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Senators Question Rep. Tom Price in Hearing for Secretary of Health & Human Services. Aired 11-11:30a ET

Aired January 18, 2017 - 11:00   ET



SEN. MICHAEL ENZI (R), WYOMING: But when you have a rural community, a rural county that big with that small of a town, it's difficult to keep a doctor without at least a P.A. there, the hospital has to close. And if that hospital closes, emergency care is 80 miles away.

Not a likely story in most of the places and -- and we need to make sure that those things are covered. And I've appreciated getting to share those with you over -- over the period of time.

I -- I was always curious as to why you left a very successful practice and were willing to come back here and try to make a difference. And I -- I want to congratulate you on the different that you have made.

Now, one of the questions I'd ask you is why are you willing to leave a place with so much responsibility and background and capability to be willing to be the secretary of Health and Human Services?


I -- it's -- when I think about the -- the mission of the Department of Health and Human Services, which is to improve the health, safety and wellbeing of the American people, it's what I've literally spent my whole life trying to do. And so to have the opportunity to -- to participate, if confirmed, to -- to be -- serve as the secretary of Health and Human Services and try to guide that -- that organization in a direction that would further fulfill that mission, I can't think of anything more exciting or fulfilling.

ENZI: Well -- and I think you have the background for doing that too, with the wide range of experience you had between the different practices and hospitals and then coming here and going through a number of different committee situations.

But what you're about to go through is rather intense, and then that's followed by probably the most productive part, if senators happen to read the answers. And that's when we get to do written questions as well, which we hope you'll provide a rapid response on. But those aren't nearly as much fun for the panelists because they aren't in public. I'll move to some questions that are a little bit more related here because we begin the serious and challenging task of restoring these health insurance markets, which are teetering on the brink now. Some are collapsing. Some counties you can't get coverage. In Wyoming, there's only one -- one provider. And it's my understanding that the incoming administration may have the ability to make some key policy changes immediately.

Some of the most critical changes for short-term stabilization of the markets might include reducing the number of special enrollment periods and requiring up-front verification, or aligning grace periods for nonpayment of premiums with state law. My understanding from those in the insurance business is that some targeted actions by the Department of Health and Human Services may provide some meaningful changes that could impact premiums for the next year.

Are those some options that you might consider?

PRICE: Absolutely. The insurers, as I think the chairman mentioned, are deciding right now, as they come forward in March and April, what the premium levels will be for 2018, calendar year 2018. What they need to hear from all of us, I believe, is a -- is a level of support and stability in the market, the kinds of things that make it so that they're able to provide product to -- to patients out there.

You mentioned that -- that there are counties in your state where there's only one provider. There are five states in this nation where there's only one insurance provider, there are -- one-third of the counties in this country only have one insurance provider.

We must, as a -- as policy makers and as folks administering these programs, we must ask ourselves, what's going on? Where are the problems out there? That -- that may work for -- for the insurers in certain instances, it may work for government but it doesn't work for patients. And so when -- if we keep the patients at the center of all of this, we'll get to the right answer and that's what I hope to do with each and every one of you.

ENZI: I appreciate that and I got to work for years with Senator Kennedy on biologics and biosimilars and having the requirements for their biosimilarity and their changeability as -- as needed, some additional information the FDA has issued guidance documents since the law passed. But they haven't set policy on interchangeability with the reference product.

I was concerned that in 2017, having gone through nearly two full presidential terms, that just yesterday, we finally got a draft of the FDA's interchangeability policy.


I'll ask that question since my time is expired in -- in writing. Thank you.

PRICE: Thank you very much, Senator.

SEN. LAMAR ALEXANDER (R), TENNESSEE: Thank you, Senator Enzi.

Senator Sanders?

SEN. BERNIE SANDERS (I), VERMONT: Thank you, Mr. Chairman.

And Congressman Price, thanks for being here and thanks for the conversation we had the other day.

PRICE: Thank you.

SANDERS: Congressman, on May 7th, 2015 -- let me begin by saying all of us know that we have come through a very unusual election process. President-elect Trump received almost 3 million votes less than Secretary Clinton, but he won the electoral college. He's going to be inaugurated this week. He won a number of states by rather slim margins.

During the course of his campaign, Mr. Trump said over and over again that he would not cut Social Security; not cut Medicare; not cut Medicaid. Let me read some quotes. On May 7th, 2015, Mr. Trump tweeted, "I was the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare and Medicaid." On April 18th, 2015, he said, quote, "Every Republican wants to do a big number on Social Security. They want to do it on Medicare. They want to do it on Medicaid. And we can't do that and it's not fair to the people that have been paying in for years, and now all of a sudden they want to be cut," end of quote.

August 10th, 2015, Mr. Trump said, quote, "I will save Medicare, Medicaid and Social Security without cuts. We have to do it. People have been paying in for years and now many of these candidates want to cut it," end quote. March 29th, 2016, Trump said, "You know, Paul Ryan wants to knock out Social Security, knock it down, way down. He wants to knock Medicare way down. And frankly -- well, two things. Number one, you're going to lose the election if you're going to do that. I'm not going to cut it and I'm not going to raise ages. And I'm not going to do all of the things they want to do. But they want to really cut, and they want to cut it very substantially -- the Republicans -- and I'm not going to do that."

On and on and on. Point being, this is not something he said in passing. I think it is likely he won the election because millions of working-class people and senior citizens heard him say he was not going to cut Social Security, Medicare and Medicaid.

Congressman Price, a very simple question: Is the president- elect, Mr. Trump, going to keep his word to the American people and not cut Social Security, Medicare and Medicaid? Or did he lie to the American people?

PRICE: I have -- I haven't had extensive discussions with him about the comments that he made, but I have no reasons to believe that he's changed his position. SANDERS: All right. So you are telling us that to the best of your knowledge, Mr. Trump will not cut Social Security, Medicare and Medicaid?

PRICE: As I say, I have no reason to believe that that position has changed.

SANDERS: Congressman Price, quoting Mr. Trump again, or at least paraphrasing him, just last week he said, roughly speaking, pharma is getting away with murder. Do you recall that tweet?

PRICE: I do.

SANDERS: OK. There are many of us on this side of the aisle who are working on legislation that would do at least two things. Number one, end the absurdity of the American people being ripped off by the pharmaceutical industry, who two years ago made -- the top five companies made $50 billion in profits, while one out of five Americans can't afford to fill the prescriptions their doctors write.

Will you and will the president-elect join us in legislation we are working on which, number one, will allow Medicare to negotiate prices with the drug companies and lower prices; and number two, allow the American people to bring in less expensive medicine from Canada and other countries? Is that something you will work with us on?

PRICE: The issue of drug pricing and drug costs is one of great concern to all Americans. I think it's important to appreciate that in a couple of areas we've had significant success, whether it's in the generic area, where costs are significantly less than they have been, and in part...

SANDERS: But you are aware, sir -- I don't mean to interrupt -- we don't have a lot of time. We are paying by far the highest prices in the world for prescription drugs. You don't disagree with that, do you?

PRICE: And -- and...

SANDERS: Do you disagree with that?

PRICE: I think that's the case. I'd have to look at the statistics. I think there are a lot of reasons for that. And if we get to the root cause of what that is, then I think we can actually solve it with bipartisan...


SANDERS: Well, one of the root causes is that every other major country on earth negotiates drug prices with the pharmaceutical industry. In our country, the drug companies can raise their prices. Today, they can double their prices. There is no law to prevent them from doing that.

Will you work with us so that Medicare negotiates prices with the pharmaceutical industry?


PRICE: You have my commitment to work with you and others to make certain that the drug pricing is reasonable and that individuals across this land have access to the medications that they need. SANDERS: That wasn't quite the answer to the question that I asked.

Congressman Price, the United States of America is the only major country on earth that does not guarantee health care to all people as a right. Canada does it. Every major country in Europe does it. Do you believe that health care is a right of all Americans whether they're rich or they're poor? Should people because they are Americans be able to go to the doctor when they need to? Be able to go into a hospital because they're Americans?

PRICE: Yes. We're a compassionate society.

SANDERS: No, we are not a compassionate society. In terms of our relationship to poor and working people, our record is worse than virtually any other country on earth. We have the highest rate of childhood poverty of any other major country on earth. And half of our senior -- older workers have nothing set aside for retirement.

So I don't think compared to other countries, we are particularly compassionate. But my question is -- in Canada, in other countries, all people have the right to get health care. Do you believe we should move in that direction?

PRICE: If you want to talk about other countries' health care systems, there are consequences to the decisions that they've made, just as there are consequences to the decisions that we've made. I believe and I look forward to working with you to make certain that every single American has access to the highest quality care and coverage that is possible.

SANDERS: "Has access to" does not mean that they are guaranteed health care. I have access to buying a $10 million home. I don't have the money to do that.

PRICE: And that's why we believe it's appropriate to put in place a system that gives every person the financial feasibility to be able to purchase the coverage that they want for themselves and for their family. Again, not what the government forces them to buy.

SANDERS: Yeah, but if they don't have any -- well, it's a long (inaudible). Thank you very much.

PRICE: Thank you.

ALEXANDER: Thank you, Senator Sanders.

Senator Hatch?

HATCH: Thank you, Mr. Chairman.

Welcome to the committee. We have -- having worked with you over the years, I've found you to be always very, very knowledgeable.

PRICE: Thank you.

SEN. ORRIN HATCH (R), UTAH: Very up front and very straightforward, very honest, and somebody who really understands the health care system of this country.

And you're just perfectly situated to be able to help turn it around and get it so it works. We hear a lot from our other side about how bad the system is and so forth. And I've got to tell you, I don't think it's very good myself. And we've got to work on it and get it done right.

But boy, I'd sure like to have you right there helping to get it done, because you're one of the really premier people in this whole Congress and in the world, as a matter of fact, understanding what needs to be done, and yet recognizing the problems of getting it done.

Now, Dr. Price, some of my colleagues have criticized you for your health-related stock holdings while serving in the House. Now, not only do House rules not prohibit members from trading stocks, but it is also not an uncommon practice for members of Congress. In fact, there are members on this committee who have, as I understand it, who have traded individual health stocks while serving on this committee.

This appears to be nothing more than a hypocritical attack on your good character. And I personally resent it because you have always disclosed. But let me -- let me just say this. Can you confirm that you have always followed the law relating to trading in stocks while serving as a member of Congress?

PRICE: Thank you, Sir. Everything that we have done has been above- board, transparent, ethical and legal. And as you know and the members of this committee know, there's an organization that's called the Office of Government Ethics that looks at all of -- all of -- for every Cabinet nominee, looks at all of the possessions, all the holdings and the like, and makes a recommendation as to what that Cabinet member must do in order to make certain that there's no conflict of interest.

The Office of Government Ethics has looked at our holdings and given advice about what would need to be done in terms of divesting from certain stock holdings, to make certain that there's no conflict of interest. We have read those and agreed to those, signed those. That document is online for everybody to see so that everybody is absolutely certain that there will be no conflict of interest whatsoever.

HATCH: Well, thank you. And you followed their advice.

PRICE: Absolutely.

HATCH: Well, Dr. Price, the collapse of Obamacare has exacerbated our nation's health care problems. Too frequently, my colleagues and I have seen European idealism strangle functional insurance design with cost-prohibitive measures. And despite these failed reforms, I don't think we can lose sight of the broader health system that is at risk.

For example, rare disease patients do not have access to life- saving treatments because policies that stem from Obamacare prevent investments in innovative therapies that can cure and save lives.


This is an issue that I'm deeply passionate about.

Dr. Price, what steps do you believe will improve the pipeline for rare disease therapies, to bring treatments and cures to patients in desperate need of hope?

PRICE: Well, the -- the Orphan Drug Act which passed, I think, 30 years ago or so, was -- was really...

HATCH: It was my first bill, by the way.

PRICE: And it really has revolutionized the ability to treat rare diseases and -- and what it did is make the United States the leader in -- in -- in coming forward with treatments for rare diseases.

And -- and I think that there are things that we can do in terms of patent protection, in terms of liability, in terms of incentivization, resources to be able to encourage the -- the discovery of cures for rare diseases.

HATCH: We have a lot more drugs coming through and even some block buster drugs that came because of that little bill.


HATCH: We just put some incentives in -- in effect and all of a sudden, there's an explosion in orphan drugs for population groups of less than 200,000 people. It's a pretty important little bill.

PRICE: One of the successful...

HATCH: Takes (ph) an awful lot of money, but it was a Republican bill.

PRICE: Yes. One of the success stories truly for -- for public policy in the country.

HATCH: Right.

Now, Dr. Price, one of the -- one of the central duties of the HHS secretary is to be diligent and thoughtful when considering a federal regulation, if necessary, and accessing whether the regulations impede research, development and innovation. Over the years, the regulatory infrastructure guiding dietary supplements has changed dramatically.

Do you recognize the importance of dietary supplements and helping Americans reach and maintain healthy lifestyles?

PRICE: Absolutely. HATCH: And will you commit to me and -- and other members of the committee to work to insure appropriate regulation and implementation of the Dietary Supplement Health and Education Act, so that we can protect public health while assuring consumers continue to access -- access safe products?

PRICE: This is one of those areas where it's incredibly important to gain the information that -- that you referred to, to gather the individuals that know the most about this area, whether it's consumers, whether it's those providing the -- the product to market, make certain that there aren't -- that there's protections for (inaudible) products. But it's absolutely vital that we get this right.

HATCH: Well, I'll tell you this. I have to commend Donald Trump for picking you.

PRICE: Thank you.

HATCH: You're clearly one of the premier people in all of Congress who understands the problems of health care and you have the professional background that I -- I don't know any other member of Congress can match to help solve the problems that we have. We've got a real messy situation here and Obamacare has not really helped.

Do you think Obamacare has helped?

PRICE: I think some of the things that have occurred with -- with the passage of the ACA have improved certain areas. The -- the coverage is -- is certainly improved, but the consequences of that, I mean, that many people as I mentioned before have coverage, but they don't have care. So there's so many things about just the decision making process. Who decides about our health care? Should it be the federal government or should it be patients and families and doctors? And -- and we certainly believe the latter as opposed to the former.

HATCH: I take it that you believe that getting health care closer to the people is a far better thing than everybody pontificating from Washington, D.C.?

PRICE: I think the -- the -- the more involvement that patients and families and doctors can have in medical decisions, the higher quality care we'll have.

HATCH: In my earlier life, I was -- one of the things I did was -- was a medical liability defense lawyer, defending doctors, hospitals, nurses, health care providers, et cetera. What do you think we should do about medical liability?

PRICE: This is a -- a really difficult challenge because it's not just the malpractice rates that -- that doctors or hospitals pay, but it's the practice of defensive medicine which are the things that physicians do that don't hurt anybody, but their tests and procedures and examinations that aren't necessarily needed to either make a diagnosis or to -- to treat...

HATCH: To show up in their history.

PRICE: It -- but it shows up in their history, so if they're called into a court of law they can say to the judge and the jury, I don't know what you wanted me to do because I did everything, when in fact, everything is rarely necessary to either treat or diagnose the patient.

So if we look it in that light and try to focus on decreasing the practice of defensive medicine to the benefit of patients, then I think we can get to the right answer, and there's some exciting opportunities out there that have been bipartisan in the past.

HATCH: Well, thank you sir. I think you're a great nomination.

PRICE: Thank you.

ALEXANDER: Thank you, Senator Hatch.

Senator Casey.

SEN. BOB CASEY (D), PENNSYLVANIA: Thank you, Mr. Chairman.

Representative Price, we're grateful you're here and thanks for the visit to our office.

PRICE: Thank you.

CASEY: And I wanted to -- to highlight something we probably don't spend enough time highlighting or talking about, and that's the -- the full protections of the -- what was known as the original bill, the Patient Protection and Affordable Care Act.


We've got a lot of shorthand terminology since then.

And I know you and I have a basic disagreement, I think it's important to be candid about that. But I think what a lot of people have forgotten about is that -- and the chairman had a chart earlier that outlined the categories of Americans that have health insurance by virtue of various programs or I think the number he had on the poster about the number of Americans in the employer sponsored coverage category, I think was 178 million people.

That's a lot of folks with coverage who had coverage before -- most of them I guess would have had coverage before the legislation and after, meaning they were paying their premiums and had coverage, but they didn't have protections that only came with the passage of the legislation. We know that -- that -- that somewhere between 11 and 12 million people have purchased health insurance through the individual market place.

And so, I wanted to ask you a couple of questions about those basic protections that are now law that were not law before. I think you'd agree with me, and you know from your practice, that you meet just remarkably inspiring people in your work, and once in a while, here in the Senate, we do as well, probably don't take enough time to have those opportunities. But one of the people I met in the lead-up to the legislation passing was Stacy Ritter. She was from Manheim, Pennsylvania. She didn't have a personal challenge, it was the challenge faced by her two daughters. They were four years old, Madeline and Hannah and as she said, as Stacy said about her daughters, she said that they would be, at that time, before the passage of the bill, punished and rejected because they had the misfortune of developing cancer as a child. And her basic problem was the caps on -- on treatment.

So the first question I'd ask you in terms of your work as secretary of Health and Human Services, should you be confirmed, would be will you commit to maintaining the protections that ensure that no child, no child is denied insurance coverage because of pre-existing conditions?

PRICE: Well, I think that -- pediatric cancer is one of those things that is remarkably challenging. I remember when I was in my residency and did a rotation on the pediatric orthopedic ward and so many of those children had cancer. And I -- I -- before I began that rotation, I almost dreaded going to -- to that month because I was worried about just the -- the -- the severity of the challenges that I would meet.

I tell you, it was one of the most uplifting months I spent in medical school and that was because the children were so uplifting. And -- and so absolutely, we need to make certain that every single child has access to the kind of coverage that they need and the care that they need and there are a number of ways to do that. And I look forward to working with you to make that happen.

CASEY: I heard the word yes there.

Secondly, and this is -- it's really hard to believe that we even have to ask a question about this next topic, which is victims of domestic violence. It was the state of the law prior to the passage of legislation that victims of domestic violence were considered Americans who had a pre-existing condition. It's still the law in some states that they are not protected. So question number two is, will you commit to maintaining the protections that ensure that victims of domestic violence will not be discriminated against when purchasing health insurance, yes or no?

PRICE: Yeah, I think it's absolutely vital that victims of domestic violence and -- and others -- anybody -- we need a system in place that insures that individuals are either not priced out of the market because they get a bad diagnosis are not eligible or able to purchase coverage that works for them because of their diagnosis.

CASEY: I have limited time, I want to interrupt. I don't want to get hung up on getting priced out of the market. What I'm asking for is an ironclad guarantee that that circumstance, that horrific circumstance will never be a bar to coverage, treatment or care?

PRICE: Well, it certainly shouldn't be. And as you well know, as -- as if -- if I'm fortunate to be confirmed, that's an administrative role and it's a policy decision that -- that the legislators would...

CASEY: Well, I think we can -- I think we can agree on that.

Number three, will you maintain to committing the protections that prohibits discrimination in health insurance on the basis of health status or disability, yes or no?

PRICE: I -- I -- I -- again, I think it's absolutely imperative that we have a system in place that works for patients. And anybody not being able to gain access to the coverage that they want or -- or -- or need is -- is not a system that works for patients.


CASEY: And -- and I'll follow up with -- with more questions. What I'm getting at here is that we've -- we had a state of the law before passage of the ACA where individuals like that, whether they happen to have a child had a preexisting condition, even if their parents are paying premiums for years, an insurance company could literally say sorry, you have a preexisting condition or your child, so you can't get coverage.

Women were discriminated against because they were women. Just a remarkable stain on America that we allowed that to happen. My concern, though, now is not just a -- a series of concerns about what you've proposed as a member of the House and -- and what you could do as secretary, but I just heard earlier that the -- the three areas that will be of focus in whatever replacement plan there is, and I'm anxious to see it, would be -- and I wrote them down. I think secretary -- or Chairman Alexander wanted to take off the table, and that's a good thing, Medicare.

But I heard that there -- there'll be three targets, that's my word, of course; the individual market, Medicaid and employer- sponsored coverage. So I hope if employer-sponsored coverage is a subject of change, that we'll ensure those -- all those protections that are in place right now. And that's why I'm asking those questions, I'll follow up more in -- in writing.

Or if we get another round, Mr. Chairman, put me on record as incorporating by reference everything Ranking Member Murray said about questions in an additional round. Thank you.

PRICE: Thank you, Senator.

ALEXANDER: Thank you, Senator Casey, dually noted and I -- I appreciate your using your seven minutes to ask questions.


Senator Isakson has deferred to Senator Paul.

SEN. RAND PAUL (R), KENTUCKY: As a fellow physician and as a fellow physician who did some of my training at Grady, congratulations, and I wish everybody on the committee could come to Grady and see working there, see what's it like to work in one of our nations biggest charity hospitals, often doing work that is just incredible. Gunshot wounds, compound fractures of the femur, you name it.

And I remember being there as a student and then as an intern some, and we used to always calculate how many hours and divide by our income and say boy, we wish we could get minimum wage. But I think it is important that we get somebody with that kind of clear reasoning and critical skills, you know, to be in charge of our government, both knowing about the medical aspect as well as, you know, the public policy aspect. I think what I regret about this kind of hearing and sort of I think what a lot of people in America regret about it is sort of the -- the vitriol and the rancor and the partisanship that should go into something that we -- you know, we kind of all want the same things.

You know, and to question your motives ,I think, is insulting. To question whether you're honest is insulting. You know, the -- the whole question of you know -- and I guess this will be my first question to you. Did you go into public service to enrich yourself or for public service?

PRICE: I have a passion for -- for public service and a passion for people, and that what -- that's what guided our decision that -- that some might think was a foolish decision for both of us to...

PAUL: Did you take a pay cut to go into public service?

PRICE: I didn't -- I didn't consider the remuneration for -- for public service.

PAUL: Right. But I'm guessing it would've been a pay cut. The motives as to what we should do -- see I think we don't -- aren't separated that much on our motives. I think we all want the most amount of insurance for people at the least amount of cost. We want, you know, people to get access to health care.

What are your motives? You know, what are your goals? What should we do with the health care system? Do you want more people to be ensured? Do you want more people to have health care? Or do you think we disagree just on how we do it and not necessarily the motives?

PRICE: No, as I -- as I tried to lay out earlier and I know time is short for -- for everybody, but the -- the principles that I think are absolutely imperative for health care system is -- is one that's affordable for everybody, one that provides the access to health care and coverage for everybody, one is that -- that its of the highest quality, that is responsive to patients, system isn't any good if it's not responding to patients, one that incentivizes innovation because it's the innovation that -- that drives the high quality health care.

And then one that ensures choices are made and preserved by patients, so patients ought to be the ones choosing who's treating them, where, when and the like.

PAUL: You and us, by extension, Republicans by extension have been accused of having no replacement ideas, no ideas for how to fix the system.

Approximately how many bills do you have that would be -- could be regarded as replacement bills or ways to improve the -- the health insurance system and our health care?

PRICE: We've had one large-term bill since March or early 2009 and then beyond that, tens of pieces of legislation to address the health care issue.