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At This Hour

Live Coverage of the HHS Secretary Confirmation Hearing. Aired 11-11:30a ET

Aired January 24, 2017 - 11:00   ET

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

REP. TOM PRICE (R-GA), NOMINEE FOR HEALTH & HUMAN SERVICES SECRETARY: Well, this is really critical, Senator, because as you mentioned area, in the rural areas, Georgia's the largest state geographically east of the Mississippi and we've got a large rural population.

[11:00:00]

And critical access hospitals are so important to communities around our state and truly around this nation.

PRICE: Well, this is really critical, Senator, because as you mentioned in the rural areas, Georgia's the largest state geographically east of the Mississippi and we've got a large rural population. And critical access hospitals are -- are so important to communities around our state and -- and truly around this nation.

But the regulatory scheme that's been put in place is choking the individuals that are actually trying to provide the care. So much so that you've got physicians and other providers who are leaving the practice, who are leaving the care -- caring for patients not because they've forgotten how to do it or they've grown tired of it, but because of the onerous nature of the regulatory scheme coming out of Washington, D.C.

The meaningful use -- a project that you mentioned -- makes it that much more difficult. We've turned physicians into data entry clerks. You just have to ask them what they're doing. And if you talk to patients, what they recognize is when they go into see their doctor, they see the top of his or her head as they're punching the information, the data into a computer, as opposed to that sharing of information that's so vital and necessary between the physician and the patient for quality health care.

So, one, a recognition of the problem is incredibly important; a recognition of the importance of rural health care in our nation and how it needs to be bolstered up. And then looking at the consequences of what we do as a government.

As I mentioned earlier, oftentimes, I don't think we look at the consequences. We pass the rule. We pass the regulation. We institute it. We think it's the greatest thing since sliced bread. But in fact what it's doing is harming the very individuals that are trying to provide the care. You don't get that information unless you ask.

SEN. PAT ROBERTS (R), KANSAS: I appreciate that. My time is up.

Thank you, Mr. Chairman.

SEN. ORRIN HATCH (R), UTAH: Senator Nelson?

SEN. BILL NELSON (D), FLORIDA: Thank you, Mr. Chairman.

Congressman, I enjoyed our visit yesterday. We had a discussion when you were kind enough to come visit me, about the fact that I have in the state of Florida 4 million-plus seniors on Medicare. And they are petrified of the idea of privatized Medicare. And I talked to you about this. And you talked about the premium support system that you're advocating.

And you pointed to a study that was done by CBO. You mentioned that you would send me a copy and we haven't gotten it. So what I did, I went and got the copy myself. And it is September of 2013. And what it concludes is opposite of what you said with regard to high-cost states like Florida.

Medicare is going to be spending four percent lower under the proposal that you were talking about in this CBO report, lower than current law, and beneficiary cost will decrease by six percent on the average, which is what you said yesterday.

But in high-cost regions like Florida, you're going to have the higher beneficiary cost than current law, under your premium support proposal. Annual premiums in Florida would increase 125 percent, according to the CBO chart on page 71. CBO says that the annual premium in a high-cost region like Florida would be $3,600 compared to the current law of $1,600. That's the 125 percent increase.

So, please help clarify what you were saying yesterday as it applies to Florida.

PRICE: Yes, thanks, Senator. And I enjoyed our time together as well.

When we talk about Medicare, it's important for everybody to appreciate, as I know that you and your colleagues do, that the Medicare trustees, Republicans or Democrats, the Medicare trustees have told all of us that Medicare in a very short period of time, less than 10 years, is going to be out of the kind of resources that will allow us as a society to keep the promise to beneficiaries in the Medicare program.

What that means -- it's important to appreciate what that means. It means that we will not be able to provide the services to Medicare patients at that time, which is very, very close, if nothing is done.

[11:05:03]

So my goal is to work with each and every one of you to make certain that we save and strengthen and secure Medicare.

I think it's irresponsible of us as policy makers to allow a program to continue knowing -- knowing that in a few short years, it's not going to be able to cover the services that we're providing. So that's the first point, and that is the current Medicare program, if nothing is done, as some have described it, goes broke.

Second point is that my role -- if I'm able to be -- if I'm confirmed and have the privilege of serving as the secretary of health and human services, my role will be one of carrying out the law that you all in Congress pass. It's not the role of the legislator, which I had when I was working to try to formulate ideas to hopefully generate discussion and get to a solution...

NELSON: OK. Let me -- let me be so rude as to stop, because I'm running out of time. Remember that Donald Trump in the campaign said that he was not going to cut Medicare spending. And I would also point to you, in a legislative solution, one of the greatest examples is -- on Medicare -- is 1983, when we were just about to go bust. And it took two old Irishmen, Reagan and O'Neill, to agree to come to an agreement that made Medicare -- in this case, it was not Medicare, it was Social Security -- actuarily sound for the next half-century.

Let me ask you, Representative Price, you had made a statement that it was a terrible idea of people who had preexisting conditions, that they would have the protection of insurance against those preexisting conditions. And what I'd like to ask you is, can you please, in light of President Trump expressing his desire to retain this basic protection, do you think his proposal to continue the ban on discriminating against people with preexisting conditions is a terrible idea?

PRICE: No, I'm not certain where you're getting that quote from. What I have always...

NELSON: It came from Politico, talking points memo, May 1st, 2012.

PRICE: Oh, well, now there's a reliable source.

(LAUGHTER)

What I've always said, Senator, is that nobody -- nobody...

NELSON: So you didn't say it's a terrible idea?

PRICE: I -- I don't believe I ever made that statement. What I've always said about preexisting conditions is that nobody, in a system that pays attention to patients, nobody ought to be priced out of the market for having a bad diagnosis. Nobody. That's a system, again, that may work for insurance companies; may work for government, but it doesn't work for patients.

So I believe firmly that what we need is a system that recognizes that preexisting conditions do indeed exist and that we need to accommodate it and make certain that nobody loses their insurance or is unable to gain insurance because of a preexisting condition.

NELSON: Mr. Chairman, as I close, I would like to insert in the record the September 2013 Congressional Budget Office analysis of premium support system for Medicare. And I would invite you, Congressman, to please respond with the CBO report that you said yesterday that supports your position, because this one does not.

PRICE: Look forward to that. Thank you, sir.

HATCH: Senator Menendez?

SEN. ROBERT MENENDEZ (D), NEW JERSEY: Thank you, Mr. Chairman. Congratulations, Congressman Price.

Let me ask you a series of questions. Given your medical training and time spent as a practicing physician, I have a couple of simple yes or no questions to start off with.

In your medical opinion, does HIV cause AIDS?

PRICE: I think that the scientific evidence is clear that HIV and AIDS are clinically directed.

MENENDEZ: And in your medical opinion, have immigrants led to outbreaks of leprosy in the United States?

PRICE: I don't know what you're referring to, but I suspect that there are instances where individuals have an infectious disease and they come to the United States and that that...

MENENDEZ: I'm not asking about an infectious disease. I'm asking specifically about immigrants in the United States causing leprosy in the United States -- in your medical opinion and scientific background?

PRICE: Again, I don't know the incident to which you refer. Are you referring to a specific incident?

[11:10:02]

MENENDEZ: There are statements that have been made in the public domain that immigrants have led to outbreaks of leprosy in the United States. As a person who's going to be designated as the director of Health and Human Services, that is not only the national but the world's health epicenter, I want to know, in your medical opinion, is there such a causation?

PRICE: The -- any time you get two individuals together for -- in -- in any relationship whatsoever, whether it's an immigrant or a visitor, and -- and one individual has an infectious disease, then it is possible that individuals transmits that infectious disease.

MENENDEZ: Including...

PRICE: Whether it's the flu or a cold...

MENENDEZ: Including leprosy?

PRICE: In -- in any infectious disease whatsoever. MENENDEZ: In your medical opinion, do abortions cause breast cancer?

PRICE: I think the science is -- is a -- is relatively clear that's not the case.

MENENDEZ: In your medical opinion, do vaccines cause autism?

PRICE: Again the science, in that instance, is -- is -- is that it does not, but there are individuals across our country who are...

MENENDEZ: I'm not asking about individuals. I'm talking about science because you're going to head a department in which science, not alternate universes of people's views, is going to be central to a trillion-dollar budget and the health of the nation.

Can you commit to this committee and the American people today, that should you be confirmed, you will swiftly and unequivocally debunk false claims to protect the public health?

PRICE: What I'll commit to doing is doing the due diligence that the department is -- is known for and must do to make certain that the factual information is conveyed to...

(CROSSTALK)

MENENDEZ: And that factual information will be dictated by science, I would hope?

PRICE: Without a doubt.

MENENDEZ: OK.

So, let me ask you about Medicaid specifically. Let me just say, I'm a little taken back about your answer on the question of immigrants and leprosy. I think the science has pretty well dictated in that regard too.

Let me ask you this. One of the most beneficial components of the Affordable Care Act was the expansion of the Medicaid program that resulted in 11 million people nationwide and over half a million in New Jersey gaining coverage, many for the first time. It's one of the biggest programs on the Republican chopping block, with proposals to not only repeal the Affordable Care's Medicaid expansion, but going further in gutting billions in federal funding to the states.

There's no doubt that this would result in catastrophic loss of coverage for tens of millions of low income families and lead to tens of billions in losses to safety net and other health care providers. Do you recognize Medicaid to be a valuable program and consider the coverage it provides to 74 million Americans to be comprehensive?

PRICE: Medicaid is a vital program for health care many individuals in this country, but one that has significant challenges. There are one out of every three physicians who should be seeing Medicaid patients who's not taking -- who are not taking any Medicaid patients. There's a reason for that. If we're honest with ourselves, we'd be asking the question why?

(CROSSTALK)

MENENDEZ: Well, if that's the case, that one in three don't treat Medicaid, you have to ask yourself, is that because Medicaid reimbursements are so low? And since provider reimbursements are set at a state level, won't cutting federal funding and hitting states with higher costs only lead to lower provider rates? And how many doctors would actually treat former Medicaid beneficiaries when they no longer have any coverage or ability to pay?

So even if there's only one of three, there's still two of three that are providing the services. Imagine if you don't have coverage, which goes to my next question. You have advocated (ph) to, in essence, block grant Medicaid. Now, the essence of Medicaid is an entitlement, which under the law it means if I meet these criteria I have the right to have that coverage under the law, when you move to a block grant, you remove the right and you make it a possibility subject to whatever funding there is going to be.

Do you recognize that in doing so, you risk the potential of millions of Americans who presently enjoy health care coverage through Medicaid no longer having that right?

PRICE: I -- I think that it's important to appreciate that -- that no system that any that -- that the president is -- has supported or that I have supported would leave anybody without the opportunity to gain coverage. Nobody.

MENENDEZ: That's not my question. So let me reiterate my question. Medicaid, under the law as it exists today, is a right, is that not the case? Yes or no.

PRICE: It's an entitlement program.

MENENDEZ: And as an entitlement, doesn't that mean you have the right if you meet the criteria that you are entitled to the services...

(CROSSTALK)

PRICE: One is eligible. That is correct.

MENENDEZ: One is eligible, meaning you have a right. When you move to a block grant, do you still have the right?

PRICE: No. I think it would be determined by how that was set up. If, in fact, that was what Congress did. Again, the role of the Department of Health and Human Services is to administer the laws that you pass, not to make the law.

MENENDEZ: Yes. But I would just simply say to you, I -- I know in our private conversation -- I appreciate you coming by to visit me -- you suggested that your role is that of an administrator of a large department.

[11:15:11] Well, that's not even what the vice president said when you were nominated. He said he expected your experience, both medically and legislatively, to help drive policy. And even beyond the expectations of the vice president in that regard, when we have regulatory abilities of the secretary to dictate regulation, that is policy.

So please don't say to me that I am here just to do what Congress says. I respect that you will follow the law and do whatever Congress says, but you will have an enormous impact. And based upon your previous opinions as it relates to Medicaid, ultimately, block granting means a loss of a right. And then it's just a question of funding and then we'll have a bigger problem with a number of providers willing provided.

So, I hope we can get to better understanding, of your commitment to Medicaid as it is an entitlement as a right.

Thank you sir.

HATCH: Senator, your time is up.

We'll go to Senator Carper now.

SEN. THOMAS CARPER (D), DELAWARE: Congressman Price, welcome to you and to your -- to your wife. I -- there's a verse of scripture -- you mentioned earlier that you're active in your church. There's a verse of scripture in the New Testament, in Matthew 25, which speaks to the least of these. When I was hungry, did you feed me? When I was naked, did you clothe me? When I was thirsty, did you get to drink? When I was sick and imprisoned, did you visit me? When I was a stranger in you land, did you take me in?

It says nothing about; when my only access to health care coverage was going into the emergency room of a hospital, did you do anything about it?

PRICE: What we sought to do with the ACA, is to do something about it. And we didn't -- in this room invent the Affordable Care Act. The genesis of the Affordable Care Act, goes back to 1993 when Hillary Clinton, first lady, was working on what was called Hillary Care. And a group of Senator's lead by Senator John Chaffee, a Republican from Rhode Island, developed legislation co-sponsored by, I think 23 senators including, as I recall, Senator Orrin Hatch and Senator Grassley. And what he did in his legislation, what he proposed in his legislation, was to use really five major concepts.

One, to create large purchasing pools for folks who otherwise may not have access to health care coverage. He called them exchanges or market places. He also proposed that there be a sliding scale tax credit to buy down the cost of people getting coverage in those exchanges within the different states.

Third thing he proposed was the notion that there should be an individual mandate, he wanted to make sure that people got covered and he realized that if they didn't mandate coverage for people getting coverage, then -- then you would end up with insurance pools that health insurance companies that could not begin to coverage (inaudible) it would be workable.

He proposed as well, employer mandates and he proposed as well, the notion that people shouldn't lose their coverage because of pre- existing conditions. Those are not Democrat ideas. Those were proposed by Republican leadership, actually in the Congress at the time. And when Governor Romney developed his own plan in Massachusetts, I don't know a decade or so later. He borrowed liberally from those ideas.

When he instituted it, as you may recall, they instituted what I call -- what others call Romney care. They had found that they were doing a pretty good job on covering people, but not such a good job on affordability. And what took place over time is you found out they had insurance pools, where a lot of the people were not young, they were not very healthy and they were older and they needed more health care. And as a result, the insurance companies, in order find -- be able to stay in business had to raise the -- the premiums.

I don't know if any of this sounds familiar to you, but it sure sounds familiar to what we've seen in the last six years or so with the -- with the Affordable Care Act. To the ideas of Senator Chaffee and the ideas of Govenor Romney, we've have added some things. We have made -- we've encouraged states to increase the number of people they cover under Medicaid by raising to about 135 percent, the primary level in at which people can receive -- can receive health care.

PRICE: We've encouraged to focus on prevention and wellness. Not just treating people when they're sick, but also trying to make sure that people stay healthy in the first place. We provide funding for contraception, we provide funding for programs that are inclined or intended to reduce obesity.

[11:20:02]

We have programs that they're intended to reduce the -- reduce smoking, the use of tobacco.. This is a -- this is not a yes-or-no question. What was wrong with that approach? What is wrong with that approach?

And last thing I'll say is this, before you answer, the health insurance companies found it difficult to stay in business in the state groups -- the group exchanges across the country. One of the reasons why they were unable to is because, I think, really we learned this from Massachusetts, we didn't raise the fine, or if you will, we didn't have the incentive high enough to get young healthy people like my sons into the -- the -- the -- the exchanges across the country.

S&P, I'm told, has just put out, about a month ago, an update looking at the financial health of the health insurance companies in this country as they have tried to figure out how to price this product. And it seems like, according to S&P, believe it or not, they seem to have sort of figured it out because the health -- financial health of the -- the health insurance companies has begun to stabilize. Your reaction to this, please.

PRICE: Well, as I mentioned in -- either in my opening or in response to -- to a question, the principles of health care that all of us hold dear, affordability and accessibility and quality and choices for patients, I think are the things that we all embrace. The next step, how we get to accomplish and -- and meet those goals and those principles, is where it takes work together to do so.

The program that you outline has much merit, whether it's making certain that individuals with pre-existing illness and disease are able to access coverage, whether it's the pooling mechanisms which I've actively and aggressively supported for years, there's a lot of merit there. So I'm -- again, what I'm hopeful that we're able to do is to, in a collegial, bipartisan way, work together to solve the remarkable challenges that we have.

One of my -- one of my physician colleagues used to tell me that he never operated on a Democrat patient or a Republican patient, he operated on a patient. And -- and that's the way that I view this system. It's not a Republican system, it's not a Democrat system. It's a system that hopefully we're focusing on the patients to, again, make certain that they have access to the highest quality care possible.

CARPER: Thank you for that.

Let me conclude, Mr. Chairman, by saying -- I'll use an analogy. If there is a large building and there are people in the large building and there was a fire in the large building but for some reason they could not use the stairways or they could not use the elevators, and they looked out the windows and there's fire fighters down in the streets saying go ahead and jump, we'll save you, but they don't have any safety nets.

And my fear is if we repeal what I've described, the -- the system that I described that we put in place of the Affordable Care Act, largely founded on Republican ideas, which I think were good ideas, and we don't have something at least as good in place to catch those people as they fall from the building, we will have done a disservice to them and to our country. Thank you.

HATCH: Thanks, Senator. Your time is up.

Senator Burr?

SEN. RICHARD BURR (R), NORTH CAROLINA: Thank you, Mr. Chairman, and a quick reminder that the Affordable Care Act was not passed with one Republican vote in the House or in the Senate.

So Dr. Price, a couple of questions just to cut to the chase. Are all of your assets currently disclosed publicly?

PRICE: They are now and they always have been.

BURR: OK. Are you covered by the Stock Act legislation passed by Congress that requires you and every other member to publicly disclose all sales and purchases of assets within 30 days?

PRICE: Yes, sir.

BURR: Now, you have been accused of not providing the committee of information related to your tax and financial records that were required of you. Are there any records you have been asked to provide that you have refused to provide?

PRICE: None whatsoever.

BURR: So all of your records are in?

PRICE: Absolutely.

BURR: Now, I got to ask you. Does it trouble you at all that you're -- as a -- as a nominee to serve in this administration, that someone will hold you to a different standard than you as a member of Congress? And I might say, the same standard that they currently buy and sell and trade assets on. Does it burn you that they want to hold you to a different standard now that you're a nominee than they are as a member?

PRICE: Well, I -- I -- I -- we know what's going on here.

BURR: Well, we do. We do.

PRICE: I mean, that -- it's -- and I understand. And -- and as my wife tells me, I volunteered for this. So...

BURR: So let's go to substance.

BURR: You and I have a lot in common.

[11:25:00]

We both spoke out in opposition to Obamacare early. We predicted massive premiums increases. When the president promised if you like your doctors, you can keep them, if you like your plan, you can keep it, we both said these promises would be broken and in fact they were.

Over the last seven years, you and I, Senator Hatch, Congressman Upton and others have actually written our own health care plans because we were, I think, brave enough to say that if you're gonna be critical of something, then put your ideas on the table. In your opinion, was it clear to the American people that repeal of Obamacare was a promise that Donald Trump made before he was elected president?

PRICE: Well, I have no doubt that it played a very prominent role in this past election and that the president is committed to fulfilling that promise.

BURR: And as the nominee, and hopefully, and I think you will be the secretary of HHS, what are the main goals of an Obamacare replacement plan?

PRICE: Main goals, as I mentioned, are outlined in those principals. That is imperative that we have a system that accessible for every single American, that's affordable for every single American, that is -- incentivizes and provides the highest quality health care that the world knows and provides choices to patients so that they're the ones selecting who's treating them, when, where and the like. So, it's complicated to do, but it's pretty simple stuff.

BURR: I want to thank you for not only testifying here but testifying in front of the Health Committee where Johnny and I both had you over there. You're brave to go through this, but the country will be much better off with your guidance and your knowledge in this slot.

Mr. Chairman, I yield back.

PRICE: Thank you, sir.

HATCH: Well, thank you.

Senator Cardin?

SEN. BEN CARDIN (D), MARYLAND: Thank you, Mr. Chairman. Dr. Price, again, thank you for your willingness to serve in this and we also thank your family for being willing to put up with your voluntary choices.

I want to talk about a few issues in the time I have. One, yesterday the president, by executive order, reinstituted the Global Gag Rule, but he also did it in a way that is more comprehensive than the previous. The new policy would prohibit any federal aid to foreign organizations that provide or promote abortion. In the past, the policy only applied to organizations to cut family planning funding, now it will apply to organizations that get global health money, potentially, including maternal help programs, anti-Zika efforts and expansion of PEPFAR to stop HIV/AIDS.

My question to you is this. If confirmed, how will you make sure that the U.S. can fully participate in these global health efforts to help with maternal health, to help stopping the spread and ending HIV/AIDS, to deal (ph) -- to make sure that the next Zika virus that we be able to contain it so it doesn't cause the catastrophic effects if the Global Gag Rule is enforced in a way that prevents us from participating in international health organizations?

PRICE: Yeah, this is really important, Senator. I appreciate the question.

The department is full of all sorts of heroes, as you well know, and incredibly talented individuals, and my goal, if I'm given the privilege and if confirmed and given the privilege of serving as the secretary of Health and Human Services, is to gather the best minds and the best talent that we have within the department and without -- and determine what is wisest policy for this nation to have it relates to, in this instance, infectious disease.

Germs know no geographic boundaries. And we do incredible work, the work that the CDC does and the work that's done by others in our nation that try to prevent -- work to prevent infectious disease, work to detect the spread of infectious disease and then provide a logical and methodical and aggressive response to the outbreak of any infectious disease is absolutely vital to protect the American people and we're committed to doing so. CARDIN: Now, I agree with that, I just hope that you will look at perhaps unintended consequences from these executive orders that could compromise our ability to be as effective as we need to using all tools at our disposal.

I want to get to tobacco regulation for one moment, an area that I think is now clear within the medical community the impact that tobacco has. The fact that the Family Smoking Prevention Tobacco Control Act of 2009 authorizes the HHS secretary through FDA to regulate tobacco products, including restricting tobacco sale to minors. It also has been expanded to include the selling of e- cigarettes, et cetera.

I know initially you did not support that legislation.

[11:30:00] If confirmed, can you commit to us that you would rigorously enforce that act to make sure particularly our children are not subjected to the new forms of tobacco products?