surveyed, for you, miss maxwell. >> few hospitals said they passed the 340b discount back to the uninsured patient. these are the ones that it's not blue cross, the uninsured patient who can hardly afford their medicine, the personal insulin, filling prescriptions at the hospital's contract pharmacy, in the -- given in the intervening three years no new guidance or regulation with the goal that the patients are the true beneficiaries of the program has been issued do you have any reason to believe that hospitals have begun to pass these savings back to the uninsured? >> we worked closely with hrsa and let them know about these situations so they were able to address them as they thought appropriate. i don't know whether hrsa did, in fact, reach out and talk to these hospitals about their current policies. >> so you have no indication either way that hospitals have begun to pass them back to the uninsured or they have not? >> that's correct. >> okay. i yield back. thank you. >> senator smith. >> thank you, chair alexander, and ranking member murray and our test fiers today and i want to just start

few hospitals said they passed the 340b discounts back to the uninsured patient. these are the ones that, it is not blue cross. it is the uninsured patient that can hardly afford their personal info -- medication, frank zappa. the contract pharmacy, given that we interviewed them for three years, no new guidance or regulation, with the goal that the patients are the true beneficiaries of the program has been issued. do you have any reason to believe that hospitals have begun to pass the savings back to the uninsured? >> we work closely with hersa and let them know about the situations. so, they were able to address them as they found appropriate. i don't know whether hersa did reach out and talk to these hospitals and out their current policies. >> so, you have no indication either way that hospitals have began to pass it back to the uninsured, or that they have not? >> that is correct. >> i yield back to you. >> thank you, senator cassidy. senator smith eric >> thank you chair alexander and ranking member mary. and, to ever testify yesterday. i wanted to start by

hospital for the uninsured and often interfaced with my colleagues who are in emergency room at some understaffed critical access hospital but so understaffed they frankly had to send all their patients to the hospital where i worked. so a lot of what i'll say now will reflect that perspective. let me first go here. i'm interested in the medicare wage index and which hospitals with a higher cost structure get more. if you will, the more get more. now it seems as if under current law, you're bationed upon your geographic area, rural hospitals in my state cannot compete with the urban hospital because medicare policy which tells the urban hospital, we're going to give you more. and so obviously if you're a nurse and have to decide where to work, you can go where you would earn more. the cost of wages, current policy does not have a floor or ceiling in place for an adjustment in which the cost of wages is considerably reimbursing providers so as i said, urban hospitals get more, rural less. i could ask many of you this question but dr. pink, does a lack of a ceiling or floor for the medicare wage index frankly give a perverse incentive for the urban hospitals to keep increasing wages to

the administration's proposal would change requirements for title ten... which provides family planning services for millions of uninsured and under-insured people. becerra says the president is playing politics with patients the department of health and human services says it will not comment on pending litigation. ( james ) san francisco mayor mark farrell is looking to add 250 more officers to the police force. we first told you this story yesterday morning. but now the mayor has officially announced his budget proposal. mayor farrell is investing 34- million dollars in public safety. the interim mayor says the passage of this budget will cement his legacy as a san francisco public servant ( james ) in the east bay... a federal judge has struck down the city of oakland's ban on coal shipments through its port.. this is a major setback for city leaders... who argued the coal operations are unsafe and unhealthy. but the judge ruled that there's not enough evidence to support that claim. the judge also said the city made mistakes in its report -- including the claim that tons of coal dust would be blowing around. oakland mayor libby schaaf expressed her frustration with the judge's decision -- tweeting the

hospital for the uninsured and often interfaced with my colleagues who are in emergency room with understaffed critical access hospital but so understaffed that frankly they had to send their patients to the hospital where i worked. a lot of what i will say now reflects that perspective. let me first go here. i'm interested in the medicare wage index. hospitals at the higher cost structure get more and if you will the more get more. it seems as if under current law you are based upon your geographic area rural hospitals in my state cannot compete with the urban hospital because of medicare policy which tells them urban hospital we will give you more. if you are a nurse you will offer -- you tend to go where you go more. the current policy does not have a floor or ceiling in place for an adjustment in which the cost of wages is comparable when reimbursing providers and so, as i just said, urban hospitals get more rural less. i guess i can ask many of you this question. doctor, does the lack of a medicare wage index frankly give up perverse incentive for the urban hospitals to keep increasing wages and to make it harder for a rural hospital in louisiana or iowa or tennessee to compet

the community where my service area is. i think in colorado overall. we had an uninsured rate of nearly 20% and that has been reduced in my community to low single digits. the coverage for patients and allowing patients to get access for care has improved the bottom line. 70% of our population is medicare and medicaid. our relationship with government payers is critical to our survival. >> did you say 70? >> 70. >> hours is up there as well. over 50. i don't think people quite understand that that is the challenge we face. we love our rural economy and communities. they are a great place for people who are aging to retire and live and it is more affordable. but that is a different mix of the population as it relates to how you build a healthcare delivery system. the medicaid expansion is so critical to that. i also wanted to ask about telemedicine. that is another delivery system for us. we have this project echo at the university of washington. you probably heard it in your state as well. it has allowed medical professionals from seattle to consult with people in the yakima basin. some of our clinics to talk about the decisions for highly complex patients for hepatitis c and su

administration sabotaged the health care system in many ways driving up premiums and recent studies show millions more people are becoming uninsured. i'm concerned that now in another attack on patient health care hhs is proposing to expand the sale of short-term junk plans that allow insurance companies to deny coverage to people with pre-existing conditions and excludes essential health care benefits like cancer treatment or maternity care. many of the junk plans spend as little as 50 cents of every premium dollar they collect on actual medical care spending the rest on executive compensation marketing and overhead. federal protections ensure that no one can be denied coverage or charged more based on their health status i want to be very clear figure proposed rule undermines those critical protections. do you agree that the short-term plan are allowed to deny coverage for individuals with pre-existing conditions or charge them higher premiums or exclude critical benefits? >> senator we share the goal. we want people have access to competitive and affordable health care insurance. the affordable health care program is not blithering on that you want to work with you and changes to

the price, we'd have nothing to bargain with and we would have -- >> although, len, when you do that you're not looking for affordable for all patients. you're looking for affordability of patients who are insured. those uninsuredl pay a higher rate. >> i can tell you like we will make our drug available on a needs basis. that really isn't the issue, becky. because the issue is when you do have insurance and you can't afford it. because people who have to have these high copays, you walk into the drugstore or you get your notice from express scripts and say, my god, $500 how do i afford that. we wanted both affordability and access and we have to have something to bargain with or many insurance companies, maybe not enlightened like express scripts. but others might say thanks for the low price but we're still going to require a 30-page form for doctors to get the drug and have a massively high copay. so we needed a bargaining chip >> because the insurers and express scripts, do you deal with the bigger rebate. >> the trouble has been this and len talked about this. with high deductible health plans, too many times people actually experience the actual price of the drug. and so if you're in that high deductible