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Inside Politics

Trump's HHS Pick Faces Senate; ObamaCare in Spotlight. Aired Noon-12:30p ET

Aired January 18, 2017 - 12:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

COLLINS: What I'm finding now is that CMS frequently does not pay for services that helps to keep people well. There is a large practice in my state that has a nurse or a medical assistant call individuals with diabetes once a week and check on their blood sugar levels, their adherence to their diets and exercise regimes.

[12:00:13]

And it's had really positive results.

Well, the irony is that if diabetes gets out of control and those individuals end up having to have amputations or go blind, CMS Medicare will pay for that, but it won't pay for that phone call to check on the individual that's helping to control their diabetes and keep them well.

Will you pledge to take a look at those kinds of policies and reevaluate what we do pay for?

PRICE: Absolutely. It's imperative that we're constantly looking and determining whether or not we're getting the outcomes that we want and the processes are either helping or obstructing those outcomes.

COLLINS: And finally, I want to touch on biomedical research, which is a passion of mine. I founded both the Diabetes Caucus in 1997 and I also am the founder of the Alzheimer's Task Force in the Senate, which Senator Warner is the co-chair of.

Alzheimer's has become our nation's most expensive disease. It costs society $263 billion a year; $150 billion of that comes from Medicare and Medicaid. It's going to bankrupt those programs. It's devastating to families and the victims of the disease. Diabetes consumes one out of three Medicare dollars.

If we invest in biomedical research, we have the possibility of not only improving lives for Americans and curing or coming up with effective treatments for devastating diseases, but also actually lowering health care costs. Do you support the increases for NIH that we have had in the last year and are on track to pass this year as well?

PRICE: Yes. NIH is a treasure for our country and the kinds of things that we should be doing to find cures for those diseases. One of the core avenues to be able to make that happen is through NIH and I supported the increase in dollars. COLLINS: Thank you. That goes along with your principle of innovation.

PRICE: Absolutely.

COLLINS: Thank you.

Thank you, Mr. Chairman.

ALEXANDER: We've been at this for about two hours. I'm going to take a -- I'm going to suspend the operation for about five minutes and then we'll go to Senator Whitehouse, just so we can take a little break.

The committee is recessed for five minutes.

WOLF BLITZER, CNN ANCHOR: All right. So they're taking a break in this hearing. The U.S. Senate Committee on health, education, labor, and pensions. They've been questioning Tom Price who has been nominated to become the next secretary of Health and Human Services. The Democrats, Jake, they really came forward with some serious important tough questions about his business deals, if you will, purchasing some stocks that they allege were inappropriate.

JAKE TAPPER, CNN ANCHOR: That's right. Especially Senator Al Franken very pointedly suggesting that he didn't believe some of the things that Congressman Price was claiming about what he knew and when he knew it in terms of the purchase of his stocks. Tom Price very firmly saying that everything he has ever done when it relates to stocks has been disclosed and transparent. Nothing inappropriate happened.

There are obviously also quite a few questions about ObamaCare and the future of ObamaCare. What might happen if ObamaCare is ultimately repealed? What might replace it? What would happen to the individuals who have health insurance because of ObamaCare? And you also heard from Senator Bernie Sanders and it happens, this has been something Bernie Sanders has been trying to do for the last few weeks, to get Tom Price on the record backing up the comments that Donald Trump made during the -- his campaign for presidency in which Donald Trump repeatedly said he did not want any cuts to Medicare, any cuts to social security, trying to get Tom Price to promise that he would abide by those pledges.

BLITZER: Let me play the exchange. This is Senator Bernie Sanders questioning Tom Price.

(BEGIN VIDEO CLIP)

SEN. BERNIE SANDERS, (D) VERMONT: In Canada, in other countries, all people have the right to get healthcare. Do you believe we should move in that direction?

PRICE: If you want to talk about other countries' healthcare systems, there are consequences to the decisions that they've made just as there are consequences to the decision 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. [12:05:06] SANDERS: Has access to does not mean that they are guaranteed healthcare. I have access to buying a $10 million home. I don't have the money to do that.

(END VIDEO CLIP)

BLITZER: That was an important exchange yet. And Bernie Sanders has been extremely consistent on this point going back to when he was obviously running for the Democratic presidential nomination.

TAPPER: And we should point out that Congressman Price's response to Bernie sanders when he said access to, I have access to buy a $10 million house but I don't have the money to do it, Congressman Price did say that it was the position of the Trump transition team and the soon to be Trump administration to provide means for those who cannot afford insurance. Now, what the details are of such a promise we don't know. We have yet to see any sort of replacement, but that was a principle articulated by Congressman Price.

BLITZER: So Sanjay Gupta, you are a physician just like -- Dr. Price is a physician. In fact, you worked at the same hospital where he was an orthopedic surgeon. What was your immediate impression listening to the exchanges not just from the Republicans but the Democrats as well?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, you know, Tom Price is somebody who's put out a plan as you pointed out, almost every year since the Affordable Care Act was put into place. We didn't hear a lot of those specific details, though. I thought that was a little bit surprising. There are couple of areas that I think they drilled down on. And one was I think very interesting. It may go under the radar a little bit, but, again, with Senator Sanders saying specifically, will you allow an organization like Medicare to negotiate prices for drugs?

It's a huge point. It's a huge point because right now they cannot negotiate prices for drugs. They are some of the biggest cost to our healthcare system. And many times what that particular issue as with other issues, there wasn't a straight response to this. I still don't know having listened for the last couple of hours exactly how he feels about that. I know what he has said in the past. I don't know what he is saying now, and I don't know how it translates going forward. So there were certain issues like that.

Also, with regard to the continuity of coverage saying, look, if you keep your healthcare coverage for 18 months prior, you will not be discriminated against based on a preexisting condition. But he also lumps that in with high risk pools. Something we talked about before the hearing started. High risk pools are difficult to administer. They're not great benefits for those who have chronic illness. I've seen that. It's very difficult for those patients who come in continuously with that sort of coverage for get good healthcare.

TAPPER: One of the things that's interesting is this -- we see this with a lot of the confirmation hearings is President-elect Trump articulating something and the cabinet nominees saying something that is more closely to conventional wisdom in Washington, for better or for worse. One of those dynamics has to do with the support for the pharmaceutical industry in this country. Pharmaceutical industry wields a lot of influence in this building behind me in Capitol Hill because of campaign donations, because of the good they do. Many different reasons. Donald Trump has been out there saying tough things about the pharmaceutical --

GUPTA: They're getting away with murder.

TAPPER: They're getting away with murder. And it's going to be interesting to see his words and how much they actually become policy among his cabinet officials.

BLITZER: And you heard Bernie Sanders saying the five largest pharmaceutical companies merged with a $50 billion profit at a time when a lot of poor people can't even afford to get a prescription.

GUPTA: Yeah. We (inaudible) 20 percent can't even afford to get some prescriptions. And (inaudible) we're talking before the break that the relationship between physicians for its pharmaceutical companies versus physicians towards insurance companies. Insurance companies are sort of like -- they're a third party interferer much in the way that the government is, according to what Tom Price is describing. And many physicians, pharmaceuticals, device makers, there's a cozier relationship.

BLITZER; The chairman, Lamar Alexander has just resumed the hearing. Let's go back to it.

SEN. SHELDON WHITEHOUSE, (D) RHODE ISLAND: And then at this time 2016 after the ACA was in place, they took a look at the actual experience up to that point, and then they did a new projection going forward based on the Affordable Care Act. And just in the following t10 years, this green period from 2016 to 2026, they're forecasting $2.9 trillion in federal healthcare savings that relate back to the Affordable Care Act. This is where that came in.

So, we throw this thing out at our peril if you care about saving Medicare, the savings to which are a significant part of this $2.9 trillion, and we throw it out right now according to the Republican plan with nothing to replace it. I've described that over the weekend at home. It's like being asked to jump out of an airplane with no parachute, but being told trust we'll build you a parachute before you hit the ground.

[12:10:03] I'm the junior Senator to Jack Reed who was an Army ranger and actually did jumped out of perfectly well operating aircraft. He insisted not on just one parachute, but two, a spare. And I think the American people are entitled to know what they're going to be offered as an alternative.

There's been some conversation in this hearing about how there are Republican ideas floating around. I'm sure there are Republican ideas floating around, but there's no Republican bill. There is no Republican plan. There's no Republican proposal. Our cards are up on the table. It's Obamacare. You want to improve it? Make suggestions. We've always been open to that. But on the other side of the table, there's nothing. And it's really hard to negotiate with nothing.

And I think the Republicans have a responsibility to put a plan together.

Now, we talked about that, Mr. Price, when you and I met in my office. And my recollection of our conversation is that you told me that you would want to keep letting people stay on their parents' policies until they're 26. Is that true?

PRICE: I think that the insurance industry has -- has included individuals up to age 26 on their parents' polices virtually across the board and I don't see -- I don't see any reason that that would change.

WHITEHOUSE: And you would want to keep, you told me, the donut- hole closed to protect seniors against those pharmaceutical costs. Is that also true?

PRICE: I think the discussion we had was about pharmaceutical costs and making certain that we did all we could so that seniors were able to afford the kind of drugs that they need.

WHITEHOUSE: My recollection is it was more specific than that; that you did not want to reopen the donut hole for seniors. Are you saying now that you're going to consider reopening the donut hole for seniors?

PRICE: No, that's not what I'm saying at all. I think that it's important -- you know well that the reopening of the donut hole would be a legislative activity, not an administrative activity.

WHITEHOUSE: But you'll be the secretary of health and human services. You will doing a lot of work to prepare this legislation and to do the technical work behind it for the administration. Are you going to be proposing in that role something that reopens the donut hole? I've got a lot of seniors that who want to hear about that if that's your plan. PRICE: I'm not aware of any discussions to do that.

WHITEHOUSE: OK. And then finally, my recollection of that meeting, and my notes, are that you told me that you would not want to return to insurance company lifetime caps or insurance company denial of preexisting conditions or insurance companies going back and looking in the files for some little tiny discrepancy and then throwing somebody off their coverage when they come in with a significant claim.

Is that true?

PRICE: I think there are always ways that we can improve coverage, and those are the -- those are areas that are existent right now and I think they need to be -- the issues need to be continued.

WHITEHOUSE: So when, as and if we ever get a Republican counter- proposal to Obamacare, you would expect to see those things in it?

PRICE: I don't know whether they'd be in it or whether they would be silent on it. But again, that's a legislative question.

WHITEHOUSE: They'd leave it in place.

PRICE: But yes, it's a legislative question, not an administrative question.

WHITEHOUSE: Now, in one of your budgets, you had a proposal that would allow states to throw what you called "able-bodied people" off of Medicaid unless they were working or looking for work or in job training. People with addiction, behavioral health, mental health issues, are they able-bodied, in your definition?

PRICE: Well, we didn't -- we weren't as specific as what the definition was. The fact of the matter is...

WHITEHOUSE: You used the words. I'm asking you now what's your -- what did you mean when you said "able-bodied" in this provision?

PRICE: The fact is that there are many, many individuals who have worked in this space for a long, long time who believe that -- that providing for an opportunity for individuals who are able bodied without children, to seek or gain employment or to study to gain employment...

WHITEHOUSE: And what do you mean by "able-bodied" is the question. You just used that term again.

PRICE: And -- and that's what would be defined in the regulation itself. It's -- I don't know that...

WHITEHOUSE: You use the term without an idea of how you would define it?

PRICE: I think people have an understanding of what "able- bodied" is. And that's somebody who doesn't have the kinds of things that you -- that you described.

WHITEHOUSE: OK. That was the simple answer to my question -- "able- bodied" does not include people who have addiction, mental health and behavioral health issues.

PRICE: Again, it's the work that would be done to develop the regulation...

WHITEHOUSE: As you use the word. I'm not asking about in some future universe -- as you use that term in your budget.

PRICE: I think individuals that demonstrated that they were in fact having challenges that would preclude them from being able to seek work or employment or education or the like, that they ought to be attended to.

WHITEHOUSE: Now, I'm a fan of and think they do good work of the American Academy of Pediatrics. I'm a fan of and think they good work of the American Lung Association. And I'm a fan of and think they do good work of the American Public Health Association.

All of those groups and many others have gone very clearly on record that climate change presents significant health issues. They signed a declaration on climate change and health, which stated that the science is clear that this is happening.

You, on the other hand, have said that the carbon pollution standards of the Obama administration, quote, "go against all common sense and that there are errors and obfuscation in the allegedly settled science of global warming." I'll pursue this with you through questions for the record because my time has expired.

But if you could give a brief answer, because it appears to every scientific organization in the country, all the legitimate major ones, and to really every American university that this actually is pretty darn settled science. And that the only people who disagree with it are people who have vast financial interests in preventing any work getting done.

And it looks to me like in making this statement, you have taken the side of those vast special interests against actually settled science. And if we can't trust you on science that is as settled as climate science, how can we trust you on public health science issues where there's a big special interest on the other side?

PRICE: I don't agree with the premise or the insinuation. But I will say that the climate is obviously changing. It's continuously changing. The question from a scientific standpoint is what effect does human behavior and human activity have on that, and what we can do to mitigate that. And I believe that's a question that needs to be studied and evaluated and get the best minds available to make some (inaudible) right thing for public policy (inaudible).

(CROSSTALK)

WHITEHOUSE: Start by finding the university that thinks the way you do. One.

ALEXANDER: OK. We're running out of time.

Thank you, Senator Whitehouse.

Senator Young, I believe is next. I don't see him.

Senator Roberts?

ROBERTS: Well, thank you, Mr. Chairman. Thank you for holding this anger-management hearing.

(LAUGHTER)

I truly hope my colleagues feel better, at least for one day, after purging themselves of their concern, their frustration and their anger. I would like to note that I asked the technician here that is running the sound system -- the audio system is working. I thought maybe Senator Bennet didn't know that. And he reminded me of my Marine D.I. back in the good days, where the D.I. would shout, "I can't hear you." I just thought I'd bring that up -- the audio system is working. Take care of yourselves.

Dr. Price, congratulations on your nomination. Thank you for being here today.

PRICE: Thank you.

ROBERTS: As many of our colleagues have already noted, you will play a most important role, if confirmed, in helping to stabilize the individual market, while Congress does repeal the law and repair the damage it has caused and enacts the reforms we believe -- I believe will put our health care system back on track.

Now, in my home state of Kansas, we have three insurance carriers left. We feel very fortunate we have three, with each individual only have access to two of those. And our premiums rose this past year over 30 percent. Down the road, it's going to be more difficult if we don't do something.

There's no doubt with regard to uncertainty and angst among consumers, I think it's important to make clear that even if Congress and the incoming administration were to do nothing, let it go, just like it's frozen -- let it go, and amending or repealing parts of the Affordable Health Care Act, that the law is not working. And we have to do something to meet that obligation. The prices are unaffordable; markets nearly nonexistent, with few or no options in several states and counties. We're not as rural as Wyoming, but we are rural in my state of Kansas.

I have a -- I have a concern. Back in the day when we sat on this committee and (inaudible) the first version of the Affordable Health Care Act. I don't know where the mark is today. It's sitting on a shelf somewhere. But we went day and night and day and night and day and night. And I was worried about something I called the rationers.

ROBERTS: I'm talking about the Independent Payment Advisory Board, IPAB; the Centers for Medicare and Medicaid Innovation, CMMI. That's a wonderful acronym; and the new coverage authorities given to the U.S. Preventive Services Task Force. And I would also mention the Patient- Centered Outcomes Research Institute, which is called PCORI.

Not many people are aware of these. I even (ph) went to the floor of this Senate and had (ph) four people riding a horse and called them the four horses of regulatory apocalypse.

But I am worried about it and the provisions, which could interrupt the doctor/patient relationship, allowing the government to dictate what coverage you can receive.

Can you share some of any concerns that you have with regards to these what I would call four rationers, with all due respect of what they're trying to do with good intent?

PRICE: I appreciate that, Senator.

I think that it's imperative that as we -- as we move forward, that we recognize, again, that -- that the patient ought to be at the center of this, and anything that gets in the way of the patient and the -- and their families and physicians making the decisions about what kind of health care they desire, is a -- is a -- we ought not go down that road.

And so, for example, the CMMI, the Center for Medicare and Medicaid Innovation -- I'm a strong -- as I've mentioned, strong proponent and advocate for innovation. But I've seen in -- in certain instances what's coming out of CMMI is -- is a -- is a desire to require certain kinds of treatment for certain disease entities that may or may not be in the best interest of the patient.

And -- and because it carries the full force of the federal government and -- and the payment for those services, it means that -- that we're answering the question of who decides about what kind of care patients receive by saying that the answer to that ought to be Washington, D.C. And I simply reject that that's where those decisions ought to be made.

ROBERTS: I appreciate that answer.

I have the privilege of being a member of this committee, the Finance Committee, and especially being chairman of the always powerful Senate Agriculture Committee. I am particularly interested in HHS, and more importantly, the FDA's work on food and nutrition policy.

During the previous administration, the FDA issued numerous regulations with limited or delayed guidance and unrealistic compliance dates. This was the case with the implementation of the Food Safety Modernization Act, called FSMA. And more recently, with the nutrition facts panel revision.

I know we all share the goal of the safe -- safe food supply and availability of accurate information for consumers. But I'm concerned the administration has not clearly or consistently communicated with the food and agriculture industry regarding new or changing requirements.

Will you commit to working with the secretary of agriculture and other relevant agencies, not to mention the committee I serve on and similar in the House, that your department is issuing science-based guidance and taking into -- taking into consideration other regulatory burdens when establishing compliance (inaudible) other regulatory actions?

PRICE: Yes, I believe that's not only imperative, but the science that's relied upon ought to be transparent and available to the public so that people can see exactly what was the basis for the decisions that were being made.

ROBERTS: Under the previous administration, we have seen increased activity and regulatory action on nutrition policies, such as issuing voluntary guidance. Yet the same administration continued to request additional resources from Congress to comply for the statutory requirements under the Food Safety Modernization Act.

I'm concerned that the administration did not prioritize FDA's mission to protect our nation's food supply, instead focusing on nutrition policies.

If confirmed, can you discuss how you will focus on the core FDA duties, such as implementing the law the Congress passed, rather than agenda-driven nutrition policy guidelines?

PRICE: Yeah, this is really important, Senator. And if I'm given -- if I'm confirmed and given the privilege of leading, I would work specifically with the FDA commissioner to make certain that we are relying on science; that it's science that is guiding the decisions that we're making; and again, that the transparency is available for folks, so that they can see what kind of decisions are made and how they're being made.

In addition to working with -- with policymakers -- you know best what's going on in your state and how it's being affected by the rules and regulations that are coming down from Washington in so many areas, but certainly in the -- in the agriculture arena. And so we ought to be having a dialogue with -- with every single individual who has an interest, to make certain that we're addressing the needs appropriately.

ROBERTS: I thank you for your response. Thank you, Mr. Chairman.

ALEXANDER: Thank you, Senator Roberts.

Senator Baldwin?

BALDWIN: Thank you, Mr. Chairman.

Welcome.

PRICE: Thank you.

BALDWIN: Congressman, you've already been asked about your investments in medical device companies, pharmaceutical companies, as part of the prior questioning. But for the record, have you also received campaign contributions over the years from political action committees associated with many of these same companies?

PRICE: I don't know, but I assume so, just as many of us do.

BALDWIN: OK. So in terms of -- I mean what the American people want to know, of course, when you get reviewed for potential conflicts of interest and, you know, procedures with the Office of Government Ethics, is that -- that in your role, you're fighting for them and not biased towards the -- the powerful companies that you've invested in and that have invested in you.

And -- and you've taken some questions on -- on that. But just lemme follow-up a little bit, to ask, first, do you think drug price increases that we're seeing right now, for example, the six-fold increase in the cost of an EpiPen, is a problem right now for Americans?

PRICE: Oh, as I've mentioned, I think there's -- there are certain areas where drug pricing increases seem to have little basis in -- in rational findings.

I do think, however, as I mentioned again, I think -- I think I did -- that -- that's it's important to appreciate that we've done some good things in the area of drug pricing, whether it's in the generic arena, where the prices have been held down significantly and the Part D area, where prices are...

BALDWIN: Since my time is limited, let me continue down this -- this track.

You've been asked already, but Trump supports Medicare drug negotiation. Will you work to repeal the prohibition on Medicare negotiating for better drug prices on behalf of the American people, if confirmed for this position?

PRICE: Well, I -- I understand that if I'm confirmed and if I have the privilege of -- of serving as secretary, that -- that the boss that I have is the -- will be the president of the United States, so.

BALDWIN: So you -- will you work to repeal the prohibition on Medicare negotiating drug prices?

PRICE: Following discussion and -- and being informed by the individuals within the department and working with the president and then carrying out his wishes.

BALDWIN: Was that a yes, or was that a no?

PRICE: Well, it -- it depends on that activity. I would hope that...

BALDWIN: He stated his position, very recently in fact, that he supports price negotiation so that people on Medicare can have the benefit of -- of that. Is that something that you would press Congress to -- to do, in other words, repeal the prohibition on that negotiation?

PRICE: I -- I think we need to find solutions to the challenges of folks gaining access to -- to...

BALDWIN: I'm not...

PRICE: ... needed medication. And it may be that one of those is -- is changing the way that the negotiations -- as you know, the negotiations right now occur for seniors with the PBMs, with the pharmacy benefit managers.

BALDWIN: Since I have limited time and you haven't said yes or no -- you just talked about transparency. Would you support drug price transparency, mandating that any drug company that wants to increase prices on their drugs, release public information on how they set their prices? Because so many of these appear to be without justification, as you just mentioned. PRICE: Yeah, I think there's a lot of merit in -- in transparency in every area and certainly in -- in this area. And I'd be -- look forward to exploring, if I'm confirmed, with you the ways to be able to make that work.

BALDWIN: Thank you.

So, I wanted to go back to the -- the first round of questioning with the -- with the chairman, who -- who showed a chart. And it seemed like the what was implicit in the back and forth was that the act of repealing the Affordable Care Act would only impact, perhaps, a very small part of the health care industry. You talked about 6 percent being covered on -- on the individual market.

The protections, like coverage on your parents' health insurance til you're 26 and mandating that people be covered if -- even if they have a pre-existing health condition, things like eliminating caps that led so many into medical bankruptcy, those apply across the health care system. So repeal in no way limits us to a conversation just about a small percentage of our population. This is about serious impacts for all of America.