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 and the breadth and severity of illnesses? >> i think it's absolutely imperative, senator. and i look forward to working with you. >> thank you, chairman. >> thank you, senator. senator thune. >> thank you, chairman. dr. price, welcome. thank you for your willingness to serve in this capacity. we have a lot of challenges ahead we need to take on. as i met with you a couple weeks ago, one of the issues that's of particular interest to me is this issue of indian health service. in 2010 there were some systemic problems that were uncovered in south dakota. 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.

after oversight hearings it became abundantly clear that time and again there was lack of followthrough by the agency. 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? >> absolutely, senator. this is an area 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're not meeting the goal of the highest quality care to be provided to individuals accessing that system. so, we're not -- we're not doing what we ought to do in that system. and i'm committed to making certain, should i be confirmed, to turning that system around. >> as i shared with you, senator ba ro bra

brasso introduced a bill which we believe will bring about structural changes. many times that act, although we think it addresses a lot of problems that cropped up, and based on consultation we received from the tribes, really is merely a first step in the process that's necessary to improve that agency. if confirmed, what types of reforms could you see yourself supporting when it comes to the ihs? obviously, starting, perhaps, with our legislation. i don't know, you probably haven't had a chance to look carefully at that yet. but i want to ask you comment specifically to it. but are there thoughts you have with respect to the ihs that when it comes to reforms, that you could work with us on? >> yeah. i appreciate that. i've had the privilege of visiting some ihs facilities in the state of wisconsin. and a couple facilities that were doing remarkable work. it appears to me that what we haven't done -- and i look forward to -- if i'm confirmed, getting into this area within the department itself, that what we haven't done is identified

best practices within the ihs system itself and shared those and incense vized the ability to move that kind of activity that is providing high-quality care for individuals in that system, in certain areas, and making certain that we're able to extend that across the country in the ihs. >> okay. we look forward to working with you on that. i think best practices is a good place to start. 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 in small and rural hospitals. i shared this with you as well. in my statement we have a lot of critical access hospitals, rural areas, big geography to cover, and 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? >> yeah, i look forward to working with you on it, senator. i think there are areas from a technological standpoint that we are missing the boat, especially in our rural areas and 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 put roadblocks up to the expansion of technology, especially into the rural areas. we ought to be incentivizing that so, again, the patients are able to receive the highest quality care. it's possible now, for example n our state, if you're an individual who is suspected of having a stroke, you go to a critical access hospital in a rural area, it's 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's improving the lives and care of patients across our state. and i think there's so many things we could do that would mirror that kind of technological expansion. >> thank you. one final point i'll make, as my time is expiring, but i know you've probably been questioned already a good amount about what happens next with respect to replacing obamacare. i would simply say that, i hope that we can work with you in beginning to shift a lot of t the -- giving the states more flexibility when it comes to designing plans that work in our states. i think one of the problems that we've had with this is there is just too much dictation from washington, d.c., and too much one size fits all. that's something that i think most -- 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 in 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, d.c., where i think too many of the problems have been happening. thank you, mr. chairman. >> look forward to it. >> senator casey. >> thank you, mr. chairman. dr. price, good to be with you again. >> thank you. >> i want to ask you a couple questions that center principally on children and individuals with disabilities. first with regard to children, i think if we're doing the right thing, as -- not only as government but as a society, if we're really about the business of justice, and if we're really about the business of growing the economy, we should invest a lot and spend a lot making sure every child has health care. the good news, despite a lot of years of not getting to that point, not moving in the right direction, the good news is, we made a lot of progress. the urban institute in an april 2016 report, i won't ask -- i won't ask the report to be made

part of the record, but i'll read a line from this urban institute report. uninsurance among children 1997 to 2015 dated april 2016, says as follows on page 3, it said that 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% in 2013 to 4.8% in 2015, unquote. so, that's a significant drought. 7.1 to 4.8 is millions of kids have health insurance today that would not have it absent the affordable care act, including the medicaid provisions as well. that 4.8% uninsured rate is at an all-time low. that means we're at a 98% 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 -- 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? >> i think that throughout our population we ought to identify individuals who are uninsured and strive to make certain they gain coverage. >> you would agree with me with regard to children especially? >> everybody in the population, but children are precious and are our future. >> great. >> just with regard to children, now that we have that number, we know the number that we've arrived at, we know the percentage, will you commit, if you're successful in your confirmation, to maintain or to even reduce that uninsured number even further? in other words, thaw will be

able to commit to us today, that that -- that the number of uninsured children will not increase under your -- during your time as secretary for ywer to be confirmed and the number of uninsured would not increase? >> our goal it is to decrease the number of uninsured population under age 18 and over age 18. >> i hope you maintain that because i think that's 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 it's -- 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 a -- an op-ed by gene spurling.

he was head of 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's what he said in pertinent part, referencing you and your budget proposals. he said, quote, together, meaning the two -- the two areas of policy that you've -- you have a long record on, full repeal of aca and block granting of medicaid, which we know is trump administration policy, quote, would cut medicaid in children's health insurance program funding by about $2.1 trillion over the next ten years, a 40% cut, unquote. how can you answer the questions i just asked you about, making sure that number of uninsured children doesn't get worse under your tenure if that is the case

with regard to -- with regard to your policies, the effect of what your policies would be, and now apparently contrary to what was said during the kaernlgs it's now the policy of the trump administration to block grant medicaid? >> with respect to both you and to mr. spurling, it's because you all are looking at this in a silo. we don't look at it in a silo. we believe it is possible to imagine, in fact, put in place, a system that allows for greater coverage for individuals. as a matter of fact, coverage that actually equals care. right now many of those individuals -- the aca actually increased coverage in this country. it's one of the things that it actually did. the problem is, is that a lot of folks have coverage but they don't have care. so, they've got the insurance card. they go to the doctor. the doctor says, this is what we believe you need and they say, i'm sorry -- >> a cut of $1 trillion, a combined cut of $1 trillion 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. >> you're looking at that in a silo. you aren't looking at that in what reform and improvement would be. >> we're look at the rebuttal in not just what gene spurling said but a whole line of public policy, advocates and experts. and i think the burden for you, sir, is to make sure you fulfill your commitment to make sure no children will lose health insurance coverage while you are secretary. >> look forward to working with you. >> senator hiller. >> thank you, mr. chairman. dr. price, thank you for being here today. thanks for your patience in working with us throughout this confirmation process. >> if you can put your mike on. >> it is on. i'll lean a little forward. mr. chairman, as you can imagine, i committed to ensuring that all have access to quality and affordable health care insurance.

i have a letter from nevada legislature, directly from our majority leader of the state senate and our speaker of the assembly. and they're good questions. five questions. obviously, they want to get the same answers that all of us want here. we have a nevada 88,000 nevadans who have health insurance through the exchange. 77,000 nevadans eligible for federal tax credits. 217,000 nevadans that receive health care coverage under expansion. basic questions. mr. chairman, if i may, can i submit these questions to the record, on 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're very good question. >> without objection. >> also if i may add f you could cc the governor also. i think the governor would also like answers to these questions. i think you're in a great position to answer these particular questions. >> thank you, sir. >> thank you.

if i may, can i get your opinion on the cadillac tax? >> i think the cadillac tax is -- 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 if so that individuals gaining their coverage through their employer are able to gain access to the kind of coverage they desire. >> the cadillac tax would affect about 1.3 million nevadans. school teachers, union members, senior citizens. and there's some disagreement as to whether or not these individuals are wealthy or not. there are some on this committee that believe the $1.1 trillion tax increase in obamacare does not affect the middle class. do you agree with that? >> i think it does affect middle class. >> i do, too. do you believe school teachers are wealthy?

>> everybody has their own metric of what wealthy is and some people use things to determine what wealth that aren't the greenbacks -- >> i would argue most school teachers don't think they're wealthy. do you think most union members are wealthy? >> i doubt they think they're wealthy. >> yeah, i would agree with that. do you think most senior citizens are wealthy? >> most senior citizens are on a fixed income. >> they would argue they're not wealthy. that's my argument on this particular tax. in fact, obamacare as a whole is it's another middle class tax increase of $1.1 trillion. my -- i guess my question and question for you is, is that if i can get your commitment to work with this committee, work with myself to end -- and the treasury secretary to repeal the cadillac tax? >> well, we'll certainly work to make certain 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. >> does the cadillac tax make the most sense? >> as i mentioned, i think there are other options that may work better. >> do you believe it is an increase, health insurance increase, to middle class america? >> i do. >> 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 -- iveng the enrollment went from 350,000 to over 600,000. and i guess the concern, and i think it's part of the letter that i gave to the chairman, is whether or not that will have an impact. what we're going to do to see that those individuals aren't impacted. probably the biggest question we have for you here today is what are we going to do about those that are part of the medicaid expansion and how that's going to impact them?

>> yeah, 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'm able to be confirmed, and 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. >> dr. price, thank you. thank you for being here. >> thank you. senator warner. >> thank you, mr. chairman. good to see you again, dr. price. >> thank you. >> let me start on something we discussed in my office. one. issues i've been working on since i've been governor, working very closely with your friend senator isaacson is the issue of how we as americans address the end of life and those issues. i think we both shared personal stories on that subject. senator isaacson and i have legislation that is called 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 into the fee schedule to provide initial reimbursement for providers to have these conversations with others. this is mentioned in 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 choice -- medicare care choices. i believe it's very important that we don't go backwards on these issues. i think we talked about, maybe the only industrial nation in the world that hasn't had this kind of adult conversation about this part of life.

again, not about limiting anyone's choices, but would you -- if you're confirmed, would you continue to work with senator isaacson and i on this very important issue? >> i look forward to doing so. >> and not be part of any effort to roll back those efforts that cms have already taken? >> i think it's important to take a look at the broad array of issues. one issue is liability. i can't remember if we discussed that in your office. the whole issue of liability surrounding these conversations is real. we need to talk about it openly, honestly and work together to try to find a solution to just that. >> i would concur with that. but i also think this is something that more families need to take advantage of. on friday, january 20th, the president -- president trump issued an executive order th that -- that says federal agencies, especially hhs, should do everything they can to, quote, eliminate any fiscal burden of any state -- on any state or any cost fee, tax penalty or regulatory burden on individuals and providers. dr. price, if you're confirmed

in this position, will you use this -- will you use this executive order in any way to try to cut back on implementation or following the individual mandate before there is a replacement plan in place? >> well, i think that if i'm -- if i'm confirmed, then i'm humble enough to appreciate and understand that i don't have all the answers and that the people at the department have incredible knowledge and an 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 intelligent decision possible. >> i'm not sure you answered my question. i just -- what i would not want to see happen, as we take -- i understand your concerns with the cadillac tax. i know there are concerns about you and others have raised about the individual mandate.

there are some that are concerned about the income tax surcharges. it's just remarkable to me, and this is one of the reasons i think so many of us are anxious to see your replacement plan, that the president has said we want insurance for everybody. he wants to keep prohibitions on pre-existing condition, keep people on policies until 26. it seems like there's at the same time a rush to eliminate all of the things that pay for the ability to have -- for americans to have those kind of services. and i would just want your assurance that you wouldn't use this executive order prior to a legal replacement to eliminate the individual mandate, which i would believe helps shore up the cost coverage and the shifting of costs that are required in an insurance system. >> yeah, i -- a replacement, a reform, an improvement of the program, i believe, is imperative to be instituted simultaneously or at a time in -- >> you will not use this executive order as a reason to, in effect, bypass the law prior

to replacement in place? >> our commitment is to carry out the law of the land. >> in these last couple minutes i want to go on. i know you've been in the past a strong critic of the center for medicare and medicaid and innovation of cmmi. i believe in your testimony last week, you saw great promise in it. to me f we're going to move towards a system that emphasizes quality of care rather than simply quantity of care, we've got to have this kind of experimentation. there's one such program, the diabetes prevention program. that last year cms certified it saved money on a per beneficiary basis. i know my time is rung out. i think they can probably be answered yes or no. do you support cmm delivery system reform demonstrations that have the potential to reduce spending without harming the quality of care? >> the second clause is the most important one. i suspect making certain we deliver money -- that we deliver care in a cost effective manner but we absolutely must not do things that harms the quality of care being provided to patients. >> if part of that quality of

care, and i'd agree with you, would mean bundled and episodic payment models that actually move us toward quality over volume, would you support those efforts? >> for certain patient populations, bundled payments make a lot of sense. >> if these experiments are successful, would you allow the expansion of these across the whole system? >> i think that what we ought to do is allow for all sorts of innovation, not just in this area. there are things i'm certain that haven't been thought up yet, that would actually improve quality and delivery of health care in our country. we ought to be incentivizing that kind of innovation. >> i would simply say, mr. chairman, cmmi is an area i would like to have seen more but it's a model and tool we ought to not discard. thank you. >> thank you, senator. senator scott. >> thank you, chairman. dr. price, good see you again. launched the nation's first statewide pay for success project with nurse/family partnership with the use of medicaid funds. 20% 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 an 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? >> it sounds like a great program that is actually has the right metric. that is the quality of care and the improvement of lives. and as you state, if it's 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. >> yes, sir. thank you. i believe you were the director of the orthopedic clinic at grady memorial hospital in atlanta. >> i was. >> you mentioned something that i think is very important. i think 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? >> it was an incredible privilege to work at grady the number of years i did. we saw patients from all walks of life and many, many uninsured individuals. they come with the same kinds of concerns, the same kinds of challenges that every other individual has. and one of the big -- they have an additional concern and that is, is somebody going to be caring for me? is somebody going to be ainl able to help me. that's why it was so fulfilling 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 the concern of whether or not people would be there to help them. >> yes, sir. i know you're aware of the title

i of every student succeeds act. head start to have access to resources. it seems to me that would be imperative for the secretary of hhs and secretary of education to look ats tos synergiz to help the underprivileged student? can i get your commitment to work with the secretary of education where it makes sense to help serve those students? we have head start under you and other programs under esa. 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. >> yeah, i -- you've identified an area that is a pet peeve of many of ours. that is, that we don't seem to collaborate across jurisdictional lines. not just in congress, but certainly in the administrative side. look forward to doing just that. having as a meertd tric, how ar

kids doing? 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 in improving their lives and able to demonstrate that? if we're not asking the right questions f we're not looking at the right metrics, we won't get the right answers to expand what's actually working or modify it and move it in a better direction. >> thank you. i think that's one of the more important parts of your opportunity in this position, is looking at those kids, and you know as well as anyone as a doctor, those ages, before you ever get into pre-k, kindergarten, the development of the child in those first three or four years are powerful opportunities for us to direct one's potential so that they maximize it. sometimes we're missing those opportunities. we think 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. my last question has to deal with the employ-sponsored health care system we're so accustomed to in this country that provides so many with their own insurance. in my home state we have 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 matter? said differently, there's been some conversation about looking for ways to decouple having health insurance through your employer. >> i think the employer system has been absolutely remarkable success in allowing individuals to gain coverage they might otherwise not gain. i think preserving the employer system is -- is imperative. that being said, i think there may be ways in which individual

employers -- i've heard employers say, if you give me the opportunity to provide my employees so they can select the coverage they want, that makes more sense to them. if that works from a voluntary standpoint for employers and for employees, then it may be something to look at. >> that would be more like the hra approach, where -- >> exactly. >> -- employer funds an account and the employee chooses the health insurance, not necessarily under the umbrella of the employer specifically? >> exactly. and gains the same tax benefit. >> thank you, chairman. >> thank you. senator mccaskill. >> at risk of being way, way away from you, and you being someone i've worked with and respected greatly i want to correct something in your opening statement. the first nominee of president trump that this senate considered was confirmed by a vote of 98-1. i would not consider that a partisan vote. the second nominee of president

trump was confirmed by a vote of 88-11. 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 sabelius. it was no bean bag. it was tough stuff. i think all of this looks different depending on where we're sitting. i wanted to make that point. as to passing obamacare without one democratic vote, we're about to repeal obamacare without one democratic vote. this will be a partisan exercise under reconciliation. it will not be a bipartisan effort. 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're not really believing, are you, that your new boss is not going to weigh in on what we -- what he wants congress to pass? we're not going to have a plan from him? >> we look forward to working with you and other members -- >> my question is, will we have a plan from the president? will he have a plan? >> if i have the privilege to being confirmed, i look forward to working with the president and bringing a plan to you. >> 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? >> i hope i have input, yes, ma'am. >> yes. so whatever trumpcare ends up being, you will have a role in it. i think it's really important to get that on the record. now, when we repeal obamacare,

we're 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? >> that's a hypothetical and you all are -- >> no, it's not a hypothetical. when we repeal obamacare, there are taxes in obamacare. and when it is repealed,there is no question that 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? >> i look forward to working with you on the plan and hopefully that will be the case. >> no, no, no, no. i'm asking, the taxes in there now, does anybody who makes less than $200,000 now, pay those taxes now? >> it depends on how you define the taxes. many individuals are paying more than they did prior to -- >> no, i'm talking about taxes.

the cadillac tax has not been implemented, so that doesn't affect anybody. i'm trying to get at the very simple question, that i don't think you want to answer. in fact, when obamacare is repealed, no one in america who makes less than $200,000 is going to enjoy the benefit of that. >> as i say, if confirmed, i look forward to working with you on that. >> that's not an answer. in my office, ending medicare, your plan and you have worked on for year, and converting medicare to private insurance markets with government subsidies, correct? >> not correct. >> well, we talked yesterday, and we kind of went through this in my office. by the end of our conversation, you admitted to me, and i'm going to quote you, that your plan for medicare in terms of people getting either tax credits or subsidies or whatever -- however you're going to pay for the medicare recipients would be them having choices on a private market. you said, yes, it was pretty similar to obamacare, with the

exception of the mandate. didn't you say that to me yesterday? >> that's a fairly significant exception. >> well, but these people are old. they don't need to be mandated to get insurance. it's not like a 27-year-old who doesn't think he's going to get sick. you don't need a mandate for people who are elderly. they have to have health insurance. so, the mandate is not as relevant, but didn't you admit to me that obamacare and private markets is very similar to what you were envisioning? didn't you use the phrase, similar? >> it is pretty similar. what i did say is the mandate is significant. >> the mandate is significant, i get, in obamacare. but we don't need a mandate for seniors, would you agree with that? you don't need to tell seniors they need health insurance? >> i hope we don't need a mandate for anybody so they can purchase the kind of coverage they want and not the kind the government forces them to buy. >> finally, you want to block grant medicaid for state flexibility and efficiency, correct? >> i believe that medicaid is a

system that is now not responding necessarily to the needs of the recipients. consequently, it's incumbent upon all of us as policymakers to look for a better way to solve that challenge. >> are you in favor of block granting medicaid? >> i'm in favor of a system more responsive. >> are you in favor of block granting medicaid? it's a simple question, congressman. for the most powerful job in health care in the country. i don't know why you're unwilling to answer block granting medicaid. it's not that complicated. >> i'm in favor of making certain medicaid is a system that responds to patients, not the government. >> i don't understand why you won't answer that. and i don't have time. i know i'm over. i will probably -- i don't know if we're going to get another round, mr. chairman. should i ask my last question or are we going to get another chance? >> i'm going to allow additional questions. i hope that not everybody will take the opportunity. >> i will digssappoint you, i'm

sorry. >> let me just on that point say that obamacare raised taxes on millions of americans families across income levels. nonpartisan joint committee on taxation in may of 2010 analyses identified significant widespread tax increases on taxpayers earning under $200,000 contained in the aca. and, 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 from an increase in the income floor for the medical expense deductions. obamacare has led to middle class tax hikes. without question, it's led to fewer insurance options, higher deductibles and higher premiums. so, i think those are facts that can't be denied.

>> i'll look forward to looking at those facts because somewhere in this mix we have alternative facts. >> well, just -- >> i think these are right, i can tell you that. >> well, i think mine are right. >> mr. chairman, point of privilege to respond? >> yes, sir. >> 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's a matter of public record. it's not an alternative factor or universe. people making $200,000 and up got their taxes cut. that was in the reconciliation bill of the republicans last year. >> well, let's see who's next here. i don't agree with that, but we'll see who's next. senator grassley -- oh, cassidy. i didn't see you. senator cassidy and then senator

grassley. >> thank you, mr. chairman. dr. price, how are you? >> i'm well, senator. >> let's talk a little about medicaid because we're getting this rosy scenario of obamacare and of the republican attempt to replace it. it does seem a little odd. first, i want to note for the record that president trump has said in various ways that he doesn't want people to lose coverage. he would like to cover as many people as under obamacare. wishes to take care of those with pre-existing conditions and to do it without mandates and lower costs. those will be your marching orders, fair statement? >> absolutely. >> now, let's go to -- you and i, we talked at a previous meeting. we both worked in public hospitals for the uninsured. and for the poorly insured, folks like medicaid. now, let's just talk about medicaid. why would we see patients on medicaid at a hospital for the uninsured? if they wanted to see an orthopedic -- orthopedist in private practice, does medicaid pay a provider well enough to pay costs of seeing an orthopedic patient? >> oftentimes it does not. as you well know, as i mentioned

before, one out of three physicians who ought to be able to see medicaid patients in this nation, do not take any medicaid patients. there's a reason for that. whether it's reimbursement or whether it's hassle factor or regulations or the like. but that's a system that isn't working for those patients. and we auought to be honest abo that, look at that and answer the question why and then address that. >> now, i'll 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. she had to discharge patients from her practice. now, the ranking members said we can't have alternative facts. agree with that. we also know new england journal of medicine article speak being 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 better for patients. >> absolutely. we need to look at the right metrics. just gaining coverage for individuals is an admirable goal. but it is -- it ought not be the only goal. providing for people on the ground, for real people and real lives. whether or not we're affecting them in a positive way or negative way. if we're affecting them in a negative way, again, we need to be honest with ourselves and say, how can we improve that? >> now, a lot of times there's this kind of conflation of per beneficiary payments to states per medicaid enrollee and block grants, which to me is a conflation. i'll note that bill clinton on the left and phil graham and rick santorum on right proposed per beneficiary payments some time ago. it's actually how -- would you agree with this, how the federal

employee self-benefit program pays for these federal employ s employees, they pay per beneficiary payment to an insurer, fair statement? >> correct. >> wouldn't it be great if medicare worked as as well as federal employee health insurance in terms of outcome? >> when you talk about the medicaid population, it's not a monolithic population. there are four different demographic groups within it -- seniors and disabled and then healthy moms and kids, by and large. we treat each one of those folks exactly the same from the medicaid rules. >> so, when you're pressed on whether, by golly, you believe in block grants, i don't hear any nuance in that queshgs are you speak being a per beneficiary payment? are you speak being each of those four, one of those four? how do you dice that? new york is an older state demographically. utah is a young statement. fair statement? >> absolutely. those are the things i think we tend not to look at, because they're more difficult to measure. they're more difficult to look at.

but when we're talking about people's lives, when we're talking about people's health care, it's imperative we do the extra work that needs to be done to determine whether or not, yes, indeed, the public policy we're putting forward will help you, not harm you. >> let me ask because there's also some criticism about health savings accounts. i love them because they activate the patient. i think we're familiar with the healthy indiana plan where on a waiver they gave folks of lower income health savings accounts and had better outcomes, decreased e usage. any comment on that? >> just when people do engage in their health care, they tend to demand more, they tend to demand better services. and individuals that have greater opportunity for choices of who they see, where they're treated, when they're treated and the like, have greater opportunity to gain better health care. >> going back to not one to have alternative facts f we contrast the experience in healthy indiana with the experience in oregon where national economic

bureau of research published in new england journal of medicine found no different outcome from those fulfilled in medicaid expansion program in oregon, contrast with good outcomes, in that which in indiana engaged patient to become activated in their own care, er usage 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. >> thanks, senator. senator grassley. >> two statements before i ask a couple questions. one is, it's 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 they don't 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 a legislation passed a few years ago called a physician's 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. i want to make very clear that the legislation i'm talking

about doesn't 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've got some studies here that we did, and some newspaper reports on them, particularly one about a psychiatrist at emory university that was not reporting everything that they should report and even the president of the 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. since you're administering this legislation and since senator blumenthal and i will think about expanding this legislation

to include nurse paractitioner assistant and even under the obamacare administration, after we got it passed, it was three years getting regulations, to get it carried out. so, effectively, it's only been working for 2, maybe 2 1/2 years. so i would like to -- if you're confirmed, would you and the department of human -- health and human services work with me to ensure that this transparency initiative is not weakened? >> we look forward to working with you, sir. i think transparency in this area and so many others is vital. again, not just -- not just in outcomes or in pricing but so many areas so patients are able to understand what's going on in the health care system. >> thank you. last one deals with vaccine safety. you're a physician. i believe you would agree that immunization is very important for modern medicine and that we've been able get rid of smallpox way back in '77,

worldwide polio, i think, in 1991. at least in the western hems 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? >> i think that science and health care has identified a very important aspect of public health, and that's the role of vaccinations. >> thank you very much. i yield back my time. >> thank you, senator. senator stabenau. >> thank you. a series of stories from public forehe forum that was held by my colleagues, that that be included in the record. >> without objection. >> thank you very much. welcome, congressman price,

and -- >> senator. >> -- and appreciate our private discussion as well as the discussion this morning. let's start out with lots of questions and see if we can move through some things quickly. you said this morning that you would not abandon people with pre-existing conditions is that basically what you're talking about is high-risk pools, is that one of the strategies that you're thinking about? i've heard that talked about this morning. >> i think high-risk pools can be incredibly helpful in making certain individuals that have pre-existing illness are able to be cared for in the highest manner possible. i think there are other methods as well. we've talked about other pooling mechanisms, the destruction of the small group market has made it such that folks can't find coverage affordable for them. one way to solve that challenge is to allow individuals in the small group market to pool together. i think we talked about this in your office.

with the old blue heel model being the template for individuals who aren't economically aligned are able to pool together their resources solely for the purpose of purchasing coverage. >> for about 35 years we have tried high-risk pools. 35 states had them before the affordable care act. frankly, it didn't produce great results. in 20110.2% of people with pre-existing conditions, 0.2%, were actually in a high-risk pool. and the premiums were 150 to 200% 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 pre-existing conditions or

without maternity coverage or without mental health coverage or insurance that would reinstate caps on cancer treatments is better? >> well, i don't know that that's what he was referring to. >> he said it would be better. if we, in fact, took away -- if we went to high-risk tools instead of covering people with pre-existing conditions or if we stopped the other coverage we have now, i'm just wondering if you define that as better. >> you'd have to give me a specific -- >> well, let me -- >> what may be better for you may not be better for me or anyone else. that's the important thing i'm trying to get across. is patients need to be at the center of this, not government. should government be deciding these things or should patients be deciding these things? >> prior to the affordable care act, about 70% of the private plans that a woman could purchase in the marketplace did

not cover basic maternity care. do you think that that's better, not to cover basic maternity care? >> i presume that she wouldn't purchase that coverage if she needed it then. >> she would have to pay more, just as in general for many women, just being a woman with a pre-existing condition. that is the reason why we have a basic set of services covered under health care. it's 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's pretty basic. for over half the population who are women, maternity care ought to be covered. let me go to another one. do you believe mental health services should be a guaranteed benefit in all health insurance plans? >> i've been a supporter of mental health inclusion, yes.

>> so, mental health should be a defined benefit under health insurance plans? >> i think mental health illnesses ought to be treated on the same model as other physical ill pss. %-p lot of discussion, and i have to say also with the nominee for office management and budget also talking today about medicare and social security, i personally believe people on medicare should be very worried right now in terms of what overall we're hearing. but i did want -- my time is up. i did want just to indicate a message from my mom who's 98 years old who said she doesn't want more choices. she just wants to be able to see her doctor and get the medical care that she needs. is not at all supportive of the idea of medicare in some way being changed into premium support into a voucher. so, i'm conveying to you somebody who's getting great

care right now and she's not interested in more choices. she just wants to keep her care. thank you. >> chairman, i would just convey to medicare population in this nation that they don't have reason to be concerned. we look forward to assisting them and gaining the care and coverage they need. >> thank you. >> senator cantwell. >> thank you, mr. chairman. congressman price, sorry we haven't had a chance to talk. >> i apologize. >> no, i think both have tried and it's been a myriad of consequences. >> weather. >> 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 the rise in medicaid cost? what is it due to? >> i think it's multifactorial. we have a system that has many, many controls that are providing greater costs to the provision of the care, that is -- that's being provided. i think that oftentimes we're not identifying the best

practices in the medicaid system, so that patients move through the system in a way that's 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 that are the outliers on the high side, where they -- where the resources spent to be able to provide their care is significant. and if you focus on those individuals, then you oftentimes -- specifically, then you oftentimes can provide a higher level of care and a higher level of quality of care for those folks and a more responsive care for those folks at a lower cost and move them down into the mainstream of the bell curve. >> okay. well, you brought up a couple of interesting points. and i want to follow up on that.

specifically, if i started that conversation, i would start with two big fa nphenomenons. if you're living 10 or 15 years longer than in the past, they're going to consume more health care. second, the baby boomer population 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're saying that you want to cap and control the cost. and what we've already established in the affordable care act are those things that are best practice incentives and ways to give the medicaid population leverage in getting affordable health care. i want to understand if you are for these things. for example, we provided

resources in the affordable care act for -- to rebalance off of -- for medicaid patients off of nursing home carrion to community-based care. why? because it's more affordable. do you support that rebalancing effort? >> i would respectfully, senator, take issue with your description of war on medicaid. we want to make sure medicaid population is able to receive the highest possible care. i've cared for thousands of medicaid patients. the last thing we want is to decrease the quality of care they have access to. clearly, the system isn't working right now. moving towards home-based care is something that is -- that is -- if it's right for the patient, it's a wonderful thing to be able to do. we ought to incentivize that. there are so many things we could do in medicaid that what provide greater quality of care that we don't incentivize right now. >> we did incentivize it in the affordable care act in your state and about other 20 states

actually did it. they took the money from the affordable care act, in fact, georgia received $57 million in transition to make sure medicaid beneficiaries got care in community-based care. it's been able to shift 10% of their long-term costs, basically, to that community-based care. so, huge savings. it's working. so, are you for repealing that part of the affordable care act? >> what i'm for is making certain, again, the medicaid population has access to the highest care possible. we'll do everything to improve that. so many in the medicaid population don't have access to the highest quality care. >> i would hope you would look at this model, and also look at the basic health plan model which is, again, what i think you're proposing and what the administration is refusing to refute, when the president said, i'm going to protect these things and my colleague, senator sanders brought this up and said, are you going to protect this and the white house chief of staff is now saying, no, no, we're basically going to cap medicaid spending. it's a problem.

what we want to do is we want to give them leverage in the marketplace. that's what the basic health plan does. that's what the community-based care plan does. it gives them the ability to get more affordable care at better outcomes and 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. >> be happy to. >> thank you. >> thank you, senator. that would end our first round. i'd like to not go through a full second round. but we've got some additional senators here who would like to ask some more, so i guess we'll start with senator wyden. >> thank you, mr. chairman. congressman, i have several ideas on -- >> we're going to break away from the hearing momentarily to assess what we've just heard. an important hearing before the senate finance committee. the confirmation process for

dr. tom price. the congressman who has been nominated to become the next secretary of health and human services. it's already three hours, jake, they've been hearing the testimony. the confirmation process going forward. a lot of democrats are deeply concerned about this nomination. >> they are. and they've been really trying to press for specifics in terms of what exactly will be the bill, the legislation that replaces obamacare after republicans repeal it. even just basic opinions. kellyanne conway, president trump's top adviser, has said publicly that they are going to take medicaid and make it a block grant program, meaning the money instead of going from the federal government to individuals will go to states. states will decide how to mete out that money. and congressman price wouldn't even offer an opinion. senator claire mccaskill, democrat of missouri, was just asking, are you in favor of block granting medicaid, and he

wouldn't answer the question. being somebody who interviews people, as are you, wolf, you can sympathize with the senator trying to get a basic answer to the question. are you in favor of this step that president trump's top adviser, one of them, has said is going to happen. given this is something that will affect millions of americans, i certainly think it's relevant. but the goal for a lot of these hearings is to avoid delving into any sort of specific. even one as cogent as this. >> the other argument a lot of democrats especially senator ron wyden of oregon, that there are ethical issues he has not adequately addressed. >> that's true. whether or not he's bought stock through a broker in companies that -- that he regulates in one way or another, or performs any sort of oversight over.