premium support options.
Insurers also would face more competition under both options because of
changes in market structure. Under the Medicare Advantage program, the
benchmarks are announced before insurers submit their bids. Under the
two premium support options, the benchmarks would be determined from
the bids themselves. Some evidence suggesting that competition among
Medicare Advantage plans is limited under the current approach comes
from a study that concluded that a $1.00 increase in a benchmark, with
all other factors (including health care costs) held constant, results
in a $0.49 increase in the average bid.\31\ In a highly competitive
system (for example, one in which each dollar that a bid was below the
bid of another plan within a region would correspond to a dollar's
difference in the premiums between the two plans), the insurers' bids
would primarily reflect their costs rather than the benchmarks.
---------------------------------------------------------------------------
\31\ Zirui Song, Mary Beth Landrum, and Michael E. Chernew,
``Competitive Bidding in Medicare: Who Benefits From Competition?''
American Journal of Managed Care, vol. 18, no. 9 (September 2012), pp.
546-552, http://tinyurl.com/odtwf87.
Insurers would be expected to respond to increased competition by
reducing their costs and lowering their bids.\32\ The reductions might
occur partly as a result of reduced administrative costs or smaller
profit margins. But they also could result from cuts in spending for
services, perhaps made possible by insurers' combining improvements in
management of care with development of more restrictive provider
networks, slower adoption of expensive technological advances, faster
adoption of methods to compensate providers that demonstrated cost-
effective care, or changes in benefit design (for example, tying cost-
sharing requirements to evidence of the cost-effectiveness of specific
services).
---------------------------------------------------------------------------
\32\ For related research, see Thomas C. Buchmueller, ``Consumer-
Oriented Health Care Reform Strategies: A Review of the Evidence on
Managed Competition and Consumer-Directed Health Insurance,'' Milbank
Quarterly, vol. 87, no. 4 (December 2009), pp. 820-841, http://
tinyurl.com/nsaff32, and ``Does a Fixed-Dollar Premium Contribution
Lower Spending?'' Health Affairs, vol. 17, no. 6 (November 1998), pp.
228-235, http://tinyurl.com/puwqjaz; David M. Cutler and Sarah J.
Reber, ``Paying for Health Insurance: The Trade-Off Between Competition
and Adverse Selection,'' Quarterly Journal of Economics, vol. 113, no.
2 (May 1998), pp. 433-466, http://tinyurl.com/ mycqvem; and Steven C.
Hill and Barbara L. Wolfe, ``Testing the HMO Competitive Strategy: An
Analysis of Its Impact on Medical Care Resources,'' Journal of Health
Economics, vol. 16, no. 3 (June 1997), pp. 261-286, http://tinyurl.com/
nvvz76c.
Under the specification of the two options that restricts insurers to
submitting a maximum of two bids for the basic benefit package in any
bidding region, CBO also expects that insurers would eliminate some of
the higher-bidding plans that would exist under the Medicare Advantage
program--reducing average bids. (Under the Medicare Advantage program,
---------------------------------------------------------------------------
insurers often submit more than two bids in their service areas.)
Increased Favorable Selection. Under both premium support options, all
private insurers in a region would submit bids indicating the payment
they would accept to provide Medicare benefits for a beneficiary of
average health, and those standardized bids would be used to establish
regional benchmarks. Payments to insurers would be adjusted to reflect
the health status of their enrollees, using a risk adjustment mechanism
that CBO assumed would be comparable to that of the Medicare Advantage
program.
It is difficult to adjust payments to reflect health status, and the
system used for Medicare Advantage is unavoidably imperfect. Medicare
beneficiaries in poor health tend to prefer to enroll in the FFS
program because it generally places fewer restrictions on the use of
health care services. That tendency is in evidence even among
beneficiaries with the same risk scores because risk scores incorporate
only limited information about health status. When a beneficiary who
enrolls in a private plan is healthier than someone with the same risk
score enrolled in the FFS program, the private plan experiences
``favorable selection'' beyond that captured by risk scores. Some
research indicates that current Medicare Advantage enrollees who have a
given risk score would have had lower costs, on average, under the FFS
program than people enrolled in the FFS program with that same
score.\33\
---------------------------------------------------------------------------
\33\ Estimates of the difference vary considerably, however. For
example, see Joseph P. Newhouse and others, ``Steps to Reduce Favorable
Risk Selection in Medicare Advantage Largely Succeeded, Boding Well for
Health Insurance Exchanges,'' Health Affairs, vol. 31, no. 12 (December
2012), pp. 2,618-2,628, http://tinyurl.com/naps2jl; Medicare Payment
Advisory Commission, Report to the Congress: Medicare and the Health
Care Delivery System (June 2012), pp. 100-101, http://go.usa.gov/DXbF;
Gerald F. Riley, ``Impact of Continued Biased Disenrollment From the
Medicare Advantage Program to Fee-for-Service,'' Medicare and Medicaid
Research Review, vol. 2, no. 4 (2012), pp. E1-E17, http://go.usa.gov/
DXbd; and Jason Brown and others, How Does Risk Selection Respond to
Risk Adjustment? Evidence From the Medicare Advantage Program, Working
Paper 16977 (National Bureau of Economic Research, April 2011),
www.nber.org/papers/w16977.
CBO expects that, under either premium support option, private plans
would experience greater favorable selection (beyond that captured by
risk scores) than they will experience under the Medicare Advantage
program. That is, people who enrolled in private plans--under either
option--would use fewer health care services, on average, than people
with the same risk score enrolled in Medicare Advantage. CBO
anticipates that outcome because increased competition would prompt
insurers to take more aggressive steps to control costs (by enhancing
utilization management or using tighter provider networks, for
example), thus rendering private insurers less attractive to
beneficiaries who would, on average, use more health care services than
---------------------------------------------------------------------------
would other beneficiaries with the same risk score.
Because of the increased favorable selection, costs per enrollee would
be lower for private plans under a premium support system than for
Medicare Advantage plans under current law if the average risk scores
in the two sets of plans were the same. Reflecting those lower costs,
private plans competing for additional enrollees under either option
would tend to reduce their bids for a beneficiary of average health
relative to those of Medicare Advantage plans, CBO anticipates.
Factors That Would Tend to Raise Bids
CBO estimates that in most counties the percentage of beneficiaries
enrolled in the FFS program would decline once either premium support
option took effect. In CBO's assessment, the reduced market share of
the FFS program would tend to boost the rates that private insurers
paid to health care providers and thereby lead them to raise their
bids. That reduction in market share, and thus the effect on private
insurers' bids, would be greater in areas where average FFS spending
was high. (CBO's methodology for estimating the proportion of
beneficiaries who would select the FFS program is discussed below.)
Declines in the FFS program's market share would affect payment rates
for private insurers through two main mechanisms. First, the importance
of payment rates from the FFS program would diminish as a determinant
of the amounts private insurers would pay health care providers for
treating Medicare enrollees (those FFS payment rates are generally a
good deal lower than the rates private insurers pay to providers of
health care for people with commercial insurance--that is, employment-
based coverage). Second, some private insurers would need to broaden
their provider networks to accommodate additional enrollees. Both
mechanisms would cause insurers to raise their bids to cover additional
costs, CBO projects.
The Reduced Importance of FFS Provider Payment Rates. CBO's assessment
of the importance to private plans of FFS payment rates is based on the
observation that, on balance, the rates paid for Medicare Advantage
enrollees are similar to or slightly above those that Medicare pays for
FFS patients' care--even though providers receive substantially higher
amounts when they offer the same services to patients in commercial
plans focused on the under-65 population.\34\ The exact cause of the
difference is not known, but it appears to arise in part because
private insurers that offer Medicare Advantage plans can exclude from
their networks any providers who are unwilling to accept Medicare's
rates, thus reducing those providers' volume of Medicare patients;
those same providers would generally end up being paid the lower rates
for treating Medicare patients in the FFS system. Moreover, when
Medicare Advantage enrollees go outside their plan's provider network
to obtain care that the plan either must cover by law (emergency care,
for example) or that it covers as a matter of choice (such as certain
highly specialized services), federal law requires providers to accept
Medicare's FFS rates as payment in full.\35\ Thus, a hospital that
might anticipate providing a certain amount of emergency care to
enrollees in a Medicare Advantage plan would not receive higher
commercial rates for treating those patients simply because it refused
to join the plan's network.
---------------------------------------------------------------------------
\34\ Information about those rates is based on interviews conducted
by CBO staff with industry sources and is consistent with reports in
the research literature. See Robert A. Berenson and others, ``The
Growing Power of Some Providers to Win Steep Payment Increases From
Insurers Suggests Policy Remedies May Be Needed,'' Health Affairs, vol.
31, no. 5 (May 2012), pp. 973-981, http://tinyurl.com/ntyyudv.
\35\ Sections 1866(a)(1)(O) and 1876(i)(1) of the Social Security
Act contain the relevant provisions for hospitals and physicians,
respectively.
The relationship between private insurers and providers is much
different for plans that serve commercial enrollees. Although there are
dominant insurers in many commercial markets, they appear to have less
leverage than the Medicare FFS program has with providers--in part, at
least, because FFS payment rates are established by law and are not
subject to negotiation. If providers are unwilling to accept rates for
their commercial enrollees that are similar to Medicare's rates, they
can be reasonably confident that other insurers will pay them more--
particularly because private insurers typically try to satisfy
consumers' desire for broad provider networks. In addition, when
enrollees in commercial plans go outside the plan's network to receive
care, the providers who treat them generally charge more than they
would have charged had they been in the plan's network. Insurers often
limit their payments for such care to predetermined amounts, but
patients are often responsible for some or all of the differences
---------------------------------------------------------------------------
between those payments and the provider's charges.
In regions where the role of the FFS program diminished under a premium
support system, CBO expects, the relationship between private insurers
and health care providers would become less similar to the relationship
in Medicare Advantage under current law and more similar to the
relationship in the commercial market for people under age 65.
Broadening of Provider Networks. Another reason bids would increase as
the share of beneficiaries in the FFS program fell is that private
insurers, on average, would need to expand their networks to
accommodate increased enrollment. As a result, private insurers would
probably need either to pay higher rates or to contract with providers
with higher-cost practice styles. Bids would rise as a result of
including higher-cost health care providers that private insurers would
tend to have excluded when their networks could be narrower. The
expansion would be greater for lower-bidding plans, CBO projects,
because those plans would experience greater increases in enrollment.
The Magnitude of the Resulting Adjustments to Bids. CBO did not adjust
its projections of private insurers' bids in counties in which it
expects that the FFS program would maintain the share that it currently
holds (or its nationwide market share, if that is lower). The agency
anticipates that, in those counties, the forces that now allow private
insurers to obtain payment rates for their Medicare Advantage plans
that are similar to those for Medicare's FFS program would continue to
prevail under a premium support system.\36\ However, where the market
share of the FFS program is projected to fall below its current level--
and where that share would be below the current national market share--
CBO expects that private insurers would pay higher rates to providers
for their premium support enrollees than they would pay under current
law for Medicare Advantage enrollees. CBO adjusted its projections for
insurers in those counties, and the adjustment was greater for counties
where larger reductions are anticipated in the FFS program's market
share. CBO also adjusted the bids upward slightly for plans at or near
the bottom of the bid distribution to account for the expected
broadening of provider networks.
---------------------------------------------------------------------------
\36\ CBO expects that the rates private insurers will pay providers
under Medicare Advantage plans will rise over time relative to
Medicare's FFS rates because private insurers are not likely to obtain
all of the reductions in payment updates that are scheduled for the FFS
program under current law. The adjustments to bids discussed in this
section were applied to projected Medicare Advantage bids, developed
under the expectation that private insurers' payment rates would be
higher relative to Medicare FFS rates than they are now.
The size of the adjustment for private plans' bids was made partly on
the basis of the agency's assessment of the average difference between
the rates paid by Medicare and the rates paid by private insurers to
hospitals, physicians, and other providers for enrollees in commercial
plans. However, the adjustment was smaller than that average difference
---------------------------------------------------------------------------
as a way to account for four main factors:
The observed difference in payment rates now is more informative
about the rise in rates that might occur under a premium support system
in which the FFS program was eliminated; rates would generally rise
much less under a system in which the FFS program was a competing
plan--particularly in regions where the FFS program retained a
significant market share.
Medicare's FFS payment rates would be used as a reference point
in negotiations between private plans and providers for their premium
support enrollees, which would tend to keep those rates below
commercial rates even in regions where the FFS program had a very low
market share.
The competitive structure of a premium support system would tend
to push rates below commercial rates. In particular, current tax-based
subsidies to health insurance for commercial enrollees result in less
competitive pressure on provider payment rates than would occur under
the premium support options analyzed here.
A reduction in the FFS market share would lower commercial
rates, reducing the difference between FFS rates and commercial rates.
Because of the reduction in the FFS market share, fewer health care
services would be paid for at relatively low Medicare FFS rates. As a
result, fewer costs associated with Medicare beneficiaries would
probably be shifted to private insurers through higher rates for
hospital services, thus reducing commercial rates.
After considering all of those factors, CBO made separate adjustments
to its estimates of the bids in each county, depending on the projected
changes in the FFS program's market share. The relationship between the
FFS market share and private plans' bids is subject to considerable
uncertainty, but CBO regards its estimates as being in the middle of
the distribution of possible outcomes.
Differences Between the Options' Effects on Bids
The combined effects of the factors that would tend to lower bids would
be slightly larger under the second-lowest-bid option than under the
average-bid option. In 2020, those effects would reduce bids by about 7
percent, on average, under the
second-lowest-bid option and by about 6 percent under the average-bid
option. In either case, the amount by which bids were reduced would
vary considerably from one region to another.
The effects of the factors that tended to increase bids also would be
slightly larger under the second-lowest-bid option than under the
average-bid option because the increased competition, and the resulting
changes in enrollment among the plans, would be greater. In 2020, that
effect would boost bids by about 3 percent, on average, under the
second-lowest-bid option and by about 2 percent under the average-bid
option.
The largest difference in the effects of the two options on bids by
private insurers would result from a difference in the degree of
competition. That difference would occur for two main reasons.
First, and more important, the benchmark would be lower under the
second-lowest-bid option than under the average-bid option in most
regions, so the premiums for a plan with a given bid would be higher.
In CBO's judgment, insurers would expect those higher premiums to
increase beneficiaries' sensitivity to differences in costs because
premiums would consume a greater share of enrollees' discretionary
income.
Second, bids for plans that wanted to attract automatically assigned
beneficiaries would tend to be lower under the second-lowest-bid option
than under the average-bid option. Under either option, according to
specifications outlined in this report, beneficiaries who made no
affirmative choice would be assigned with equal probability to an
available plan that had submitted a bid that was at or below the
regional benchmark (or to one of the four lowest-bidding plans if more
than four met that criterion). Although such beneficiaries would be
comparatively less attractive to plans than those who made an active
enrollment choice, some plans would nevertheless seek to obtain them
through assignment. Because no more than two plans would receive
automatically assigned beneficiaries under the second-lowest-bid option
in most instances, compared with as many as four under the average-bid
option, the plans that wanted to enroll such beneficiaries would have
greater incentives to submit lower bids under the second-lowest-bid
option.
Changes Over Time in Effects on Bids
Under either option, the combined effects of the factors that tended to
reduce bids would increase over time, as would the combined effects of
the factors that tended to increase bids. On balance, CBO anticipates,
the difference between private insurers' bids under the two options and
average FFS costs would remain fairly constant for the decade following
the first few years of implementation.
CBO expects that the increased competition in particular would lead
insurers to reduce costs even more after 2020 so they could keep their
bids as low as possible in subsequent years. However, for three
reasons, the incremental reductions would probably be smaller than the
initial drop: First, one assumption of this analysis is that the
legislation that created a new premium support system would provide
private insurers with several years to determine how to reduce their
costs before the system was implemented with the result that many
changes would probably be undertaken in the first few years. Second,
because many beneficiaries would probably remain in the first plan they
chose without thoroughly evaluating their options in subsequent years,
insurers would have an especially strong incentive to submit low bids
in the first year of the new system. Third, insurers would tend to
undertake the easier reductions first, and additional reductions would
probably involve more difficult actions.
However, CBO also projects that Medicare Advantage bids under current
law will rise more rapidly than average spending in the FFS program. As
a result, greater cost reduction under the premium support options
would be necessary in future years to maintain the percentage savings
relative to FFS spending projected for 2020. By CBO's estimate, the
additional cost reductions would roughly offset the trends in Medicare
Advantage bids projected under current law through the 2020s.
Estimating Federal Spending for Medicare and Beneficiaries' Total
Payments
The methods for estimating combined federal spending and beneficiaries'
total payments were similar for both options CBO analyzed. CBO
projected bids for a given year as described in the previous section.
The agency used those bids (and, for the average-bid option, past
enrollment) to estimate benchmarks in each county and premiums for each
plan in each county. It then simulated the enrollment of a large sample
of beneficiaries in different plans on the basis of premiums and
previous patterns of enrollment, calculated federal spending as the sum
of the risk-adjusted federal contribution for each beneficiary, and
compared total federal spending with the baseline projection. To
project beneficiaries' total payments, CBO used claims data to estimate
cost-sharing payments by each beneficiary for the services covered by
Medicare and combined those estimates with the plans' premiums.
The estimates incorporated data from administrative records for a
sample of about 600,000 Medicare beneficiaries, along with county-level
projections of the FFS program's bid and the bids of private plans. CBO
adjusted the estimates of out-of-pocket spending to match the actuarial
value of the plans and current distributions of health spending by age,
health risk, and other factors.
The enrollment simulations were based in part on estimates of two
especially important aspects of beneficiaries' choices of plans: their
sensitivity to premiums and the likelihood that they would actively
choose to enroll in a plan. The analysis also incorporated the effects
of CBO's expectation that patients who enrolled in private plans would
have their diagnoses coded more intensively than would patients in the
FFS program. Possible spillover effects on Medicare FFS spending from
increased enrollment in private plans were not considered in the
estimates.
Sensitivity to Premiums
To develop its projections of the plans that Medicare beneficiaries
would choose under different premium support proposals, CBO conducted
its own analysis and it examined findings from the research literature
concerning beneficiaries' sensitivity to premiums in selecting health
plans.\37\ In the agency's judgment, there are two main reasons that
beneficiaries' sensitivity under either option would be greater than is
generally reported in the literature for the Medicare population.
First, they would face larger differences in premiums under the options
than those that have been studied previously. Second, beneficiaries
would receive information on the features of available plans--including
premiums--in ways that would make comparison among plans simpler than
is generally the case under current law. Moreover, CBO anticipates,
beneficiaries who are new Medicare enrollees in the future will be more
sensitive, on average, than current beneficiaries are to differences in
premiums. CBO expects those beneficiaries to be healthier generally
(and thus less likely to have strong ties to providers who might not be
in some plans' networks) and, because of their experience in the health
insurance marketplace, to be more conversant than many current
enrollees are with the process of choosing among plans that offer
different premiums and packages of benefits.
---------------------------------------------------------------------------
\37\ See, for example, Thomas C. Buchmueller and others, ``The
Price Sensitivity of Medicare Beneficiaries: A Regression Discontinuity
Approach,'' Health Economics, vol. 22, no. 1 (January 2013), pp. 35-51,
http://tinyurl.com/oo2rrk4; Steven D. Pizer, Austin B. Frakt, and Roger
Feldman, ``Nothing for Something? Estimating Cost and Value for
Beneficiaries From Recent Medicare Spending Increases on HMO Payments
and Drug Benefits,'' International Journal of Health Care Finance and
Economics, vol. 9, no. 1 (March 2009), pp. 59-81, http://tinyurl.com/
p7xjtvh; Thomas C. Buchmueller, ``Price and the Health Plan Choices of
Retirees,'' Journal of Health Economics, vol. 25, no. 1 (January 2006),
pp. 81-101, http://tinyurl.com/m6p93dz; Adam Atherly, Bryan E. Dowd,
and Roger Feldman, ``The Effect of Benefits, Premiums, and Health Risk
on Health Plan Choice in the Medicare Program,'' Health Services
Research, vol. 39, no. 4 (August 2004), pp. 847-864, http://
tinyurl.com/o4wl339; Bryan E. Dowd, Roger Feldman, and Robert Coulam,
``The Effect of Health Plan Characteristics on Medicare+Choice
Enrollment,'' Health Services Research, vol. 38, no. 1, part 1
(February 2003), pp. 113-135, http://tinyurl.com/p34m69r; Anne Beeson
Royalty and Neil Solomon, ``Health Plan Choice: Price Elasticities in a
Managed Competition Setting,'' Journal of Human Resources, vol. 34, no.
1 (Winter 1999), pp. 1-41, http://tinyurl.com/o2m3br7; David M. Cutler
and Sarah J. Reber, ``Paying for Health Insurance: The Trade-Off
Between Competition and Adverse Selection,'' Quarterly Journal of
Economics, vol. 113, no. 2 (May 1998), pp. 433-466, http://tinyurl.com/
mycqvem; and Thomas C. Buchmueller, ``The Health Plan Choices of
Retirees Under Managed Competition,'' Health Services Research, vol.
35, no. 5, part 1 (December 2000), pp. 949-976, http://tinyurl.com/
lajxa4w.
In most regions, under either option, beneficiaries would be able to
choose from several private plans that are likely to be more similar to
one another than to the FFS program in terms of the size of provider
networks and approaches to utilization management. Therefore, CBO
anticipates, beneficiaries would be more sensitive to premiums when
choosing among private plans than they would be when choosing between
any private plan and the FFS program. Additionally, CBO expects,
beneficiaries would become somewhat less sensitive to the cost of
premiums after the first few years; once beneficiaries are in a plan,
they generally do not seem to switch readily.\38\ Nevertheless, the
possibilities of attracting new enrollees each year and of losing
existing enrollees to competitors would provide incentives for private
plans to continue to keep bids low.
---------------------------------------------------------------------------
\38\ For related discussion, see Benjamin R. Handel, ``Adverse
Selection and Inertia in Health Insurance Markets: When Nudging
Hurts,'' working paper (University of California at Berkeley, March
2013, http://emlab.berkeley.edu/bhandel/index.shtml; Peter J.
Cunningham, Few Americans Switch Employer Health Plans for Better
Quality, Lower Costs, Research Brief 12 (National Institute for Health
Care Reform, January 2013), www.nihcr.org/Health-Plan-Switching;
Jonathan D. Ketcham and others, ``Sinking, Swimming, or Learning to
Swim in Medicare Part D,'' American Economic Review, vol. 102, no. 6
(October 2012), pp. 2639-2673, http://tinyurl.com/ow8luxd; Keith M.
Marzilli Ericson, Consumer Inertia and Firm Pricing in the Medicare
Part D Prescription Drug Insurance Exchange, Working Paper 18359
(National Bureau of Economic Research, September 2012), www.nber.org/
papers/w18359; and Kathleen Nosal, ``Estimating Switching Costs for
Medicare Advantage Plans,'' working paper (University of Arizona, June
2012), www.u.arizona.edu/nosal/research.html.
The constraints on Medicare payment rates for providers embodied in
current law may result in diminished access to care and in reduced
quality of care for beneficiaries in the FFS program, although the
timing and extent of such changes are very difficult to predict. In
this analysis, CBO anticipates that beneficiaries would respond to the
possibility of reduced access or quality by being somewhat more
inclined to choose a private plan than to choose the FFS program when
the FFS rates for health care providers fell relative to those of
private plans.
Active Choice of a Plan
In CBO's assessment, a significant proportion of beneficiaries would
not actively choose a plan in the first year that a premium support
system was implemented. Under the specifications adopted for this
report, beneficiaries who did not make a choice would be assigned
randomly to a plan with a bid at or below the benchmark (or to one
among the four lowest-bidding plans, if more than four bid at or below
the benchmark). To project that share of beneficiaries, CBO analyzed
the behavior of Medicare Advantage enrollees whose plans had left the
market, and it reviewed research on enrollment in the Part D program.
CBO expects that a higher percentage of beneficiaries would choose a
plan under the second-lowest-bid option than under the average-bid
option because the higher average premiums would be more likely to
impel beneficiaries to learn about the new program and choose a plan.
CBO projects that, on average, about 15 percent of beneficiaries would
not choose a plan in the first year of premium support under the
second-lowest-bid option and about 20 percent would not choose a plan
in the first year under the average-bid option. The percentages would
be expected to vary according to certain demographic characteristics
and health status identified in CBO's analyses and in its review of
related research. The agency also projects that most beneficiaries who
were assigned to a plan in 2018 would still be in that plan by 2020
(the reference year for the analysis of beneficiaries' premiums) but
that some beneficiaries who did not choose a plan in the first year
would switch from the low-bidding plan to which they were assigned to a
higher-bidding plan later.
More Intensive Diagnostic Coding by Private Insurers
Evidence suggests that private insurers in the Medicare Advantage
program record a larger number of diagnoses than FFS providers do, so a
given beneficiary would be expected to have a higher risk score in a
Medicare Advantage plan than in the FFS program. Because higher risk
scores result in larger payments, private insurers have a financial
incentive to ensure that every appropriate diagnosis is coded for each
enrollee; such an incentive does not generally exist in the FFS sector.
Although the Medicare program adjusts the risk scores of Medicare
Advantage enrollees downward to attempt to account for the difference--
and that adjustment was incorporated in the risk scores used in this
analysis--there is recent evidence that the adjustment is probably
insufficient.\39\ CBO expects that under the two options private
insurers would code diagnoses more intensively than providers treating
FFS patients to the same extent that they would do so in the Medicare
Advantage program under current law and that the Medicare program would
adjust the risk scores of enrollees in private plans to the same extent
that is projected for Medicare Advantage under current law. Thus, no
adjustments to plans' projected bids in Medicare Advantage were needed
to account for those practices.
---------------------------------------------------------------------------
\39\ The Centers for Medicare and Medicaid Services has estimated
that reported risk scores for Medicare Advantage enrollees are 3.4
percent higher than they would have been in the FFS sector, and the
agency adjusts the reported risk scores downward by 3.4 percent when it
calculates payments to the plans. Under current law, beginning in 2014
and continuing until 2018, the agency must increase the adjustment
until the downward adjustment reaches at least 5.9 percent. The
Government Accountability Office has estimated that the difference in
coding boosts risk scores for Medicare Advantage enrollees by between 5
percent and 6 percent relative to likely scores in the FFS system and
that the difference has widened over time. See Government
Accountability Office, Substantial Excess Payments Underscore Need for
CMS to Improve Accuracy of Risk Score Adjustments, GAO-13-206 (January
2013), www.gao.gov/products/GAO-13-206.
However, CBO expects that the more intensive coding of diagnoses would
affect federal spending under a premium support system even though it
would not affect the bids of private plans relative to those under
current law. In particular, under both options, a larger fraction of
the Medicare population would be covered by private plans, and thus
more of the population would be subject to more intensive coding, on
average, than is the case under current law. Therefore, CBO accounted
for differences in coding in its projections of payments to insurers.
CBO expects that beneficiaries who switched from the FFS program to a
private plan would end up with higher risk scores and that the Medicare
program would adjust for only part of that difference in calculating
payment amounts for the insurers. As a result, the federal government
would pay more for such beneficiaries under a premium support system,
all else being equal, than it would if there was no difference in
coding or if the Medicare program adjusted the risk scores of private
plans to completely remove the effects of coding differences.
Possible Spillover Effects on Medicare FFS Spending
There is evidence that increases in the proportion of beneficiaries
enrolled in Medicare Advantage plans lead to lower federal spending for
beneficiaries in the FFS program and in a lower intensity of their
treatment.\40\ Such spillover effects could occur through at least two
pathways: Increased managed care penetration could change the way
physicians treat all of their patients, not just those enrolled in
managed care plans, and it could influence investment decisions and the
adoption of new technology in local markets. For this report, CBO did
not incorporate such spillover effects on the FFS program.
---------------------------------------------------------------------------
\40\ See Katherine Baicker, Michael Chernew, and Jacob Robbins, The
Spillover Effects of Medicare Managed Care: Medicare Advantage and
Hospital Utilization, Working Paper 19070 (National Bureau of Economic
Research, May 2013), www.nber.org/papers/w19070; Michael Chernew,
Philip DeCicca, and Robert Town, ``Managed Care and Medical
Expenditures of Medicare Beneficiaries,'' Journal of Health Economics,
vol. 27, no. 6 (December 2008), pp. 1,451-1,461, http://tinyurl.com/
qxfh4h9; and Laurence C. Baker, ``The Effect of HMOs on Fee-for-Service
Health Care Expenditures: Evidence From Medicare,'' Journal of Health
Economics, vol. 16, no. 4 (July 1997), pp. 453-481, http://tinyurl.com/
kf28hus. The study of Baicker and others presented estimates of the
effects of Medicare Advantage plans' market share on hospitals'
resource costs of treating Medicare beneficiaries, which do not
directly determine Medicare's payments for FFS beneficiaries under the
prospective payment system. The two other studies estimated the effects
of Medicare Advantage plans' market share on Medicare spending for FFS
beneficiaries.
In CBO's estimation, such effects would be very small or even
negligible in 2020, although the agency will explore the issue more in
future analyses. The sustainable growth rate mechanism for physicians
and the provisions of the Affordable Care Act that restrain payment
updates for most other FFS providers also will restrain federal
spending in Medicare's FFS program, suggesting that any additional
reductions in Medicare spending on the FFS program that might result
from a spillover effect would be smaller than has been estimated in the
past.\41\
---------------------------------------------------------------------------
\41\ The Affordable Care Act comprises the Patient Protection and
Affordable Care Act and the health care provisions of the Health Care
and Education Reconciliation Act of 2010.
Over the longer term, the size of spillover effects would depend in
part on whether the restraints on payment updates in the FFS program
specified under current law are maintained. However, as discussed in
the section of the text on ``Effects After the First Several Years,''
stronger price-based competition under a premium support system would
probably affect the emergence and diffusion of new technology and
services in ways that might reduce FFS spending (for a beneficiary of
---------------------------------------------------------------------------
average health, relative to that under current law) in the longer term.
______
Appendix B:
Analysis of Uncertainty in the Estimates
To characterize uncertainty in the estimated effects of the two
illustrative options for a premium support system (one called the
second-lowest-bid option and the other called the average-bid option)
on federal spending for Medicare and on beneficiaries' total payments,
the Congressional Budget Office (CBO) determined ranges of values for
five key parameters and estimated the effects of varying those
parameters. Those estimates focused on results for 2020, which CBO used
as a reference year in the analysis. The ranges for the parameters'
values were chosen to represent CBO's judgment that, accounting not
only for uncertainty about those parameters but also about most of the
sources of uncertainty in the analysis (assuming that a premium support
system was implemented as specified here), there would be about a two-
thirds chance that CBO's central estimate for the effect on federal
spending would be within the range reported.
CBO varied the following parameters to construct the ranges:
Bids of Medicare Advantage plans relative to Medicare fee-for-
service (FFS) spending as projected under current law,
The amount by which private insurers would reduce their bids
relative to Medicare Advantage bids under current law in response to
the increased competitive pressure created by the premium support
system and other factors,
The higher rates that private insurers would need to pay
providers (with corresponding increases in bids) that CBO projects
would result if the market share of the FFS program fell significantly,
The responsiveness of beneficiaries to differences in premiums
when choosing among plans, and
The percentage of beneficiaries who would not actively choose a
plan in the first year of premium support and who therefore would be
assigned to a plan with a bid at or below the benchmark.
Effects on Federal Spending
CBO estimated a range of effects on federal spending by simultaneously
varying all five key parameters in ways that would result in higher or
lower spending under the premium support options. To do so, the agency
examined how varying each parameter would affect spending.
Bids by Medicare Advantage Plans Relative to Fee-for-Service Spending
If Medicare Advantage bids under current law were lower than those in
CBO's projections and FFS spending was as CBO projects, then federal
savings under both options would be greater, according to CBO's
estimates, because the benchmarks under the options would be lower than
projected. Conversely, if Medicare Advantage bids under current law
were higher than those in CBO's projections and FFS spending was as CBO
projects, federal savings would be smaller than projected. Although
CBO's estimates of the effects of a premium support system are
sensitive to changes in the bids of Medicare Advantage plans relative
to FFS spending, those estimates are not directly sensitive to equal
percentage changes in Medicare Advantage bids and FFS spending--that
is, to an across-the-board increase or decrease in Medicare spending
relative to the amounts that CBO projects--because the difference
between the benchmarks under the options and federal spending for
Medicare under current law would not be affected. However, if such an
across-the-board change occurred, it could affect the amount by which
private insurers under a premium support system reduced their bids
relative to Medicare Advantage bids (as discussed below).
Reduction of Bids of Private Plans in Response to Increased
Competitive Pressure and Other Factors
If private insurers responded to increased competitive pressure by
reducing their bids by more than the amounts in CBO's central
estimates, federal savings would be correspondingly greater under both
options because the benchmarks would be lower than estimated. But
federal savings would be lower if private insurers reduced their bids
by less than the central estimates.
In addition, if FFS and Medicare Advantage costs were higher across the
board (because of greater systemwide growth in costs), there might be
more opportunity for cost savings, depending on the underlying drivers
of that growth, and the amounts by which private insurers reduced their
bids under the premium support options would probably be greater than
they are in the agency's central estimates. Similarly, if costs were
lower across the board, the amounts by which private insurers reduced
their bids under the premium support options would probably be smaller
than they are in the agency's central estimates.
Rates That Private Insurers Would Pay to Providers
If the decline in the market share of the FFS program under a premium
support system resulted in higher payment rates for health care
providers and therefore in higher bids from private insurers than in
CBO's central estimates, federal savings would be correspondingly
smaller because both those bids and the benchmarks would be higher, all
else being equal. If that effect was smaller than in the central
estimates, however, federal savings would be correspondingly greater.
Beneficiaries' Sensitivity to Premiums
Departures from the central estimates in beneficiaries' responsiveness
to differences in premiums would influence federal spending both
through the effects on plans' bids and through the effects on the share
of beneficiaries enrolled in private plans. If beneficiaries were more
responsive to differences in premiums than is predicted in CBO's
central estimates, private insurers' bids would be lower than they are
in those estimates (because insurers would have a stronger incentive to
reduce their bids if such reductions led to larger increases in
enrollment); those lower bids would result in greater federal savings.
Conversely, if beneficiaries were less responsive to differences in
premiums than in the central estimates, the private insurers' bids
would be higher and federal savings would be lower. Regarding
enrollment shares, if beneficiaries were more responsive to differences
in premiums than in the central estimates, a larger proportion would
switch to lower-bidding plans under premium support, causing several
indirect effects on federal savings (as discussed below). If they were
less responsive, the opposite would occur.
Active Choice of a Plan
If a larger percentage of beneficiaries did not actively choose a plan
in the first year of premium support than is predicted in CBO's central
estimates and if those beneficiaries were assigned to plans with bids
at or below the benchmark, a larger percentage of beneficiaries would
be enrolled in low-bidding plans, all else being equal. Conversely, if
a smaller percentage of beneficiaries did not actively choose a plan, a
smaller percentage would be enrolled in low-bidding plans. The
implications for federal savings under the two premium support options
would be similar to the indirect effects (discussed below) that would
occur through changes in the shares of enrollment in private plans when
beneficiaries were more, or less, sensitive to differences in premiums
than is predicted in the central estimates. (Although one might expect
that having a higher share of beneficiaries not actively choosing a
plan would have effects similar to beneficiaries' being less sensitive
to premiums, that is not the case because the beneficiaries who did not
choose a plan would be assigned to a low-bidding plan.)
Effects of Changes in the Proportion of Beneficiaries in Lower-Bidding
Plans
A greater responsiveness of beneficiaries to differences in premiums
when choosing among plans and a larger percentage of beneficiaries not
actively choosing a plan in the first year would both lead to a larger
proportion of beneficiaries being enrolled in lower-bidding plans.
Similarly, less responsiveness to differences in premiums and a smaller
percentage of beneficiaries not actively choosing a plan would lead to
a smaller proportion of beneficiaries being enrolled in lower-bidding
plans. Those differences in enrollment would have indirect effects on
federal savings through three main mechanisms:
Under the average-bid option, having a greater proportion of
beneficiaries in lower-bidding plans would result in lower benchmarks
(because benchmarks are constructed by weighting each plan's bid by its
enrollment in the prior year) and thus would result in greater federal
savings. And if a smaller proportion were enrolled in lower-bidding
plans, higher benchmarks and lower federal savings would result. Under
the second-lowest-bid option, however, having a higher or lower
proportion of beneficiaries enrolled in lower-bidding plans would not
directly affect benchmarks.
In most regions, the lower-bidding plans would be private plans,
and higher enrollment in those plans would be accompanied by a lower
market share for the FFS program, which would increase bids of private
plans for reasons discussed above, all else being equal. Lower
enrollment in private plans would have the opposite effect.
For any given set of bids, CBO expects, greater enrollment in
private plans would result in smaller federal savings because
diagnostic coding by private insurers would be more intensive than that
by FFS providers under a premium support system (as is now the case
under the Medicare Advantage program) and federal payments to private
plans would be adjusted to account for only part of that difference in
coding. Again, lower enrollment in private plans would have the
opposite effect.
Effects on Beneficiaries' Total Payments
CBO estimated a range of effects on beneficiaries' total payments by
simultaneously varying all five key parameters in ways that would
result in higher and lower payments under the premium support options.
In CBO's assessment, the uncertainty of the estimated effects on
beneficiaries' total payments is greater than that concerning the
estimated effects on federal spending because there are especially
broad ranges of plausible values for the two parameters that would
affect beneficiaries' payments the most: their sensitivity to premiums
and the percentage who would not initially choose a plan. Varying other
parameters also affects the estimates.
If beneficiaries were more sensitive to premiums than CBO's central
estimates indicate, more of them would enroll in lower-bidding plans,
and their total payments would be lower, on average, than the central
estimates indicate (because enrollees in low-bidding plans would pay
lower premiums and use fewer medical services and therefore pay less
out of pocket for services). The opposite also is true: If
beneficiaries are less sensitive to premiums, fewer would enroll in
lower-bidding plans, and their total payments would be higher, on
average.
By the same logic, if the proportion of beneficiaries who did not
choose a plan in the first year of a premium support system was larger
than that indicated by the central estimates, their total payments
would be lower, on average, than predicted (because those who did not
choose a plan would be assigned to one with a bid at or below the
benchmark). And if the proportion of beneficiaries who did not choose a
plan was smaller than in the central estimates, their total payments
would be higher, on average.
Beneficiaries' payments under the premium support options also would
depend on other factors that contribute to the uncertainty of CBO's
estimates. Private plans' bids could differ from the agency's central
estimates if the current-law bids for Medicare Advantage were higher or
lower than they are in CBO's estimates, if private insurers reduced
their bids under a premium support system by more or less than the
amounts in those estimates, or if the adjustment to plans' provider
payment rates (and thus their bids) reflected a decline in the FFS
market share that was smaller or larger than that in the estimates. For
example, if the bids of private plans were below the central estimates,
then payments would be lower for enrollees in those plans (because of
lower premiums and reduced cost sharing) and higher for those who
enrolled in the FFS program (because the lower cost of private plans
would reduce benchmarks and raise FFS premiums). As a result,
beneficiaries would have a greater incentive to switch from the FFS
program to private plans, and beneficiaries' total payments would be
lower than CBO's central estimates would indicate (assuming that the
number of beneficiaries enrolled in the FFS program was not so large
that the increase in payments for those beneficiaries outweighed the
reduction in payments for enrollees in private plans and the reduction
in the standard premium for all beneficiaries as a result of the lower
benchmarks). If private plans' bids were higher than predicted by the
central estimates, beneficiaries' total payments would rise relative to
the central estimates.
______
About This Document
This Congressional Budget Office (CBO) report was prepared in response
to interest expressed by Members of Congress. In keeping with CBO's
mandate to provide objective, impartial analysis, the report makes no
recommendations.
Jessica Banthin, James Baumgardner, Tom Bradley, Melinda Buntin
(formerly of CBO), Holly Harvey, Paul Jacobs, Jeffrey Kling, Paul Masi,
Eamon Molloy, Lyle Nelson, Romain Parsad, and Andrew Stocking
contributed to the analysis and prepared the report with guidance from
Linda Bilheimer and Peter Fontaine. Additional assistance was provided
by numerous analysts in CBO's Budget Analysis Division and in its
Health, Retirement, and Long-Term Analysis Division.
Henry Aaron of the Brookings Institution, Joseph Antos of the American
Enterprise Institute, Thomas Buchmueller of the University of Michigan,
Michael Chernew of Harvard University, Mark Duggan of the University of
Pennsylvania, Alain Enthoven of Stanford University, Roger Feldman of
the University of Minnesota, Amy Finkelstein of the Massachusetts
Institute of Technology, Paul Ginsburg of the Center for Studying
Health System Change, Mark McClellan of the Brookings Institution, Mark
Miller of the Medicare Payment Advisory Commission, Joseph Newhouse of
Harvard University, Patricia Neuman of the Kaiser Family Foundation,
and Robert Reischauer of the Urban Institute provided comments about
CBO's analytical approach. (The assistance of external experts implies
no responsibility for the final product, which rests solely with CBO.)
Kate Kelly edited the report, and Maureen Costantino and Jeanine Rees
prepared it for publication. An electronic version is available on
CBO's website (www.cbo.gov/publications/44581).
Douglas W. Elmendorf
Director
September 2013
______
Table 1.
Change in Net Federal Spending for Medicare Under Illustrative Premium
Support Options, Relative to That Under Current Law, 2020
------------------------------------------------------------------------
Second-Lowest-Bid Option Average-Bid Option
------------------------------------------------------------------------
In Billions of -45 -15
Dollars a
As a Percentage of -6 -2
Net Federal
Spending for
Medicare
As a Percentage of -11 -4
Net Federal
Spending for Parts
A and B for
PAffected
Beneficiaries b
------------------------------------------------------------------------
Source: Congressional Budget Office.
Note: Although estimates of percentage changes are based on CBO's March
2012 baseline projections (which are the projections underlying the
analysis in this report), the dollar savings are based on applying
those percentages to CBO's most recent projections (see Updated Budget
Projections: Fiscal Years 2013 to 2023, May 2013, www.cbo.gov/
publication/44172).
a Rounded to the nearest $5 billion.
b Affected beneficiaries include everyone who would have enrolled in
Medicare under current law, except dual-eligible beneficiaries (people
who are simultaneously enrolled in Medicare and Medicaid). Spending
for affected beneficiaries includes all spending for Part A (Hospital
Insurance) and Part B (Medical Insurance) except spending that was
excluded because it is not covered by the bids that Medicare Advantage
plans submit under current law--namely, the additional payments to
disproportionate-share hospitals (whose share of low-income patients
exceeds a specified threshold) and spending for medical education,
hospice benefits, and certain benefits for patients with end-stage
renal disease. Spending for Part D prescription drug insurance is
excluded.
Table 2.
Change in Net Federal Spending for Medicare and in Beneficiaries'
Payments Under Illustrative Premium Support Options, Relative to Amounts
Under Current Law, 2020
------------------------------------------------------------------------
(Percent) Second-Lowest-Bid Option Average-Bid Option
------------------------------------------------------------------------
Net Federal Spending
for Parts A and B
for Affected
Beneficiaries a
Central Estimate -11 -4
Range -9 to -14 -1 to -7
Total Payments by
Affected
Beneficiaries b
Central Estimate 11 -6
Range -2 to 24 0 to -12
Net Federal Spending
for Parts A and B
for Affected
Beneficiaries Plus
Total Payments by
Affected
Beneficiaries a, b,
c
Central Estimate -5 -4
Memorandum:
Premiums Paid by
Affected
Beneficiaries c, d
Central Estimate 31 -6
------------------------------------------------------------------------
Source: Congressional Budget Office.
Note: Affected beneficiaries include everyone who would have enrolled in
Medicare under current law, except dual-eligible beneficiaries (people
who are simultaneously enrolled in Medicare and Medicaid).
a The reported range for the second-lowest-bid option is not symmetric
around the central estimate because of rounding. Spending for affected
beneficiaries includes all spending for Part A (Hospital Insurance)
and Part B (Medical Insurance) except spending that was excluded
because it is not covered by the bids that Medicare Advantage plans
submit under current law--namely, the additional payments to
disproportionate-share hospitals (whose share of low-income patients
exceeds a specified threshold) and spending for medical education,
hospice benefits, and certain benefits for patients with end-stage
renal disease. Spending for Part D prescription drug insurance is
excluded.
b Payments include premiums and out-of-pocket costs for deductibles,
copayments, and coinsurance for services and supplies covered by Part
A and Part B. Payments include the standard Part B premium and the
income-related premium (applicable for beneficiaries whose income
exceeds specified threholds) but exclude any additional amounts paid
for enhanced benefits or supplemental (medigap) coverage.
c Range has not yet been estimated.
d Under current law and under the options, premiums are for the basic
package of Medicare benefits covered under Parts A and B. They exclude
any additional amounts paid for enhanced benefits or supplemental
(medigap) coverage and any amounts paid for the incomerelatedpremium.
[GRAPHIC] [TIFF OMITTED] T12417.001
[GRAPHIC] [TIFF OMITTED] T12417.002
Box 1.
------------------------------------------------------------------------
-------------------------------------------------------------------------
The Medicare Program
------------------------------------------------------------------------
In 2013, Medicare will provide federal health insurance for 52 million
people who are elderly (age 65 or older) or disabled or who have end-
stage renal disease. Of that group, about 85 percent are elderly.
Medicare's Part A (Hospital Insurance) primarily covers inpatient
hospital, skilled nursing facility, and hospice care. Part B (Medical
Insurance) mainly covers services provided by physicians and other
practitioners and by hospital outpatient departments. Home health care
may be covered by Part A or by Part B. Medicare's Part D is the
prescription drug program. Nearly 30 percent of Medicare beneficiaries
receive care through the Medicare Advantage program, or Part C, in
which private health insurers assume responsibility for, and the
financial risk of, providing Medicare benefits. Almost all of the
remaining beneficiaries receive care in the traditional fee-for-service
(FFS) program. In 2012, gross spending for Medicare was $557 billion.
Net of offsetting receipts (mostly premiums paid by beneficiaries),
federal spending for the program was $472 billion.
Medicare's Financing
The various parts of Medicare are financed in different ways. Part A is
financed primarily by a payroll tax. Beneficiaries' premiums (including
income-related adjustments paid by higher-income beneficiaries) cover
just over one-quarter of the outlays for Part B, and general funds from
the U.S. Treasury cover nearly all of the rest. The government's
payments to Medicare Advantage plans are financed by funds from Parts A
and B. For Part D, enrollees' premiums cover about one-quarter of the
cost of the basic prescription drug benefit, the federal government
receives payments from states for dual-eligible beneficiaries (who are
enrolled simultaneously in Medicare and Medicaid), and general funds
cover most of the remaining cost. In fiscal year 2012, payroll taxes
financed about 37 percent of Medicare outlays, beneficiaries' premiums
covered about 13 percent, and most of the rest came from general funds
of the Treasury.
Medicare's Traditional Fee-for-Service Program
Enrollees in the traditional FFS program are covered for services
delivered by any participating provider, and both the package of
benefits and the rates paid to providers are set by law. Medicare
beneficiaries share those costs through deductibles and coinsurance,
but because cost-sharing liabilities can be substantial (in part
because traditional Medicare does not include an annual cap on what
beneficiaries spend), about 90 percent of beneficiaries in the FFS
program have supplemental insurance that covers most or all of their
cost sharing, often through retiree plans offered by former employers
or through individual insurance policies (known as medigap plans) or
Medicaid.
Medicare Advantage
In most places in the United States, Medicare beneficiaries may choose
among competing private insurers--through the Medicare Advantage
program--instead of the traditional FFS program. Participating
insurance companies submit bids indicating the per capita payment they
are willing to accept for providing Part A and B benefits to a
beneficiary of average health. (A separate bidding process determines
payments for Part D.) The federal payment per enrollee then depends on
what the insurance company bids and on how that amount compares with a
``benchmark'' that is announced by the federal government before those
bids are submitted. Under a system set to be fully phased in by 2017,
benchmarks will be based on per capita spending in the FFS program at
the county level, and they will range from 95 percent of FFS spending
per capita in the one-quarter of counties where such spending is
highest to 115 percent of FFS spending per capita in the one-quarter of
counties where such spending is lowest. Plans with quality ratings
above a specified threshold will have bonus amounts added to their
benchmarks.
Plans that submit a bid below the benchmark for a service area receive
federal payments that equal their bid plus a rebate that is a
percentage of the difference between the bid and the benchmark.
(Beginning in 2014, the rebate will range from 50 percent to 70
percent, depending on the plan's performance on certain quality
measures.) Plans must return the rebate to enrollees in the form of
reduced cost sharing for benefits, coverage for items not covered by
Medicare, or reduced Part B or Part D premiums. Plans with a bid that
equals or exceeds the benchmark receive federal payments that equal the
benchmark and must charge enrollees a premium for their Medicare
coverage equal to the amount by which their bid exceeds the benchmark.
Plans' payments from Medicare are larger or smaller, respectively, for
enrollees who are in worse- or better-than-average health.
------------------------------------------------------------------------
Table 3.
Examples of Determining Premiums Under Illustrative Premium Support Options, Using Hypothetical Bids and
Enrollment
----------------------------------------------------------------------------------------------------------------
Region With High Fee-for-Service Region With Low Fee-for-Service Spending
Spending -----------------------------------------
------------------------------------------
Annual Proportion Bid Annual Proportion
Bid Premium Enrolled Premium Enrolled
----------------------------------------------------------------------------------------------------------------
Second-Lowest-Bid Option
Fee-for-Service Program 14,000 4,300 0.25 9,900 1,900 0.75
Private Plans
A 11,800 2,100 0.15 10,100 2,100 0.05
B 11,600 1,900 0.15 9,900 1,900 0.05
C 11,400 1,700 0.15 9,700 1,700 0.05
D 11,200 1,500 0.15 9,500 1,500 0.05
E 11,000 1,300 0.15 9,300 1,300 0.05
Benchmark 11,200 n.a. n.a. 9,500 n.a. n.a.
Standard Premium n.a. 1,500 n.a. n.a. 1,500 n.a.
Average-Bid Option
Fee-for-Service Program 14,000 3,300 0.25 9,900 1,500 0.75
Private Plans
A 12,000 1,300 0.15 10,300 1,900 0.05
B 11,800 1,100 0.15 10,100 1,700 0.05
C 11,600 900 0.15 9,900 1,500 0.05
D 11,400 700 0.15 9,700 1,300 0.05
E 11,200 500 0.15 9,500 1,100 0.05
Benchmark 12,200 n.a. n.a. 9,900 n.a. n.a.
Standard Premium n.a. 1,500 n.a. n.a. 1,500 n.a.
Enrollment-Weighted Average 12,200 1,500 n.a. 9,900 1,500 n.a.
----------------------------------------------------------------------------------------------------------------
Source: Congressional Budget Office.
Notes: Under the second-lowest-bid option, the benchmark would equal the lower of the second-lowest bid from a
private plan and the bid of the fee-for-service program. Under the average-bid option, the benchmark would
equal the enrollment-weighted-average bid among all plans, including the fee-for-service program.
Proportion enrolled is for the previous year. Equal proportions among private plans are used to simplify
the example. (According to CBO's estimates, enrollment would be higher in low-bidding plans.)
Under both options, premiums would equal the standard premium plus the bid minus the benchmark, and
federal contributions for a beneficiary of average health would equal the benchmark minus the standard
premium. Those federal contributions would be $9,700 and $8,000 under the second-lowest-bid option in regions
with high and low fee-for-service spending, respectively, and $10,700 and $8,400 under the average-bid option
in such regions, respectively.
n.a. = not applicable.
[GRAPHIC] [TIFF OMITTED] T12417.003
Table 4.
Average Annual Premiums Charged by Plans for Medicare Part A and B Benefits Under Illustrative Premium Support
Options, Weighted by Population, 2020
----------------------------------------------------------------------------------------------------------------
Second-Lowest-Bid Option Average-Bid Option
-------------------------------------------------------------------------------
Change From Part Change From Part
Annual Premium B Premium Under Annual Premium B Premium Under
(Dollars) Current Law (Dollars) Current Law
(Percent) (Percent)
----------------------------------------------------------------------------------------------------------------
Second-Lowest-Bidding Private 1,500 -6 900 -44
Plan
Median-Bidding Private Plan 1,800 13 1,200 -25
Fee-for-Service Program 3,100 94 2,400 50
----------------------------------------------------------------------------------------------------------------
Source: Congressional Budget Office.
Note: Premiums charged by plans are averages weighted by the Medicare population in each region. (Those averages
differ from the average premiums paid by beneficiaries, which are based on CBO's projections of enrollment in
plans.) Under current law and under the options, premiums are for the basic package of Medicare benefits
covered under Part A (Hospital Insurance) and Part B (Medical Insurance). They exclude any additional amounts
paid for enhanced benefits or supplemental (medigap) coverage and any amounts paid for the income-related
premium (applicable for beneficiaries whose income exceeds specified threholds). Under current law, for most
beneficiaries, Part A will have no premium and the premium for Part B (excluding income-related adjustments)
will be $1,600 in 2020, CBO projects. Amounts are rounded to the nearest $100.
[GRAPHIC] [TIFF OMITTED] T12417.004
[GRAPHIC] [TIFF OMITTED] T12417.005
Box 2.
------------------------------------------------------------------------
-------------------------------------------------------------------------
Grandfathering of Beneficiaries Under a Premium Support System
------------------------------------------------------------------------
Under one type of proposal for a premium support system, current
beneficiaries and those who became eligible for Medicare before the new
system took effect would continue to receive coverage under the
existing Medicare program; only those beneficiaries who became newly
eligible on or after a specified date would enroll in the premium
support system. Such an arrangement would require the federal
government to address several important design questions-some are
unique to such a system and others are relevant for any premium support
system but have added significance if grandfathering is part of the
design. Although policymakers might also consider changing the existing
Medicare program if it remained in operation, this discussion focuses
on design issues specifically related to a grandfathering provision in
a premium support system, and it assumes that beneficiaries who
remained in the existing system could choose Medicare's fee-for-service
(FFS) program or a Medicare Advantage plan and that private insurers
could participate in the premium support system, the Medicare Advantage
program, or both.
Enrollment in Part B
An important question for any premium support system is whether
enrollment in Medicare's Part B (Medical Insurance) would remain
voluntary, and if so, how beneficiaries who declined that coverage
would be treated by the system. About 8 percent of Medicare
beneficiaries are not enrolled in Part B currently, generally because
either they or a spouse are still working and have employment-based
coverage as primary insurance with Medicare as a secondary insurer.
Among the Medicare population age 65 or older, younger beneficiaries are
more likely to decline Part B coverage, and the percentage that does so
has increased as more people have stayed in the workforce past age 65.
(The late-enrollment penalty for Part B is waived for active workers in
larger companies that offer employment-based coverage. If such workers
were to enroll, Medicare would be a secondary payer for their health
care costs, which would reduce the value of the coverage.) Some 19
percent of 65-year-old Medicare beneficiaries were not enrolled in Part
B in 2011, up from 15 percent in 1999. If a premium support program
included grandfathering, the question of whether Part B enrollment
would remain voluntary would be especially important because the
younger segment of the retirement-age population would constitute a
substantial fraction of the beneficiaries covered in the first few
years.
Bidding Regions
Depending on how the regions were defined, in many regions the number of
beneficiaries in a premium support system with a grandfathering
provision could initially be very small. If dual-eligible beneficiaries
also were excluded from the new system, the Congressional Budget Office
(CBO) projects, just 5 percent of the Medicare population would be
covered by the system after the first year, and only 25 percent would
be covered after the fifth year.
Some proposals would have bidding regions correspond to health care
markets within states. In that case, grandfathering would result in
some regions' enrolling very small numbers of people in the new system
in the first few years. Because personal health care expenditures vary
widely, the actual costs of enrollees in private plans and the FFS
program could differ greatly from those plans' bids for their regions.
That uncertainty could make participation less attractive to private
insurers, cause them to raise their bids if they chose to participate,
and create significant year-to-year variation in the amounts of the
bids. In regions with few beneficiaries, private insurers also would
have less incentive to modify health care plans to contain costs.
Bids and Risk Adjustment
Under the illustrative premium support options analyzed for this report,
insurers would submit a bid for a beneficiary with average expected
health care costs (that is, a beneficiary with a risk score of 1.0),
and federal payments to insurers would be adjusted to account for
differences between their enrollees' expected costs and those of the
average beneficiary. CBO assumed that the risk adjustment would be
comparable to that for the Medicare Advantage program, in which federal
payments to insurers are adjusted on the basis of enrollees' medical
conditions and demographic characteristics.
In the initial years of a system with grandfathering, a substantial
proportion of covered beneficiaries would not have the history of past
Medicare claims data necessary to compute a risk score. For those
beneficiaries, payments to plans could be adjusted using a version of
the risk adjuster based entirely on demographic characteristics. That
approach lacks the completeness of the standard risk adjuster, which
includes information on medical conditions, so pursuing it would raise
questions about the adequacy of risk adjustment in the first few years.
Under a grandfathering provision, the bidding and risk adjustment
mechanism could reflect average expected costs for a beneficiary in the
premium support system. That approach would necessitate ``rescaling''
the risk adjustment factors to correspond to the segment of the
Medicare population enrolled in the premium support system or
reestimating those factors (because particular risks are associated
with costs in ways that would differ between that segment and the
Medicare population as a whole). If the existing risk adjustment
mechanism was used instead, insurers would base their bids on a
population that differed from the population served under the premium
support system. An analogous set of issues would confront the Medicare
Advantage program. Once the premium support system began, the
proportion of beneficiaries eligible to enroll in a Medicare Advantage
plan would decline each year as new people entered the premium support
system.
Beneficiaries' Premiums
For both illustrative options, CBO assumed that beneficiaries who
enrolled in a plan with a bid equal to the benchmark would pay a
standard premium determined using the same formula used to calculate
the Part B premium under current law. With grandfathering, that premium
could be determined in various ways. One approach would be to compute a
single standard premium for the entire Medicare population that would
apply both to beneficiaries in the premium support system and to those
who were grandfathered into Medicare in its current-law form. In a
second approach, separate computations could be made for a standard
premium under the premium support system and for the Part B premium
that would apply to the grandfathered population; a standard premium
could be computed as one amount, or standard premiums could differ by
beneficiaries' age. Each approach would involve a different
distribution of health care costs and of potential savings from a
premium support system among age groups.
------------------------------------------------------------------------
[GRAPHIC] [TIFF OMITTED] T12417.006
______
Politico, April 30, 2012
GOP Split on Reforming Health Care
By Jennifer Haberkorn
Ask the 242 House Republicans what kind of health policy they'd like to
enact instead of President Barack Obama's health care reform law and
you might get 242 different answers.
Even after 3 years of railing against Obama's plan, Republicans have
coalesced around only a few basic tenets of health policy--let alone a
full replacement plan.
They are even divided over whether some of the popular pieces of
Obama's health law are a good idea. For example, most Republicans
support the health law's requirement that insurance companies accept
all applicants--but the replacement plan put forward by the most
prominent Republican ignores that idea.
``It's a terrible idea,'' Rep. Tom Price (R-GA), the sponsor of the
plan, told Politico. He said Democrats only enacted the provision in
order to require exactly what kinds of insurance Americans must have.
He would rather expand coverage voluntarily.
The wide range of GOP opinions could make it hard for the party to come
together behind a single plan to replace Obama's health care law if
it's overturned by the Supreme Court this summer.
A ruling against all or part of the legislation has the potential to
reopen the health care wars of 2009, putting the differences among
Republicans on full display. It's a divide Democrats would try to
exploit as they press Republicans on how they're going to solve the
country's health care problems.
``If the Supreme Court throws out the president's plan, we're going to
have to have something on the table,'' said Rep. Paul Broun (R-GA), a
physician.
House Republicans won't be the only ones with replacement plans. Gov.
Mitt Romney's health agenda relies more on state-level reforms and
private competition than Obama's law.
On Capitol Hill, there are a handful of pending Republican health
bills.
Days before the Supreme Court heard oral arguments over the health law,
Broun introduced a plan that allows Americans to deduct all of their
health care costs; encourages the use of health savings accounts;
converts Medicare to a ``premium support'' model that subsidizes
private coverage; allows consumers to buy insurance across state lines;
and encourages the use of association health plans, which allow groups
of people or co-workers to buy health care together.
Broun said he's trying to drum up support among lawmakers and outside
groups and already has the backing of FreedomWorks, the conservative
group led by Dick Armey.
The plan that's likely to get the closest look from Republicans is
sponsored by Price, an orthopedic surgeon and one of the House's
leading voices on health care. He released a video on Wednesday touting
the plan, which he originally introduced in 2009.
______
Prepared Statement of Hon. Thomas Price, M.D., Nominated to be
Secretary, Department of Health and Human Services
Thank you, Chairman Hatch, Ranking Member Wyden, and all the
members of this committee, for the opportunity to speak with you today
and engage in a discussion about the road ahead for our great Nation.
These proceedings, and this entire process, would not be possible
without the work of your staff, and so I want to extend my appreciation
to them as well for the great service they provide. Thanks so much to
Senator Johnny Isakson for his generous introduction. We've known each
other for nearly 30 years--and I'm so grateful for his friendship and
kindness, and our State is blessed to have had his service and
leadership. I wish also to especially thank my wife of 33 years, Betty.
Her support, encouragement and advice (which is always correct) mean
more than I could ever say.
Over the past few weeks, I have had the chance to meet with many of
you individually and have gained a real appreciation for the passion
you all have about the critical work of the Department of Health and
Human Services. Please know that I share that passion. That is why I am
here today--and why I'm honored to have been nominated by the President
to serve as the next Secretary of HHS.
We all come to public service in our own unique ways that inform
who we are and why we serve. My first professional calling was to care
for patients. That experience as a physician and later as a legislator
has provided a holistic view of the complex interactions that take
place every day across our communities and across this country that,
when done correctly, are in service to the greater good we seek to
achieve. Today, I hope to share with you how my experience has helped
shape my understanding of and appreciation for the work of the
department and its team, which I hope to lead.
From an early age, I had an interest in medicine. My earliest
memories are of a farm in Michigan where my family and I lived before
moving to suburban Detroit at the age of five. I spent most of my
formative years being raised by a single mom--and I assumed a lot of
responsibility since there were 5 of us. Some of my fondest memories
were spending time with my grandfather--a physician--as he made house
calls to see patients. Having both a father and grandfather as
physicians surely influenced my path toward medicine. And it was very
likely that the orthopedist who treated my many broken bones in my
youth gave me a particular fascination for fixing things--and not just
broken bones.
After graduating with a medical degree from the University of
Michigan, I went south to Atlanta, GA--which I've called home for
nearly 40 years. It's where I met my wife Betty and where we raised our
son. I did my residency at Emory University and Grady Memorial Hospital
in downtown Atlanta. I would return to Grady later in my career to
serve as Medical Director of the Orthopedic Clinic. Throughout my
professional career I treated patients of every age--from all walks of
life--including many children. Anyone who has ever treated a child
knows how fulfilling it is to look into the eyes of a parent and tell
them our team has helped heal their son or daughter--to give them peace
of mind. My memories of Grady are filled with the gracious comments
from parents and patients for the team of health care specialists with
whom I had the privilege of working. I cherished my time there.
After 25 years of school and training, I hung out my shingle to
start a solo private orthopedic practice. Over the years, this practice
grew and eventually became one of the largest, non-academic orthopedic
groups in the country--a group I would eventually serve as Chairman of
the Board. Whether as part of that team or on staff at a hospital, it
was apparent early on that every person involved in the delivery of
care, no matter their role--doctors, nurses, lab techs, orderlies--all
had one goal in mind--and that was to get our patients well again, to
heal them. It was always a team effort and wherever you fit into that
team, you appreciated the value of those working with you.
During 20 years as a practicing physician--both in office and
hospital setting--I learned a good bit about not just treating patients
but about the broader health care system and where it intersects with
government--local, State and Federal. A couple of lessons stand out.
One--many patients I knew or treated were never more angry and
frustrated than when they realized that there was someone other than
themselves and /or their physician making medical decisions on their
behalf--when there was someone not involved in the actual delivery of
care that was standing between them and their doctor or treatment.
Another lesson came the day I noticed that there were more
individuals within our office who were dealing with paperwork,
insurance filings, and government regulations than there were
individuals actually seeing and treating patients. It was in those
moments that it became crystal clear that our health care system was
losing focus on the number one priority--the individual patient. Having
had no greater joy than taking care of patients, I felt compelled to
broaden my role in public service, and help solve the issues harming
the delivery of medicine--so I ran for the State Senate in Georgia.
Anyone here who has ever served at the State level knows that State
government has a different feel to it--a different pace. In Georgia, I
found the State Senate to be a remarkably bipartisan place where
collegial relationships were the norm. This is the environment in which
I learned to legislate--reaching across the aisle to get the work
done--needing the buy-in and the support of more than just one party. I
worked with Democrats including then State senator, now-Atlanta Mayor,
Kasim Reed. He and I did not see eye to eye on everything, for sure,
but we were successful in finding our way together through some really
challenging issues for our State.
In Congress, I have been fortunate to have been a part of
collaborations that broke through party lines to solve problems
including those pertaining to health care. Early in my congressional
career, I was privileged to work alongside then-
representative, now Senator, Tammy Baldwin to introduce legislation
that would have empowered States to come up with new ideas to provide
health care coverage to their uninsured populations. Just this past
Congress, it was a bipartisan, bicameral effort that actually succeeded
in ridding Medicare of a broken physician payment system and which has
now begun the creation of a new system that, if implemented properly,
will help ensure that seniors have better access to higher quality
care.
If confirmed, my obligation will be to carry to the Department of
Health and Human Services both an appreciation for bipartisan, team-
driven policymaking and what has been a lifetime commitment to work to
improve the health and well-being of the American people. That
commitment extends to what I call the six principles of health care--
six principles that, if you think about it, all of us hold dear:
affordability, accessibility, quality, choices, innovation, and
responsiveness. We all want a health care system that's affordable,
that's accessible to all, of the highest quality, with the greatest
number of choices, driven by world-leading innovations, and responsive
to the needs of the individual patient.
But HHS is more than just health care. There are real heroes at
this department doing incredible work to keep our food safe, to develop
new drugs and treatment options--driven by scientists conducting truly
remarkable research. The Centers for Disease Control and Prevention--
which we in Atlanta are proud to have headquartered in our city--is the
first place the world turns to when there's a health care threat that
requires the greatest, most capable minds to solve.
There are heroes among the talented, dedicated men and women
working to provide critical social services--helping families and,
particularly, children have a higher quality of living and the
opportunity to rise up and strive to achieve their American Dream--
something we all want for ourselves and our loved ones.
The role of HHS in improving lives means it must carry out its
responsibilities with compassion. It also must be efficient, effective
and accountable, as well as being willing to partner with those in our
communities already doing remarkable work. In every aspect of the
department, across the spectrum of issues and services it handles,
there is embedded a promise that has been made to the American people.
Governor Michael Leavitt, during his confirmation hearing in 2004 to
take on this task, spoke of our highly regarded ``brands''--the CDC,
FDA, NIH, and others--and how they must be preserved and strengthened
because they guarantee that those promises are kept.
Today's challenges make it even more important that we strengthen
our resolve to keep the promises we, as a society, have made to our
senior citizens and to those among us who are most in need of care and
support. That means saving, strengthening, and securing Medicare for
today's beneficiaries and future generations. It means ensuring that
our Nation's Medicaid population has access to quality care. It means
maintaining, and expanding, America's leading role in medical
innovation and the treatment and eradication of disease.
As I noted at the outset, I share your passion for these issues--
having spent my life in service to them. And yet, there's no doubt that
we do not all share the same point of view when it comes to addressing
each and every one of them. Our approaches to policies may differ, but
there surely exists a common commitment to public service and
compassion for those we serve. We all hope, by our actions, to help
improve the lives of the American people, to help heal individuals and
whole communities. With a healthy dose of humility and appreciation for
the scope of the challenges before us, with your assistance and with
God's will, we can make it happen. I look forward to working with you
to do just that.
Thank you very much for the privilege of appearing before you
today.
______
SENATE FINANCE COMMITTEE
STATEMENT OF INFORMATION REQUESTED
OF NOMINEE
A. BIOGRAPHICAL INFORMATION
1. Name (include any former names used): Thomas Edmunds Price, M.D.
2. Position to which nominated: Secretary of the Department of Health
and Human Services.
3. Date of nomination: January 20, 2017.
4. Address (list current residence, office, and mailing addresses):
5. Date and place of birth: October 8, 1954, Lansing, Michigan.
6. Marital status (include maiden name of wife or husband's name):
7. Names and ages of children:
8. Education (list secondary and higher education institutions, dates
attended, degree received, and date degree granted): Dearborn High
School, 1969-1972, Diploma; University of Michigan, 1972-1979,
Bachelor's Degree and Doctor of Medicine.
9. Employment record (list all jobs held since college, including the
title or description of job, name of employer, location of work, and
dates of employment): Surgical Intern, Emory University School of
Medicine/Grady Health System, Atlanta, GA, 1979-1980; Orthopaedic
Surgical Resident, Emory University School of Medicine/Grady Health
System, Atlanta, GA, 1980-1984; Orthopaedic Surgeon, solo and group
practice (North Fulton Orthopaedic Clinic, Compass Orthopaedics,
Resurgens Orthopaedics), Roswell/Atlanta, GA, 1984-2002; Assistant
Professor, Orthopaedic Surgery, Emory University School of Medicine/
Grady Health System, Atlanta, GA 2002-2004; Georgia State Senator,
State of Georgia, Atlanta, GA, 1997-2005; Member of Congress, GA06,
House of Representatives, Washington DC, 2006-present.
10. Government experience (list any advisory, consultative, honorary,
or other part- time service or positions with Federal, State, or local
governments, other than those listed above): See Appendix A.
11. Business relationships (list all positions held as an officer,
director, trustee, partner, proprietor, agent, representative, or
consultant of any corporation, company, firm, partnership, other
business enterprise, or educational or other institution): Founder/
owner, North Fulton Orthopaedic Clinic, Roswell, GA; co-
founder/president, Compass Orthopaedics, Roswell, GA; Director/chairman
of board, Resurgens Orthopaedics, Atlanta/Roswell, GA; managing
partner, Chattahoochee Associates, Roswell, GA (owns medical office
building); member and co-owner, Diagnostic Ventures of Roswell, LLC,
Roswell, GA (owns medical office building); member and co-owner, RMC3,
LLC, Roswell, GA (owns stake in Diagnostic Ventures of Roswell, LLC,
which owns medical office building); limited partner, Carolina
Properties, Ltd., (owns apartment buildings in North Carolina, South
Carolina, and Virginia).
12. Memberships (list all memberships and offices held in
professional, fraternal, scholarly, civic, business, charitable, and
other organizations): Roswell Rotary Club, 1985-present, president
1996-1997; American Academy of Orthopaedic Surgeons; American Medical
Association; Medical Association of Georgia; Medical Association of
Atlanta; Atlanta Orthopaedic Society; Kelly Orthopaedic Society;
Georgia Orthopaedic Society; American College of Surgeons;
Chattahoochee Nature Center; Georgia Ensemble Theatre; Georgia
Arthritis Foundation.
13. Political affiliations and activities:
a. List all public offices for which you have been a candidate.
Georgia State Senate District 56; U.S. House of Representatives
GA06.
b. List all memberships and offices held in and services rendered
to all political parties or election committees during the last 10
years.
Member of Congress, GA06, Republican.
c. Itemize all political contributions to any individual, campaign
organization, political party, political action committee, or similar
entity of $50 or more for the past 10 years.
See Appendix B.
14. Honors and awards (list all scholarships, fellowships, honorary
degrees, honorary society memberships, military medals, and any other
special recognitions for outstanding service or achievement):
See Appendix C.
15. Published writings (list the titles, publishers, and dates of all
books, articles, reports, or other published materials you have
written):
Saving the American Miracle: The Destruction and Restoration of
American Values. Paperback--self-published, January 20, 2011.
In addition, a listing of all requested Op-Eds authored by Dr.
Price has been attached as Appendix D.
16. Speeches (list all formal speeches you have delivered during the
past 5 years which are on topics relevant to the position for which you
have been nominated):
See Appendix E.
17. Qualifications (state what, in your opinion, qualifies you to
serve in the position to which you have been nominated):
My strengths are commitment, passion, and expertise. My entire
adult life has been dedicated to service--professionally as an
orthopaedic surgeon, politically as a State Senator and member of
Congress, and in our community through numerous volunteer and charity
activities. As a third-generation physician, I am well aware of the
challenges of caring for patients and the societal needs of
populations. For over 20 years, I had the privilege of practicing
orthopaedic surgery in both private and public settings, training in an
urban medical center including service in a veterans hospital, and
treating folks of all ages and all walks of life. I founded North
Fulton Orthopaedic Clinic and over time co-founded Resurgens
Orthopaedics--reputed to be the largest private group practice of
orthopaedic surgeons in the country. While serving as a Georgia State
Senator, I was responsible for training students, interns, and
residents in a large, major urban hospital in Atlanta. Those
experiences coupled with being a legislator at both the State and
Federal levels has given me a comprehensive understanding of the
complex interactions taking place every day between patients and their
families, physicians, providers, insurers, as well as local, State, and
Federal Governments. It is a perspective that has reinforced my belief
that the individual patient must always be at the center of health-care
policy decisions. Having examined many systems and collaborated with
many individuals and groups to bring improvements to our health-care
financing and delivery, my breadth of experience and understanding has
uniquely qualified me for this post. I have a deep passion for finding
positive solutions to improve the human condition and allowing each
member of our society to realize their full potential. I am not daunted
by the challenge before us and have confidence in the promise that HHS
may bring with its many agencies and broad jurisdiction to assist our
communities and citizens. As a student of scientific principles, I have
a profound appreciation for the role of basic scientific research, for
the development of innovative treatments and cures, and for the
imperative that America remains a leader in those pursuits.
B. FUTURE EMPLOYMENT RELATIONSHIPS
1. Will you sever all connections with your present employers,
business firms, associations, or organizations if you are confirmed by
the Senate? If not, provide details.
Yes, any and all necessary.
2. Do you have any plans, commitments, or agreements to pursue
outside employment, with or without compensation, during your service
with the government? If so, provide details.
No.
3. Has any person or entity made a commitment or agreement to employ
your services in any capacity after you leave government service? If
so, provide details.
No.
4. If you are confirmed by the Senate, do you expect to serve out
your full term or until the next presidential election, whichever is
applicable? If not, explain.
Yes.
C. POTENTIAL CONFLICTS OF INTEREST
1. Indicate any investments, obligations, liabilities, or other
relationships which could involve potential conflicts of interest in
the position to which you have been nominated.
None. The nominee will comply with all Office of Government Ethics
recommendations for current and future personal investment holdings.
2. Describe any business relationship, dealing or financial
transaction which you have had during the last 10 years, whether for
yourself, on behalf of a client, or acting as an agent, that could in
any way constitute or result in a possible conflict of interest in the
position to which you have been nominated.
None. The nominee will comply with all Office of Government Ethics
recommendations for personal business relationships, dealings, and
financial transactions.
3. Describe any activity during the past 10 years in which you have
engaged for the purpose of directly or indirectly influencing the
passage, defeat, or modification of any legislation or affecting the
administration and execution of law or public policy. Activities
performed as an employee of the Federal Government need not be listed.
Only as a member of Congress.
4. Explain how you will resolve any potential conflict of interest,
including any that may be disclosed by your responses to the above
items.
I intend to operate as I always have during all of my years in
public service: by making ethical compliance a cornerstone of my public
service and operating without reproach. Any personal holdings or
positions which could conceivably present a potential conflict of
interest have been disclosed to the Office of Government Ethics, and
appropriate resolution of any potential conflict of interest will be
resolved prior to my confirmation.
5. Two copies of written opinions should be provided directly to the
committee by the designated agency ethics officer of the agency to
which you have been nominated and by the Office of Government Ethics
concerning potential conflicts of interest or any legal impediments to
your serving in this position.
6. The following information is to be provided only by nominees to
the positions of United States Trade Representative and Deputy United
States Trade Representative:
Have you ever represented, advised, or otherwise aided a foreign
government or a foreign political organization with respect to any
international trade matter? If so, provide the name of the foreign
entity, a description of the work performed (including any work you
supervised), the time frame of the work (e.g., March to December 1995),
and the number of hours spent on the representation.
N/A.
D. LEGAL AND OTHER MATTERS
1. Have you ever been the subject of a complaint or been
investigated, disciplined, or otherwise cited for a breach of ethics
for unprofessional conduct before any court, administrative agency,
professional association, disciplinary committee, or other professional
group? If so, provide details.
The nominee was the subject of an investigation by the Office of
Congressional Ethics in 2010 for matters involving fundraising
activities associated with his principal campaign committee. Although
the matter was referred for further consideration by the House
Committee on Standards of Official Conduct, the committee dismissed the
matter finding no wrongdoing and recommending that no further action
was necessary. The public record associated with this investigation is
available at the following link: https://oce.house.gov/january-26-2011-
oce-referral-regarding-rep-tom-price/.
2. Have you ever been investigated, arrested, charged, or held by any
Federal, State, or other law enforcement authority for a violation of
any Federal, State, county or municipal law, regulation, or ordinance,
other than a minor traffic offense? If so, provide details.
No.
3. Have you ever been involved as a party in interest in any
administrative agency proceeding or civil litigation? If so, provide
details.
No.
4. Have you ever been convicted (including pleas of guilty or nolo
contendere) of any criminal violation other than a minor traffic
offense? If so, provide details.
No.
5. Please advise the committee of any additional information
favorable or unfavorable, which you feel should be considered in
connection with your nomination.
N/A.
E. TESTIFYING BEFORE CONGRESS
1. If you are confirmed by the Senate, are you willing to appear and
testify before any duly constituted committee of the Congress on such
occasions as you may be reasonably requested to do so?
Yes.
2. If you are confirmed by the Senate, are you willing to provide
such information as is requested by such committees?
Yes.
APPENDIX A
Leadership Positions and Standing Committee Assignments
1997-1998--Georgia Senate
Health and Human Services
Insurance and Labor
Reapportionment
Special Judiciary
Youth, Aging, and Human Ecology
1999-2000--Georgia Senate
Minority Whip
Consumer Affairs
Education
Health and Human Services
Reapportionment
Special Judiciary
2001-2002--Georgia Senate
Minority Whip
Education
Health and Human Services
Reapportionment
Rules
Veterans and Consumer Affairs
2003-2004--Georgia Senate
Majority Leader
Appropriations
Economic Development and Tourism, Vice-chair
Education, ex-officio
Ethics
Health and Human Services
Insurance and Labor ex-officio
Reapportionment and Redistricting, Secretary
Rules, Secretary
2005-2009--U.S. House of Representatives
Financial Services
Education and Workforce/Labor
2009-2011--U.S. House of Representatives
Chair--Republican Study Committee
Financial Services
Education and Labor
Ranking Member--Workforce Protections Subcommittee
Ranking Member--HELP Subcommittee
Franking Commission
2011-2013--U.S. House of Representatives
Chair--Republican Policy Committee
Ways and Means
Budget
Franking Commission
2013-2015--U.S. House of Representatives
Ways and Means
Vice-Chair--Budget Committee
Education and Workforce
Franking Commission
2015-2017--U.S. House of Representatives
Chair--Budget Committee
Ways and Means
APPENDIX B
Contributions Made By Thomas and Elizabeth Price
------------------------------------------------------------------------
Contributor Name Committee Name Transaction Date Amount
------------------------------------------------------------------------
Clark-Price, Norwood, Charlie August 23, 2000 $250
Elizabeth via Norwood for
Congress
------------------------------------------------------------------------
Clark-Price, Gingrey, J. July 27, 2002 $1,000
Elizabeth Phillip via
Gingrey for
Senate Inc.
------------------------------------------------------------------------
Clark-Price, Isakson, John June 6, 2003 $200
Elizabeth Hardy via
Georgians for
Isakson
------------------------------------------------------------------------
Price, Elizabeth Handel, Karen June 29, 2013 $1,000
Christine via
Handel for
Senate Inc.
------------------------------------------------------------------------
Price, Elizabeth Handel, Karen December 18, 2013 $1,000
Christine via
Handel for
Senate Inc.
------------------------------------------------------------------------
Price, Elizabeth Georgia March 21, 2013 $250
Republican
Party, Inc.
------------------------------------------------------------------------
Price, Elizabeth Georgia March 10, 1999 $200
Republican
Party, Inc.
------------------------------------------------------------------------
Price, Elizabeth Georgia June 9, 1997 $500
Republican
Party, Inc.
------------------------------------------------------------------------
Price, Elizabeth Gingrey, J. August 28, 2002 $1,000
Phillip via
Gingrey for
Senate, Inc.
------------------------------------------------------------------------
Clark-Price, Romney, Mitt/ June 28, 2012 $1,000
Elizabeth Paul D. Ryan
via Romney for
President, Inc.
------------------------------------------------------------------------
Price, Thomas E., Georgia May 4, 1999 $295
M.D. Republican
Party, Inc.
------------------------------------------------------------------------
Price, Thomas E., Gingrey, J. July 27, 2002 $1,000
M.D. Phillip via
Gingrey for
Senate, Inc.
------------------------------------------------------------------------
Price, Thomas E., Gingrey, J. August 28, 2002 $1,000
M.D. Phillip via
Gingrey for
Senate, Inc.
------------------------------------------------------------------------
Price, Thomas E., Republican October 23, 2000 $250
M.D. National
Committee
------------------------------------------------------------------------
Price, Thomas E., Bush, George W. January 22, 2004 $2,000
M.D. via Bush-Cheney
'04 (Primary)
Inc.
------------------------------------------------------------------------
Price, Thomas E., Republican October 23, 2000 $250
Mrs. National
Committee
------------------------------------------------------------------------
Price, Thomas E., Political Action June 6, 2002 $250
M.D. Committee of
the American
Association of
Orthopaedic
Surgeons--PAC
of AAO
------------------------------------------------------------------------
Price, Thomas E., Dole, Elizabeth August 24, 1999 $1,000
M.D. via Elizabeth
Dole for
President
Exploratory
Committee Inc.
------------------------------------------------------------------------
Price, Thomas E., Georgia May 24, 2000 $300
M.D. Republican
Party, Inc.
------------------------------------------------------------------------
Price, Thomas E., Biggert, Judy September 23, 2012 $2,000
M.D. via Judy
Biggert for
Congress
------------------------------------------------------------------------
Price, Thomas E., NRCC December 11, 2008 $220
M.D.
------------------------------------------------------------------------
Price, Thomas E., Gingrich, Newton January 22, 1998 $1,000
M.D. L., via Friends
of Newt
Gingrich
------------------------------------------------------------------------
Price, Thomas E., Price, Thomas July 28, 2004 $99,000
M.D. Edmunds via
Price for
Congress--Loan,
since repaid
------------------------------------------------------------------------
Price, Thomas E., Price, Thomas August 6, 2004 $150,000
M.D. Edmunds via
Price for
Congress--Loan,
since repaid
------------------------------------------------------------------------
Joint Fundraising Contributions
These are contributions to committees who are raising funds to be
distributed to other committees.
The breakdown of these contributions to their final recipients may
appear below.
------------------------------------------------------------------------
Contributor Name Committee Name Transaction Date Amount
------------------------------------------------------------------------
Price, Mrs. Trump Make September 15, 2016 $1,000
Elizabeth America Great
Again Committee
------------------------------------------------------------------------
Recipient of Joint Fundraiser Contributions
These are the Final Recipients of Joint Fundraising Contributions.
------------------------------------------------------------------------
Contributor Name Committee Name Transaction Date Amount
------------------------------------------------------------------------
Price, Mrs. Trump, Donald J./ September 15, 2016 $800
Elizabeth Michael R.
Pence via
Donald J. Trump
for President,
Inc.
------------------------------------------------------------------------
Georgia Contributions
------------------------------------------------------------------------
PAC
Contributor's Affiliation/ Date
Recipient Name Occupation/ Received Type Amount
Employer
------------------------------------------------------------------------
Georgia Hon. Thomas E. Physician Self- April 25, Monet $4,863
Republican Price Employed 2006 ary
Party, Gene
Inc. ral
------------------------------------------------------------------------
Georgia Hon. Thomas E. Physician Self- April 25, Monet $4,956
Republican Price Employed 2008 ary
Party, Gene
Inc. ral
------------------------------------------------------------------------
Georgia Hon. Thomas E. Physician Self- April 27, Monet $5,220
Republican Price Employed 2010 ary
Party, Gene
Inc. ral
------------------------------------------------------------------------
Georgia Hon. Thomas E. Physician Self- January 5, Monet $5,220
Republican Price Employed 2010 ary
Party, Gene
Inc. ral
------------------------------------------------------------------------
Karen Elizabeth Price Councilwoman, January 5, Monet $1,000
Handel for City of 2010 ary
Governor, Roswell Prim
Inc. ary
------------------------------------------------------------------------
Georgia Elizabeth Price Physician March 21, Monet $250
Republican Compass 2013 ary
Party, Orthopedics Gene
Inc. ral
------------------------------------------------------------------------
Keep Judge Elizabeth Price Physician April 16, Monet $500
Tom Compass 2014 ary
Campbell; Orthopedics Gene
Thomas ral
Ralph
Campbell
Jr.
------------------------------------------------------------------------
Fulton Elizabeth Price Homemaker N/A January Monet $150
County 22, 2009 ary
Republican Gene
Party, ral
Inc.
------------------------------------------------------------------------
Fulton Elizabeth Price Homemaker N/A February Monet $50
County 13, 2009 ary
Republican Gene
Party, ral
Inc.
------------------------------------------------------------------------
Fulton Elizabeth Price Homemaker N/A April 29, Monet $150
County 2010 ary
Republican Gene
Party, ral
Inc.
------------------------------------------------------------------------
Fulton Elizabeth Price City October 7, Monet $10
County Councilman, 2011 ary
Republican City of
Party, Roswell
Inc.
------------------------------------------------------------------------
Fulton Elizabeth Price City October 7, Monet $180
County Councilman, 2011 ary
Republican City of
Party, Roswell
Inc.
------------------------------------------------------------------------
Friends to Thomas E. Congressman October Monet $1,000
Elect Todd Price, MD United States 25, 2013 ary
Tyson, Spec
Inc., Todd ial
Tyson
------------------------------------------------------------------------
Georgia Thomas E. Physician Self- December Monet $250
Medical Price, MD Employed 3, 2014 ary
Political Prim
Action ary
Couunittee
(GAMPAC)
------------------------------------------------------------------------
APPENDIX C
Awards Received by Dr. Thomas Price
1988 In Appreciation--Chairman, Bylaws Committee--North Fulton
Regional Hospital 1988
In Appreciation--American Cancer Society
1990 In Appreciation--Chairman, Department of Surgery--North Fulton
Regional Hospital
1993 President's Award--``Rx for Georgia''--Medical Association of
Georgia
Pr esident's Award--Medical Association of Atlanta--Chairman,
Health Care Reform Committee
1994 Pr esident's Award--Medical Association of Atlanta--Chairman,
Health Systems Reform Committee
Pr esident's Award--Medical Association of Atlanta--Chairman,
Health Care Reform Committee
1996 Partners in Education--Fulton County Schools
In Appreciation--1st Vice President--Medical Association of
Georgia
1997 In Appreciation--Northside Alliance for Mentally Ill
Re cognition--Support of Georgia Rotary Student Program--Georgia
Rotary Student Endowment
Distinguished Service Award--Medical Association of Atlanta
1998 Rotarian of the Year--Roswell Rotary Club
Outstanding Rotarian--Past Service--Roswell Rotary Club
Legislative Service Award--Association of County Commissioners of
Georgia
Certificate of Achievement--Georgia Emergency Management Agency
1999 Ou tstanding work as a friend of medicine and demonstrating
dedication to patients of Georgia--Medical Association of Georgia
In Appreciation--Kiwanis Club of Historic Roswell
Senator of the Year--Georgia Republican Party
Legislative Leadership Award--Georgia Hospital Association
In Appreciation--Honorable and Holy Calling to Public Service--
Presbytery of Greater Atlanta
2000 Will Watt Fellow--Rotary International
In Appreciation--Member of Governing Council--Organized Medical
Staff Section, American Medical Association
In Appreciation--Medical Team--Roswell High School
Legislative Leadership Award--Georgia Hospital Association
2001 In Appreciation--Georgia Alcohol Policy Partnership
In Appreciation--North Georgia Community Action, Inc.
In Appreciation--Coalition for Hospital Choice
In Appreciation--Friends of Scouting, North Fulton Team
Fa mily Practice Legislator of the Year--Leadership in Health
Care--Georgia Academy of Family Physicians
2002 Aven Citizenship Cup--Medical Association of Atlanta
Na than Davis Award--Outstanding State Senator--American Medical
Association
In Appreciation--Keep Roswell Beautiful
2003 President's Award--National Republican Legislators Association
Ch ampion of 2003 Legislative Session--Perimeter Community
Improvement Districts
Cottage School--commencement speaker
In Appreciation--Northside Baptist Church dedication
2005 NWYC Constituent Communication Award
Rotary Club of Roswell East
Civil Air Patrol
University of Phoenix Award
Consulate General of Israel--Friend of Israel Award
New South Energy Award
Governor's Office of Highway Safety
National Health Museum Charter Membership Award
College of American Pathologists Award
Americans for Tax Reform--2005 Hero of the Taxpayer Award
Spirit of Enterprise Award--U.S. Chamber of Commerce
2006 U.S. Chamber--Spirit of Enterprise Award
Tommy Nobis Center--Award Presentation
Adopt a Road Award
ATR Hero of the Taxpayer Award
60 Plus Association of the Guardian of Senior's Rights Award
Association of Builders and Contractors--Champion of Merit Shop
JWOD Congressional Champion Award
Club for Growth Defender of Economic Freedom Award
National Tax Limitation Committee Tax Fighter Award
National Museum of Patriotism--Patriotism Award
All Saints Catholic Church--Community Fellowship Award
Cobb Chamber Award
National Society of Sons of the American Revolution
Armor Troops Foundation, Inc. Award
National Hemophilia Foundation Award
National Taxpayers Union--Taxpayers' Friend
International Foodservice Distributors Association--Thomas
Jefferson Award
2007 U.S. Chamber--Spirit of Enterprise Award
Georgia Ensemble Theater--Legacy Award
National Taxpayers Union--Taxpayers' Friend
NAPUS Georgia Chapter Award
2008 North Fulton Chamber of Commerce Pioneer Award
U.S. Chamber of Commerce Spirit of Enterprise Award
U.S. English Award
Medicare Choices Award
A in English Award
Americans for Tax Reform Award--Hero of the Taxpayer
Na tional Association of Mutual Insurance Companies--Benjamin
Franklin Public Policy Award
Club for Growth's Defender of Economic Freedom Award
American Legion--Certificate of Appreciation
Oglethorpe Student Body and Phi Delta Epsilon's Thank You Award
GA Civilian Aide to Secretary of Army--Appreciation Award
Coalition for Medicare Choices--The Medicare Choices Leadership
Award
IFDA--Thomas Jefferson Award
National Taxpayers Union Taxpayers' Friend
2009 Na tional Association of Manufacturers--Manufacturing Legislative
Excellence
Na tional Orthopedic Leadership Conference--leadership on
musculoskeletal diseases and conditions
American Conservative Union Defenders of Liberty Award
National Taxpayers Union--2008 Taxpayers' Friend Award
60 Plus Association--Ben Franklin Award to thank you for working
against the death tax
AAOS--Congressional Leadership Award
Club for Growth Defender of Economic Freedom Award
Weyrich Awards Reception--You are receiving an award
U.S. Chamber--Spirit of Enterprise Award
Fulton County Republican Party--Leadership and Service Award
Cherokee County Volunteer Aging Council Award
FHL Bank--Key to Homeownership Award
Am erican Academy of Orthopedic Surgeons--Congressional
Leadership Award
Doctors for Patient Freedom--Ed Annis Award for Medical
Leadership
Logisticare Appreciation Award for Presentation to Logisticare
Operations
2010 National Taxpayers Union--Friend of the Taxpayer Award
U.S. Chamber of Commerce Spirit of Enterprise Award
AAOS Advocacy Communications Award
Na tional Association of Mutual Insurance Companies--Benjamin
Franklin Public Policy Award
American Conservative Union Defenders of Liberty Award
U.S. English Award
ProEnglish--American Unity Award
GM Executive Retirees Club of GA
GA GOP 6th District--Ronald Reagan Freedom Fighter Award
Am erican Academy of Orthopedic Surgeons Advocacy--Communications
Award
International Foodservice Distributors Association--Thomas
Jefferson Award
Club for Growth's Defender of Economic Liberty Award
2011 Institute for e-Health Policy--leadership award on HIT policy
issues
Na tional Association of Manufacturers--Manufacturing Legislative
Excellence
National Taxpayers Union's--Taxpayers' Friend Award
Emory Board of Trustees--GA Delegation Award
60 Plus Association's Guardian of Seniors' Rights Award
American Conservative Union Defender of Liberty Award
Club for Growth's Defender of Economic Liberty Award
Health Care Leadership Council--Champion of Healthcare
Innovation
GA Association of Physicians of Indian Heritage Award
2012 Cobb County Republican Women--Trumpet Award
U.S. Chamber of Commerce Spirit of Enterprise Award
Rotary International's Polio Eradication Champion Award
Healthcare Leadership Council--Champion of Healthcare Innovation
Small Business Council of America's 2012 Congressional Award
IFDA--Thomas Jefferson Award
RetireSafe--2012 Standing Up for America's Seniors Award
Freedomworks Award
NFIB Guardian of Small Business Award
Fulton County JRTOC's Coin of Excellence Award
National Society of Daughters of the American Revolution
NASA-Space Shuttle Discovery GA flag
American Congress of Obstetricians and Gynecologists--Public
Service Award
2013 National Association of Manufacturers--Award for Excellence
American Conservative Union Foundation Award
American Congress of Obstetricians and Gynecologists--Public
Service Award
U.S. Chamber of Commerce Spirit of Enterprise Award
Dearborn High School Hall of Fame
Senior Connections--Summer 2013 Champion of Senior Award
America's Essential Hospitals Essential Physician Leader Award
National Taxpayers Union--2012 Taxpayers' Friend Award
Doctors for Patient Freedom--Ed Annis Award for Medical
Leadership
Southern Ortho Association's Award
American Urological Association--Presidential Lecturer Award
2014 U.S. Chamber of Commerce Spirit of Enterprise Award
America's Essential Hospital Essential Physician Leader Award
ACU Annual Award
Association of Builders and Contractors--Champion of Merit Shop
National Retail Federation--Hero of Main Street Award
International Foodservice Distributors Association--Thomas
Jefferson Award
Virginians for Quality Healthcare--Healthcare Freedom Guardian
Award
National Association of Manufacturers--Award for Excellence
Na tional Taxpayer Union--National Taxpayers Union's Taxpayers'
Friend Award for 2013
Association of Mature American Citizens--Friend of AMAC Award
National Active and Retired Federal Employees Award
Rx Drug Abuse Summit
Am erican College of Cardiology--President's Award for
Distinguished Public Service Award
ACC President's Award for Distinguished Public Service
International Foodservice Distributors Association--Thomas
Jefferson Award
2015 FRC Action True Blue Award
National Association of Manufacturers--Award for Excellence
Am erican Society of Transplantation--Organ Transplantation and
Donation Legislative Leaders of the Year Award
American Academy of Ophthalmology--Academy's Visionary Award
American Conservative Union--Award for Conservative Excellence
60 Plus Association--Member Tax Reform Award
U.S. Chamber of Commerce Spirit of Enterprise Award
Al liance for Patient Access and National Association of
Nutrition and Aging Services Programs--2015 Medicare Part D Patient
Access Champion Award
ACU Annual Award
Rotary Club of Dunwoody--Certificate of Appreciation
GA Ortho Society--James Funk Distinguished Service Award
GA Association of College Republicans--Order of Reagan
FRC Action True Blue Award
2016 AMRPA Chairman's Award
ACU--Award for Congressional Excellence
American Medical Rehab Providers Association--Chairmen's Award
American Transaction Processor Coalition--Legislative Champion
Award
ATPC Friend of Industry Award
U.S. Chamber of Commerce Spirit of Enterprise Award
He althcare Leadership Council--Champion of Healthcare Innovation
IFDA--Thomas Jefferson Award
Campaign to Fix the Debt--Fiscal Hero Award
National Retail Federation--Heroes of Main Street Award
GA Life Alliance--Advocate for Life Award
HME--Congressional Leadership Award
World Harvest Church Award
Campaign to Fix the Debt Fiscal Hero Award
National Retail Federation--Heroes of Main Street Award
No Year Coalition for Medicare Choices--Leadership Award
SIRPAC
Al liance for Patient Access Medicare Part D--Patient Access
Champion Award
Veterans Issues--William Cobb VFW of Roswell Award
Republic of Korea
Naval Academy--Certificate of Appreciation
American's Essential Hospital--Essential Physician Leader
NFIB Guardian of Small Business (111th Congress)
NFIB Guardian of Small Business (113th Congress)
NFIB Guardian of Small Business (114th Congress)
As sociated Builders and Contractors Champion of the Merit Shop
(111th Congress)
Theodore Roosevelt American Unity Award (111th Congress)
As sociated Builders and Contractors Champion of the Merit Shop
(110th Congress)
NFIB Guardian of Small Business (112th Congress)
As sociated Builders and Contractors Champion of the Merit Shop
(112th Congress)
APPENDIX D
Op-Eds Authored by Dr. Tom Price--May 2011 to the Present
The listing of pertinent Op-Eds begins on the table below and
contains website addresses for direct access to the specified
publications. In instances where a particular Op-Ed is not
available via an internet source, a copy of the actual
publication is attached for the committee's reference.
------------------------------------------------------------------------
Date Publication Title Link
------------------------------------------------------------------------
May 13, 2011 Health Reform Empowering http://tomprice.house.gov/
Report America's op-ed/empowering-
Seniors americas-seniors
------------------------------------------------------------------------
May 14, 2011 The Daily Caller Debt Limit http://tomprice.house.gov/
and Spending op-ed/debt-limit-nnd-
Reforms are spending-reforms-are-
Inextricably inextricably-linked
Linked
------------------------------------------------------------------------
June 28, TownHall.com Cutting What http://tomprice.house.gov/
2011 Washington op-ed/cutting-what-
Has Yet to washington-has-yet-spend-
Spend and and-cannot-afford
Cannot
Afford
------------------------------------------------------------------------
October 10, Human Events Empowering http://tomprice.house.gov/
2011 Patients op-ed/empowering-
First Act: patients-first-act-
The Solution solution-obamacare
to Obamacare
------------------------------------------------------------------------
November 15, Cobb Medical H.R. 3000-- Attached
2011 Society Empowering
Patients Not
Government
------------------------------------------------------------------------
November 16, Big Government Patient http://tomprice.house.gov/
2011 Centered op-ed/patient-centered-
Healthcare healthcare-possible
is Possible
------------------------------------------------------------------------
November 26, The Washington PRICE: http://tomprice.house.gov/
2011 Times Preserving op-ed/price-preserving-
the promise promise-patients
to patients
------------------------------------------------------------------------
December 1, Reporter Republicans, http://tomprice.house.gov/
2011 Newspapers Democrats op-ed/republicans-
see democrats-see-different-
different fixes-fiscal-stalemate
fixes to
fiscal
stalemate
------------------------------------------------------------------------
December 12, Chicago Tribune Getting http://tomprice.house.gov/
2011 America out op-ed/getting-america-
of deep debt out-deep-debt
------------------------------------------------------------------------
December 16, The Oregonian/ Medicare pro: http://www.oregonlive.com/
2011 McClatchy Reasonable opinion/inPdex.ssf/2011/
reforms can 12/
provide fair medicare_pro_reaPsonable
fees for _reform.html
physicians
and ensure
patients
receive
quality
treatment
------------------------------------------------------------------------
February 15, The Hill President http://tomprice.house.gov/
2012 obviously op-ed/president-
doesn't obviously-
grasp the doesn%E2%80%99t-grasp-
seriousness seriousness-fiscal-
of fiscal situation
situation
------------------------------------------------------------------------
May 31, 2012 The Daily Caller Obamacare http://tomprice.housc.gov/
Medical op-ed/obamacare-medical-
Device Tax: device-tax-hazardous-
Hazardous to america%E2%80%99s-health
America's
Health
------------------------------------------------------------------------
June 5, 2012 The Hill IPAB is not http://tomprice.house.gov/
the way to op-ed/ipab-not-way-lower-
lower medicare-costs
Medicare
costs
------------------------------------------------------------------------
July 1, 2012 Marietta Daily Try http://tomprice.house.gov/
Journal Principled op-ed/try-principled-
Solutions to solutions-health-care-
Health Care fix
Fix
------------------------------------------------------------------------
July 26, USA Today Plenty of http://tomprice.house.gov/
2012 Alternatives op-ed/plenty-
to alternatives-government-
Government health-care
Health Care
------------------------------------------------------------------------
Fall 2012 Jewish Policy A Principled https://
Center Health Care www.jewishpolicycenter.o
rg/2012/08/31/health-
care-empower-patients/
------------------------------------------------------------------------
July 30, The Washington Regulations http://tomprice.house.gov/
2012 Times Are Choking op-ed/regulations-are-
Small choking-small-business-
Business engine-growth
Engine of
Growth
------------------------------------------------------------------------
December 6, AJC House http://tomprice.house.gov/
2012 Republicans op-ed/house-republicans-
Stand by stand-taxpayers
Taxpayers
------------------------------------------------------------------------
February 6, Red State Require A http://tomprice.house.gov/
2013 Plan op-ed/require-plan
------------------------------------------------------------------------
March 12, FoxNews.com Introducing a http://tomprice.house.gov/
2013 responsible, op-ed/introducing-
reasonable responsible-reasonable-
plan to plan-balance-federal-
balance the budget
federal
budget
------------------------------------------------------------------------
April 19, The Hill President's http://origin-
2013 budget nyi.thehill.com/blogs/
ignores the congress-blog/economy-a-
will of the budget/295025-presidents-
people budget-ignores-the-will-
of-the-people
------------------------------------------------------------------------
May 20, 2013 Real Clear The Unserious http://tomprice.house.gov/
Politics Senate op-ed/unserious-senate-
Budget budget
------------------------------------------------------------------------
May 30, 2013 Washington President http://tomprice.house.gov/
Examiner Obama is op-ed/president-obama-
Responsible responsible-his-
for His administration
Administrati
on
------------------------------------------------------------------------
May 31, 2013 AJC Stop the http://tomprice.house.gov/
Obamacare op-ed/stop-obamacare-
train wreck train-wreck
------------------------------------------------------------------------
July 17, The Hill How to http://tomprice.house.gov/
2013 Replace op-ed/how-replace-
Obamacare obamacare
------------------------------------------------------------------------
July 31, The Daily Caller We can't http://tomprice.house.gov/
2013 trust the op-ed/we-can%E2%80%99t-
IRS to trust-irs-enforce-
enforce obamacare
Obamacare
------------------------------------------------------------------------
October 8, Marietta Daily All http://tomprice.house.gov/
2013 Journal Republicans op-ed/all-republicans-
want is want-fairness-all-
fairness for americans-and-thats-why-
all we-fight
Americans,
and that's
why we fight
------------------------------------------------------------------------
December 5, National Review Empowering http://tomprice.house.gov/
2013 Patients op-ed/empowering-
First patients-first
------------------------------------------------------------------------
February 10, ConservantiveUSA Let's Begin http://
2014 .org Again--Patie www.conservativeusa.org/
nts First updates/lets-begin-again-
patients-first-rep-tom-
price-md-ga-06-
reptomprice-feb-10-2014
------------------------------------------------------------------------
February 19, Red Alert A Better http://tomprice.house.gov/
2014 Politics Prescription op-ed/better-
for prescription-millenials
Millenials
------------------------------------------------------------------------
March 7, Maryland State There's No Attached
2014 Medical Journal Code for
Quality Care
------------------------------------------------------------------------
March 20, AMA SE New Attached
2014 Challenges
Mean New
Opportunitie
s
------------------------------------------------------------------------
March 24, Medical Modernizing Attached
2014 Association of Medicare to
Georgia E- Protect
Newsletter Seniors
------------------------------------------------------------------------
August 11, Roll Call Save http://tomprice.house.gov/
2014 Medicare's op-ed/save-medicares-
Home Health home-health-benefit
Benefit
------------------------------------------------------------------------
January 23, Real Clear A Healthy http://tomprice.house.gov/
2015 Politics Economy for op-ed/healthy-economy-
All all
------------------------------------------------------------------------
March 17, USA Today Balance the http://tomprice.house.gov/
2015 budget for a op-ed/balance-budget-
prosperous prosperous-america
America
------------------------------------------------------------------------
April 1, AMA SE Prepared to Attached
2015 Act on
Patient-
Centered
Reform
------------------------------------------------------------------------
April 6, SC Times House budget http://www.sctimes.com/
2015 plan would story/opinion/2015/04/05/
set U.S. on house-budget-plan-set-us-
right fiscal right-fiscal-path/
path 25277905/
------------------------------------------------------------------------
July 30, Independent Medicare and http://tomprice.house.gov/
2015 Journal PReview Medicaid op-ed/medicare-and-
Turn 50 medicaid-turn-50-today-
Today. Let's let%E2%80%99s-keep-them-
Keep Them healthy
Healthy
------------------------------------------------------------------------
February 2, Medical A Step in the Attached
2016 Association of Right
Georgia E- Direction
Newsletter
------------------------------------------------------------------------
March 10, Medical Keep the Attached
2016 Association of focus on the
Georgia E- patient
Newsletter
------------------------------------------------------------------------
April 5, AMA SE Focused on Attached
2016 Solutions
------------------------------------------------------------------------
April, 13, Real Clear How and Why http://tomprice.house.gov/
2016 Politics We Budget op-ed/how-and-why-we-
budget
------------------------------------------------------------------------
September 7, Roll Call Obamacare http://tomprice.house.gov/
2016 Agency op-ed/obamacare-agency-
Escapes escapes-congressional-
Congressiona oversight
l Oversight
------------------------------------------------------------------------
October 13, JAMA Forum Three http://tomprice.house.gov/
2016 Congressmen' op-ed/3-
s Views on congressmen%E2%80%99s-
ACA's Flaws, views-aca%E2%80%99s-
Alternatives flaws-alternatives-
for Health health-system-reform
System
Reform
------------------------------------------------------------------------
October 17, FoxNews.com Reps. http://www.foxnews.com/
2016 Burgess, opinion/2016/10/17/reps-
Price, Roe: burgess-price-roe-our-
Our diagnosis-as-doctors-
diagnosis as obamacare-is-about-to-
doctors--Oba collapse.html
maCare is
about to
collapse
------------------------------------------------------------------------
November 1, TownHall.com Obamacare is http://tomprice.house.gov/
2016 failing. op-ed/obamacare-failing-
Let's try a let%E2%80%99s-try-better-
Better Way way
------------------------------------------------------------------------
______
A Step in the Right Direction
By Congressman Tom Price, M.D. (GA-06)
On December 28th of last year, President Obama signed into law the
Patient Access and Medicare Protection Act (S. 2425)--legislation that
included several health-care reforms that had bipartisan support in
Congress. Included in that package of reforms was a provision
addressing electronic health record (EHR) meaningful use requirements--
specifically hardship exceptions for physicians who would be unable to
comply with the Centers for Medicare and Medicaid Services' (CMS) final
Stage 2 modification rule. At issue was the fact that CMS released its
rule with less than the requisite 90 days left to comply in 2015.
The hardship exceptions provisions in S. 2425 are based on a bill that
I had introduced, the Meaningful Use Hardship Relief Act (H.R. 3940),
almost 2 months prior. We acted because it was clear that many
physicians would likely be unfairly penalized due to CMS's failure to
offer health-care providers adequate time to comply with new
requirements pertaining to the electronic health records program. Under
the new law, physicians are able to more easily obtain a hardship
exception due to insufficient time in the 2015 reporting period.
Additionally, CMS is now also able to batch process hardship exception
applications for groups of physicians, rather than strictly on a more
burdensome individual case-by-case basis.
On January 22nd, CMS released guidance on the updated hardship
exception application, and our office is continuing to closely monitor
this issue as well as the meaningful use and electronic health records
program. We would encourage you to apply for the hardship exemption.
You can do so by going to CMS.gov. This is a small step but a step
nonetheless toward protecting the critical doctor-patient relationship.
Patients and physicians face many challenges in today's health-care
system. Anything that can be done to allow physicians to focus more of
their time and energy on the practice of medicine ought to be done so
that we can further improve the quality and responsiveness of care.
______
There's No Code for Quality Care
By Congressman Tom Price, M.D. (GA-06)
Physicians are used to dealing with complex systems--the human body
being the most obvious example. They devote their years of education
and their craft to finding answers to tough questions, solutions to
difficult and--for patients and their families--very personal
challenges. The eagerness of physicians, scientists, and other health-
care providers to tackle the complex and at times unknown is driven by
the knowledge that their time and commitment is in service to the
health and well-being of others. Providing the best care for patients
is the motivation.
So it is with particular concern and consternation that today
physicians are being inundated with a new set of complex problems to
solve. The purveyor of these new challenges is, generally speaking, the
regulatory state. It's the folks who are not so much in charge of
actually caring for patients but the ones who have taken it upon
themselves to be in charge of telling physicians more and more how to
care for patients.
Their more widely known mandates and regulations center most recently
on the implementation of electronic health records (EHRs) and
meaningful use requirements. The sorts of items that can justifiably be
applied to improving quality care if physicians have the flexibility,
the time and the resources to comply in an orderly fashion. That's a
big ``if.''
But then you have the complexities being handed down from upon high
that have at best a tangential relationship to serving the needs of
patients. Perhaps none will be more frustrating and costly to the
delivery of care than the new ICD-10 diagnosis coding system that
American physicians, hospitals, and other health-care providers are
being told to adopt.
The ICD-10 system has already earned a reputation as a bridge a bit too
far--a sign that the regulatory state has become far too prescriptive
to the point of being comical. You've likely heard of some of the more
humorous new diagnosis codes. ICD-10 applies specific codes to injuries
related to burning water skis, injuries sustained through an accident
with a military vehicle while riding an animal, or being struck by any
number of different animals for example, an orca.
Could those examples and any of the others listed in the ICD-10 system
occur? One supposes almost anything is possible. But the ``more is
better'' mentality that sits behind the drafting and implementation of
this system portends a very arduous and in many cases financially
perilous environment for physicians and their practice.
Resources that might be applied to new innovative technologies,
expanded capacity to serve new patients, or even charitable payment
scenarios will be diverted to pay for the adoption and implementation
of ICD-10. Those most likely to be squeezed are the private practices--
particularly those caring for patients in rural or under-served
communities--that operate on narrow margins. That shifts the delivery
of care to hospitals where the quality can be equal but the costs
disproportionately higher.
As an orthopaedic surgeon who practiced medicine for over 20 years in
the Metro Atlanta area, I know firsthand about practicing medicine both
in a private and hospital setting. There are benefits and drawbacks to
both. But what makes our health-care system most beneficial to patients
is the flexibility and diversity of care. The regulators are on
schedule to continue destroying that flexibility and diversity of care.
We see it in the manner in which the Affordable Care Act (ACA) is
defining quality care based on a Washington-centric point of view. And,
we see it with the unwillingness on the part of the Centers for
Medicare and Medicaid Services (CMS) to consider a delay in the
implementation of ICD-10 coding requirements. CMS Director Marilyn
Tavenner recently confirmed that Washington would consider no more
delays and that it was ``time to move on.''
Thankfully, Congress has taken action--albeit in a limited capacity.
Legislation recently signed into law included a 1-year delay of the
ICD-10 deadline. It pushes back the date at which medical providers
must adopt the new coding system from October 1st of this year to
October 1, 2015.
So where does that leave physicians trying to practice their profession
and care for patients? According to a February 2014 report commissioned
by the American Medical Association (AMA), a small medical practice
will be on the hook for anywhere between $56,639 to over $226,000 in
costs associated with the transition. For a medium size practice, AMA
estimates pre- and post-implementation costs rising to as high as
$824,735. And, the ``typical large practice'' can expect to pay
anywhere in the range of $2 million to $8 million.
Perhaps in Washington that's not considered a lot of money. But in the
real world where the cost of health-care delivery is already rising due
to any number of other forces--including innovation and other
regulations--adding hundreds of thousands to millions of dollars to the
cost of care is incredibly troubling.
It should come as no surprise that an overwhelming majority of
physicians were not ready for this year's October 1st deadline. A
survey by the Medical Group Management Association found that slightly
fewer than 10 percent of medical practices claim to have made
significant progress on implementing the overhaul of the ICD system. In
other words, if you were to put aside the argument about whether or not
shifting to the new coding system was wise or necessary, folks still
are not ready.
In Congress, there's a broader effort underway to avoid this coming
train wreck altogether. H.R. 1701, the Cutting Costly Codes Act of
2013--of which I'm a co-
sponsor--would prohibit the Secretary of Health and Human Services from
moving forward with the ICD-10 implementation.
What happens if a year passes, no action is taken to prohibit the
implementation, and further delays are not forthcoming? If Washington
ignores the facts and the frustration shared by many in the medical
community? The initial costs associated with adopting ICD-10 will
likely seem like a drop in the bucket over the longer term as medical
practices struggle to familiarize themselves with the new litany of
codes. It is expected that the number of codes will grow from roughly
20,000 to over 150,000.
Any failures to properly apply the right diagnostic label may be met
with rejection or withholding of payment for services already rendered.
Furthermore, fines and other costly legal proceedings could be incurred
by physicians and medical practices whose only crime may be that they
had unwittingly failed to comply properly with this complex new system.
Were the new ICD-10 diagnosis codes coming online in otherwise
relatively calm waters in the Nation's health-care system, the
disruption could perhaps have been contained. But that's not the
reality physician's face today. With the implementation of the
Affordable Care Act, America's health-care system and those
participating in it have been thrown one curve ball after another--told
to get on board or get out of the way.
Far too often that's how a bureaucracy functions, and it is the
strongest argument against endowing regulators with the type of
prescriptive power they are now preparing to wield. For the sake of
patient access to quality, affordable care, we must continue to search
for solutions that will let physicians do what they are trained to do--
care for those in need. To be successful, physicians must engage in the
public debate.
______
New Challenges Mean New Opportunities
By Congressman Tom Price, M.D. (GA-06)
There is no shortage of issues these days competing for our attention.
We have turmoil and upheaval around the world. There are long-running
disagreements and troubles here at home. And while it can all be a tad
overwhelming, it's important to find within these challenges the
opportunity to affect positive change. Of note right now are five key
areas that do deserve our focus--all of which, coincidentally, have
emerged either from action or inaction on the part of your government.
As a physician, I have watched with particular concern the troubled
rollout or unraveling of the President's health-care law. Frankly, what
we have is the expected outcome of truly disastrous policymaking. The
law is not working--at least not as advertised. It is not working for
patients, families or physicians. And, its failures are not merely the
result of incompetence on the part of the Obama administration. They
are the product of a fundamental conflict between the law and those
principles of health care we hold dear: affordability, accessibility,
choices, innovation, quality, and responsiveness.
Premiums are rising. Provider networks made available through the new
exchange plans are smaller. Folks are losing the coverage they had and
access to the doctors they trusted. Less access and less affordability
mean choices are being taken away from Americans. The law taxes
innovation--literally a tax on life-saving medical devices. All of this
will contribute to diminished quality of care as the system becomes
more responsive to the needs of bureaucrats and less so to the needs of
patients, families and doctors.
So what can be done? Anyone who has taken care of patients knows that
the status quo that existed prior to the passage of Obamacare was not
working either. So no one should pretend we can simply uproot the
current law and that will solve everything. We need a set of reforms
that serve patients and those who care for them. Patient-centered
solutions--like those I've introduced in H.R. 2300, the Empowering
Patients First Act--would expand access to more health care choices by
making it financially feasible for folks to purchase the coverage they
want.
We'd solve the insurance challenges of portability and pre-existing
conditions by allowing folks to own their coverage no matter who's
paying for it and to pool together and gain the purchasing power of
millions. That way we can make sure no one is priced out of the
insurance market due to a pre-existing injury or illness.
To go after the rising costs of care in America, H.R. 2300 would enact
medical malpractice reforms. Our plan would deter the practice of
defensive medicine by giving physicians an affirmative defense in a
court of law built on standards agreed upon and established by
physicians--not Washington.
Just as we need broader health-care reform, we also need to once and
for all rid Medicare of its current payment formula. The sustainable
growth rate (SGR) formula is not working for patients or doctors. The
effort to repeal and replace it with one that does work has gone on too
long. Thankfully, some encouraging steps have been taken in recent
weeks.
In the House of Representatives, we have passed a bill to repeal the
SGR and modernize the payment system--giving physicians time to adjust
to new rules that will hopefully provide the type of certainty and
flexibility needed to increase the quality of care. The ball is now in
the Senate's court. Our hope is that they will work with us so that
there is a credible plan to move forward. We need to get this specific
issue resolved in a way that protects seniors and respects American
taxpayers.
It is out of respect for American taxpayers that we must also keep our
eye on the tremendous fiscal challenges we are facing as a Nation right
now. As vice-chairman of the House Budget Committee, I've had the
opportunity to work with many of my colleagues on different budget
proposals over the years--plans that would balance the Federal
Government's books, save and strengthen critical programs like Medicare
and Social Security, and enact pro-growth policies like fundamental tax
reform to get this economy moving. A budget is a blueprint for the
positive direction we can take our Nation if we have the courage to
make real, tough decisions on behalf of this generation and the next.
Right now the committee is working on the next budget for fiscal year
2015. With the President offering his plan that taxes more in order to
spend more, there's a real opportunity and obligation to provide that
better, alternative vision.
Another pro-growth area we ought to be focused on is America's ongoing
energy revolution. Whether one is talking about the growth in our
ability to safely harvest more and more of America's abundant natural
resources or the growth in new energy technologies, there are exciting
opportunities here that will truly benefit our Nation. A robust energy
market means more direct and indirect jobs and economic freedom.
Internationally, a lessening of dependence on foreign sources of energy
and a growing of America's impact on the global energy markets means we
have greater influence in diplomatic and national security affairs.
One doesn't have to look farther than the recent events in Ukraine to
see an opportunity to leverage an all of the above energy strategy.
With Russia exercising power in that part of the world thanks to their
prolific energy production and distribution we can directly undermine
their coercive powers by expanding our production and sale of energy
resources to allies in the region.
Lastly, what contributes to the disgust many feel watching Russia
invade and annex a piece of another country is that this action flies
in the face of democratic values we hold sacred here in America. Those
values were written into our Constitution and made explicit when our
founders declared our rights came from God, not man. Chief among them
is the First Amendment's right to freedom of speech.
Unfortunately, that fundamental freedom has been under assault from an
overactive regulatory environment in Washington. We know that the IRS
unfairly targeted and abused certain Americans whose only crime was
attempting to speak up for their beliefs. Now, the IRS is attempting to
codify that level of abuse through new regulations affecting groups--
including veterans' organizations and those engaged in civic
education--that file as nonprofits under the tax code's 501(c)(4)
designation.
Under that section of the code, activities by these nonprofits that are
for the purposes of ``social welfare'' are tax exempt. The IRS wants to
rewrite the rules after 55 years to essentially force these
nonprofits--many of which hold political views in conflict with the
current administration--to re-classify under a different section of the
code or become subject to taxation. Either way, the end result would be
to silence voices and expose more Americans to further abuse and unfair
treatment.
All of these issues--whether foreign, domestic or both--impact our
lives in some form or another. We should not shy away from these
challenges because with them comes opportunity to improve our lives and
that of our families, friends, and neighbors. If we can find a way to
bridge differences, reinforce time-honored principles, and show
leadership, I'm confident we will find positive solutions that build a
stronger future for our Nation.
______
Modernizing Medicare to Protect Seniors
By Congressman Tom Price, M.D. (GA-06)
The Medicare program is a vital life-line for millions of American
seniors. Unfortunately, the current program is not working as well as
it should for either those in retirement or the physicians who care for
them. In addition to the real financial challenges the program as a
whole faces in the next few years--challenges that ought to be
addressed with broader reforms to Medicare--we have an even more
immediate concern as it relates to Medicare's current payment formula.
Efforts to address the broken sustainable growth rate formula (SGR)
have been underway for years. In the meantime, Congress has acted to
avoid the SGR's looming large cuts in physician reimbursements by
enacting a series of delays--some longer than others. This has been
done to buy time for policymakers to coalesce around a responsible
solution that will repeal the SGR permanently and replace it with a
system that makes sense. The cost of those delays has been substantial,
but it has also been necessary in order to protect access to care for
seniors.
Thankfully, promising steps have been made in the last several months
to forge a consensus on a real plan to modernize the Medicare payment
system. Introduced in February, the SGR Repeal and Medicare Provider
Payment Modernization Act of 2014 (H.R. 4015) enjoys bipartisan,
bicameral support. On March 14th the House of Representatives passed
the bill and sent it to the Senate for its consideration.
In order to ensure these solutions both protect seniors and respect
taxpayers, the legislation endorsed by the House of Representatives
included a delay in the Affordable Care Act's individual mandate to
offset the costs associated with a repeal of the SGR. The Obama
administration has already implemented a de facto delay to this
provision of the President's health-care law through executive fiat. We
thought it better to do so through the normal and constitutional
lawmaking process.
The latest projections show cuts to physician reimbursement rates in
the range of 24% if nothing is done. Temporary patches will continue to
buy more time but in the aggregate over the years they also prove more
costly than a full repeal and replace scenario. More importantly, the
level of uncertainty and anxiety that will persist so long as this
issue remains unresolved exacts its own costs on physicians and seniors
that cannot be measured in dollars and cents.
It is rare in Washington these days that you can find an issue that
secures both bipartisan support and action. We should not miss this
opportunity to enact a positive set of solutions that will modernize
Medicare's payment system. Our hope is that the Senate will come to the
table with the House of Representatives so we can work together to
protect seniors' access to health care.
______
Prepared to Act on Patient-Centered Reform
By Congressman Tom Price, M.D. (GA-06)
This summer the Supreme Court of the United States will render a
verdict in the case of King v. Burwell, which could have a lasting
impact on whether the Affordable Care Act or ``Obamacare'' remains the
law of the land. The fundamentals of the case are fairly
straightforward: should the Obama administration be allowed to offer
subsidies to help Americans purchase health-care coverage through
Obamacare exchanges established by the Federal Government? The text of
the law states that subsidies are to be made available to those who
have enrolled in an insurance plan through an exchange established by
the State. Since the enactment of Obamacare, 37 States have chosen not
to establish their own exchanges or have partnered with the Federal
Government in some fashion--meaning millions of Americans have gained
health-care coverage with the help of subsidies through a Federal
exchange.
If the Court rules in favor of the actual text of the law, which does
not explicitly provide financial assistance to those purchasing
coverage through the Federal exchange, those millions of Americans who
purchased that insurance coverage would lose access to subsidies and
face even higher health-care costs. For its part, the Obama
administration has claimed it has no strategy in place to handle the
aftermath of such a ruling--despite being complicit in the creation of
the law itself and its, quite possibly soon to be ruled illegal,
interpretation.
Conversely, in March, I introduced the Medical Freedom Act (H.R.
1234)--legislation to allow States the freedom to offer within their
jurisdiction health plans, health savings accounts, and other
arrangements that are currently restricted under Obamacare, and the
Medicare Patient Empowerment Act (H.R. 1650)--allowing patients and
physicians to voluntarily contract for a service outside of the
dictates from CMS. This type of flexibility within States to regulate
their markets and ensuring doctors may practice as they see most
appropriate would be strong first steps toward mitigating the fallout
from the King v. Burwell ruling. At the same time, committees of
jurisdiction in the House of Representatives and the Senate have been
hard at work putting together policy proposals of their own that would
be needed to respond should the court rule that the Federal exchange
subsidies are indeed illegal. No matter the makeup of our response,
Congress is aiming to be prepared so that the American people are not
made to suffer any more than they already have from Obamacare.
Even if the Court rules in favor of the Obama administration's
interpretation and keeps the subsidies flowing on the Federal
exchanges, there still remains real, fundamental concerns with how this
law has been implemented, the impact it is having on the quality and
affordability of health care in America, on access to physicians and on
innovation.
Those of us who believe we ought to have a health-care system less
geared toward Washington and more in the hands of patients, families
and physicians have to continue to push our colleagues and Congress and
take our case to the American people. We have to keep the conversation
going, and make clear that there are positive, patient-centered
solutions out there that are far better for the health of our Nation
than what Obamacare has to offer.
For several years now, I have introduced legislation each Congress
called the Empowering Patients First Act--a set of solutions that would
expand access to quality affordable health-care choices and put
patients, families and doctors in charge of health-care decisions, not
Washington, DC. We have offered patient-centered reforms like
Individual Member Associations so folks can pool together for the
purpose of purchasing affordable coverage; lawsuit abuse reform to end
the practice of defense medicine that adds hundreds of billions of
dollars to America's health-care bill each year; health-care tax
credits so folks have the financial wherewithal and incentive to
purchase the sort of coverage that meets their individual needs.
There are many other aspects of the Empowering Patients First Act that
would enhance the quality, affordability and accessibility of care in
our country. Indeed, there are a myriad of positive, promising ideas
that my colleagues in Congress have put forward and each of those ideas
should continue to be a part of an honest and open debate on a broader
reform effort.
Depending on its decision, the Supreme Court's ruling later this year
may initiate an unraveling of Obamacare or it may have no real impact.
Either way, policymakers need to be prepared to respond. Physicians and
other health-care practitioners across the country need to be ready as
well to play a constructive role in ensuring that not only in the near
term but in the long run, we protect and preserve the sanctity of the
doctor-patient relationship.
______
Focused on Solutions
By Congressman Tom Price, M.D. (GA-06)
America's Founding Fathers wisely chose to give Congress--the branch of
government closest and most accountable to the people--the power to
write laws, determine how many hard-earned tax dollars are necessary to
administer those laws, and to ensure the executive branch is faithfully
carrying out those laws. For our Nation's experiment in self-government
to work, those roles and responsibilities must be respected.
At the Committee on the Budget in the U.S. House of Representatives--on
which I am honored to serve as chairman--we have been hard at work
doing just that. The House Budget Committee is tasked with putting
together an annual budget. We provide lawmakers a blueprint for how
Congress can assert the spending and oversight authorities given it
under the Constitution and do so in a responsible, responsive manner.
In March, the House Budget Committee introduced and approved our fiscal
year 2017 budget resolution which we call A Balanced Budget for a
Stronger America. This proposal would balance the Federal budget within
10 years without raising anyone's taxes. It keeps the Federal
Government's books in balance beyond the coming decade which puts us on
a path to pay off the national debt. If the policies we advocate were
enacted, we would achieve over $7 trillion in deficit reduction through
a combination of savings and economic growth. Those savings come from
common sense reforms we propose to make government more efficient,
effective, and accountable.
Some of the more critical reforms are in the area of health care. We
put forward a plan to save and strengthen the Medicare program. We
advocate for an improved system that enhances quality, gives seniors
more choices, and ensures that traditional Medicare is always available
to Americans when they reach retirement age.
Under current law, if nothing is done, Medicare will go insolvent in
2030. This will result in a significant reduction in benefits for
seniors' health care. We believe this would be irresponsible. Our plan
would prevent this from happening with patient-centered reforms, and
ensure this program, which millions have paid into, will be there for
them when they need it.
For the brave men and women of our armed forces, for our veterans, and
for our military families, our budget encourages additional health-care
reforms at both the Department of Veterans Affairs (VA) and the
Department of Defense (DoD). Those who protect and defend our Nation
must have access to the care they need when they need it.
For those Americans who are struggling to afford health-care coverage,
our budget rejects the broken status quo and calls for innovative
solutions. We would give States the flexibility to design and implement
their Medicaid programs to meet the unique needs of their communities.
At the same time, we would get rid of the top-down, Washington-knows-
best model that is currently in place in private-sector health care and
implement patient-centered solutions to ensure every American has
access to the health coverage they want, not the one Washington forces
them to buy.
What these solutions ultimately comprise is part of a conversation
currently being held in Congress and, specifically, among those of us
on the House Task Force on Health Care Reform. We are developing a
package of reforms that would create a patient-centered health-care
system where Americans have access to quality, affordable choices, the
doctor-patient relationship is respected, and real insurance challenges
like pre-existing conditions are solved through policies that protect
and empower individuals, not government mandates.
The task force is committed to building these solutions from the ground
up. However, we do not come to this challenge empty handed. Numerous
health care policy ideas--including H.R. 2300, the Empowering Patients
First Act which I have introduced for the past several congresses--have
been circulating for years, both before and after passage of the
President's health-care law.
The Task Force on Health Care Reform is one pillar of a larger effort
to advance a positive, proactive agenda. A perfect partner in that
effort is the annual budget resolution which is why the House Budget
Committee has been committed to bringing this positive proposal
forward. We are focused on getting results and solving the numerous
challenges facing our country--from the economy to national security--
so we have a more secure and more prosperous Nation.
______
Empowering Patients Not Government
By Congressman Tom Price, M.D. (GA-06)
While practicing orthopaedic surgery for over 20 years, my focus was,
as it should be, on the patients and serving their needs to the best of
my ability. Unfortunately, during the early 1990s under then-President
Clinton's attempt to overhaul America's health-care system, it became
clear that policy decisions were continuing to be made in Washington
that would have a profound, and oftentimes, negative impact on the
practice of medicine. Many of those decisions were being made by
individuals, probably with good intentions, but who knew little to
nothing about the practice of medicine--who had never cared for
patients or understood what it took to do so.
While President Clinton's efforts were unsuccessful, last year
President Obama signed into law a massive health reform law that is
destructive and fails to protect and promote the principles of health
care we cherish, including affordability, accessibility, quality,
responsiveness, innovation, and choices. The challenge to improve our
health-care system and make it accessible to more Americans still
stands; i.e., the status quo is unacceptable, which makes it incumbent
upon those of us who disagree with the overhaul enacted in the previous
congress to propose positive solutions in line with health-care
principles that protect the rights of patients and doctors.
In order to ensure health-care choices in America, Congress must repeal
the President's health-care law first and foremost and then reform the
system in a common sense manner. As one of a growing number of
physicians in the House of Representatives, we understand that changes
must be made. In order to move the debate forward, I recently
introduced legislation to repeal and replace the President's health-
care law.
The Empowering Patients First Act (H.R. 3000) encourages individuals to
obtain health coverage and makes it financially feasible for
individuals and families to do so. It addresses the issue of lawsuit
abuse and defensive medicine, which was completely ignored in last
year's health-care law, and it keeps Washington out of the way of
health-care decisions. At its core, it advances patient-centered
solutions to the challenges we face.
Many of us in the medical profession have seen firsthand the
distortions and disruptions that defensive medicine and excessive
bureaucracy have on the practice of medicine. Inserting misguided
government controls and regulations will lead to the denial of care and
the elimination of health-care choices and personal decision-
making. Under current law, there is even an unaccountable, unelected
board of 15 bureaucrats--the Independent Payment Advisory Board
(IPAB)--that will have the power to deny health care to America's
seniors. That is wrong and does not have to happen in order to make our
health-care system stronger. It will only weaken the quality of
medicine for seniors and all Americans.
Since physicians know the best care for their patients, the Empowering
Patients First Act establishes doctor-led quality measures. And we
encourage healthier lifestyles by allowing employers more flexibility
in offering discounts to their employees through wellness and
prevention programs.
The health-care system in America needs to be reformed and improved--
there is no doubt about that--but this must be done without handing
over greater authority to the Federal Government. As a physician and
someone who spent years caring for patients, the damage that can be
done to the health of our great Nation by government interference is
clear and unacceptable. The current situation demands that we advance a
plan not only to halt that interference, but also one to improve access
to quality, affordable health care. That solution is H.R. 3000!
______
Keep the Focus on the Patient
By Congressman Tom Price, M.D. (GA-06)
A patient-centered health-care system is built upon six principles:
accessibility, affordability, quality choices, responsiveness, and
innovation. Today, there are many instances where those principles are
being violated--more often than not through rules and regulations
handed down from bureaucratic agencies in Washington, DC. For an
example, we need only look at how physicians and hospitals have had to
go about adopting electronic health records (EHR).
As part of the economic stimulus package that became law in the early
days of the Obama administration, there was a concerted effort to help
spur adoption of EHR among physicians and hospitals. The law states
``the Secretary [of Health and Human Services] shall seek to improve
the use of electronic health records and health-care quality over time
by requiring more stringent measures of meaningful use.''
From this text was born a complex and burdensome set of requirements
known as Meaningful Use (MU) Stage 1, 2, and 3. Although well-
intentioned, the MU requirements have chiefly missed the mark by
focusing more on data entry and less on patients and their doctors.
Physicians face a number of impediments to meeting the MU requirements,
many of which are outside of their control. These include the lack of
usability and interoperability among EHR, significant data exchange
fees, interference with face-to-face patient care, time-consuming data
entry, the degradation of clinical documentation, and in inflexible
metrics.
A total of 209,000 physicians will face penalties in 2016 for failing
to meet EHR MU criteria. While 80 percent of physicians have adopted
EHR in their practices, less than 10 percent of physicians have
successfully participated in MU Stage 2 so far. If we want higher
quality care, healthier patients, and a more efficient use of time and
resources, then the MV program needs to be reevaluated so it moves in
the direction of our health-care principles.
This past October, the Centers for Medicare and Medicaid Services (CMS)
released its modified Stage 2 rule of the MU program. CMS issued its
directive with less than the requisite 90 days remaining in the 2015
program year. That meant it was virtually impossible for doctors to
meet the requirement deadlines.
Anticipating this challenge, I introduced H.R. 3940--the Meaningful Use
Hardship Relief Act--to provide physicians with much-needed relief by
ensuring they would be granted a hardship exception to avoid penalties
stemming from the delayed rulemaking. Working with colleagues in
Congress, physicians and various stakeholders, we were able to get
language based on the solutions that we introduced included in a larger
package of reforms--S. 2425, the Patient Access and Medicare Protection
Act--which was signed into law just prior to the new year.
On January 22, CMS released a hardship application for physicians and
hospitals to use when filing an exception to the MU penalty for the
2015 program year. In the past, providers and hospitals had separate
application forms. Under the new law, the application is now
streamlined and can be used by both. Providers may file as individuals
or in groups--while before each individual provider would have had to
submit a separate application to be considered by CMS on a case-by-case
basis. This new streamlined process also allows CMS to process hardship
applications more efficiently in batches.
All physicians are encouraged to go to CMS.gov and apply for a hardship
exception under the category ``EHR Certification/Vendor Issue (CEHRT
Issues),'' which references ``insufficient time'' in accordance with
CMS's delayed rulemaking. Applications must be submitted to CMS by
March 15.
Sadly physicians know all too well that the work of defending the
principles of patient-centered care never ends. While MU penalties
affect physicians and hospitals nationwide, here in Georgia our
laboratories and physician groups were facing a more unique threat at
the beginning of this year. Under a blatantly prejudiced reimbursement
policy related to new codes for drug testing. CMS was threatening a 33
percent cut from the national payment rate for Georgia labs and
doctors. Thanks to the Medical Association of Georgia and others, we
were able to get this serious discrepancy repaired and ensure that
Georgia health-care providers were treated fairly.
With solutions to improve our health-care system that adhere to our
principles, we can protect the doctor-patient relationship from undue
influence and interference, and put patients, families, and doctors in
charge.
______
APPENDIX E
Speeches and Remarks Made by Dr. Tom Price--2012 to the Present
------------------------------------------------------------------------
Date Name Topic Location
------------------------------------------------------------------------
2016 Speeches and Remarks by Dr. Tom Price
January 13, REMARKS: What, If Anything DC
2016 Brookings Event Congress is
Likely to
Accomplish in
This Election
Year
January 23, REMARKS: Georgia Washington Update GA
2016 Medical
Directors
Association
Winter Symposium
January 30, REMARKS: Healthcare GA
2016 Conservative Update, Emphasis
Policy on H.R. 2300
Leadership
Institute
February 24, REMARKS: NAHU Health Care--ACA DC
2016 Meeting replacement
March 1, 2016 REMARKS: AMRPA Congressional DC
Leadership Forum Update and
Gratitude for
the AMRPA
Chairman's Award
March 22, 2016 REMARKS: Pete General DC
Sessions Medical Healthcare
Professionals Overview
Fly-in
March 24, 2016 REMARKS: Emory The State of the GA
College GOP and H.R.
Republicans 2300
April 11, 2O16 REMARKS: Issues of GA
Healthcare Healthcare
Symposium with Economics and
Berry College Policy in the
U.S.
April 13, 2016 REMARKS: Idea No topics listed DC
Forum on
Healthcare
Reform
April 14, 2016 REMARKS: Georgia Washington Update DC
Society of
Ophthalmology
Breakfast
April 19, 2016 REMARKS: NASS General/Broad DC
Event Update on
Healthcare as it
Stands in the
House and From
his Perspective
as Chairman of
the Budget
Committee
May 4, 2016 REMARKS: Emory Federal Funding GA
Science Advocacy for Biomedical
Network Research,
Particularly for
the National
Institutes of
Health (NIH) and
National Science
Foundation (NSF)
June 27, 2016 REMARKS: Washington Update NY
Roundtable Lunch With a Focus on
Event with Budget Committee
Market News Activity and Dr.
International Price's Work on
Connect Health Care
July 13, 2016 REMARKS: Health Your Perspective DC
on Wednesday as a Leader in
the House on
Finalizing
Health
Initiatives in
the 2nd Session
of Congress;
Standard
Healthcare
Speech
July 21, 2016 REMARKS: Future of Health OH
Washington Post Care and Health
Panel on Policy Issues
Healthcare the Next
President Will
Face
August 7, 2016 REMARKS: GPLA; Perspectives on GA
Perspectives on Physician
Physician Leadership
Leadership Communication
Communication
August 13, REMARKS: The Current State GA
2016 Concierge of Healthcare
Medicine and Emerging
Conference Entrepreneurial
Forms of
Healthcare
Delivery in
America
August 25, REMARKS: MVP Vets Your Work in GA
2016 Event With Washington and
Elekta and How It's
AdvaMed Essential to the
Medical
Technology
Community
(Medical Device
Tax or Even the
Breakthrough
Pathways
legislation,
e.g.)
August 25, REMARKS: AARP Social Security GA
2016 Financial Forum (Challenges to,
With Senator the Future of,
Isakson Possible
Solutions) and
any Other
Financial
Initiatives at
the Federal
Level You Would
Like to
Highlight
September 10, REMARKS: AKSM Washington/ GA
2016 Medical Director Healthcare
Meeting Update
September 13, REMARKS: PhRMA CMMI and 2017 DC
2016 Board Agenda
September 20, REMARKS: AAMC Present DC
2016 Information
About Mr.
Trump's
Platform,
Especially as it
Related to
Health Care
September 28, REMARKS: U.S. Better Way Health DC
2016 Chamber's E8 Care Plan
Committee
October 10, REMARKS: Emory Future of Health, GA
2016 School of Healthcare, and
Business's Congressional
Speaker Series: Roll
Medical
Technology
(Health IT and
Medical Devices)
October 17, REMARKS: Seniors Senior's Call
2016 for Trump Healthcare
Conference Call (Medical and
Supplementary
Coverage)
October 20, REMARKS: Eastern Federal LA
2016 Orthopedic Healthcare and
Society How it Affects
Orthopaedic
Surgeons
November 1, REMARKS: Healthcare PA
2016 Healthcare Event
With Trump
November 2, REMARKS: Medtrade AAHomecare GA
2016 Conference Washington
Update
November 12, REMARKS: RIPON: National Health DC
2016 PANEL 4 Service vs.
Obamacare
November 21, REMARKS: Panel Importance of GA
2016 Discussion With U.S. Global
U.S. Global Leadership and
Leadership to Highlight the
Coalition Positive Impacts
America's
Development and
Diplomatic
Programs Have on
Georgia
2015 Speeches and Remarks by Dr.Tom Price
January 12, REMARKS: Heritage Vision for the DC
2015 Action Policy House Budget
Summit Committee +
Upcoming Fiscal/
Economic
Deadlines (ex:
SGR)
January 30, REMARKS: American Affordable Care DC
2015 Society of Act Update
General Surgeons
Conference
January 31, REMARKS: Empowering GA
2015 Conservative Patients First
Policy Act
Leadership
Institute
February 9, REMARKS: MASA SGR, ICD-10 and DC
2015 Conference How the Doctor's
Caucus Can Have
More Influence
in Congress as
Far as Medical
Issues
February 12, REMARKS: ASCO SGR Reform and DC
2015 Oncology Meeting How it is
Impacted by the
Budget Process
February 18, REMARKS: Panel Obamacare/ GA
2015 Discussion With Healthcare
Senator Isakson: Reform
NFIB/GA Small
Business Day
February 24, REMARKS: AMA Budget, Medicare, DC
2015 National etc.
Advocacy
Conference
February 28, REMARKS: CPAC What Have His MD
2015 Former
Colleagues in
Medicine Told
Him About How
Obamacare is
Affecting Their
Practices, and
What Effect
Might This Have
on Federal
Spending?
March 2, 2015 REMARKS: American General Update on DC
Academy of Healthcare
Neurology
Reception
April 16, 2015 REMARKS: American Medicare Payment DC
Academy of Outlook
Ophthalmology
April 27, 2015 REMARKS: GNFCC's Your Health Care GA
Healthcare Plan and
Technology Obamacare Repeal
Roundtable and Replacement
April 27, 2015 REMARKS: Repeal of the SGR FL
Emergency and Interested
Department in What Will
Practice Happen Moving
Management Forward
Association's
Solutions Summit
April 28, 2015 REMARKS: Big Opening Remarks-- DC
Cities Health Share Your
Coalition Personal Story
Breakfast
Briefing With
John Lewis
April 30, 2015 REMARKS: Laffar Discuss What Your DC
Associates 55th View Is as to
Washington the Most
Conference Important
Economic
Legislative
Agenda Items and
Current Events
May 1, 2015 REMARKS: American What It's Like to DC
Association of Be a Member of
Orthopaedic Congress and
Surgeons Former Surgeon;
Budget Outlook;
Healthcare
Landscape--Post-
SGR
May 6, 2015 REMARKS: Lecture A Balanced Budget NJ
With the for a Stronger
Princeton Tory America: Federal
Spending,
Obamacare, and
Other Washington
Updates
May 13, 2015 REMARKS: American H.R. 23OO DC
Tax Reform
Meeting
May 19, 2015 REMARKS: National Primary Focus: DC
Association of Dr. Price's
Spine Patient Shared
Specialists: Billing
(NASS) Capitol Legislation--H.R
Hill Day 2015 . 1650, Medicare
Patient
Empowerment Act
June 8, 2015 REMARKS: SE Healthcare IL
Breakfast at AMA
June 15, 2015 REMARKS: American H.R. 2300 GA
Society of
Actuaries
June 23, 2015 REMARKS: Brief Overview of DC
Healthcare Work in the Ways
Leadership and Means
Council Luncheon Committee
July 20, 2015 REMARKS: Town Meaningful Use-- GA
Hall Meeting Town Hall Is
With AMA Focused on
President Stack Electronic
Health Records
and Looming
Regulations
August 1, 2015 REMARKS: Current State of GA
Concierge Healthcare and
Medicine Emerging
Conference Entrepreneurial
Forms of
Healthcare
Delivery in
America
August 9, 2015 REMARKS: GPLA Perspectives on GA
Physician
Leadership
August 14, REMARKS: South Policy and the GA
2015 Atlantic Region Impact on
Architecture for Healthcare
Health Annual Delivery
Conference
August 17, REMARKS: UCB Healthcare GA
2015 Politics and Related Topics--
Pizza Luncheon Vision for the
U.S. Healthcare
System--FDA
Reform, etc.
August 21, REMARKS: WellStar Healthcare/Budget GA
2015 Board Meeting-- Update
Reception and
Dinner
September 24, REMARKS: Your Specialty in MI
2015 University of Medicine and
Michigan Young Perhaps Touch on
Americans for Some Important
Freedom Legislative
Issues
(Obamacare)
September 28, REMARKS: Health Reform and DC
2015 Chairman's Budget
Council Policy
Conference
October 3, REMARKS: GOS No topics listed GA
2015
November 16, REMARKS: AMA Personal GA
2015 Southeastern Experience in
Delegation Medicine and
Breakfast Transition to
Government
December 3, REMARKS: First Health Policy and DC
2015 Quality Forum Related Budget
Issues
December 9, REMARKS: AEI No topics listed DC
2015 Speech
2014 Speeches and Remarks by Dr. Tom Price
January 15, REMARKS: MMP Bill DC
2014 Healthcare Completive
Policy Briefing Bidding (They
May Bring Up
SGR, ACA, etc.)
February 10, REMARKS: Heritage H.R. 2300 DC
2014 Action Panel
February 22, REMARKS: Tea Healthcare GA
2014 Party Patriots Update--H.R.
Healthcare Event 2300
February 27, REMARKS: Lone Healthcare DC
2014 Star Leadership Roundtable--E&C,
PAC Breakfast W&M Perspective
February 27, REMARKS: Galen Healthcare Reform DC
2014 Institute Health Proposals
Solutions
Conference
February 28, REMARKS: AEI Healthcare Reform DC
2014 Symposium
March 6, 2014 REMARKS: CPAC The New Medical MD
Panel Realities We All
Face: Rationing,
Denial of Care,
Doctor Shortages
and a Loss of
Religious
Liberty Under
Obamacare
March 7, 2014 REMARKS: AEI The Health of DC
Panel America's Health
Policy
March 9, 2014 REMARKS: RJC-- Healthcare GA
Atlanta Update, Emphasis
on H.R. 2300
March 12, 2014 REMARKS: The Affordable Care DC
Commonwealth Act, its
Fund's Harkness Prospects for
Fellows Expanding
Coverage,
Transforming the
U.S. Health Care
System and
Containing Costs
March 24, 2014 REMARKS: American Current Major DC
Psychiatric Healthcare
Association Issues in
Advocacy Congress
Leadership
Conference
(annual fly-in)
March 27, 2014 REMARKS: American Healthcare: SGR, DC
Association of ACA, etc.
Physicians of
Indian Origin
(AAPI)
March 27, 2014 REMARKS: NASS Importance of DC
Washington Physician
Conference Advocacy and
Visiting
Washington, DC,
to SGR
April 1, 2014 REMARKS: Health Care and DC
Obamacare: What the Economy
to Watch in 2014 Between Now and
November
April 3, 2014 REMARKS: Tax Your Thoughts on DC
Council the
Comprehensive
Reform Process,
SGR, Highways,
and Other Items.
April 9, 2014 REMARKS: Las Healthcare and DC
Vegas the Impact on
Metropolitan American
Chamber of Employers Both
Commerce Large and Small
Conference
April 10, 2014 REMARKS: PDMA Healthcare in MD
2014 and Beyond
April 11, 2014 REMARKS: Heritage If You Like This DC
Conference Session, You Can
Keep it--Real
Health Care
Solutions As
Obamacare
Unravels
April 14, 2014 REMARKS: Forsyth The Un-Affordable GA
County Tea Party Care Act/
Tax Day Rally Obamacare--``0ne
Giant Tax''
April 23, 2014 REMARKS: National Drug-Related GA
Rx Abuse Summit Legislation He
Has Supported
and any Stories
He Could Tell
About the
Epidemic in
Georgia
April 23, 2014 REMARKS: St. The Future of MO
Louis Health Care
Orthopaedic Reform: A
Society Dinner Physician's
Perspective on
Policy Making
April 26, 2014 REMARKS: Alabama Navigating the AL
Orthopaedic ACA and the
Society Meeting Battle for
PPatient-
Centered
Solutions
May 8, 2014 REMARKS: Concern That is VA
Virginians for Percolating
Quality Among the
Healthcare Forum Republican Base
and the Media
That the
Leadership
Actually Has no
Intention to
``Repeal and
Replace''
May 12, 2014 REMARKS: St. Healthcare Update GA
Joe's General
Medical Staff
Meeting
May 17, 2014 REMARKS: Atlanta Healthcare Update GA
International from DC--
Trauma Symposium Emphasis on
Reform
June 17, 2014 REMARKS: Crafting Health DC
Government Innovation That
Health Works for
Information Patients and
Technology Doctors
Conference
June 17, 2014 REMARKS: ASCA An Update on DC
Dinner Healthcare
August 12, REMARKS: Medical Healthcare NC
2014 Forum: ``Federal Problems
Issues Facing Confronting
the Medical Doctors, Nurses,
Community in Administrators,
NC's 3rd and Patients
Congressional
District''
August 13, REMARKS: Federal Issues NC
2014 Roundtable Lunch that Will Affect
with Congressman Eastern NC's
Walter Jones and Medical
Special Guest Community
Congressman Tom
Price
August 17, REMARKS: Perspectives on GA
2014 Leadership Physician
Session--GPLA Leadership
September 30, REMARKS: Keynote Sustaining DC
2014 Speaker, AHIP Medicare for
Medicare and Future
Medicaid Generations:
Conference Views From the
Hill
November 20, REMARKS: Speech/ General DC
2014 Panel With Discussion on
Benjamin Rush How One Goes
Institute, From Medicine to
Georgetown Congress
Chapter
2013 Speeches and Remarks by Dr. Tom Price
January 10, REMARKS: Florida Update on What is FL
2013 Healthcare Happening in DC
Reception on the Health
Care Front Since
Election Day--
Federal
Viewpoint
February 27, REMARKS: Call Reintroduction of Call
2013 With Coalition the Medicare
or State Medical Patient
and National Empowerment Act.
Specialty (Dr. Price)--
Societies Medicare Patient
Empowerment Act
in the New
Congress and
Strategies to
Get it Passed
March 4, 2013 REMARKS: AWARD Physician DC
American Payments: Cuts,
Congress of Bumps, and
Obstetricians Bruises
and
Gynecologists
(ACOG) 31st
Annual
Congressional
Leadership
Conference
March 4, 2013 REMARKS: AAMC Current Climate DC
Government on Capitol Hill
Relations as it Relates to
Conference Federal Health
Care Spending
(Particularly,
Medicare,
Medicaid, Public
Health Service
Programs Like
the National
Health Service
Corps, and the
NIH)
March 6, 2013 REMARKS: Meeting U.S. Health DC
With Reform and the
Commonwealth Sustainability
Fund's Fellows of Medicare and
Medicaid, the
Challenge of
Improving the
Quality of Care
and Access to
the Latest
Technologies and
Medications
While Containing
Spiraling Health
Care Costs
March 17, 2013 REMARKS: American Impact of the VA
Urological Affordable Care
Association Act on
Physicians
April 7, 2013 REMARKS: Self- Perspectives on DC
Insurance Implementation
Institute of of the ACA and
America, Inc. any Future
(SIIA) Actions Being
Taken by the
House Affecting
Healthcare
Reform
May 3, 2013 REMARKS: National Entitlement DC
Orthopaedic Reform: Long-
Leadership Term Economic
Conference Projections and
(AAOS) the Outlook for
Medicare Reform
May 6, 2013 REMARKS: RADPAC Specifics on DC
Healthcare and
Comments on
Radiology Bill--
H.R. 846--and
H.R. 3269 Last
Congress That
Had More Than
270 Co-Sponsers
May 15, 2013 REMARKS: PPO Impact of DC
Capital Caucus Obamacare and
the Next Steps
as We Look Ahead
to 2014
May 22, 2013 REMARKS: American Problems With DC
Association for Medicare's
Homecare Competitive
Washington Bidding Program
Legislative and Benefits of
Conference the Market
Pricing Program
(MPP) HME
Provider
Compliance and
Audit Issues;
Power Mobility
Issues; and
Efforts to
Eliminate
Medicare Fraud
and Abuse
June 15, 2013 REMARKS: Becker's Orthopaedic, IL
ASC Review Panel Spine, and Pain
Management
Practices and
ASCs--6 Defining
Issues
June 17, 2013 REMARKS: AMA SE Status of IL
Delegation Obamacare
Breakfast
June 24, 2013 REMARKS: National Obamacare and GA
Association of Your Plan on
Health Reducing Costs,
Underwriters' From the
Annual Provider Side of
Convention Business
July 9, 2013 REMARKS: Alliance Healthcare DC
of Specialty
Medicine
July 16, 2013 REMARKS: 2013 What DC
Health Care Representative
Payments and Price Thinks
Policy About Emerging
Conference Health Reform
Issues in the
113th Congress
July 20, 2013 REMARKS: Southern Obamacare Current ..................
Orthopaedic Perspective
Association
August 10, REMARKS: GA Perspectives on GA
2013 Physicians Physician
Leadership Leadership
Academy
August 17, REMARKS: American How Will The MD
2013 Society of Affordable Care
General Surgeons Act Influence
the Practice of
Surgery in the
Near Future?
August 20, REMARKS: GNFCC's ACA GA
2013 Healthcare Panel
September 23, REMARKS: Elekta Importance of GA
2013 Learning and Elekta to
Innovation Georgia and the
Center (LINC) Health Care
Grand Opening/ Industry
Ribbon Cutting
October 9, SPECIAL GUEST: Talk About SGR, DC
2013 U.S. Oncology Government
Network PAC Shutdown, and
Board Thoughts of What
Happens Over the
Next Couple of
Months; Anything
Physician
Related
October 21, REMARKS: GA/Cobb Affordable Care GA
2013 Chamber Act--The Story,
Healthcare The Politics and
Summit Policy, and the
Future
October 24, REMARKS: CA Panel of GOP ..................
2013 Lincoln Club Fly- members Who Are
in Working on a GOP
Plan/Alternative
to Obamacare--
Very Casual/
Informal
Discussion
November 16, REMARKS: Keynote As the Largest DC
2013 address Medical Medical Student
Student Section Organization in
at the AMA-MSS the Country the
Interim Assembly AMA-MSS is
Meeting Dedicated to
Representing
Medical
Students,
Improving
Medical
Education,
Developing
Leadership, and
Promoting
Activism for the
Health of
America
November 16, REMARKS: 4th Current MD
2013 Edward Annis Republican
Medical Freedom Health Reform
Awards Dinner/ Proposals
Give Award to
Dr. Carson
November 17, REMARKS: Physicians as MD
2013 International Leaders and
Medical Legislators
Graduates
Section
November 18, REMARKS: AMA SE Developments on DC
2013 Delegation ACA and Some on
Breakfast SGR
December 4, REMARKS: Ripon The Health Care DC
2013 Society Debate: Reform
Breakfast vs. Reality
December 11, REMARKS: ATR H.R. 2300 DC
2013 Wednesday
Meeting to Roll
Out H.R. 2300
Score
2012 Speeches and Remarks by Dr. Tom Price
January 23, REMARKS: 39th March for Life DC
2012 Annual March for
Life
February 21, REMARKS: Cushman Healthcare Update GA
2012 and Wakefield
Healthcare CFO
Roundtable
February 23, REMARKS: Healthcare GA
2012 Southeast Update,
Permanente Including the
Medical Group Revolving Status
Board of of the ACA
Directors Legislation and
Meeting What SPMG Can Do
to Best Position
Itself for the
Future
February 29, REMARKS: Luncheon Physician Payment DC
2012 for the American Reform and the
Association of Prospects of
Clinical Passing H.R.
Endocrinologists 1700 Given the
Inability of
Congress Thus
Far to Enact
Permanent
Medicare
Physician
Payment Reform
March 5, 2012 REMARKS: American Perspective on DC
Urological Where Medicine
Association is Going,
Implementation
of the Health
Reform Bill,
etc.
March 7, 2012 REMARKS: Academic Conference DC
Health Centers Committee
Fly-in Outcome; What
Will the 2012
Election Mean
for Teaching
Hospitals,
Payroll Tax
Conference, and
SGR?
March 13, 2012 REMARKS: Colorado The Nexus of CO
School of Medicine and
Medicine Politics . . .
Benjamin Rush Closer Than you
Society Think!
March 16, 2012 REMARKS: RPA Future of DC
Reception Healthcare
March 22, 2012 REMARKS: Townhall Athena's DC
Meeting With Innovative
Athena Health Approach to
Incentivizing
Meaningful
Health
Information
Exchange and a
Recent OIG
Opinion the
Company
Successfully
Obtained That
Has the
Potential to at
Last Unleash the
Technological
Innovation in
the Health Care
Sector That Has
Eluded Policy
Makers for
Decades
March 22, 2012 REMARKS: National Medication DC
Association of Adherence: How
Chain Drug Important it Is
Stores for Patients to
Take Their
Medications, and
Take Them
Correctly; One
of the Items in
our MTM Bill
That We Stress
is That Patients
in Transition of
Care Need Extra
Help to Make
Sure They Take
Their Meds, Take
Them Properly,
and Continue to
Take Them Until
the Physician
Has Determined
They Stop
March 27, 2012 REMARKS: Hands Hands Off My DC
Off My Healthcare
Healthcare Rally
April 12, 2012 REMARKS: Lunch Health Care DC
With AMA Reform From the
Students Perspective of a
Physician in
Congress
April 12, 2012 REMARKS: Speaking Healthcare in DC
at the Commons America: Where
Seminar Have We Come
From and Where
Are We Going?
April 13, 2012 REMARKS: Medical Physician AL
Association for Leadership:
State of Alabama Critical for
Annual Meeting Preserving the
Profession; Why
Physicians
Should be More
Involved in the
Political
Process
April 23, 2012 REMARKS: North A Washington/ GA
Fulton Hospital Healthcare
(Semi- Annual Update
Medical Staff
Meeting)
April 26, 2012 REMARKS: National Discussion on How DC
Journal Keynote Congress Can Act
Interview in the Interest
of the American
Public and the
Policy Issues
Americans Want
Their Elected
Officials to
Focus on for the
Remainder of the
112th Congress
April 26, 2012 REMARKS: American No Topic Listed DC
Association of
Orthopaedic
Surgeons
April 30, 2012 REMARKS: To A Principled ..................
Hilldale Prescription for
Students America's
Health: The
Perspective of
Doctor-Turned-
Lawmaker
May 8, 2012 REMARKS: College Outlook in DC
of American Congress for the
Pathologists Rest of the
Breakfast Year; What's the
GOP View on
Health Care and
Medicare Reform?
What Happens
Next in Health
Care if ACA is
Repealed or is
Not Repealed?
May 21, 2012 REMARKS: Health Care MO
University of Financing in
Missouri Medical General and
School Financing of
Graduate Medical
Education
May 22, 2012 REMARKS: Richmond Healthcare GA
County Medical Update; Status
Society of Healthcare
Reform
Legislation
June 3, 2012 REMARKS: GA/SC Our Bill, H.R. SC
Radiology 3269; How We Can
Societies Joint Get it Into End
Chapter Meeting of Year Package,
etc.; SGR; Your
Bill to Repeal
and Replace ACA
June 15, 2012 REMARKS: Faith Panel: Obamacare: DC
and Freedom Repeal, Replace,
Coalition and Reform
June 18, 2012 REMARKS: AMA No topic listed IL
Southeastern
Breakfast
June 22, 2012 REMARKS: Stand Up Your/House GA
for Religious Perspective on
Liberty Rally HSS Mandate;
Role the Federal
Government is
Playing to
Infringe on the
Rights of
Religious
Organizations;
Any Updates From
the House on
These Issues
June 26, 2012 REMARKS: American Personal Story of MD
Orthopaedic How You Got
Association Involved in
Politics
July 10, 2012 REMARKS: American Repealing and DC
Action Network Replacing
and Crossroads Obamacare
GPS Healthcare
Panel
July 10, 2012 REMARKS: American Price/Boustany DC
Association of Medicare
Neurological Physician
Surgeons Fly-in Payment Bill and
Private
Contracting
July 20, 2012 REMARKS: Smart Healthcare, Next VA
Girl Politics Steps
July 27, 2012 REMARKS: Lincoln Obamacare FL
Day Dinner with
Ross
July 31, 2012 REMARKS: B26 Healthcare NC
Romney Breakfast
August 3, 2012 REMARKS: ASCRS/ Medicare Call
ASOA Retreat Physician
(via Payment Reform,
teleconference) the SGR, IPAB
Repeal
August 7, 2012 REMARKS: GAMES Healthcare: Home GA
Legislative Health Care:
Breakfast Medicare
Competitive
Bidding and the
Current Audit
Environment
August 7, 2012 REMARKS: Healthcare/ GA
Brunswick Washington
Medical Update
Community Event
August 12, REMARKS: Georgia Perspective on GA
2012 Physicians Physician
Leadership Leadership
Academy
August 24, REMARKS: The Opportunity CA
2012 Strathspey for Reforms to
Crown: A New the ACA
Model for
Healthcare
August 25, REMARKS: No topic listed CA
2012 Government
Affairs Panel:
Creating a New
Era in
Healthcare
August 28, REMARKS: Healthcare Panel FL
2012 Bipartisan
Conversation on
Healthcare
August 29, REMARKS: The Hill No topic listed FL
2012 Healthcare Panel
September 9, REMARKS: Docs 4 U.S. VA
2012 Patient Care Congressional
Solutions for
Obamacare
September 10, REMARKS: American The Outlook for DC
2012 Academy of Health Care
Dermatology Legislation and
Legislation
Impacting
Physicians
Broadly and,
More
Specifically,
Dermatologists
September 13, REMARKS: American Providing an Call
2012 Congress of Assessment of
Obstetricians the Post-SCOTUS
and Health Reform
Gynecologists Landscape
Government
Relations
Committee
September 13, REMARKS: SC-04 Healthcare, DC
2012 Chambers of General Ideas
Commerce and Thoughts
National Issues About PPACA, the
Fly-in Supreme Court
Ruling on PPACA,
and Healthcare
Issues in
General as it
Relates to the
Business
Community
November 10, REMARKS: Mount Obamacare's GA
2012 Vernon Towers Impact on
Retirement Seniors
Facility
November 11, REMARKS: Emory Healthcare GA
2012 Johns Creek Update; H.R.
Hospital 3000
November 16, REMARKS: Medtrade H.R. 6490--Why GA
2012 Expo (Power for That Would be
Funding Welcome Better Than the
Reception) Current
Competitive
Bidding
Methodology
November 22, REMARKS: SCI Healthcare Update/ GA
2012 Solutions Legislative
Healthcare Trends in
Meeting Healthcare
Policy
November 24, REMARKS: National Health Policy TX
2012 Association of Issues Facing
Spine Congress
Specialists
------------------------------------------------------------------------
______
Questions Submitted for the Record to Hon. Thomas Price, M.D.
Questions Submitted by Hon. Ron Wyden
brokerage account documentation
Question. In the hearing, you were asked to reaffirm that trades in
your brokerage accounts were controlled by your stock broker and not by
yourself.
Please provide the management and brokerage agreements for all
accounts that hold individual health-care stocks including but not
limited to the Morgan Stanley account labeled Morgan Stanley #1 in your
2015 House of Representatives Financial Disclosure and the Morgan
Stanley account labeled Morgan Stanley #2 in your 2015 House of
Representatives Financial Disclosure.
Answer. I previously provided the Senate Finance Committee
(``SFC'') with substantial information regarding the nature of the
brokerage accounts described in this inquiry and have no further
information to provide at this time. Additional information regarding
Morgan Stanley's management and brokerage policies is also readily
available in the public domain.
management of shares in innate immunotherapeutics
Question. As discussed in the disclosure memo, which was made part
of the record of the hearing, you purchased shares in Innate
Immunotherapeutics in private placements in 2016.
In what account and in what form were those shares held at the time
you filed your financial disclosures, as a nominee, with Federal ethics
officials and your response to the committee's questionnaire? In what
account and in what form are those shares currently held? If shares
were transferred between accounts, when were they transferred and at
whose direction?
Answer. I previously provided the SFC with substantial information
regarding the issues raised in this question. As the committee is fully
aware, the shares of Innate Immunotherapeutics (``Innate'') purchased
in 2016 through private placement were held with the company in
electronic certificate format up until recently. In the process of
gathering information to respond to committee questions (posed on
January 17, 2017) in the wake of due diligence meetings with committee
staff, I learned that these electronic certificate holdings have now
been transferred to his Wells Fargo Joint Brokerage Account #1. The
desire to transfer this holding from electronic certificate form to a
brokerage account was discussed during the due diligence meeting with
SFC staff. Both the SFC and OGE were appropriately notified of the
transfer upon its completion.
brokerage trades
Question. In testimony to the Senate HELP Committee, you stated
that you directed your broker to purchase shares in Innate
Immunotherapeutics.
During your time in Congress, have you ever directed your broker to
make any other transactions in stock of specific companies? If so,
please identify the companies, the date, and volume of the transaction.
Answer. To the best of my knowledge, I have not undertaken such
actions. Throughout my time as a member of the U.S. House of
Representatives, I have abided by and adhered to all ethics and
conflict of interest rules applicable to me.
trans-pacific partnership negotiations
Question. Did you or your staff consult with the House Ethics
Committee at any time concerning the possibility or appearance of a
conflict of interest or other ethics concern arising from your
ownership of shares in Innate Immunotherapeutics and your role as a
member of the House Ways and Means Committee concerning negotiations
related to the Trans-Pacific Partnership, or the receipt of any
information that you received in that capacity or as a member of the
House concerning such negotiations?
Answer. To the best of my knowledge, neither I nor my staff has had
such consultations. Throughout my time as a member of the U.S. House of
Representatives, I have abided by and adhered to all ethics and
conflict of interest rules applicable to me.
innate immunotherapeutics purchases
Question. The nominee owns 461,238 shares of Innate
Immunotherapeutics Ltd. (``Innate''), a small Australian
biopharmaceutical firm developing a multiple sclerosis therapy. The
nominee acquired the stock in four separate purchases on January 8, 9
and 23 of 2015 (``2015 tranche''), and in a pair of private stock
placements on August 31, 2016 (``2016 tranche''). Regarding Innate:
Please describe how and when the nominee first learned about
Innate.
Answer. I previously answered this question for the SFC. I learned
about Innate during the course of a conversation in the fall of 2014
with Representative Chris Collins regarding their respective personal
backgrounds. I cannot recall the specific date of that conversation.
During that exchange, Representative Collins told me that he sat on a
number of public company boards including Innate, which was developing
a treatment for multiple sclerosis (MS).
Question. Did the nominee or his staff ever meet or otherwise
communicate with current or former employees, directors, consultants,
or other officials affiliated with Innate? If so, please describe the
communication, including who it involved, the date, subject, place and
form (e.g., in person, by phone) of communication.
Answer. I previously answered this question for the SFC.
I communicated with Representative Collins, who is a director of
Innate. As noted above, I learned about Innate through a general
conversation with him in the fall of 2014. I also communicated with
Simon Wilkinson of Innate regarding my interest in participating in the
2016 private placement of company stock. According to Innate's website,
Mr. Wilkinson is currently the Managing Director and CEO of Innate.
My congressional staff has not met or otherwise communicated with
current or former employees, directors, consultants or other officials
affiliated with Innate.
Question. Please describe any communication between the nominee and
Congressman Collins regarding Innate Immunotherapy, including the date,
subject, place and form.
Answer. I previously answered this question for the SFC.
I had a conversation with Representative Collins in the fall of
2014 that brought Innate, as a company, to my attention. The nature of
that conversation did not, however, influence my decision to invest in
the company in either 2015 or 2016.
I believe I had subsequent general communications with
Representative Collins regarding Innate. I do not have a specific
recollection of when those conversations occurred or their substance.
Any such communications did not impact my investment decisions,
however, because my purchases of Innate stock were based solely on my
own research.
Question. The nominee bought 400,316 shares in the 2016 tranche in
a private stock sale that included two placements at two prices. Please
provide the number of shares bought in each placement, and the price at
which the shares were bought.
Answer. I previously answered this question for the SFC. I
purchased 250,000 shares of Innate in Private Placement 1 at US$0.18/
share--the same price offered all participants in this private
placement. I purchased 150,613 shares of Innate in Private Placement 2
at US$0.26/share--the same price offered all participants in this
private placement.
zimmer biomet stock holding
Question. Did you or your staff meet with Zimmer Biomet employees
or representatives, including but not limited to lobbyists, executives,
or board members, between July 14, 2015 and April 1, 2016? If so,
please describe the communication, including who it involved, the date,
subject, place and form (e.g., in person, by phone) of communication.
Answer. To the best of my knowledge, neither I nor any members of
my staff met with or attended an event with a lobbyist or
representative from Zimmer Biomet during the specified dates.
house ethics committee consultation
Question. House rule 3, clause 1, provides that members of the
House ``shall vote on each question put, unless having a direct
personal or pecuniary interest in the event of such question.''
However, the House Ethics Manual (House Ethics Manual, U.S. House of
Representatives Committee on Standards of Official Conduct, 110th Cong,
2d Sess. (2008), pp. 233-37) makes a sharp distinction between, on one
hand, voting on the House floor, and, on the other, more active
advocacy. The House Ethics Manual states:
The provisions of House Rule 3, clause 1, as discussed in this
section apply only to members voting on the House floor. They
do not apply to other actions that members may normally take on
particular matters in connection with their official duties,
such as sponsoring legislation, advocating or participating in
an action by a House committee, or contacting an executive
branch agency. Such actions entail a degree of advocacy above
and beyond that involved in voting, and thus a member's
decision on whether to take any such action on a matter that
may affect his or her personal financial interests requires
added circumspection. Moreover, such actions may implicate the
rules and standards, discussed above, that prohibit the use of
one's official position for personal gain. Whenever a member is
considering taking any such action on a matter that may affect
his or her personal financial interests, the member should
first contact the [Ethics] Committee for guidance.
Before, or any time after, you introduced H.R. 4848, the Healthy
Inpatient Procedures Act of 2016 (HIP Act) in the 114th Congress, did
you consult with the House Ethics Committee concerning the possibility
of, or appearance of, a conflict of interest or other ethics concern
arising from your ownership of shares in ZimmerBiomet? If so, when?
Answer. My investment accounts, particularly the Morgan Stanley
Portfolio Management Program account wherein the noted stock
transaction occurred, were established so as to place trading
discretion in the hands of my broker/financial advisor. No conflict of
interest existed and no consultation was necessary. Throughout my time
as a member of the U.S. House of Representatives, I have abided by and
adhered to all ethics and conflict of interest rules applicable to me.
Question. Before, or at any time after, you introduced H.R. 4185,
the Protecting Access through Competitive-pricing Transition Act of
2015 (the PACT Act) in the 114th Congress, did you consult with the
House Ethics Committee concerning the possibility of, or appearance of,
a conflict of interest or other ethics concern arising from your
ownership of shares in health-care stocks? If so, when?
Answer. My investment accounts, particularly the Morgan Stanley
Portfolio Management Program account wherein the noted stock
transactions occurred, were established so as to place trading
discretion in the hands of my broker/financial advisor. No conflict of
interest existed and no consultation was necessary. Throughout my time
as a member of the U.S. House of Representatives, I have abided by and
adhered to all ethics and conflict of interest rules applicable to me.
Question. Before, or at any time after, you introduced H.R. 5400,
an Act to amend the Internal Revenue Code of 1986 to make permanent the
deduction for income attributable to domestic production activities in
Puerto Rico in the 114th Congress, did you consult with the House
Ethics Committee concerning the possibility of, or appearance of, a
conflict of interest or other ethics concern arising from your
ownership of shares in Eli Lilly, Bristol Myers Squibb, and Amgen? If
so when?
Answer. My investment accounts, particularly the Morgan Stanley
Portfolio Management Program account wherein the noted stock
transactions occurred, were established so as to place trading
discretion in the hands of my broker/financial advisor. No conflict of
interest existed and no consultation was necessary. Throughout my time
as a member of the U.S. House of Representatives, I have abided by and
adhered to all ethics and conflict of interest rules applicable to me.
Question. Before, or at any time after, you introduced H.R. 5210,
the Patient Access to Durable Medical Equipment (PADME) Act of 2016 in
the 114th Congress, did you consult with the House Ethics Committee
concerning the possibility of, or appearance of, a conflict of interest
or other ethics concern arising from your ownership of shares in
Blackstone, Inc. or any other company that markets or manufacturers
durable medical equipment? If so, when?
Answer. My investment accounts were established so as to place
trading discretion in the hands of my broker/financial advisor. No
conflict of interest existed and no consultation was necessary.
Throughout my time as a member of the U.S. House of Representatives, I
have abided by and adhered to all ethics and conflict of interest rules
applicable to me.
resurgens orthopaedics
Question. Do you have any financial or business relationship
including an equity or ownership stake in Resurgens Orthopaedics, and/
or do you derive any financial interest or benefit from the company? If
so, please detail the type of financial or business relationship you
have, and any income you do or may derive related to Resurgens. In
addition, if you answered ``yes,'' please describe your plan to divest
your financial interest in the company.
Answer. I have no current financial stake or interest in Resurgens
Orthopaedics.
lgbtq health care
Question. LGBTQ individuals often experience exceptional barriers
to care; health disparities associated with gender identity are
partially driven by lower rates of insurance. Under the ACA, the LGBTQ
population cannot be excluded from health plans due to pre-existing
conditions such as HIV. Discrimination based on sex and gender identity
is also prohibited for programs receiving Federal funds. Additionally,
all insurance plans must offer the same coverage to married same-sex
couples as is offered to opposite-sex couples. In terms of national
health surveys, the ACA changed data collection requirements to include
sexual orientation and gender identity, which supports future advocacy
and research.
Will you maintain health-care protections for the LGBTQ community?
Please explain.
Answer. It is essential that health-care services be available to
all people with the highest level of quality, affordability, and
respect for their human dignity. If confirmed, I will ensure that HHS
follows Congress's lead in defining and enforcing nondiscrimination
laws, and that HHS will comply with all statutory and judicial
requirements in doing so.
medicaid and disability services
Question. Medicaid serves as the primary health insurance program
for Americans with disabilities, especially those with limited income.
A lack of adequate health and long-term care coverage is often cited as
a primary barrier to the ability to live in the community and the
ability to succeed in employment. Many of the most important Medicaid-
funded services for people with disabilities can be the most expensive.
States must offer three of these services: inpatient hospital care,
home health care, and Early and Periodic Screening, Diagnostic, and
Treatment (EPSDT). State Medicaid programs currently have the option to
cover the remaining services important to Americans with disabilities
including: many home-and-community based services; prescription drugs;
private duty nursing, physical therapy, occupational therapy; speech,
hearing, and language therapy; prosthetic devices; intermediate care
facilities; and personal care services.
Since the enactment of the Americans with Disabilities Act (ADA) in
1990, there has been a concerted effort at the State, Federal, and
community levels to transform the Medicaid program from institutional-
care focused financing mechanism into a comprehensive and flexible
community-based long-term services and supports program. Examples of
such congressional efforts can be seen in the Affordable Care Act,
which strengthened and expanded the Money Follows the Person program
and created the State Balancing Incentive Program and Community First
Choice Option.
How will the administration ensure Medicaid supports the
protections of the Americans with Disabilities Act?
Answer. The coordination of two complex laws such as Medicaid and
the Americans with Disabilities Act requires the close interaction of
those who are expert in each. At some level the protections referred to
are best supported by allowing States the flexibility to approach them
in a way that makes sense for their program, so long as Federal
requirements are met. As to those Federal requirements, there may be a
need for close coordination with the Department of Justice or the Equal
Employment Opportunity Commission as well as the Department's own
Office for Civil Rights.
Question. How will you ensure that Federal dollars are not used in
a way that promotes unnecessary institutionalization of individuals
with disabilities?
Answer. Community integration, beneficiary autonomy in decision
making, and person-centered planning are central tenets articulated in
CMS' approach to Home and Community Based Services and the HCBS
Settings Rule with a compliance date in March 2019, and I support each
of those principles. It is also important to note that many
residential, disability-specific settings have long provided a safe and
integrated community alternative to institutional placement for
individuals with disabilities, and appropriate weight should be given
to the preferences of families and individuals with disabilities
because they are in the best position to decide what type of setting
best meets their individualized needs and circumstances.
Question. How will you work to ensure States have sufficient
resources to fund home- and community-based services?
Answer. As with any program or initiative relying on States, the
central question for the State is often one of funding. If confirmed, I
would work to see that the Department is a helpful resource to the
States with respect to these services at least by providing clarity
regarding their flexibility, technical assistance and support as
needed, and sharing best practices.
Question. Will you direct CMS in its approval of waivers to
encourage States to expand home- and community-based services and shift
away from waiting lists and institutional care?
Answer. Every State is unique in their specific approach to the
provision of services for the population eligible to receive HCBS, and
we stand ready to assist States as they develop strategies to meet
their particular goals.
medicaid equal access rule
Question. Congressman Price, as you have previously stated, some
providers do not accept Medicaid. Studies show that provider payment
rates are a leading reason that some providers choose not to
participate in Medicaid.
Recently, the Centers for Medicare and Medicaid Services (CMS) has
finalized two major rules to help address this issue--the ``equal
access'' rule and the Medicaid managed care rule.
Congressman Price, given that this is an issue you seem
particularly concerned about, will you commit to ensuring successful
enforcement of the Medicaid Equal Access rule, the Medicaid managed
care rule, and other Federal standards that help ensure States set
appropriate payment rates as required under the Medicaid statute's
equal access provision?
Answer. If confirmed as Secretary, I will faithfully implement laws
written by Congress and the regulations issued by the Department. This
includes enforcement action as appropriate. As a doctor who has
actually treated thousands of Medicaid patients, I do care deeply about
the Medicaid program and the access of Medicaid patients to actual
care, not just a card they can carry with them.
medicare balance billing
Question. Congressman Price, you have championed legislation to
allow providers participating in Medicare to enter into private
contracts with Medicare beneficiaries, meaning that those providers
would be permitted to balance bill seniors and other Medicare
beneficiaries for the difference between what Medicare pays and what
the provider decides to charge--potentially putting seniors and other
Medicare beneficiaries on the hook for high medical bills. More than 30
years ago, Congress passed legislation to protect against exactly that
situation. One study found that out-of-pocket medical spending declined
by 9% in Medicare households as a result of these protections.
Those who want balance billing in Medicare often claim that doctors
are fleeing the Medicare program, but evidence demonstrates this is
simply not true. Provider participation in Medicare remains strong. In
fact, 9 in 10 primary care physicians accept Medicare, and 96 percent
of people with Medicare report having regular access to a physician's
care. Allowing balance billing would essentially create two tiers of
Medicare beneficiaries--those who can afford to access needed care and
those who cannot.
Will you commit to the more than 55 million Americans who rely on
Medicare that, if confirmed as HHS Secretary, you will advise the
President to veto any legislation that would undermine these decades-
old protections and allow providers participating in Medicare to
balance bill seniors and other Medicare beneficiaries?
Answer. In considering Medicare, it is important to appreciate that
the bipartisan Medicare Trustees have told everyone that Medicare, in
less than 10 years, is going to be out of the kind of resources that
will allow us as a society to keep the promise to beneficiaries of the
Medicare program. My goal, if confirmed, is to work with Congress to
make certain that we save and strengthen Medicare. It is irresponsible
for us to do anything else. If I am confirmed, my role will be one of
carrying out the laws Congress passes and as to that I would convey to
the Medicare population that we look forward to assisting them in
getting the care they need.
Question. Do you believe low- and middle-income seniors can afford
to pay more for Medicare services than they currently do?
Answer. In previous legislation, I have proposed giving our seniors
more flexibility within the Medicare Program and providing the
opportunity to make decisions with their physicians without
interference from Washington. The measure would help ensure that
Medicare beneficiaries maintain adequate access to health-care
professionals by increasing the number of physicians who will accept
Medicare patients and addressing physician shortages by attracting new
professionals to the field of medicine. In addition, the bill provides
safeguards to Medicare beneficiaries. More importantly, it would allow
a provider to see a Medicare patient pro-bono or charge minimal cost
(below the standard fee schedule) without prosecution.
raising the medicare eligibility age
Question. Congressional Republicans support increasing the Medicare
eligibility age from 65 to 67 to generate savings for the Federal
Government. It is well documented that these savings ultimately shift
costs to the American people, States, and employers. According to 2014
estimates, increasing the Medicare eligibility age would result in a
$11.4 billion shift to individuals, States, and employers. The Federal
savings would amount to only half of this cost, or $5.7 billion.
Most Americans retire well before age 67. By age 63, nearly half of
the population is no longer working. Advocacy groups argue that
increasing the Medicare eligibility age is an across the board benefit
cut that undercuts a promise made to working families and seniors more
than 50 years ago.
Would you recommend President Trump veto legislation that would
increase the Medicare eligibility age?
Answer. In considering Medicare, it is important to appreciate that
the bipartisan Medicare Trustees have told everyone that Medicare, in
less than 10 years, is going to be out of the kind of resources that
will allow us as a society to keep the promise to beneficiaries of the
Medicare program. My goal, if confirmed, is to work with Congress to
make certain that we save and strengthen Medicare. It is irresponsible
for us to do anything else. If am confirmed, my role will be one of
carrying out the laws Congress passes and as to that I would convey to
the Medicare population that we look forward to assisting them in
getting the care they need.
Question. If implemented, would Federal savings from a higher
eligibility age be shifted onto Medicare beneficiaries, States, or
employers instead?
Answer. If such a change is made and the savings do not accrue to
beneficiaries and the Trust Fund, then we may be right back where we
started without the change. However, the allocation of savings from
such a change, whether to the Medicare Trust Fund or to other budgetary
priorities, will be a decision for the Congress.
mental health
Question. As you must know, mental illness is highly prevalent in
the United States. Over 43 million adults, just over 18 percent of the
population, had any mental illness in 2014. In the past year, over 68
million Americans, representing 20 percent of the population,
experienced a psychiatric or substance use disorder.
Medicaid is the country's primary payer for all mental health
services and is an important source of funding for mental health
services that would otherwise be out of reach for low-income people.
Under Medicaid, children and adults with mental illness receive vital
services and supports that are not typically covered by private
insurance. Medicaid accounted for 25% of all mental health spending in
the United States in 2014.
Thanks to Medicaid expansion under the Affordable Care Act (ACA),
an additional 3.8 million Americans have access to mental health
coverage. Furthermore, due to consumer protections under the ACA, it is
now required that health insurers provide mental health and substance
use disorder services as an essential health benefit.
In your 2017 budget and 2015 reconciliation bill, you call for a
full-out repeal of the Medicaid expansion; do you still support full
repeal?
Answer. This is a matter for the legislative branch to consider. If
confirmed, I will work to ensure that HHS (appropriately) implements
the statutes within its purview.
Question. In 2015 you voted to eliminate important coverage
protections for Medicaid beneficiaries in alternative benefit plans so
they can access the treatment they need.
Do you still support eliminating these protections?
Answer. This is a matter for the legislative branch. I remain
committed to making sure health care is affordable and accessible for
all Americans. And if confirmed, I will work to ensure that HHS
(appropriately) implements the statutes within its purview.
Question. In your Empowering Patients First Act you call for full
repeal of the ACA including important protections such as mental health
parity that help to ensure that a person receives the same level of
mental health coverage that they would for any physical illness.
Do you still support repeal of these protections?
Answer. I believe it is important that we as a nation make sure
that every American has access to the kind of mental health and
substance abuse care that they need. This is a matter for the
legislative branch, however, and if confirmed, I will work to ensure
that HHS (appropriately) implements the statutes within its purview.
Question. The Office of the Assistant Secretary for Planning and
Evaluation (ASPE), which will be your principal advisor as HHS
Secretary should you be confirmed, reported that in States that didn't
expand Medicaid nearly 2 million low-income adults with mental health
and substance use disorders are uninsured.
How do you plan to work with States to expand Medicaid coverage to
these individuals?
Answer. Every State has different demographic, budgetary, and
policy concerns that shape their approach to Medicaid and Medicaid
expansion. That is one of the reasons I devoted so much time working to
help identify creative solutions, and why I believe a one-size-fits-all
approach is not workable for a country as diverse as the United States.
If I am confirmed, I will work with CMS and SAMHSA to help the
population of uninsured low-income adults with mental health and
substance use disorders.
I note that the conversation and focus in these topics has been the
question of coverage rather than true access to care. For many
Americans, they might have an insurance card and yet not be able to
afford care or it might not be available to them for other reasons.
opioids and medicaid expansion
Question. In November, I released a report describing the
consequences of not adequately funding treatment and prevention
services for opioid addiction. However, as we both know, the effects of
opioid crisis go far beyond mere statistics. People all across the
country end up struggling with opioid addiction simply because they got
into a car accident, or had a painful surgery. Medicaid expansion has
provided millions of Americans an opportunity to get the treatment they
need to get back on their feet.
Congressman Price, in your 2017 budget you call for ending the
Medicaid expansion, can you confirm whether you still support getting
rid of the Medicaid expansion?
Answer. This is a matter for the legislative branch. If confirmed,
I will work to ensure that HHS (appropriately) implements the statutes
within its purview.
Question. In your role as a cabinet Secretary, would you advise the
President to veto a bill that repeals the Medicaid expansion?
Answer. I am committed to making sure all Americans have access to
affordable health care that is of the highest quality. Every State has
different demographic, budgetary, and policy concerns that shape their
approach to Medicaid. That is one of the reasons I devoted so much time
to working with States to help them to identify creative solutions, and
why I believe a one-size-fits-all approach is not workable for a
country as diverse as the United States. I would encourage anyone to
keep this principle front and center in considering any changes to
Medicaid, which themselves might well be part of a greater context that
further informs the best approach. In the meantime, I look forward to
faithfully executing whatever law that Congress passes and the
President signs, if I am confirmed. I will promise you this: Regardless
of the final legislative outcome, I would work as HHS Secretary to
ensure that the Medicaid program is well administered, effective, and
available for eligible beneficiaries and that the States/Governors are
given the flexibility to pursue innovative approaches that fits the
needs of their States.
Question. Would you advise the President to support ending coverage
for the 1.6 million Americans struggling with substance use disorders
who gained access to coverage for treatment under the Medicaid
expansion?
Answer. It is important that we as a nation make sure that every
American has access to the kind of mental health and substance abuse
care that they need. If I am confirmed, I am committed to ensure that
access is not diminished.
Question. Will you promise that people dealing with opioid
addiction will not lose their Medicaid expansion coverage that has
provided them with the treatment they need and deserve?
Answer. Opioid addiction has had a severe and devastating impact to
communities and families across the country. If I am confirmed, I am
committed to ensure that access to treatments is not diminished and
will work with CMS and SAMHSA to help low-income adults with mental
health and substance use disorders.
network adequacy rules for specialty pharmacies
Question. Pharmacy Benefit Managers (PBMs) may or may not own the
pharmacies in their pharmacy networks. Recently, PBMs have been
criticized for using aggressive tactics to restrict access to
pharmacies that they do not own. If pharmacy networks are narrowed,
then individuals will have limited access to pharmacies and necessary
medications.
I have heard from Oregon pharmacies that pharmacy benefit managers
(PBMs) are using aggressive tactics to, in the pharmacies' opinion,
restrict access to pharmacies not owned by the PBM.
This issue was described in a January 9, 2017 New York Times
article: (https://mobile.nytimes.com/2017/01/09/business/specialty-
pharmacies-say-benefit-manag
ers-are-squeezing-
themout.html?_r=0&referer=https%3A%2F%2Fwww.google.com%
2F).
I am concerned that if pharmacy networks are narrowed, access to
needed medications will be limited.
Can you explain if practices described in the New York Times
article are permitted under Medicare Part D and the Exchanges
established under the Affordable Care Act (ACA)?
Answer. Part D plans are required to accept any pharmacy willing to
participate in the plan under the terms of its standard contract.
Qualified health plans do not have such a requirement though State
insurance commissioners may consider such practices in their regulatory
oversight.
Question. What minimum standards regarding network adequacy for
specialty pharmacies exist for both Part D plans and plans offered on
the ACA Exchanges?
Question. For Part D plans, network adequacy requirements are set
forth in 42 CFR 423.120 and in subregulatory guidance. The requirements
vary by the type of drug. For home infusion drugs, they vary by State.
See https://www.cms.gov/Medicare/Prescription-Drug-Coverage/
PrescriptionDrugCovContra/Downloads/Adequate-Access-to-HI-Pharmacies-
Rewrite-012610.pdf.
For Qualified Health Plans, network adequacy requirements are set
forth at 45 CFR 156.230, 45 CFR 156.122(e), and QHP application and
attestation materials, as well as in State laws.
preventive care
Question. Countless studies have proven that early detection of
disease saves lives and improves quality of life. Early detection,
through preventive screenings, can save the health-care system the
expense of more costly treatments that may be necessary with a later
stage diagnosis. However, early detection of disease is often not
possible without preventive screenings, for both acute conditions like
cancer and chronic conditions like diabetes. High copays and high
deductibles can be a deterrent to patients utilizing these preventive
screenings, regardless of socioeconomic status.
The ACA included a provision requiring private health plans to
cover recommended preventive services without any co-payments or cost-
sharing. It also added coverage of an annual wellness visit and
eliminated cost-sharing for recommended preventive services under the
Medicare program.
As HHS Secretary, how will you guarantee that Americans will retain
their current level of coverage for preventive screenings and ensure
early detection screenings are preserved?
Answer. I would convey to the Medicare population that we look
forward to assisting them in getting the care they need and the
caregivers that they need too.
As we consider what to do with regards to the Affordable Care Act,
my hope is to move in a direction where insurers can offer products
people want and give them the coverage they want. Getting to that kind
of system requires changes that will inevitably involve working with
Congress and considering the tradeoffs of various proposals to achieve
our shared objective of the best and highest quality care being
available to Americans.
spousal impoverishment protections
Question. In the 1980s, married couples commonly were driven into
complete poverty when one spouse developed a need for nursing home
care. The couple often had to spend down their joint resources to just
a few thousand dollars before Medicaid could provide assistance.
Congress addressed this problem in 1988 legislation signed by President
Reagan. Beginning in October 1989, the spouse of a nursing home
resident has been allowed allocations of income and resources in
determining the resident's Medicaid eligibility. These allocations
allow the at-home spouse to retain adequate but not lavish amounts of
income and savings. To allow for State flexibility, the Federal
Government sets a range for these allocations, and indexes those ranges
to inflation. Each State sets its own income allocation and resource
allocation, as long as the allocation falls within the Federal range.
Spousal impoverishment protections are mandatory for nursing home
residents and were optional for people receiving home and community-
based services (HCBS). Due to the Affordable Care Act, people receiving
HCBS are also entitled to spousal impoverishment protections.
Do you support the requirement for State spousal impoverishment
protections?
Answer. I support the flexibility of States to make decisions about
eligibility so that they can ensure the broadest set of people get
access to the highest quality care on the budget available to the
State. Spousal impoverishment protections allow States to delay or
prevent the impoverishment of spouses lest they too need to be added to
the Medicaid rolls.
Question. Should a person be required to receive long-term care in
a nursing home in order to protect a spouse from poverty?
Answer. My hope is that we can move to a system where States can
make decisions like this with their population, values, dynamics, and
funding in mind.
Question. How will HHS ensure spouses are protected from living in
poverty when a loved one reaches a stage of fragility that requires
long-term care?
Answer. I have seen that the best solutions to seemingly
intractable problems like this rely on States to find the right
approach for that State. If confirmed, I look forward to working with
Governors (and Congress) to help States chart their course in this
regard.
women's health
Question. Congressman Price, in the past, when asked whether birth
control should have to be covered, you've stated that not a single
woman has been left behind.
Will you reject any proposals that limit a women's access to
contraceptive care or make it cost more for her?
Answer. Women should have the health care that they need and want.
The system we ought to have in place is one that equips women and men
to obtain the health care that they need at an affordable price.
Question. As a cabinet adviser to the President, will you advise
the President to veto any bill that reduces guaranteed access to
affordable contraceptive coverage?
Answer. As we consider what to do with regards to the Affordable
Care Act, my hope is to move in a direction where insurers offer
products people want and give them the coverage they want. Getting to
that kind of system requires changes that will inevitably involve
working with Congress and considering the tradeoffs of various
proposals to achieve our shared objective of the best and highest
quality care being available to Americans.
Question. In your hearing last week, you were asked about your vote
against the DC Council's efforts to protect employees from being fired
for taking birth control. Congressman Price, to clarify for the record,
do you or do you not think an employer should be able to fire or
discriminate against an employee for taking birth control?
Answer. I do not believe so. My vote regarding the DC Council law
you mentioned does not relate to this particular issue or question.
Question. Will you advise the President to veto any bill that rips
access to care away from hundreds of thousands of women by defunding
Planned Parenthood?
Answer. Deciding whether to sign any particular law, particularly
one that involves as many different moving parts as one to replace the
Affordable Care Act, inevitably involves considering many competing,
complementary, or countervailing issues. If Congress passes a law that
makes certain that every single American has access to the coverage
they want for themselves and ensures the individuals who lost coverage
under the Affordable Care Act get or maintain coverage, that is
something I would hope would be strongly considered for signature.
Question. You sponsored the 2015 reconciliation bill (H.R. 3762)
that would repeal key components of the Affordable Care Act (ACA) and
rescind Federal funding for Planned Parenthood for 1 year. Please
provide the names of providers other than Planned Parenthood health
centers that H.R. 3762 would prohibit from participating in Medicaid?
Answer. H.R. 3762 restricts the availability of Federal funding to
a State for payments to any entity that is a 501(c)(3) tax-exempt
organization, is an essential community provider primarily engaged in
family planning services and reproductive health; provides abortions
other than in cases of rape, incest or life of the mother, and receive
a total of more than $350 million under Medicaid in FY 2014.
It should also be noted that H.R. 3762 would increase funding
available to the Community Health Center Program (CHC) by $470 million
over 2 years. As I said in my hearing before the Senate Health,
Education, Labor, and Pensions (HELP) Committee last week, community
health centers are a vital part of the health care delivery system,
filling a void in so many areas across the county. We need to do all we
can to strengthen them, ensuring they are staffed with the highest
quality providers and providing the highest quality care, and look
forward to working with you on this if confirmed.
work requirements for medicaid services
Question. Your Budget Plan for 2017 proposes work requirements for
so called ``able-bodied'' adults in order to qualify for Medicaid
coverage. Specifically, these individuals must be actively seeking
employment or participating in an education or training program in
order to qualify for health-care coverage under Medicaid.
According to independent evaluations of programs that have imposed
work requirements, imposition of work requirements found only modest,
short-term increases in employment with families living in deep poverty
rising under such programs. The evidence also shows that over the long-
term, those in programs with work requirements were as likely to find
employment as enrollees in Medicaid programs that did not have strict
work requirements.
How do you define an ``able-bodied'' adult?
Do you support work requirements in order for these ``able-bodied''
adults to qualify for Medicaid?
Given you're interest in employment, how do you plan on working to
support local economies to ensure that those looking for work
regardless of income are actually able to obtain jobs?
Answer. One major lesson learned from welfare reform signed into
law by President Clinton is that the American people, when given the
opportunity, work exceptionally hard. This view is also shared by
President Trump and reflected in his commitment to job creation and the
dignity of work. Encouraging work allows more families to realize the
American dream, earn their success and rise out of poverty. I will
faithfully execute any laws passed by Congress to institute work
requirements and if given the opportunity to serve I will allow States
greater flexibility for determining how to care for their most needy
citizens.
ama recusal
Question. Congressman Price, in your January 11th letter to the
Associate General Counsel for Ethics at HHS, you said you would resign
from your position as a Delegate of the American Medical Association
(AMA) if confirmed as HHS Secretary. You also promised that--for 1 year
after your AMA resignation--you would ``not participate personally and
substantially in any particular matter involving specific parties in
which (you know) the American Medical Association is a party or
represents a party, unless (you are) first authorized to participate.''
In 2016 alone, the AMA submitted 21 formal comment letters to HHS
and CMS--almost two per month on average--covering a wide range of
issues, including, for example, the implementation of the Medicare
physician payment reforms in MACRA (the Medicare Access and CHIP
Reauthorization Act) and key provisions of last year's Comprehensive
Addiction and Recovery Act (CARA).
In this context, what criteria would you use to determine what
constitutes participating ``personally and substantially'' in a matter?
Answer. I view the term ``personally and substantially'' in the
context of its statutory and regulatory definitions. To the extent
necessary, I will seek advice from his designated agency ethics
official and other appropriate parties when assessing whether
participation in a matter is indeed personal and substantial.
Question. In this context, what criteria would you use to determine
whether the level of AMA's involvement means that it is a party or
represents a party in a particular matter?
Answer. I will abide by the actions agreed to in my publicly
available ethics agreement with the Office of Government Ethics, and
seek advice (when necessary) from the designated agency ethics official
and other appropriate persons.
Question. Will you recuse yourself from any matter in which the AMA
has submitted formal comments to HHS or CMS?
Answer. This matter has already been addressed with the OGE and
designated agency ethics official, and I will abide by the obligations
agreed to in my publicly available ethics agreement.
Question. For example, will you recuse yourself from any decision-
making regarding the implementation of the physician payment reforms in
MACRA--given how actively engaged AMA has been with HHS and CMS on that
issue?
Answer. This matter has already been addressed with the OGE and
designated agency ethics official, and I will abide by the obligations
agreed to in my publicly available ethics agreement.
Question. Will you also recuse yourself from any matter about which
the AMA sent correspondence to HHS or CMS?
Answer. This matter has already been addressed with the OGE and
designated agency ethics official, and I will abide by the obligations
agreed to in my publicly available ethics agreement.
Question. Do you think an HHS Secretary can effectively do his job
if he cannot participate in any of the above described matters?
Answer. Adherence to all applicable ethics and conflict of interest
obligations under Federal law is an essential component of being an
effective HHS Secretary, and in no way limits the ability of an
individual to successfully carry out his or her responsibilities within
the Department.
automatic cuts to entitlements
Question. The day after you were nominated for HHS Secretary, you
rolled out a set of budget process changes that would force automatic
cuts to almost all Federal programs--including Social Security,
Medicare, and Medicaid--if the national debt exceeds targets specified
by Congress. If the Trump tax plan is signed into law, but Congress
cannot agree on how to pay for its cost of more than $6 trillion over
10 years, your budget process would automatically cut Social Security
by $1.7 trillion and Medicare by $1.1 trillion over 10 years. This
would cut the average Social Security benefit by $168 per month.
President Trump has pledged not to cut Social Security, Medicare, and
Medicaid; but your budget process seems to provide a way to cut these
programs without President Trump having to sign any specific cuts into
law.
If Congress passed your budget changes today, would you recommend
he veto that legislation?
Answer. Should the budget pass, I will carefully review the
legislation and communicate the health-care implications of that budget
to the President.
Question. The sequester, under current law, shields vulnerable
populations from across the board cuts. Why do you believe the
sequester should be expanded to programs that serve the most vulnerable
Americans?
Answer. It is my belief that the Federal Government needs to
strengthen mandatory programs if we are going to ensure future
generations have access to the programs.
children's health coverage
Question. Congressman Price, you once remarked that low-income
children already have access to all the health care they need. You've
publicly said that you, ``know of no study that shows these individuals
have no access,'' and that uninsured children are already treated by
doctors and hospitals even though they often do not pay for the care
they receive.
Do you still believe that all children had adequate access to
health care before the ACA?
Answer. Though programs like CHIP have made substantial progress in
the availability of health-care coverage to children, there has always
been more work to do in this regard. I should add that what is most
important in this regard is not just that children have coverage but
also actual access to care that is affordable and available to them.
Question. Do you agree that maintaining these coverage gains and
not taking a step back on children's health is vitally important?
Answer. With regards to health care for children, our goal is to
make certain that every single American has access to the coverage they
want for themselves and their children and ensures the individuals and
children who lost coverage under the Affordable Care Act get or
maintain coverage.
Question. Congressman Price, according to independent reports,
repeal of the ACA would mean over 4 million children would become
uninsured. As advisor to the President, will you advise the President
to veto any bill if the result is fewer children have coverage?
Answer. Deciding whether to sign any particular law, particularly
one that involves as many different moving parts as one to replace the
Affordable Care Act, inevitably involves considering many competing,
complementary, or countervailing issues. I look forward to working with
the Congress to ensure that fewer children having coverage is not one
of those tradeoffs, but rather that every single American has access to
the coverage they want for themselves and their children and ensures
the individuals and children who lost coverage under the Affordable
Care Act get or maintain coverage.
children's health insurance program (chip)
Question. Today, the bipartisan Children's Health Insurance Program
provides 8 million children with access to comprehensive, affordable
health care including thousands of children in Oregon's Healthy Kids
program. Yet you've publicly referred to CHIP as ``government-run
socialized medicine'' and put forth proposals that would have denied
families with access to more affordable care for their children through
this successful bipartisan health program.
Congressman Price, in your role as a cabinet Secretary, would you
advise the President to support an extension of the Children's Health
Insurance Program?
Answer. It is important that every child has access to high-quality
health coverage, and CHIP plays an important role in accomplishing this
objective.
Question. Will you commit to ensuring that not a single child under
Oregon's Healthy Kids program gets left behind under any CHIP
extension?
Answer. If confirmed as Secretary, my goal would be to ensure that
no child in Oregon or anywhere else is left behind. CHIP plays a major
role in this, but there is also a need for coordinated family coverage
in the private market and employer plans, and giving States the needed
flexibility to accomplish this.
Question. As a cabinet-level advisor to the President, will you
advise the President to veto any bill that results in coverage being
stripped away from a single child in Oregon benefiting from our Healthy
Kids program?
Answer. Deciding whether to sign any particular law inevitably
involves considering many competing, complementary, or countervailing
issues. I look forward to working with the Congress to ensure that
fewer children having coverage is not one of those tradeoffs, but
rather that every single child in Oregon and America has access to
high-quality care. That means not just having a card, but being able to
access the care it covers.
cost sharing in medicaid
Question. Your 2017 budget used the Healthy Indiana Plan as an
example of an innovative State program that is reducing State Medicaid
costs. However, the Healthy Indiana Plan has not worked as intended in
some important ways and has created access barriers for some. In fact,
studies show that the required premiums for many low-income people
depress participation and make it harder for people to access the
coverage they need. According to an independent evaluation of the
program, thousands of individuals in the program were penalized or
kicked off and locked out of coverage under the complicated structure.
If these types of complicated structures used in a State's Medicaid
program is shown to keep eligible people from getting the health care
they need, will you disallow it as not meeting the objectives of the
Medicaid statute?
Answer. The Healthy Indiana Plan has long been and continues to be
a national model for State-led Medicaid reforms pertaining to the low-
income, able-bodied adult population. It is important that Medicaid's
design helps its members to transition successfully from the program
into commercial health insurance plans, as HIP's
consumer-driven approach and underlying incentive structures encourage.
HIP members are more engaged with their providers, less reliant on the
emergency room, and more satisfied with their coverage than traditional
Medicaid members. HIP is achieving Indiana's objective to increase
access to consumer-driven coverage as well as the broader objectives of
the Medicaid program, and I support the use of HIP's reforms in future
1115 demonstration requests by other States.
delivery system reform
Question. Congressman Price, you have been an outspoken critic of
the delivery system reforms included in the Affordable Care Act (ACA),
particularly the Center for Medicare and Medicaid Innovation (CMMI) and
the movement away from traditional fee-for-service payments for
providers and toward value-based payment models such as bundled
payments.
Do you agree that the traditional fee-for-service payment system--
in which providers are paid based on volume instead of value--creates
incentives for overutilization of health-care services?
Answer. Our health-care system is complex, and we cannot attribute
overutilization trends to a single cause. For instance, efforts to curb
overutilization in emergency rooms have been unsuccessful.
Overutilization is a complex issue that needs to be carefully
addressed.
Question. Do you also agree that the successful implementation of
the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA)
will require the continued development of value-based payment models?
Answer. The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) is built on the principle of encouraging providers to develop
Alternative Payment Models (APMs) that can ultimately be adopted by CMS
and commercial payers.
Question. Will you commit to supporting the continued development
of value-based payment models in Medicare and increasing the percentage
of provider payments made through those models?
Answer. We share the goal of improving Medicare by empowering
providers to be creative and develop payment models that best suit the
unique needs of their patients to ultimately improve patient care.
medicare-medicaid coordination office
Question. ``Dual eligibles'' receive benefits under the Medicare
and Medicaid programs. Full benefit dual eligibles suffer from serious
health care needs including debilitating physical and mental
disabilities, often requiring complicated and expensive long-term
services and supports. The ACA created the Medicare-Medicaid
Coordination Office, also called the Medicare-Medicaid Coordination
Office, to coordinate and address the needs of dual eligibles. The
office has led Federal efforts to improve how programs are delivered to
this high need, high cost population.
Will the administration continue to support the Medicare-Medicaid
Coordination Office?
Answer. If confirmed as Secretary, and if legislation regarding
this Office changes, I will work with the CMS Administrator to consider
how best to deploy the tremendous resources of CMS against the enormous
challenge of ensuring access to the highest quality care for dual
beneficiaries. In the meantime, I will implement the law as passed by
Congress.
Question. Does the administration plan to continue the financial
alignment demonstration currently underway in several States?
Answer. Commenting on specific potential models is premature at
this point. These models go through a lengthy development and modeling
process, as well as internal review and approval at CMMI and OMB. If
confirmed, as HHS Secretary, I plan to work closely with CMS to ensure
that CMMI--after appropriate consultation with Congress, the States,
health-care stakeholders, and Innovation Center staff--tests innovative
models that reduce costs and improve quality for Medicare and Medicaid
beneficiaries.
federal data collection
Question. The Department of Health and Human Services (HHS)
collected valuable data related to the Affordable Care Act (ACA). This
includes rate filings, enrollment data, and analytical reports on the
efficacy of the law in different sectors of the health system.
Additionally, the ACA invested in the implementation of a new health
data collection and analysis strategy. Section 4302 of the Affordable
Care Act contains provisions requiring all national Federal data
collection efforts collect information on race, ethnicity, sex, primary
language and disability status. The law also provides HHS the
opportunity to collect additional demographic data to further improve
our understanding of health-care disparities.
Will health-care data collected by the government continue to be
publicly available to promote government transparency?
Answer. If confirmed as Secretary, I would implement the law
regarding these topics as written and passed by the Congress.
Question. Will health-care data continue to require the collection
of information on race, ethnicity, sex, primary language, and
disability status?
Answer. If confirmed as Secretary, I would implement the law
regarding these topics as written and passed by the Congress, including
with respect to the data points required to be collected.
Question. How does CMS plan to leverage this data to address health
disparities?
Answer. Any data that can inform CMS's approach to understanding
where people's needs are not being met will help us understand how best
to move towards a system where every single American has access to the
coverage they want for themselves.
ban on health agency communications
Question. News reports on January 24th indicate that Trump
administration officials have issued what amounts to a gag order
essentially muzzling external communications by employees of the
Department of Health and Human Services (HHS) and the National
Institutes of Health between now and February 3. This ban on external
communications reportedly includes correspondence with public officials
including members of Congress as well as press releases and social
media posts.
What communications are covered by the Trump administration's
restriction of external communications?
Are there any exceptions allowed for releases of information about
matters of public health or safety?
If a public health or safety matter arises between now and February
3rd, will the agencies be prevented from communicating with public
officials or the general public about these matters?
Under what circumstances would external communications be allowed?
Who within the Department is authorized to allow communications in
a public health or safety situation or otherwise? Please provide the
criteria that has been developed to determine if and when external
communications are permitted.
What impact will this restriction have on whistleblowers who are
exercising rights protected by law?
What is the reason for this action?
Is it possible the restriction will be extended beyond February
3rd? Under what circumstances could it be extended?
Does the restriction apply to Federal employees' personal use of
social media or only use of official agency accounts?
Will the restriction prevent HHS employees from responding to
outstanding questions from members of Congress including letters or
other communications awaiting answers? If so, when will such questions
be answered?
Will questions submitted by members of the Finance Committee be
answered in a timely manner and in any case before February 3rd
notwithstanding the restriction on external communications?
Answer. The Acting Secretary Memo to Department of Health and Human
Services operating and staff division heads is straightforward and
consistent with Chief of Staff Memo issued on behalf of President Trump
with regard to regulatory review of new or pending regulations and
guidance. As noted in the HHS memo, the purpose of the directive is to
ensure ``President Trump's appointees and designees have the
opportunity to review and approve any new or pending regulations or
guidance documents.'' Furthermore, the Chief of Staff memo provides
explicit exceptions for ``emergency situations or other urgent
circumstances relating to health, safety, financial, or national
security matter. . . .'' This request is standard for a new
administration. With regard to correspondence to public officials, such
as members of Congress, the memo outlines a clear and expedited process
for adequate review and is by no means intended to impede the agencies
or staff divisions from continuing their important work on behalf of
the American people, including routine constituent service
communications.
cost-sharing reductions
Question. Under the Affordable Care Act, individuals and families
with incomes between the Federal poverty level and 250 percent of the
poverty level are eligible for cost-sharing reductions (CSRs) if they
are eligible for a premium tax credit and purchase a silver plan
through the health insurance exchange. The cost-sharing reductions
reduce the deductibles, copayments, and other out-of-pocket costs for
these lower- and moderate-income Americans.
In House v. Burwell, House Republicans challenged the legality of
Federal funding of CSR subsidies. In a May 2016 ruling, U.S. District
Judge Rosemary Collyer ruled in favor of the House Republicans,
although she stayed implementation of the ruling. The previous
administration appealed the decision, but the case was stayed until
after the 2016 presidential election.
If confirmed as HHS Secretary, will you recommend that the
administration continue to reimburse insurers for the cost-sharing
reductions that reduce deductibles, copayments and other out-of-pocket
costs for lower- and moderate-income Americans?
Answer. The agency is currently involved in litigation related to
this matter, and it would be inappropriate for me to comment at this
time.
Question. If confirmed as HHS Secretary, will you recommend that
the administration protect the Federal Government's authority to make
payments for cost-sharing reductions, which was challenged in House v.
Burwell, and move forward with its appeal of the lower court's ruling?
Answer. The agency is currently involved in litigation related to
this matter, and it would be inappropriate for me to comment at this
time.
Question. If confirmed as HHS Secretary, will you recommend that
the administration seek an appropriation from Congress for the cost-
sharing reductions?
Answer. It will be up to the President and Congress to determine
the appropriate policy on this issue. My job, if confirmed, would be to
faithfully execute that law.
risk corridor payments
Question. The Affordable Care Act's temporary risk corridor program
was intended to promote accurate premiums in the early years of the
exchanges (2014 through 2016) by cushioning insurers from extreme gains
and losses. It was modeled after the Medicare Part D prescription drug
program's successful risk corridor program. The Federal Government
currently owes insurers approximately $8.3 billion under the risk
corridor program to offset losses from 2014 and 2015. This is largely
due to a rider attached to the 2015 and 2016 appropriations bills
requiring the risk corridor program to be revenue neutral, meaning that
the Centers for Medicare and Medicaid Services (CMS) can only pay out
funds under the program that it collected under the program.
Under the previous administration, HHS and CMS acknowledged that
risk corridor payments are an obligation of the government and that
full payment must be made to insurers. The Department of Justice
defended the lawsuits brought by insurers for the full risk corridor
payments, but also expressed a willingness to engage in settlement
discussions.
If confirmed as HHS Secretary, will you also acknowledge that risk
corridor payments are an obligation of the government and that full
payment must be made to insurers?
Answer. The agency is currently involved in litigation related to
this matter, and it would be inappropriate for me to comment at this
time.
Question. If confirmed as HHS Secretary, will you recommend that
the administration engage in settlement discussions with insurers on
overdue risk corridor payments?
Answer. The agency is currently involved in litigation related to
this matter, and it would be inappropriate for me to comment at this
time.
gender rating
Question. Before the Affordable Care Act, insurance companies were
able to charge women more for their health insurance compared to men.
This practice was widespread, as 92 percent of the best-selling plans
on the individual market used gender rating in setting their premiums.
This cost women approximately $1 billion in additional costs each year
that men did not have to pay.
Do you believe that insurance companies should be required to
charge men and women the same rate for premiums?
Answer. The setting of premiums is something that has historically
been a matter of State law and regulation, so that the dynamics of that
State and its population and risk pool and consumer behavior can be
taken into account. Nevertheless, of course, if confirmed as HHS
Secretary, my role would be to implement the law as it is now written.
1332 waivers
Question. The ACA included a provision known as the State
Innovation Waiver (SIW), or 1332, that provides States the opportunity
to tailor their own health care system in a way that best aligns with
the individual State's needs. This waiver was written to give States a
chance to implement the ACA better; it was not written as a tool to
undermine the law. States may apply to use these waivers beginning
January 1, 2017.
As a reminder, a waiver must meet the following requirements:
Ensure that individuals get insurance coverage that is at
least as comprehensive as provided under the ACA.
Ensure that insurance coverage offered to individuals is at
least as affordable as it would be under the ACA.
Ensure that as many people are covered as would be under the
ACA.
Not increase the Federal deficit.
Please respond to the following questions.
What opportunities do you see for States to use the SIW? Are there
particular reforms that you think would enhance access to affordable,
quality coverage?
Answer. These waivers present an opportunity for CMS to encourage
State innovation and allow for adaptation of national requirements to
the needs of individual States. If confirmed, I would work with CMS to
enable States to utilize this--and other--authority provided by
Congress to ensure access to high-quality, affordable health insurance.
Question. How do you envision the SIW working in conjunction with
Medicaid and any corresponding Medicaid waivers? What checks would you
put in place to ensure that those individuals entitled to Medicaid
receive the full benefits and protections afforded them under title
XIX?
Answer. There is a tremendous opportunity to allow States to
innovate with respect to the intersection of their Medicaid programs
and qualified health plans and the risk pools within each. State fair
hearing processes (as well as the Medicaid waiver process and CMS
oversight) provide substantial procedural and other protections that
would address concerns regarding Medicaid beneficiaries not getting
benefits due to them.
Question. What precautions would you put in place to ensure
consumers are protected in States that choose to move forward with a
1332 waiver application?
Answer. The statute itself has protections in place relating to the
findings that must be made that would protect consumers in States that
move forward with a 1332 waiver application. Furthermore, the
democratic process in each State, where government is even closer to
the people, provides substantial protection with regards to any 1332
waiver application and its implementation. Such protection may well be
even more effective than that available to consumers vis-a-vis the
Federal Government.
Question. What steps would you take, as Secretary of HHS, to
implement this provision, as intended by congressional drafters, to
ensure it is not used to undermine the ACA?
Answer. As part of the ACA, the use of section 1332 to allow States
to innovate would not undermine the ACA. In fact, failing to
successfully use this important tool to allow States flexibility with
regards to the ACA as allowed by the law would undermine the ACA.
rural health
Question. Americans living in rural areas often have difficulty
accessing quality care due to physical and economic barriers. The
Health Resources and Services Administration estimates that 65 percent
of primary care health professional shortage areas are in rural areas.
These challenges translate into significant health disparities for
rural populations, including higher rates of chronic disease and
disability as well as lower life expectancy. Rural Americans have also
historically experienced lower rates of insurance. The Affordable Care
Act provided new access to coverage for people living in rural areas
through the Health Insurance Marketplaces and Medicaid expansions, as
well as critical consumer protections.
If confirmed how will you protect access to quality health care in
rural areas?
Answer. Too often rural health care is overlooked in the broader
discussion of national health-care issues. Significant health
disparities exist for rural populations for a variety of reasons,
including challenges with access to affordable coverage and health-care
services. Rural Americans are acutely aware of the dire need for
expanded health insurance options. If confirmed, I will work tirelessly
to address the health-care needs of all Americans, rural or urban.
pre-existing conditions and continuous coverage requirement
Question. The Affordable Care Act prohibits insurers from denying
coverage to individuals with pre-existing conditions, charging them
higher premiums, or refusing to cover benefits related to a pre-
existing conditions.
Your Empowering Patients First Act (H.R. 2300 in the 114th
Congress) repeals the Affordable Care Act in its entirety (including
the protections for those with pre-existing conditions) and instead
puts in place a ``continuous coverage requirement,'' meaning that
individuals with pre-existing conditions must maintain continuous
health insurance coverage for at least 18 months in order to qualify
for protections against discrimination by insurers. Under your
legislation, insurers would once again be allowed to exclude coverage
of a pre-existing condition for lengthy periods of time or charge much
higher premiums unless individuals had maintained continuous coverage
for at least 18 months.
According to a recent report from the HHS Office of the Assistant
Secretary for Planning and Evaluation (ASPE), up to 133 million non-
elderly Americans may have a pre-existing condition, and nearly one-
third (44 million) went uninsured for at least 1 month during the 2-
year period beginning in 2013.
If any of these individuals were to face difficult circumstances
that resulted in a temporary loss of coverage--such as losing a job or
being unable to work due to serious illness--your legislation would
allow insurers to refuse to cover services related to the pre-existing
condition or charge a much higher premium than many of these
individuals would likely be able to afford.
Do you agree that individuals with pre-existing conditions who
experience a loss of coverage--for example, due to the loss of a job or
being unable to work due to a serious illness--should not be denied
coverage for their condition or charged high, unaffordable premiums as
a result of that temporary loss of coverage?
Under the continuous coverage requirement included in your
Empowering Patients First Act, what would prevent insurers from doing
exactly that to any individual with a pre-existing condition who
experiences a temporary loss of coverage?
Answer. I believe it is important that we as a nation make sure
that every American has access to the kind of mental health care and
health coverage that best meets their need. Additionally, it is
imperative that all Americans have access to affordable coverage and
that no one is priced out of the market due to a bad diagnosis. This is
a matter for the legislative branch, however, and if confirmed, I will
work to ensure that HHS appropriately implements the statutes within
its purview.
human services programs
Question. In recent years, there has been an increasing focus on
using evidence to make policy decisions.
What is your view on this?
Answer. There is no question we must use available evidence when
making governmental decisions.
Question. What evidence would you use to decide whether policies or
program changes that you have championed are successful?
Answer. When championing policy or program changes, outcomes should
always be a top indicator when determining whether or not those changes
are successful.
Question. What evidence leads you to believe that TANF was a
success?
Answer. Since the passage of TANF, we have seen employment rates of
single mothers increase, lower poverty rates among female-headed
households with children and African-American households, a reduction
in child poverty overall, and a sharp decline in the number of families
receiving cash assistance.
Question. The annual data from HHS through the Adoption and Foster
Care Analysis Reporting Systems (AFCARS) released in fall 2016 show a
third consecutive annual increase in foster care to 427,910 children.
This represents an 8-percent increase since 2012. Your home State is no
exception. A recent AP story stated that, ``the most dramatic increase
has been in Georgia, where the foster-care population skyrocketed from
about 7,600 in September 2013 to 13,266 last month. The State is
struggling to provide enough foster homes for these children and keep
caseloads at a manageable level for child-protection workers.'' \1\ HHS
recently indicated that:
---------------------------------------------------------------------------
\1\ http://www.bigstory.ap.org/article/
12658e69b70148fc8d4743fa631fa9f9/5-states-struggle-surging-numbers-
foster-children.
A rise in parental substance use is likely a major factor
driving up the number of children in foster homes. Citing
opioid and methamphetamine use as the most debilitating and
prevalent substances used, some State officials expressed
concern that the problem of substance use is straining their
child welfare agencies.\2\
---------------------------------------------------------------------------
\2\ https://www.acf.hhs.gov/media/press/2016-number-of-children-in-
foster-care-increases-for-the-third-consecutive-year.
Clearly, substance use is having a big impact on children,
families, and child welfare systems. I am particularly concerned about
the strain the epidemic is placing on grandparents and other relatives
who often unexpectedly take on the role of caretaker for children in
foster care and at risk of entering foster care. Thankfully, there are
programs that work and can even save taxpayer dollars over the long
run. For example, research shows that when parents are able to get into
substance use treatment programs that permit them to live with their
children, two-thirds of these parents successfully complete the
program. That compares with only one-fifth of parents when their
children aren't allowed to stay in the treatment facility with them.\3\
The results achieved by these model programs have saved millions of
dollars every year in the costs of keeping kids in foster care.
---------------------------------------------------------------------------
\3\ https://www.ncbi.nlm.nih.gov/pubmed/11291901 and https://
www.ncbi.nlm.nih.gov/pubmed/11291900.
What will you do to ensure that drug treatment and services will be
both maintained and coordinated to target these families that need
treatment and whose children could end up in foster care without the
---------------------------------------------------------------------------
appropriate services?
Answer. There needs to be better coordination between Federal
departments, State governments, and local governments to ensure we are
meeting the challenges of one of the great crises of our times: the
opioid epidemic. A top agenda of all levels of government is to ensure
innocent children, including those in foster homes, are protected from
the scourge of this epidemic. As a strong proponent of the
Comprehensive Addiction and Recovery Act of 2016, I will do all I can
to effectively administer and implement this law should I be confirmed
as Secretary.
Question. How will you help grandparents and other family members
receive the supportive services they need in the event that parents
cannot safely retain custody of their children?
Answer. Should I be confirmed as HHS Secretary, I will do all
within my power, under the laws passed by Congress, to help
grandparents and other family members receive supportive services.
Question. Will you pledge to me that, if confirmed, you will work
with me to provide Federal support for effective programs, and to
ensure that the children and grandparents caught up in the opioid
epidemic get support from your Department?
Answer. I absolutely pledge to work with you to ensure support for
effective programs and to see that children and grandparents get
appropriate support from HHS to deal with the tragic opioid epidemic.
Question. As part of the Comprehensive Addiction and Recovery Act
of 2016, Congress required States to have plans of ``safe care'' for
infants born exposed to substances.\4\ This requirement, along with
numerous existing requirements, is a condition of State receipt of
grants under the Child Abuse Prevention and Treatment Act, or CAPTA.
Grants to States under CAPTA total $26 million per year. Discretionary
spending for child welfare services under CAPTA, the Adoption/Kinship
Incentives Program, the Promoting Safe and Stable Families Program and
Child Welfare Services have all faced significant reductions in
appropriations over the past 5 years.
---------------------------------------------------------------------------
\4\ http://www.cwla.org/discussion-on-plans-of-safe-care/.
What is your position on proposals that would move mandatory
funding to discretionary funding (thus limiting the committee's ability
---------------------------------------------------------------------------
to fund both child welfare and other vital services)?
Answer. This is a legislative matter. Should I be confirmed as HHS
Secretary, I will implement the laws passed by Congress.
Question. How will you ensure adequate funding for these services
that have suffered significant reductions over the recent past despite
a backdrop of increasing foster care numbers?
Answer. Should I be confirmed as HHS Secretary, I will strive to
make effective use of all dollars appropriated by Congress in order to
provide the most effective services possible.
Question. The United States is the only industrialized country
without paid maternity leave.\5\ The President has endorsed such leave
for new mothers.
---------------------------------------------------------------------------
\5\ http://www.oecd.org/els/family/
PF2_5_Trends_in_leave_entitlements_around_childbirth.
pdf.
If confirmed, how might you lead the Department to help support
this goal? Please be specific about resources and expertise that may be
available at HHS, including in such areas as benefit design,
---------------------------------------------------------------------------
eligibility determination, IT systems, and program access.
Answer. If I am so honored as to be confirmed as HHS Secretary, I
will implement the laws passed by Congress and support the President's
initiatives as they fall within HHS's authorities. I will do so in a
way that is as effective and as efficient as possible, drawing on the
expertise and experience of the fine men and women currently working at
HHS.
Question. Access to high-quality child care is fundamental to the
economic security of families and too many parents cite lack of
dependable child care as a key barrier to finding and maintaining
employment. The President's child care tax proposals would primarily
benefit high-income families through tax deductions, while providing
little or no help to low- and middle-income families.\6\ The most
significant Federal child care program for families of modest means is
the Federal Child Care and Development Block Grant (CCDBG) which
provides funds to States to help low-income families afford child care
of their choice. Yet the CCDBG serves only one out of seven children
eligible for assistance.
---------------------------------------------------------------------------
\6\ https://papers.ssrn.com/sol3/
papers.cfm?abstract_id=2842802&download=yes.
If confirmed, under your leadership how might the Department
improve access to high quality child care? Please be specific about
resources and expertise that may be available at HHS, including in such
areas as benefit design, eligibility determination, IT systems, and
---------------------------------------------------------------------------
program access.
Answer. Should I be confirmed as HHS Secretary, I will implement
the laws passed by Congress. I will do so in a way that is as effective
and as efficient as possible, utilizing the ample and exemplary
expertise available by the fine men and women currently working at HHS.
Question. As Budget Chairman, you proposed eliminating funding for
the Social Services Block Grant (SSBG), a flexible funding stream for
social services programs such as substance use disorder treatment
services, child protection, elder protection, services for the elderly
like Meals on Wheels, and other critical safety net programs. It also
helps fill in financial gaps for overburdened State foster care systems
which are facing an increased strain in light of the opioid epidemic.
In light of increased demands on State human services programs
brought on by the opioid epidemic, has your position on the SSBG
changed?
Answer. During my time in Congress, I have been acutely aware of
the need to eliminate duplicative programs and strengthen those
programs that work. However, as SSBG continues to be a program
authorized by Congress, I will do all I can to effectively administer
this law should I be so honored as to be confirmed as HHS Secretary.
Question. If not, where do you suggest States turn to make up for
the loss of these flexible SSBG dollars if funding is eliminated?
Please be specific in terms of which programs you believe would fill
the void left by SSBG.
Answer. Given the nature of our Federal system, there is not a one-
size fits all approach to how States might react should there be an
elimination of any Federal program.
Question. Can you explain what makes the flexibility in the Social
Services Block Grant inherently different and worse than either
existing or proposed block grants (such as TANF as it exists or
Medicaid as you have proposed)? I'd be especially interested in why you
consider SSBG to be a failure while you consider TANF to be a success.
Answer. As a 2011 GAO report pointed out, SSBG is a program of
fragmentation, overlap, and duplication. SSBG essentially offers a no-
strings-attached approach whereas TANF, while maintaining a great deal
of flexibility for the States, has been successful in moving recipients
off of welfare and on to work. That being said, SSBG continues to be a
program authorized by Congress, I will do all I can to effectively
administer this law should I be confirmed as HHS Secretary.
Question. One of the most significant sources of assistance on the
human services side of the Department of Health and Human Services is
Temporary Assistance for Needy Families, or TANF. During the hearing,
in your response to Senator McCaskill, you touted the success of TANF.
However, according to HHS data, between 1996--when the welfare reform
law was enacted--and 2015, the number of poor families in Georgia
receiving support through TANF dropped from 82 per 100 to just 5
families per 100 while the population of poor Georgia families
increased by over 50 percent.\7\ While Georgia is one of the most
drastic examples, this overall trend is not unique to your home State.
Nationally, TANF reached 68 percent of poor families when the 1996 law
passed. It now reaches just 23 percent of such families, despite the
fact that extreme poverty has more than doubled.\8\ Moreover, TANF has
faced effective cuts of over 30 percent since its creation in 1996 and
benefit levels have also declined.\9\
---------------------------------------------------------------------------
\7\ http://www.cbpp.org/sites/default/files/atoms/files/
tanf_trends_ga.pdf and http://www.
cbpp.org/research/family-income-support/how-states-use-funds-under-the-
tanf-block-grant.
\8\ http://www.cbpp.org/research/family-income-support/tanf-
continues-to-weaken-as-a-safety-net and http://poverty.ucdavis.edu/faq/
what-deep-poverty.
\9\ http://www.cbpp.org/research/family-income-support/tanf-cash-
benefits-have-fallen-by-more-than-20-percent-in-most-states and https:/
/fas.org/sgp/crs/misc/RL32760.pdf.
Do you believe TANF has been a success both across the Nation and
---------------------------------------------------------------------------
in your home State of Georgia?
Answer. Yes. Since the passage of TANF, we have seen employment
rates of single mothers increase, lower poverty rates among female-
headed households with children and African-American households, a
reduction in child poverty overall, and a sharp decline in the number
of families receiving cash assistance.
Question. What metrics do you use in making this determination?
Please specifically address time periods beyond 2005 in describing your
views.
Answer. I think the best way to measure the success of the law is
to see where the Nation was prior to its passage and where we are now.
As I've pointed out, since passage of TANF, we have seen employment
rates of single mothers increase, lower poverty rates among female-
headed households with children and African-American households, a
reduction in child poverty overall, and a sharp decline in the number
of families receiving cash assistance.
Question. Can you provide a commitment that Medicaid will not see
cuts like what you've proposed in your budget and what has happened to
TANF?
Answer. I will provide a commitment that if I am honored to be
confirmed as HHS Secretary, I will faithfully implement and administer
all the laws passed by Congress.
Question. President George H.W. Bush's welfare advisor and one of
the conservative architects of the 1996 law, Ron Haskins, has said,
``States did not uphold their end of the bargain,'' and argued that
TANF is not a model for other programs, asking ``So why do something
like this again?'' \10\ A recent piece published by the conservative
think-tank, American Enterprise Institute came to a similar conclusion
noting that unfortunately, ``some States have abandoned their
responsibility to provide support to poor families and help them get
jobs,''and that enough States have stopped spending money on core
services that, ``it tarnishes the entire program.'' \11\
---------------------------------------------------------------------------
\10\ http://www.cbpp.org/blog/tanfs-worsening-track-record-shows-
why-its-not-a-model.
\11\ https://www.aei.org/publication/welfare-reform-progress-
states-step-up/.
However, you resisted recent Republican-authored legislation that
aimed to ensure States met even the most basic TANF spending
obligations.\12\ You insisted on changes that essentially would
grandfather in practices that let Georgia and other States continue to,
to use the AEI publication's words, ``abandon their responsibility to
provide support to poor families and help get them jobs.''
---------------------------------------------------------------------------
\12\ https://waysandmeans.house.gov/event/39841647/ and http://
mlwiseman.com/wp-content/uploads/2016/05/Profiles-in-
Courage.052216.pdf.
If confirmed, will you continue to oppose efforts to ensure States
hold up their end of the bargain with respect to investing their own
---------------------------------------------------------------------------
dollars into the TANF program?
Answer. States should contribute their part in State-Federal human
services programs, even if we don't always agree on the method for
getting there. I have an open mind and welcome proposals to improve
State-Federal human services programs to achieve the goal to reduce
low-income families' dependence on government aid through high levels
of paid work, especially those that are well supported by evidence. We
have a duty to the American taxpayers, and the people these programs
were created to help, to find workable solutions to problems within
these programs. If I am privileged to serve as the HHS Secretary, I
will follow the policies adopted by the Congress and signed into law by
the President that reform State-Federal human services programs.
Question. Specifically, will you advise the President to oppose
legislation, like H.R. 2959 as introduced in the 114th Congress, that
would phase out the practice of States being able to count third party
spending towards their TANF maintenance of effort requirements? \13\
---------------------------------------------------------------------------
\13\ https://www.gpo.gov/fdsys/pkg/BILLS-114hr2959ih/pdf/BILLS-
114hr2959ih.pdf.
Answer. The ultimate objective of human services programs is to
help people stand on their own again after they have fallen down.
Certain interpretations cut against this objective by keeping people
down even when they want to stand up. I have a broad and open mind and
welcome proposals to improve programs like TANF that would help people
stand on their own again, especially those that are well-supported by
evidence. If I am privileged to serve as the HHS Secretary, I will
follow the policies adopted by the Congress and signed into law by the
---------------------------------------------------------------------------
President.
Question. In your testimony and meetings with committee staff, you
stressed the need to establish better measures by which to evaluate the
effectiveness of Federal human services programs. As you know, timely,
accurate and relevant evaluations rely on: modern, efficient and
integrated State and Federal data systems; effective data use
agreements; and transparent and strong privacy and data security
measures. Moreover, system modernization cannot only improve client
services but reduce waste, fraud, and abuse. However, much of the
funding currently being used to modernize and integrate systems comes
through ACA and the OMB A-87 waiver.
Will you commit to working, if confirmed, with Congress and the
administration to sustain the current efforts to improve State and
Federal health and human services data systems?
Answer. Good data is an essential element for ensuring that we have
accurate information and are able to effectively manage the programs
under our charge. While funding decisions ultimately rest with
Congress, if I am privileged to serve as the HHS Secretary, I will
follow the policies adopted by the Congress and signed into law by the
President to modernize State and Federal human services data systems.
Question. The Maternal, Infant, and Early Childhood Visitation
program (MIECHV) is a program that members on both sides of the aisle
have championed due to the demonstrated success of its models in
improving the health and well-being mothers and children. MIECHV's
innovative model has well-established goals, outcomes and metrics.
MIECHV is due for reauthorization this year. At current funding
levels ($400M/year), the Department of Health and Human Services (HHS)
estimates that only 3% of the eligible population receives MIECHV
services. To me, reauthorization represents an opportunity to increase
access to the program and improve the life course of children born into
low-income households, while also reducing preventable government
spending in the short and long term.
In your home State of Georgia, the Great Start Georgia program
receives MIECHV funds. The program's aim is to provide evidence-based
home visiting services to those families who are most in need of
support and has met all 6 program benchmarks, including maternal and
newborn health, family economic self-sufficiency, improving at-risk
students' school readiness, and reducing crime and domestic violence.
If confirmed, how do you plan on continuing the successful MIECHV
program?
Answer. I share your goal of increasing access to affordable,
quality health coverage. While I cannot comment specifically on
legislation that would reauthorize MIECHV, I look forward to working
with you on examining this program's funding and working on ways to
improve rural and child health using evidence-based approaches.
______
Questions Submitted by Hon. Bill Nelson
Question. Your health proposal would remove protections for
individuals with pre-existing conditions, allowing insurers to charge
them higher premiums or denying them coverage altogether, unless an
individual has maintained coverage for 18 months. Your bill would
expand high-risk pools as an option to individuals with pre-existing
conditions. In Florida, more than 7.8 million people have pre-existing
conditions.
Please explain how you believe high-risk pools will provide quality
coverage to the 7.8 million people in my State who have pre-existing
conditions.
Answer. Pooling mechanisms that allow individuals to come together
for the purchase of coverage, like the traditional Blue Cross Blue
Shield Plan, have been successful in bringing down the cost of
insurance for Americans. I believe this same concept could be
successful in pooling the risk among those Americans with pre-
existing conditions.
Question. Have high-risk pools been successful in providing
adequate and affordable coverage in populous, high-costs States like
New York or Florida?
Answer. If confirmed, I look forward to working with you to
implement commonsense solutions that prioritize flexibility for States
like New York and Florida to design and operate their own high-risk
pools or other risk-mitigation programs that suit their citizens'
unique needs.
Question. You introduced the 2015 reconciliation bill, which would
have repealed key parts of the Affordable Care Act, had it not been
vetoed. The nonpartisan Congressional Budget Office released a report
on the effects of your bill, including increased numbers of uninsured
Americans and increased premiums.
Last week, President Trump said the Republican replacement plan is
``coming down to the final strokes.'' He said that as soon as the HHS
Secretary is confirmed, a repeal and replace plan will be submitted,
``essentially simultaneously.''
Is there a nearly fully formed replacement plan?
If yes, what's in the replacement plan?
Does it provide insurance coverage for everyone as President Trump
said?
Does it protect individuals with pre-existing conditions from
paying higher premiums or being denied coverage altogether?
Does it allow children to stay on their parents' insurance until
age 26?
Does it ensure that individuals struggling with substance use
disorders or diagnosed with behavioral health conditions have adequate
access to quality treatment?
Answer. Plans for real health-care reform are a work in progress,
but the President and I share the same goal: to provide relief to all
Americans from Obamacare. Obamacare has raised premiums and
deductibles, narrowed doctor networks, reduced choices of plans,
limited Americans' liberty, and undermined the doctor patient
relationship. The goal is to make certain that every single American
has access to the coverage they want for themselves.
Question. What will you do to provide coverage to the more than
800,000 Floridians that could have been covered by Medicaid expansion?
Answer. I look forward to faithfully executing whatever law that
Congress passes and the President signs, if I am confirmed. I will
promise you this: Regardless of the final legislative outcome, I would
work as HHS Secretary to ensure that the Medicaid program is well
administered, effective, and available for eligible beneficiaries and
that the States/Governors are given the flexibility to pursue
innovative approaches that fit the needs of their States.
Question. Can you explain how, under a Medicaid block grant
program, States like Florida would cover the unforeseen costs
associated with public health crises, like Zika virus, or high cost
prescription drugs, or unexpected sudden changes in demographics
without harming another population?
Answer. My work in the Congress has been focused on how to improve
Medicaid and provide additional flexibility. If I have the privilege of
being confirmed as Secretary, I would look forward to the opportunity
to work with States and Congress using the tools and authorities given
by Congress in legislation. The mechanics of any new Medicaid program
along the lines described would be a legislative decision that would
need to account for how to encourage States to save for such
eventualities or how the Federal and State governments do so together.
Question. Florida is currently in the process of renegotiating its
section 1115 Medicaid managed care waiver.
What safeguards and beneficiary protections do you believe HHS
should keep in place when reviewing Medicaid waivers?
Answer. The 1115 waivers are an important tool for States to
innovate within the Medicaid program, as they have for many years prior
to the ACA becoming law. The statute itself has requirements for
certain procedures. Furthermore, the democratic process in each State,
where government is even closer to the people, provides substantial
protection with regards to any 1115 waiver application and its
implementation.
Question. You introduced a bill to allow practitioners to enter
into private contracts with their Medicare patients and charge higher
fees than what is currently allowed under the Medicare program.
Currently, when seniors in Medicare see their doctors, they are
responsible for a set amount of costs and don't encounter any surprise
bills. Under current law, physicians who choose to participate in
Medicare are not allowed to bill their patients for any costs that
remain once Medicare pays their share of the bill, a practice that is
commonly known as balance billing.
Did you know that half of all Medicare beneficiaries had incomes of
less than about $24,000 and savings below $63,350 in 2014? Is this the
population that your bill targets?
Answer. The Medicare Patient Empowerment Act is one approach to
giving our seniors more flexibility within the Medicare Program and
providing the opportunity to make decisions with their physicians
without interference from Washington. The measure would help ensure
that Medicare beneficiaries maintain adequate access to health-care
professionals by increasing the number of physicians who will accept
Medicare patients and addressing physician shortages by attracting new
professionals to the field of medicine. In addition, the bill provides
safeguards to Medicare beneficiaries. More importantly, my legislation
would allow a provider to see a Medicare patient pro-bono or charge
minimal cost (below the standard fee schedule) without prosecution.
Without this legislation, a physician can be charged with fraud for
failure to attempt to collect the full coinsurance amount under
Medicare.
Question. The Medicare Advantage program provides quality care to
over 1.6 million Floridians and over 18 million seniors across the
United States.
Do you have any ideas about how to strengthen and build upon this
vital and proven part of the Medicare program? In your role as
Secretary of HHS, will you commit to supporting Medicare Advantage and
protecting the Nation's seniors as they age?
Answer. Medicare Advantage provides an important option for
Medicare beneficiaries to access coordinated care and greater benefits.
If confirmed as Secretary, I would seek to ensure Medicare Advantage
remains a stable option for beneficiaries and that Medicare Advantage
plans are afforded the flexibility to design plans that beneficiaries
want and give them the coverage they want.
Question. Today, I joined a bipartisan group of Senators in
reintroducing the Public Health Emergency Response and Accountability
Act, which would fund the nearly empty Public Health Emergency Fund
through mandatory appropriations designated as emergency spending, a
proposal modeled after FEMA's disaster relief fund.
As HHS Secretary, would you work with me to protect my constituents
from the Zika virus and other public health emergencies? Do you support
the creation of an emergency health fund to provide mandatory
appropriations to fight Zika and other infectious diseases?
Answer. If confirmed as HHS Secretary, I give you my word I will do
all within my power to protect your constituents, and the constituents
of every Senator, from the Zika virus and other public health
emergencies. Should Congress create a new program or alter an existing
program, I will work to ensure the program is as effective as it can be
in fighting Zika and other infectious diseases.
Question. The increased use of generic drugs results in real
savings due to their lower costs as compared to brand name drugs.
Senator Collins and I asked GAO to examine the factors behind recent
spikes in some generic drugs. GAO found that Part D generic drug prices
declined overall since 2010--they fell about 59 percent. Additionally,
GAO found that 300 of the more than 1,400 established generic drugs
analyzed had at least one price increase of 100 percent or more between
2010 and 2015.
What do you believe should be done to keep generic drugs
affordable?
Answer. I appreciate that generic drugs play an important role in
meeting many American's health-care needs. If confirmed, I look forward
to focusing on how we can make health care more affordable, including
prescription drugs, and build on policies that have helped to empower
patients in meeting their health-care needs.
Question. Amyotrophic lateral sclerosis (ALS) usually strikes
people between the ages of 40 and 70, and for unknown reasons, military
veterans are approximately twice as likely to be diagnosed with ALS.
There is currently one FDA approved drug that modestly slows the
progression of ALS in some people. While there is no cure or treatment
that that halts or reverses ALS, scientists have made significant
progress in learning more about this disease.
The Centers for Disease Control and Prevention operate a National
ALS Registry, which is a critical resource for (1) providing data to
researchers focused on developing treatments and prevention strategies;
and (2) matching patients to potential clinical trials.
Please advise how the administration will support this work in
fiscal year 2018 and work with Congress to make the registry even more
effective at confronting ALS.
Answer. ALS is a devastating disease with far-reaching consequences
for both those afflicted and their families, and as a physician I
understand the hardships these individuals must endure. If confirmed, I
plan to work to advance patient-
focused health care, which will support efforts to better serve those
suffering from ALS.
Question. The ACA reauthorized the Minority Centers of Excellence
(COE) program, housed within the Department of Health and Human
Services. The Florida Agricultural and Mechanical University (FAMU)
Pharmacy, located in Florida, is a grantee. COE supports curriculum-
based initiatives for increasing minority and underrepresented
individuals to become health professionals.
Do you support preserving important programs like COE, Health
Careers Opportunities Program, and Area Health Education Centers?
Answer. As a physician, I understand the critical importance of
diversity among health-care practitioners in order to meet the varied
health-care needs of the American people. If confirmed, I look forward
to working with you and others to ensure that we are supporting efforts
to increase diversity within our Nation's health-care workforce as part
of advancing patient-focused health care.
Question. CT colonography (CTC), also known as virtual colonoscopy,
are diagnostic medical tests, which produce detailed images of the
colon by using a combination of 2-dimensional x-rays and a 3-
dimensional computer views. They have the ability to identify lesions
and tumors on the kidneys and other organs and blockages in the
coronary arteries.
Currently, Tricare and private payers in 21 States and the District
of Columbia cover virtual colonoscopies for colorectal cancer
screening, but Medicare does not.
Will you use your authority as Secretary to consider the addition
of virtual colonoscopies as a colon cancer screening option for
Medicare beneficiaries?
Answer. As you know, CMS has a detailed process for making
determinations regarding whether items and services are reasonable and
necessary, if they can be considered eligible for Medicare coverage
given other restrictions and prohibitions. I understand CMS's decision
to cover CT colonography only for diagnostic testing but not screening
was based on the state of the technology at the time and the possible
need for a confirmation colonoscopy in so many cases. If confirmed as
Secretary, I would look forward to working with you to understand if
revisiting this issue is appropriate and warranted.
Question. On July 16, 2015, Proposed/Draft Local Coverage
Determination for Lower Limb Prostheses (DL33787) (Draft LCD) was
published by the four Durable Medical Equipment Medicare Administrators
(``DME MACS''). Last year, the Coverage and Analysis Group, headed by
CMS, was created to review the DME MAC recommendations. That Group
continues to deliberate.
Can you speak to what actions as an administrator you would take on
finalizing this Draft LCD?
Answer. Medicare coverage for prostheses can be a particularly
challenging topic given the role this durable medical equipment plays
in the lives of many Medicare beneficiaries. I understand CMS has
stated it is committed to providing high quality care to Medicare
beneficiaries in need of a prosthesis, that it has committed to a
Workgroup the task of making recommendations concerning the best and
most relevant measures in this realm, and that CMS will ensure there is
opportunity for public comment and engagement. If confirmed as
Secretary, I would be pleased to work with you to look into the timing
of this matter and see what can be done to either expedite it or
further support the work so there is assurance of its comprehensiveness
and objectivity.
Question. Representative Price, I know you are very familiar with
the Centers for Medicare and Medicaid Service's (CMS) Home Health pilot
program known as the ``Pre-Claim Review Demonstration (PCRD)'' which
affects five States, including Florida. I am concerned that the PCRD
may restrict beneficiary access to timely services, divert clinical
resources to paperwork management, and incur high administrative costs.
These concerns were amplified after hearing what the State of Illinois
had been dealing with when PCRD began there in August 2016.
In response to my concerns, CMS delayed PCRD in Florida until April
2017. While I understand the concern, CMS has with needing to tackle
the improper payment rates, PCRD may not get to the root of the
problem.
As Secretary, how do you plan to tackle the problem of improper
payments? Do I have your commitment that you will work with me to
alleviate the concerns raised by the PCRD?
Answer. The topic of improper payments is one of concern in the
Medicare program--both overpayments and in some cases underpayments.
Tackling them requires close support for the payment integrity team
within CMS and close cooperation with the Office of the Inspector
General and the Department of Justice. But it also involves a
definition of scope and a prioritization--which improper payments are
ones that reflect services not rendered and which involve a missing
signature on a form. With that prioritization in mind, I am hopeful we
can align resources to those areas of highest risk.
As to the Pre-Claim Review Demonstration (PCRD), if confirmed, I
would be pleased to work with you to address your concerns. For
example, we may want to explore the experience of the Prior
Authorization of Repetitive Scheduled Non-
Emergent Ambulance Transport demonstration to understand if there are
applicable lessons for PCRD or vice-verse.
Question. During the public comment period for the FDA's tobacco
deeming rule, the Small Business Administration's Office of Advocacy
filed concerns that the economic impact analysis conducted by FDA was
``deficient'' and should be recalculated. Small business premium cigar
retailers and manufacturers in my State have expressed the same concern
to me. Unfortunately, FDA took no action to address these concerns.
Do you believe additional review of the costs of this regulation
should be conducted before any additional implementation?
Answer. Whenever the Federal Government implements its regulatory
responsibilities, it is important to consider the costs, especially
those imposed on small businesses. Any time economic impact analyses
are conducted, I believe they must be fact-based. If I am confirmed, I
would seek to better understand the SBA's views of the regulation in
question, which is consistent with the President's commitment to reduce
the overall regulatory burden on American businesses.
______
Questions Submitted by Hon. Thomas R. Carper
Question. The number one concern I hear from my constituents about
health care is affordability. I was pleased to hear the President say
that under his plan, health insurance will be better and less expensive
for all Americans. Americans cannot afford to pay more for their health
care. Even supporters of the President value the health benefits they
have gained through the Affordable Care Act and could not bear the
higher deductibles and decreased benefits that your earlier plans have
called for.
Can you ensure that under the President's health-care plans, health
insurance premiums, deductibles, and co-pays will decrease for all
Americans? How exactly will you do this?
Answer. President Trump and I have the same goals for health-care
reform and the same general approach to meeting those goals. Neither
one of us is wedded to a particular plan to the exclusion of all
others. We see eye-to-eye on this, and are looking forward to giving
the American people what they've been longing for, for 7 long years:
real health-care reform. But they have never wanted Obamacare: It has
raised premiums and deductibles, narrowed doctor networks, reduced
choices of plans, limited Americans' liberty, and undermined the doctor
patient relationship.
Question. The Congressional Budget Office (CBO) has found that
repealing the ACA will cause more than 30 million Americans to lose
their insurance and increase premiums by more than 20 percent.
Do you agree that the President's executive order to begin
repealing the Affordable Care Act while there is no alternative plan
creates instability and uncertainty that will only drive up costs in
our health-care system?
Answer. The insurers are deciding right now as they come forward in
March and April what the premium levels will be for 2018. What they
need to hear from us is a level of support and stability in the market,
the kinds of things that are able to provide stability. There are
counties in the State where there is only on provider. We must, as
policymakers, ask what is going on. Where are the problems out there?
The President's Executive order is directed towards exactly that--
reducing costs and the other burdens on the American people imposed by
Obamacare. The initial reactions to the order from plans and others
indicate this is something they anticipated based on the President's
promises and that the recent and current discussions regarding how to
address the issue of costs have been productive. In fact, it is the
costs of inaction which are not acceptable.
Question. Do you believe that all Americans, regardless of income,
should have health insurance and does the President share your views on
this? Have you told the President that repealing the ACA without a
replacement means 32 million Americans will lose their health insurance
and add $9 trillion to our national debt? Have you had direct
discussions with members of the Transition Team or the President's
current health-care advisers since your nomination? Would you insist
that Congress hold multiple bipartisan hearings on the President's
health care proposal? Will you commit to, should you be confirmed, to
answer our questions when such a proposal is sent to Congress and
evaluated by the non-partisan, independent Congressional Budget Office?
Answer. I think the conversation and focus in these topics has been
the question of coverage rather than true access for too long. By that
I mean that Americans might have an insurance card and yet not be able
to afford care or it might not be available to them for other reasons.
And so when we talk about coverage we ought to make clear what we
really mean and want to have happen. In any case, the President has
made clear his hope and plan for a replacement to Obamacare. The goal
is to make certain that every single American has access to the
coverage they want for themselves.
Question. Sixty percent of the children born outside of marriage
are from unplanned pregnancies. This is a major public health
challenge, as children born from unintended pregnancies and raised in
single parent households have a higher rate of mental health problems,
a lower rate of high school graduation, earn less income than their
peers, and cost more to taxpayers. Because of the Affordable Care Act,
millions of American women can now afford contraception, without co-pay
or cost-sharing, and the rate of unplanned pregnancies has dropped.
Will the President's plan to replace the ACA ensure these women
will not have to pay more for contraception and put birth control out
of reach for millions of young women and families?
Answer. Women should have the health care that they need and want.
The system we ought to have in place is one that equips women and men
to obtain the health care that they need at an affordable price.
Question. Health-care experts have found that obesity, smoking, and
mental health challenges are the ``root causes'' of our country's most
persistent public health challenges. Together, tobacco, obesity, and
mental health lead to more than a million deaths and cost us more than
half a trillion dollars each year. It's critical that all health
insurance plans fully cover the treatment for these conditions. If the
ACA is repealed, Americans would lose access to treatment for mental
health care, smoking cessation, and obesity treatment.
Under the bills and proposals you have championed, would the
treatment and cost of insurance coverage for obesity, smoking
cessation, and mental health care remain the same or decrease?
Answer. It has been the goal, for any legislation I have
championed, for the treatment and cost of insurance coverage for all
Americans to decrease.
Question. The obesity epidemic has had a devastating impact on our
health-care system, increasing the prevalence of nearly every major
chronic condition, including heart disease, hypertension, diabetes, and
cancer, and costing our country hundreds of billions of dollars every
year to treat the variety of conditions attributable to this
increasingly prevalent disease. A critical step in combating obesity
was the decision by the AMA in 2013 to designate obesity as a disease.
This designation is an important step towards ensuring the best medical
care is provided to those suffering from this disease.
Will you, as Secretary of Health and Human Services, follow the
leading medical association and declare obesity as a disease and will
you assist us in maximizing the use of all the medical interventions
currently available to combat this crisis?
Answer. Obesity is a chronic condition that takes its toll over
many years and in many quiet ways. I agree it is an important priority
for all involved in the health-care system to address this toll. This
is particularly the case because obesity is generally a preventable
condition and can be controlled through changes in behavior.
Fundamental to that is the relationship between patient and doctor
which our current system has undermined in many ways. I can tell you
that I will consider the legal framework within which any decision
regarding the formal designation of any disease ought to take place and
come to any decision with these considerations in mind.
Question. Have you ever been a member of the Association of
American Physicians and Surgeons? This group has said that the
government poses a greater threat to patients than tobacco use, drug
addiction, and excessive alcohol intake, and that patients should seek
doctors who do not participate with Medicare, Medicaid, and private
health insurers. When you were a member of this group, did you agree
with this position? Do you agree with this position now? This group has
also compared the use of advance directives--the process by which
patients and their health-care providers plan for end of life care
decisions in advance and when they are of sound mind and body--as
``population control.'' Do you agree with this comparison?
Answer. My work has been focused on making sure that physicians and
patients are ones making medical decisions, rather than the government.
Once that relationship is undermined and patients do not trust their
doctors or doctors do not think first about their patients then no
other medical or public health goal can be achieved. This is important
when it comes to chronic disease, preventive care and healthy choices,
and life and death decision-making. For all these reasons, I have
fought alongside many to ensure patients have these choices to make for
themselves and with their doctors.
Question. As you know, the Affordable Care Act prohibits health
insurance companies from limiting coverage to individuals on the basis
of sexual orientation and gender identity. But a number of your
previous statements regarding lesbian, gay, bisexual, and transgender
people indicate that you don't support these consumer protections.
As HHS Secretary would you support reversing these protections and
jeopardizing the LGBT population's access to health care? As Secretary
of Health and Human Services, would you uphold the department's efforts
to ensure that health insurance companies do not deny or limit health-
care coverage to LGBT people?
Answer. If confirmed, my efforts and work as Secretary will be to
seek the availability of the highest quality care for all Americans.
The goal is to make certain that every single American has access to
the coverage they want for themselves. Of course, consumer protections
at Federal and State levels ought to be available to all consumers, not
just certain ones who meet certain criteria.
Question. Data has shown repeatedly that Federal resources devoted
to fighting health-care fraud is well worth the investment. The Health
and Human Services Department has found that for every dollar that is
invested to fight fraud, the government recovers $5. On January 23,
2017, the President announced a hiring freeze on government workers,
which would include a freeze on hiring investigators and attorneys
devoted to protecting Medicare and Medicaid from criminals. The GAO has
repeatedly listed Medicare and Medicaid as two of the Federal
Government programs most vulnerable to fraud, waste, and improper
payments. Unfortunately, this freeze only leaves Medicare and Medicaid
more vulnerable to fraud.
Do you agree with these concerns and if confirmed, will you
recommend to the President that the hiring freeze should be lifted for
Federal workers fighting criminal activity, waste, and fraud in
Medicare and Medicaid?
Answer. The President's memorandum is not for time immemorial. It
provides that within 90 days of its issuance, the Director of OMB, in
consultation with the Director of OPM, shall recommend a long-term plan
to reduce the size of the Federal Government's workforce through
attrition and that the ``freeze'' will expire upon implementation of
the OMB plan. If confirmed as Secretary, I will take into account in
weighing in with OMB and OPM the clearly important role our fraud
fighters play which you outline.
Question. During your time in Congress, you have supported
proposals that would block grant Medicaid or put a per capita cap on
Medicaid spending. The Congressional Budget Office has found that
reversing the Medicaid expansion under the Affordable Care Act would
lead to the loss of health care for millions of Americans and would
lead to State funding shortfalls of $1 to $2 trillion.
Do you support proposals to block grant or cap Medicaid? Do you
agree that block granting or capping Medicaid would save the Federal
Government as much as $1 to $2 trillion?
Answer. Every State has different demographic, budgetary, and
policy concerns that shape their approach to Medicaid. That is one of
the reasons I devoted so much time to working with States to help them
to identify creative solutions, and why I believe a one-size-fits-all
approach is not workable for a country as diverse as the United States.
Of course, the specifics of any particular proposal to provide more
flexibility to States will determine its budgetary consequence.
Question. The American Association of Actuaries has pointed to risk
corridors and other risk mitigation programs as important mechanisms
for stabilizing our insurance markets. These programs were also
included in the Medicare Part D program and remain in place today.
Please just give us a yes or no answer to the following questions.
Do you support the use of these programs in Medicare Part D? Did
you support these programs as a part of the State insurance
marketplaces created by the Affordable Care Act? Do you think these
types of programs should be included in any plan to improve on the ACA
or to replace the ACA?
Answer. Risk adjustment is used to adjust payments to health plans
based on the relative risk of plan participants. Reinsurance has been
used to reimburse insurers for the cost of individuals who have
unusually high claims. And risk corridors are used to mitigate the
pricing risk that insurers face when they lack data on health spending
for potential enrollees. Part D has successfully deployed these
mechanisms consistent with the underlying direction of Congress. The
issue with any of these programs is often in the way they are
implemented and the direction Congress gives with respect to them. In
any current or future legislation, it would be important to consider
these issues closely.
Question. You have expressed concerns with delivery system reforms
and in particular, bundled payments.
Please talk about your recommendations for how we can move away
from fee for service reimbursement to a health care payment system that
rewards better health outcomes and reduced costs.
Answer. For certain populations, bundled payments make a lot of
sense. And they can often lead to both better health outcomes and
reduced costs. But it is important we not get fixated on one of those
two outcomes. That is, I support making certain that we deliver care in
a cost-effective manner but we absolutely must not do things that harm
the quality of care being provided to patients. What we ought to do is
allow for all sorts of innovation. Not just in this area. There are
things that haven't been thought up yet that would actually improve
health-care delivery in our country and we ought to be incentivizing
that kind of innovation. And in finding our way to those innovations,
we ought to remember we are not talking about science experiments in a
lab or a computer simulation, but about experiments involving real
patients' lives.
Question. During your time in Congress, how have you worked to
strengthen and improve community health centers in your district and in
the country? Do you think we should increase the presence of community
health centers to increase Americans' access to health care?
Answer. Community health centers are a vital part of our medical
infrastructure. They fill a void in so many States and are often times
the entry point if not the main source of health care. I have sought to
support them to make sure they can provide the highest quality care and
will continue to do so if confirmed.
Question. I have always felt that we can't manage what we can't
measure. You point to having good metrics as an important tool for
ensuring we've made good progress. I agree with you wholeheartedly.
With your wealth of experience as a physician, a State legislator,
a Congressman, and the chairman of a major House committee writing
major legislation, please share with me the metrics we should use to
measure our progress towards a more just and equal health-care system
that ensures affordable and high quality health care for all Americans.
If you cannot name any specific metrics, can you outline the process by
which we should determine what metrics we should use to measure
progress towards increasing access to health care?
Answer. The fundamental metric for knowing that our system is on
the right track is the centrality of the patient in the system and
their ability to make choices about their care in consultation with
their doctor. Without that, the most impressive facilities and
technology are not serving our people's needs, nor is the most
efficient system doing what is most important. With the patient at the
center of the system as a foundation, all else is possible and
achievable.
Question. During the debate over the Affordable Care Act, Congress
held more than 100 bipartisan hearings, roundtable discussions, and
negotiations, which were predominantly open and transparent to the
public. The legislation was open to amendment by both parties in
lengthy committee markups and by the full Senate, completely evaluated
by the Congressional Budget Office, and reported on extensively by the
news media before Congress voted on final passage. I understand that
you place a high premium on transparency and honesty.
Will you commit to having the same level of bipartisan discussion,
transparency, and honesty in putting together the President's proposal
for reforming our country's health-care system and ensuring that all
Americans will have affordable and high quality health care?
Answer. The President has made clear his hope and plan for a
replacement to Obamacare. At the same time, many in Congress have their
own ideas. And the conversation about how those will play out is
ongoing. That is the nature of our democracy. I certainly hope we will
have bipartisan support for any approach to fixing the current system,
which we must all agree is broken. If confirmed, I look forward to
working with anyone in Congress willing to work with me and the
administration generally to come up with the best replacement plan
under the procedures and involving the processes the Congress considers
appropriate so as to make available the highest quality care to all
Americans.
Question. Do you agree with the President that the sale of health
insurance over State lines will increase competition and lower the cost
of health insurance? Section 1333 of the Affordable Care Act already
allows States to form interstate compacts to allow for the sale of
health insurance over States lines? The States of Georgia, Maine,
Kentucky, and Wyoming allow for out-of-state insurance sales, but
virtually no out-of-state insurers have tried to sell insurance in
these States. How would you increase the sale of insurance over State
lines while maintaining consumer protections such as insurance coverage
for contraception, preventive screenings, maternity care, and mental
health treatment?
Answer. The idea of allowing interstate sale of insurance may take
many different forms. I agree with the President that it is an
important option to increase competition and lower the cost of
insurance. While the details of any such proposal would have to
consider the extent to which benefit design varies among States, it is
important that individuals be able to purchase the coverage that they
want and there has to be a floor of creditable coverage.
______
Questions Submitted by Hon. Chuck Grassley
Question. As someone who is being considered to lead the Department
of Health and Human Services, and as a physician, do you have any
doubts about safety and effectiveness of vaccines?
Answer. I understand the significant impact vaccines have had on
our Nation's public health, as well as the importance of patients
having confidence in the therapies they receive as part of their care.
Question. As a physician would you recommend that families follow
the recommended vaccine schedule that has been established by experts
and is constantly reviewed?
Answer. As a physician, I encourage individuals and families to
consult with their physician on the most appropriate care for them and
their loved ones.
______
Questions Submitted by Hon. Robert Menendez
clampdown on communications with the public and congress
Question. Shortly after your hearing concluded, press reports came
out that a memo was issued to employees of the Department of Health and
Human Services and the National Institutes of Health prohibiting any
external communication throughout the entire Department. Specifically,
the press accounts quote the memo as stating ``[f]or your additional
awareness, please note that (HHS employees) have been directed not to
send any correspondence to public officials (to include Members of
Congress and State and local officials) between now and February 3,
unless specifically authorized by the Department[.]''
I find this to be an unconscionable clampdown of information and a
rejection of basic transparency and accountability standards that
should seriously concern all Americans. This is made all the more
concerning given the health-care, public safety, research, and
biodefense programs that operate within HHS.
Do you support this directive or any other department-wide order to
suppress the flow of information between the Department of Health and
Human Services, the public and Congress?
If confirmed, do you commit to never imposing such restrictions on
any agency, office, or employee at HHS that limits their ability to
communicate with the public and Congress?
During your hearing today you agreed ``to provide a prompt response
in writing to any questions that may be submitted to you or addressed
to you by any Senator of this committee[.]'' Do you believe this
directive prohibits you from fulfilling that commitment to the
committee?
Were you aware this directive was going to be issued prior to the
time of your hearing on January 24, 2017?
Answer. The Acting Secretary Memo to Department of Health and Human
Services operating and staff division heads is straightforward and
consistent with the Chief of Staff Memo issued on behalf of President
Trump with regard to regulatory review of new or pending regulations
and guidance. As noted in the HHS memo, the purpose of the directive is
to ensure ``President Trump's appointees and designees have the
opportunity to review and approve any new or pending regulations or
guidance documents.'' Furthermore, the Chief of Staff memo provides
explicit exceptions for ``emergency situations or other urgent
circumstances relating to health, safety, financial, or national
security matters. . . .'' This request is standard for a new
administration. With regard to correspondence to public officials, such
as members of Congress, the memo outlines a clear and expedited process
for adequate review and is by no means intended to impede the agencies
or staff divisions from continuing their important work on behalf of
the American people, including routine constituent service
communications.
fidelity to science and to debunking dangerous falsehoods
Question. During the hearing I raised a series of debunked and fake
health and science claims, all of which have been perpetrated and
advanced by the Association of American Physicians and Surgeons, a
group to which you currently, or previously, have been a member. These
debunked and factually inaccurate claims include linking undocumented
immigrants to a spike in leprosy, connecting abortions to breast
cancer, and claiming that the HIV virus doesn't lead to AIDS. This
group has also promoted widely debunked and untrue claims that
vaccinations lead to the development of autism spectrum disorder. These
are dangerous claims made all the more toxic for being promoted by a
group comprised of medical professionals. What's even more dangerous is
that the President himself has a long history of promoting falsehoods
linking vaccinations to autism.
Will you state unequivocally that vaccines do not have any link to
the development of an autism spectrum disorder and confirm that such
all claims are fraudulent and have been widely debunked?
Answer. General scientific consensus at this time is that vaccines
do not lead to autism spectrum disorder. As always, this is an area
where patients and the parents of patients should consult with their
doctor.
Question. Will you, if confirmed to be the Nation's highest ranking
health care official, actively work to debunk these types of false
health-care and scientific claims?
Answer. If confirmed, I will work to hold HHS to the highest
scientific standards.
Question. Do you ensure that no political appointee within any
agency, department or office in the Department of Health and Human
Services believes in, or has promoted, demonstrably false statements
about health-care practices or debunked scientific claims?
Answer. As a physician, I understand the importance of patients
having confidence in the therapies they receive as part of their care.
When confirmed, I commit to conducting the due diligence HHS must to
ensure that factual, science-based information is clearly communicated
to the American people.
Question. Will you advise that the President not appoint anyone to
the staff of the Executive Office of the President who believes in, or
has promoted, demonstrably false statements about health-care practices
or debunked scientific claims?
Answer. As a physician, I understand the importance of patients
having confidence in the therapies they receive as part of their care.
When confirmed, I commit to conducting the due diligence HHS must to
ensure that factual, science-based information is clearly communicated
to the American people.
autism policy
Question. Since I first learned that New Jersey has the highest
incidence of autism in the country, I have been Congress's leading
advocate for advancing Federal policy to help individuals and families
with autism and other developmental disabilities. Recently, the CDC
released updated numbers showing that 1 in just 41 children in New
Jersey are diagnosed with an autism spectrum disorder by the age of 8.
This is the highest rate in the Nation.
In 2014, I authored the Autism Collaboration, Accountability,
Research, Education, and Support Act of 2014, known as Autism CARES.
Among the several key policies included in this law was the
continuation of the Interagency Autism Coordinating Committee and the
elevation of a senior Health and Human Service official to serve as the
HHS Autism Coordinator.
Do you commit to ensuring individuals appointed to these key
positions maintain a fidelity to science, and will you ensure that they
will have the ability and freedom to debunk false claims linking autism
to vaccines (or any other similar demonstrable falsehoods) without fear
of retribution from you or the White House?
Do you commit to promoting, through your capacity as Secretary and
through the President's annual budget, increased funding for autism
research and supports and services programs?
What specific steps will you take as Secretary to promote and
support a robust environment throughout the Department that focuses on
research into diagnosis, treatments, supports and services,
specifically those targeting adolescents and adults with autism and
other developmental disabilities?
The Centers for Disease Control and Prevention report that a child
with an autism spectrum disorder can be diagnosed as early as age 2,
yet children are frequently much older at the time of diagnosis. List
the specific steps will you take to promote early diagnosis and early
intervention?
Answer. As a physician, I understand the importance of patients
having confidence in the therapies they receive as part of their care.
If confirmed, I commit to conducting the due diligence HHS must to
ensure that factual, science-based information is clearly communicated
to the American people. HHS is involved in a number of autism-related
initiatives with the important goal of helping the individuals and
families living with autism. When confirmed, I look forward to
continuing this important work on behalf of these individuals and
families.
Question. The Affordable Care Act, as part of the Essential Health
Benefit Package for plans sold on the Marketplace, requires that all
carriers provide coverage for behavioral health-care services,
including those for autism. This was an amendment that I had included
into the ACA, and it has provided families across the Nation with
assurances that their children's coverage will provide them with the
care they need.
Do you commit to maintaining nationwide access to behavioral health
care by preserving the Essential Health Benefits package?
Answer. My hope is to move in a direction where insurers offer
products people want and give them the coverage they want. And in so
doing, we want to not lose sight of our shared objective of the best
and highest quality care being available to every American. I refer to
care because ultimately, having maternity or other coverage is not
meaningful if one cannot access the care they need or the quality of
care leaves them worse off. So we must work towards both coverage and
care.
Question. Do you strongly disavow any attempt to weaken this
coverage standard or any attempt at the Federal level to preempt
States, like New Jersey, that have a long-standing State requirement
that insurance provides benefits that cover services for autism?
Answer. I am respectful of the role of States and, if confirmed as
Secretary, will work to provide States with flexibility along the lines
described and consistent with President Trump's Executive order
Minimizing the Economic Burden of the Patient Protection and Affordable
Care Act Pending Repeal.
Question. Medicaid is a literal lifeline to those with autism and
other developmental disabilities. Every year, 50,000 of these
individuals age out of school-based services and need access to home
and community-based care to ensure they live as active and integrated a
life as possible. This is largely accomplished through Medicaid.
List the specific policies will you promote as Secretary to expand
access to home and community-based services for individuals with autism
and other developmental disabilities?
Answer. Every State is unique in their specific approach to the
provision of services for the population eligible to receive HCBS, and
we stand ready to assist States as they develop strategies to meet
their particular goals.
Question. List the specific steps will you take to improve outcomes
for transition-aged youth and ensure that they maintain access to
services and supports?
Answer. If confirmed, I would work as HHS Secretary to ensure that
the Medicaid program is well administered, effective, and available for
eligible beneficiaries and that the States/Governors are given the
flexibility to pursue approaches that fit the needs of their States.
Question. The Autism CARES Act of 2014 requires the Secretary of
Health and Human Services to submit to this committee a report
concerning young adults with autism and the challenges related to the
transition from existing school-based services to those services
available during adulthood. This report is long overdue.
When will this report be finalized? Will you prioritize the
finalization and submission of this report to Congress before March 31,
2017?
Answer. If confirmed, I would be pleased to work with you on the
status and finalization of this report.
community health centers
Question. Federally Qualified Health Centers (FQHCs) are the
health-care home for more than 25 million patients nationwide with
494,912 Community Health Center patients in New Jersey. In New Jersey,
FQHCs save the State and hospitals millions of dollars when patients
are seen at health centers rather than in emergency rooms. FQHCs cost
of care is substantially lower than other types of providers, even
though they provide a wide range of ancillary services not offered in
other health-care settings. As an example, FQHCs in New Jersey have a
lower average per-
episode cost than health centers nationally, and almost half that of
hospitals.
Further, community health centers are essentially one-stop shops
for health care, providing medical, oral health, mental health,
substance abuse, and other critical services at the same location. The
23 New Jersey Community Health Centers make up the largest primary care
network in the State, providing care to almost half a million patients
in over 131 sites of care including in schools, homeless centers, and
public housing. Beyond just providing health care, our State's FQHCs
employ more than 180,000 individuals, and generate over $26 billion
annually in economic impact to some of the Nation's most distressed
communities.
What is the specific dollar amount that Community Health Centers
stand to lose as a result of ACA repeal and the repeal of Medicaid
expansion funding?
Answer. I am not aware of the specific dollar amount.
Question. How many fewer patients will not get health-care services
at Community Health Centers as a result of ACA repeal and the repeal of
Medicaid expansion funding?
Answer. I do not have this figure.
Question. What will be the impact on any ongoing Community Health
Center expansion project that will be halted as a result of ACA repeal
and the repeal of Medicaid expansion funding?
Answer. We are committed to supporting Community Health Centers,
providing increased access to care for patients across the Nation.
Question. Please provide an economic impact, including lost jobs
and diminished economic impact, that will occur as a result of ACA
repeal and the repeal of Medicaid expansion funding?
Answer. To my knowledge, repeal of the ACA is projected to have a
positive impact on the labor market and the economy.
Question. If the ACA is repealed, list the specific steps you will
take to further promote the importance of seeking preventative care
rather policies which encourage patients to wait until they have to go
to the emergency room?
Answer. Our goal is to ensure that all Americans have access to
affordable coverage that best meets the needs of them and their
families so that they can receive preventative care from the doctor of
their choice in a primary care setting.
Question. Do you commit to maintaining current funding levels for
Community Health Centers, not only in the Department's annual budget
submission to Congress, but in ongoing operations that will be
financially damaged by the repeal of the Affordable Care Act?
Answer. I support Community Health Centers, however, funding levels
are determined by Congress. If confirmed, I will uphold the law as
passed by Congress and signed by the President.
interstate sale of health insurance
Question. One of the policies that you and President Trump often
refer to in your talks about an ACA ``replace'' plan is to allow
insurance to be sold across State lines. As you must be aware, the ACA
already allows for this, and several States--including your home State
of Georgia--have passed State laws to allow for it too.
In the 5 years since Georgia started allowing out-of-state
insurance to be sold, how many insurance companies have started selling
out-of-state plans?
How has allowing out-of-state plans impacted consumer choice in
available health insurance plans, what has been the impact on insurance
costs, and what has been the impact on access to care in Georgia?
How many States have indicated they want to form a compact to allow
out-of-state plans, under the current law?
How would this lack of interest on the part of States and insurance
companies change under the plan you've previously proposed (e.g., title
III of H.R. 3200, the Empowering Patients Act)?
As a former physician who had to negotiate with insurance companies
to be in their networks, wouldn't you prefer to work with an insurance
company that knew you and your patients, or would you prefer one from
across the country that knows nothing about you, your practice, or your
patient population?
Answer. It's no surprise that an overwhelming majority (85%) of
Americans support the ability to purchase insurance across State lines.
More important than insurance companies' views about more competition
or State regulators' views about greater regulatory competition is the
fact that American families are desperate for more affordable health-
care choices. It's our job to make certain that every American has
access to the highest quality care and coverage that is possible.
Opening up more health options for American families by allowing them
to purchase a plan from another State will do just that.
Understandably, insurance companies and States have been reluctant to
take bold action to sell products across State lines with the heavy
burden of Obamacare already on the books. Removing Obamacare's
insurance mandates and regulations combined with the ability to reach
more customers will ultimately reward American families with more
choices at lower costs.
Question. One of the consistent arguments you've made against the
ACA is that it was a Federal takeover of health care and that oversight
of the health industry is better left to States.
If you do in fact believe that, how does undermining States and
their insurance commissioners by imposing interstate sale of health
insurance follow that same logic?
Answer. If confirmed, I look forward to working with States to
increase access to affordable coverage.
recusal from ama-related activities
Question. The American Medical Association's (AMAs) House of
Delegates is, to quote their website, the ``principal policy-making
body of the AMA.'' You've been a Delegate for more than a decade and
have presumably been involved in the development of the organization's
policies relating to key issues before both Congress and HHS during
that time. You've stated that if confirmed you intend to recuse
yourself from any issues the AMA has worked on for 1 year.
How did you determine that a year is a sufficient period of time
for your recusal from all AMA-related activity?
Answer. This matter has already been addressed with the OGE and
designated agency ethics official, and I will abide by the obligations
agreed to in my publicly available ethics agreement.
Question. Does the clock on this year start on the day you assume
the role of Secretary or do you currently consider that year to have
already started?
Answer. The terms of my publicly available ethics agreement, which
I entered into in consultation with the Office of Government Ethics and
my designated agency ethics official, make clear that the 1-year
recusal window begins on the day of the confirmation.
Question. If the Department's General Counsel, Office of Inspector
General or any other authority within the HHS determines that a year
recusal is insufficient to properly distance yourself from your
previous work with the AMA, will you commit to extending the recusal
period for the remainder of your tenure as Secretary?
Answer. I will abide by the obligations agreed to in my publicly
available ethics agreement, which I entered into in consultation with
the OGE and my designated agency ethics official.
Question. A quick search on the AMA's website shows that the
organization has formally commented on issues as varied as Medicare
Advantage, the physician fee schedule, FDA oversight of laboratory
developed tests, Medicaid and CHIP, CMS quality measures, Medicare
prescription drug benefits, electronic health record meaningful use
requirements, guidelines for opioid prescribing, and the comprehensive
joint replacement model you've spoken out against so frequently.
Obviously the group representing doctors has myriad interests in the
workings of virtually every agency and office within HHS.
Please provide me with documentation outlining exactly how you will
recuse yourself from all AMA-related activities, which includes
specific details on the HHS policies this recusal impacts. Further,
please provide a list of all personnel within the Department that will
be designated to act on your behalf for all the listed polices for
which you will be recused.
Answer. This matter has already been addressed with the OGE and
designated agency ethics official, and I will abide by the obligations
agreed to in his publicly available ethics agreement.
I have not yet been confirmed or hired any personnel to assist
efforts in the Department of Health and Human Services.
Question. As a member of the AMA's House of Delegates for more than
a decade, it's safe to presume that you are familiar with, and
supportive of, their policies. One of these policies states that the
``AMA recognizes that uncontrolled ownership and use of firearms,
especially handguns, is a serious threat to the public's health''
because they are the leading cause of premature death in the country.
Do you agree that guns are a top cause of intentional and
unintentional death, as the AMA states?
As a member of the AMA's House of Delegates, at any point did you
fight against the AMA taking a stance declaring guns to be a public
health issue?
Do you oppose government prohibitions on studying how gun violence
affects the public health? If confirmed, will you commit to not
imposing government prohibitions on any agency, department or office
from conducting gun-related health research to improve public health?
Answer. Violence is a challenge in our society that deserves
greater attention. All Americans want our communities to be safe places
to live, learn, work and play. To my best recollection, I have not
taken an individual stance on this matter. To the question of how best
to prevent the tragic loss of innocent lives, I believe we must take a
hard look at the underlying issues contributing to these tragic events,
including too often unmet mental health needs among our citizens. A
proper diagnosis and treatment as part of patient-focused care are
critical to ensuring we are identifying indicators of violent behavior
that may contribute to tragic events.
evidence-based home visiting programs
Question. I have been a strong supporter of the Maternal, Infant,
and Early Childhood Visitation program (MIECHV), which has always
enjoyed bi-partisan support. MIECHV was enacted as part of the
Affordable Care Act to help States build capacity to provide in-home
visits to at-risk mothers and families with the stated goals of
improving maternal and child health, preventing child abuse and
neglect, encouraging positive parenting, and promoting child
development and school readiness.
The Medicare Access and CHIP Reauthorization Act (MACRA), passed in
2015, reauthorized the program for 2 years. This reauthorization
maintains current funding, which unfortunately is only enough resources
to provide services to only 3 percent of the eligible population who
are currently receiving MIECHV services. This points to a missed
opportunity to improve the life course development of children born
into low-income households, while also reducing preventable government
spending in the short and long term.
Do you commit to supporting continuation of funding for the MIECHV
program in the Department's annual budget submission? Do you recognize
the value of the MIECHV program and its evidence-based design by
proposing increases in funding to capture more than just 3 percent of
those children and families who could greatly benefit through the
program's services?
Answer. I share your goal of increasing access to affordable,
quality health coverage for rural America. While I cannot comment
specifically on legislation that would reauthorize MIECHV, I look
forward to working with you on examining this program's funding and
working on ways to improve rural and child health using evidence-based
approaches.
diversity in hiring
Question. The Affordable Care Act expanded health-care coverage to
millions of Americans who were previously uninsured. Because of the
greater demands on the health-care industry, the ACA has also become an
engine for job growth in the health related fields. This is especially
true for women and people of color.
For example, women represent 75% of the health-care workforce.
Nearly half of workers in the long-term/residential and home health-
care services are people of color. The future of our American workforce
in the health industry promises increasing diversity. Between 2003-2004
and 2013-2014 the number of doctoral degrees conferred in health
profession fields increased by 61 percent (from 41,900 to 67,400
degrees).\14\ In 2013-2014, one-third of those doctoral degrees were
awarded to people of color.\15\ The importance of a diverse workforce
in the health industry has been well-documented in scientific
literature. One of the more significant outcomes of a diverse workforce
is greater access to and quality patient care.\16\ Diversity in the
workforce also increases career opportunities for people of color.
---------------------------------------------------------------------------
\14\ https://nces.ed.gov/programs/coe/indicator_svc.asp.
\15\ https://nces.ed.gov/programs/digest/d15/tables/
dt15_324.25.asp.
\16\ Mitchel, D.A. and Lassiter M.A. (2006) Addressing health care
disparities and increasing workforce diversity: The next step for the
dental, medical, and public health professions, American Journal of
Public Health, 96 (12), pp. 2093-2097.
Given the fact that the current administration intends on gutting
the Affordable Care Act, which, along with leaving millions of
Americans uninsured, will also leave thousands of women and minorities
---------------------------------------------------------------------------
without an opportunity to build a career in their field of study:
Will you commit to minimizing the impact of leaving thousands of
incoming women and minority health-care professionals without a career
path to look forward to?
Answer. Workforce issues are a major challenge in health care. We
should work together to expand career options and paths for all health-
care professionals.
Question. The Department of Health and Human Services is among the
most diverse agencies to work for within the government, except when it
comes to its Hispanic labor force. In FY 2015, Hispanics comprised
3.08% of HHS's workforce compared to 9.96% of the National Civilian
Labor Force.\17\
---------------------------------------------------------------------------
\17\ https://www.hhs.gov/sites/default/files/asa/ohr/spd/di/
newsletter/dinewsletterfallwinter
15.pdf.
What concrete steps does the Department of Health and Human
Services plan to take to increase diversity and inclusion in its
---------------------------------------------------------------------------
agency, especially at its Senior and Executive levels?
Answer. If confirmed, I would be pleased to work with you to
identify steps that could be taken to ensure the Department is drawing
upon the widest and most diverse pool of applicants possible in the
hopes of it resulting in an even more diverse workforce.
diversity in health outcomes
Question. Eliminating health-care disparities among Americans from
minority racial and ethnic backgrounds has long been a bipartisan
issue. In 1985 under President Reagan, then Secretary of Health a Human
Services Margaret Heckler commissioned a report on Black and Minority
Health where she noted that there was a ``continuing disparity in the
burden of death and illness experienced by [. . .] minority Americans
as compared with our Nation's population as a whole.'' The report, as
she envisioned, should have marked ``the beginning of the end of the
health disparity that has, for so long, cast a shadow on the otherwise
splendid American track record of ever improving health.'' \18\
---------------------------------------------------------------------------
\18\ https://minorityhealth.hhs.gov/assets/pdf/checked/1/
ANDERSON.pdf.
Unfortunately that shadow is still cast over our country. There is
a significant body of literature that indicates that disadvantaged
populations, such as racial and ethnic minorities, still face systemic
barriers to achieving ideal health. For example, African Americans are
50% more likely to die from heart disease or stroke; Asian/Pacific
Islanders are 60% more likely to have acute Hepatitis B, which causes
liver disease; and African-American, Native Hawaiian/Other Pacific
Islander, and Hispanic adults all have rates of HIV infection diagnosis
that range from three to nine times the rate of non-Hispanic Whites.
\19\ To that end, the Affordable Care Act established Offices of
Minority Health within six agencies, thus expanding the work begun by
President Reagan 30 years ago. The purpose of creating these offices
was to have greater interagency coordination when it comes to
eliminating minority health disparities.
---------------------------------------------------------------------------
\19\ https://minorityhealth.hhs.gov/assets/pdf/
FINAL_HHS_Action_Plan_Progress_Report_11_2
_2015.pdf.
To the extent that this administration has taken and will continue
to take concrete steps to repeal the ACA, which created the Offices of
Minority Health within the Agency for Healthcare Research and Quality
(AHRQ), the Centers for Disease Control and Prevention (CDC), the Food
and Drug Administration (FDA), the Health Resources and Services
Administration (HRSA), the Centers for Medicare and Medicaid Services
(CMS), and the Substance Abuse and Mental Health Services
---------------------------------------------------------------------------
Administration (SAMHSA):
Will you commit to prioritizing the elimination of minority health
disparities in America a priority? Please provide specifics of how you
plan to make this a priority.
Answer. Health outcome disparities are a challenge and prioritizing
work in this area is important. Using the proper metrics may provide
important insight into new solutions.
______
Question Submitted by Hon. Rob Portman and Hon. Sherrod Brown
Question. HHS, through CMS, has a long tradition of supporting
nursing education. Our State of Ohio is home to 12 facilities that
receive Medicare pass-through funding for nursing education. Over the
past few years, CMS support for nursing education funding has been
under threat due to accreditation changes. We have authored a bill, the
MEND Act that would ensure CMS support of nursing education through
pass-through funding continues and that we can continue educating high
quality nurses.
If you are confirmed, will you commit to work with us in Congress
to provide technical assistance and ensure that the MEND Act is quickly
implemented if passed?
Answer. I look forward to working with you on this issue and
sharing both feedback and assistance regarding the important policy and
technical issues in nursing education funding, an issue related to and
similar to the challenges with physician shortages but broader in
geographic scope and impact. If the law is implemented, and if
confirmed, I will ensure it is implemented on the timeline Congress
imposes.
______
Question Submitted by Hon. Rob Portman and Hon. Robert P. Casey, Jr.
Question. Section 154 of MIPPA 2008 specifically excludes from the
Medicare DME competitive bidding program (CBP) CRT power wheelchairs,
as well as the accessories that consumers use with those wheelchairs.
Consistent with the law, Congress did not include those CRT items in
Rounds 1 or Rounds 2 of the DME bidding program and has repeatedly
expressed to CMS that it was not the intent of the law to apply bid
rates to accessories used with CRT wheelchairs. Unfortunately, CMS has
interpreted MIPPA contrary to congressional intent and in December 2014
CMS posted on-line a ``Frequently Asked Questions'' (FAQ) document
stating that starting in January 2016 CMS intended to use bid pricing
information obtained from the CBP for standard wheelchair accessories
to reduce the payment amounts for CRT wheelchair accessories.
At the end of 2015, Congress included in the Patient Access and
Medicare Protection Act (PAMPA) a 12-month delay (through December 31,
2016) of CMS's planned application of CBP prices based on standard
accessories to CRT accessories that share the same HCPCS code. In
December 2016, as part of the 21st Century Cures Act, Congress included
an additional 6-month delay that will expire on June 30, 2017.
Based on your support for this non-application of CBP prices to CRT
accessories as a member of Congress, if confirmed as Secretary of HHS,
can you commit to work with Congress to correct this CMS policy and
adhere to the intent of Congress in MIPPA?
Answer. As a member of Congress, I have been engaged in
understanding and improving the competitive bidding program. If
confirmed, I will continue this work but with the different role of
carrying out the law for the benefit of the American people. If
confirmed, I fully expect to work with Congress on this issue and many
others that arise when Congress's intent encounters the details of
implementation. I also hope to bring to that role, if confirmed, the
informative and valuable perspective of serving as a member of Congress
writing and voting on these laws.
______
Questions Submitted by Hon. Benjamin L. Cardin
cmmi and health care delivery innovation
Question. What are your views of State demonstrations, State
innovation, and Centers for Medicare and Medicaid Innovation (CMMI)
authority?
Answer. I believe these authorities can be important ways to ensure
there is flexibility in CMS programs and activities for the individual
and varying needs of States.
drug prices
Question. Last year the country was shocked by a series of price-
hikes on older, off-patent drugs by manufacturers who had played no
part in the research and development that produced them. The Senate
debated numerous solutions last Congress to prevent price gouging
behavior, and many put the ball squarely in HHS's court.
What is your view on HHS's role in preventing price-gouging, and if
confirmed, how do you propose to use the Office of Secretary to ensure
Americans have access to affordable prescription drugs?
Answer. The issue of drug pricing and drug costs is one of great
concern to all Americans. You have my commitment to work with you and
others to make certain that Americans have access to the medications
that they need. If confirmed, I look forward to focusing on how we can
make health care more affordable, including prescription drugs. I share
your concern regarding the importance of individuals and families being
able to afford the prescription drugs they need.
emergency health services
Question. The Balanced Budget Act of 1997 requires Medicaid managed
care organizations (MCOs), and others, to cover emergency services
without prior authorization and established a Federal ``prudent
layperson standard.'' This standard defines an ``emergency medical
condition'' as one that manifests itself by acute symptoms of
sufficient severity (including severe pain) such that a prudent
layperson, who possess an average knowledge of health and medicine
could reasonably expect the absence of immediate medical attention to
result in placing the health of the individual in serious jeopardy,
serious bodily functions, or serious dysfunction of any bodily organ or
part.
Do you support this Federal policy?
Answer. I appreciate the aim of this Federal policy is to ensure a
minimum level of emergency room coverage for Medicaid managed care
organizations. Every State has different demographic, budgetary, and
policy concerns that shape their approach to Medicaid and potential
Medicaid managed care coverage requirements. While I believe that in
the long run a one-size-fits-all approach is not workable for a country
as diverse as the United States, my hope is to make sure that Medicaid
beneficiaries need not rely on the emergency room to reliably access
care because they have a doctor they trust in their community and a
strong relationship and reliable access to that doctor.
Question. Will you ensure the Centers for Medicare and Medicaid
Services continues to enforce the prudent layperson standard for all
Medicaid MCOs?
Answer. If confirmed as Secretary, I will faithfully implement laws
written by Congress and the regulations issued by the Department. This
includes enforcement action as appropriate. As a doctor who has
actually treated thousands of Medicaid patients, I do care deeply about
the Medicaid program and the access of Medicaid patients to actual
care, not just a card they can carry with them.
federal workers
Question. Do you believe that the Office of the Actuary's actuarial
and economic projections should be based on ``best professional
estimates'' and remain as free as possible from political
considerations? Why or why not?
Answer. In getting advice from any professional it is important
that advice be objective and consistent with relevant professional
standards. Just as I would expect that from any doctor I visit I would
expect the same from an actuary.
global health security agenda
Question. What are your views on President Obama's Global Health
Security Agenda?
Answer. In an interconnected world, no nation is safe from the
risks posed by infectious diseases. I agree that the international
community must continue to work together towards the common goal of a
world safe from infectious diseases. I also agree that the
international community must build-up our capacities in order to
achieve this goal. If confirmed I will meet with the Office of Global
Affairs and CDC to review the progress we have made on this agenda.
Question. For decades the U.S. Government has been a leader in
strengthening health systems around the world to prevent, detect, and
minimize the impact of emerging infectious diseases. The United States
is one of over 50 countries that have committed to the Global Health
Security Agenda, which aims to help countries improve their capacity to
prevent, detect, and respond to infectious disease outbreaks.
As Secretary, how would you support and enhance global efforts to
detect, prevent, and respond to diseases internationally to prevent
them from becoming a threat to the United States?
How will you ensure that we effectively address emerging crises and
maintain our leadership role in global health?
Answer. No global effort to detect, prevent, and respond to
diseases internationally can be successful without an active and
engaged United States. Rapid response in fighting infectious diseases
is essential. Oftentimes, we can ensure these diseases do not spread to
our shores if we do what we can to stop them spreading abroad. Few
responsibilities are more important than keeping the public safe from
potential public health pandemics and if confirmed I will make this a
top priority.
Question. America's approach to global health has been extremely
successful, including the effort to move toward ending the epidemics of
AIDS, tuberculosis and malaria. The hallmark of America's work against
the three diseases has been to support results-oriented, accountable
and transparent programming through the Global Fund and bilateral
programs including PEPFAR, PMI and the USAID tuberculosis program. The
Global Fund and our bilateral programs closely coordinate their work
and depend on each other to implement comprehensive programming.
As Secretary, will you be committed to continuing America's
leadership against AIDS, TB and malaria through Global Fund
investments?
Answer. United States leadership has been crucial in fighting AIDS,
TB and malaria. Should I be confirmed, I fully expect these efforts to
continue as we build upon and learn from our past and current
initiatives. HHS and CDC are critical to fighting a range of global
health security threats from Ebola and Zika to polio and HIV/AIDS. Yet,
as was made clear during the Ebola epidemic, severe shortages of health
workers greatly hamper efforts for infectious disease prevention,
detection and response.
Question. HHS and CDC are critical to fighting a range of global
health security threats from Ebola and Zika to polio and HIV/AIDS. Yet,
as was made clear during the Ebola epidemic, severe shortages of health
workers greatly hamper efforts for infectious disease prevention,
detection and response.
In your view, what is the role of the Department of Health and
Human Services in growing and developing a better-trained health
workforce worldwide?
Answer. If confirmed as HHS Secretary, I look forward to working
with the health secretaries of other nations in helping the world
community train an international health workforce capable of tackling
the myriad public health challenges of the 21st century.
graduate medical education (gme)
Question. The current Medicare GME system is not producing enough
doctors who will practice in rural America. Data show less than 5% of
all graduates practice in rural areas. When Congress set limits on the
number of Medicare funded GME slots (BBA 1997) there was clear intent
in both the statute and the report language to treat rural training
differently and provide special consideration to meet the needs of
underserved rural areas. Unfortunately, the technicalities of the
statute, and the regulations deriving from it, have not succeeded in
achieving this intent.
What will you do as Secretary of HHS, specifically, to support
changes to Medicare GME to increase the production of physicians
practicing in rural areas?
Answer. I have always been a strong supporter of efforts to support
medical education. Congress has used the Medicare program from its
inception to invest in future generations of doctors. Regardless of
what we do in Washington, health care should always be about that one
to one relationship of a patient to a doctor. That relationship of
course requires a doctor. And so I am hopeful we can continue to find
ways to remove disincentives to the practice of medicine and its
rewards as well as support the profession in other ways. This issue is
all the more important in the case of a rural area, where there is
already an ongoing physician shortage and difficulty in recruiting
talent and capital for medical infrastructure. If confirmed as
Secretary, I would look for opportunities to address these situations
through GME but also through programs administered by the Health
Resources Services Administration and by taking a closer look at
telemedicine.
medicare
Question. Your ACA replacement proposal, the Empowering Patient's
First Act, eliminates benefit expansions for beneficiaries such as free
preventive benefits (blood pressure screenings, colorectal screenings
and immunizations) and closing the Part D donut hole which helped with
out-of-pocket prescription drug costs.
If confirmed as HHS Secretary, how will you prevent any care
reductions for or our-of-pocket health-care cost increases to Medicare
beneficiaries?
Answer. In considering Medicare, it is important to appreciate that
the bipartisan Medicare Trustees have told everyone that Medicare, in
less than 10 years, is going to be out of the kind of resources that
will allow us as a society to keep the promise to beneficiaries of the
Medicare program. My goal, if confirmed, is to work with Congress to
make certain that we save and strengthen Medicare. It is irresponsible
for us to do anything else. If I am confirmed, my role will be one of
carrying out the laws Congress passes and as to that I would convey to
the Medicare population that we look forward to assisting them in
getting the care they need.
mental health workforce
Question. Mental health professions face chronic workforce
shortages, and the future for many of these professions remain grim.
For example, a recent survey from the American Association of Medical
Colleges found that almost 60% of psychiatrists are aged 55 or older,
making psychiatry the fourth oldest medical specialty in terms of
practitioner age.
Along with the overall shortage, the distribution of mental health
practitioners heavily favors key urban and suburban areas of the
country over rural regions. The 21st Century Cures Act requires the
Substance Abuse and Mental Health Services Administration to develop a
strategic plan every 4 years to identify strategies to improve the
recruitment, training, and retention of a mental health and substance
use disorder workforce.
While this provision and similar provisions are steps in the right
direction, the numbers clearly suggest that growing a robust workforce
to meet the mental health and substance use needs of nearly 70 million
Americans will be of paramount importance in the coming years. Please
describe in detail how you, if confirmed, will support the growth of
the next generation of mental health practitioners.
What strategies will you use to encourage medical students and
others to pursue careers in these fields?
Answer. It is important that we as a nation make sure that every
single individual has access to the kind of mental health and substance
abuse care that they need. If I am confirmed, I look forward to working
closely with you and the other members of Congress to faithfully
execute the 21st Century Cures Act, which aims to ensure that the
mental health profession is adequately staffed for current and the
future generations.
minority health
Question. In Maryland, the ethnic minorities make up roughly 41% of
the State's population. This is important because the health outcomes
of minority populations are significantly lower and morbidity rates are
higher than that of majority populations. Your Department, HHS,
recognized this when it produced with what is commonly called the
Heckler Report back in the 1980s, under President Ronald Reagan,
looking at what are now commonly called ``health disparities'' and the
need for more health professionals coming from minority and
underrepresented backgrounds.
Racial and ethnic communities suffer disproportionate higher rates
of illnesses, disabilities and preventable deaths. In fact, according
to Johns Hopkins and University of Maryland researchers, racial health
disparities cost the United States $229 billion between 2003 and 2006.
The Affordable Care Act is allowing communities coverage and access
to much needed care, treatment, and prevention services from diabetes,
to cancer, to asthma, and more. Specifically, how do you plan to
further the elimination of racial and ethnic health disparities?
Answer. I am committed to ensuring that minorities in this country
have access to the highest quality care. To address these challenges,
we need to examine what is happening on the ground in these
communities. From there, we can establish better metrics and better
accountability, and I look forward to working with you on this when I
am confirmed.
national institutes of health (nih)
Question. Young scientists in the United States are finding it more
difficult--and more time-consuming--to secure stable funding to launch
their research careers, which stifles America's competitiveness. More
and more talented young people are dropping out of the scientific
workforce or choose not to enter in the first place.
What do you plan to do to ensure barriers facing young scientists
are addressed and can we count on your leadership to implement the
recommendations that come out of the National Academies report?
Answer. If confirmed, I will look at flexibilities given to us
through the 21st Century Cures Act and the focus on ``young emerging
scientists'' to better recruit and retain top talent in order to help
us achieve our mission of promoting innovation in order to benefit
patients and their families across the country.
Question. What do you see as the future roadmap for NIH over the
next four years?
Answer. If confirmed, I will work with NIH leadership to map out a
forward-
leaning NIH agenda. As I mentioned in my testimony, NIH is a true
treasure for our country. With the increased resources provided in the
Cures Act and the President's commitment to innovation and patient-
centric health care, great opportunities lie ahead for the NIH.
pediatric dental
Question. According to the CDC, tooth decay (cavities) is one of
the most common chronic conditions of childhood in the United States
and if left untreated, tooth decay can cause pain and infections that
may lead to delays in important cognitive skills, such as eating,
speaking, playing, and learning.
How will you plan to ensure that children will continue to have
access to early prevention services for oral health?
Answer. If confirmed as Secretary, I would hope to work with you to
revisit the current CMS' ``Oral Health Strategy'' for children (https:/
/www.medicaid.gov/medicaid/quality-of-care/downloads/cms-oral-health-
strategy.pdf). I would also aim to provide States with flexibility in
their Medicaid programs to provide both coverage and access to these
services. Lastly, there may be opportunities to encourage innovation in
both the coverage and payment for these services as well as the actual
technology and even the relevant public health education strategies.
social services block grant (ssbg)
Question. This important program funds a variety of social services
programs, from child protection to elder abuse to Meals on Wheels. I
see every day in Maryland how this grant program helps our neediest and
most vulnerable citizens. You proposed eliminating this $1.7 billion a
year program as the chairman of the House Budget Committee.
What was your rationale for trying to eliminate this program, and
what would you put in its place?
Answer. During my time in Congress, I have been acutely aware of
the need to eliminate duplicative programs and strengthen those
programs that work. As a 2011 GAO report pointed out, SSBG is a program
of fragmentation, overlap, and duplication. SSBG essentially offers no-
strings attached approach and a blank check to States. However, as SSBG
continues to be a program authorized by Congress, I will do all I can
to effectively administer this law should I be so honored as to be
confirmed as HHS Secretary.
substance use disorders
Question. The United States currently faces a growing epidemic in
the form of prescription drug misuse, abuse, addiction and overdose.
The numbers are disquieting. One person dies every 19 minutes from a
drug overdose, now the leading cause of death among those ages 25-44,
according to Johns Hopkins experts.
In Maryland in 2015, fatal overdoses in the State were up 21
percent from the year before, and nearly twice the number in 2010.
There is an urgent need for evidence-informed solutions ready for rapid
implementation.
How will HHS balance the twin-priorities of preventing new cases of
opioid addiction and expanding access to effective addiction treatment
while safely meeting the needs of patients experiencing pain?
Answer. The opioid epidemic is real. This epidemic is a rampant
crisis that is harming families and communities across the Nation. I
firmly believe it is vital that those suffering from substance abuse
have continued access to addiction treatment. If confirmed, I am
committed to working closely with you and the other members of Congress
to ensure that the Substance Abuse and Mental Health Services
Administration (SAMHSA) fulfills its duty of treating those who are in
addiction recovery, and prioritizes prevention efforts to keep
America's families and communities healthy.
Question. Last month, the Centers for Medicare and Medicaid
Services (CMS) granted Maryland a Medicaid section 1115 waiver to
implement initiatives to address substance use disorders throughout the
State. This is great news for my home State and a first step to
addressing opioid abuse and heroin use. Now, Medicaid enrollees will
have access to residential treatment for substance use disorders,
putting them on the road to recovery.
If confirmed as HHS, will you commit to ensuring States' ability to
use Medicaid section 1115 models to provide life-saving care, including
addiction treatment and recovery services covered by Medicaid, to
Americans in need?
Answer. If I am confirmed, I will work with CMS and SAMHSA to help
low-
income adults with mental health and substance use disorders. With
respect to Medicaid specifically, every State has different
demographic, budgetary, and policy concerns that shape their approach
to Medicaid. That is one of the reasons I devoted so much time to
working with States to help them to identify creative solutions, and
why I believe a one-size-fits-all approach is not workable for a
country as diverse as the United States. Waivers are an important tool
for States to innovate within the Medicaid program. If confirmed, I
would work with CMS to ensure that it evaluates waivers like Maryland's
on their merits, taking into account the desirability of States
charting their own course, and ensure that they are compliant with the
law.
temporary assistance for needy families (tanf)
Question. I am concerned that, while the TANF caseload had declined
by over 60 percent over the last 2 decades, the number of children in
poverty and deep poverty (meaning income below half the poverty line)
has increased.
What steps would you take to reverse this trend?
Answer. If confirmed as HHS Secretary, I am going to do all I can
to effectively and efficiently administer the laws passed by Congress
to address and alleviate the very real problem of children living in
varying levels of poverty.
Question. Do you agree that TANF is not succeeding as a program
even if caseloads are declining while the number of persons in poverty
and deep poverty are increasing?
Answer. Respectfully, I must disagree with this assessment of
TANF's success. Since passage of TANF, we have seen employment rates of
single mothers increase, lower poverty rates among female-headed
households with children and African-American households, a reduction
in child poverty overall, and a sharp decline in the number of families
receiving cash assistance.
therapy caps
Question. As you know, the therapy cap exceptions process expires
in less than a year--on December 31, 2017. We have all heard from
constituents whose therapy needs exceeded the cap and their conditions
have deteriorated, necessitating more expensive medical intervention.
As Secretary of HHS, how will you support the repeal of these
arbitrary and discriminatory limits and maintain access to
rehabilitation therapy that Medicare beneficiaries clearly need?
Answer. If confirmed as Secretary, I will look into this issue and
seek to understand the competing objectives and issues motivating the
current CMS policy. Part of the frustration with the current health-
care system is rules like this that do not make sense to many people.
However, that is not surprising when one considers that Medicare Parts
A, B, C, and D have each developed in silos and that even payment for
particular types of services sometimes reflect silos within the silos.
It may be that other approaches to therapy provide greater quality care
at reduced cost with more respect for the individual needs of each
patient in consultation with their doctor. If confirmed as Secretary, I
would hope to break down these silos and encourage approaches based on
a broader perspective.
Question. Given the problems associated with monitoring the therapy
cap, are the Centers for Medicare and Medicaid capable of achieving a
timely uniform and defensible streamlined, responsive, and transparent
process for manual medical review of Medicare records by Medicare
administrative contractors?
Answer. Any time there is manual review of anything in an
organization with the scale of Medicare, there is a recipe for
something to go wrong. If confirmed as Secretary, I would be pleased to
work with you to confirm whether the staffing and other resources
needed would be up to the challenge you describe.
______
Questions Submitted by Hon. Dean Heller
medicaid expansion
Question. Do I have your commitment to working with Congress, and
members of this committee, to protect access to care for all patients
in Nevada, particularly the over 600,000 Nevadans currently covered
under Medicaid?
Answer. I am committed to ensuring that Medicaid is available for
eligible beneficiaries, and working with States to ensure they are able
to make the most use of available resources to serve their citizens, if
confirmed as Secretary of Health and Human Services. Each State has
different needs, and I believe CMS needs to work with States to ensure
that, consistent with those needs, the Medicaid and CHIP programs
provide the best possible coverage to their residents.
Question. Under your leadership, how will the U.S. Department of
Health and Human Services work with States likes Nevada, who expanded
Medicaid, to ensure that they are successful in protecting access to
health care, particularly the 200,000 newly eligible Nevadans, as we
transition out of Obamacare?
Answer. I look forward to faithfully executing whatever law that
Congress passes and the President signs, if I am confirmed. I will
promise you this: Regardless of the final legislative outcome, I would
work as HHS Secretary to ensure that the Medicaid program is well
administered, effective, and available for eligible beneficiaries and
that the States/Governors are given the flexibility to pursue
innovative approaches that fits the needs of their States.
doctor shortage
Question. Nevada is 47th in the Nation for doctor-to-patient ratio.
What can Congress and HHS do to attract more health-care providers to
practice medicine in rural and underserved areas in States like Nevada
that are facing a significant doctor shortage?
Answer. If confirmed, I would work closely with the Center for
Medicare within CMS to see that critical access hospitals are able to
serve rural populations well. I would also work with the HRSA (Health
Resources and Services Administration) Administrator to consider how
CMS and HRSA can best cooperate with regards to community health
centers and other issues. I would also consider how we can allow for
reimbursement of telehealth in general and to further help address
provider shortages.
Question. Do you believe that tele-medicine would be helpful for
predominantly rural States like Nevada expand access to care for
patients in underserved areas?
Answer. Telemedicine is an exciting innovation that will allow for
individuals to access resources that are otherwise not available. In
the State of Georgia, we have a program that is a spoke and wheel
program. There is a neurologist who works with a network of clinics and
hospitals around the State. If somebody comes in with symptoms of a
stroke, that neurologist is able to see the patient in real time and
determine if they are having a stroke, whether they can be treated in
the community or ought to be transferred. Innovations like this have
been particularly helpful for rural areas.
financial disclosure
Question. To the best of your knowledge, as a member of the House
of Representatives, did you fully comply with the Stop Trading on
Congressional Knowledge Act (STOCK Act, Pub. L. 112-105) and the Office
of Government Ethics (OGE) to publicly disclose your personal financial
transactions?
Answer. To the best of my knowledge, I have met all compliance
obligations for the disclosure of personal financial transactions by
members of the House of Representatives.
Question. If confirmed, do you commit to fully complying with the
law that would require you to sell stock in companies regulated by HHS?
Answer. If confirmed, I commit to fully comply with all applicable
ethics and conflict of interest obligations required by law, including
the divestment of all applicable securities identified for sale in my
publicly disclosed ethics agreement with the Office of Government
Ethics (``OGE'').
nevada state legislature
Question. Please see the attached questions from the Nevada State
Legislature. I respectfully ask that you respond to these important
issues in the State, and cc Governor Sandoval.
Answer. I look forward to writing to you and the Governor regarding
these important issues. I expect my response will include the
following.
Q. What steps do you plan to take to ensure that the more than
88,000 Nevadans who have purchased health insurance through the Silver
State Health Exchange continue to have the ability to purchase health
insurance with adequate coverage in a transparent marketplace?
A. I think the conversation and focus in these topics has been the
question of coverage rather than true access for too long. By that I
mean that Americans might have an insurance card and yet not be able to
afford care or it might not be available to them for other reasons. And
so when we talk about coverage we ought to make clear what we really
mean and want to have happen. In any case, the President has made clear
his hope and plan for a replacement to Obamacare. The goal is to make
certain that every single American has access to the coverage they want
for themselves.
Q. What steps do you plan to take to ensure that the more than
77,000 Nevadans who are eligible for Federal tax credits under the
Affordable Care Act to help purchase private insurance will continue to
have access to affordable health insurance options with adequate
coverage?
A. I think the conversation and focus in these topics has been the
question of coverage rather than true access for too long. By that I
mean that Americans might have an insurance card and yet not be able to
afford care or it might not be available to them for other reasons. And
so when we talk about coverage we ought to make clear what we really
mean and want to have happen. In any case, the President has made clear
his hope and plan for a replacement to Obamacare. The goal is to make
certain that every single American has access to the coverage they want
for themselves.
Q. What steps do you plan to take to ensure that the 217,000
Nevadans who are receiving health care under the Medicaid expansion
remain covered?
A. Regardless of the final legislative outcome, I would work as HHS
Secretary to ensure that the Medicaid program is well administered,
effective, and available for eligible beneficiaries and that the
States/Governors are given the flexibility to pursue innovative
approaches that fits the needs of their States.
Q. The Affordable Care Act guarantees coverage vital to
preventative services for women, including cancer screenings and birth
control. What steps do you plan to take to ensure that the Affordable
Care Act's coverage guarantees remain intact for women's health?
A. My hope is to move in a direction where insurers can offer
products people want and give them the coverage they want. Getting to
that kind of system requires changes that will inevitably involve
working with Congress and considering the tradeoffs of various
proposals to achieve our shared objective of the best and highest
quality care being available to Americans. And note that I refer to
care because ultimately, having maternity or other coverage is not
meaningful if one cannot access the care they need or the quality of
care leaves them worse off. So we must work towards both coverage and
care.
Q. The Affordable Care Act guarantees that Nevadans with pre-
existing conditions will not be denied health care and ends lifetime
minimums on coverage. It also allows younger people, many of whom are
saddled with college debt and cannot afford insurance, to stay on their
parents' insurance until they are 26. What steps do you plan to take to
preserve those coverage guarantees?
A. Nobody ought to lose insurance because they get a bad diagnosis.
As to coverage until age 26, the insurance industry has applied that
across the board. In any case, if confirmed as HHS Secretary, my role
would be to implement the replacement passed by Congress and signed by
President Trump. Regardless of my own ideas, it is Congress that will
ultimately decide what a replacement bill will look like, and my job
would be to faithfully execute the law as passed by Congress.
______
Questions Submitted by Hon. Michael F. Bennet
Question. The Medicare Advantage program has been used to provide
quality, affordable health care to about 18 million seniors and
individuals with disabilities. Many of these seniors indicate that they
are satisfied with their choice of Medicare Advantage program. In fact,
36% of Coloradans are in Medicare Advantage plans.
In your role as Secretary of HHS, how do you plan to support
Medicare Advantage plans? What other steps do you plan to take to
ensure that seniors have access to coordinated care plans?
Answer. Medicare Advantage provides an important option for
Medicare beneficiaries to access coordinated care and greater benefits.
If confirmed as Secretary, I would seek to ensure Medicare Advantage
remains a stable option for beneficiaries and that Medicare Advantage
plans are afforded the flexibility to design plans that beneficiaries
want and give them the coverage they want.
Question. According to the Medicare Boards of Trustees, the
Affordable Care Act (ACA) has extended the solvency of the Medicare
hospital insurance trust fund by 11 years in total. The Committee for a
Responsible Federal Budget estimates that a full repeal of the ACA
would push up the insolvency date to 2021 and more than triple the
program's 10-year deficit.
How would you structure an ACA replacement bill that does not
reduce the solvency of the Medicare Hospital Insurance Trust Fund?
Answer. Neither President Trump nor I are wedded to a particular
plan to the exclusion of all others. We are looking forward to giving
the American people what they've been longing for, for 7 long years:
real health-care reform. But they have never wanted Obamacare: It has
raised premiums and deductibles, narrowed doctor networks, reduced
choices of plans, limited Americans' liberty, and undermined the doctor
patient relationship. A replacement need not affect the Medicare trust
fund if the provisions related to Medicare are ones that are carefully
considered.
Question. Do you plan to advise the administration to advocate for
premium support as a means of extending the Medicare trust fund?
Answer. One of my goals in discussing these matters is to lower the
temperature regarding what we are talking about. These issues have
real-life impact for folks in their lives and so, if confirmed, I would
advise the administration that we convey to the Medicare population
that they do not have reason to be concerned and that we look to
assisting them in getting the care they need and the caregivers that
they need too.
Question. Colorado has 2.3 million people living with a pre-
existing condition that rely on the protections of the ACA to receive
coverage.
How would your plan keep coverage for pre-existing conditions and
control costs while dissolving other parts of the ACA such as the
individual mandate, the exchanges, and Medicaid expansion?
Answer. Our goal is to ensure every single American has access to
the coverage they want for themselves and ensures the individuals who
lost coverage under the Affordable Care Act get or maintain coverage.
If we preserve the patient-doctor relationship and put the patient at
the center, then we will see quality go up and costs go down. In any
case, I look forward to faithfully executing whatever law that Congress
passes and the President signs, if I am confirmed.
Question. I have heard from rural hospitals in Colorado that may
lose significant funding if the ACA is repealed. The Medicaid Expansion
provided some financial stability to hospitals that were on the brink
of closure before the bill was passed. In fact, hospitals in Colorado
saw a 30% drop in uncompensated care.
What metrics would you use to ensure that an ACA replacement does
not hurt rural or critical access hospitals?
Answer. Our goal is to ensure every single American has access to
the coverage they want for themselves and ensures the individuals who
lost coverage under the Affordable Care Act get or maintain coverage.
This of course includes individuals who access care at rural or
critical access hospitals. And so the best metric in the end is one
that measures the extent of access to actual care, not just coverage
and the quality of that care as determined by patients working
individually with their doctors.
Question. You have included health savings accounts in previous
proposals to replace the ACA. As you know, health savings accounts are
essentially a way for people to save their own money that they can then
spend on health care. They are not a substitute for quality coverage
and are paired with a high deductible, making it difficult to obtain
health care.
How can a middle-class family making $60,000 a year successfully
use a health savings account if they live paycheck to paycheck and
can't afford to set aside thousands of dollars to pay for their health-
care bills?
Answer. Our goal is to ensure every single American has access to
affordable coverage they want for themselves and their families. Health
savings accounts are powerful tools that can be used to help lower
costs and empower individuals, providing greater flexibility to spend
health-care dollars as they see fit.
Question. The ACA took steps to enhance price transparency of
health-care services by requiring health plans to be more explicit
about what they cover. A knee replacement in the United States could
cost $11,000 in one area of the country and nearly $70,000 in another
area. Consumers are still largely unaware of what they will be billed
after a certain test or procedure.
What steps do you plan to take as HHS Secretary to improve price
transparency for consumers?
Answer. If confirmed as HHS Secretary, I would work to improve
price transparency to foster and facilitate patient choice. In so
doing, I would be focused on actual costs and not costs billed to
insurance companies or from a master price list no one uses. At the end
of the day though, until patients rather than government are making the
purchasing decisions, the price transparency information we might aim
to provide is of limited utility because it does not reflect the
patients' collective choice and willingness to pay but the
government's.
Question. I worked with Senator Portman to introduce the Medicare
PLUS Act which would set up a pilot program to help the top 15% of the
highest-cost Medicare beneficiaries by coordinating their health care
needs. As you may know, 15% of Medicare beneficiaries have six or more
chronic conditions and account for 50% of total Medicare spending.
What steps will you take as HHS Secretary to pilot this program and
ensure that these patients get the coordinated care they need?
Answer. If confirmed as Secretary, I would explore what voluntary
options we can make available to the Medicare beneficiaries with the
greatest needs and their physicians. I think many will appreciate the
opportunity to work with a care manager and possibly others who will
spend the time and effort needed to help the patient make different
choices to manage their own care. I would seek to work with you on your
proposal to explore how it and others like it can be a path to
empowering those who are subjected to the most uncoordinated and
challenging aspects of our health-care system.
Question. Congress and the last administration have made it a
priority to pursue delivery system reforms that improve quality and
lower costs. The Advancing Care for Exceptional (ACE) Kids Act, on
which I worked with Senator Grassley, aims to coordinate care for
vulnerable children with complex medical conditions.
What steps will you take as HHS Secretary to promote increased
emphasis on reforms that target the needs of children with complex
medical conditions?
Answer. If confirmed as Secretary, I would look across the
Department to identify all the ways in which HHS aims to help these
children in need. And I would hope to encourage our use of existing
authorities and funding to better align resources to meet this
challenge. I would also work with members of Congress on their ideas on
this important topic.
Question. Over 500,000 children in Colorado are enrolled in
Medicaid. Nationally, the program covers over 30 million kids.
If Medicaid is transformed from an entitlement program to a block
grant, can you guarantee that those children will maintain coverage?
What metrics will you use to ensure that those children are covered and
have access to the same services that they do today?
Answer. It is important that every child has access to high-quality
health coverage, and Medicaid plays an important role in accomplishing
this objective. If confirmed as Secretary, my goal would be to ensure
that no child in Colorado or anywhere else is left behind.
Question. The Children's Health Insurance Program (CHIP) currently
covers 60,000 children in Colorado, increasing access to routine check-
ups, prescriptions, and emergency services for vulnerable kids.
Extension of the program needs to occur early this year in order for
States to plan and have budget certainty.
What is your position on CHIP? What reforms would you recommend as
HHS Secretary before supporting extending the program?
Answer. It is important that every child has access to high-quality
health coverage, and CHIP plays an important role in accomplishing this
objective. CHIP plays a major role in this, but there is also a need
for coordinated family coverage in the private market and employer
plans, and giving States the needed flexibility.
Question. The National Health Service Corps Loan Repayment Program
has been vital in supporting primary care providers who then practice
in Health Professional Shortage Areas (HPSAs). The ACA expanded this
program and it has added necessary primary care providers in Colorado.
If confirmed as HHS Secretary, will you recommend that Congress
support this program to increase the number of primary care providers
in rural and underserved areas?
Answer. As a physician, I understand the value and importance of
the National Health Service Corps (NHSC) and the NHSC Repayment
Program. I have included loan forgiveness for primary care providers in
past legislative proposals, and I look forward to working with Congress
on this issue when I am confirmed.
Question. The Pharmacy and Medically Underserved Areas Enhancement
Act recognizes pharmacists as health-care providers in underserved
areas in order to expand access to care. In areas with a shortage of
primary care providers, pharmacists may play a key role in helping
patients manage their diseases to avoid Emergency Department visits and
hospitalizations. These services are especially important for patients
with multiple chronic conditions who may be taking several medications
at a time. As HHS Secretary, would you support this approach as a way
to increase care in rural and underserved areas?
Answer. We ought to step back and say, ``What are we doing wrong?''
as one out of every eight physicians no longer sees Medicare patients.
Therefore, if confirmed as Secretary, I would be open to all options to
address the impact of the ongoing physician shortage in rural areas.
Paying pharmacists in underserved areas to engage in certain medical
services could work well in those States where pharmacists have such
licensure and a setting appropriate to the services, where primary care
doctors continue to be involved in care, and where there is a patient
and consumer demand for such services.
______
Questions Submitted by Hon. Sherrod Brown
medicaid expansion
Question. During your testimony in front of the Senate HELP
Committee last week, you told Senator Murkowski that Medicaid is an
absolutely imperative program. You also said, in a response to one of
Senator Young's question, that Medicaid is a program where ``the States
know best how to care for their Medicaid population.''
I agree that every State's role in the Medicaid program is
significant, which is why I want to protect State flexibility when it
comes to this program. Thirty-one States--including my home State of
Ohio--have made the decision to expand Medicaid coverage under the
Affordable Care Act (ACA).
Ohio's Governor John Kasich, in a letter to Senator Hatch just last
week, wrote ``we strongly recommend that States be granted the
flexibility to retain the adult Medicaid coverage expansion and Federal
matching percentage.''
Governor Kasich's letter also said that those States that have
opted to expand Medicaid are experiencing significant positive results.
In Ohio, high-cost ER utilization has gone down, health status has
improved, and most enrollees have found it easier to keep or find work.
Further, thanks to ACA's Medicaid expansion, Ohio was able to extend
coverage to 700,000 previously uninsured Ohioans.
Do you support the flexibility provided to States under the ACA to
expand Medicaid?
Answer. State flexibility is an important component in making
Medicaid more workable for patients. Every State has different
demographic, budgetary, and policy concerns that shape their approach
to Medicaid and Medicaid expansion. That is one of the reasons I
devoted so much time to working to help identify creative solutions,
and why I believe a one-size-fits-all approach is not workable for a
country as diverse as the United States.
Question. As a cabinet-level advisor to the President, how will you
advise the President on any bill that would limit a State's flexibility
to expand Medicaid--like Ohio did--as provided for under the ACA?
Answer. I look forward to faithfully executing whatever law that
Congress passes and the President signs, if I am confirmed.
Furthermore, I am committed to ensure that the Medicaid program is well
administered, effective, and available for eligible beneficiaries and
that the States/Governors are given the flexibility to pursue
innovative approaches that fit the needs of their States.
Question. As part of the Medicaid program in Ohio, Governor Kasich
has led efforts to engage providers, payers, community organizations,
and employers and encourage them to work with the Medicaid population
and provide a ladder out of poverty. As a result, more than 70% of the
expansion population in Ohio reports that, since getting covered, it
has been easier for them to keep or find a job.
One program in particular, CareSource's Life Services pilot program
provides supports and mentoring to help individuals achieve physical
and behavioral health and economic stability. The CareSource Life
Services program could serve as a national model for lifting
individuals out of poverty.
As Secretary of Health and Human Services, how will you work to
support and expand funding for programs like Life Services?
Answer. I understand that some enrollees in CareSource's Medicaid
managed care product have access to a program called Life Services
which provides services and supports to help the enrollees obtain and
keep jobs. Although I understand this Life Services program is a
benefit of the managed care plan and not part of an Ohio Medicaid 1115
waiver demonstration, I would be interested to explore with you and
others how such programs might be integrated or associated with a
Medicaid waiver. This kind of development shows why waivers are an
important tool for States to innovate within the Medicaid program, as
they have for many years prior to the ACA becoming law.
medicare negotiations/drug prices
Question. Last week when you testified in front of the HELP
Committee, you were also asked how we should address the high cost of
prescription drugs.
You avoided answering questions from many of my colleagues by
saying that, as Secretary of HHS, your job will be to ``administer''
programs and not ``legislate.''
President Trump supports the elimination of the noninterference
clause in Medicare Part D. He would like to have the Centers for
Medicare and Medicaid Services (CMS) negotiate directly with drug
manufacturers to get the best deals on prescription drugs for our
Nation's seniors.
If Congress passes legislation supported by the President that
gives the Secretary of HHS the authority to negotiate and this
legislation is signed into law--would you use this administrative
authority to negotiate better prices on behalf of the more than 40
million Part D beneficiaries?
What are your ideas on effective ways to reduce out-of-pocket
prescription drug costs for Medicare beneficiaries?
Answer. We all share concern when prescription drug prices are too
high for anyone to access the drugs they need. This especially concerns
me as a doctor. If confirmed, I look forward to using tools Congress
provides to lower health-care costs. In addition, we need to continue
to build on the gains towards affordability allowed by the Generic Drug
User Fee Act and find additional ways to facilitate more efficient
generic entry. This starts with making sure that we are giving generic
sponsors clear guidance so that they can prepare approvable
applications on the first try. If I'm confirmed, I'm committed to
working with the FDA (and Congress, if appropriate) to find additional
efficiencies and administrative steps that can help facilitate
appropriate generic entry.
fair pay/home-care workers
Question. The majority of the home-care workforce--or those
individuals who provide services to older Americans and individuals
with disabilities who receive home- and community-based services
through Medicaid--is made up of female workers.
This workforce is primarily paid through Medicaid and, on average,
States pay these workers an average of just $13,000 a year. This means
that those women caring for the disabled and elderly are often forced
to rely on Medicaid themselves.
In order to provide the highest level of quality care to our most
vulnerable Americans--the elderly and those with disabilities--do you
agree that those home-care workers providing this care full time should
be paid more than $13,000 a year by their State Medicaid program--
``yes'' or ``no''?
Answer. I agree it is important to provide those who care for our
most vulnerable total compensation that reflects the important work
they do. In many cases, this compensation may include more than wages
and could, depending, e.g., on housing prices, be significantly more
than the number given.
Question. Past leadership at CMS committed in writing to exploring
Federal actions under its current authority that could work with States
to strengthen and support home-care workers. In a meeting with Finance
Committee Staff last week, you expressed an interest in building off of
the work of the prior administration.
Will you commit to continuing this work to ensure fair pay and
advancement opportunities for the home-care workforce. Describe how you
would go about achieving this goal.
Answer. If confirmed, I would be pleased to work with you to
explore such options. One potential issue is to ensure that such
workers are not somehow considered State employees and therefore
subject to unique requirements and diversions from income that relate
to that labor workforce. Another longer term situation is to empower
patients, as the ultimate recipient of these services to make choices
regarding providers of these services that leads to a competitive
market for higher performing workers who satisfy customers.
infant mortality/tobacco
Question. Ohio has one of the highest infant mortality rates in the
country. In 2015, our State ranked 42nd in the Nation for infant
mortality, and even worse for African American babies.
We don't know exactly why Ohio does so poorly when it comes to
infant mortality, but one thing that we do know is that health
complications caused by preterm births are the leading causes of infant
mortality. We also know that a major factor in premature births is
tobacco use, and Ohio's smoking rate among pregnant women is nearly
twice the national rate.
In addition to providing coverage to an additional 20 million
Americans, the Affordable Care Act also strengthened Medicaid coverage
of services that help tobacco users to quit. Local groups have taken
advantage of these provisions in their fight against infant mortality.
Medicaid covers nearly 50 percent of births in this country. Do you
support the current requirement that State Medicaid programs provide
pregnant women with effective tobacco cessation services without cost
sharing?
Answer. The science is pretty clear that tobacco use during
pregnancy is risky for both moms and babies. States should have maximum
flexibility to prioritize critical health risks such as smoking during
pregnancy. When it comes to Medicaid requirements, I hope to return a
lot of control to States, and if confirmed, I will be reviewing such
requirements and their efforts in order to develop policy
recommendations for reform.
Question. How will you work with Congress to maintain this
requirement so that all pregnant women--regardless of their income--has
access to tobacco cessation services?
Answer. The science is pretty clear that tobacco use during
pregnancy is risky for both moms and babies. Availability of cessation
programs is important. I look forward to faithfully executing whatever
law that Congress passes and the President signs, if I am confirmed.
Regardless, I commit to work as HHS Secretary to ensure that the
Medicaid program is well administered, effective, and available for
eligible beneficiaries and that the States/Governors are given the
flexibility to pursue innovative approaches that fits the needs of
their States.
infant mortality
Question. As I mentioned in the hearing and in my question above,
the infant mortality rate among African American infants in the State
of Ohio is among the worst in the United States. The overall rate of
infant mortality in Ohio is 42nd in the Nation. I have introduced
legislation to improve prevention efforts nationwide by improving
Federal reporting of infant and childhood deaths, putting the power in
the hands of the Secretary of HHS to generate the metrics by which
these incidences are reported.
As Secretary of HHS, how would you work to ensure adequate funding
for the issue of infant mortality, and which metrics and protocols
would you use to improve reporting of infant mortality cases across the
country?
Answer. Infant mortality is a serious concern for our Nation. While
many of the underlying factors that contribute to infant mortality are
poorly understood, we know that certain health behaviors, including
alcohol consumption and tobacco use during pregnancy, have contributed
to higher rates of infant mortality in the United States. Access to
prenatal care is also vitally important.
If confirmed as Secretary of HHS, I would work to examine the range
of HHS programs, including research to prevent infant mortality,
programs to prevent child abuse and neglect, efforts to increase access
to health services for low-income pregnant women and infants, childhood
vaccination initiatives, home visitation programs, and other
initiatives across the Department to ensure these resources are used
more effectively to address this issue and, if necessary, seek
additional funds.
Regarding metrics used to report infant mortality, I agree that
measurement is extremely important as we tackle this problem. I intend
to work with the Congress and within the Department to bring more
consistency and accuracy to how we measure infant mortality.
medicare part d/dir payments
Question. As you know, community pharmacies serve on the front
lines as health-care providers and play an integral role as part of the
Medicare Part D benefit. In recent years, however, pharmacies have
faced increasing uncertainty in their ability to serve Medicare
beneficiaries due to the increasing use of post-claim adjudication
price concessions and fees imposed by pharmacy benefit managers, called
Direct and Indirect Remuneration (DIR) fees.
CMS has recognized issues with how DIR fees are reported by part D
plan sponsors, how these fees impact pharmacy business, and the
resulting challenges they create for Part D beneficiaries. To respond
to these issues, CMS proposed guidance (Proposed Guidance on Direct and
Indirect Remuneration and Pharmacy Price Concessions) to standardize
the timing of how these fees are reported on September 29, 2014. This
proposed guidance would help pharmacists better serve Part D
beneficiaries by providing greater clarity about their reimbursement
when medications are dispensed and would benefit beneficiaries in that
they would be able to make more accurate comparisons in plan
selections.
Will you commit to supporting the finalization of such guidance?
Are there other things you would do to ensure pharmacies have the
information they need--in real time--to best serve their beneficiaries?
If so, what are they?
Answer. If confirmed, I will look forward to working with you to
consider how to resolve this pending guidance issue. Incidentally, I
understand that on January 19, 2017, CMS released a fact sheet with
information about recent trends in drug costs and Direct and Indirect
Remuneration (DIR) under Medicare Part D.
epsdt
Question. Identifying and treating conditions early in life--during
childhood--before they become expensive long-term liabilities, is not
only the right thing to do, but also cost effective. In 1967, Congress
added a guaranteed benefit for children in the Medicaid program called
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
benefit.
To this day, EPSDT continues to guarantee that children in the
Medicaid program are appropriately screened and given the necessary
treatments they need to thrive. If Medicaid were turned into a block
grant--and existing Federal standards were cut back--EPSDT would be at
serious risk, and child health would be put in jeopardy.
Are you committed to maintaining EPSDT as a guaranteed benefit for
children in the Medicaid program?
Answer. Children are, and will continue to be, a high-priority
population within the Medicaid program. States are well-positioned to
determine the most appropriate ways to ensure access to the highest
quality care for children, which includes diagnosis and screening
procedures and the illnesses and conditions they uncover.
Question. What are the most important metrics in evaluating the
success of the EPSDT program?
Answer. From a clinical perspective, successful diagnosis and
screening procedures are determined by how well they identify illnesses
and conditions. Successful treatment of those illnesses and conditions
is best evaluated by the extent to which the patient's care goals are
achieved.
Question. If confirmed, how will you use your authority to make
sure EPSDT remains an effective program in ensuring children's health
through Medicaid?
Answer. I look forward to working with States interested to advance
initiatives designed to improve the quality of care provided to all
Medicaid members, especially children.
Question. Through the creation of the EPSDT benefit, Medicaid
solidified dental services as a necessary component of coverage for
low-income children and adolescents. Similarly, Congress recognized the
need to include dental coverage as a requirement in the second
iteration of the Children's Health Insurance Program (CHIP). The ACA
then built on these two programs, and now pediatric dental coverage and
preventive oral health services are included in many private insurance
packages. Despite these advances, tooth decay remains the most common
chronic condition among children.
How would you ensure that any major health reform efforts
appropriately prioritize children's oral health, both in terms of
benefits and affordability?
Answer. If confirmed as Secretary, I would hope to work with you to
revisit the current CMS's ``Oral Health Strategy'' for children
(https://www.medicaid.gov/medicaid/quality-of-care/downloads/cms-oral-
health-strategy.pdf). I would also aim to provide States with
flexibility in their Medicaid programs to provide both coverage and
access to these services. Lastly, there may be opportunities to
encourage innovation in both the coverage and payment for these
services as well as the actual technology and even the relevant public
health education strategies.
medicaid payment parity
Question. On average, Medicaid pays providers about 70 percent of
what a Medicare provider receives for the same service. The only
difference is the age of the patient being served. There are 45 million
children enrolled in Medicaid and as you noted in your hearing, and
inappropriately low Medicaid payments impede the ability of providers
to accept more patients--both pediatric and adult--covered through this
program.
Along with Senator Murray, I have worked to introduce the Ensuring
Access to Primary Care for Women and Children Act in past Congresses,
legislation that would solidify parity between Medicare and Medicaid
reimbursements for primary care.
In today's hearing, you mentioned that only one in three providers
accepts Medicaid patients. You cannot deny that lower Medicaid
reimbursements is a contributing factor to this issue.
This is a platform in which the HHS Secretary can take a stance and
move legislation forward. Do you believe that a child's care should be
valued at only 70 percent of that of an adult?
Answer. A child's care should not be valued at only 70 percent of
that of an adult. The current Medicaid payment system is an inelegant
combination of base rates set by States, supplemental payments to
providers, and other Federal and State funding sources for care to the
Medicaid or uninsured populations.
Question. If confirmed, how will you work to improve access to care
under Medicaid by adequately and equitably reimbursing physicians that
treat Medicaid patients?
Answer. I agree that adequate Medicaid reimbursement is essential
to ensuring care for some of our most vulnerable citizens, and I look
forward to working with Congress to accomplish this important
objective.
lead
Question. Dr. Price, do you believe that there is no safe level of
lead in children's blood?
Answer. Science should guide our conclusions in this area. If
confirmed, I look forward to working with you to ensure safe
environments for America's children.
Question. The CDC very recently lowered its reference level for
public health intervention for elevated childhood blood lead levels
from 5 to 3.5 micrograms per deciliter.
Lead is a neurotoxin, and exposure to it can have devastating
lifelong consequences for children. Ohio is one of 29 States receiving
funding from CDC for a State-wide lead poisoning prevention program. In
2014, almost 6,000 children under age six in Ohio, or 3.85% of those
tested, had elevated blood lead levels.
If confirmed, will you keep the CDC's lowered lead reference level?
Answer. If confirmed, I pledge to work with our public health
specialists at CDC and throughout the Department to learn more about
the impact of lead poisoning and communicate the dangers to families
and communities.
Question. At the end of 2016, CMS committed to developing and
improving a targeted blood lead screening policy to ensure more
children eligible for EPSDT benefits are tested. Can you commit to
continuing this work and improving coordination across Federal agencies
to enhance our lead screening and treatment policies and achieve better
outcomes?
Answer. If confirmed, I commit work to improve coordination across
Federal agencies to enhance our lead screening and treatment policies
to achieve better outcomes.
Question. What additional actions would you have HHS take to reduce
the number of American children with elevated blood lead levels?
Answer. If confirmed, I pledge to work with our public health
specialists at CDC and throughout the Department to learn more about
the impact of lead poisoning and communicate the dangers to families
and communities in order to reduce the number of American children with
elevated blood lead levels.
temporary assistance for needy families (tanf)
Question. As part of welfare reform, Congress restructured the
Temporary Assistance for Needy Families--or TANF--program as a fixed
block grant. Evidence shows that one effect of turning TANF into a
block grant program has been that States are spending less and less on
TANF programs and instead using these Federal dollars to support gaps
in State budgets. This change has resulted in more Ohioans who struggle
to support their families with earnings below the poverty level.
What does that say about other proposals to block grant programs
like Medicaid? Do you think that the block grant approach should be a
model for other safety net programs?
Answer. While this would ultimately be a matter for Congress to
decide, I have long supported States finding their own solutions in
addressing unique or complex situations in their States.
Question. In November 2015, the State of Ohio asked HHS for a TANF
waiver that would have (1) removed the distinction between ``core'' and
``non-core'' hours, (2) increased the vocational education training
limit from 12 to 36 months, (3) increased the job search and job
readiness time limit from 6 to 12 weeks and removed the 4 consecutive
week time limit, and (4) removed the 16 hour monthly cap on good cause
hours credited towards work participation (while maintaining the 80
hour annual cap). HHS never acted on this request.
Given that this application has the support of Governor Kasich, if
confirmed as HHS Secretary, would you grant this waiver to the State of
Ohio?
Answer. In 2012, GAO responded to a congressional inquiry about an
ACF Information Memorandum inviting States to apply for waivers to the
TANF work requirement. GAO concluded that the Information Memorandum
was a rule that must be submitted to Congress and the Comptroller
General before taking effect. If confirmed as HHS Secretary, I will
enquire about the status of this matter and the waiver request from the
State of Ohio, and provide a response if one has not previously been
sent.
medicare observation status/3-day rule
Question. Instead of privatizing Medicare or raising the
eligibility age, we should be discussing ways to make Medicare stronger
for our Nation's seniors. One way to strengthen the program--which you
brought up in today's hearing--is to enable beneficiaries better access
to skilled nursing facilities after hospitals stays by revisiting the 3
day rule.
In order for Medicare Part A to cover skilled nursing facility
care, a beneficiary must be admitted to a hospital for 3 days under
inpatient status. I have heard from too many Ohioans whose skilled
nursing facility care was not fully covered by Medicare because their
hospital stays were classified as ``observation'' rather than
inpatient.
My Improving Access to Medicare Coverage Act, which I plan to
reintroduce this Congress, which would enable time beneficiaries spend
in the hospital under observation to count toward the 3-day requirement
for Medicare coverage.
If confirmed, will you work to administratively correct this
billing technicality that adversely impacts Medicare beneficiaries? If
you are unable to do so administratively, will you work with me to pass
this legislation to correct the deficiency in current law?
Answer. If confirmed, I will be pleased to work with you to further
consider the necessity of the 3 day rule and its pros and cons. I will
endeavor to work with CMS to identify what more can be done with regard
to the observation status issue as well. And if the best path forward
involves legislation, I would be pleased to work with you on that as
well.
biosimilars
Question. Last year, a number of my colleagues and I sent a letter
to then President-elect Trump, encouraging him to work with us on
reducing prescription drug prices for all Americans. Specifically, we
highlighted the need to promote innovation and foster competition in
drug development.
I have introduced legislation in the past that would help achieve
this by shortening the patent exclusivity period for expensive, brand-
name biologic drugs and allow biosimilars to enter the market sooner.
Biosimilars, which are equivalent in safety and efficacy to their
reference biologics, have the capacity to reduce prescription drug
costs, yet physicians must be willing to prescribe them and patients
need the information necessary for them to be confident in taking them.
As a physician, do you believe physicians and patients understand
what biosimilars are and how they work? Do you believe the patients and
physicians see biosimilars as a safe, effective, and less-costly
alternative to biologics?
What do you believe to be the FDA's role in educating patients,
providers, and other stakeholders about biosimilars? How will you, as
Secretary of HHS, support and encourage the robust uptake of
biosimilars in the United States?
Answer. As a doctor, I appreciate your concern that health-care
providers and patients be informed when making health-care decisions.
It is important that the FDA provide clear and timely guidance as it
carries out its responsibilities with respect to biosimilars. I
understand that this is particularly important given that the number of
biosimilars available to consumers is expected to increase and the
potential that these products have to increase consumers' health-care
options.
cost-sharing
Question. More than 25 years ago, Congress implemented protections
to ensure that Medicare beneficiaries are treated and billed fairly by
their providers in response to growing concerns that patients charged
more than the standard 20% Part B coinsurance were opting out of
critical care due to high out-of-pocket costs. However, while you were
in Congress, you backed legislation that would have weakened these
protections, allowing Medicare providers to enter into private
contracts with seniors and people with disabilities to determine cost
sharing amounts.
Do you maintain your position that these patient protections should
be undone and will you continue to advocate for permitting doctors who
serve seniors to charge them more than 20% over what Medicare pays,
your concern being that those limits compromise access to care for
seniors?
Answer. If there are any program changes in this area, they should
be voluntary for both patient and physician.
Question. Do you believe that Medicare doctors should be allowed to
charge patients whatever they choose?
Answer. If there are any program changes in this area, they should
be voluntary for both patient and physician.
Question. What would you say to fixed-income seniors who receive
unexpected additional costs simply so that physicians can be paid more
than the agreed-upon insurance coverage limit? Is this not putting
patients above profits?
Answer. Our goal is to ensure all Medicare recipients are able to
obtain the highest quality health care. If there are any program
changes in this area, they should be voluntary for both patient and
physician.
state health insurance assistance programs (ships)
Question. The State Health Insurance Assistance Programs (SHIPS)
are the only source of one-on-one Medicare counseling for seniors and
people with disabilities. In 2015, over 7 million people with Medicare
received help from SHIPs, including 375,000 Ohioans using the Nation's
best-ranked SHIP program in the country. Since 1992, counseling
services have been provided via telephone, one-on-one in-person
sessions, interactive presentation events, health fairs, exhibits, and
enrollment events. Individualized assistance provided by SHIPs almost
tripled over the past 10 years.
This modest program is operated in every State and U.S. territory,
and has been significantly under-funded for years despite the growing
demand for services by our Nation's seniors and individuals with
disabilities.
Will you pledge to support increased funding for SHIPs as the
country's Medicare-eligible population continues to grow in the
President's proposed budgets?
Answer. If confirmed, I will fairly consider the needs and work of
the SHIPs in light of a growing Medicare population, as well as
consider other ways to support them to make them even more efficient.
SHIPs and others like them play an important role in making sure
patients are actual health-care consumers. This is a virtuous cycle
because it facilitates putting the patient at the center of both health
care and health-care coverage decision-making.
drug pricing
Question. In December, President Trump told Time magazine, ``I'm
going to bring down drug prices. I don't like what has happened with
drug prices.''
Do you agree with President Trump? If confirmed as Secretary of
HHS, will you work to bring down drug prices?
Answer. Yes. We all share concern when prescription drug prices are
too high for anyone to access the drugs they need. This especially
concerns me as a doctor. If confirmed, I will ensure that CMS looks for
ways to ensure that it uses the authorities and tools it has at its
disposal to ensure drug prices in the Medicare program, in both part B
and part D, are manageable for beneficiaries.
Question. Given the significant burden prescription price tags have
on individuals and taxpayers, what do you see as the best market-based
solution to combat prescription drug price gouging?
Answer. In addition, we need to continue to build on the gains
towards affordability allowed by the Generic Drug User Fee Act and find
additional ways to facilitate more efficient generic entry. This starts
with making sure that we are giving generic sponsors clear guidance so
that they can prepare approvable applications on the first try. If I'm
confirmed, I'm committed to working with the FDA (and Congress, if
appropriate) to find additional efficiencies and administrative steps
that can help facilitate appropriate generic entry.
Question. Do you believe that Americans deserve more information
about when and how prescription drug prices rise so that they can make
the most informed decisions for their families?
Answer. Yes. I support empowering patients by putting more
information in their hands so they can make health care consumer
choices that make sense for them and their families.
office of refugee resettlement
Question. The Secretary of HHS responsible for overseeing the
Office of Refugee Resettlement at HHS. This office is in charge of
providing for the basic needs of refugees when they first arrive in the
United States, including victims of human trafficking, torture
survivors, individuals who are granted asylum, and those who are
resettled here after helping our troops abroad because it is no longer
safe for them in their home country.
If confirmed, what will you do to ensure these necessary services
are provided despite a significant lack of funding for this program?
What are your plans for this office?
Answer. The law is clear when it comes to administering services
for refugees, survivors of torture, and other populations who receive
assistance through ORR. If I am confirmed, I will work to effectively
and efficiently administer this Office.
Question. Will you advocate for additional resources for this
office, given the current refugee crisis across the globe?
Answer. Should circumstances on the ground change, and current
resources are found to be insufficient, I will inform Congress and work
with them on finding solutions.
Question. How will you work with our partners around the globe to
ensure a safe and smooth transition for refugees coming into the United
States?
Answer. Should I be confirmed, it would be my expectation to work
with the U.S. Department of State, as well as our partners around the
globe, to ensure a safe and smooth transition for refugees coming into
the United States.
center for medicare and medicaid innovation (cmmi)
Question. You've stated that you support innovation and see
potential in CMMI. Would you support continued testing through CMMI in
its current form?
Answer. CMMI is a program providing significant opportunity for
testing new models for health-care financing and delivery. I defer to
the Congress regarding the funding of the Innovation Center and any ACA
repeal and replacement legislation. If confirmed, as HHS Secretary--and
if the Innovation Center remains funded--I will ask CMS to pursue
models that will lower health-care costs and improve quality for
Medicare and Medicaid beneficiaries.
accountable care organizations (acos)
Question. Many hospitals, physicians, nursing facilities, and
others have invested significant resources to participate in ACOs and
bundled payment systems. Ohio is home to some of the largest ACOs, by
membership, in the Nation.
How would you respond to the concerns of ACO administrators and
providers that there may be delays or disruptions in their innovative
models due to a repeal of the ACA?
Answer. If confirmed, I am committed to working with all providing
health care to incentivize innovative models for care financing and
delivery.
Question. Do you support the continued implementation of the
current voluntary models--ACOs and bundled payment models?
Answer. In general, yes. I look forward to reviewing all models, if
confirmed. As a physician, I appreciate the goal behind the creation of
the ACO model: better patient care. As a legislator, I would agree
their successes have been modest to date, and there are some challenges
they face as well. ACOs are a tool in the toolbox to help ensure high
quality, low cost health care for beneficiaries. They are not a silver
bullet to all of our country's delivery system challenges. If
confirmed, I plan to work with the CMS Administrator to ensure that we
learn from ACOs' successes and challenges to date as we chart the path
forward.
For certain populations, bundled payments make a lot of sense. And
they can often lead to both better health outcomes and reduced costs.
But it is important we not get fixated on one of those two outcomes.
That is, I support making certain that we deliver care in a cost-
effective manner but we absolutely must not do things that harm the
quality of care being provided to patients.
What we ought to do is allow for all sorts of innovation. Not just
in this area. There are things that haven't been thought up yet that
would actually improve health-care delivery in our country and we ought
to be incentivizing that kind of innovation. And in finding our way to
those innovations, we ought to remember we are not talking about
science experiments in a lab or a computer simulation, but about
experiments involving real patients' lives.
pama implementation
Question. In 2014, Congress passed the Protecting Access to
Medicare Act (PAMA), which included a provision to change the way labs
are reimbursed under the Medicare program by moving away from the
Clinical Laboratory Fee Schedule (CLFS) and toward a more market-based
payment methodology.
We are concerned that CMS's regulations implementing this
provision, finalized in June 2016, contain a reporting deadline that is
difficult for the laboratory community to meet. In addition, many of
our community-based and regional laboratory constituents serving the
Medicare program have expressed significant concerns over requirements
from the regulation that make reporting accurate data a concern, and
requirements from the regulation that result in the exclusion of market
data from the hospital outreach laboratory community. Lastly, we have
concerns over CMS's definition of an ``applicable lab'' in the final
regulation. We believe the current definition would result in very few
labs having to report their data.
The Office of the Inspector General has also raised each of these
issues--the timeline, accuracy, exclusion of hospital labs, and lack of
required reporting--as potential flaws in the regulation in their
September 2016 report, which addressed PAMA implementation. In fact,
the OIG reported that only 5% of labs will be required to report payer
data, excluding 95% of the market and thereby potentially skewing the
market rates.
In order to fulfill the goals of PAMA, it is critical that the
market data collected and assessed by CMS represents the entire
laboratory market, consistent with the statute, to ensure both
equitable and successful implementation of the law. Understanding that
this regulation is on a short time-line, given that CMS is set to
finalize a new fee schedule in 2017 for implementation in 2018, what
would you do to address the concerns listed above and ensure the new
market-based payment methodology and payment processes for clinical
laboratory tests are not unduly burdensome on community-based labs or
potentially detrimental to patient access?
Answer. I appreciate your concerns regarding the implementation of
PAMA. Certainly, we should strive for accuracy in this market data
collection process. I look forward to following up with CMS staff and
agree that community-based labs should not be unduly burdened and thus
limiting patient access.
Question. Will you commit to revisiting the definition of
``applicable lab'' to ensure equitable and successful implementation of
the law, accurately reflecting the entire market?
Answer. As you know, section 216(a) of the Protecting Access to
Medicare Act of 2014 (PAMA) added section 1834A to the Social Security
Act (the Act), which requires revisions to the payment methodology for
clinical diagnostic laboratory tests paid under Medicare, including
reporting requirements for laboratories.
CMS finalized a low expenditure threshold to reduce the reporting
burden on small laboratories. Under the final rule, CMS will generally
exclude a laboratory from being an applicable laboratory, and thus from
having its private payor data reported, if it is paid less than $12,500
under the CLFS during a data collection period. CMS expects that 95
percent of physician office laboratories and 55 percent of independent
laboratories will not be required to report. Additionally, I understand
CMS-imposed reporting requirements at the TIN level will be less
administratively burdensome for the laboratory industry as compared to
requiring data to be reported at the NPI level.
medicaid and family planning services
Question. Two-thirds of births from unintended pregnancies in the
United States are paid for by Medicaid or the Children's Health
Insurance Program (CHIP). In 2010, these unintended pregnancies cost a
total of $21 billion dollars, including $824 million in Ohio.
We know that publicly funded family planning allows families to
prevent unwanted pregnancies, and it is estimated that investing in
family planning services would have saved public funding of unintended
pregnancies by a total of $15 billion, including $607 million for Ohio.
That's striking--almost 75 percent of the money that would otherwise be
spent could be saved through more robust, fully funded family planning
programs.
Do you acknowledge the effectiveness of investing in contraception
and the need to continue the Medicaid State option to expand family
planning services?
Answer. If confirmed, I would work as HHS Secretary to ensure that
the Medicaid program is well administered, effective, and available for
eligible beneficiaries and that the States/Governors are given the
flexibility to pursue approaches that fit the needs of their States.
That being said, I would be hesitant to develop policy on the basis of
financial cost of life.
Question. How will ensure that family planning services, included
access to preferred contraception methods, will remain available to all
women, as you committed to do in today's hearing?
Answer. Women should have the health care that they need and want.
The system we ought to have in place is one that equips women and men
to obtain the health care that they need at an affordable price. As we
work towards a replacement for the ACA, I expect this will be one of
the topics of discussion.
federal research
Question. As chairman of the House Budget Committee, you stated in
your FY17 Budget Resolution that ``the Federal Government has a role to
play in supporting breakthrough research.'' As a medical doctor, you
must understand the importance not only of funding research to find
better cures for your patients, but also of funding the training of the
next generation of doctors and researchers.
If confirmed, how do you pledge to protect and advocate for the
government's critical Federal research initiatives?
Answer. As a physician, I am keenly aware of the progress that has
been made and still to be made through important research initiatives
that are fully or partially funded by the Federal Government.
Implementing the recently passed 21st Century Cures Act will be a
priority in coming months and years, including leveraging the
significantly increased funding for the NIH. NIH plays a leading role
in so many public-private initiatives, and if confirmed, I look forward
to working with leaders at the NIH to advance their important mission
and our administration's efforts to promote innovation on behalf of the
American people.
syringe exchange programs
Question. Like many communities in Ohio, your district in Georgia
has been hit by a significant increase, a 4,000 percent increase, in
opioid-related deaths in the last 5 years. Simultaneously, we are also
seeing an increase in hepatitis C infections and HIV infections among
those who inject opioids and share syringes. One of the clearest
examples of this connection is the HIV outbreak in Scott County,
Indiana, the home State of Vice President Pence. In response to this
crisis, then-Governor Pence declared a public health emergency and
changed Indiana's policy to allow State dollars to support Syringe
Exchange Programs or SEPs.
The Centers for Disease Control and Prevention (CDC), Institute of
Medicine, and many other scientific bodies have stated unequivocally
that SEPs are highly effective in stopping the spread of HIV/AIDS and
Hepatitis C. Cleveland has one of the longest standing SEPs, and as a
result has seen a decrease in the rate of new HIV infections as a
result of intravenous drug use. In response to progress like this,
Congress partially lifted the restrictions related to the use of
Federal funds for SEPs in 2015. In fact, I note that your wife, who
serves in the Georgia House of Representatives, has also worked to
expand access to needle exchange programs.
In the past, you have voted against funding for needle exchange
programs. Has your position changed?
Answer. As I mentioned in the hearing, I recognize that the opioid
epidemic is real and that substance abuse disorders are plaguing many
Americans. It is important that we as a nation make sure that every
single individual has access to the kind of mental health and substance
abuse care that they need. I have a broad and open mind and welcome
proposals to our Nation's mental health and substance-abuse related
crises, particularly those solutions that are evidence-based. If I am
privileged to serve as the HHS Secretary, I will follow the policies
adopted by the Congress and signed into law by the President.
Question. Do you support continued availability of Federal funds
for SEPs, based on local public health department determination of
need? Why did you oppose it in the past?
Answer. The opioid epidemic is real and substance abuse disorders
are a serious concern for communities across the country. It is
important that we as a nation make sure that every single individual
has access to the kind of mental health and substance abuse care that
they need. I recognize that we may not always agree on the solutions,
but we have a duty to those who are suffering to work together to find
the best answers to these severe problems. I welcome proposals to our
Nation's mental health and substance-abuse related crises, especially
those that are well supported by evidence. Funding decisions ultimately
rest with the Congress, which holds the power over the purse. If I am
privileged to serve as the HHS Secretary, I will follow the policies
adopted by the Congress and signed into law by the President.
Question. If confirmed as Secretary of HHS, how will you work with
States to ensure they have the resources and support necessary to
continue and open new SEPs?
Answer. It is important that we as a nation make sure that every
single individual has access to the kind of mental health and substance
abuse care that they need. All levels of government need to engage and
collaborate to identify effective solutions to these problems.
antibiotic resistance
Question. The emergence of this superbug is extremely serious and
illustrates both how quickly infectious pathogens can spread across the
world and the need for international cooperation in detecting newly
emerging health threats.
Do you agree that a dedicated effort to improving surveillance,
data collection and research efforts is needed to prevent such rapid
spread and evolution of antibiotic resistant bacteria?
Will you advise President Trump to continue President Obama's
National Strategy for Combating Antibiotic-Resistant Bacteria (CARB
initiative)?
How will you ensure that the threat of antimicrobial resistance
remains a high priority for HHS and its affiliates the National
Institutes of Health (NIH), Food and Drug Administration (FDA), and
CDC? In your opinion, how should the United States work with other
nations to combat these threats?
Answer. I share your concern regarding the need to take seriously
the public health threat posed by antibiotic resistance. I appreciate
the important role HHS can play in combatting this public health
threat, from identifying resistance and educating the American people
about it, to helping to advance innovative, new therapies to treat
emerging infections. If confirmed, I look forward to continuing to work
in this area as part of HHS' public health mission.
powdered caffeine
Question. In 2014, Logan Stiner--who was a senior at Keystone High
School in LaGrange, OH--died just 3 days before his high school
graduation from ingesting too much powdered caffeine. For the last
several years, I have worked with Logan's family to raise awareness
about the dangers of powdered caffeine and encourage the FDA to take
meaningful action to limit access to powdered caffeine.
Right now, children and teenagers can buy this potentially deadly
chemical in bulk from domestic and international retailers by simply
going online and clicking a button--without their parents even knowing
about it. Further, companies are trying to find creative new ways to
reach consumers and to dodge States like Ohio that have already passed
laws cracking down on this dangerous substance.
The FDA advises consumers against using powdered caffeine and has
called upon manufacturers to more accurately label these products. But
these actions by the FDA do not go far enough. As Secretary of HHS,
which has jurisdiction over FDA, how will you ensure that the
Department's affiliates, particularly the FDA, are effectively
educating and protecting consumers about the products available to
them?
Answer. FDA plays a valuable role in providing the American public
with timely information about FDA regulated products. I appreciate the
importance of FDA informing individuals and families about whether or
how to use these products. If confirmed, I will ensure that FDA is
fulfilling its statutory responsibilities consistent with its public
health mission.
medicare advantage star ratings program
Question. As you know, CMS uses a star rating system to display the
quality of Medicare Advantage plans. High performing plans receive
quality bonus payments. CMS also has an audit and appeals process by
which to periodically evaluate plans on specific measurements.
Over the past several years, there have been several circumstances
we are aware of where plans are penalized in their star-ratings based
on deficiencies found in an audit. We have heard from a plan based in
our home State of Ohio that was penalized by the interaction between
the audit and appeals policies and the star-ratings program.
If you are confirmed, can you commit to taking a deeper look at the
interaction of these two policies and the potentially negative effect
on plans, on beneficiaries, and on innovative care delivery?
Answer. Yes. If confirmed, I would be pleased to work with your
office and CMS to ensure that the Medicare Advantage stars system
reflects quality and the Medicare Advantage sanctions system reflects
program audit performance, as well as explore whether and how these
policies can be made to work in concert rather than against each other.
cancer moonshot
Question. During last year's State of the Union address, President
Obama announced the Cancer Moonshot initiative, an ambitious project
aimed at improving cancer prevention, diagnosis, and treatment at twice
the rate of current progress of clinical cancer research. The 21st
Century Cures Act re-committed to this critical initiative through the
inclusion of funding for the next 5 years of the program.
Academic and clinical centers in Ohio are playing important roles
in the execution of this initiative, through partnerships like that
that exists between The Ohio State University's Comprehensive Cancer
Center and Columbus's Richard J. Solove Research Institute with Tampa's
Moffitt Cancer Center to form the ORIEN partnership. This initiative is
particularly focused on inclusion and retention of minorities in
cancer-specific clinical trials, an important diversity metric to
improve clinical care for all Americans.
As Secretary of HHS, how will you work to facilitate collaborations
between researchers and clinicians to improve cancer care under the
goals outlined by the Cancer Moonshot?
Answer. If confirmed, we will make treating and helping to cure
cancer a priority and there likely will be overlap with the Cancer
Moonshot goals. Implementing the recently passed 21st Century Cures Act
will be a priority in coming months and the administration will
accelerate efforts to promote innovation in many areas--including the
prevention, diagnosis and treatment of cancer.
tuberculosis
Question. Globally, tuberculosis is now killing more people than
HIV/AIDS, with a death toll of nearly 5,000 per day. In 2015, the
United States experienced the first national increase in TB cases since
1992, with 9,557 total cases. And in 2013, CDC identified drug
resistant TB as a serious public health threat.
CDC provides critically important support to local health
departments to address the TB epidemic, and it supports crucial TB
research. CDC also provides crucial support to the global fight against
drug resistant TB.
Despite these sobering statistics and impressive work done by the
CDC, funding for CDC's domestic TB program has remained stagnant since
FY 2005 at $135 million. As a result, the CDC has stated that are our
national response to TB ``has stalled.''
If confirmed, will you implement the U.S. National Action Plan for
Combating Multi-Drug Resistant Tuberculosis, and will you support
increased Federal funding for the U.S. response to this deadly,
airborne infectious disease?
Better TB drugs and diagnostics are being developed, thanks to U.S.
ingenuity, and these new tools can help us stop this epidemic. What
will you do, if confirmed as Secretary of HHS, to advance these drugs
and diagnostics and provide support to the communities working to
develop new treatments?
Answer. As a physician, I recognize and share your concern
regarding the public health threat posed by tuberculosis, particularly
drug resistant tuberculosis. If confirmed, I look forward to working
with CDC officials in their efforts to combat the spread of
tuberculosis.
low-income heating assistance program (liheap)
Question. As you may know, the LIHEAP program plays a key role in
helping low-income families stay warm in the winter and avoid dangerous
heat in the summer. It is a program that is critical to nearly 450,000
households in Ohio that otherwise would be forced to choose between
keeping warm or going hungry.
If confirmed, will you commit to maintaining the program as
currently structured?
Answer. If I am confirmed, I will implement the program dutifully
in as effective and efficient manner as possible.
Question. Nationwide, nearly 7 million of our Nation's poorest and
most vulnerable households rely on the program. Will you commit to
maintaining and possibly even supporting an increase in the program's
annual appropriation?
Answer. If I am confirmed, I will implement the program dutifully
in as effective and efficient manner as possible. Should circumstances
on the ground change, and current resources are found to be
insufficient, I will inform Congress and work with them on finding
solutions.
nuclear medicine
Question. Diagnostic nuclear medicine procedures help millions of
Medicare beneficiaries detect life altering illnesses, such as heart
disease and cancer, each year. The quick turnaround on nuclear testing,
when used appropriately, helps improve the quality and efficiency of
care by helping to reduce inappropriate or unnecessary procedures.
Despite these positives, CMS continues to treat the diagnostic
radiopharmaceutical drugs used in nuclear medicine procedures as
supplies--not drugs--and, as a result, they are not appropriately
reimbursed under this system.
Physician and industry groups have been working for years to try to
address this issue. If confirmed, will you work with stakeholders to
develop superior payment models to these drugs and nuclear medicine
procedures are appropriately reimbursed?
Answer. I share your concerns and look forward to working with you,
if confirmed.
therapy caps
Question. As you know, the therapy cap exceptions process expires
in less than a year--on December 31, 2017. We have all heard from
constituents whose therapy needs exceeded the cap and their conditions
have deteriorated, necessitating more expensive medical intervention.
As Secretary of HHS, how will you support the repeal of these
arbitrary and discriminatory limits and maintain access to
rehabilitation therapy that Medicare beneficiaries clearly need?
Answer. Rehabilitative therapy is a vital component of recovery for
many patients. Arbitrary limits on its use are not a wise decision for
patient-centered care. If confirmed as Secretary, I will look into this
issue and seek to understand the competing objectives and issues
motivating the current CMS policy. Part of the frustration with the
current health care system is rules like this that do not make sense to
many people. However, that is not surprising when one considers that
Medicare Parts A, B, C, and D have each developed in silos and that
even payment for particular types of services sometimes reflect silos
within the silos. It may be that other approaches to therapy provide
greater quality care at reduced cost with more respect for the
individual needs of each patient in consultation with their doctor. If
confirmed as Secretary, I would hope to break down these silos and
encourage approaches based on a broader perspective.
Question. Given the problems associated with monitoring the therapy
cap, is CMS capable of achieving a timely uniform and defensible
streamlined, responsive, and transparent process for manual medical
review of Medicare records by Medicare administrative contractors?
Answer. We will strive to do so. Any time there is manual review of
anything in an organization with the scale of Medicare, it is a recipe
for something to go wrong. If confirmed as Secretary, I would be
pleased to work with you to confirm whether the staffing and other
resources needed would be up to the challenge you describe.
addiction treatment
Question. If confirmed as Secretary of HHS, how will you prioritize
the prevention, treatment, and recovery from mental and substance use
disorders in States like Ohio?
As our country continues to explore potential reforms to our health
care delivery systems, what will you do to prioritize access to
behavioral health services?
Answer. Mental and substance abuse disorders continue to be a
serious challenge felt in communities across the Nation. I firmly
believe, that it is absolutely vital that substance abuse disorders and
other mental health problems are treated. If confirmed, I will work
closely with you and the other members of Congress to ensure that the
Substance Abuse and Mental Health Services Administration fulfills its
duty of treating those who are in addiction recovery while working to
prevent people from becoming addicted in the first instance.
pharmacists
Question. The Pharmacy and Medically Underserved Areas Enhancement
Act recognizes pharmacists as healt-care providers in underserved areas
in order to expand access to care. In areas with a shortage of primary
care providers, pharmacists may play a key role in helping patients
manage their diseases to avoid Emergency Department visits and
hospitalizations. These services are especially important for patients
with multiple chronic conditions who may be taking several medications
at a time.
If confirmed as HHS Secretary, would you support this approach as a
way to increase care in rural and underserved areas?
Answer. We ought to step back and say, ``What are we doing wrong?''
as one out of every eight physicians no longer sees Medicare patients.
Therefore, if confirmed as Secretary, I would be open to all options to
address the impact of the ongoing physician shortage in rural areas.
Paying pharmacists in underserved areas to engage in certain medical
services could work well in those States where pharmacists have such
licensure and a setting appropriate to the services, where primary care
doctors continue to be involved in care, and where there is a patient
and consumer demand for such services.
______
Questions Submitted by Hon. Robert P. Casey, Jr.
medicaid and chip
Question. You have proposed eliminating the Patient Protection and
Affordable Care Act, an action that would end the expansion of Medicaid
to millions of people and would result in an addition $1.1 trillion
being cut from State budgets. This action would throw millions of
people into the realm of the uninsured, including hundreds of thousands
with disabilities. They would no longer have access to such services
and treatments as behavior health care, mental health treatment, and
preventative services. The services provided by Medicaid expansion have
greatly improved the quality of life for millions of citizens,
particularly those with disabilities.
Do you propose those individuals return to being uninsured? Do you
propose that their health care, including mental health treatments, be
discontinued? Does your plan mean you support returning hundreds of
thousands of people with disabilities into the category of the
uninsured?
Answer. Our goal is to ensure access to affordable, quality health
care for all citizens.
Question. If your plan is implemented, many people who will lose
Medicaid coverage will be people with disabilities who depend on
Medicaid for services that are unavailable through private insurance;
services such as personal care services, respite care, or intensive
mental health services. These health, personal care, and preventative
services allow individuals to live in the neighborhoods of their
choice, be independent, work, and participate in their communities.
Many of these people, capable, able people, will be forced into
institutions if they lose access to these crucial services. They will
lose their independence and we will pay more tax dollars for their
care.
How is this a good outcome for these people and for America?
Answer. Changes to the ACA should not be done in isolation. Our
goal is to ensure access to affordable, quality healthcare for all
citizens. This, of course, includes people with disabilities who depend
on Medicaid. I note that community integration, beneficiary autonomy in
decision making, and person-centered planning are central tenets
articulated in CMS' approach to Home and Community Based Services and
the HCBS Settings Rule with a compliance date in March 2019, and I
support each of those principles. It is also important to note that
many residential, disability-
specific settings have long provided a safe and integrated community
alternative to institutional placement for individuals with
disabilities, and appropriate weight should be given to the preferences
of families and individuals with disabilities because they are in the
best position to decide what type of setting best meets their
individualized needs and circumstances.
Question. Federal flexibility in Medicaid has allowed Pennsylvania
to take extra steps to ensure that children with extensive health care
needs have access to Medicaid, in what's referred to as Family of One
program. This program, in addition to the Medicaid expansion for
parents, has improved the economic security of families in
Pennsylvania. The State's budget relies on the Federal share in order
to support these Medicaid programs. However, the budget you authored in
the House last year would have cut Medicaid funding by $1 trillion
dollars, about one-third over a 10-year period.
Given that half of Medicaid enrollees in this country are children,
how will you ensure that children and families aren't harmed by cuts in
Medicaid funding through block grants?
Answer. Changes to the ACA should not be done in isolation. Our
goal is to ensure access to affordable, quality health care for all
citizens.
Question. As a physician you know that Medicaid covers a broad
range of services to address the diverse needs of the populations it
serves. In addition to covering the services required by Federal
Medicaid law, many States elect to cover optional services such as
prescription drugs, physical therapy, eyeglasses, and dental care.
Coverage for Medicaid expansion adults contains the ACA's ten
``essential health benefits,'' which include preventive services and
expanded mental health and substance use treatment services. Medicaid
provides comprehensive benefits for children, known as ``EPSDT,'' that
are considered a model of developmental pediatric coverage. EPSDT is
especially important for children with disabilities because private
insurance, which is designed for a generally healthy population, is
often inadequate to their needs.
Unlike commercial health insurance and Medicare, Medicaid also
covers long-term care, including both nursing home care and many home
and community-based long-term services and supports. More than half of
all Medicaid spending for long-term care is now for services provided
in the home or community that enable seniors and people with
disabilities to live independently rather than in institutions. Given
that both EPSDT for kids and long term services and supports are not
generally covered in commercial health plans, I fail to see how people
will not be worse off if the structure or financing of the Medicaid
program is restructured in the ways that you and other administration
officials have suggested.
Can you guarantee that under a block grant, per capita cap and/or
an HSA structure that all of these vital services will be covered for
the millions of Americans who count on them?
Answer. My work in the Congress has been to improve Medicaid and
provide additional flexibility. If I have the privilege of being
confirmed as Secretary I would look forward to the opportunity to work
with States and Congress using the tools and authorities given by
Congress in legislation to ensure the highest number of people get
access to the highest quality care.
Question. Forty percent of Pennsylvanian children rely on Medicaid
and CHIP, which serves our State's most vulnerable children: children
living in or near poverty; infants, toddlers and preschoolers during
key developmental years; children with special health-care needs; and
children who have been place in foster care due to neglect or abuse.
Medicaid's comprehensive, pediatrician-recommended services under
EPSDT--Early and Periodic Screening, Diagnostic and Treatment
services--are critical for their health and to ensure that they hit key
development milestones. In recent years, there is clear evidence of the
long-term return on investments in Medicaid. Children enrolled in
Medicaid are healthier as adults and more likely to graduate from high
school, attend college, resulting in greater economic success.
Do you support the EPSDT benefit package for children which ensures
that America's most vulnerable children receive the services they need
to thrive? Are you willing to protect these benefits by not allowing
States to waive this important benefit?
Answer. Every State has different demographic, budgetary, and
policy concerns that shape their approach to Medicaid and Medicaid
expansion. That is one of the reasons I devoted so much time to working
with States to help them to identify creative solutions, and why I
believe a one-size-fits-all approach is not workable for a country as
diverse as the United States. If I am confirmed, I will work with CMS
as they take a look at waivers that are pending and appropriate for my
input and will have to make a decision at that point.
Question. Your 2016 budget proposal would have block granted
Medicaid and would have eliminated many critical patient protections.
With our current Medicaid structure, children have a right to the full
array of services they need, from critical health screenings for cancer
treatment to services for children with autism or mental health needs.
For many children, this coverage can be the difference between life and
death. Medicaid as currently structured also enables children with
disabilities to live up to their potential, be successful in school,
and have the opportunities to be full citizens.
Do you support the continuation of Medicaid's requirement to cover
a comprehensive array of services for children through the Early
Periodic Screening Diagnosis and Treatment (EPSDT) program? Will you
commit to ensuring that HHS will actively enforce the requirement to
provide screenings, diagnosis, and treatment for children with
disabilities or with potential disabilities?
Answer. Our goal is to ensure every single American has access to
the coverage they want for themselves or their children and dependents.
I think the conversation and focus in these topics has been the
question of coverage rather than true access for too long. By that I
mean that Americans might have an insurance card and yet not be able to
afford care or it might not be available to them for other reasons.
Question. Many people with disabilities want to work and can do so
with the services only available through Medicaid, to help them work.
These services include supported employment for people with mental
health disabilities or personal care attendants for those with
intellectual or physical disabilities. Without these services, many
people with disabilities will be unable to work.
How will you ensure that a person with a disability, mental health,
intellectual, physical, sensory, or any other type of disability as
defined by the Americans with Disabilities Act, has access to the
services currently available through Medicaid?
Answer. I look forward to faithfully executing whatever law that
Congress passes and the President signs, if I am confirmed. I commit to
work as HHS Secretary to ensure that the Medicaid program is well
administered, effective, and available for eligible beneficiaries and
that the States/Governors are given the flexibility to pursue
innovative approaches that fit the needs of their States.
Question. As economies evolve, professions change and while new
types of jobs emerge, certain types of jobs are reduced or eliminated
and workers must make transitions. This happens to people across the
workforce, but it happens almost twice as often to workers with
disabilities.
Do you support taking away people's Medicaid coverage because they
lose their jobs? How will you ensure that people with disabilities who
become unemployed are able to retain Medicaid benefits?
Answer. Medicaid is a vital safety-net program, and it is our goal
to strengthen it. If confirmed, I look forward to faithfully executing
laws to strengthen the Medicaid program that Congress passes and the
President signs.
Question. In 1999, in the Olmstead decision, the U.S. Supreme Court
agreed that individuals with significant disabilities have the right,
under the Americans with Disabilities Act, to access services in the
community rather than only in an institutional setting. Since the
Olmstead decision, the U.S. Department of Health and Human Services has
employed its authority over Medicaid waivers to encourage States to
expand home and community-based services and to shift away from
overreliance on institutional care.
Will you continue this longstanding Federal policy? If no, why not?
If yes, what steps will you take?
Answer. I support encouraging the use of home and community-based
services if the services are appropriate, the individual does not
oppose the treatment, and the services can be reasonably accommodated.
Question. Since the Olmstead decision, Congress has authorized
several programs to incentivize States to meet their obligations under
the Olmstead decision by increasing Federal dollars for providing
community-based services. These programs include the Money Follows the
Person program, the State Balancing Incentive Program, the Community
First Choice State Plan option, and the Home and Community Based
Services option. These programs are implemented and managed through the
Department of Health and Human Services.
Is it your view these programs should continue? Why or why not?
Answer. I support ensuring that individuals are able to receive
services in community-based settings.
Question. You are a vocal proponent of passing Federal laws to
change Medicaid from a program that includes an open-ended Federal
financial commitment to fixed block-grant payments to the States.
Would this change end the Federal oversight and incentive programs
that have helped State systems transform into systems that allow
individuals with significant disabilities to live in the community? How
would you ensure that any changes in Medicaid would not move people
with disabilities back into nursing homes and other institutional
settings that are linked to significantly poorer quality of life,
physical and mental health outcomes, and longevity?
Answer. We are committed to supporting high-quality health care for
all Americans, including individuals with disabilities. If confirmed, I
look forward to working with you to achieve these goals.
Question. In 2011, the Department of Health and Human Services
promulgated a rule to ensure that Medicaid funds designated for
services in home and community-based settings were not used to fund
services in segregated, institutional settings. For example, the second
floor of a building used to provide inpatient hospital care could not
be considered a community-based setting. That rule has been championed
by the disability community as critical to afford people with
disabilities the chance to live independent and fulfilling lives in
their own homes and communities.
Do you support the continuation of this rule? Do you commit to
ensure that HHS assertively enforces it?
Answer. Community integration, beneficiary autonomy in decision
making, and person-centered planning are central tenets articulated in
the Home and Community Based Services (HCBS) Settings rule you refer
to, and I support each of those principles. It is also important to
note that many residential, disability-specific settings have long
provided a safe and integrated community alternative to institutional
placement for individuals with disabilities, and appropriate weight
should be given to the preferences of families and individuals with
disabilities because they are in the best position to decide what type
of setting best meets their individualized needs and circumstances.
States must come into compliance with the final rule by March 17, 2019,
and I plan to work with States during this transition period to ensure
continuity of services for Medicaid participants and minimize any
disruptions to them and the service systems they currently rely on.
Question. With an additional 16 million people gaining access to
Medicaid since its expansion and a total of 75 million people covered
by the program, Medicaid continues to be a critical, State-based health
care program. In order to provide effective, high-quality care, States
need dedicated funding for the full Medicare-eligible population as
well as sufficient Federal funding that reflects actual State costs and
increases in health-care costs.
As Secretary of HHS will you ensure that State-funding for health
care is adequate and reflects the actual costs of caring for each
State's Medicaid population?
Answer. States are not just regulatory partners in the Medicaid
program but also co-funders. As we look to provide them with more
flexibility but also continue to provide Federal funds, I agree it is
important States meet their funding commitments and the Federal
Government oversee and check that is the case.
Question. Medicaid provides care to some of the Nation's most
vulnerable and complex populations. In order for States to continue to
provide high-quality and effective care, adequate and sustainable
funding is required.
As Secretary of HHS, will you work to prevent disruption and ensure
adequate and sustainable funding for Medicaid?
Answer. If confirmed, as Secretary I will work to prevent
disruption and ensure adequate and sustainable funding for Medicaid. In
fact, it is just this goal that is at the root of many improvements I
have offered in my career.
Question. During the hearing in the Finance Committee, you gave
your commitment that you would ``absolutely'' support an extension of
the Children's Health Insurance program, and even expressed support for
a longer extension of the program, beyond the typical 5-year
authorization. Yet Gene Sperling wrote in the New York Times on
Christmas Day that--``Mr. Price's own proposal, which he presented as
the chairman of the House Budget Committee, would cut Medicaid by about
$1 trillion over the next decade. This is on top of the reduction that
would result from the repeal of the Affordable Care Act, which both Mr.
Trump and Republican leaders have championed. Together, full repeal and
block granting would cut Medicaid and the Children's Health Insurance
Program funding by about $2.1 trillion over the next 10 years--a 40
percent cut.''
Do you deny that you have advocated for these changes to Medicaid
and CHIP? You also said during the hearing that there were elements of
the budget that you did not support. Which parts do you not support?
Answer. In the past, as a member of Congress, I have advocated
policies that would strengthen our health-care programs so that they
remain solvent for the sake of future generations.
Question. During the hearing, you claimed we were looking at CHIP
and Medicaid in a silo, instead of looking at the entire range of what
the policy will be with respect to health insurance programs. We do not
have anything to compare CHIP and Medicaid to, because this
administration cannot provide a clear plan that is a viable alternative
to the Affordable Care Act, the CHIP program and Medicaid.
What will those policies be, and how will they provide better
options for the children and individuals with disabilities who rely on
CHIP and Medicaid?
Answer. If confirmed, I look forward to working with you to ensure
there are better options available.
Question. In your answer to Senator Alexander's question at the
HELP Committee hearing, you stated, ``folks at the State level know
their populations better than we (in Washington) ever could know
them.'' The bipartisan, consensus-driven National Association of
Medicaid Directors advocated for continuing the State Innovation Model
(SIM) out of the Center for Medicare and Medicaid Innovation. The SIM
has fueled 35 States (led by both Democrats and Republicans) to improve
their local health-care systems.
Given your desire to move decisions and innovation to the local
level, as HHS secretary would you continue to support CMMI's State-
level initiatives?
http://medicaiddirectors.org/wp-content/uploads/2016/12/Key-
Considerations-in-Affordable-Care-Act-Repeal-and-Replace-
Initiatives.pdf
Answer. CMMI is a program providing significant opportunity for
testing new models for health-care financing and delivery.
Question. In reference to your reply to Senator Alexander, 16
States who have expanded Medicaid have Republican leadership. As of
January 19th, at least 5 Republican governors have publicly advocated
to retain the Federal-State Medicaid expansion partnership.
Given that several local leaders--including Republicans--favor
retaining this program, what is your plan as HHS secretary to honor the
wishes of State leadership, preserve this program, and avoid adverse
consequences to States?
http://www.politico.com/story/2017/01/gop-governors-republicans-
obamacare-233576
Answer. If confirmed, I look forward to working with Congress and
Governors to ensure access to affordable, quality health care for all
citizens.
Question. In the past, you have stated support of expanding State
waiver authority for the Medicaid program. Do you support efforts to
evaluate the impact of these waivers in terms of access to care,
quality of care, and costs of care?
Answer. It is my strong belief that we need to look at all possible
outcomes of policy changes.
Question. In 2015, your budget proposal would have repealed the
Affordable Care Act, reduced Medicaid spending, and cut the
Supplemental Nutrition Assistance Program--all told, up to $519 billion
in cuts to needy families--yet your proposal would have increased
defense spending higher than the administration requested, gathering
criticism from other Republicans.
Are you only concerned with increased Federal spending when it
benefits families and children?
Answer. In my time in Congress, I have been concerned with
increased Federal spending at all levels.
Question. In your conversation with Senator Warren and Senator
Kaine during your appearance at the HELP committee, you cited access to
care as your critique for the Medicaid program. You stated that
Medicaid recipients have access to insurance, but they do not have
access to the care they need. Yet the Government Accountability Office
has stated that ``Medicaid enrollees report access to care that is
generally comparable to that of privately insured individuals and
better than that of uninsured individuals.'' The report does cite more
challenges with accessing specialty and dental care.
Do you agree with the GAO's assessment? If so, what strategies
would you suggest to increase access to specialty and dental care for
Medicaid recipients? If you don't agree with the GAO's assessment,
please outline your plan to increase access to Medicaid-eligible
Americans.
Answer. As a doctor who has actually treated thousands of Medicaid
patients, I do care deeply about the Medicaid program and the access of
Medicaid patients to actual care, not just a card they can carry with
them. I know from personal experience the difficulties Medicaid
patients face, and I receive letters about it all the time. My plan is
to work with States to ensure they have the flexibility to make high
quality care truly available.
Question. It is true that Medicaid faces challenges, including low
payment rates and barriers to interstate care which limit access and
must be improved. Greater consistency of national data could
significantly improve Medicaid's ability to serve children and other
beneficiaries and drive quality improvement. Access to certain
services, such as pediatric mental health services is a pressing
concern.
What would you do as Secretary to drive improved outcomes in child
health across States?
Answer. Ensuring children have access to the health care they need
is undoubtedly a top priority. If confirmed, I look forward to working
with you to increase access to affordable health plans for families and
children as well as taking the necessary steps to strengthen American
families.
Question. A major focus of Congress and the administration has been
on pursuing delivery system reforms that improve quality and reduce
costs. The Federal Government over time has focused more on the needs
of children in these reforms, but Medicaid for children still lags
behind Medicare in supporting improvements in care.
What steps will you take to promote increased emphasis on reforms
targeting the unique needs of children?
Answer. Our goal is to make certain that every single American has
access to the coverage they want for themselves and their children; and
we must ensure that the individuals and children who lost coverage
under the Affordable Care Act are able to access quality health care.
If confirmed, I look forward to working with you on this effort.
Question. To ensure kids continue to receive the critical care they
need under Medicaid, any potential restructuring needs to consider
children's unique health care needs and the impact of limiting our
investments into their future and the Nation's as a whole. Any reforms
must ensure children's funding is stable, clearly defined, protects
current services, and begins to remediate shortages in critical areas,
such as mental and behavioral health services.
How will you ensure that Medicaid continues to deliver essential
services tailored to the unique needs of children?
Answer. If confirmed, I look forward to working with you to
prioritize a nation of healthy children through increased access to
affordable health plans for families and children, as well as taking
the necessary steps to strengthen American families.
medicare
Question. Do you support converting Medicare's successful
Independence at Home (IAH) demonstration into a nationwide program? Do
you support the inclusion of licensed mental health professionals on
the primary teams for home-based team care?
Answer. If confirmed, I look forward to working with you on this
issue. As a general matter, I believe we ought to allow for all sorts
of innovation. Not just in this area. There are things that haven't
been thought up yet that would actually improve health-care delivery in
our country and we ought to be incentivizing that kind of innovation.
And in finding our way to those innovations, it is important to
remember many of these experiments involve real patients' lives.
Question. The Medicare program requires that to receive telehealth
services, a patient must be in a rural area and at an eligible
originating site that currently does not include the patient's home. Do
you support making a rural Medicare beneficiary's home as an eligible
originating site for the use of telehealth services?
Answer. This is certainly something that we will take under
consideration. Telehealth holds great promise, particularly for rural
areas experiencing physician shortages and for patients with limited
mobility. At the same time, allowing a beneficiary's home to qualify as
an eligible originating site could create significant Program Integrity
challenges. If confirmed, I will certainly direct CMS to take another
look at this issue to ensure we are doing everything we can to maximize
beneficiary access to care with appropriate safeguards against fraud.
Question. Do you support the continuation of the new Merit-based
Incentive Payment System as presented in the final rule on the Medicare
Access and CHIP Reauthorization Act (MACRA)?
Answer. The recent CMS MACRA final rule approached the first year
of the Quality Payment Program as a transition year, and took steps to
address physician concerns regarding the burdens associated with
program participation. I think significant challenges remain with
respect to provider burden, and, if confirmed, I plan to direct the CMS
Administrator to ensure that the program is structured to achieve its
quality and budgetary goals, while ensuring that patients and the
providers who care for them are at the center of our reform efforts.
Question. In both the Medicare and Medicaid programs, we are
witnessing increased participation in managed care plans. Yet in 1995,
you objected to managed care as ``the antithesis of our society,''
citing that managed care threatens the doctor-patient relationship.
As HHS Secretary, what plans do you have to monitor the quality and
effectiveness of Managed Care plans offered in Medicare (through
Medicare Advantage) and Medicaid programs?
Answer. If confirmed, I will not pick winners and losers among
different plans or methods of health-care delivery. It is my intention
to fairly and accurately monitor the quality and effectiveness of our
entire care system, including managed care Medicare and Medicaid plans.
The facts on the ground will determine our plan ahead.
Question. In September 2011, DHHS released a new policy that
implements the recommendations of the Memorandum on Hospital
Visitation. The rules updated the Conditions of Participation (CoPs).
The policy states that hospitals receiving Medicare or Medicaid
payments should allow patients to designate visitors, regardless of
sexual orientation, gender identity, or any other non-clinical factor.
The HHS policy has enhanced hospital visitation rights of same-sex
couples.
Assuming no legislative changes are made, as HHS Secretary, will
you continue to support and enforce these existing rules?
Answer. It is essential that health-care services be available to
all people with the highest level of quality, affordability, and
respect for their human dignity. As a physician, I believe that
patients should be at the center of health care. This policy allows
patients to designate their visitors, regardless of their identity, and
I believe patients should have that authority.
Question. In 2012, the Center for Medicare and Medicaid Innovation
under Provision 5590 of the ACA funded the Medicare Graduate Nurse
Education Demonstration project to address the primary care provider
shortage, including the Hospital of the University of Pennsylvania. In
Philadelphia alone, the project has produced 703 advanced practice
nurses, the majority of whom have assumed primary care roles, a 78%
increase since before the project launched.
As HHS Secretary, do you plan to continue to support novel
reimbursement models to address the Nation's shortage of primary care
providers? Would you consider expanding the successful Graduate Nurse
Education demonstration project to other sites?
Answer. I remain committed to ensuring that every American receives
access to the care that he or she needs. Funding decisions, however,
ultimately rest with the Congress, which holds the power over the
purse. If I am privileged to serve as the Secretary of Health and Human
Services, I will implement the policies agreed upon by the Congress and
signed into law by the President.
Question. There is universal agreement on the need to improve
patient care and reduce costs. One way to do so is for the Federal
Government to continue to promote the growth of health information
technology and electronic health records. One success in this space
over the past several years has been the development and growth of the
Direct Exchange network, which has allowed for millions of health care
record exchanges over the past several years.
Will you as HHS Secretary continue to support the expansion of
Health IT and the use of networks such as Direct Exchange working with
HHS-ONC to encourage and ensure the safe and interoperable exchange of
medical records?
Answer. Electronic information sharing, as supported by
interoperable health information technology (IT) systems, impacts
overall care and the patient experience. Patients and providers often
rely on the fast exchange of relevant, trustworthy information across
health IT systems. Methods to improve flexibility and patient
engagement, and clear the way for increased health IT interoperability
should be examined as we work to improve health-care delivery. I look
forward to continued discussions with you regarding various means to
improve the current health IT infrastructure.
foster care and child welfare
Question. You have hardly any record on child welfare issues. The
largest Federal investment in child welfare is made through title IV-E
of the Social Security Act, which reimburses States for activities
associated with foster care, and it is managed by the Department of
Health and Human Services. While foster care is a critical, often life-
saving intervention, we should be moving toward a system that not only
supports children who can no longer remain safely with their families,
but one that also helps stabilize struggling families so that they can
keep their children when it is possible to do so safely. This focus on
prevention is not only often in the best interest of children, but also
in the best interest of State budgets, and States that have started
shifting to a prevention-focused model have seen lower downstream costs
associated with foster care, homelessness, health care and criminal
justice. This is an especially critical issue right now, at a time when
we are seeing foster care caseloads increasing as a result of the
opioid epidemic.
Do you agree that we must make investments in services aimed at
helping vulnerable families?
Answer. Yes. The family is the foundation of society. It is
critical that we build and sustain strong families by providing
assistance when necessary for those struggling with addiction and
mental health issues so that we prevent child neglect and violence
against children.
Question. The Department of Health and Human Services is the lead
Federal agency responsible for addressing child abuse and neglect,
including prevention, foster care, reunification, and adoption when
children cannot return home. As was discussed during your hearing, the
new administration is proposing to block grant Medicaid, which is the
primary source of services to help families involved in the child
welfare system. This system is experiencing additional strain as a
result of the opioid epidemic, which has shattered many families across
the Nation.
Have you considered the potential implications of block-granting
Medicaid for families in the child welfare system?
Answer. I look forward to working with the Congress to ensure that
all children have access to the coverage, regardless of family
situation or personal circumstance.
Question. Will you commit that, if confirmed as Secretary of Health
and Human Services, you will take action to guarantee parents coverage
of and access to mental health and substance use disorder services, to
prevent child abuse and neglect and help reunify families?
Answer. Substance abuse disorder is a problem and the opioid
epidemic is real. As I mentioned in the hearing, this is a rampant
crisis that is harming families and communities across the Nation. This
harm includes the potential for abuse and neglect that you mention. I
also said, and I firmly believe, that it is vital that substance abuse
disorder and other mental health problems are treated. If confirmed I
will work closely with you and other members of Congress to ensure that
the Substance Abuse and Mental Health Services Administration (SAMHSA)
fulfills its duty of leading public health efforts to advance
behavioral health and reduce the impact of substance abuse and mental
illness on America's communities.
Question. According to the Substance Abuse and Mental Health
Administration, there are 21.6 million people that have a substance use
disorder, with just 9.3 percent receiving treatment. According to
research by Richard G. Frank, the Department of Health Care Policy at
Harvard Medical School, and Sherry Glied, Dean of the Wagner School of
Public Service at NYU, repeal of the Affordable Care Act will take $5.5
billion from the treatment of low-income individuals with mental and
substance use disorders--11 times the funding that Congress just
provided through the 21st Century Cures Act.
Do you think such a reduction in both mental health and substance
use treatment funds through a repeal will have an impact on the child
welfare system and foster care numbers?
Answer. Changes to the ACA should not be done in isolation. I
remain committed to ensuring that every American receives access to the
mental health and substance abuse care that he or she needs. If I am
privileged to serve as the Secretary of Health and Human Services, I
will implement the policies agreed upon by the Congress and signed into
law by the President.
Question. The Affordable Care Act included a provision to allow
children aging out of foster care to continue their health coverage
through Medicaid up to age 26. Block-granting or capping Medicaid would
essentially end this guarantee.
Do you believe we should end this right to health coverage for
former foster youth?
Answer. This would be a part of the new legislation that Congress
will be voting on, so that decision is in Congress's hands. If
confirmed, I will work to ensure that HHS appropriately implements the
statutes within its purview.
Question. Currently, when families adopt children with special
needs from foster care, those children are guaranteed Medicaid coverage
through the age of 18. This is an important support for these children
and their adoptive families.
If confirmed as Secretary of Health and Human Services, what
assurances can you give to these children and their adoptive parents
that their health-care needs will continue to be met?
Answer. The life and health of children with special needs is of
great importance to me, as it has been when I practiced medicine and
while I have been in Congress. I offer every assurance to children and
their adoptive parents that I will do all I can, if confirmed as HHS
Secretary, to ensure their needs continue to be met to the best of the
Department's ability.
ethics of providing health care to people on public plans
Question. You have been a member of a fringe physician group, the
American Association of Physicians and Surgeons (AAPS), which espouses
a number of very dangerous ideas, including perpetuating debunked myths
about vaccines and claiming that it is ``immoral'' for doctors to
provide care to people who rely on publicly funded health plans such as
Medicare, Medicaid, and CHIP.
Were you aware of these positions published by AAPS before joining
the organization, and do you support those positions?
Answer. My initial membership in AAPS was based on their successful
opposition to destructive health policy changes promoted in the early
1990s.
the opioid epidemic
Question. According to the recent Facing Addiction: Surgeon
General's Report on Alcohol, Drug, and Health, ``Substance misuse and
substance use disorders are estimated to cost society $442 billion each
year in health-care costs, lost productivity, and criminal justice
costs.'' The National Survey on Drug Use and Health (NSDUH) reported in
2015 that 21.5 million people in the United States, over 8 percent of
the population, had a substance use disorder. The Center for Disease
Control and Prevention reported over 52,000 drug overdose deaths in
2015. Of the millions of people struggling with a substance use
disorder, only about 10 percent receive substance use disorder
treatment in a given year.
If confirmed as Secretary of Health and Human Services, what
actions will you take to address the needs of Americans struggling with
substance use disorders, especially those who are seeking treatment?
Answer. Substance abuse disorder is a problem and the opioid
epidemic is real. As I mentioned in the hearing, this is a rampant
crisis that is harming families and communities across the Nation. This
harm includes the potential for abuse and neglect that you mention. I
also said, and I firmly believe, that it is absolutely vital that
substance abuse disorder and other mental health problems are treated.
If confirmed, I will work closely with you and other members of
Congress to ensure that the Substance Abuse and Mental Health Services
Administration (SAMHSA) fulfills its duty of leading public health
efforts to advance behavioral health and reduce the impact of substance
abuse and mental illness on America's communities treating those who
are in addiction recovery while working to prevent people from becoming
addicted in the first instance, and explore other means available to
HHS to assist those struggling with substance use disorders obtain
treatment and to prevent addiction.
Question. If confirmed as Secretary of Health and Human Services,
will you commit to supporting, and as a Cabinet member advising the
President to support, continued funding for opioid crisis grants, as
administered by SAMHSA?
Answer. I remain committed to ensuring that every American receives
access to the mental health and substance abuse care that he or she
needs. Funding decisions, however, ultimately rest with the Congress,
which holds the power over the purse. If I am privileged to serve as
the Secretary of Health and Human Services, I will implement the
policies agreed upon by the Congress and signed into law by the
President.
Question. If confirmed as Secretary of Health and Human Services,
will you commit to supporting, and as a Cabinet member advising the
President to support, funding for the Substance Abuse Prevention and
Treatment Block grant to preserve the critical safety net for Americans
who require substance abuse treatment but who are uninsured?
Answer. Access to mental health and substance abuse care is
absolutely vital. If I am privileged to serve as the Secretary of
Health and Human Services, I will implement the policies agreed upon by
the Congress which holds the power of the purse, and signed into law by
the President.
Question. If confirmed as Secretary of Health and Human Services,
would you commit to supporting, and as a Cabinet member advising the
President to support, funding requests for the National Institute of
Mental Health and the National Institute on Drug Abuse to develop
better treatments for substance use disorders?
Answer. I remain committed to ensuring that all Americans maintain
access to the mental health and substance abuse disorder treatments;
however, funding decisions ultimately rest with the Congress, which
holds the power over the purse. If I am privileged to serve as the HHS
Secretary, I will implement the policies adopted by the Congress and
signed into law by the President.
Question. Integrated primary care and mental health care is one
promising strategy to improving outcomes for Americans with substance
use disorders. If confirmed as Secretary of Health and Human Services,
will you support demonstration programs--which as Secretary you would
have the ability to direct--to integrate primary and behavioral health
care, through the Center for Medicare and Medicaid Innovation?
Answer. CMMI is a program providing significant opportunity for
testing new models for health-care financing and delivery. If
confirmed, as HHS Secretary, I plan to work closely with CMS to ensure
that CMMI--after appropriate consultation with Congress, the States,
health-care stakeholders, and Innovation Center staff--tests innovative
models that reduce costs and improve quality for Medicare and Medicaid
beneficiaries.
Question. A key challenge to effectively addressing the opioid
epidemic in the United States is a shortage of qualified providers. The
Affordable Care Act included a provision to establish a National
Healthcare Workforce Commission, yet this Commission has never met.
If confirmed as Secretary of Health and Human Services, would you
commit to supporting, and as a Cabinet member advising the President to
support, a congressional appropriation to convene this commission so we
can understand the root cause of mental health provider shortages and
develop evidence-based strategies to address them?
Answer. As I mentioned in the hearing, it is important that we as a
nation make sure that every single individual has access to the kind of
mental health and substance abuse care that they need. I look forward
to working closely with you and the other members of Congress to ensure
that the mental health profession is adequately, if not robustly,
staffed for this and the future generations.
coverage
Question. On January 7, 2009, you penned a commentary in the Wall
Street Journal that advocated for ``access to coverage for all
Americans and coverage that is truly owned by patients.'' Yet under the
policy proposals you have authored, according to the Congressional
Budget Office, ``the number of people who are uninsured would increase
by 18 million in the first new plan year.'' After repeal of Medicaid
expansion and exchanges, 32 million Americans would be uninsured by
2026.
How do you reconcile your position in 2009 with the analysis by the
CBO in 2017?
Answer. I disagree with the conclusion drawn by CBO. If there are
any changes to Medicaid, they should not be done in isolation.
Question. You introduced the Medical Freedom Act of 2015, which
would repeal the requirement that insurers offer dependent coverage
until the age of 26. HHS estimates this provision has affected 2.3
million young adults.
If confirmed, what is your plan to protect the health and well-
being of young adults under the age of 26?
Answer. This would be a matter for Congress to determine through
legislation. If confirmed, I will work to ensure that HHS appropriately
implements the statutes within its purview.
children
Question. Oftentimes, changes in the larger health-care landscape
take place, for example in the Medicare program, without a full
examination of how these changes could potentially impact children,
even inadvertently.
As you look at health-care changes at the national level as
Secretary, how will you ensure that children's unique health-care needs
are taken into account?
Answer. I look forward to working with Congress to ensure that
children will not be inadvertently impacted by potential changes to the
health-care system.
liheap
Question. The Low-Income Home Energy Assistance Program (LIHEAP)
provides short-term aid to vulnerable populations for heating or
cooling assistance, crisis assistance or weatherization assistance.
Without this support, many low-income participants would quickly fall
behind on their bills and face shut-off of essential energy services.
The program effectively utilizes a partnership between the Federal
Government, State government and the private sector.
LIHEAP protects the most vulnerable in our society. According to
the Campaign for Home Energy Assistance, in Pennsylvania in 2014, 35%
of households receiving LIHEAP were elderly, 30% were disabled, and 18%
had children under 5. You were a member of the Task Force on Poverty,
Opportunity, and Upward Mobility that drafted the ``A Better Way'' plan
that proposed to combine LIHEAP with 10 other social program grants to
create a large block grant to States. Should such a plan come to pass,
it would eliminate a dedicated fund for utility crisis assistance. In
addition, your recent budget took across the board cuts from safety net
programs and highlighted LIHEAP as one of several ``duplicative anti-
poverty programs.'' While the Department of Energy also oversees an
energy program (the Weatherization Assistance program), this program
provides grants to States to improve the weatherization and energy
efficiency of low-income homes. Thus, serving a different, though just
as important, service from LIHEAP.
Can you explain why you think LIHEAP is a duplicative anti-poverty
program and which other programs in particular you think are providing
the same services?
Answer. One of the main goals of the ``A Better Way'' plan was to
match poverty-fighting programs with the needs of those on Federal Aid
more effectively so that it is easier for them to get back on their
feet. Using block grants, rather than dedicated grants, gives States
and communities more freedom to use the funds where they are most
necessary.
Question. According to the National Energy Assistance Directors
Association, States have been forced to reduce the number of households
served by LIHEAP from 8 million to the current level of 6.7 million due
to Federal cuts to the program. This equates to 1.3 million eligible
households nationwide that did not receive assistance.
LIHEAP is a critical safety net program to support the elderly and
families as the country recovers from the economic recession. Families
should not have to choose between heating their homes and putting food
on the table. You have previously voted in the House of Representatives
against increasing funding for LIHEAP.
Do you support increasing funding for LIHEAP? If not, why do you
not support it?
Answer. If confirmed, I will administer LIHEAP as effectively and
efficiently as possible. If once in office, and should circumstances on
the ground change and current resources are found to be insufficient, I
will inform Congress and work with them on finding solutions.
Question. Will you support maintaining the funding at the current
level of $3.3 billion in the President's final recommendations for FY
2017 and proposed FY 2018 budget?
Answer. If confirmed, I will administer LIHEAP at the levels passed
by Congress.
tax issues
Question. Do you think the President should disclose how much he
stands to benefit from the repeal of the net investment income tax
prior to signing the repeal of the Affordable Care Act into law?
Answer. This is a matter for the President.
Question. With respect to subsidizing the cost of health care,
please explain why an annually disbursed refundable tax credit is
superior to a monthly insurance premium support credit.
Answer. There are many health-care scholars who have promoted the
superiority of a credit versus a subsidy, as it may provide greater
flexibility and options for patients.
______
Questions Submitted by Hon. Debbie Stabenow
continuous coverage
Question. Last week we held a forum and asked folks from around the
county to share their stories and help inform the debate around repeal
of the ACA. One of the women on the panel, Holly Jensen, was a small
business owner insured with a plan she selected on the marketplace.
Holly was living with undiagnosed depression, anxiety, and obsessive
compulsive disorder that was getting worse by the day. It got to the
point that she withdrew from her community, her work, and was really
struggling. She was unable--understandably--to make her monthly premium
payments. Luckily, because of Medicaid expansion, she was able to get
the treatment she needed a few months later and is doing well today.
Her small business is back up and running. However, she did not
maintain coverage continuously, as your plan and many others require.
If the continuous coverage requirement were in place, Holly would
re-enter the health insurance market and could be labeled with a pre-
existing mental health condition, correct? How do you believe this
problem is best addressed?
Answer. I believe it is important that we as a nation make sure
that every American has access to the kind of mental health care and
health coverage that best meets their need. Additionally, it is
imperative that all Americans have access to affordable coverage and
that no one is priced out of the market due to a bad diagnosis. This is
a matter for the legislative branch, however, and if confirmed, I will
work to ensure that HHS (appropriately) implements the statutes within
its purview.
maternity coverage
Question. As I mentioned today, prior to the ACA, the vast majority
of plans on the individual market did not offer maternity coverage. You
said today that women would likely opt not to purchase one of those
plans if they were pregnant or planning to be. However, over the course
of a health plan year, couples and families make many decisions about
their health-care future, sometimes including whether or not to have a
child.
Given this fact, do you believe that all health plans should be
required to cover maternity and newborn care?
Answer. My hope is to move in a direction where insurers can offer
products people want and give them the coverage they want. That, of
course, can and would in many cases include maternity and newborn care.
Getting to that kind of system requires changes that will inevitably
involve working with Congress and considering the tradeoffs of various
proposals to achieve our shared objective of the best and highest
quality care being available to Americans. And note that I refer to
care because ultimately, having maternity or other coverage is not
meaningful if one cannot access the care they need or the quality of
care leaves them worse off. So we must work towards both coverage and
care.
______
Questions Submitted by Hon. Maria Cantwell
long-term care
Question. Do you share my view that patients should be able to age
in their homes and communities instead of in nursing homes and other
institutional/inpatient settings, so long as the patient chooses this
option and it is clinically appropriate?
Answer. Our health-care system should be able to accommodate the
choices of patients, in consultation with their physicians, regarding
the ideal setting for their care.
Question. Do you agree with me that home- and community-based care
is, in general, far less costly and more convenient for patients
compared to institutional care in nursing homes?
Answer. Home- and community-based care is often less costly and
more convenient as compared to institutional care in nursing homes. Our
goal ought to be the right care in the right setting and the best care
possible for Medicaid patients and all Americans. Too many Medicaid
beneficiaries lack access to care.
Question. Do you support incentives for States to transition or
``rebalance'' their Medicaid long-term care population from nursing
homes to home- and community-based care?
Answer. If confirmed, I will work to provide States the flexibility
to pursue innovative approaches that fit the unique needs of their
citizens.
Question. Are you aware that, under the Affordable Care Act's
Balancing Incentive Program (section 10202), the State of Georgia was
approved for $57 million to transition Medicaid beneficiaries from
institutional long term services and supports (LTSS) settings to home-
and community-based settings (HCBS), and, as a result of that
investment, Georgia has been able to shift more than 10 percent of its
long-term care costs from high-cost nursing homes to low-cost home and
community care, according to reports submitted to CMS and Georgia's
program application?
Answer. Each State has different needs, and I believe CMS needs to
work with States to ensure that, consistent with those needs, the
Medicaid program provides the best possible coverage to their
residents. It is not surprising that providing States with flexibility
to tailor their Medicaid program leads to good results in general.
Question. Do you support the Balancing Incentives Program in the
Affordable Care Act?
Answer. I am committed to ensuring that Medicaid is available for
eligible beneficiaries, and working with CMS to make sure that States
are able to make the most use of available resources to serve their
citizens with the highest quality care, if I am confirmed.
Question. If you do support this program, or if you at least agree
with its intent and goals, will you commit to working with me and my
staff to expand Federal incentives for States to ``rebalance''?
Answer. Yes, I will look forward to working with you and your staff
to explore proposals you have in mind and otherwise consider how best
to provide States with flexibility to provide the highest-quality care
for Medicaid beneficiaries.
Question. Do you believe that, if executed well, ``rebalancing''
programs such as Balancing Incentives can improve the care experience
for patients and reduce State Medicaid costs?
Answer. The experience of our system is that while many different
States may face the same problem, the approach that is most likely to
succeed may depend on the particular State and other details specific
to the circumstances.
basic health program
Question. The Basic Health Program (section 1331 of the Affordable
Care Act) is a State option that is providing health insurance and
access to care to more than 750,000 working low-income individuals in
New York and Minnesota. States that have taken advantage of this
voluntary program are seeing lower costs for beneficiaries, higher
enrollment, and net State budget savings, compared to not implementing
the program. Through the Basic Health Program, States are price-makers,
not price-takers.
Do you support the Basic Health Program as a way to empower States
to negotiate a better deal on health insurance for their citizens?
Answer. I support the efforts of States to innovate and find
solutions for their citizens with respect to health care, in the area
of insurance and otherwise.
Question. Will your Department and CMS commit to funding and
administering the Basic Health Program as required under current
Federal law?
Answer. If confirmed as Secretary of HHS, my role will be to
administer the laws of the land as they originate from the Congress,
including those relating to the Basic Health Program.
Question. If Congress repeals the Affordable Care Act, will you
commit to ``not pulling the rug out'' from the 750,000 low-income
individuals who are benefitting from the Basic Health Program?
Answer. In working through the current situation and options for
the future, I am committed to working towards solutions that provide
meaningful access to care, not just insurance but actual care, for all,
including--of course--these individuals.
Question. In other words, will you use your administrative
discretion as HHS secretary to not rescind funding for State Basic
Health Programs, unless a rescission of that funding is explicitly
required by a change to the statute?
Answer. If confirmed, I will follow the directions of Congress as
contained in appropriations and other law regarding funding for health-
care programs.
delivery system reform
Question. Washington State and the Pacific Northwest have led the
way in pioneering nationally recognized innovations in the delivery of
health care--whether it is the Qliance Direct Primary Care medical home
model, Group Health Cooperative's highly popular integrated coverage
and care model, the Everett Clinic's price transparency initiatives,
Boeing's Accountable Care Organizations, or dozens of others. Despite
their innovations, health-care providers in my State are paid nearly
$2,000 less (per Medicare enrollee, per year) than the national
average, based on CMS spending data compiled by the Kaiser Family
Foundation. I would argue that, due to our current volume-based system,
my constituents are paid less specifically because they are efficient
and because they do a good job of keeping patients healthy.
Should the Federal Government reward such high-value health care
providers, as long as we clearly define and agree upon metrics for what
constitutes ``high-value'' care?
Answer. I look forward to faithfully executing the laws Congress
passes pertaining to health-care provider reimbursement.
Question. Does the current fee-for-service system encourage
unnecessary health-care spending? If so, can you please explain
specifically how this system encourages unnecessary health-care
spending, including in which specialties of medicine?
Answer. The current system encourages unnecessary spending since
too many of the decisions providers and patients make are determined by
a distant Federal bureaucracy and not based on the value of care that
is provided to patients by their health-care providers. If confirmed, I
look forward to executing laws that reduce unnecessary health-care
spending.
Question. As a physician, do you share my view that clinicians
should focus more on keeping their patients healthy and less on
paperwork?
Answer. Clinicians should focus more on keeping their patients
healthy and less on paperwork. Unfortunately, it does not seem that is
the current trend.
Question. As a physician, do you share my view that the current
fee-for-service system requires significant paperwork, including
substantial time spent on coding and billing for each individual
procedure or service rendered?
Answer. Clinicians should focus more on keeping their patients
healthy and less on paperwork. Unfortunately, it does not seem that is
the current trend.
Question. You voted for the bipartisan Medicare Access and CHIP
Reauthorization Act (MACRA) when it was considered on the House floor.
Will you commit to working with Washington State health-care providers
to help them succeed in Medicare's new Quality Payment Program, as
outlined in regulations by CMS, including Advanced Alternative Payment
Models?
Answer. If confirmed, I commit to work closely with the CMS
Administrator to make sure we implement MACRA in a way that is easy to
understand, minimizes burden, and is fair to all affected providers.
Question. Will you commit to fund and administer Medicare's
Accountable Care Organizations, including the Medicare Shared Savings
Program under section 3022 of the Affordable Care Act, and will you
commit to helping health-care providers participate in these models,
should they choose to do so? Will you commit to not taking any
administrative action that would make it more difficult for Medicare
beneficiaries or health-care providers to participate in this voluntary
program?
Answer. As a doctor, I appreciate the goal behind the creation of
the ACO model: better patient care. As a legislator, I would agree
their successes have been modest to date, and there are some challenges
they face as well. ACOs are a tool in the toolbox to help ensure high
quality, low cost health care for beneficiaries. They are not a silver
bullet to all of our country's delivery system challenges. If
confirmed, I plan to work with the CMS Administrator to ensure that we
learn from ACOs' successes and challenges to date as we chart the path
forward.
Question. Will you commit to fully fund approved grants under the
Center for Medicare and Medicaid Innovation (CMMI), and will you
continue to fund and administer future payment initiatives under CMMI,
consistent with the legislative intent of Congress in the Affordable
Care Act?
Answer. If confirmed, I will work to ensure that HHS
(appropriately) implements the statutes within its purview.
Question. Do you share my view that, given Congress's significant
ongoing investment in the delivery of health-care services, the Federal
Government should fund research into health-care quality? Will you
commit to not taking administrative actions that would weaken the work
of the Agency for Healthcare Research and Quality (AHRQ) within HHS?
Answer. I appreciate your concerns about health-care quality. I
also appreciate the fact that health-care research may address patient
safety, care management and methods to broaden access to health-care
services, among other issues. Health-care studies also help to inform
the discussion on ways to improve the quality of care and reduce costs.
As you know, Congress will ultimately make the decision on whether to
fund the Agency for Healthcare Research and Quality (AHRQ).
Nonetheless, if confirmed, I look forward to working with you to more
carefully examine AHRQ and determine how it may best drive positive
patient-centered solutions in healthcare. And if confirmed, I will work
to ensure that HHS (appropriately) implements the statutes within its
purview.
health care legislation
Question. I have authored bipartisan legislation (S. 2259 in the
114th Congress) to make it easier for rural health-care providers to
participate in the Medicare Shared Savings Program by allowing CMS to
adopt a broader beneficiary assignment method than is provided under
current law. Will you commit to providing me and my office responsive
and accurate technical assistance on this legislation?
Answer. I look forward to working with you on this issue and
sharing both feedback and assistance regarding the important policy
issues in beneficiary assignment for the Medicare Shared Savings
Program.
Question. I have authored bipartisan legislation (S. 2373 in the
114th Congress) to require Medicare to cover an essential preventive
product, compression therapy items, for beneficiaries who experience
swelling from lymphedema. Will you commit to providing me and my office
responsive and accurate technical assistance on this legislation?
Answer. As you know, CMS has a detailed process for making
determinations regarding whether items and services are reasonable and
necessary, if they can be considered eligible for Medicare coverage
given other restrictions and prohibitions. From time to time, Congress
sees it fit to make its own determination regarding specific items or
services. If confirmed, I would be pleased to work with your team to
provide information on the Medicare coverage process and potentially
relevant considerations.
Question. I have cosponsored bipartisan legislation (S. 3129) to
preserve patient access to outpatient therapeutic services in Critical
Access Hospitals and other rural hospitals. Similar legislation has
been signed into law the last 3 years. Will you commit to working with
me, my staff, and bill sponsors and cosponsors, on this issue?
Answer. If confirmed, I look forward to working with you and others
in the Congress to see that critical access hospitals are best enabled
to serve rural populations well.
Question. Will you commit to providing me and my office responsive
and accurate technical assistance on any future legislation I author or
on which I seek assistance?
Answer. Federal agencies play a significant role in the legislative
process, often including providing technical assistance. Such technical
assistance can involve situations where the agency provides feedback
but clarifies that the assistance does not reflect the views or
policies of the agency or administration. If confirmed, I will endeavor
to work with you in this way as appropriate to ensure proposed
legislation is consonant with the existing statutory and regulatory
scheme.
washington state's section 1115 medicaid waiver
Question. On January 9, 2017, CMS approved Washington State's
proposed Medicaid waiver (``Medicaid Transformation Project, No. 11-W-
00304/0'') under section 1115(a) of the Social Security Act. In
securing agreement on this waiver, Washington State health officials
and CMS spent countless hours over more than a year in good-faith
negotiations. This approved waiver will help Washington State pursue a
smarter and more innovative Medicaid program that reflects changes in
health-care delivery, technology, and the preferences of patients.
Will you commit to honor this approved waiver and not take any
administrative action to rescind, weaken, or de-fund its components?
Answer. It would be inappropriate at this point to comment on any
specific waivers under consideration at CMS, but, if confirmed, I would
work with the CMS Administrator to ensure that CMS uses its waiver
authority to provide much needed flexibility to States to innovate
within the Medicaid program.
graduate medical education
Question. The vast majority of Washington State counties are Health
Professional Shortage Areas (HPSA's) according to HHS's HRSA. Do you
agree with an established body of research illustrating that there are
physician shortages in the United States, especially in primary care
specialties and in rural communities?
Answer. Access to care is a critical issue in many parts of the
country, particularly for primary care in rural areas. The underlying
physician shortage is sometimes worsened by government policies. If
confirmed, I look forward to the opportunity to address these physician
shortages, particularly as they relate to the Medicare and Medicaid
programs.
Question. Do you agree with previous congressional intent that the
Federal Government, through Medicare and other programs, has a strong
role to play in graduate medical education (GME) policy and funding?
Answer. I have always been a strong supporter of efforts to support
medical education. Congress has used the Medicare program from its
inception to invest in future generations of doctors. Regardless of
what we do in Washington, health care should always be about that one
to one relationship of a patient to a doctor. That relationship of
course requires a doctor. And so I am hopeful we can continue to find
ways to remove disincentives to the practice of medicine and its
rewards as well as support the profession in other ways.
Question. Was your own surgery residency funded by Medicare?
Answer. Both my wife and I were residents at Emory University. I
completed my residency in 1984. The Medicare program has paid for some
portion of GME at participating hospitals since its inception in 1965.
______
Questions Submitted by Hon. Mark R. Warner
affordable care act
Question. In December 2016, the Congressional Budget Office issued
a report noting that it would define as insurance coverage only ``a
comprehensive major medical policy that, at a minimum, covers high-cost
medical events and various services, including those provided by
physicians and hospitals.'' The ACA established a set of services,
known as Essential Health Benefits, that all insurance policies must
include to make sure patients have appropriate health coverage.
What would you advise the President define as ``coverage'' under a
Republican ACA replacement plan?
In a repeal-and-replace scenario, will coverage obtained by
individuals provide adequate financial protections against high medical
costs?
Will you advocate for insurance policies under the Republican
replacement plan that provide meaningful coverage so that insurers
could not once again: (1) charge higher premiums to women, people with
pre-existing conditions, or others for reasons such as their profession
or the industry in which they work; (2) drop or severely limit benefits
such as maternity care and prescription drugs, which insurers must
currently cover as ``essential health benefits;'' (3) reinstate annual
and lifetime limits on coverage; or (4) charge deductibles, co-payments
and co-insurance without limits?
Will you commit to safeguarding the consumer protections that the
Affordable Care Act put in place?
Answer. This is a work in progress. If confirmed, I would
appreciate your thoughts on how best to address these matters. It is
important that any system have safeguards so that no one loses access
to care due to a bad diagnosis. Additionally, credible coverage is
important. Patients should be provided an array of options so they may
select the one best for themselves and their family; and consumer
protections are integral to any patient-centered system.
drug prices
Question. The rise in prescription drug costs is squeezing American
families as well as Federal spending. We need to address this now. In
your testimony to the HELP Committee last week, you agreed that we need
to work in ``a bipartisan way (to address the) root causes of drug
prices, (and) to make sure that drug pricing is reasonable.'' But you
refused to commit to specific policies. President Trump has said that
we should allow Medicare to leverage its power as a payer, and
negotiate drug prices with pharmaceutical companies.
Do you agree with President Trump that Medicare should negotiate
drug prices?
Answer. The issue of drug pricing and drug costs is one of great
concern to all Americans. You have my commitment to work with you and
others to make certain that Americans have access to the medications
that they need. If confirmed, I look forward to focusing on how we can
make health care more affordable, including prescription drugs. I share
your concern regarding the importance of individuals and families being
able to afford the prescription drugs they need.
drug price and value
Question. While we are moving towards paying for value in many
areas of healthcare, in the drug space we have largely lagged behind.
In the past year, we have seen some insurers and drug manufacturers
pilot value-based arrangements that hold the manufacturer accountable
for how their product performs in the real world on an agreed upon set
of metrics. In 2015, I led a letter with my colleagues, Senator Kaine,
Senator Nelson, Senator Shaheen, and Senator Heitkamp, to the Centers
for Medicare and Medicaid asking them to examine the potential of using
value-based arrangements in Medicare and other public programs.
Will you commit to working with me to identify potential regulatory
policy barriers that should be reviewed in order to continue to move
towards reimbursement for value rather than volume in the drug space?
Answer. If confirmed, I look forward to working with you and others
to ensure that we are moving toward a health-care system defined by
high-quality, patient-focused care. I appreciate how reimbursement--and
other regulatory policies impact physician behavior. If confirmed, I
will ensure that HHS is a good steward of taxpayer dollars, with the
goal of delivering the highest-quality care through its health-care
programs, including the Medicare program serving our Nation's seniors.
gabriella miller/nih
Question. Gabriella Miller, a 10-year old girl from Leesburg, VA
who suffered from pediatric brain cancer, became an extremely
impressive activist on behalf of childhood cancer awareness before her
untimely death. Her work led to the passage of the Gabriella Miller
Kids First Act, and NIH has been moving forward to implement this law
and expand pediatric research.
Will you prioritize pediatric cancer research and implement the
Gabriella Miller Kids First Research Act?
Answer. I am always inspired by the courage cancer patients bring
to their fight against this devastating disease. This is particularly
true when the patients are some of the youngest amongst us. It
underscores why we must cure cancer. The NIH plays a pivotal role in
supporting cutting-edge biomedical research across our country,
including key efforts related to pediatric research, and I recognize
that we must make progress on this front for the adults and children
fighting cancer. If confirmed, I look forward to continuing HHS's
important work to advance cancer research and bring forward innovative
treatments as part of our shared goal of defeating cancer.
cybersecurity/internet of things
Question. The declining cost of digital storage and Internet
connectivity have made it possible to connect an unimaginable range of
products and services to the Internet, with medical devices at the
forefront of this trend. However, in many cases, manufacturers have
brought insecure devices to market, with few incentives to design the
products with security in mind, or to provide ongoing support to
address vulnerabilities. For example, we have seen cases where an
implantable device lacked meaningful authentication methods, leaving it
susceptible to unauthorized or malicious commands sent remotely.
The FDA has taken important steps to addressing cybersecurity in
the ``Internet of things.'' This includes promulgating post-market
guidance, working closely with cybersecurity researchers, and engaging
manufacturers to promote development of more secure devices. Will you
commit to continue and build on these efforts?
Answer. The safety of American citizens will always be a top
priority of the HHS and ensuring the security of medical devices
against the threat of hacking is critical to that end. If I am
confirmed, the FDA will continue and improve upon its efforts to
strengthen cybersecurity within the medical device industry as well as
other related industries.
ban on cdc gun research
Question. Since 2013, Americans have died from incidents involving
firearms and automobiles at almost identical rates. Over the last two
decades, the Federal Government has spent $240 million a year on motor
vehicle safety research, and motor vehicle deaths plummeted nearly 25
percent from 2004 to 2013 thanks to data supporting new policies. CDC
has done virtually no research into gun-related injuries and deaths
after an appropriations rider was added that prohibits the CDC from
``participating in advocacy or promotion of gun control.'' Roughly
100,000 Americans injured or killed each year by guns, including over
2,000 in 2016 from accidental shootings alone. The original author of
the appropriations rider, Representative Jay Dickey (R-AR), has
declared he regrets it and would like to see the CDC able to research
violence and injury related to firearms. To make smart policy, it's
necessary to have accurate information and data.
If confirmed, would you direct CDC staff to interpret the
appropriations rider in a reasonable way, so that CDC could in fact
conduct unbiased research on the relation of firearms to public health?
Answer. The CDC performs an important role in helping to understand
and communicate public-health issues. If confirmed, I will work to
faithfully ensure that the Department and its operating divisions
fulfill their statutory responsibilities.
rural hospitals
Question. Rural hospitals, serve older, sometimes more economically
disadvantaged populations challenged by less access to primary, dental,
and mental health care than their urban counterparts. Rural hospital
leaders from across Virginia continue to share with me their concerns
with efforts to repeal the Affordable Care Act. The ACA lowered the
percentage of uninsured by 8 percentage points in rural counties,
decreasing bad debt for providers in these areas, and providing them
with some financial breathing room. Yet despite this progress, the
Virginia Hospital Association estimates that 43% of rural hospitals in
Virginia operate at a financial loss.
Should there be supports included in an ACA replacement proposal to
ensure these safety net providers can afford to keep their doors open
to serve these vulnerable patients?
Answer. Our goal is to ensure access to affordable, quality health
care for all citizens. This of course includes individuals who access
care at rural or critical access hospitals. And so the best metric in
the end is one that measures the extent of access to actual care, not
just coverage, and the quality of that care as determined by patients
working individually with their doctors. I look forward to working on
this important issue with you, if confirmed.
Question. Last week, CBO reported that in the first year after a
repeal of the ACA marketplace subsidies would take effect, about half
of the Nation's population would live in an area that would have no
insurer participating in the individual market, increasing to three-
quarters of the population by 2026. You have emphasized ``access'' to
coverage but the report suggests repeal in its effects will eliminate
choice, competition, and access in rural communities, reversing much of
the progress we've made to reduce the number of the uninsured, as well
as reducing uncompensated care.
What advice would you give President Trump on addressing the bad
debt issues these rural hospitals would face post-repeal?
Answer. Changes to the ACA should not be done in isolation. Our
goal is to ensure access to affordable, quality health care for all
citizens.
home infusion
Question. While I supported the 21st Century Cures Act when it
passed in December, I remain concerned about a provision which caused
the misalignment of effective dates of two important policies. The act
included a provision Senator Isakson and I fought hard to include that
would pay for services associated with allowing Part B to reimburse for
Medicare patients to receive infusion drugs at their home starting in
January 2021. However, a provision which was used to help pay for such
payment, a cut to the reimbursement rates for Part B Durable Medical
Equipment (DME) home infusion drugs, had an effective date of January
2017. This leaves a 4-year gap where home infusion services will not be
adequately reimbursed. While I work with my colleagues in Congress to
fix this issue, I hope that the Centers for Medicare and Medicaid
Services (CMS) will make every effort to ensure Medicare beneficiaries
continue to have access to these lifesaving medications.
Can you commit to report back on actions CMS and HHS can take to
protect beneficiaries from losing access to life-saving care?
Answer. Yes. I look forward to working with you to find approaches
to this issue that ensure access to the highest quality care.
telehealth
Question. I've worked with bipartisan members of the Finance
Committee to expand the use of telehealth, especially in Medicare, and
I was glad that at your hearing last week you called telehealth an
``exciting innovation for rural and underserved areas.''
As Secretary, will your Department work with my staff and others to
find ways to fully leverage HHS's existing authority to lower barriers
for telehealth and remote patient monitoring in Medicare?
Answer. I share your interest in promoting telehealth. Telehealth
can provide innovative means of making health care more flexible and
patient-centric. Innovation within the telehealth space could help to
expand access within rural and underserved areas. If confirmed, I look
forward to continued discussions on telehealth, including on the best
means to offer patients increased access, greater control and more
choices that fit their medical needs.
______
Submitted by Hon. Debbie Stabenow, a U.S. Senator From Michigan
DPCC FORUM ON HEALTH AND HUMAN SERVICES
NOMINEE TOM PRICE
_______________________________________________________________________
THURSDAY, JANUARY 19, 2017
OPENING STATEMENT OF HON. DEBBIE STABENOW,
A U.S. SENATOR FROM MICHIGAN
Senator Stabenow. Well, good afternoon. We so appreciate all of you
being with us, and I want to thank all of my colleagues for being here
and for their hard work.
Senator Murray will be joining us; she has been involved in helping
to create the success of today, as well as Senator Warren. Senator
Kaine of course is here, and Senator Hassan. It's very important for us
to have an opportunity to hear from all of you as we are reviewing and
making decisions on who will head the Health and Human Services
Department for our country.
And Senator Murray has joined us; welcome. Let me just start by
saying that on all of these issues this is not personal to any nominee,
this is about differences, fundamental differences, and ideas and
policies and what helps people, what hurts people. I mean these are
very important debates, and your voice, your opinions are very
important to all of us.
So you're here at a critical time, and we know that just last week
Republicans in both the House and the Senate pulled the first thread
that will unravel potentially the entire health-care system, voting to
adopt a budget resolution that would allow for repeal of the Affordable
Care Act, and we don't know what comes after that. If this happens,
according to the Congressional Budget Office, 32 million people,
including many of you on this panel today, would lose health insurance
coverage and individual market premiums would double in the next 10
years, according to the budget office.
Unfortunately, the damage would not end there. Another 52 million
adults, including 1.7 million in my own home State of Michigan, could
become uninsured due to pre-existing conditions. Forty-eight million
people could lose mental health parity protections, which makes sure
that diseases are treated above the neck, as well as below the neck. We
could be sent back to a time when being a woman was a pre-existing
condition, when insurance companies would cut you off when you hit an
annual or lifetime limit on coverage, even if you needed more care.
One hundred and five million Americans no longer face bankruptcy
when they get sick because those caps have been eliminated, and that is
a good thing. The Medicare trust fund has been extended by 11 years,
preserving future benefits, and 11 million seniors have saved an
average of $2,000 because what has been called the ``donut hole,'' this
gap in coverage, has been phased out; it's now closed so there is
continuous coverage.
I could go on with the numbers, but the most important thing is not
the numbers. The most important thing is how all of this effects your
families, our families, our children, our parents, our grandparents.
If confirmed by the Senate, the Secretary has tremendous power. His
or her decisions in office will affect all of us. His or her voice will
strongly influence the President's decision to promote, sign, or veto
legislation.
We have heard mixed messages. Our President-elect campaigned on not
cutting Medicare or Medicaid. Just over the weekend he said we would
have insurance for everyone. We would certainly welcome the opportunity
to see that plan, we do welcome it. But at the same time, just this
fall, Congressman Price said he expects Medicare to be overhauled
``within the first 6 to 8 months'' of President Trump's administration.
He also believes, ``the age of eligibility needs to be increased,'' and
that, ``the better solution is premium support,'' which is another word
for vouchers.
When it comes to covering pre-existing conditions, he has indicated
that he thought that was, ``a terrible idea.'' So this is important,
this is about ideas and policies and values and perspectives, and we
are very grateful that all of you are here.
We had asked the Chairmen of the two committees responsible for the
nomination if we could in fact have a panel of all of you, of others,
to share voices at the formal confirmation hearing. That was rejected,
and so we're doing a public forum to give you an opportunity to share
your thoughts.
So thank you again, and before introducing our panelists, our
terrific ranking member from the Health, Education, Labor, and Pensions
Committee, Senator Murray, is here, if you would like to say a few
words.
OPENING STATEMENT OF HON. PATTY MURRAY,
A U.S. SENATOR FROM WASHINGTON
Senator Murray. Well, I won't talk long because I really do want to
hear from all of you, it's so important, and I want to thank Senator
Warren and Senator Stabenow for putting this together, because, as all
of you know, we did have a hearing yesterday.
I was disappointed we couldn't ask more questions of the nominee
himself. We were only given one round. There is a lot to be concerned
about.
Congressman Price has a long record of making decisions I would not
make, taking away affordable health care, going after people who depend
on Medicaid. He is a politician who has worked hard to undermine
reproductive rights, seniors who rely on Medicare--the list goes on--
and this is a cabinet secretary who will oversee the lives of literally
every family in this country.
So we have a responsibility to hear from those families in this
country and the impact this department will have on them. So I really
appreciate your doing this, and I look forward to all of your
testimony.
And I just want to give a shout out to our Democrats, both here and
on my committee, who really did an excellent job, both with this
hearing and the DeVos hearing, in really, in the very limited amount of
time we had, showing some of their record.
So, thank you all very much for being here.
Senator Stabenow. Thank you so much. Senator Warren, who has played
such an integral role as we have been bringing forth public voices on
the nominees, is here. Thank you.
Senator Warren?
OPENING STATEMENT OF HON. ELIZABETH WARREN,
A U.S. SENATOR FROM MASSACHUSETTS
Senator Warren. So, thank you very much, Senator Stabenow, for your
leadership in pulling this together so we get to have these people's
hearings, and I also want to say ``thank you'' to Senator Murray. She
really is our leader, and the one who is keeping us in this fight on
the nominees, and the fight to protect what it is that we stand for
here.
And I welcome our newest member, Senator Hassan, who is also on the
committee, and Senator Kaine. So we have a bunch of people who are in
there fighting.
You know, President-elect Trump has spent the past few weeks
filling his cabinet and putting together his team for how he wants to
run his administration. The decisions that he makes will have
tremendous consequences on the lives of everyone in this country, and
when it comes to the Secretary for the Department of Health and Human
Services, President Trump's choice will have an enormous effect on the
lives of everyone in this room and everyone in this country.
They will help determine whether millions of Americans continue to
have access to medical care, whether contraception or cancer screenings
or flu shots must be covered by your health insurance, whether Medicare
and Medicaid are protected for the 100 million Americans that rely on
this program. In short, the hiring decisions that President-elect Trump
is making tell us about the values of the incoming Trump
Administration.
Now, unlike many of President-elect Trump's nominees, who have
little or no experience as they take over their various departments,
Congressman Price has a lot of experience in health-care policy, and
that is why we are so worried. His record makes clear that he has some
very radical, scary ideas about how to change health care in America.
Congressman Price once described the ACA's ban on discriminating
against individuals with pre-existing conditions as ``a terrible
idea.'' He has voted 10 times to defund Planned Parenthood, which
provides lifesaving cancer screenings and treatment for sexually
transmitted diseases to millions of people a year. He has proposed
privatizing Medicare and increasing the eligibility age for coverage,
and he has championed massive cuts to the Medicaid program that will
leave millions of people either uninsured or with fewer benefits.
Twenty-four Senators, led by Senator Casey of Pennsylvania, sent
letters to Senator Hatch and Senator Alexander, asking them to include
witnesses in Congressman Price's nomination hearings, witnesses who
could talk about what the impact of his radical policy proposals would
be on the lives of real people.
Now, I am sorry that the Republicans refused to hear your voices,
but I am deeply grateful that you came here today to make sure that
your voices are heard anyway. I am grateful to my colleagues who are
doing everything they can to amplify your voices, and to make sure that
as the United States Senate considers its sacred obligation on advice
and consent of the nominees in front of us, that we remember, most of
all, that we are here to serve you. So thank you for being here.
Senator Stabenow. Thank you so much.
We have been joined by Senator Hirono from Hawaii, and with the
indulgence of the rest of our distinguished Senators who are here, I
think I'll move to hearing from our guests and then move to questions,
if that is all right with everyone.
So let me first take home State advantage here, our prerogative, by
introducing Anne Serafin from Ferndale, Michigan. She lives with
Multiple Sclerosis and is covered by Medicare.
Anne and her husband also supported Anne's mom for the last decade,
and after years of financial stress were able to get her mom into a
nursing home, with the cost of her care covered by Medicaid, and we
greatly appreciate hearing your story.
We'll introduce everyone and then we will come back to you. And I
am going to turn now to Senator Warren for our next guest.
Senator Warren. That's right. I have the privilege of introducing
Kanisha Hans, who is here today with us to talk about the impact of the
Affordable Care Act on her personally.
I just want to add that Kanisha discovered her passion for advocacy
by volunteering in political campaigns, good for you, candidates for
local office.
Today Kanisha lives in Boston, and she works in a Cambridge tech
start-up. She graduated from Boston University in 2015 with a B.A. in
Political Science and a minor in Public Health.
She is taking off time from work to be here today, and we are very
grateful that she is willing to share her story, which underlines the
critical protections that the Affordable Care Act gives us for women's
health care.
So thank you very much for joining us today, Kanisha.
Senator Stabenow. Kanisha, welcome.
Now we have also been joined by Senator Blumenthal from
Connecticut; welcome.
Alyce Ornella from Harpswell, Maine. So you've come a little bit,
how is the snow up there right now? Much colder; okay.
Alyce and her husband were self-employed when they were able to get
health insurance coverage through the ACA exchange. Alyce's plan
provided free pre-natal care, including prenatal tests while she was
pregnant with her son, Sam. When Sam was unexpectedly born with serious
birth defects, her plan covered all of his intensive care and surgery
costs, and Sam now receives care through Medicaid, which has covered
every test and exam that he has needed, and we wish him well, we hope
where is Sam?
Oh, well we want to see Sam.
Okay, is that who I met earlier, with the terrific sweater on?
Okay, we need to have him come back.
So welcome, we're so glad to have him, and close to home, riding
the Metro in I think today to avoid all the traffic, Diane Fleming.
Diane is 75 years old, lives in Washington, DC, went on Medicare at age
65, 5 years ago was diagnosed with thyroid cancer. Medicaid has covered
the bills from the four surgeries, radioactive iodine treatment, CT
scans, sonograms, MRIs, and needle biopsies she has needed to treat her
cancer.
We are very grateful to have you here to hear from your story and
have you elaborate as well.
And I know that Senator Brown is hoping to join us. I know I just
left him a while ago in the Finance Committee.
So, Holly, he wanted to introduce you, but I know he is going to
join us if he can. Holly is from Cleveland, Ohio. Self-employed as a
non-profit consultant in Cleveland, runs her own LLC., was able to
access mental and behavioral health services through Medicaid, and has
been able to go on--I'll let you tell your story about what you have
been able to actually receive in terms of help as a result of that, but
we are so pleased you are here as well.
And Senator Bob Casey from Pennsylvania has just joined us. So I am
going to ask Anne if you could share your story. We ask everyone to
take no more than 5 minutes to start so that we can have an opportunity
to ask questions as well, but, Anne, thanks so much for you and your
husband being here.
STATEMENT OF ANNE SERAFIN, PANELIST FROM FERNDALE, MI
Ms. Serafin. Good afternoon. My name is Anne Serafin. I live in
Ferndale, Michigan, and I am 66 years old. I just want to say, I'm
reading this statement, so it may not convey the real passion I feel
about this issue. But please know how important this is to me.
I've had personal experience with Medicare since I was 40 years
old, when I was diagnosed with multiple sclerosis.
As you may know, MS is a neurological condition, which varies in
severity and it's very unpredictable. My particular version resulted in
functional quadriplegia. As a result, I am unable to walk, but I can
stand up with personal assistance and a grab bar. I can use my right
arm, in a limited fashion, but have no use of my left arm. Fortunately
my vision, speech and cognitive abilities have been spared.
At the time I was diagnosed, I was a marketing professor at
University of Detroit-Mercy. The University placed me on disability,
and a year later my application for Social Security disability benefits
and Medicare was approved. Thanks to strong union support, the
University picked up my secondary health insurance until I turned 65.
Within a few years, new MS medications started coming onto the
market, and my neurologist and I chose Copaxone. The price started out
at about $8,000 a year, but is now $84,000 a year. After ten years, it
became apparent that Copaxone was not working, so I tried several other
medications, including Acthar Gel.
In the '70s, this cost $50 a month, but when the drug company
realized it could benefit many people with MS, it shot up to $30,000 a
month. Because it was off label, my insurance would not cover it. The
National Organization for Rare Diseases helped for two months, but I
could not afford to continue after that.
I am currently on Gilenya, with a co-pay of $38 per month. Without
Medicare or secondary insurance, this one drug would cost about $75,000
a year, which is nearly our total household income including our Social
Security benefits. I have a handout that can show you if you'd like to
see it about how prices have shot up for all MS medications.
Disability is costly even beyond medications. Making our home
accessible, purchasing an accessible vehicle, the scooter I drive, and
hiring personal assistance; it gets expensive. This is why my 68-year
old husband continues to work part time as a self-employed writer,
while also serving as my primary caregiver. His monthly insurance costs
were $900 before he turned 65.
We rejoiced when he was able to get Medicare and have that number
come down to $200 for supplemental insurance. Without Medicare, I would
have had to decide: do I eat, or do I get my meds? Without Medicare, I
would have to pay an astronomical cost for private insurance, if I can
get coverage at all.
While I was dealing with my own health issues, my aging parents
needed increasing care and support. My father was a U.S. Army veteran
who served as a paratrooper in World War II. He helped liberate
Normandy with his D-Day combat jump. He was also an independent artist
and relied on Medicare and the VA hospital for his health care. Even
though my dad worked until his death at age 91, my husband and I needed
to financially support my parents to keep them in their home. This is
what they wanted, to age with dignity. We're Greek, and Greeks take
care of their own.
I also have experience with Medicaid, which my mother relied on for
the last 3 years of her life. My husband and I took care of her
financially before she passed away at 98 this past October. Until my
dad passed, my mother had Medicare with supplemental insurance. But my
parents had no savings and no assets--we had bought them a condo and
took over the mortgage payments. When my mother's dementia worsened to
the point that she needed full-time care, we had to place her in a
nursing home. I could not care for her complex needs; I needed help for
my own care.
Even a bare-bones nursing home would've been too much for us at
$6,000 a month. She received $1,190 a month in Social Security and
widow's VA pension benefits. It was only because of Medicaid that she
was able to get the help that she needed at the end of her life.
Without Medicare and Medicaid, things would have been very different
for my family. I don't know how I could have cared for my mother on top
of managing my own care. My family would have lost our home and all our
savings trying to keep up with the bills.
So many families are squeezed like ours, having to afford care for
their aging parents and their own care or childcare at the same time.
But with support, we don't have to suffer just being alive.
I can't cook for myself, I can't get myself out of bed, but I can
still contribute. Because of these public programs, I can be productive
and be involved in things that are important to me. This includes being
here with you in Washington, talking with legislators, and volunteering
as an advocate with Michigan United, Caring Across Generations, and the
MS Society. All because of the support I get from Medicare.
If these programs are cut, people will face more catastrophes than
ever before. People are panicking. If these services are cut, it will
have a huge, huge, huge impact on the lives of many people. Congress
needs to know that. Thank you for listening.
Senator Stabenow. Thank you so much, Anne. We really appreciate it.
Kanisha Hans, welcome again.
STATEMENT OF KANISHA HANS, PANELIST FROM BOSTON, MA
Ms. Hans. Hi my name is Kanisha Hans, and I am from Boston,
Massachusetts. I am 23 years old and an Indian immigrant, and a recent
college graduate. Thank you to Senator Warren and all the Senators here
who have invited me today to share my story about how important the
affordable care act and access to reproductive health-care providers
like Planned Parenthood cannot be repealed without devastating impacts
on the health and well-being of millions of people.
Like the vast majority of American women, I rely on birth control.
And like millions of young people I rely on my parent's insurance plan
for my health-care coverage. Both have allowed me to pursue a college
education and ultimately secure and maintain employment. When I was 15
years old I needed a birth control prescription for debilitating
periods I was having that caused me to pass out during class. Being
from a reserved Indian family I didn't feel comfortable discussing my
situation at home. So I told a friend whose mother brought me to
Planned Parenthood. My doctor at Planned Parenthood prescribed me birth
control and helped me to afford it. This was one of the first times I
felt like someone was listening to me about my own health-care needs.
Remembering the caring and non-judgmental services provided to me, I
saw Planned Parenthood again when I needed to change birth control
methods due to other health concerns.
Unfortunately my insurance failed to cover the high cost of the
specific type of birth control that I needed. Forcing me to use a
prescription that didn't suit me and even exacerbated my symptoms.
Luckily, I was eventually able rely again on a doctor I trusted at my
local planned parenthood to manage my condition. There they were able
to cover the cost of my long acting reversible contraceptives at a cost
that I could afford. This was before the Women's Preventative Benefits
in the ACA and I was charged $100 instead of $1,000. This was critical
for me because I would have been unable to afford the method that was
best for my health while I was also pursuing an undergraduate degree
and balancing other living expenses like tuition and rent.
Unfortunately, I know many women and many students who were priced
out of this privative care. But today thanks to the Affordable Care Act
these same barriers no longer exist like they once did for me.
Six years ago the passage of health-care reform was a historic step
for women of all ages. Thanks to the Affordable Care Act, I've joined
the 55 million women nationwide who benefit from no co-pay for birth
control and expanded insurance coverage. What's more important is that
women like me are able to afford the right of birth control for our
bodies or conditions with no out of pocket cost and in consultation
with our doctors.
Beyond just birth control I now join millions of young people
getting access to needed health-care coverage as a result of being able
to stay my parents insurance until age 26 and I am not forced to pay
more because I am a women or because I have a preexisting condition. I
am grateful to have a job and while I am not financially dependent on
my parents I am able to stay on their health care. So by staying on my
parents plan I am both able to stay healthy and pay my student loans on
my own every month. Hopefully someday I will also be able to pursue a
graduate degree and pay that off as well.
This winter I was able to go back to Planned Parenthood to get a
new IUD. After the results of the election I became fearful that I
wouldn't be able to afford this care anymore. Tom Price has a history
of working to reduce access to care and leading the Federal health care
agency. I am concerned he is out of touch of the health-care needs of
patients like myself. To be clear without Planned Parenthood and the
Affordable Care Act I would not have been able to afford the birth
control I needed to manage my condition. If Congressman Tom Price is
successful in rolling back the ACA I will be forced to pay for care I
need, charged more because I am a women and could even lose my health
insurance all together. He isn't looking out for me and he isn't
looking out for women, men, or young people. And he isn't looking out
for the well-being of Planned Parenthood patients. He cannot be trusted
with my health or the health of this country. Thank you.
Senator Stabenow. Thank you very much. We have been joined by
Senator Jeff Merkley from Oregon. Welcome, and, Alyce, I believe Sam
has entered the room. Yes, welcome, Sam. Sam has the coolest sweater
on, you have to see Elmo. Hi, Sam. He is living proof of the importance
of affordable access and health care.
Senator Kaine. He can have my seat if I can have the sweater.
Senator Stabenow. Yes, just not for a while. Yes, welcome.
STATEMENT OF ALYCE ORNELLA, PANELIST FROM HARPSWELL, ME
Ms. Ornella. Yes, thank you. I hear myself echoing. Three years ago
my husband and I were expecting our first child. At the time we were
self-employed as small business owners and we couldn't afford the high
cost of health insurance. This was before the ACA. When the Affordable
Care Act was passed we found an affordable plan on the market place.
Suddenly all of my prenatal care was covered, my pregnancy was
completely normal and uneventful. Just as everyone hopes the plan we
signed up for through the marketplace covered advance testing for
genetic conditions and all my results came back clear. But then the
unexpected happen as tends to happen. No one wants to face the
devastation of their baby being born with life threatening medical
problems but that is exactly what happened to us.
Our son Sam was born with multiple congenital birth defects, none
of which could be detected before he was born. He was rushed by
ambulance teams to the Maine Medical center in Portland. When he was
just 2 days old the pediatric surgeons performed surgery there to save
his life. The medical bills in his first month alone toped $100,000.
Within his 2 years of life Sam has been seen by nearly a dozen
specialist and has gone through 20 tests and procedures to ensure that
his health remains stable.
Later in his infancy Sam was approved for SSI benefits which meant
he also became covered by Medicaid--the transition to that coverage was
seamless I only needed to make sure his pediatrician put in an
authorization for his medication and specialist. He was able to
continue seeing the same specialist that he'd seen since birth and his
Medicaid coverage has fully provided for every test and exam he's
needed. Knowing that Sam can receive all the care his doctor's want for
him has greatly lessened anxiety we've felt regarding his multiple
conditions. His access to testing has enabled us to confirm positive
side changes in his conditions which has allowed him to go off certain
medications sooner than expected.
Sam is now a thriving happy 2 year old who seems like any kid his
age. I've been able to return to work part time since he is doing so
well. Sam's health will still require a team of pediatric specialists
to ensure care for him throughout his childhood.
The protections the Affordable Care Act has provided ensure that we
have been able to get him the tests, medicine, therapies, doctor visits
that he needs to stay healthy. The Affordable Care Act ensures that he
can never be denied coverage. And that our family is not charged
exuberant premiums fees and high deductibles because of his medical
needs and means he will never face lifetime limits in coverage for the
conditions he has had since he was born. The Affordable Care Act has
been critical to how well he is doing today.
Due in part to our fears regarding the ACA repeal my husband and I
have given up self-employment so that we can attain more security
regarding health-care coverage in the future. My husband has recently
accepted a job that will take him away from home more than we are used
to but comes with a solid employment based health-care coverage for our
family. This is our priority now that the new administration and Senate
Republicans have made the ACA repeal their first goal. However I cannot
rest assured that Sam's long-term future will be as secure if we lose
the provisions for no denial pre-existing conditions. I fear the return
of yearly or lifetime limits on coverage. And high risk pools. What if
my husband loses his job? What will health-care access look like for
Sam 5 or 10 years from now? What will be available to him when he is an
adult looking for coverage as a person who was born with multiple
medical conditions and has a complex medical history? No one should
face financial ruin because they need medical help and no one should be
forced to go without the medical care they need.
It would be irresponsible to our representatives in Washington to
pull the rug out from under millions of people around the country who
have health care because of the Affordable Care Act. I know how it
would affect my son's life if that were to happen and it would be
devastating for him and our family.
Senator STABENOW. Thank you so much for sharing your testimony and
for sharing Sam. It is a blessing to see him acting so well, like a
normal 2-year-old. Oh, before I forget, welcome, Senator Sheldon
Whitehouse, joining us from the Great State of Rhode Island. So, Diane,
welcome.
STATEMENT OF DIANE FLEMING, PANELIST FROM WASHINGTON, DC
Ms. Fleming. Good afternoon, everyone. It is such a pleasure, and
thank you for allowing us to be here. My name is Diane Fleming. I am a
75-year-old young adult. I live in Anacostia neighborhood which is ward
eight, 10 minutes from the Capital here. I am a retired member of the
International Association of Machinists. And I am here today on behalf
of the alliance for retired Americans. I am pleased to be surrounded by
others who are fighting to protect our hard earned Medicare benefits. I
worked for United Airlines for 35 years as a reservation and ticket
agent. But when the airline went bankrupt I lost most of my pension. So
you know that is a little less money. Luckily, my job provided me with
health care coverage until I was 65 and went on Medicare.
Five years ago I was diagnosed with thyroid cancer. Since then I
have had four surgeries, radioactive iodine treatment twice, the cancer
has recurred and I will need to have surgery again. After being
diagnosed with the thyroid cancer I've had CT scans, sonograms, MRIs to
detect the target areas, little biopsies, and most of these procedures
are very expensive. We are talking $1,000 to $3,000, to $3,000 for one
thing. I have also had to have blood work regularly to check the
levels. And I don't know how I would have been able to afford all of
these treatments and test done without Medicare to cover the bills.
In addition to the cancer, I suffer from glaucoma, which is
hereditary through my family, and I need daily drops.
Medicare has help to make sure I receive treatment every 4 months
to check the eye pressure. While others have private Medicare advantage
plans. I chose the traditional Medicare. It has made my cancer a lot
more bearable, enabling me to focus on getting better rather than going
bankrupt. I know I speak for millions when I say no cuts to Medicare
and no privatization. With premium support of vouchers a person with my
pre-existing condition, with my age, I probably wouldn't be able to get
insured, and if I could it would be very costly. So I need the
guaranteed coverage that Medicare offers. Not a coupon or voucher.
Those things don't work anyway that I could not afford. Millions of
older Americans are able to enjoy their retirement without astronomical
medical expenses because of Medicare.
In the age of small or nonexistent pensions, minimal retirement
savings, and skyrocketing prescriptions, Medicare is literally a
lifesaver. My sister just had to go on a medication, and a 28-day
supply is $30,000. So without Medicare she would not be able to do
this. I retired at age 62, but I was lucky that United did provide
health coverage and I was able to continue with that until I turned 65.
So most Americans don't have that. We must make sure that Donald Trump
keeps the promise not to cut Medicare so medical expenses don't
bankrupt millions of seniors and their families.
Since November the President-elect and Republican support on
Capitol Hill have taken steps towards dismantling and cutting our
earned Medicare benefits. President-elect Trump has named house budget
committee chairman Tom Price of Georgia to be the Secretary of U.S.
Health and Human Services. Representative Price has spent years trying
to privatize and cut Medicare in the past. I wonder what he is cutting
out of his area. Representative Price has promised to cut and change
Medicare into a voucher program. As Secretary, Price will have
significant control over Medicare including RD plan and policies
affecting the price of prescription drugs. His views are out of touch
and he is just not a very sensitive person. We Americans have paid for
decades and we continue to pay. Money comes out of my monthly Social
Security checks to cover Medicare.
So Representative Price and the President-elect will be working
closely together with House Speaker Paul Ryan. He has tried to do this
over and over again. If Speaker Ryan's plans were to become law,
seniors would become deeply hurt. We simply cannot afford to wait until
we are 67 to go on Medicare and the privatization that the speaker
calls for. The members of the Alliance will fight Donald Trump, and
thank all of you all, fighting Paul Ryan and Price every step of the
way. We need to guarantee the benefits that Medicare offers, not coupon
care that leaves seniors like me hanging out to dry. Thank you very
much.
Senator Stabenow. Thank you very much. We are pleased to be joined
by Senator Baldwin; welcome. And we are so pleased now to hear from
Holly Jensen. Welcome again.
STATEMENT OF HOLLY JENSEN, PANELIST FROM CLEVELAND, OH
Ms. Jensen. Thank you so much and good afternoon. I am Holly
Jensen, and I am 32 and from Cleveland, and I am honored to tell you
how the ACA and Medicare saved my life. I own a small business that
helps nonprofits with communications and fundraising. I am a really
hard worker and I love what I do. Most of my business comes from
referrals from causes I support and I am proud to say that I am good at
my work. This is my first business card, I still am proud of it and am
excited by it. Part of the gig economy comes with the risk. If I don't
produce I don't get paid. I don't get paid sick days. I don't get paid
vacation days. So when the Affordable Care Act passed, it was huge
relief.
I had never had my own insurance before. I had been living before
undiagnosed with anxiety, depression, and OCD. It began to severely
impact my life. Tasks that normally took an hour began to take all day
and things began to feel insurmountable. I remember one project I was
excited about working with the Compassionate Communications Center for
Ohio and was going to go down from Cleveland to Columbus to meet with
the board to discuss their Middle East peace activism. As I was
preparing my disorder was beginning to spiral out of control and pretty
much fell apart. I had to cancel this trip that I was really looking
forward to at the last minute. This is one example of the way my
untreated disorders were effecting my life. It was horrible and really
embarrassing. My increasing inability to function dealt not only a blow
to my bank account but also my livelihood and self-respect. I withdrew
from my community and the arts world, which often involved organizing
small business owners such as myself. My once active life became small
and empty. I felt like I was slipping out of society.
However, the most painful act of being untreated was seeing my
relationship with my loved ones crumble. Including my mom who is my
best friend in the world. She just turned 65 in August. I hope she
doesn't mind me saying that. Sorry, mom. She is going through the
process of Medicare and is having tests that she has never had before.
So my mother lives three blocks from me, and my brother lives one block
from me. And at this point weeks would go by without me as much as
answering a text message from them. So it was getting scary. And about
a year ago I hit rock bottom. I couldn't keep up with my premiums or
any bill. And it was winter in Cleveland and I don't have a car, so I
slug through the snow and sleet to the free medical clinic in
Cleveland. At this point I didn't have anywhere else to turn. Asking
for help took a really long time and was incredibly humbling. When I
got there my mind was so rattled that I didn't even know how to begin
filling out the paperwork. A women there walked me through it, helped
me through it, and treated me with respect and efficiently helped me
re-figure out my life. Ta-da; this is my ticket, my golden ticket.
On that day, I felt like a person who deserved to care. And even
before the process of receiving treatment started, that glimmer of hope
meant so much. It meant I wasn't a disposable person. And it took so
long to ask for help, if I would've been turned away, I really might
have lost hope entirely. And if they'd said I needed regular employment
to access Medicaid, I definitely would've continued going in a downward
spiral. Requiring employment for Medicaid would've been like telling me
you'll throw me a life preserver after I stop drowning.
My psychiatric care has given me the foundation on which to rebuild
my life. I take medications, such as this, and I have weekly counseling
therapy sessions that help me heal and grow. I also do an enormous
amount of work on my own to make sure that I keep up my progress. This
care not only saved my life, it gave me back my life. Thanks to
Medicaid, I'm becoming the professional I want to be again. But more
important, I'm becoming the person I want to be.
I have faith in growing my business, not just struggling to keep it
alive. I'm back, actually working with [the] compassionate
Communications Center of Ohio, doing psych redesign and branding, and I
really love working with all of my clients. And once again, organizing
and participating in arts events in my community and I'm volunteering
at my local recovery clubhouse, applying my communication and
development skills to help them to continue to support the community.
I'm reconnecting with my friends and loved ones. Perhaps most
important, [I'm] restoring my relationship with my mom. It feels good
to pay my bills, but it feels even better to be part of something.
Mental and behavioral health is no joke. Without Medicaid, I know I
would have eventually depended on emergency care, taxpayer funded
rehab, and the legal system. I would've cost taxpayers much more than
the expense of my basic care now. My goal is to continue healing,
regain my earning potential, get my private health coverage, and
happily support Medicare and Medicaid in my tax dollars. Despite my
relatively high tax rate for self-employed people, I would be proud to
support these life-saving and tax dollar saving programs. And I know
I'm not alone. We cannot afford to discard and destroy the ACA and
Medicaid for millions of people like me who would be turned away. For
me, that would've meant discarding me exactly when I needed support the
most. Thank you for allowing me to share my story.
Senator Stabenow. Well, thank you so much. Hi, we've been joined by
my friend and colleague, the great Senator of Michigan, Gary Peters.
You have the full Michigan delegation here, Anne. You have all of us
here with you. So, let me begin. We want to give all of our colleagues
the chance to ask a question.
I have to say that listening to all of you, whether it's talking
about maternity care, I remember the fights in the Finance Committee
when colleagues did not believe that that should not be in the central
service and it makes me smile to hear you talk about maternity care and
to see Sam and to have each of you talk about things that so many of us
fought so hard for. But, I do want to particularly, Holly, thank you
for being here, as the author of the mental health parity provisions in
the ACA because of my own family's situation. I want to thank you for
your courage, because we have done less research over our country's
history on the organ called the brain, we're finally doing that. But,
whether it's a chemical imbalance in the brain, like my dad had, and
was finally diagnosed as bipolar. And once that happened and he got the
mediation he needed, he went on to live a very effective life. So, I
saw what it was like when he didn't and when he did. And, a tremendous
difference. So, I have always felt that, and I know my colleagues have,
that whether its diabetes and you're checking your sugar, or whether
it's a chemical imbalance in your brain, we want to have the same view
in terms of access to care. And not have a stigma, depending on which
part of our body the disease is in. So, I just want to thank you for
your courage and for speaking out for millions of people; one out of
five people in our country are struggling with a disease that involves
behavior health. And so, thank you very much for doing that.
Anne, I wanted to ask you a question, actually a couple of
questions. You were talking about your prescription drug costs. When we
look at these numbers, unbelievable, $50/month to $30,000/month or
$8,000/year, was it, to $84,000/year. I mean, these are astronomical
increases, and there's a whole range of things, dealing with cost of
medicine that we need to tackle still in this country for sure. But, I
wonder if you might speak about where you would be right now without
Medicare, speak a little bit more about that. So, costs, what that
would mean to you. And if we saw Medicare turn into some kind of a
voucher, no matter what we call it, being in support of a voucher,
where it wasn't guaranteed coverage and guaranteed prescription drug
coverage, how would that work for you?
Ms. Serafin. Well, first of all, without Medicare, I would have to
get insurance and because of my preexisting condition, I would not be
able to get insurance. Second, without Medicare, I think my husband and
I would've ended up on Medicaid because we would've been bankrupt. I
mean, we have a small nest egg, which we have, as I've shared before,
used a substantial portion of to help out my parents. That would've
been gone. The costs are just prohibitive; we couldn't have done that.
$6,000, $8,000, $84,000/month and actually, the MS----
Senator Stabenow. A month? So, it's $84,000/month?
Ms. Serafin. No, sorry; that was a year.
Senator Stabenow. Oh, a year, okay. Either way it's a lot of money.
More than most people make a year.
Ms. Serafin. It's a lot of money, but the Acthar Gel is $30,000/
month.
Senator Stabenow. All right, thank you. We have many colleagues I
want to make sure have a chance to ask questions. So, thank you, for
now and, Senator Warren.
Senator Warren. Thank you, and thank you all again for being here.
You know, yesterday at the hearing for Congressman Price to be
Secretary of HHS, I asked him about the cuts that he has proposed to
Medicare and Medicaid. You know, he's already proposed $449 billion in
cuts to Medicare and over $1 trillion in cuts to the Medicaid program.
And so I asked him if he would commit to follow through on Donald
Trump's promise, ``I won't cut Medicare or Medicaid.'' And, there was a
lot of dancing back and forth, but the bottom line is, no, he would not
commit, which I'm suppose should not have been a surprise. But what I
just want to do, as briefly as I can, is to just focus in, just a
little bit, down the line and put a face to that. What it means to put
those kind of cuts into the system. So, if I can, let me start with you
Ms. Fleming. You used to work at United Airlines, as I understand. How
many years did you pay into the Medicare system?
Ms. Fleming. [Mic did not pick up.]
Senator Warren. And how long have you worked there?
Ms. Fleming. Thirty-nine years.
Senator Warren. Thirty-nine years that you paid into the Medicare
system. So, when Congressman Price proposes cutting $449 billion out of
the Medicare system, I just want to ask, that's going to put more out-
of-pocket costs on you. Does that sound fair to you?
Ms. Fleming. [Mic did not pick up.]
Senator Warren. Nice question. Where else is it we so much need to
spend $449 billion that you can spend more out of pocket so that money
can go somewhere else--like tax cuts for rich people. Ms. Jensen, can I
ask you--just because I want to be clear about this. One of the things
that Medicaid does is make sure you get access to mental health
services. If you lose that access, what happens to your life?
Ms. Jensen. Um, that would entirely change my life. I wouldn't be
able to afford the services I need. My medications alone right now run
about as much as my rent. And I know that weekly counseling or therapy
sessions would really be out of reach. It would threaten not only the
growth of my business but the existence of my business. Basically no
Medicaid, no business. That would kind of be the end of one of my
dreams. And, untreated disorders--my untreated disorder, I know I would
retreat from society. I would retreat from my loved ones. I would not
be a productive citizen. I would probably get in trouble and cost the
taxpayers some money. Mental and behavioral health is no joke. There
are fatal consequences, and it's a matter of life and death for a lot
of people--including me.
Senator Warren. Thank you. Thank you. And Ms. Serafin--I know that
you have dealt with both systems, both Medicare and Medicaid. For just
1 minute, I'd like to focus on the Medicaid part of that. Your mother,
after your father passed, your mother declined, needed full time care.
And she was supported by Medicaid during that period of time. She was
able to be in a facility that could take care of her. If Medicaid
hadn't been available to you--if there had been a trillion dollar cut
to Medicaid, what would have happened to you and your husband?
Ms. Serafin. Well, physically I could not take care of anyone else,
I can hardly take care of myself. So, we would have had to hire someone
or we would have had to move because our home was not accommodating for
another person with a disability. Second, the care my mother received
in the nursing home was so personally gratifying; I could sleep at
night. My mother was a really strong woman, she could have been a CEO.
She was born in the wrong era. But as a daughter, as mothers and
daughters often do, we didn't always see eye to eye on everything. And
people in the nursing home loved her--they loved her feisty manner,
they loved the things that she would say. And I would think, ``Oh god,
I would never say that.'' But they thought she was wonderful.
Senator Warren. My mother was like that too.
Ms. Serafin. I could sleep at night. I could feel good because I so
cannot do things as it is for myself, and there were loving people who
would go to her and say, ``I love you, Anita,'' and it just made my
heart feel that wonderful feeling.
Senator Warren. That's the face of Medicaid. And one more on
Medicaid. And that is Sam. Right, Ms. Ornella?
Ms. Ornella. Yes.
Senator Warren. Sam is the happy face of Medicaid. If there's $1
trillion in cuts to Medicaid, and Sam is not able to get help through
Medicaid, what happens to Sam?
Ms. Ornella. We barely qualified for Medicaid as it was, so if
there are any cuts to it, we would have been in that group of people
who I believe wouldn't have qualified on the financial basis. Medicaid
has provided him to be able to go to his kidney doctors and to keep his
status check on his kidneys, which is what we think his long-term
issues are going to be. Medicaid has been there to cover tests for
swallowing, for swallowing functions, for all the different parts of
his body that are affected by his disorder. So, my fear is that if we
do get employer based coverage, anything can happen in life--what if my
husband lost his job and then we didn't qualify for Sam to get Medicaid
anymore? How would we deal with that double whammy of losing employer
coverage and then not qualifying for Medicaid for a medically complex
child?
Senator Warren. Thank you. I'm very grateful to all four of you for
putting a face on what Medicare and Medicaid mean. I suggested
yesterday to Congressman Price that if he is confirmed to be the head
of HHS, that he cut out the statement of Donald Trump, ``I will not cut
Medicare or Medicaid,'' and tape it above his desk and look at it every
single day--because you are what that's all about. You are the reason
we must not cut Medicare and Medicaid. Thank you, thank you for being
here.
Senator Stabenow. Thank you so much, that is so true. Senator
Kaine?
Senator Kaine. Well thank you, Senator Stabenow, and to my
colleagues for doing this. Thank you for sharing your stories, these
are very important.
Kanisha mentioned the words, ``kind of afraid of what might
happen,'' and I just kind of jotted that down. There's about 66 million
Americans who are really disappointed about what happened in November,
but there's a subset of people who are really personally very, very
afraid. And I think the job of us, the job of those of us who are
disappointed is to have the backs of those who are afraid.
People are afraid because they might lose their healthcare. People
are afraid because they're worried about rollback of marriage equality.
People are afraid because they're worried that they might be deported.
People are afraid for a lot of reasons. And it gives me a lot of
motivation to try to have the backs of folks who have legitimate
concerns and fears. And coming and sharing your stories is important.
Congressman Price poses particular challenges to us because you can
kind of look in vain in his record to see support for virtually
anything that's a part of the health-care coverage safety net. He wants
to turn Medicaid into a block grant program and is against ESGIA, voted
repeatedly against it, called it ``socialized medicine.'' Most programs
cover more than 800,000 Virginians.
He wants to repeal the Affordable Care Act. That's a program that
helps millions of Virginians, if you add up all pieces of it together.
He wants to change Medicare into a premium support program that would
raise costs, by CBO estimate, of 1.3 million Virginian seniors. And he
wants to defund Planned Parenthood which is the primary health care
provider of choice for tens of thousands of Virginians. If you look at
everything that's in the coverage space, that's in the access space, he
is opposed to it. And so that's what makes him so problematic as a next
HHS Secretary.
On my webpage I put up a little thing, kaine.senate.gov/ACAStory,
and a week ago I asked Virginians to share stories much like you shared
today. We have more than a thousand submissions of stories just like
yours.
I'm going to ask one question based on a theme that's emerging from
the stories that I have not been paying much attention to but both
Alyce and Holly, you mentioned it in your testimony. The ACA makes it
easier to be self-employed and start your own business compared to what
we had before. And if we can get over the rush to repeal that's
injecting so much uncertainty into this question of, ``will we be able
to count on this or should we go back and work with an employer
provided plan?''
The ACA has turned into this motivator for entrepreneurial spirit
and start-up businesses and innovators. Exactly the kind of thing we
want to do, so, separate and apart from all the health care benefits,
which are fantastic--that's reason enough to fight for them--the ACA
has also given people who have a dream to start their own business, to
start their own nonprofit the ability to do it, and have health
insurance if they do it.
It's interesting, Senator Stabenow, the number of stories I've
gotten on my website of people who have come up to me and mention this
aspect of the Affordable Care Act, even though sometimes that's not the
story they're telling me. Something about their child who has a special
need, but they're telling me they're able to have health insurance as
an entrepreneur, as a small business owner, as a startup or nonprofit
because of the ACA.
So I'm seeing this really positive economic effect and I imagine
that again, that was in Alyce and Holly's stories. It might not have
been the main theme of the story, but it was an element in both your
stories. And I think that's something we have to fight to protect. I'd
be interested in hearing your thoughts.
Ms. Ornella. I'll just give an example. Before the ACA was passed,
my husband and I, who were both self-employed, went without insurance,
because in Maine the quote for what was available to us, and we were
two adults under the age of 35, was $1,200 a month. And that was a huge
part of our income. We've not ever been people who have made a lot of
money so we went without insurance. And then when we were able to sign
on to the ACA plan we paid $200 a month.
So, for that reason, we were able to continue our small business
activities for longer than we would have otherwise and we supported
ourselves for a number of years that way. Obviously priorities change
when you have a child and if you have a child that has complex medical
needs you start to assess whether or not you can--especially when
there's talk of repealing the ACA and protections for people with
preexisting conditions you start to rush into thinking, ``I need to
work for someone else now.''
Senator Kaine. But if we stabilize this and get over this rushed,
this foolish rush to repeal----
Ms. Ornella. Yes.
Senator Kaine. We have something that we think we need in place for
people like you, the chance again to say, ``Hey I want to be my own
boss and start my own business.''
Ms. Ornella. Oh yes, absolutely.
Ms. Jensen. I've actually never had health insurance from my
employer. I went without it for a long time until the ACA and
eventually Medicaid. It is absolutely essential to my business. My
well-being is the cornerstone of it. It's more important than my credit
line, it's more important than tax rates. Nothing gets done when I'm
unwell. And we can't claim to support small businesses if we don't
support small business owners. Yes, my business would probably not
exist without Medicaid at this point to be honest. And in the larger
picture, I worry about how that will dampen America's innovation and
entrepreneurship. If it becomes an unbearable risk to start your own
business, guess what? We're losing a lot of small business owners in
America.
Senator Kaine. Thank you. I appreciate it.
Senator Stabenow. Thank you so much. And, Senator Kaine, I have
heard the same thing from so many people who have been able to go into
small business and their life's dream because they've been freed from
that chain of having to be somewhere with insurance from their
employer. So thank you so much for that. I know Senator Merkley has to
leave at 1 and, to just briefly say something, we will let you jump in
here to do that. I am going to step away to ask a question at the
Finance Committee of Mr. Mnuchin--we're beginning a second round--and I
will stop back, so we're doing our version of Beam Me Up, Scotty, as
we're running back and forth between everything--but, Senator Merkley?
Senator Merkley. Inaudible 1:12:33-1:13:13. I think it's vetted in
the issue of Medicare, Medicaid, and ACA. We have a health-care system
that's just, when you need care, when you have that disease, that
accident, you know you can access it, and then you pay more and you get
the care that you need. So I just wanted to share that comment.
[Inaudible comment] . . . have questions for Sue. Thank you for sharing
your testimony. We need a health-care system. It gives peace of mind to
Americans, not distress of whether you'll be able to get care, not go
bankrupt, and that's what we're fighting for. Thank you.
Senator Hassan. Well, thank you. I want to thank Senator Stabenow
more--you really were the driving force in organizing this. I also just
really want to thank all five of you for being able to be here to tell
us your experiences, because change occurs when people are willing to
stand up, especially in a democracy, and not only talk about ideas, but
talk about real life experiences so that policy makers understand what
the impact of their ideas and philosophies are and really can be
informed as we work to make sure that things work for the American
people. I am struck by the themes that your combined testimony have
raised for today's panel, and I hope for everybody who's watching and
listening cause I think we really see and heard from you a wide range
of experiences that really talks about the individual peace of mind,
the physical health, and the economic health that comes with
accessible, affordable, high quality health care. I want to touch on a
particular subset of what I've heard, just because I think given
Congressman Price's, nominee Price's, record is important. But before I
do that, a special shout out, Alyce, to you, we have something in
common having had kids with special needs and it has its challenges but
it has its good rewards too, so, thank you for what you're doing to
raise Sam.
Ms. Ornella. Thank you.
Senator Hassan. You're Welcome. And, Kanisha, I wanted to talk to
you a little bit more about your experience. First of all, given
Congressmen Price's record of repeatedly voting to defund Planned
Parenthood, you talked about how important Planned Parenthood had been
to your care at critical times in your life. Can you just tell us a
little bit more about what your experience as a patient at Planned
Parenthood was like and how it impacted your ability to do what you
wanted to do with your life?
Ms. Hans. Sure. So, when I went to Planned Parenthood when I was in
high school; it's because I had no other place to go. And now I go to
Planned Parenthood by choice because I trust them with my health care.
I've mentioned before I had a medical condition that went undiagnosed
for a while. I'd gone to several different doctors before, and Planned
Parenthood was the first one to diagnose me with my condition and was
able to treat me. And thanks to title X funding, I was able to afford
my care, and that's why I keep returning to Planned Parenthood, because
I trust them.
Senator Hassan. I take it would also concern you to know that Dr.
Price voted as a Congressmen against a District of Columbia law that
would prohibit employers from discriminating against employees with the
decisions they make about their reproductive health and birth control.
Is that something you're aware of and does it concern you?
Ms. Hans. Yes it does concern me. I'm 23 years old and I am
employed so I am worried about getting kicked off my parent's
insurance, and if I do go on my employer's insurance, it's not my
boss's business about my health care and it is something that is very
concerning, and having grown up most of my adult life with the Obama
administration, I never imagined I would have to worry about this. And
it's kind of really throwing me for a loop.
Senator Hassan. Right; well, thank you. I too am going to have to
leave; this is what happens. Senator Kaine, you can sit right here.
Senator Kaine. I do have other questions, but I wasn't planning on
sharing. I may have to go too. I'll keep it rolling.
Senator Hassan. What I hope you all know, again, is how grateful we
are to you for telling your stories. Each and every one of you has been
willing to talk about something that used to be very hard to talk
about, and particularly Holly, as I just ended my term as Governor of
New Hampshire, and I'm dealing with an opioid crisis, as many States
are. We also know that behavioral health challenges and substance use
disorder sometimes co-occur, and so the importance of people with
behavioral health challenges and/or substance misuse speaking up for
themselves, the same way it's important for women who need access to
strong and good reproductive health care speaking up for themselves,
for people with disabilities, or parents for people with disabilities,
the willingness to speak up about the need to be included is just
critical, and in a democracy, where every single one of us counts, you
guys have done us all proud today reminding us of that, so thank you so
much, and let's keep at it because this rush to repeal is so misguided,
and with regard to Congressman Price's nomination, I hope very much, at
the very least, that he will understand and reflect on your testimony
should he become confirmed. Thank you.
Senator Hirono. Senator Kaine, you have one question to ask?
Senator Kaine. I do, I do, thank you, Senator Hirono. I'm so glad
that we got into the reproductive health issue. This week, there was an
amazing announcement, and it didn't get enough attention and that's the
unwanted pregnancy rate in the United States, it's at its lowest ever
since history has been able to record that rate. What a great thing.
The Affordable Care Act and the fact that Planned Parenthood has not
been defunded is one of the reasons--two of the reasons why unwanted
pregnancy rates has come down. This is not really a question, it's an
editorial comment. I am stunned at the number of individuals who take
policy positions that would suggest they're very much against unwanted
pregnancies who want to repeal the Affordable Care Act. I'm stunned at
institutions that have taken an anti-ACA position who are institutions
that would suggest production of the unwanted pregnancy rate. I can't
imagine anybody in society who would look at the reduction of unwanted
pregnancy and say that's a bad thing. I think virtually everybody in
society, regardless of politics, political party or political at all,
regardless of region, regardless of race, regardless of anything, would
look at reductions in unwanted pregnancy and say ``that's a good
thing.'' And yet some of the people who are the most claiming to be
forward are the ones trying to undo the very health-care safety that
has been able to bring down the rates of unwanted pregnancy. If they
are successful in that, the unwanted pregnancy rates will go back up.
That's one of the many things I have a hard time figuring out. And I
will turn it back to my colleague, Senator.
Senator Hirono. Thank you now that everybody has left, not you
folks, but Mahalo for being here, and you know that we were joined by
so many of our Senate colleagues today to hear your stories, and I know
you understand that we are in the midst of confirmation hearings for
many of President-elect Trump's nominees, and so I know you understand
why people are going in and out.
We have a nominee for HHS Secretary who wants to privatize
Medicare, who wants to dismantle Medicaid, who wants to defund Planned
Parenthood, and you have come in today to tell us your own experiences
and stories about how these programs have literally saved your
families, saved you and allowed you to go forward and thrive. So, I
will join my colleagues in fighting tooth and nail against the
voucherizing of Medicare and the privatizing of these kinds of programs
that really are the lifelines for millions of people in our community.
I think that finally, with the potential demise or repeal of the
Affordable Care Act and voucherizing of Medicare and the huge cuts to
Medicaid, the defunding of Planned Parenthood, it is finally, I think,
sinking into our country what these kinds of actions would mean to
them.
I was a member of the United States House of Representatives when
we were working on the Affordable Care Act, and I remember, sadly, how
many people on Medicare, including people from the state of Hawaii who
were on Medicare, who came to me and called me and said, ``Don't touch
Medicare but don't pass the Affordable Care Act.'' These seniors are
going to find out that with the repeal of the Affordable Care Act, they
will end up paying more for drugs because the Affordable Care Act was
the prescription drug donut hole. They will not be able to access the
kind of preventative care that allows them to age in place and maintain
their lives with the repeal of the Affordable Care Act.
This is sad, that so many people who came forward to say that we
shouldn't pass the ACA will be among the millions who will be hurt with
the repeal of the ACA. So, we have a President-elect who recently said
that ``my health-care plan will cover everyone.'' Did you . . . he said
that. There will be health care for everyone. How do you all think that
is supposed to happen? How is that supposed to be implemented with
Secretary Price at the helm? Anybody? It's more than just a rhetorical
question.
I would like you all to say that on the record what you all think
will happen to President-elect Trumps pledge that his health care plan
will cover everyone.
Ms. Jensen. It does not seem logical to me if he is making that
statement and he is nominating or choosing someone who, in what touches
me personally, says he does not believe that preexisting condition
should be considered as an accommodation or a protection, and I'm
thinking of my own child who was born that way. He didn't acquire them
through any of his own choices in life, or anything that he did.
There's millions of children and individuals who are in way worse
position than Sam is. So how does that add up if you say you want to
have coverage for everyone but then the person you pick to be in charge
is already excluding individuals before their record is of exclusion. I
don't understand how that makes sense.
Senator Hirono. Thank you. With the other people who have come
forward, would you like your comments to this question to be on the
record?
Ms. Fleming. Yes, I'd like to comment. Obviously, the President-
elect has not really looked at Representative Price's record in voting
the things that he has voted against, so I think that hopefully, he
will take a look at his record in what he has done in the past and give
him some new ideas that this is not good in what you're planning to do.
Senator Hirono. Ms. Serafin?
Ms. Serafin. I think that if he is chosen, he will decimate
Medicare and Medicaid as we know it. I believe that his stance will be
``you can go out and figure out how to take care of yourselves on your
own. We'll give you the costs, we'll give you the money for whatever
else we need the money for.'' It will be chaos, I believe it will be
complete chaos.
Ms. Hans. Yes, I would like to go in everyone else's comments in
that I don't think the President-elect has really done his homework in
who he's been nominating and that's been made very clear by Tom Price's
record. And it doesn't seem like Tom Price doesn't really care about
the health of the citizens of the United States. And therefore, it
makes no sense that he should be at the helm of HHS. His record has
consistently shown that he doesn't care about people who rely on these
health programs the most.
Senator Hirono. Ms. Jensen, would you like to add to this?
Ms. Jensen. Yes, I would. Thank you for the opportunity. I very
much agree, it's like Trump hasn't met Price. For instance, one of the
ideas thrown around about employment requirements for Medicaid seem
counter intuitive for me. I feel like it's the law makers' job to
represent the caring majority, not the minority of the wealthy, and I
feel like we're going in that direction. Yes, and I don't know how
we're supposed to reconcile these two entirely exclusive plans that we
have on the table. Yes, I believe that lawmakers need to work to
protect the vulnerable, nurture small business, and save the taxpayers
money.
Senator Hirono. Thank you. Senator Blumenthal, we can proceed to
you with your question.
Senator Blumenthal. Thank you Senator. Thank you all of you for
being here today. Your stories, as Senator Warren said, have really
given us a face and a voice to this somewhat abstract issue to many
Americans. People take their health for granted until they don't have
it and then it becomes the most important thing in the world as each of
you know from your personal experience. All of us know it because we've
all had bad health, it's not like wealth gives you immunity, but it
enables you to do a lot of preventive care, and that's what I want to
focus on is the prevention. Cause just as we ignore the economic impact
of small businesses as Holly has said so well, we also ignore the
increased cost of health care if preventive steps aren't taken. At a
very early age, Sam's age, to forestall diabetes and obesity and
smoking and even opioid prevention because preventing addiction is so
much more cost effective than treating it later. You mentioned, Anne,
that the cost of your medicine is $75,000 a year; do I have that right?
Ms. Serafin. It would be, for the one drug I talked about, it would
be $84,000 a year. As it is now, the Gilenya I'm on is $6,000 a month,
so that is $72,000 a year.
Senator Blumenthal. So, you can see just the cost of that one
medication and your medical cost may not be preventable in the same way
but we can really save a lot of money through prevention and we can
bring down the cost of medication. One area that I think perhaps in
this conversation that has not been emphasized is the effects and the
goals of the Affordable Care Act in restraining and diminishing the
growing cost of health care. That was one of the objectives, not just
create more demand for it and put more money into the health-care
system, but also try to make it more efficient and effective. So I
don't know whether any of you any have observations on that aspect of
it, I would welcome.
Ms. Hans. Yes, I think that a lot of people have kind of lost sight
that that was the goal of the ACA: when more people have coverage, it
actually drags cost down. When people don't have coverage, they keep
putting off care. I know--I personally had to put off care because I
couldn't access it, and when you keep delaying care, it's more costly
in the end. And in the end, the taxpayers are still paying for it,
they're just paying a lot more.
Ms. Fleming. My view is that preventive care is necessary. This is
a good thing, we're becoming a healthier society with this, and if you
eliminate some of the preventive care, the early exams that you can
have, which we cannot do before, because of the cost, you can really
target if there is an issue, you can target right away and take care of
it which in the long run will cost us a lot less than someone that has
to have really severe care, so the preventive part of it is from early
childhood all the way up, to us older folks. Thank you.
Ms. Ornella. I'll just quickly add with Sam's conditions, he
requires regular monitoring to ensure that no further problems arise or
if they do, they are caught in a timely manner. So I don't know if we
want to consider that, I guess we'd consider it because by doing
monitoring, which can range from minor tests that cost a few hundred
dollars to tests that cost a few thousand dollars, it's heading off any
problems be exacerbated but, you know, especially with a young child
that cannot really communicate what's going on in their body, so being
able to access that kind of care is important to maintaining a stable
health condition.
Ms. Serafin. I just want to add that the disease modifying drugs
that are there for multiple sclerosis are there to retard any
advancement. So even though they are costly, hopefully they're actually
lessening your chances of developing a more severe disease and more
costly problems.
Ms. Jensen. And I'd like to add specifically for mental health and
behavioral health, preventative care in that world is kind of a new
frontier. I definitely had that attitude of ``I can handle this. I can
do this. I can dig my way out of this.'' I didn't want to ask for help.
Maybe that's a very American thing: ``I can do it myself.'' And that is
what the preventative care is coming up against a lot of times. And I
would say that education about mental health and behavioral health, the
idea that was raised before that mental health and behavioral health
are part of health care. So education about that could be very
effective. And also reducing the stigma, even by covering these things
we do a little bit to reduce the stigma. You're saying, you're a person
worth care. You're not disposable, you're not discardable. And also
reducing the stigma about asking for help which I hope I can do in a
tiny way today.
Senator Blumenthal. Just so you know Holly, for, I think it's more
than 8 years, there's been a law on the books that requires, it's
called, parity. In other words insurance companies are required to
cover mental health care in the same way that they cover physical
healthcare. That's a matter of Federal statute but there was a delay in
adopting regulations to implement the statute. That delay occurred
under both the Bush and Obama administrations and I was involved in
helping to advocate that law. We did it in Connecticut which is my
State, and then that law became a model for the Federal statute but
only recently has it been implemented and even now it's not fully
enforced. So my colleague Chris Murphy and I, we're both from
Connecticut, we've both advocated that there be enforcement of that
statute in part to deal with the stigma that you mentioned which is
still a major obstacle.
Ms. Jensen. You can't ask for help if you don't think there's
anyone out there to help you.
Senator Blumenthal. Well said. Thank you all.
Senator Hirono. Thank you, Senator Blumenthal. I'm going to ask
Senator Casey to wrap up, but before I do that I want to thank all of
you once again. You represent millions and millions of affected people
in our country and I think our voices, and I say ``our'' because you
know we are with you, need to be heard. As we say in Hawaii, ``Mahalo
nui loa.'' And thank you, Ms. Jensen, for pointing out the importance
of mental health services because, as Senator Blumenthal has pointed
out and many of us know, there has been a lack of parity as to the
treatment and the access to care for the mental health side which can
be just as debilitating if not more so than physical injuries, so,
Senator Casey, thank you very much. Mahalo.
Senator Casey. Senator Hirono, thank you very much, and Senator
Blumenthal and all those who are here. I'm the last one; because I am,
I won't ask questions. I just wanted to make a comment about your
testimony, maybe a comment about the process, and give you the last
word if you so choose. We've been here a while.
One thing I want to say at the outset is, both Alyce and Diane, I'm
using your first names even though we don't know each other, I don't
know who to commend more on multitasking with Sam, but that's a pretty
good tag team. I don't know if you practiced that this morning but it
sure looked seamless. But we're grateful for your testimony.
I want you to know something and I say this in a very serious way,
not just as a way to say thanks for making the trip here. We live in a
society where on an hourly basis it seems, the lives of movie stars or
athletes or even politicians or wealthy people, depending on what
category someone's in, their lives are always chronicled, always on the
news, always a subject of interest and debate and coverage so to speak.
Every once and awhile the lives of real people are put up with the same
degree of prominence but frankly not enough. And in this debate, right
now it's more than just a debate, it's a fight.
Chapter 1 is stopping the repeal of the Affordable Care Act, and
that's a fight we're in right now. Chapter 2, in my judgment, would be
if they're successful in Chapter 1, fighting like hell to make sure
whatever they replace it with, and no one's been able to find it--we
might want to hire a private investigator to find it in the replacement
bill, but it doesn't seem to have surfaced yet; I'm hoping it does--but
to fight like hell to make sure that whatever is in the replacement
bill is substantial enough to meet all of your needs and the needs of
lots of other people.
But your stories are not stories that are customarily on display in
Washington; yours are the stories of people that have lived quietly
triumphant lives. You've had to triumph over things that I've never had
to worry about and a lot of people in this building have not had to
worry about. Not everyone, but a lot of us haven't had those same
worries. So in your own way, in a very quiet way, you've been
triumphant in a way most of us haven't been able to appreciate. And
that story that you told is both inspirational but also instructive and
even instrumental. And I say that because the process. If you take your
stories out of the debate, years ago when we were trying to pass the
ACA and I was here and played a role in that, but even more so now if
you took your stories out of this debate to stop repeal and to make
sure we get the right result down the road, we lose.
Because if it's just a bunch of Senators rattling off numbers--and
they're great numbers to talk about: 20 million people insured and all
of that. We've got to keep using numbers; they're important. But what
is indispensable in winning this battle is how often we tell your
story, how often we excerpt from it in a floor speech, and how often we
use a 20-second sound bite in an interview or back home or on the road
or in debates in committee. All of those stories are going to be
indispensable to that.
So this isn't just a nice thing to do today. You're contributing to
the effort to win the battle. Your stories are persuasive, numbers once
and awhile can help you persuade, your stories are persuasive. So it's
up to us to make sure that we keep telling your stories, and stories
like yours all across the country. So you're playing a big role in this
debate and in so many ways that's doing something for your country.
You've come here to talk about your life which isn't easy to do.
And politicians like me, we talk a lot and we talk about issues but
rarely we don't talk about our own personal lives. That is much more
difficult than what we do every day. To tell a story, to admit that
things weren't going well in your life or that the struggles you had or
that the suffering you or your family endured. That's not easy to do
for anyone and we appreciate you doing that.
So that effort, that sacrifice, that commitment to going beyond
yourself is very, very meaningful to the debate. So I hope you
understand that and that you don't ever get dispirited in this fight
because we need you very much in this fight and you've already been
willing to sign up and not only put your hand up but walk towards the
goal that we're trying to achieve.
Holly, one of the best lines today is yours: ``It feels good to pay
my bills, but more so to be part of something.'' And not just the kind
of care that saved your life but gave your life back. So the measure of
our success will be how often we can put your stories on the record in
the interview. So I just want you to know how much we appreciate you.
Secondly in the process, today I'm going back and forth between the
hearing from the Finance Committee--we have Mr. Mnuchin for Treasury
Secretary. That's what we're doing today, we're asking him a lot of
questions about tough topics like mortgage foreclosures and things like
that. But we're going to finish that hearing today; obviously it'll go
for a while more, and we'll vote on that nomination.
But we're kind of in the middle of the Representative Price
nomination. I'm on both committees that he testified in front of, but
only the Finance Committee will be where the vote is. So he'll appear
there in front of our committee where we're doing Treasury today, and
that's where the vote will be. And because of your testimony today,
you've given me more, I won't use the word ammunition, but you've given
more information for us to be able to present in questions or comments
in that hearing on Representative Price.
And obviously we can't just do a good job in these hearings, we
have to do a lot more on the road back in our States. So that's the
process and we're going to continue to fight very hard to give meaning
and value and really to validate what you've told us today.
This is critically important, that we preserve all these
protections. And absent any other comments, we can wrap up, but I just
want to give you the last word. You traveled and took time to be here,
so if anyone wants to make any final comments, and then we'll gavel out
with the gavel. We actually have a gavel; I'll do that.
Ms. Serafin. Thank you for this opportunity. It has helped me
personally to be able to share this story and feel like I'm part of
what's going on and it's helped me to live with the next 4 years.
Senator Casey. Ann, thank you very much. We're grateful. Anybody
else?
Ms. Fleming. I just want to thank everyone. It's good to put faces
to it all with you all as well and I think one of the things that's
missing is the eye to eye contact that you're, you know, going to
implement something but you can't look me straight in the face or
straight in the eye and tell me what you're going to take away and not
give me anything else. This is good to be able to, the empathy that you
have and that you have all presented in front of us today, which I
don't see that happening in the next round of people. There's no
compassion--where is it? It's missing. So thank you all.
Senator Casey. We'll do a better job on our end. If we're in the
middle of a debate, figuratively speaking and sometimes literally, we
say, ``Well, I know you don't like what I said, but answer Diane's
question. How can you help her? How can you make sure she doesn't have
a circumstance that's unimaginable and will have the help that she
needs?''
Ms. Fleming. I wanted to say, I live right across the bridge, so
any time, just give me a call.
Senator Casey. You're close.
Ms. Fleming. I'll come in.
Senator Casey. Thanks. Anybody else?
Ms. Hans. Yes, I would like to echo Diane's comments. It was really
great meeting everyone. After everyone's questions and comments, I feel
hopeful, and I haven't since November.
Senator Casey. Good; thank you. Well, absent any other comments, I
get to--this is really amazing that I get to hit this gavel. I just
want to make it official. We are adjourned.
______
Anna Isis-Brown
Caring Across Generations activist
Los Angeles, CA
January 2017
Attn: Members of Congress and fellow Americans
Every member of my immediate family has benefitted from the Affordable
Care Act (ACA). I am a 30-year-old newly-wed. I applied for individual
health insurance in 2010, before the ACA went into effect. At the time,
I was working full-time at a university bookstore, but the job did not
offer me health insurance. I was denied coverage due to my pre-existing
conditions--which included various allergies, minor dermatologic issues
(eczema, acne), and depression. I went without an Epipen (a lifesaving
emergency medication for my most severe food allergies) and stopped
taking my antidepressant medication for the 2 years that followed
because I didn't have health insurance. I have health insurance through
my employer now, but it is very important to me to know that if I ever
lost my employer-sponsored health insurance in the future, the ACA
would protect me from being excluded from the individual insurance
market again.
Last year, at age 60, my father was diagnosed with two types of skin
cancer. He lost his job about 2 years before the diagnosis. After he
lost his job, he paid for COBRA for a while, but its high cost became
completely unaffordable for him. He didn't seek treatment for the
suspicious-looking patches of skin on his face, ears, and back because
he was frankly afraid to find out what they were and how much they
would cost to treat. He eventually applied for insurance through the
Arizona state exchange, on the assumption that it would be cheaper to
pay for the plans available on the exchange than it would be to keep
paying for COBRA. When he finally applied to the exchange, he learned
that, due to his income and Arizona's Medicaid expansion, he was
actually eligible to get coverage for free. With his new coverage, he
finally got a diagnosis and treatment. His doctor told him that without
treatment, his face could have been disfigured by the basal cell
carcinoma, and if the patches of squamous cell carcinoma had just
spread unchecked, they could've become much more serious. My dad is
still with us today because his cancer was caught and treated early
enough.
My sister is 27 years old and has a mental health condition. She works
full-time as the General Manager of a movie theater that is part of a
small local chain. Until December 2016, her job did not offer health
insurance. They just began offering her a plan last month, and she is
now on it. For about the past 2 years, she purchased her health
insurance through the California state exchange. The ACA allowed her to
have coverage she could afford, and get treatment for her mental health
conditions, when her company didn't offer any coverage.
My husband also works full-time as the Operations Manager for a small
company in the film industry here in Los Angeles. He is the company's
only full-time employee. The company does not offer health insurance.
Until we got married in August 2016, he purchased his health insurance
through the California state exchange. For about a year, when his
income was lower, he got a small subsidy to help pay for the insurance.
The ACA is the only option for many working people whose jobs simply do
not offer insurance.
The ACA has made a difference in each of our lives, and for that, I am
very grateful. I have such a sense of security knowing that, whatever
happens in my career path in the future, I will always be able to get
the Epi-pens that have saved my life once already. I am grateful for my
time with my father, knowing that he was able to access the care he
needed to treat his cancer before it got too advanced, and that he will
be able to treat it again if it ever returns. And I felt enormous peace
of mind that my sister and husband have been able to get the coverage
they needed when they couldn't obtain it through their employers. In a
time when many people need more help, it is not right to be offering
less and to get rid of the only affordable option that many have. The
ACA has been a lifeline for my family, as I'm sure it is for so many
others.
______
Carol Gloor
Savanna, IL
In 2015, after several years of chronic pain, MRI's, and cortisone
injections, I was finally told I needed to have my left hip replaced. I
have always been an active person and the gradual loss of the ability
to walk long distances was devastating to me. Thanks to Medicare, I had
my hip replaced over a year ago. The hospital bill alone was over
$50,000, not counting the cost of the physical and occupational therapy
which followed. Medicare paid for most of it, my supplemental insurance
paid for some, and I paid the balance. I am one of the lucky ones in
that I have supplemental insurance and some liquid assets, but without
Medicare I could never have afforded the operation. Being well and my
quality of life would have come at the cost of my savings and my
assets. I am sure there are many others in the same situation looking
for assistance. Instead, some people want to take that away from the
people who need it most. I am hiking again and volunteering in many
ways to make my community and my state a better place. Thank you,
Medicare.
______
Kim Thomas
Raleigh, NC
My name is Kim Thomas. I'm a home care worker from Raleigh, NC. I
became a home care provider after caring for my terminally-ill mother.
As a home care worker, I assist with activities of daily living--such
as toileting, bathing, mobility, meal preparation, and medication
reminders--that make it possible for seniors and people with
disabilities to live at home with dignity and independence. I have a
true passion for caregiving. I became a Certified Nursing Assistant. I
obtained my LPN, with special certifications and training in
Alzheimer's/Dementia care, Diabetes care, all stages of cancer,
Parkinson's, end-of-life care, wound, and respiratory care. I have a
genuine love for seniors and the elderly--that's why I work as hard as
I do.
And I work hard. I work about 100 hours a week or more. I work 16-hour
shifts Monday through Saturday and three 14-hour night shifts each
week. I don't receive paid time off, holidays, vacation, sick time,
health insurance, or retirement benefits. And still, my wages are so
low, $8 or $9 per hour, that I struggle to get by.
Though my job is all about taking care of people, I found it hard to
take care of myself before the Affordable Care Act. I have diabetes and
had a hard time finding coverage because of this pre-existing
condition.
I used to go to the Emergency Room and pay $100 a visit for diabetes
medication. But I wasn't getting the care I needed to stay healthy and
work hard for my family. I determined to find insurance coverage.
After weeks of research and rejections, I was able to get a ``high
risk'' plan for $479 per month with huge deductibles.
Not long after that, I got really sick. I was vomiting and had diarrhea
for more than 24 hours. I clearly needed to go to the hospital. But I
was scared of using my insurance plan--scared they would take it away
from me. I finally crawled across the floor to call 911.
Doctors at the hospital determined my gallbladder had erupted and I
needed surgery. But I kept telling the hospital staff that I couldn't
stay there because I couldn't afford it. And when I called in to work,
they asked me if I was ``really sick'' and suggested I get a second
opinion.
I was in the hospital for 5 days. I came home to a $3,000 hospital bill
and a note from my insurance company that my premium was being raised
to more than $800 per month. I had to let my life insurance plan go,
because I couldn't afford both. I sometimes missed car insurance
payments--and I need my car to get to work. When the Affordable Care
Act went into effect, I decided to visit HealthCare.gov and see if I
could do better than $800 per month. I visited the website, then spoke
with an agent who told me they could have me insured starting January 1
for $73.28 per month. Now, I get my diabetes medication at the pharmacy
for $4, instead of haphazard $100 ER visits.
Without the Affordable Care Act, I wouldn't be able to manage my
diabetes and be as healthy as I am. If it goes away, I am scared of the
impact it will have on my life, including my ability to work and
support my family. When every dime goes to medication or insurance
premiums, you can't afford your other bills.
I can't believe someone would want to take this healthcare away from
the American people. As a home care worker, it's not just me who
depends on Obamacare and other programs such as Medicaid, it's my
consumers, too, who receive Medicaid coverage. Medicaid is largest
provider of long term care coverage in the country and more
specifically home and community based care. Many of my consumers would
be unable to remain in their homes or get the life-saving care they
need if it were not for Medicaid. In fact, one of my consumers had a
massive stroke and lost his ability to speak. Without Medicaid
coverage, he would be unable to afford his medications--putting him at
risk for another stroke.
If I lose my health coverage, if I'm no longer covered because of a
pre-existing condition, if I have to go back to paying $800 per month
for health insurance, it will cause chaos in my life. If the Medicaid
program is cut and if I no longer have a job or my hours are reduced
and my consumers don't have access to the care they need, it will not
only cause chaos in my life, but chaos in their lives as well.
The Affordable Care Act and Medicaid have changed my life and the life
of my consumers for the better. It has made me healthier and able to
work hard to support my family. Please don't take that away.
______
Michael Lostutter
Bloomington, Indiana 47401
January 6, 2017
My wife Mary and I are both age 64, we have been married 43 years. We
grew-up in rural Indiana. We had one child, a daughter who passed away
in 2010. She was a traumatic brain injury survivor due to an auto
accident in 1996. We were her caregivers for 14 years as she was
permanently disabled due to her injuries, confined to a wheelchair.
Mary and I both worked longer than we were married, her mostly part-
time at various jobs, myself from several full time positions finally
retiring as the administrator of a multi-employer pension plan.
Prior to our daughter's demise, we had no plans to retire early or
otherwise as we had our daughter's economic future as our primary
consideration. After her unexpected death, our world changed as did our
expectations for the future. We decided to retire early.
Working full time provided Mary and I with group health insurance
however, at retirement the employer sponsored group plan was no longer
available. COBRA coverage also was not available due to the size of the
employment group.
The Affordable Care Act (ACA) with it requirement to insure without
regards to preexisting conditions allowed us to secure affordable
coverage at age 62. We have maintained coverage through 2016, as I have
now become eligible for Medicare and Mary likewise will be eligible in
February.
The ACA has allowed us to enjoy our early retirement. It also, has
allowed deserving younger folks the opportunity to replace us in the
workforce improving their lives as well.
______
Mikki Chalker
Binghamton, NY
Most people do not realize what a godsend the ACA has been for people
with disabilities. Until the ACA, many people with disabilities were
doomed to poverty. Private insurance was unaffordable, or simply
unavailable. My daughter suffered a traumatic brain injury at birth,
leading to severe spastic cerebral palsy, a lifelong condition which
will require lifelong care. Until the ACA, private insurance simply
would not cover her. People like my child, who need insurance to be
able to live, were doomed to stay under the limits of poverty for life
in order to qualify for Medicaid and Social Security. Removing the pre-
existing conditions barrier allows my 13 year old daughter, and others
like her, to have insurance and yet still become tax-paying citizens
with full independent lives.
Also, Medicaid and the waiver services it provides have allowed
millions of people to live and thrive in the comfort and dignity of
their own homes. Medicaid waiver services have allowed my daughter to
receive nursing care at home which makes a difference in how often she
is hospitalized. It also means that we can have the equipment to give
her the care she needs at home--wheelchairs, lifting equipment, suction
machines, mobility aids, and bathing aids. My daughter needs almost 100
percent assistance with daily living activities. Having insurance to
provide these means she lives at home, not in an institution. With me
providing that care at home with help from a nurse means she is
hospitalized less, improving not just her health and daily life, but
also saving untold thousands in hospital care and additional medical
costs. Most importantly, it allows her to be a 13-year-old girl, with
hopes and dreams and ambitions, not just a patient, not just a body in
a nursing home or institution. I can't imagine going back to life with
less access to these services. Not only does my daughter deserve
better, she deserves more.
These are not small things in our lives. I am grateful for the work of
Caring Across Generations that allows me to share how critical the ACA
has been for my life and my daughter's life.
______
Mina R. Schultz
Fairmont, WV
When I was 25, I was finishing my graduate program at the University of
Missouri and preparing to enter the Peace Corps. I had student
insurance, but it would end upon graduation, and I would have about 9
months without coverage before my Peace Corps service began. I didn't
give it much thought; I was young, healthy, didn't go to the doctor
much. My parents foresaw the gap in coverage and told me about a new
law that would allow me to stay on their coverage until I turned 26. I
said, sure, sign me up. Didn't really matter to me, but why not? So I
joined their plan.
The pain started in April 2011, about a month before graduation. I
wrapped my knee, iced it, and took a break from running for a while so
it would heal. After graduation I was planning on taking a temporary
job in rural Montana, to pay the bills until my Peace Corps service
started. I was still having pain, and not wanting to end up in the
middle of nowhere Montana with a torn ligament, I scheduled an MRI. I
will never forget the MRI techs telling me, ``You'll be glad you came
in.'' I was sure I had torn something. I was on my parents' insurance
at the time.
I will never forget the phone call, when the doctor said, ``Ms.
Schultz, it appears you have a tumor.''
The tumor was osteosarcoma, an aggressive bone cancer usually found in
children and adolescents. I endured 5 surgeries, including a total knee
replacement, and 9 rounds of chemotherapy (each involving 3 doses of
chemo, so 27 doses all together) over the course of a year. Most of my
treatment was inpatient, though I also received at-home physical
therapy and IV services. Just one of my post-chemo injections cost
thousands of dollars. Because I had taken that insurance, most of my
treatment was covered, and my parents avoided bankruptcy. I would not
have qualified for charity care. I don't know how we would have
afforded my lifesaving treatment had I chosen to forego coverage
because I was 25 and thought I was healthy. I think about it every day.
Now I am an enrollment assister in rural north-central West Virginia. I
help my community members navigate the Health Insurance Marketplace,
expanded Medicaid, and the ACA in general, because I believe everyone
has the right to the access and care that I received when I was sick.
No one should have to experience what I did, but especially no one
should go bankrupt because they want to survive an illness. I try to
explain this to people on a daily basis, that it is a responsibility to
get coverage to protect yourself from the exploding cost of health care
in our country, because you truly never know when something
catastrophic might happen. I carry coverage so that I can cover my own
costs and remain a contributing member of society. While I am coming up
on 5 years cancer free, I have secondary conditions as a result of
treatment, and take medications to manage my health. Because of my
previous diagnosis and resulting side effects, I would be considered
uninsurable without the ACA requirement to cover those of us with pre-
existing conditions.
I am a contracted worker. I purchase my own insurance through the
Marketplace exchange and receive a subsidy to help me afford this
coverage. Because of the threat to the law, I am having to look for a
new job, one that will offer me benefits so that I can't be denied
coverage, and hopefully one that won't cap my benefits. I love my
current job, but I won't be able to afford high risk pool coverage
should the ACA be repealed and replaced. I take pride in being able to
cover my own expenses, and I fear that I will have to rely on my
community to care for me if I no longer have the ACA to protect me. I'm
just trying to do my best, but I feel like my congressmen and women are
trying to take away my autonomy by taking my care. I thought government
was supposed to protect its people. Please protect me by keeping the
ACA in place, so I can continue to have access to the care I need to
maintain my health and contribute to my community.
______
Risa Morimoto
Caring Across Activist
New York, NY
January 2017
Attn: Members of Congress and fellow Americans
Without Medicare, Medicaid, and the Affordable Care Act, health care
would be much more difficult for my family. Like many others, my family
is pressed between providing care for our parents and for ourselves
too. These programs are what make it possible for all of us to access
the different kinds of care that we all need.
My mother had just turned 65 when she had a stroke in 2001. She was
covered by Medicare and spent 3 months receiving care in the hospital.
Ten years later, she was diagnosed with Parkinson's disease and needed
24/7 care. She refused to go into a nursing home and insisted that she
be cared for in her own home.
Until her stroke, my mother was a hardworking small business owner--she
opened up the first Japanese restaurant in Long Island. When she got
sick, we had to sell her business, the thing she had worked so hard on
for most of her life, and that was difficult for all of us. That left
her with her house, but she didn't have many assets beyond that. We are
Japanese, and taking care of our parents is a very big deal in Japanese
culture. My brother and sister and I did our best. At the time, we
weren't aware that my mother was eligible for Medicaid, and we could
not afford to pay out of pocket for in-home help. Even with taking
turns, after 10 years, my siblings and I were both completely burned
out from our own full-time work and full-time caregiving. It really
started to tear our family apart, both financially and emotionally.
Now she is covered by Medicaid, and we've been able to hire aides
through the community-based Medicaid program. My mother is eligible to
receive 106 hours of in-home care per week, but Mom is very particular
about who spends time in her home with her. We were able to hire
Japanese caregivers, which helped us transcend some of these cultural
and language barriers and made her feel much more comfortable. Living
with the effects of a stroke and Parkinson's for 16 years shows what a
strong person my mother really is, and my siblings and I are happy we
get to support her. It's not easy--she cannot really do anything
without assistance, but she knows she wants to be in her home where she
is most comfortable and everything is familiar. Community Medicaid is
what keeps her safe and comfortable at home, keeps her out of a nursing
home, and we know it saves the state money.
My brother moved into my parents' home, and my sister lives next door.
I make the trip out to Long Island every weekend from my home in New
York City to help out. Even with the three of us sharing the
responsibility of caring for her, we could not do it if it weren't for
the caregivers who come to her home to take care of her. This is what
allows my brother and sister and I to continue our full time jobs and
maintain our own lives as well as pitch in to help with Mom. Without
these aides, she would lose everything and I have no idea where she
would live.
My husband and myself are small business owners, and insurance has
never been easy or inexpensive for us without the benefit of receiving
coverage through an employer. So when the Affordable Care Act was
announced, we thought this would finally be something where we'd have a
real option for substantial health care. Before the ACA, we had health
insurance through Freelancers Union. I was always trying to cobble
something together for both of us, or thinking we'd have to just rely
on a catastrophic plan. Last year was stressful and frustrating--mid-
year our insurance company cut my doctor and hospital out of the
network. One example is that my husband and I needed to get physicals
and blood work in September so I had to find a new doctor who turned
out to be one of the worst doctors we had ever been to. The doctor's
office mistakenly sent our bloodwork to the wrong lab (even though we
explicitly told them they had to go to Quest Lab to which they answered
they knew).
Even though they said they would fix the error, they didn't. Their
mistake cost us $500. I don't know why our doctor and hospital dropped
our insurance coverage mid-year, and while I understand that there have
been some problems since the ACA rolled out, I don't believe the answer
is throwing it all out. The solution is to improve it and make it
stronger. Getting more people covered through the ACA will help
stabilize it. Having coverage that we can afford through the ACA is a
huge relief. I have a close family friend who for many years could not
afford insurance. When he finally had to drop his coverage, he was
diagnosed with leukemia shortly afterwards. He lost his house, his
business--everything. I get such peace of mind knowing that my coverage
provides preventative care, and knowing that if some unexpected
emergency arises, we will be covered and we will be okay.
My family has been able to afford the care we need because of Medicare,
Medicaid, and the Affordable Care Act, and I think we as a country can
do even better to make sure that everyone is able to get the care they
need. Cuts and defunding these programs would make things much more
difficult for many Americans--and no one says that it should be easy,
or that the government should do it all, but where we can make things
better, why wouldn't we? I am proud of these programs that help people
get the help they need.
I am happy to be an advocate for better care with Caring Across
Generations as part of the Caring Majority, and to be able to tell my
family's story. Supporting these programs is bigger than politics--it
is about people's lives. This is a moment when we need to take steps
forwards, not backwards. I hope Congress does what the majority
actually wants--it's their job.
______
Rita Morris
Birmingham, Alabama
I am Rita Morris of Birmingham, AL and proud daughter of Mrs. Katie. I
thank you in advance for your valuable time in allowing me to share my
personal experience as a family member and consumer of nursing home
care with Medicaid. At some point in our lives we will be a caregiver
or in need of a caregiver. I ask of you today to consider your family
as I share a glimpse of ours. I ask that you recognize your partnership
with us. As Mother's caregiver of 14 years, an only child, wife, cancer
survivor and mother, my hope was for quality of life, quality of care
and peace of mind for all of us. Nursing home care directly affects our
loved ones as well as our families. My mother became a widow at the age
of 45; I was 16. Out of necessity I quickly learned about our family
finance needs and importance of health care. Years later as a
Registered Nurse, I was well aware that health care is driven by
federal and state regulations. When my Mother was diagnosed with
vascular dementia, her life and our family's life changed. At that
time, I was a stay at home mom with a child in kindergarten. Our
journey started at that time. We had many partners in caring for Mother
along the way--the Grace of God, family, friends, faith, Medicaid,
Medicare, Social Security, and many wonderful health care providers--
but our journey would have been completely different if not for
Medicaid.
As Mother's dementia advanced, her physical, mental and spiritual needs
increased. She was able to live in her home for 2 years with
assistance, in our home for 1 year with sitters, for 4 years in
specialty assisted living, and for 7 years in a nursing home. After 4
years in assisted living, the dementia had progressed and she required
pureed food and more care. When this occurred, we were no longer
eligible for assisted living. The next transition was to the nursing
facility. I researched the regulations (OBRA) for nursing homes and
Medicaid before we moved in. We were prepared. The rules and
regulations of Medicaid, Medicare, and Social Security are clear in
purpose and process. They served our family as intended and were
greatly needed.
In 2007 we were told that Mother could possibly live 6 months in the
nursing home. We recognize and respect that the decisions for our
federal funded health insurance programs are in the hands of our
legislative partners. Medicaid was the most life-enriching benefit that
Mother received at her most vulnerable time. She moved into the nursing
facility in August of 2007. Her financial assets were depleted, her
dementia had advanced, and she required care around the clock. Dementia
symptoms were not limited to the hours of 8 am to 5 pm; they were
around the clock for 24 hours. I completed the Medicaid application
with the online form and directions. I submitted the form personally to
our local office and received a follow-up call 3 weeks later. She moved
into the nursing home in August 2007 and was approved by Medicaid
retroactively in October 2007.
As a cancer survivor, my biggest fear was that I would no longer be
there to care for her. I often asked myself: Who would care for her in
my absence? My hope was to be able to care for her as she did for me,
my father, and my family: simply with love. Her focus was always on us;
she did not focus on finances, insurance or direct care. Medicaid
provided Mother with the 24 hour a day care that she needed, the
necessities that she required, and a state surveyor to monitor the care
and assure that the facility was in compliance with the regulations. As
an only child, I had peace of mind knowing that in the event of my
absence, her care would be paid for and she would get the care she
needed, with protection and oversight.
As a result of the necessities and protections Medicaid provides, my
Mother lived an additional 7 years with respect, dignity, and quality
of care and quality of life. Her wishes were simple. She used to say,
``I don't want to be the one someone would see and say `that poor
thing' '' and ``I don't want to be a burden on you.'' She was never in
a situation of being neither ``that poor thing'' nor a burden. In those
7 years she was admitted to the hospital only one time for a fractured
hip. She had no skin breakdown, limited contractures, and was treated
in her own bed for pneumonia and urinary tract infections over the
years. She was provided care by loving caregivers, and she was loved by
many. The staff of the two sister facilities that she called home
became our extended family.
I was able to be a partner, assist in her care, be an involved mother
in after school activities, help my son with his homework, and serve as
room mom at his school. I was able to be present in our home as wife
and mother in our family commitments. Our one income family was able to
provide for our immediate needs and to save for our son's college
needs. This was not always easy, but it was our new ``normal'' and we
did the best we could. The stress of caregiving is tremendous. It takes
a village to raise our children and it takes a village to care for our
vulnerable loved ones of all ages and needs in all settings. The
nursing home setting had a profound impact on our family. Long-term
care is the most precious, personal and spiritual time for transitions
in roles and in preparation for the final transition to Glory.
I would like to take a moment to share with you a glimpse of what our
lives could have been without our Medicaid partner. In 2007 the
potential of living 6 months could have been a reality. We would have
had two options if we had to leave the assisted living without
Medicaid. One would have been to care for Mother in our home, a home
with a then 13 year old still needing to be driven to school and
activities, increased homework, wife to prepare meals and provide 24
hour care during a time that Mother was still walking and wandering.
The focus was caring for Mother and family. When Mother was in our
home, she found it to be stressful living with us before she chose to
move to the assisted living. She wanted to be with friends her own age
in her own ``home.'' In our home, she had the constant reminder of her
losses and her dependence on us. We required sitters in my absence
along with medical equipment. If we continued to care for Mother in our
home, she may not have received the highest quality of care that she
deserved and she may never have achieved a high quality of life.
Our second option without Medicaid would have been to pay privately for
the nursing care that she needed 24 hours a day. As an estimate in
2007, the private rate for the nursing home was $5,000 per month or
$60,000 a year. Over a period of 7 years the total would have been a
minimum of $420,000. Our family would have required loans to meet those
needs. We were and still are a one income family. We would have done
everything needed to care for Mother. However, as parents to our only
child, we also had to anticipate his college needs. This would have
been an overwhelming situation and limited at best.
These are two very different options both affecting our family and most
importantly the quality of care and the quality of life that Mother
would have experienced. There would have been no peace of mind for any
of us with either of these two options. In closing I would like to
express my thanks to you and to ask for your continued support of
Medicaid as an essential way to meet our medical needs and financial
support not only for our loved ones, but for families as well. As the
generation before us, we have contributed to our Social Security and
have anticipated having Medicare and Medicaid in place as our needs
arise. It has been a privilege and an honor to walk with Mother as her
partner on this journey. Mother's last transition occurred on September
1, 2014 when she was called home to Glory. As my husband and I walked
with Mother out the front door in the early hours we left with no
regrets. It was well with my soul. I hope that our experience with
Medicaid can relay the profound impact that the decisions made with a
vote can have on the lives of those you serve. The photo of my hand
with Mother's reflects my commitment of love and care and her fragile
dependence and trust.
With our Medicaid partner, Mother was afforded quality of care and
quality of life while I was afforded the peace of mind to continue to
serve in my proudest role, Daughter.
Sincerely,
Rita Morris
Daughter of Mrs. Katie
______
Susan Flashman
Mt. Rainier, MD
My name is Susan C. Flashman, and I have been on Social Security since
I became disabled following brain surgery in 2011. And 2 years later I
was eligible for Medicare coverage. My husband, Richard A. Bissell, has
been on Medicare for 12 years.
We are both retired and live on a fixed income made up of Social
Security and our retirement pensions from our years of Union employment
with the International Brotherhood of Electrical Workers. We pay
monthly for our Medicare coverage, as well as our supplemental
insurance offered through our UNION.
Because we have Medicare coverage, we have been able to repair injured
and worn parts of our bodies through surgery. The repairs have helped
us to maintain an active life with minimal pain. Following my brain
surgery, and as soon as I was well enough, I could have a breast biopsy
performed to make certain that a mass seen during my annual mammogram
was not the start of cancer.
This peace of mind following brain surgery was priceless. Since then,
Medicare has helped to pay for the repair of my left wrist, and my
broken toe. Both important to keep me living a full and independent
life. In this same manner, my husband had surgery to repair a torn
rotator cuff in his shoulder. Without such surgery, the pain would have
incapacitated him.
The importance of Medicare to us is that we can stay healthy enough to
continue to contribute to our community in voluntary activities, as
well as maintain an independent life in our own home. In doing so, we
do not burden our families, or the long-term care system.
If we were unable to have Medicare help maintain our health through
regular doctor's visits and medical tests, we might become less healthy
more quickly as we age. The enormous cost of health care for those who
are no longer able to earn additional funds is critical.
If Medicare were to become part of the insurance business, I am afraid
that I and every subscriber would have to hire a lawyer to be certain
that these companies fulfilled their legal obligations of coverage. I
have personally encountered this type of dilemma following my brain
surgery. In order to receive the benefits I deserved from a
catastrophic medical insurance plan, I had to rely on legal counsel.
What is even worse than having to fight for what is due, is to have to
fight when you are least able. The insurance industry counts on this to
help reach their profit margin.
While we were working, we contributed to Social Security and Medicare
and now the Congress thinks privatizing care for seniors should be
profitable. Hogwash!
It is time to expand Social Security--so that everyone in this country
has the basics they need to live a decent life, not just those lucky
enough to have inherited wealth.
Sincerely Submitted by Susan C. Flashman on January 16, 2016.
______
Lezrette Hutchinson
Bronx, NY
My name is Lezrette Hutchinson. I live in the Bronx, NY, and I am 60
years old and a mother of three. Thank you for convening a public forum
to give voice to American families who would be harmed by proposals
that would make people with Medicare and Medicaid pay more for their
care. Please accept this letter as formal comment for the forum record.
In 1999, after years of working at New York's Board of Education, I was
diagnosed with sarcoidosis. Sarcoidosis is an inflammatory disease that
affects my lungs, which makes me depend on oxygen. With little
information about the disease, I became extremely ill.
Two years later, I became homeless for a time after a fire burned down
my home. The side effects of the disease and my medications made me
depressed. This was because I didn't know where to go for proper
treatment, and I was prescribed the incorrect medications. I was unable
to go to work nor to take meaningful part in my children's lives as
they grew into adulthood.
My health turned around once I found a sarcoidosis clinic at Mount
Sinai Hospital, which accepts both my Original Medicare and fee-for-
service Medicaid coverage. After receiving the care I desperately
needed, I was able to become an activist and participate in a support
group for those with sarcoidosis. Later, I joined the board of my
medical center to implement changes that my fellow advocates and I knew
would improve patients' quality of life. I also attended a recreational
support group called the 50s-plus Program, and then joined the
Workgroup for People with Medicare and Medicaid, part of the Duals
Coalition of New York's Medicare Rights Center.
If I didn't have my original Medicare, I would need to find a plan that
would cover me best, knowing that I have a serious, rare disease. I
would need to make sure I found a way to continue to receive the care I
need with the right doctors who can service my chronic disease. This
would be a challenge for me since not many doctors specialize in my
illness, and if I couldn't continue to see them my illness would take a
turn for the worse.
With my current income, by the time I pay my rent and bills, I do not
have much left. If my Medicare costs increased that would be a big
financial hardship for me. Thanks to my Medicare and Medicaid, I am
provided with affordable, vital services that enhance my life. I would
love to continue to get the quality of care that I am getting now. Yes,
I am ill but I don't want that to stand in my way. I recently found out
I am going to be a grandmother and I want to take part in my
grandchild's life and make up for the years I was unable to be in my
own children's lives due to my illness.
______
Theresa Maguire
Queens, NY
My name is Theresa Maguire. I live in Queens, NY, and I am a mother of
two and recently became a grandmother. Thank you for convening a public
forum to give voice to American families who would be harmed by
proposals to repeal the Affordable Care Act (ACA) and undo the Medicare
and Medicaid guarantee. Please accept this letter as formal comment for
the forum record.
On December 28, 2010, I received a fully favorable (100% disabled)
decision in connection with my Social Security Disability Insurance
Benefits application. At 57 years old, I had been a grammar school
teacher consecutively for the previous 26 years. I am disabled from
Chronic Interstitial Cystitis (IC) with Hunner's Lesions. I also have
Pelvic Floor Dysfunction, Pudendal Nerve Involvement, hypertension,
tachycardia, IBS, and anxiety.
Since 2010, I have been treated by Dr. Robert Moldwin for my IC
condition and its related issues. Dr. Moldwin is one of the leading
specialists in the United States for IC and is the author of ``The
Interstitial Cystitis Survival Guide.'' He has played a primary and
pivotal role in my treatment. I first saw Dr. Moldwin in May of 2010
and I continue to visit his practice generally on a weekly/bi-weekly
basis.
In June of 2010, Dr. Moldwin ordered me to begin bladder installations.
Each installation lasts approximately 1 hour and consists of 15 steps.
I must undergo these treatments on a semi-weekly, and often weekly,
basis. On several occasions, the installations will puncture one of my
Hunner's lesions which causes five or more hours of steady bleeding.
During this time, I am forced to stay in or near a bathroom and drink
copious amounts of water. With time, the bleeding subsides. In addition
to the installation procedures, I receive ``internal nerve block
injections'' into the walls of my pelvis. I also endure ``internal
physical therapy.'' This is to assist with the pain associated with my
conditions.
All efforts at relieving my pain thus far have been only temporary in
nature. After suffering from the pain and devastating change of
lifestyle brought about by my condition, I began to see a mental health
specialist in October of 2010, and my treatment with her has been
ongoing since. My pain is moderate to severe, and occurs on a daily
basis. This is exacerbated by my particularly small bladder which
causes further pain. This also causes my frequency of urination to
increase along with the increased pain.
I wake up multiple times a night. I live with fatigue, loss of sleep,
and bladder spasms, among other symptoms. My experience of pain or
other symptoms is severe enough to interfere with attention and
concentration on a frequent basis, and I am incapable of even a low
stress job. I can only sit continuously for 20 minutes, stand for 20
minutes, and total sit, stand, or walk less than 2 hours in an 8-hour
period.
My condition dictates bathroom visits that can be 20 times in a 24-hour
period. Urinating is a burning painful experience for me a majority of
the time. I suffer the inability to sit at times due to the
excruciating pain of my condition. I have a prescription from my
neurologist that allows me to be in a kneeling position in the car when
I cannot transfer to a sitting position due to temporary paralysis of
my pelvic floor. All together, I need 10 prescription medications, 5 to
regularly manage my conditions and an additional 5 for bladder
installations.
I had to wait 2 years to receive Medicare. For those 2 years, I needed
to pay COBRA premium payments. The burden of my illness exacerbated and
strained my ability to meet even the simplest daily tasks. Furthermore,
the emotional and psychological strain and stress of medical insurance
payments and medical co-payments while waiting for Medicare was enough
to push me over the edge. Since I was a teenager, I worked diligently
as a tax-paying citizen and continued to do so my entire adult life.
Here I was at 57 years old sinking with a monetary situation that added
to my already debilitated medical condition. If I were to get sick now,
I would have the ability to shop for other, potentially less expensive,
insurance options than that COBRA coverage through New York State's
health exchange--thanks to the Affordable Care Act (ACA).
Since I began receiving Medicare, I have been privileged with being
treated by the same doctors as prior to my Medicare coverage, and I
have been comfortably reassured with my present Medicare coverage that
I can continue to receive the cutting edge treatments available to me.
I pay $104 per month for Medicare (which is deducted from my Social
Security Disability Benefit), and I do not have any other medical
insurance coverage. I cannot take on the burden of paying for
additional coverage. I receive a Social Security Benefit of $1,550 per
month, and I receive a disability insurance check for $775 per month.
My out-of-pocket co-pays for 2016 were slightly more than $3,215 in
addition to my Medicare premiums.
I hope my story conveys the fragile, debilitating situation one is put
in when one can no longer function as a productive member of society
and can therefore no longer earn a living. Medicare needs to remain
with its benefits, at the very least, intact. I cannot endure the
thought of elected officials dictating changes in Medicare that
determine not only my quality of life, but my life itself. I deserve to
have a fighting chance, and I need my Medicare benefits to remain
stable to be granted that fighting chance. With your help, your
actions, your foresight, and your good consciences, you can save lives.
I hope all members of Congress will step up to the challenge and battle
for what is a human right--the right to decent medical benefits for the
disabled.
______
Prepared Statement of Hon. Ron Wyden,
a U.S. Senator From Oregon
The American public heard a lot of promises about health care from
the new administration. No cuts to Medicare or Medicaid. Nobody hurt by
ACA repeal. ``Insurance for everybody . . . much less expensive and
much better.'' Congressman Price's own record undercuts those promises,
and this morning I'll get to those issues.
But first I'm going to start with questions about ethics and
undisclosed assets. Congressman Price owns stock in an Australian
biomedical firm called Innate Immunotherapeutics. His first stock
purchase came in 2015 after consulting Representative Chris Collins,
the company's top shareholder and a member of its board. In 2016,
Congressman Price was invited to participate in a special stock sale
called a private placement. The company offered the private placement
to raise funds for testing on an experimental treatment it intends to
put up for FDA approval. Through this private placement, Congressman
Price increased his stake in the company more than 500 percent. He has
said that he was unaware he paid a price below market value.
That claim doesn't pass the smell test. Company filings with the
Australia Stock Exchange clearly state that this specific private
placement would be made at below-market prices. The Treasury Department
handbook on private placements says they are ``. . . offered only to
sophisticated investors in a nonpublic manner.'' Congressman Price also
said last week that he directed this stock purchase himself, departing
from what he said was his typical practice.
Then there's the issue of what was omitted from the Congressman's
notarized disclosures. Congressman Price's stake in Inna te is more
than five times larger than the figure he reported to ethics officials
when he became a nominee. He disclosed owning less than $50,000 of
Innate stock. At the time the disclosure was filed, by my calculation,
his shares had a value of more than $250,000. Today his stake is valued
at more than half a million dollars. Based on the math, it appears that
the private placement was excluded entirely from the Congressman's
financial disclosure. This company's fortunes could be affected
directly by legislation and treaties that come before Congress.
It also appears Congressman Price failed to consult the House
Ethics Committee following trades of several health care stocks, as
they were directly related to two bills he introduced and promoted.
Even if some of those trades were not made at his direction, he would
have been aware of them as soon as he filed his Periodic Transaction
Reports with the House of Representatives.
Set aside the legal questions. It's hard to see how this can be
anything but a conflict of interest and an abuse of his position.
Finally, one of the most important questions on the Finance
Committee's biographical questionnaire is whether nominees have been
investigated for ethics violations. Congressman Price has been the
subject of two investigations stemming from fundraising practices. This
too was not disclosed.
I believe this committee needs to look into these matters more
thoroughly before moving ahead with this nomination.
Let's turn now to policy, starting with the Affordable Care Act and
the scheme known as ``repeal and run.'' The secret Republican
replacement plan is still hidden away, but already the administration
is charging forward with a broad executive order endangering people's
health care. As the Budget chairman, Congressman Price is the architect
of repeal and run.
If his repeal bill became law, 18 million Americans would lose
their health-care plans in less than 2 years. In one decade you'd go
from 26 million people without insurance to 59 million. Repeal and run
would raise premiums 50 percent in less than 2 years. Costs would
continue to skyrocket from there. The market for individuals to buy
health insurance would collapse. No-cost contraceptive coverage for
millions of women--gone. By defunding Planned Parenthood, nearly
400,000 women would lose access to care almost immediately. Hundreds of
thousands more would lose their choice to see the doctors they trust.
The Price plan takes America back to the dark days when health care
worked only for the healthy and the wealthy.
Congressman Price's other proposals don't offer much hope that the
damage will be undone. By the Trump rubric of ``insurance for
everybody,'' ``great health care . . . much less expensive and much
better,'' the Congressman's plans get a failing grade.
In another bill, the Empowering Patients First Act, the Congressman
Price brought back discrimination against people with pre-existing
conditions such as pregnancy or heart disease. It gave insurers the
power to deny care and raise costs on people with pre-existing
conditions if they didn't maintain coverage. In effect, the bill said
insurance companies could take patients' money and skip out on paying
for the care they actually need.
His bill also gave insurers the green light to reinstate lifetime
limits on coverage and charge women higher rates just because they're
women. It gutted the tax benefits that help working people afford high-
quality health-care plans. It slashed the minimum standards that
protect patients by defining exactly what health plans have to cover.
All this from a proposal called the Empowering Patients First Act. It'd
be a stretch to find a bill with a more ironic title, considering how
much power it handed to giant insurance companies.
If there's a theme developing, it's that the Congressman's
proposals push new costs onto patients. The massive cuts to Medicare
proposed in Congressman Price's budget are another prime example. In my
view, the Congress has a duty to uphold the promise of Medicare--the
promise of guaranteed benefits.
Congressman Price advocated privatizing Medicare and cutting it by
nearly half a trillion dollars. After his nomination, he said he wants
to voucherize Medicare within the first 6 to 8 months of the
administration.
He also supports ``balance billing.'' That means seniors could be
forced to cover extra charges above what Medicare pays for the services
they receive in the doctor's office. So in this case, it's extra costs
pushed onto elderly people who live on fixed incomes.
Congressman Price has also called for block granting and capping
Medicaid, a plan that would shred the safety net for millions of
America's most vulnerable patients.
Medicaid insures 74 million people. More people rely on Medicaid to
help pay for nursing home care and home-based care than any other
program. The program pays for nearly half of all births and covers
millions of children. It's a critical source of mental health care and
substance use treatment, which is vital at a time when communities
nationwide are battling the opioid epidemic. But Congressman Price's
most recent block grant proposal cut Medicaid by a trillion dollars.
Setting that huge cut aside, there's also a concerning pattern to
the way some lawmakers look at programs that have undergone this kind
of transformation. At first it's a block grant, a few years later it's
declared a slush fund, and then it gets slashed to the bone.
Unfortunately, that pattern has also defined Congressman Price's
approach to other areas that would be within his jurisdiction as
Secretary. His budget called for trillions of dollars in cuts to
programs that support millions of vulnerable people--everything from
job training to housing assistance to child nutrition. He also voted no
on the reauthorization of the Violence Against Women Act when it sailed
through the House on a bipartisan basis.
As I wrap up, I want to return to health care. The Congressman and
many others say patients should be at the center of care, and nobody
would dispute that idea. When I look at Congressman Price's proposals,
I don't see the patient at the center of health care. I see money and
special interests at the center of health care.
His plans would tell vulnerable Americans that their health care
will go only as far as their bank accounts will take them. The well-to-
do might be able to afford Congressman Price's proposals and the costs
they push onto patients, but millions of working Americans cannot.
Congressman, I thank you for joining the committee today and I
appreciate your willingness to serve. I look forward to your testimony.
______
MEMORANDUM FOR FINANCE COMMITTEE MEMBERS
From: Senate Finance Committee Staff
Date: January 23, 2017
RE: Nomination of Dr. Thomas E. Price
_______________________________________________________________________
This memo describes the Senate Finance Committee staff review of
the 2013, 2014, and 2015 tax returns, and other documentation of Dr.
Thomas E. Price in connection with his nomination to be the Secretary
of the Department of Health and Human Services (HHS).
Background
Finance Committee staff conducted a review of Dr. Price's Senate
Finance Committee (Committee) Questionnaire, tax returns for 2013,
2014, and 2015, and financial disclosure statements. As part of this
review, a due diligence meeting was held with the nominee and his legal
representation on January 16, 2017. His accountant participated via
telephone. In addition to the due diligence meeting, staff submitted
multiple rounds of written questions to the nominee.
At the conclusion of this process, three issues have been
identified that have been deemed appropriate to bring to the attention
of committee members.
Senate Finance Committee Questionnaire--Ethics Investigation and Late
Property Tax Payments Omitted
All nominees referred to the committee are required to submit the
Senate Finance Committee Statement of Information Requested of Nominee
(``Questionnaire'').
Part D. Legal and Other Matters, Question 1, asks nominees: ``Have
you ever been the subject of a complaint or been investigated,
disciplined, or otherwise cited for a breach of ethics for
unprofessional conduct before any court, administrative agency,
professional association, disciplinary committee, or other professional
group?''
In his response, submitted December 21, 2017, Dr. Price responded,
``No.'' However, in 2010, the Office of Congressional Ethics (OCE), an
independent office of the House of Representatives, conducted an
investigation into Dr. Price's 2009 fundraising activities. OCE voted
4-0-1 to refer the case to the House Ethics Committee, which, after
conducting a second investigation, ultimately found no wrongdoing in
2011.
In written questions submitted to Dr. Price on January 6, 2017,
committee staff requested an explanation for the omission of the ethics
investigation. Dr. Price stated it was an inadvertent omission and that
the majority of activities investigated related to his authorized
campaign committee, rather than him personally. The information
pertaining to this investigation has been and continues to be available
on the web page of the House Ethics Committee.
Part F. Financial Data, Question 10, asks nominees: ``Have you paid
all Federal, State, local, and other taxes when due for each of the
past 10 years?'' Dr. Price responded, ``Yes.'' However, upon examining
Washington, DC and Nashville, Tennessee real estate tax records,
Committee staff determined late tax payments had been made in relation
to rental properties owned by Dr. Price, totaling $1,583.45 for late
payments made over the past 7 years.
In written questions submitted to Dr. Price on January 6, 2017,
Committee staff requested an explanation for the omission of the late
tax payments. Dr. Price stated that, regarding the DC property, he
believed that ``late fees and penalties derived from not receiving
timely property tax notices.'' Regarding the Tennessee property, the
nominee noted that ``notices regarding property taxes for this rental
property . . . were either not being received or being wrongly mailed
to the tenant at the property and not reaching the nominee and his
spouse.''
Depreciation of Land Value and Miscellaneous Employment Deductions
Committee staff received 2013, 2014, and 2015 tax returns from Dr.
Price on December 21, 2016. In addition to the written questions
submitted on December 28, 2016 and January 6, 2017, Committee staff
spoke with Dr. Price's accountant on January 9, 2017. Following the due
diligence meeting with Dr. Price, Committee staff then submitted an
additional round of written questions to the nominee on January 16,
2017.
Improper Inclusion of Land Value in Depreciation Calculations
Taxpayers who own rental property are generally allowed to deduct
depreciation expenses associated with the wear and tear of those
buildings. Taxpayers are not, however, allowed to include the value of
land in the depreciable amount.
Dr. Price owns rental condominiums in Washington, DC and Nashville,
Tennessee, and claimed depreciation expenses associated with those
properties for years 2013, 2014, and 2015. It appears these values
included depreciation for the value of the land. According to property
tax records, the land value of Washington, DC condominium was listed as
$95,640, and the land value of his Nashville condominium was listed as
$30,000.
Under current tax rules,\1\ these values are not allowable for
depreciation expenses. Committee staff asked for clarification on this
issue in the due diligence meeting with Dr. Price and sent written
follow-up questions on January 16, 2017.
---------------------------------------------------------------------------
\1\ Treasury Reg. Sec. 1.167(a)-5, T.C. Memo. 1982-51, Meier v.
Commissioner.
In his response to the committee, received on January 23, 2017, Dr.
Price's accountant stated he had taken the position that the land had a
fair market value of zero. However, given the lack of another valuation
besides the property tax assessments, Dr. Price has committed to
address the discrepancy by filing a Form 3115 to adjust the
depreciation and account for the improper deductions on his 2016 tax
---------------------------------------------------------------------------
returns, though adjustments may be spread out over 4 years.
Absence of Documentation of Employment Deductions
In 2013, 2014, and 2015, Dr. Price claimed miscellaneous employment
deductions, totaling $19,034. Dr. Price, and his wife, also a medical
doctor, both list their occupations as ``PHYSICIAN'' on the second page
of their Form 1040s. Neither Dr. Price nor his wife actively works as a
physician, though Dr. Price has noted he has maintained his medical
license. Committee staff requested substantiation and further
explanation of the deductions in written questions submitted December
28, 2016.
Committee staff spoke with Dr. Price's accountant on this matter on
January 9, 2017, and again during the due diligence meeting on January
16, 2017. In those discussions, Dr. Price's accountant noted that Dr.
Price and his wife, Elizabeth, would compile a variety of expenses,
including vehicle expenses, and discuss with the accountant what
portion of those expenses would be appropriate to deduct as employment
expenses, frequently settling on an amount equal to roughly 60 percent.
Though the Prices no longer actively work as physicians, their
accountant believed that the deductions were appropriate, and were
reflective of expenses incurred by Mrs. Price. After the January 16,
2017, due diligence meeting, staff suggested that in the absence of
full documentation of the deductions, that the returns be amended.
In a response, received January 23, 2017, Dr. Price's accountant
noted that proper documentation could not be located. Dr. Price's 2013,
2014, and 2015 tax returns will be amended to remove the $19,034 of
deductions. Since Dr. Price was subject to the Alternative Minimum Tax
(AMT) in each of those years, the changes will not result in any change
to tax liability.
Asset Values
In separate financial disclosure filings to the House of
Representatives, to the committee, and to the public through the Office
of Government Ethics (OGE) Form 278, the nominee reported ownership of
stock in an Australian pharmaceutical company--Innate
Immunotherapeutics Ltd. The nominee purchased these shares in two
tranches: one in 2015 valued at $10,000 at the time of purchase, but
was valued at between $15,000 and $50,000 on December 20, 2016, the
date of filing. A second tranche was purchased in August 2016 of
400,613 shares, through a private placement offering, and was listed on
the committee questionnaire as being valued between $50,000 to
$100,000, which was based upon the purchase price. An analysis done by
multiplying the number of shares by the market price on December 20,
2016 demonstrates a value higher than that reported by the nominee. The
nominee noted that the amounts reported to the committee were a good
faith valuation. The nominee agreed to recalculate the value of the
shares based on the market value at the time the committee
Questionnaire was completed. The revised value of the second tranche
was between $100,000 and $250,000 when filed.
The nominee and committee staff also agreed that the tranche of
shares acquired in August 2016 was not accounted for on the OGE Form
278, and the nominee told staff that income attributable to his holding
in the company reported on OGE Form 278 was incorrect. The nominee
noted that it is unclear how information related to his holding in this
stock was misstated on the published form. The nominee agreed to
contact OGE to correct the form.
______
Senate Finance Committee--Bipartisan Vetting Process
January 24, 2017
The Finance Committee has a long, bipartisan tradition of engaging in a
very thorough process for vetting nominees. It has served the committee
well and it has served the country well.
It has several steps. First, we review the paperwork, consisting of the
committee questionnaire, financial disclosure (OGE Form 278), ethics
agreement, ethics letters, and 3 years of tax returns. Frequently,
there have to be several rounds of written, follow-up questions before
the paperwork is satisfactorily reviewed.
Next, we have three staff meetings; one to complete the due diligence
review (financial), one to discuss policy with the chairman and ranking
member's staff, and one with the staff of committee members. Only after
all of these steps have been completed do we notice a hearing, seven
days prior to the hearing's date.
The two nominations that we are considering so far each raise issues
that have taken some time to review. In the case of Mr. Mnuchin, he has
very complicated financial affairs, with partnerships embedded within
other partnerships. It took some time just to get a good understanding
of his financial affairs. In the case of Dr. Price, it has been
difficult to value his stake in an Australian drug company. In fact,
Dr. Price revised his committee questionnaire just yesterday, January
23, 2017, to correct inaccurate information about the ownership of this
stock.
Below is an overview of the dates of meetings, materials received,
rounds of questions asked, and responses received between committee
staff and the nominees through the bipartisan vetting process.
______
Mr. Steven T. Mnuchin
Materials Submitted
December 16: Tax Returns
December 19: Questionnaire; Interim OGE Form 278
January 10: Revised Questionnaire; OGE Ethics Materials; OGE
Form 278
January 15: 2nd Revised Questionnaire
Meetings
January 13: 1st due diligence (financial)
January 17: 2nd due diligence (policy)
January 17: 3rd due diligence (Committee Member staff)
Rounds of Questions
December 23: Initial Tax Compliance
Responses received: December 30, January 4,
January 6
January 4: Follow-up Tax Questions and due diligence matters
Responses received: January 6, January 9, January
13
January 10: Follow-up Tax Questions and due diligence matters
Responses received: January 12, January 18
January 13: Tax and Non-tax follow-up questions, following 1st
due diligence meeting
Responses received: January 18
The Honorable Thomas E. Price
Materials Submitted
December 21: Questionnaire; Tax Returns
January 11: OGE Ethics Materials; OGE Form 278
January 23: Revised Questionnaire
Meetings
January 16: 1st due diligence (financial)
January 17: 2nd due diligence (policy)
January 17: 3rd due diligence (Committee Member staff)
Rounds of Questions
December 28: Initial Tax Compliance
Responses received: January 4
January 6: Due diligence matters
Responses received: January 12
January 10: Additional Tax Compliance
Responses received: January 12
January 16: Tax follow-up questions, following 1st due diligence
meeting
Responses received: January 23
January 17: Non-tax follow-up questions, following 1st due
diligence meeting
Responses received: January 22
______
The Washington Post, January 23, 2017
HHS Nominee's Mix of Investments, Donations, Legislation
Keeps Raising Questions
By Kimberly Kindy and Amy Goldstein
Representative Tom Price, the Georgia Republican nominated by President
Trump to lead the Department of Health and Human Services, is under
increasing scrutiny for a trifecta of financial, campaign and
legislative activities that some longtime ethics lawyers describe as
``extremely rare'' and revealing ``an extraordinary lack of good
judgment.''
In recent years, Price has repeatedly traded stock in dozens of health-
related companies while pushing bills that could have benefited many of
them. At the same time, he has been uncommonly reliant on campaign
contributions from the health-care industry, accepting more than
$700,000 from physicians, hospitals, drug companies and insurers during
his 2016 run for a seventh congressional term, according to the Center
for Responsive Politics.
``I haven't seen anything like this before, and I've been practicing
and teaching about securities law for 30 years,'' said Richard W.
Painter, who was chief White House ethics lawyer for President George
W. Bush from 2005 to 2007.
Given that Price has some influence legislatively over the health-care
sector, his volume of trades in related companies is unusual, according
to a former chief counsel to the House and Senate ethics committees. In
the past few years, more lawmakers have moved away from investing in
individual stocks, opting instead for mutual funds, Treasury bills or
municipal bonds as investments.
``They are allowed to do this type of trading, but I would advise
against it,'' said Rob Walker, who served in the bipartisan counsel
positions from 1999 to 2008. ``The level of scrutiny he is facing goes
along with the territory of making these kinds of investments.''
Price's investments and donations coincide with a pattern, dating back
to his years as a state senator, of strenuously promoting legislation
that advances the interests of the medical profession. An orthopedic
surgeon for 20 years before he entered politics and still an active
member of the American Medical Association, he has sought as both a
Georgia legislator and congressman to make it more difficult for
patients to win medical malpractice lawsuits and to limit certain
damage awards in such cases.
``Whether it be liability or any policy issues about how health care is
delivered, how it is paid for, how it is accessed, it is doctors all
day every day,'' said longtime critic Mark Taylor, a Democratic
lieutenant governor in Georgia during most of Price's tenure in the
state Senate and first years on Capitol Hill.
And while Price speaks often of pursuing a patient-centered health-care
system, he rails against what he calls an excessive federal role in
health care, voting at one point against an expansion of the Children's
Health Insurance Program. ``The desire of those on the left to
gradually move every American to Washington-controlled bureaucratic
health care is so strong they will stop at nothing,'' he said before
casting that vote in 2007.
In Congress, he has been one of the most ardent opponents of the
Affordable Care Act, sponsoring the only bill to repeal the sprawling
health-care law that passed Congress. Then-President Barack Obama
vetoed it early last year.
Price's investment and legislative records are central themes that
Democrats plan to pursue in his confirmation hearing Tuesday before the
Senate Finance Committee. During a ``courtesy'' hearing last week
before a different Senate panel, he faced sometimes-heated
interrogation by Democrats over the timing of stock purchases and the
extent of his involvement in them.
The nominee has said he would divest financial interests in any
companies that could pose a conflict of interest for him as HHS
secretary. But some lawmakers, as well as the advocacy group Public
Citizen, are calling for an investigation by the Office of
congressional Ethics. They also have filed complaints against Price
with the Securities and Exchange Commission.
A congressional probe would cease if he were to become HHS secretary.
An SEC investigation would continue.
An HHS spokesman reiterated Monday that Price had no knowledge of any
trades in his financial portfolio, with the exception of those in one
company. The spokesman declined to provide the name of Price's broker
or to share a copy of his written agreement with the investment firm.
Price's legislative office did not respond to repeated requests for
comment over several days.
If confirmed, the 62-year-old congressman, who chairs the House Budget
Committee, would run one of the biggest federal agencies and its $1.1
trillion budget. Supporters suggest a doctor best understands what the
nation's health-care system needs, with Senator Orrin G. Hatch (R-Utah)
describing Price as ``very upfront and very straightforward, very
honest, and somebody who really understands the health-care system of
this country.''
Price has largely defended his investment activities by saying his
broker made nearly all of the stock purchases without his knowledge.
Brokers cannot make securities trades for clients without their
expressed permission in writing, and Senators Patty Murray (D-WA) and
Ron Wyden (D-OR) sent a letter Friday asking Price for such proof.
Aides in their offices said Monday that he has not responded.
And regardless, said Painter, now a law professor at the University of
Minnesota, ``It's a pretty weak defense since he could have gone online
at any time and seen the trades that were being made on his behalf.''
Representative Louise M. Slaughter (D-NY), the co-author of the 2012
Stop Trading on Congressional Knowledge (STOCK) Act, shares that
sentiment. The law passed after media reports on the close ties between
lawmakers' stock portfolios and legislative actions. It requires that
trades be publicly reported within 45 days instead of annually--the
sole reason Price's stock activity last year has come to light in the
midst of his confirmation.
``The weakest link here is this notion that some broker bought all
these things without his knowledge,'' Slaughter said.
A spokesman for the Trump transition countered on his behalf last week,
although Phil Blando addressed only the issue of campaign fundraising.
``Any effort to connect campaign contributions to Dr. Price's policy
positions is an increasingly stale and desperate Democratic talking
point,'' he said.
Of particular concern to Slaughter and her Democratic colleagues is
Price's largest stock buy last year--between $50,000 and $100,000--in
an Australian biomedical firm, Innate Immunotherapeutics. Price
acknowledged last week that this purchase, and several smaller ones
made in the company in 2015, occurred without a broker's aid. He told
members of the Senate Health, Education, Labor and Pensions Committee
that he learned of the company from Representative Chris Collins (R-
NY), who serves on Innate's board, and then did his own research on it
and the multiple sclerosis drug it was developing.
The 2016 investment was done through what's known as a ``private
placement offering'' made by a company to a select group of potential
investors. Price contended that he received no insider information
ahead of time.
Price's denial didn't satisfy Murray, who also pressed him on the
timing of the trades. They coincided with final negotiations on the
sweeping 21st Century Cures bill, aimed in part at helping to
accelerate clinical trials and approval of drugs like Innate's.
Simon Wilkinson, Innate's chief executive, told The Washington Post
that about 640 investors purchased stock through the special offer. The
company did not directly approach Price, he said.
According to David Blake, an Australian securities analyst, the shares
the lawmaker purchased in the special offering are now worth between
$337,500 and $675,000--a 575 percent increase.
Another trade in the spotlight involves Zimmer Biomet, a major
manufacturer of orthopedic and dental implant devices.
CNN was the first to report financial disclosure records showing that
Price bought between $1,001 and $15,000 worth of Zimmer Biomet shares
last March. A week later, he introduced legislation to delay a new
payment model that industry analysts said could have serious financial
implications for the company.
The HHS regulation carried ``tremendous risk and complexity for
patients and health-care providers,'' Price said when he introduced his
bill. ``Rushing its implementation would be unreasonable and
potentially detrimental to patients and their quality of care.''
Federal Election Commission records show Price received $2,000 in
campaign donations from the company's political action committee in
November 2015 and June 2016.
In a statement, Zimmer Biomet spokeswoman Monica Kendrick said it ``did
not support'' Price's legislation and was unaware of his investment in
the company. She said the company had long backed efforts such as the
payment model Price sought to block.
Price also purchased stock in three pharmaceutical companies in the
months leading up to his introduction last June of a bill that would
have provided the businesses with massive tax breaks for their
manufacturing and production activities in Puerto Rico, records show.
Amgen, Eli Lilly and Bristol-Myers Squibb gave a combined $20,000 to
his 2016 reelection campaign, according to filings with the Federal
Election Commission.
The bill ultimately did not pass the House. Blando stressed last week
that Price had ``no say or input into these trades'' and that to
insinuate a connection ``is insulting.''
Overall, Price is far more reliant on donations from health
professionals than other lawmakers in comparable positions in the
House. Since he was first elected to Congress in 2004 from an affluent,
conservative district in northern Atlanta, they have given more than
$3.5 million in campaign contributions, more than any other donor
sector, according to data from the Center for Responsive Politics.
In contrast, the previous chairman of the House Budget Committee,
Speaker Paul D. Ryan (R-WI), has received $1.3 million in contributions
from health professionals since 1998.
While Price resembles many House Republicans in his zeal for
dismantling the ACA, his focus on medical malpractice lawsuits is
distinctive.
Starting in 2009, he has four times introduced the Empowering Patients
First Act, with the most recent three bills seeking to repeal the ACA.
All would have weakened patients' hand in medical malpractice cases by
setting $250,000 caps on noneconomic damages, creating clinical
guidelines to protect doctors from liability or both. And he sponsored
two separate bills aimed at creating such guidelines for use in
malpractice lawsuits.
None got out of House committees.
Julie Tate, Alice Crites, and Matea Gold contributed to this report.
______
Communications
----------
American Association of Hip and Knee Surgeons (AAHKS)
OFFICE: 847-698-1200 FAX: 847-698-0704 WEB: aahks.org
9400 W. Higgins Road, Suite 230 Rosemont, IL 60018-4976
The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Finance
219 Dirksen Senate Office Building 219 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
Dear Chairman Hatch and Ranking Member Wyden:
The American Association of Hip and Knee Surgeons (AAHKS) strongly
supports the nomination of Congressman Tom Price, MD as Secretary of
the United States Department of Health and Human Services (HHS). AAHKS
is the foremost national specialty organization of 2,900 physicians
with expertise in total joint arthroplasty procedures. The mission of
AAHKS is to advance hip and knee patient care through education and
advocacy, and we look forward to working with federal officials to
improve our health care system.
Prior to entering public service, Congressman Tom Price practiced
medicine as an orthopaedic surgeon. He spent nearly two decades in
private practice caring for patients and their families. Dr. Price's
experience as a physician gives him a critically important perspective
on the real-world impact of health policy including the importance of
access, coverage, the doctor-patient relationship, clinical decision
making and challenges of navigating a complex health care environment.
Most importantly, we have confidence that as a physician, he will seek
to put patients first in his role as HHS Secretary.
Dr. Price was also an educator. He was an assistant professor at Emory
University School of Medicine and Medical Director of the Orthopedic
Clinic at Grady Memorial Hospital, a public hospital serving the
greater Atlanta area. His contributions to the education of resident
physicians under his tutelage are a testament to his commitment to
secure a healthy future for all Americans.
AAHKS respectfully urges the Senate to confirm Dr. Price's appointment
as Secretary of HHS.
Sincerely,
William A. Jiranek, M.D. Michael J. Zarski, J.D.
President Executive Director
______
Association of Web-Based Health Insurance Brokers (AWHIB)
Introduction
The Association of Web-Based Health Insurance Brokers (AWHIB)
appreciates the opportunity to provide comments on the nomination of
The Honorable Thomas Price to be Secretary of the Department of Health
and Human Services. AWHIB is a trade association of web-broker entities
(WBEs) that have signed agreements with the Centers for Medicare and
Medicaid Services (CMS) and are currently leveraging the Federally
Facilitated Marketplace's (FFM) direct enrollment application
programming interfaces (APIs). Our members include brokerage firms that
sell health insurance online directly to consumers, private health
insurance exchanges, and technology companies that support individual
agents and brokers. AWHIB seeks to collaborate with consumers, issuers,
regulators, lawmakers, and other industry groups to continually develop
technologies and enrollment strategies that provide Americans with the
greatest access to health insurance products and services.
AWHIB members have played a significant role in enrolling consumers in
individual market health insurance policies. During the plan year 2016
annual open enrollment period, AWHIB members alone facilitated nearly 1
million initial enrollments and active reenrollments, or over 12% of
initial enrollments and active re-enrollments by consumers in the
Federally-facilitated Marketplace states and states using the Federal
platform. This amount is in addition to the hundreds of thousands of
off-exchange individual market enrollments facilitated by AWHIB member
companies. Our web broker technology is used by tens of thousands of
independent health insurance agents nationwide, and AWHIB member
companies have partnerships with the world's largest health insurance
brokers, tax preparation firms, and health insurance technology firms,
including Jackson Hewitt; Tax Act; Mercer; Buck (Xerox); Lockton;
Bankrate; NFP; SummaCare Inc.; HealthSpan Inc.; HealthSpan Integrated
Care Inc.; H&R Block; Walgreens; Working America; CUNA Mutual Group;
Benaissance; Direct Health; and Assurex Global.
AWHIB offers its support for Congressman Price to be the next Secretary
of HHS based upon his significant experience in the House of
Representatives, including his role as Chairman of the House Budget
Committee during the 114th Congress, as well as 20 years as a
practicing orthopaedic surgeon. If confirmed by the Senate, AWHIB looks
forward to working with Secretary Price to improve the health of all
Americans.
Principles for Stabilization and Reform of the Individual Health
Insurance Market
The nation's individual health insurance market is at a critical
juncture as it enters its fourth year following the full implementation
of the Affordable Care Act. AWHIB recognizes that the Administration,
along with many members of Congress, intend to take steps to modify
and/or replace many of the elements implemented under the Affordable
Care Act, including potentially the health insurance Exchanges. As key
players in assisting consumers make an informed choice of insurance
products, AWHIB's members want to offer their perspectives and
recommendations regarding the individual health insurance market for
consideration by an incoming Secretary of HHS.
To promote the availability of coverage, AWHIB recommends that an
incoming Secretary consider the following six key tenets to help guide
changes to the individual health insurance market:
Expand Consumer Choice of Enrollment Venue--Provide consumers
with choices on how to enroll in health insurance and support multiple
channels for enrollment, including private sector channels. Private
health insurance exchanges and WBEs have enrolled consumers in health
insurance products prior to the ACA, and as part of the ACA both on and
off the exchanges. They also have extensive third party partnerships
with retailers, tax preparation firms, unions, employers and other
organizations that could be leveraged to reach consumers ``where they
are.'' Despite this experience, private sector enrollment channels have
been highly underutilized by the Exchanges to date.
Provide for Versatile Eligibility Determination Regardless of
Enrollment Channel--Whether the ACA Exchanges continue or are replaced,
Federal and state governments should provide simple and versatile
approaches to render eligibility determinations, such as a standalone
eligibility service (SES), that can interact with a variety of
enrollment channels. This would enable health insurance enrollment
efforts to leverage a variety of private and public sector based
enrollment channels.
Promote Innovation--One of the core strengths of private health
insurance exchanges and WBEs is their ability to use technology
innovations to meet the needs of their consumers. While AWHIB
recognizes the need for robust consumer protections, WBEs and private
exchanges also need flexibility to take full advantage of innovation.
To achieve this balance, Federal and state governments should focus on
defining the overall policy aims, while permitting flexibility for
innovation within defined policy guardrails.
Strengthen Support for Continuous Coverage--Improve the health
of the insurance risk pool by implementing enrollment policies
emphasizing continuous coverage. This includes improving the
administration of special enrollment periods and making changes to the
annual open enrollment process. If the individual mandate is removed,
AWHIB supports guaranteed renewability and other incentives to further
continuous coverage.
Use Refundable Advanceable Tax Credits to Further Insurance
Accessibility--Base tax incentives for health coverage on refundable
advanceable tax credits rather than tax deductions. Refundable
advanceable tax credits are versatile and can be used by consumers to
lower the cost of monthly health insurance premiums, making health
insurance accessible to more consumers than tax deductions and non-
refundable credits.
Improve the Overall Health of the Insurance Market--Implement
policies that would support a more healthy insurance market that is
sustainable for health insurance carriers and affordable for consumers.
Congress and HHS should consider implementing risk mitigation
strategies such as a revised reinsurance program or national high-risk
pool, as well as allowing for greater availability and incentives for
health savings accounts.
Near-Term Changes to Strengthen the Current Exchange Market
Based upon the above principles, AWHJB recommends the following near-
term actions should the ACA Exchanges remain in place for the near term
or an indefinite period of time:
Implement Enhanced Direct Enrollment for the FFM for PY 2018--
Federally-
facilitated Exchanges and state Exchanges that use the Federal
enrollment platform permit WBEs to enroll consumers into Exchange
coverage using a so-called ``direct enrollment process.'' However, the
current process is not consumer friendly and requires the consumer to
be redirected to HealthCare.gov before being redirected back to the WBE
website to select a plan. This experience is jarring and confusing to
the consumer, rendering it nearly non-functional.
HHS has proposed to replace the current direct enrollment
process with an enhanced direct enrollment process, which would permit
the consumer to complete the Exchange application and select a plan on
the WBE platform, however, has not firmly committed to a timeframe for
fulfilling those original intentions. AWHIB strongly recommends that
HHS implement enhanced direct enrollment for PY 2018, as this would
permit WBEs to significantly increase the number of consumers that
could enroll in coverage through the Exchanges. Furthermore, this could
also be used to support eligibility determination for refundable
advanceable tax credits under future replacement plans.
Strengthen Special Enrollment Periods--To improve the health
insurance risk pools, HHS should require full verification of
eligibility for special enrollment periods. In addition, Congress and
HHS should shorten the 3-month grace period for non-payment of premiums
by consumers receiving advance premium tax credits, and prevent such
consumers from taking advantage of enrollment rules to drop and
reenroll in coverage. These changes would help to stabilize the
individual market, providing greater predictability for carriers and
reducing the potential for adverse selection.
Long-Term Changes if the Role of Public Exchanges Is Altered
Significantly
If the public exchanges' role in facilitating consumer shopping is
significantly altered or replaced, consumers will still need tools to
help them understand, compare, select and enroll in available health
insurance products. WBEs and private exchanges are well positioned to
fill this void as a private sector alternative to the public exchanges,
as they already provide consumers with online shopping platforms
designed to help consumers understand, compare and select available
health insurance products. Furthermore, they have extensive experience,
having served as an additional channel for consumers to shop for and
enroll in public exchange coverage (specifically with respect to
Federally-facilitated Exchange), and as a shopping and enrollment
portal for off-exchange health insurance products.
AWHIB recommends the following changes to promote broad access in a
reformed market:
Promote Consumer Choice in Enrollment Venue--AWHIB recommends
that consumers be able to shop for and enroll in health insurance
coverage in any online portal that meets Federal or state requirements,
including a public exchange, WBE/private exchange or carrier portal.
This will provide consumers with greater choice according to which type
of portal best suits their needs, as each type of portal may provide
value to different types of consumers.
Implement Refundable Advanceable Tax Credits--As noted above,
AWHIB recommends that tax incentives in a reformed marketplace be
structured as refundable advanceable tax credits, as this will enable
consumers to use their tax credits to lower the cost of health
insurance premiums. Refundable advanceable tax credits help make health
insurance more accessible for consumers than tax deductions.
Seamlessly Verify Tax Credit Eligibility--If tax credits are
refundable and advanceable, consumers need to know whether they are
eligible for the tax credit when shopping for a health plan. To support
broad access to insurance, HHS should provide WBEs, private exchanges
and carriers with access to a standalone eligibility service (SES).
With SES, a WBE, private exchange or carrier would be able to submit
tax credit application data to the Federal government (IRS or HHS on
behalf of IRS), and then receive an official Federal eligibility
determination--all through back-end web-services. As a result, the
consumer could obtain a tax credit eligibility determination as part of
the WBE, private exchange or carrier's consumer shopping and enrollment
experience, making it easier for consumers to access health insurance
coverage.
Transact Enrollment Directly With Carrier--Permit WBEs and
private exchanges to enroll consumers directly with the health
insurance carrier, unless otherwise specified by a state. ACA
enrollments are currently processed through the Exchange, even if plan
selection takes place on a WBE/private exchange or carrier shopping
platform. A more efficient and seamless process would allow for WBEs,
private exchanges and carriers to enroll consumers directly with the
carrier, with the carrier transmitting enrollment information with HHS
for purposes of tax credit administration once the consumer has
effectuated enrollment with the carrier.
Maintain Guaranteed Renewability; Implement Incentives for
Continuous Coverage--Should the individual mandate be eliminated,
maintain guaranteed reewability provisions in order to encourage
consumers to maintain coverage and avoid enrolling in coverage only
when needed. Also implement clear disincentives for incurring gaps in
coverage, including late enrollment fees or waiting periods for
consumers who do not maintain continuous coverage and otherwise qualify
for a special enrollment period. Such measures would help to mitigate
adverse selection and support risk pool health in place of an
individual mandate.
Improve the Overall Health of the Insurance Market--Consider
changes to improve the overall health of the insurance market,
including risk mitigation strategies such as revised reinsurance, risk
adjustment, risk corridor, and/or national high-risk pool programs.
Also consider options to promote a broader range of health insurance
products, including the expanded availability of health savings
accounts.
Conclusion
The individual health insurance market is at a critical moment--one
that will require strong leadership from HHS. AWHIB believes that
short-term action is needed to help bring greater stability to the
market and offers specific recommendations if broader reforms are
undertaken. AWHIB looks forward to working with Congressman Price to
improve the health of all Americans if confirmed by the Senate as the
next Secretary of HHS.
______
Letter Submitted by Steven P. Brasch, M.D.
January 26, 2017
Senate Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
Dear Senators:
I hereby file my OPPOSITION to the confirmation of Representative Tom
Price for Secretary of Health and Human Services.
Because of many of Dr. Price's views on matters of public health, the
ACA, medical and social services to the poor, underserviced, gay, and
disenfranchised citizens of America, I believe he is poorly qualified
to serve as our next Secretary of HHS.
Please contact me if you have any questions.
______
Letter Submitted by Lesli Choat, MT (ASCP)
January 24, 2017
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
I would like to express my opposition to the Nomination of Tom Price
for HHS Secretary.
My health care career has spanned 32 years and I continue to function
as STD Counseling and Testing Coordinator in an STD program. I was
working in health care before HIV and hepatitis C (HCV) were
identified. I am a scientist who has seen the great strides the United
States and the world have made to test and treat for HIV, HCV and other
infectious diseases. I saw so many die in the beginning of the AIDS
epidemic and I am proud to see so many live healthy lives with the
advances we have made in HIV care. I serve on my local HIV planning
group to advance HIV prevention and care in my community. I support
Planned Parenthood and the services they provide to so many that have
no other access to health care. I see HCV as a looming public health
threat that must be addressed. My voice should be heard as a citizen
who works every day on the front lines of American Public Health!
I oppose Representative Tom Price as HHS Secretary. I do not feel Tom
Price has the expertise or background knowledge to run such a vital
department overseeing so many branches of American health care.
Representative Price has spent the last 8 years undermining efforts
aimed at providing health care and social services to communities both
living with, and vulnerable to, HIV/AIDS and other health conditions.
These actions include voting to repeal the Affordable Care Act (ACA)
multiple times, pushing for the privatization Medicare, supporting to
defund Planned Parenthood, pledging cuts to social service and safety
net programs--all while demonstrating a hostile voting record on
lesbian, gay, bisexual, transgender and queer (LGBTQ) issues.
Throughout the recent hearing before the Senate Committee on Health,
Education, Labor and Pensions (HELP), Price made several indications to
continue a trend to dismantling existing systems, without details of a
replacement that sustains access to health care and social services.
At a time when we are at the forefront of new and exciting science to
deliver better antiretroviral therapies for HIV, breakthroughs in cures
for HIV, and pathways for making TB treatments shorter and more
tolerable, the nomination of Tom Price threatens to impede the progress
of both scientific research and its implementation. Upon confirmation,
I feel Tom Price will, as promised, oversee the dismantling and
overhaul of health care systems that are responsible for delivering
many of these medical advances to people in the United States,
particularly those communities impacted by health, social, and economic
disparities as well as stigma.
HHS is not just the department that oversees our health care system,
but also governs our public health, research, and regulatory agencies,
such as the Centers for Disease Control and Prevention (CDC), National
Institutes of Health (NIH), and the Food and Drug Administration (FDA).
The recent revelation of ethics violations and refusal to clearly
answer questions on these issues during the Senate HELP hearing clouds
my trust in Price to ensure the sanctity and impartiality of these
agencies. Trust in HHS leadership is needed in prioritizing pressing
public health challenges and countering emerging threats such as Zika,
Ebola, drug-resistant TB and antimicrobial resistance through robust
R&D, proactive epidemiology, pharmacovigilance, and accelerated
research and response.
Price's worrisome background as a member of the American Academy of
Physicians and Surgeons--an organization that promotes and endorses the
theory that HIV does not cause AIDS, despite a substantial evidence
base to the contrary--puts into question his capabilities to end an
epidemic. Health conditions like HIV thrive on stigma. Price has only
perpetuated stigma and marginalized vulnerable communities by voting
against bills that afford protections to the LGBTQ community. With
attention needed for other neglected populations, such as prisoners
impacted by HIV and HCV, it becomes less likely under a Price-led HHS
that key populations will be able to access needed health care and
treatment.
With Price's support of the repeal of ACA and efforts to defund
Medicaid, the hopes and vision of providing health care that include
ending the HIV epidemic and curbing HCV transmission among the poorest
and most vulnerable Americans will vanish.
Sincerely,
Lesli Choat
______
Letter Submitted by Richard and Jill Claybour
January 25, 2017
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
Honorable Chairman and Members of the Committee:
We are private citizens writing to beg that you oppose confirmation of
Tom Price as the new Secretary of Health and Human Services.
His history of support for views with little or no foundation in
science, his apparent willingness to leave needy sick citizens without
health care and a reasonable transition to a supposed ``much better''
program are in themselves sufficient reasons in our eyes to disqualify
him. We are shocked, however, at the continued revelations of his
conflicts of interest and believe that in no way should these matters
be swept under the rug. At a time when Americans have sent a clear
signal of their distrust in Washington, we look to you to make sure
that our leaders are setting an example of probity and conformance to
the highest ethical standards.
Thank you for your consideration.
Sincerely,
Richard and Jill Claybour
______
Letter Submitted by Robert K. Darrow
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
January 27, 2017
Senators:
I am writing to you as a 32-year survivor, thriving and living with
AIDS, and in opposition to President Trump's nomination, Tom Price, for
Secretary of HHS. Tom Price's questionable fitness to head a multi-
agency cabinet-level department charged with the health of U.S.
residents can simply be ascertained from his own record as a
Congressional representative to parts of Atlanta's northern suburbs--a
district and metro area with extremely high rates of HIV and a
flourishing opioid epidemic. Despite the abundance of epidemiological
data illustrating the impact of the HIV epidemic in his own district
and in the southeastern United States, Representative Price has spent
the last 8 years undermining efforts aimed at providing health care and
social services to communities both living with, and vulnerable to, HIV
and other health conditions. These actions include voting to repeal the
Affordable Care Act (ACA) multiple times, pushing for the privatization
of Medicare, threatening to cap and block-grant Medicaid, supporting to
defund Planned Parenthood, pledging cuts to social service and safety
net programs--all while demonstrating a hostile voting record on
lesbian, gay, bisexual, transgender and queer (LGBTQ) issues.
Throughout the recent hearing before the Senate Committee on Health,
Education, Labor and Pensions (HELP), Price made several indications to
continue a trend to dismantling existing systems, without details of a
replacement that sustains access to health care and social services.
At a time when we are at the forefront of new science to deliver better
antiretroviral therapies for HIV, breakthroughs in cures for HCV, and
pathways for making TB treatments shorter and more tolerable, the
nomination of Tom Price threatens to impede the progress of both
research and implementation. Upon confirmation, Tom Price will, as
promised, oversee the dismantling and overhaul of health care systems
that are responsible for delivering many of these medical advances to
people in the United States, particularly those communities impacted by
health, social and economic disparities as well as stigma.
Before the ACA, hundreds of people every year were waitlisted for the
AIDS Drug Assistance Program (ADAP). People living with HIV (PLHIV)
would need an AIDS diagnosis to be eligible for Medicaid. Pre-existing
conditions would also disqualify many PLHIV from gaining insurance.
While the ACA is not perfect, thousands of PLHIV have been transitioned
onto insurance through marketplaces and have become eligible for
Medicaid benefits. This has provided many with access to comprehensive
health care for the first time, with profound effects on public health
and prevention outcomes. Much of the success we're seeing in increasing
viral suppression rates and reducing the number of diagnoses annually
will be put in jeopardy if the ACA is repealed without replacement.
Without replacement and stewardship by the incoming Secretary of Health
and Human Services, access to treatment, prevention and other services
will remain out of reach for many of these communities.
HHS is not just the department that oversees our health care system,
but also governs our public health, research, and regulatory agencies,
such as the Centers for Disease Control and Prevention (CDC), Indian
Health Services (IHS), National Institutes of Health (NIH), and the
Food and Drug Administration (FDA). The recent revelation of ethics
violations and refusal to clearly answer questions on these issues
during the Senate HELP hearing clouds any trust in Price to ensure the
sanctity and impartiality of these agencies. Trust in HHS leadership is
needed in prioritizing pressing public health challenges, ensuring drug
and device safety, and countering emerging threats such as Zika, Ebola,
drug-resistant TB, and antimicrobial resistance through robust R&D,
proactive epidemiology, pharmacovigilance, and accelerated research and
response.
Price's worrisome background as a member of the American Academy of
Physicians and Surgeons--an organization that promotes and endorses the
theory that HIV does not cause AIDS, despite a substantial evidence
base to the contrary--puts into question his capabilities to end an
epidemic. Health conditions like HIV thrive on stigma. Yet, Price has
only perpetuated stigma and marginalized vulnerable communities by
voting against bills that afford protections to the LGBTQ community.
With attention needed for other neglected populations, such as
prisoners impacted by HIV and HCV, it becomes less likely under a
Price-led HHS that key populations will be able to access health care
and treatment.
Now more than ever, ending the epidemics of HIV, TB, and HCV requires a
combination of bipartisan federal and state leadership, evidence-based
policies, and adequate resources in proper alignment to deliver the
promise of biomedical and public health advances. Efforts to lower drug
prices for HIV and HCV while sustaining U.S. leadership in R&D for TB
and other neglected diseases remain inevitable challenges to the
successor of HHS and the Trump administration. Tom Price, however,
remains a concerning and unqualified candidate to lead HHS given a
track record that only marginalizes communities, raises questions on
his ethics and integrity to run an expansive $1 trillion department,
and putting forth policy proposals that seek to fast-track the loss of
lifesaving health care for 18 million Americans. Ending the epidemics
remains impossible by destroying access to health care and treatment.
With Price's support of the repeal of ACA and efforts to defund
Medicaid, the hopes and vision of providing health care--including
ending the HIV epidemic, curbing HCV transmission, eliminating TB--
among the poorest, sickest, most disenfranchised, most vulnerable
Americans will vanish.
Respectfully,
Robert K. Darrow, executive director emeritus
The Philadelphia Center--Shreveport
______
Letter Submitted by Angela Wilson Gyetvan
January 19, 2017
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
Dear Committee Members:
I am writing in regards to the Full Committee Hearing for the
Nomination of Tom Price to serve as Secretary of Health, held January
18, 2017.
I object to Mr. Price's nomination on the following grounds:
(1) Potential ethics violations: There is evidence that Mr. Price
invested in at least one health-care company, then introduced
legislation favorable to the company after he made the investment. At
the very least, this is a violation of House ethics rules. At the most,
it is insider trading--and must be investigated before any
confirmation.
(2) Conflicts of interest: Price holds positions in multiple
healthcare companies, and must divest or put those holdings into a
blind trust prior to any confirmation. He also has ties to the tobacco
industry--smoking is the leading cause of preventable death!--and has
consistently voted against tobacco regulation as a result.
(3) Non-support for social safety net and general lack of
compassion: Price supports the roll-back of Medicare and Medicaid, the
repeal of the Affordable Care Act, and blocked the expansion of the
Children's Affordable Health program. He even voted to block medical
treatment if a Medicare co-pay is not available: a position that is
directly opposed to the Hippocratic Oath he took when he became a
doctor.
(4) Track record on women's and LGBTQ rights: Price supports
overturning Roe v. Wade and has voted against legislation that prevents
discrimination based on sexual orientation.
The Health Secretary needs to be a representative for all of us. Mr.
Price is not that person.
Thank you.
Angela Wilson Gyetvan
______
Human Rights Campaign
1640 Rhode Island Ave., NW
Washington, DC 20036
P 202-628-4160
F 202-423-2861
http://www.hrc.org/
Written Statement of David Stacy
Government Affairs Director
I submit this testimony on behalf of the Human Rights Campaign's 2
million members and supporters. As the nation's largest organization
advocating for the civil rights of lesbian, gay, bisexual, transgender,
and queer (LGBTQ) people, I raise severe concerns regarding the ability
of Representative Tom Price to serve and represent the health and well-
being of all Americans as Secretary of the Department of Health and
Human Services (HHS). Representative Price has developed a lengthy
public record attacking LGBTQ people and every hard-fought victory that
we have achieved as a community in recent years. He has used his
position as a Congressman elected to represent Georgia voters as a
national platform to deny federal rights--including protection from
violence--for LGBTQ people nationwide.
Representative Price has consistently voted against critical pieces of
legislation that would protect LGBTQ people including the Employment
Nondiscrimination Act (ENDA), the Matthew Shepard and James Byrd, Jr.
Hate Crimes Prevention Act, and the 2013 reauthorization of the
Violence Against Women Act (VAWA). Beyond these votes, Representative
Price has publicly spoken against equality, regularly partnering with
groups known for promoting anti-LGBTQ views--using the privilege of his
position to spread intolerance and misinformation. He has even argued
that legislation like ENDA, designed to protect vulnerable workers and
promote equal opportunity, would have ``remarkably negative''
consequences and should be evaluated for the medical and health-care
costs of ``promoting a homosexual lifestyle.'' I must clarify that the
real impact of nondiscrimination provisions on health and well-being of
LGBTQ people are remarkably positive, to use Representative Price's
descriptor.
We know that systemic discrimination in employment, housing, health
care, and education increases the risk of poverty and compounds the
health disparities already facing our community. Fear of discrimination
deters many LGBTQ people from seeking necessary and important
preventative health care, and when they do enter care, studies indicate
that the respect that LGBTQ people receive is not consistent with the
respect that all patients deserve. Recent studies have shown that
transgender people are particularly at risk for discrimination--
especially in the health-care setting. One third of transgender people
seeking care reported experiencing discrimination, harassment, assault,
or even denial of care simply because of their gender identity. One in
four transgender people avoided care altogether fearing discrimination.
Nondiscrimination provisions provide individuals and families with the
security they need to lead full and productive lives. They also
increase access to insurance coverage and reduce incidents of arbitrary
denial of care based on bias.
It is critical that healthcare facilities treat every patient with
respect, recognize patients' gender identity, and provide equal access
to gender appropriate facilities while providing treatments. This basic
standard of care is embraced by major medical establishments and
organizations including the American Academy of Pediatrics and the
American Counseling Association. These groups have made it clear that
this access is not just an issue of civil rights, but also public
health. However, Representative Price has directly attacked transgender
people's rights to access appropriate facilities calling this most
basic right ``absurd.'' This dismissal of basic rights and welfare is
deeply disturbing.
Since joining Congress, Representative Price has failed to adequately
represent the nearly 10,000 LGBTQ Georgians living in his district. He
has consistently refused to recognize them as deserving constituents
and has failed to represent even their most basic needs to Washington.
Representative Price's repeated choice to place his personal anti-LGBTQ
ideology ahead of this significant portion of his own Congressional
district calls into question his ability and true willingness to serve
all Americans as Secretary of HHS. This role demands a public servant
dedicated to improving health-care coverage and outcomes for all
people, not a culture warrior with an outdated and dangerous agenda.
We are also concerned by Representative Price's longstanding opposition
to the Affordable Care Act (ACA). The ACA is a critical tool to combat
the stark disparities facing our community by expanding access to
coverage and ensuring that everyone--regardless of who they are or who
they love--has access to the care they need. The federal government has
published regulations implementing the nondiscrimination provision of
the ACA to explicitly protect individuals on the basis of gender
identity or sex stereotyping. These protections are critical for some
of the most vulnerable members of our community. This rule also makes
clear to providers that transgender patients must be treated consistent
with their gender identity, including with respect to facilities and
patient rooms. The regulation also prohibits the categorical exclusions
in insurance coverage that have plagued the transgender community for
so long and have put basic transition related care out of the reach of
so many.
Because of the ACA, many LGBTQ people have access to comprehensive
health-care coverage for the first time. This security and assurance of
quality care without discrimination can be life changing.
Representative Price's clear commitment to dismantling the ACA and his
hostility towards nondiscrimination provisions generally could
seriously undermine the health-care outcomes for our community for
years to come.
Finally, as Secretary of HHS, Representative Price will be charged with
leading one of the world's largest medical and health research
organizations--overseeing the Centers for Disease Control and
Prevention as well as the National Institutes for Health. He will also
lead administrations and sub-agencies like the Substance Abuse and
Mental Health Services Administration (SAMSHA) that has published
cutting edge research impacting the LGBTQ community including a report
addressing the well-established medical harms of so-called ``conversion
therapy.'' However, Representative Price has done little throughout his
career as a Congressman or as a physician to prove his commitment--or
even belief--in evidence based science.
Representative Price is a longstanding member of the Association of
American Physicians and Surgeons, a fringe organization that publicly
questions well-established public health concepts including childhood
vaccination and the safety or abortion. Perhaps most troubling for our
community is the organization's suggestion that HIV does not in fact
lead to AIDS. Although Representative Price has stated that he does not
personally hold this view regarding HIV/AIDS, his continued association
with an organization that is so clearly anti-science is deeply
disturbing. As Secretary of HHS Representative Price will be called on
to be a research visionary, committed to science and to pursing answers
to the nation's most complex health questions with dedicated
compassion. Absolutely nothing in Representative Price's record shows
that he is up to this job.
______
LeadingAge
2519 Connecticut Ave., NW
Washington, DC 20008-1520
P 202-783-2242
F 202-783-2255
http://leadingage.org/
January 24, 2017
Dear Senator:
LeadingAge is a nonprofit aging services association. Our 6,000+
members and partners include nonprofit organizations representing the
entire field of aging services, 39 state partners, hundreds of
businesses, consumer groups, foundations, and research partners. Among
our members, we count more than 2,000 nonprofit nursing homes, either
as free-standing nursing homes, or as a component of a multi-level
community. According to GAO, nonprofit nursing homes tend to have
higher staffing ratios and are more likely to be higher quality as
rated by the CMS 5-star system.
CMS recently issued a final rule implementing new requirements for
participation for nursing homes in the Medicare and Medicaid programs.
This 105-page rule adds new requirements, mandates previously voluntary
provisions such as corporate compliance programs, and revises
requirements currently in effect.
As you consider the nominations of Representative Tom Price for
Secretary of HHS and Seema Verma for Administrator of CMS, we urge you
to address the following concerns.
LeadingAge strongly supports high quality for nursing homes and
transparent standards. Our community based, nonprofit providers are a
vital element of the post-acute and long-term care continuum, and are
often recognized as exemplars of person-centered care and quality. We
support many aspects of these new regulations, including the focus on
person-centered care. In fact, prior to the enforcement date of the new
regulations, our members were actively engaged in the process of
integrating the components of Compliance and Ethics, and Quality
Assurance Process Improvement (QAPT) into their day-to-day operations.
However, we are gravely concerned about the broad scope of these new
regulations (stated by CMS to be the most significant changes to
nursing home regulation since 1991), as well as the incredibly short
time frame by which providers must comply. We submitted extensive
comments to CMS during the regulatory comment period on the content of
the regulations including a particular concern about having sufficient
time to implement. We are also participating as stakeholders in the
various meetings and calls conducted by CMS. To date, the agency has
not been responsive.
Specifically, we have particular concerns about the following aspects:
(1) Workforce: Many sections of the regulations require new
staffing or changes to the training and competencies of existing staff.
Some of these went in to effect November 28, 2016 less than 2 months
after the final rules were published. Providers were expected to comply
immediately with the requirements, but given little guidance as to
these competencies. This left insufficient time for providers to
develop the necessary skills training and assessments to comply with
the new requirements. And lastly, many rural communities have a
workforce shortage and simply do not have sufficient numbers of workers
to employ to meet these regulations.
(2) Delayed Guidance: CMS normally develops written guidance
explaining the regulations, provides definitions and instructions for
implementation, and identifies resources for training. However, it has
failed to do so for many of the new policies and procedures that went
into effect in November, or for the new systems that must be in place
later this year.
(3) Guidance Going Beyond Regulatory Language: Where draft
guidance has been shared with stakeholder groups, there is considerable
concern that this guidance goes well beyond the scope of the actual
regulations and thus creates a whole new set of compliance requirements
for enforcement that are not defined in regulation. Guidance that
exceeds the regulations but is enforced like regulations should not be
enforceable.
(4) Timing: As stated above, the extremely short time frames
required for compliance create impossible burdens for many providers,
particularly for those smaller and rural providers. The risk is
therefore that many of these vital community-based homes will close,
rather than face severe enforcement penalties. When these homes close,
the negative impact on the community is widespread: Vulnerable
residents often are displaced and providers--who are often the primary
employer in that community--lose their jobs.
Implementation of broad regulations that impose unrealistic time
frames, fail to recognize the negative impact in a challenging
workforce environment, and for which guidance and resources have not
yet been thoroughly considered or shared with the very providers who
will be expected to comply, can only set up providers for failure. This
will negatively impact patients and communities for years to come.
We ask for a thoughtful evaluation of these new regulations and a
realistic time frame by which providers are able to comply.
Thank you for your consideration.
Sincerely,
Katie Smith Sloan
President and CEO
LeadingAge
______
Letter Submitted by Debbie Murzyn
January 24, 2017
Dear Senate Finance Committee:
I oppose the nomination of Tom Price for the Secretary of Health and
Human Services. I request that you oppose President Trump's pick and
challenge his nomination. Tom Price's questionable fitness to head a
multi-agency cabinet-level department charged with the health of U.S.
residents can simply be ascertained from his own record as a
Congressional representative to parts of Atlanta's northern suburbs--a
district and metro area with extremely high rates of HIV and a
flourishing opioid epidemic. Despite the abundance of epidemiological
data illustrating the impact of the HIV epidemic in his own district
and in the Southeastern United States, Representative Price has spent
the last 8 years undermining efforts aimed at providing health care and
social services to communities both living with, and vulnerable to, HIV
and other health conditions. These actions include voting to repeal the
Affordable Care Act (ACA) multiple times, pushing for the privatization
Medicare, threatening to cap and block-grant Medicaid, supporting to
defund Planned Parenthood, pledging cuts to social service and safety
net programs--all while demonstrating a hostile voting record on
lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues.
Throughout the recent hearing before the Senate Committee on Health,
Education, Labor and Pensions (HELP), Price made several indications to
continue a trend to dismantling existing systems, without details of a
replacement that sustains access to health care and social services.
At a time when we are at the forefront of new science to deliver better
antiretroviral therapies for HIV, breakthroughs in cures for HCV, and
pathways for making TB treatments shorter and more tolerable, the
nomination of Tom Price threatens to impede the progress of both
research and implementation. Upon confirmation, Tom Price will, as
promised, oversee the dismantling and overhaul of health care systems
that are responsible for delivering many of these medical advances to
people in the United States, particularly those communities impacted by
health, social and economic disparities as well as stigma.
Before the ACA, hundreds of people every year were waitlisted for the
AIDS Drug Assistance Program (ADAP). People living with HIV (PLHIV)
would need an AIDS diagnosis to be eligible for Medicaid. Pre-existing
conditions would also disqualify many PLHIV from gaining insurance.
While the ACA is not perfect, thousands of PLHIV have been transitioned
onto insurance through marketplaces and have become eligible for
Medicaid benefits. This has provided many with access to comprehensive
health care for the first time, with profound effects on public health
and prevention outcomes. Much of the success we're seeing in increasing
viral suppression rates and reducing the number of diagnoses annually
will be put in jeopardy if the ACA is repealed without replacement.
Without replacement and stewardship by the incoming Secretary of Health
and Human Services, access to treatment, prevention and other services
will remain out of reach for many of these communities.
HHS is not just the department that oversees our health care system,
but also governs our public health, research, and regulatory agencies,
such as the Centers for Disease Control and Prevention (CDC), Indian
Health Services (IHS), National Institutes of Health (NIH), and the
Food and Drug Administration (FDA). The recent revelation of ethics
violations and refusal to clearly answer questions on these issues
during the Senate HELP hearing clouds any trust in Price to ensure the
sanctity and impartiality of these agencies. Trust in HHS leadership is
needed in prioritizing pressing public health challenges, ensuring drug
and device safety, and countering emerging threats such as Zika, Ebola,
drug-resistant TB, and antimicrobial resistance through robust R&D,
proactive epidemiology, pharmacovigilance, and accelerated research and
response.
Price's worrisome background as a member of the American Academy of
Physicians and Surgeons--an organization that promotes and endorses the
theory that HIV does not cause AIDS, despite a substantial evidence
base to the contrary--puts into question his capabilities to end an
epidemic. Health conditions like HIV thrive on stigma. Yet Price has
only perpetuated stigma and marginalized vulnerable communities by
voting against bills that afford protections to the LGBTQ community.
With attention needed for other neglected populations, such as
prisoners impacted by HIV and HCV, it becomes less likely under a Price
led HHS that key populations will be able to access health care and
treatment.
Now more than ever, ending the epidemics of HIV, TB, and HCV requires a
combination of bipartisan federal and state leadership, evidence-based
policies, and adequate resources in proper alignment to deliver the
promise of biomedical and public health advances. Efforts to lower drug
prices for HIV and HCV while sustaining U.S. leadership in R&D for TB
and other neglected diseases remain inevitable challenges to the
successor of HHS and the Trump administration. Tom Price, however,
remains a concerning and unqualified candidate to lead HHS given a
track record that only marginalizes communities, raises questions on
his ethics and integrity to run an expansive $1 trillion department,
and putting forth policy proposals that seek to fast-track the loss of
lifesaving health care for 18 million Americans. Ending the epidemics
remains impossible by destroying access to health care and treatment.
With Price's support of the repeal of ACA and efforts to defund
Medicaid, the hopes and vision of providing health care--including
ending the HIV epidemic, curbing HCV transmission, eliminating TB--
among the poorest, sickest, most disenfranchised, most vulnerable
Americans will vanish.
Thank you for your time.
Debbie Murzyn
______
National Center for Lesbian Rights (NCLR)
1100 H Street, NW, Suite 540
Washington, DC 20005
January 25, 2017
4The Honorable Orrin Hatch The Honorable Ron Wyden
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Finance Committee on Finance
104 Hart Senate Office Building 221 Dirksen Senate Office Building
Washington, DC 20510 Washington, DC 20510
The Honorable Lamar Alexander The Honorable Patty Murray
Chairman Ranking Member
U.S. Senate U.S. Senate
Committee on Health, Education,
Labor, and Pensions Committee on Health, Education,
Labor, and Pensions
455 Dirksen Senate Office Building 154 Russell Senate Office Building
Washington, DC 20510 Washington, DC 20510
Dear Chairman Hatch, Ranking Member Wyden, Chairman Alexander, and
Ranking Member Murray:
The National Center for Lesbian Rights (NCLR) writes to oppose the
nomination of Representative Tom Price as Secretary of Health and Human
Services (HHS). We have grave concerns that Representative Price will
not work toward HHS's goal of enhancing and protecting the health and
well-being of all people.
It is imperative that the person chosen to lead the Department of
Health and Human Services demonstrate a commitment to health-care
access and science-based public health and health-care policy. This
important federal official must also be free from discriminatory or
hostile attitudes toward minority and vulnerable groups, and administer
our critical health-care programs free from ideological bias.
Representative Price's record as a legislator casts serious doubt on
his ability to perform this role.
Representative Price's Opposition to LGBT Equality
Representative Price has espoused negative views of LGBT people, who
have only in recent years begun to achieve critical protections for our
health and relationships. In 2013, on a conference call, Representative
Price was asked if Congress should be required to consider the ``fiscal
impact'' of legislation involving LGBT people because of the supposed
health and economic costs of LGBT people's so-called ``lifestyles.'' He
stated that was ``absolutely right,'' and that ``the consequences of
activity that has been seen as outside the norm are real.'' \1\
Representative Price is also a member of the Association of American
Physicians and Surgeons, which supports conversion therapy and calls
transgender identity a pathology.
---------------------------------------------------------------------------
\1\ http://www.rightwingwatch.org/post/rep-tom-price-fears-
negative-health-and-economic-impacts-of-gay-rights-bills/.
In May of 2016, the Departments of Justice and Education issued
guidance to schools on title IX clarifying that the law protects
transgender students and requires that they be treated consistent with
their gender identity in schools. Representative Price responded with a
Facebook post that the guidance was ``absurd.'' \2\ Such an attitude
calls into question his ability to enforce essential health care
nondiscrimination protections. In a 2015 national survey,\3\ 3% of
transgender people who had gone to a doctor or a hospital had been
turned away because of who they are. In that same survey, 23% of
transgender people nationally said they had avoided getting care when
they were sick or injured because they were afraid of that kind of
discrimination. Section 1557 of the Affordable Care Act (ACA) prohibits
discrimination in health-care programs or activities on the basis of
race, color, national origin, sex, age, or disability. This is the
first time that federal law has broadly prohibited sex discrimination
in health care. Health insurers, hospitals, clinics, and any other
entities that receive federal funds are covered by this law. Prior to
section 1557, there were no broad federal protections against sex
discrimination in health care or health insurance. The regulations
implementing this important provision that were issued last year state
that prohibited sex discrimination includes discrimination based on
gender identity and sexual orientation. These critical protections
would not exist if the ACA had not been enacted or were repealed, as
Representative Price has repeatedly voted to do. Representative Price's
plan to replace the ACA, the Empowering Patients First Act, did not
include a similar prohibition on discrimination in health care programs
on the basis of sex.
---------------------------------------------------------------------------
\2\ https://www.facebook.com/reptomprice/posts/10154118633590421.
\3\ http://www.transequality.org/sites/default/files/docs/USTS-
Full-Report-FINAL.PDF.
Representative Price has also co-sponsored the ``First Amendment
Defense Act,'' considered by many to be the most sweeping anti-LGBT
bill in Congress as it would establish sweeping new religious
accommodations that would seriously harm legal rights and protections
for millions of Americans and permit unprecedented types of
discrimination against LGBT individuals, same-sex couples, and others.
Its aim is to enable a wide range of ``persons''--defined in the bill
to include government employees, recipients of government grants and
contracts, and even for-profit businesses--to violate constitutional or
statutory law so long as the violation is based on a sincerely held
---------------------------------------------------------------------------
religious belief about marriage or sexual relationships.
In 2007, Representative Price offered an amendment to Federal Housing
Finance Reform Act that required all adults in a household to present
specific forms of identification before they could receive assistance
through affordable housing grants.\4\ Such a law presents a significant
barrier to homeless persons because they often lack these types of
identification.\5\ Given that homelessness has become a critical issue
for those in the LGBT community,\6\ we cannot support a nominee who
actively works to build barriers to safe shelter for those in need.
---------------------------------------------------------------------------
\4\ https://www.congress.gov/crec/2007/05/22/CREC-2007-05-22-pt1-
PgH5560.pdf.
\5\ https://www.nlchp.org/documents/ID_Barriers.
\6\ http://williamsinstitute.law.ucla.edu/wp-content/uploads/Durso-
Gates-LGBT-Homeless-Youth-Survey-July-2012.pdf.
We are further concerned by Representative Price's record of opposing
the repeal of Don't Ask, Don't Tell,\7\ legislation that would ban
employment discrimination on the basis of sexual orientation, and LGBT
hate crimes protections, as well as his continued opposition to the
Supreme Court's recognition that the Constitution requires equal
protection of LGBT people, including with respect to marriage.\8\
---------------------------------------------------------------------------
\7\ https://www.congress.gov/crec/2010/12/15/CREC-2010-12-15.pdf.
\8\ https://tomprice.house.gov/press-release/price-responds-scotus-
marriage-ruling.
Representative Price's Opposition to Reproductive Health Care
Representative Price's consistent opposition to reproductive health
care for women also raises serious concerns. Despite access to birth
control being widely recognized as one of the most important public
health achievements of the 20th century, resulting in improved health
and safety for millions of women, Representative Price has consistently
opposed the publicly funded family planning network, the title X
program, the contraception benefit under the Affordable Care Act, and
the Medicaid program's family planning freedom-of-choice provision,
while seeking to bar Planned Parenthood from receiving critical federal
funding even for health care services entirely unrelated to abortion
and despite the dependence of millions of low-income women on those
services.
Representative Price has co-sponsored legislation that would define
life at conception, which would outlaw abortion entirely, along with
several of the most effective and widely used forms of birth control,
and prohibit in vitro fertilization. Representative Price also
sponsored legislation in Georgia that would require health-care
providers to give medically inaccurate information to patients seeking
abortion.
Ideological opposition to contraception and abortion, and the use of
misinformation to reduce access to these essential reproductive health-
care services, renders Representative Price unfit to hold the position
as the head of our nation's public health care infrastructure.
Representative Price's Opposition to Protecting Access to Healthcare
As a member of Congress, Representative Price has proposed a
``replacement'' for the ACA that would strip coverage from millions of
Americans, including LGBT people and their families. Under
Representative Price's plan, LGBT people would lose not only
nondiscrimination protections (described above) but also health-care
coverage they can only afford because of the law.
Representative Price's alternative legislation would allow insurers to
dramatically raise premiums for some people with pre-existing medical
conditions, including HIV/AIDS, which would have a dramatic impact on
gay and bisexual men. His plan would also fully repeal the Medicaid
expansion, a provision of the ACA that extended Medicaid coverage to
people making less than approximately $16,000 per year. Because of
employment discrimination that pushes many LGBT people into
unemployment or low-wage jobs that do not offer health insurance, LGBT
people are disproportionately likely to need alternatives such as
Medicaid. Representative Price's ACA alternative would also decimate
federal funding for HIV/AIDS treatment.
For the foregoing reasons, we oppose the nomination of Representative
Tom Price to lead the Department of Health and Human Services.
Sincerely,
National Center for Lesbian Rights
______
Letter Submitted by Marilyn D. Quinn
January 24, 2017
Re: The potential appointment of Tom Price to be Secretary of HHS
Dear Committee Members,
As a citizen and a woman who will soon be 70, I want to tell you what I
think about the nomination of Congressman Tom Price for Secretary of
HHS and some of the health-care issues that are important to me, my
family, my friends, and to all Americans. I was able to watch some of
his hearing, and I have read some of his statements concerning health
care and health insurance.
(1) Obamacare:
My 36-year-old working daughter was finally able to get health
insurance due to Obamacare. As a resident of New York State, she was
also able to pick her coverage from a state-endorsed exchange. I tried
to help her get insurance before Obamacare, I called health insurers
who would have charged twice the amount she finally paid for a policy
after passage of the ACA. She also has a pre-existing condition
(asthma), and her employer does not offer health insurance.
We are afraid of a future without the ACA. I believe that the ACA was
damaged by two actions during its enactment: (1) the removal of the
coverage mandate and (2) the removal of the ``public option.'' These
would have created a bigger pool of insured and would have provided
insurance for those who are too poor to pay the coverage fees. These
two provisions were killed by the Republicans (and a few misguided
Democrats under pressure from people with the wrong information).
I say, ``Fix it.'' Don t kill it.
This country would be spending less on health care if it considered it
to be a right for all American citizens, as it is in many other
nations. I believe that single-payer Medicare for all would create the
kind of broad pool necessary to keep costs down for patients and
providers alike, as it does in most other developed countries. Imagine
how much less time and money it would take for the government and the
nation's medical offices to administer the policies. Imagine how much
less it would cost if everyone had access to affordable preventive
care. I keep hearing that the potential problem with ``single payer''
is the ensuing difficulty for many doctors and hospitals to make more
money off their patients. (Why not reward those who successfully
improve their patients' lives or fill the needs of the under-served and
those who are unlucky enough to live in impoverished urban deserts?)
I believe firmly also that many of the people I know who would love to
change jobs, or love to move to another state for work or study, or
want to start their own business, perhaps by working from home as
entrepreneurs, would also benefit by having a policy that is affordable
and portable. My best friend started a business in Europe where health
care was available for everyone, regardless of employment, place of
domicile, and income.
Too much time, stress, and money go into the intricacies, changes, and
details regarding insurance, which consume and direct the courses of
our lives. This is a waste for all citizens and ultimately for our
government.
It is advantageous for citizens to learn the truth about all of this.
People should know that if they help pay for the health care of
everyone else, not just themselves, both the country and themselves
will benefit.
(2) Access to affordable contraception and legal abortion:
I need only point out how these benefits to women have saved many lives
and improved the health of women and their families. Pregnancy and
childbirth wreak many changes on a woman's body, some of them deadly.
Illegal abortion, of course, is dangerous. The protection of the right
to a safe abortion should not be weakened by those who follow religious
dogmas or unscientific views of pregnancy and the medical procedures
used in modern America. I know women who suffered great indignities in
the 1960s (e.g., transport in the trunk of a car) and dangers (e.g.,
inserting sharp objects into the vagina or ingesting poison) before the
passing of Roe v. Wade. Women will always be willing to do these things
in order to control their destinies.
For many years, I have been protecting access to clinics and doctors
who bravely give women the service they need to reduce their family's
size, or to complete a college education, or to take a job that would
be impossible without affordable quality childcare. This country was
founded on freedom of and from religion. We need to respect that right,
which formed the basis of our country's beginnings. Someone's religious
beliefs should not be used to deny another woman even minimal access to
these basic needs. The lives of individual women and of their family
members should be respected no matter how much their religious belief
differs with regard to definitions of life, personhood, female versus
male, sexual preferences and activities, and health conditions. There
is no 100% effective form of birth control, but many of them work well
enough to permit modern women sexual fulfillment, wider career choice,
and a healthier body for starting a family when she is ready and
willing.
One other aspect of reproductive choice should be included in the work
of the HHS. The United States must cooperate with organizations and
help other nations in need of assistance to provide contraception,
childcare, health care, and safe abortion access. When women have these
benefits, they become more economically productive, better mothers, and
better able to counter the actions of autocratic or theocratic
governments. The world's environment would also benefit from the
amelioration of the effects of overpopulation, the resulting pollution,
and increasing warfare over necessities for life.
Thank you for listening. I was one of those many, many individuals,
along with my husband and daughter, who marched in Washington on
January 21st. If I must, I will return, and I will march, write, and
put my money toward keeping women's healthcare and reproductive choices
free from misinformed or misogynistic people in power. I will speak out
against anyone who tries to take away any person's right to affordable
health care and reproductive choice.
Sincerely,
Marilyn D. Quinn
______
Letter Submitted by Stacey Ravanesi
To: Senate Finance Committee
Date: January 24, 2017
I am in deeply concerned about the nomination of Representative Tom
Price (R-GA) for Secretary of Health and Human Services (HHS). As a
matter of fact I am intensely opposed to his nomination. I strongly
request the Senate Finance Committee to challenge his nomination to
helm an agency that plays an exceedingly important and complex role in
ending the certain epidemics in the United States and around the world.
Individuals impacted by HIV, tuberculosis (TB), hepatitis C (HCV), and
other infections; their families and their communities could face
serious and often deadly consequences if someone with Representative
Price's agenda leads this vital multi-agency cabinet-level department.
Representative Price's questionable suitability to head HHS and be
ultimately responsible for policies that directly affect the health of
U.S. residents can simply be ascertained from his own record as a
congressional representative to parts of Atlanta's northern suburbs--a
district and metro area with extremely high rates of HIV and a
flourishing opioid epidemic. Despite the abundance of epidemiological
data illustrating the impact of the HIV epidemic in his own district
and in the Southeastern United States, Representative Price has spent
the last 8 years undermining efforts aimed at providing health care and
social services to communities both living with, and vulnerable to, HIV
and other health conditions. These actions include voting to repeal the
Affordable Care Act (ACA) multiple times, pushing for the privatization
of Medicare, threatening to cap and block-grant Medicaid, supporting to
defund Planned Parenthood, pledging cuts to social service and safety
net programs--all while demonstrating a hostile voting record on
lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues.
Throughout the recent hearing before the Senate Committee on Health,
Education, Labor, and Pensions (HELP), Price made several indications
to continue a trend to dismantling existing systems, without details of
a replacement that sustains access to health care and social services.
At a time when we are at the forefront of new science to deliver better
antiretroviral therapies for HIV, breakthroughs in cures for HCV, and
pathways for making TB treatments shorter and more tolerable, the
nomination of Representative Price threatens to impede the progress of
both research and implementation. Upon confirmation, Representative
Price will, as promised, oversee the dismantling and overhaul of
health-care systems that are responsible for delivering many of these
medical advances to people in the United States, particularly those
communities impacted by health, social, and economic disparities.
HHS is not just the department that oversees our health-care system,
but also governs our public health, research, and regulatory agencies,
such as the Centers for Disease Control and Prevention (CDC), Indian
Health Services (IHS), National Institutes of Health (NIH), and the
Food and Drug Administration (FDA). The recent revelation of ethics
violations and refusal to clearly answer questions on these issues
during the Senate HELP hearing clouds any trust in Representative Price
to ensure the sanctity and neutrality of these agencies. Trust in HHS
leadership is needed in prioritizing pressing public health challenges,
ensuring drug and device safety, and countering emerging threats such
as Zika, Ebola, drug-resistant TB, and Gonorrhea, infant mortality
increases from infections such as congenital Syphilis, and
antimicrobial resistance through robust R&D, proactive epidemiology,
pharmacovigilance, and accelerated research and response.
Representative Price's worrisome background as a member of the American
Academy of Physicians and Surgeons--an organization that promotes and
endorses the theory that HIV does not cause AIDS, despite a substantial
evidence base to the contrary--puts into question his capabilities to
end an epidemic. Health conditions like HIV thrive on stigma. Yet Price
has only perpetuated stigma and marginalized vulnerable communities by
voting against bills that afford protections to the LGBTQ community.
With attention needed for other neglected populations, such as
prisoners impacted by HIV, HCV, and TB; it becomes less likely under a
Price-led HHS that key populations will be able to access health care
and treatment.
Now more than ever, ending public health epidemics requires a
combination of bipartisan federal and state leadership, evidence-based
policies, and adequate resources in proper alignment to deliver the
promise of biomedical and public health advances. Efforts to lower drug
prices while sustaining U.S. leadership remain inevitable challenges to
the successor of HHS and the Trump administration. Representative
Price, however, remains a concerning and unqualified candidate to lead
HHS given a track record that only marginalizes communities, raises
questions on his ethics and integrity to run an expansive $1 trillion
department, and putting forth policy proposals that seek to fast-track
the loss of lifesaving health care for 18 million Americans. Ending the
epidemics remains impossible by destroying access to health care and
treatment. With Representative Price's support of the repeal of ACA and
efforts to defund Medicaid, the hopes and vision of providing health
care among the poorest, sickest, most disenfranchised, most vulnerable
Americans will vanish.
The practice of slashing proven best public health practices from the
most helpless Americans is shameful and morally horrendous, while also
stigmatizing populations that have been historically marginalized
throughout American history. Therefore, I am begging please do NOT
confirm Representative Price for Secretary of HHS.
Thank you.
Stacey Ravanesi
______
Letter Submitted by Indu Subaiya, M.D., MBA
CEO, Health 2.0
350 Townsend Ave.
San Francisco, CA 94107
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
January 30, 2017
Honorable members of the Senate Finance Committee:
My name is Indu Subaiya, M.D., MBA, and I am Co-Chairman and CEO of
Health 2.0, the largest health care innovation conference and network
in the world. I submit this letter to oppose Tom Price's nomination for
Secretary of Health and Human Services.
We know that the ACA reduces barriers to health care for millions of
Americans, but what many don't know is that it also fuels a vibrant
segment of the private sector, the health technology innovation
economy.
In a decade of working alongside thousands of health-care innovators
globally, and in chapters in over 40 U.S. cities from Nashville to
Boston, Dallas to Chicago, we have never seen our health-care system
adapt so beautifully to reward private enterprise while saving lives
and taking care of our most vulnerable without the heavy hand of
government.
Dr. Price appears to be a well-intentioned, educated man, but he has
been out of both the practice of medicine and a transforming health-
care industry for too long to lead us in this dynamic market.
Appointing him to architect a replacement plan for the ACA would be
like hiring a dinosaur to build a space station.
What health care needs today is a pragmatic voice who can put pedal to
metal on the progress that's begun, who can work on reforming the ACA
dispassionately with business leaders, entrepreneurs and patients
represented in equal proportions, and who understands the health care
innovation economy.
But Dr. Price is far too polarizing in his politics to be taken
seriously by the diverse and moderate mainstream on both sides of the
aisle. Those of us fixing health care on the ground have blasted silos,
left partisanship at the door and figured out how to advance a common
interest. Ask Republican Governor Charlie Baker, Republican former Head
of the ONC, Dr. David Brailer, Chelsea Clinton of the Clinton
Foundation, Mark Bertolini, CEO of Aetna, Bernard Tyson, CEO of Kaiser
all of whom we've warmly welcomed on stage at Health 2.0 not just as
speakers but as partners in the work of transforming health care.
Dr. Price on the other hand has never reached out to our community, and
he's had a decade to do so. Instead he has represented the Association
of American Physicians and Surgeons, seen as a fringe group promoting
self-interest, technophobia, and a ``doctor knows best'' philosophy.
That era in medicine is over. The era of shared decision-making, data
transparency, evidence-based medicine and providers as partners in care
and innovation is here. Our era needs a Secretary of HHS who will
command the respect of the brightest lights in the health care
innovation economy and Dr. Price is just not that person.
What do I mean by the innovation economy in health care? I am not
referring to the old generation of electronic medical record companies
(EMR) that indirectly received incentives under the HITECH act. I'm
referring to the more than 4,000 new companies and many more thousand
jobs that were created in response to the ACA's imperative to make
health care more accountable for its outcomes. These companies have
applied the best of American business and technological ingenuity to
support doctors in their workflow and decision-making, to promote
collaboration among caregivers, to avoid redundancy in testing, to
improve patient safety and to allow patients to take more
responsibility for their health and care.
As a sector, they've raised over $19.8 billion in venture capital since
2011 because investors could bet on the momentum of a system aligning
around the best interests of patients for the first time in history.
What happens when you leave the doctor's office or hospital has always
mattered to individuals and families; but now it made business sense.
All this capital isn't just lining the pockets of Silicon Valley
startups. Economic development corporations in New York City,
Massachusetts, Detroit, and Louisiana are making long-term, strategic
investments in the health technology innovation economy to attract
innovative companies to set up shop in their cities to provide badly
needed solutions and to be powerful engines of job growth.
That's great you say. We'll keep this thriving and virtuous economy
alive, we're just going to get rid of the individual mandate, some
nasty corporate penalties and poorly run exchanges that limit choice
and raise premiums for patients and we'll handle pre-existing
conditions with hiving off those patients into separate pools. But
that's a fool's errand.
It was precisely because the ACA widened the tent of coverage that new
private sector markets were created. It was precisely because of
exchanges that Americans woke up to the fact that you need to take
responsibility for your health and spend your pre-deductible dollars
wisely, and private sector businesses rose to the occasion to build
tools to educate consumers on managing health-care expenses and
decision-making.
Overstretched health systems also see innovative technology as a way to
do more for patients with less overhead, to reach people in rural areas
and at home cheaply and effectively, to refer repeat visitors to the ER
to a lower cost option in the community. Hospitals like Massachusetts
General in Boston, Cedars Sinai in Los Angeles, Dell Medical Center in
Texas, UPMC in Philadelphia and New York Presbyterian in New York City
all have either started their own or participated in health technology
innovation programs to test new models of care delivery in partnership
with the entrepreneurial community in health care.
It was the ACA's imperative to take care of a wider and more diverse
population that created demand for new products to address the social
determinants of health that are killing our small towns: caregiving
burden, mental health, substance abuse, food insecurity, health
literacy, social support for the elderly and so much more. These social
ills normally depend on inefficient government programs. But thanks to
the ACA, for the first time entrepreneurs have paying customers for
solutions to these issues. Customers like public health departments,
community clinics and hospitals. At the national conference we run on
health innovation, the session on ``Community Health'' normally draws a
handful of do-gooders. This past year you couldn't get in the room if
you tried; it was packed with entrepreneurs. The ACA had created a
market for doing well by doing good.
The train of progress toward a healthier America and a more efficient
health-care system has left the station. If confirmed, Dr. Price would
waste time trying to run after it only to get run over by it. We have
better Republican candidates to choose from who have worked shoulder to
shoulder with patients and innovators, who've been part of the
transformation of American health care on the ground, not in DC and not
in the ivory tower.
Don't appoint him because you are comfortable with him as a congressman
and a doctor. Neither role prepares him for this job. Don't appoint him
because the AMA endorsed him. The AMA is a friend to the innovation
community but it speaks for a minority of physicians. You have already
heard from thousands of doctors who aren't involved in politics who
oppose this nomination. Take your time and don't rush this vote. Let's
fix what's broken together without taking a wrecking ball to progress.
On behalf of those of us with real experience making positive change in
the trenches of health care, I ask you to vote ``no'' on Tom Price.
Thank you for your consideration.
Sincerely,
Indu Subaiya, M.D. MBA
CEO, Health 2.0
______
Treatment Action Group (TAG)
90 Broad St., Suite 2503
New York, NY 10004
Tel 1-212-253-7922
Fax 1-212-253-7923
http://www.treatmentactiongroup.org/
January 24, 2017
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
Dear esteemed members of the Senate Finance Committee:
Treatment Action Group (TAG) submits this statement for the record in
strong opposition to the nomination of Representative Tom Price (R-GA)
for Secretary of Health and Human Services (HHS). We urge critical
community action and implore the Senate Finance Committee to challenge
his nomination to helm an agency that plays an exceedingly important
and complex role in ending the HIV, tuberculosis (TB) and hepatitis C
(HCV) epidemics in the United States and ultimately around the world.
TAG is an independent, science-based research and policy think-tank
fighting for better treatment, vaccine and a cure for HIV/AIDS, TB, and
HCV. We work closely and interface extensively with U.S. health care,
research, and regulatory institutions to support expanded access to
health care, centralize community engagement and ethically accelerate
vital research.
Tom Price's questionable fitness to head a multi-agency cabinet-level
department charged with the health of U.S. residents can simply be
ascertained from his own record as a Congressional representative to
parts of Atlanta's northern suburbs--a district and metro area with
extremely high rates of HIV and a flourishing opioid epidemic. Despite
the abundance of epidemiological data illustrating the impact of the
HIV epidemic in his own district and in the Southeastern United States,
Representative Price has spent the last 8 years undermining efforts
aimed at providing health care and social services to communities both
living with, and vulnerable to, HIV and other health conditions. These
actions include voting to repeal the Affordable Care Act (ACA) multiple
times, pushing for the privatization of Medicare, threatening to cap
and block-grant Medicaid, supporting to defund Planned Parenthood,
pledging cuts to social service and safety net programs--all while
demonstrating a hostile voting record on lesbian, gay, bisexual,
transgender, and queer (LGBTQ) issues. Throughout the recent hearing
before the Senate Committee on Health, Education, Labor and Pensions
(HELP), Representative Price made several indications to continue a
trend to dismantling existing systems, without details of a replacement
that sustains access to health care and social services.
At a time when we are at the forefront of new science to deliver better
antiretroviral therapies for HIV, breakthroughs in cures for HCV, and
pathways for making TB treatments shorter and more tolerable, the
nomination of Representative Tom Price threatens to impede the progress
of both research and implementation. Upon confirmation, Representative
Price will, as promised, oversee the dismantling and overhaul of
health-care systems that are responsible for delivering many of these
medical advances to people in the United States, particularly those
communities impacted by health, social, and economic disparities as
well as stigma.
Before the ACA, hundreds of people every year were waitlisted for the
AIDS Drug Assistance Program (ADAP). People living with HIV (PLHIV)
would need an AIDS diagnosis to be eligible for Medicaid. Pre-existing
conditions would also disqualify many PLHIV from gaining insurance.
While the ACA is not perfect, thousands of PLHIV have been transitioned
onto insurance through marketplaces and have become eligible for
Medicaid benefits. This has provided many with access to comprehensive
health care for the first time, with profound effects on public health
and prevention outcomes. Much of the success we're seeing in increasing
viral suppression rates and reducing the number of diagnoses annually
will be put in jeopardy if the ACA is repealed without replacement.
Without replacement and stewardship by the incoming Secretary of Health
and Human Services, access to treatment, prevention and other services
will remain out of reach for many of these communities.
HHS is not just the department that oversees our health-care system,
but also governs our public health, research, and regulatory agencies,
such as the Centers for Disease Control and Prevention (CDC), Indian
Health Services (IHS), National Institutes of Health (NIH), and the
Food and Drug Administration (FDA). The recent revelation of ethics
violations and refusal to clearly answer questions on these issues
during the Senate HELP hearing clouds any trust in Representative Price
to ensure the sanctity and impartiality of these agencies. Trust in HHS
leadership is needed in prioritizing pressing public health challenges,
ensuring drug and device safety, and countering emerging threats such
as Zika, Ebola, drug-resistant TB, and antimicrobial resistance through
robust R&D, proactive epidemiology, pharmacovigilance, and accelerated
research and response.
Representative Price's worrisome background as a member of the American
Academy of Physicians and Surgeons--an organization that promotes and
endorses the theory that HIV does not cause AIDS, despite a substantial
evidence base to the contrary--puts into question his capabilities to
end an epidemic. Health conditions like HIV thrive on stigma. Yet
Representative Price has only perpetuated stigma and marginalized
vulnerable communities by voting against bills that afford protections
to the LGBTQ community. With attention needed for other neglected
populations, such as prisoners impacted by HIV and HCV, it becomes less
likely under a Price-led HHS that key populations will be able to
access health care and treatment.
Now more than ever, ending the epidemics of HIV, TB, and HCV requires a
combination of bipartisan federal and state leadership, evidence-based
policies, and adequate resources in proper alignment to deliver the
promise of biomedical and public health advances. Efforts to lower drug
prices for HIV and HCV while sustaining U.S. leadership in R&D for TB
and other neglected diseases remain inevitable challenges to the
successor of HHS and the Trump administration. Representative Tom
Price, however, remains a concerning and unqualified candidate to lead
HHS given a track record that only marginalizes communities, raises
questions on his ethics and integrity to run an expansive $1 trillion
department, and putting forth policy proposals that seek to fast-track
the loss of lifesaving health care for 18 million Americans. Ending the
epidemics remains impossible by destroying access to health care and
treatment. With Representative Price's support of the repeal of ACA and
efforts to defund Medicaid, the hopes and vision of providing health
care--including ending the HIV epidemic, curbing HCV transmission,
eliminating TB--among the poorest, sickest, most disenfranchised, most
vulnerable Americans will vanish.
In summary, we urge the Senate Committee on Finance to challenge the
nomination of Representative Tom Price as he is unqualified and unfit
to lead HHS in a critical juncture to end the HIV/AIDS, TB, and HCV
epidemics. Should you have any questions or concerns in regards to our
statement of opposition to the nomination of Representative Tom Price
for HHS Secretary, please contact TAG policy staff Kenyon Farrow at
(202) 236-3274 or via email at [email protected],
and Suraj Madoori at (917) 530-5996 and
[email protected].
Thank you.
Mark Harrington
Executive Director
Treatment Action Group
______
Letter Submitted by Elizabeth Vallance
January 25, 2017
U.S. Senate
Committee on Finance
Dirksen Senate Office Bldg.
Washington, DC 20510-6200
To the committee members:
I write in strong protest of the nomination of Tom Price to head the
Department of Health and Human Services.
Nothing in Representative Price's record suggests that he is fit to
hold this position. Nothing in his record suggests an understanding of
the public health issues faced by people of limited incomes, by the
elderly, by people with AIDS or addiction problems, by people in
minority communities including the LGBTQ community. He has repeatedly
fought efforts to provide women's health through Planned Parenthood,
has fought to cut desperately needed social services and safety-net
programs which are effective and solvent, including (they work, though
he disdains them) the Affordable Care Act, Medicare, and Medicaid.
My mother was a proud nurse practitioner in a public clinic in
Appalachian Pennsylvania for many years before she died (of cancer--we
need that cancer research!) in 1997, and her stories of the many women
(anonymous of course)--young women, poor women, women without health
plans, women who were alone and frightened by symptoms they couldn't
understand, many with their male partners, women new to the area who
had no other resources--were extremely moving tales of gratitude for
the compassionate care they received. It was clear to her, and it is
clear to me, that providing professional health care was critical to
the health of these women and the well-being of their families, their
children, and the community. Surely all existing programs can be
improved upon, and I would welcome genuine improvements--in
accessibility and efficiency--in any of them. But Representative Price
has offered no solutions, only his intentions to reduce important
national programs without a clue as to what might replace them. The
women my mother treated in those years before the Affordable Care Act
were fortunate to have that clinic, but that was not typical and her
clinic couldn't reach everyone.
Donald Trump seems bent on destroying much of what we as a nation have
so painstakingly created over the past decades, programs that might
begin to bring this country a bit higher in the lists of international
rates of healthiness and longevity. The Programs under HHS are the most
crucial to this slow progress we have made. HHS needs a leader who
understands, respects, and wants to improve on them, not someone whose
only interest in the job seems to be to wreck the department and its
critical programs.
There are thousands of FAR better candidates out there, responsible
health-care and health-policy professionals whose commitment to the
health and well-being of our citizens is clear. Reject this terrible
choice and let's find someone more qualified than Tom Price to head the
programs that the health and well-being of so many millions of
Americans depends on.
Thank you for your consideration,
Elizabeth Vallance,
Citizen and voter.
[all]