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Tom Price Confirmation Hearning. 12-12:30p ET

Aired January 24, 2017 - 12:00   ET


SEN. PAT TOOMEY (R), PENNSYLVANIA: And I wonder if you would commit to working with me and others who share this view to ensure that we have a better proportionality in terms of the allocation of resources and the breadth and severity of illnesses.


REP. TOM PRICE (R-GA), NOMINEE FOR HEALTH & HUMAN SERVICES SECRETARY: I think it's absolutely imperative, Senator, and I look forward to working with you.

TOOMEY: Thank you, Mr. Chairman.

SEN. ORRIN HATCH (R), UTAH: Thank you, Senator.

Senator Thune.

SEN. JOHN THUNE (R), SOUTH DAKOTA: Thank you, Mr. Chairman.

Dr. Price, welcome and thank you for your willingness to serve in this very important capacity. We've got a lot of challenges ahead that we need to take on. As I met with you a couple of weeks ago, one of the issues that's of particular interest to me, which I conveyed to you, is this issue of Indian Health Service. In 2010, there were some systemic problems that were uncovered in South Dakota and an administrative action plan was set in motion to help remedy many of these findings.

Similar issues popped up again throughout South Dakota in 2015 and they continue to this day, and after oversight hearings, it became abundantly clear that time and again there was a lack of follow- through by the agency. My question is will you commit to follow up with me in writing that you will designate someone at HHS to be the point person that my staff and I can contact to ensure, one, that reforms are being implemented and two, that we continue to collaborate on reforming the IHS?

PRICE: Absolutely, Senator. This is an area that is of significant concern because it appears to me, as I know you -- you shared with me, that in the Indian Health Service, there are so many areas where we're not meeting the goal of the highest quality care to be provided to individuals accessing that system. And so we're not -- we're not doing what we ought to do in that system and I'm committed to making certain, should I be confirmed, to -- to turning that system around. THUNE: And as I shared with you, Senator Barrasso and I introduced a bill last year called the IHS Accountability Act which we believe will bring about a lot of structural changes within the IHS. And as I've said many times, that act, although we think it addresses a lot of the problems that have cropped up and is based upon consultation that we received from the tribes, really is merely a first step in the process that's necessary to improve that agency.

If confirmed, what types of reforms could you see yourself supporting when it comes to the IHS and obviously starting perhaps with our legislation (inaudible) probably haven't had a chance to look carefully at that yet. But I won't ask you to comment specifically to it. But are there thoughts that you have with respect to the IHS that, when it comes to reforms, that you could work with us on?

PRICE: Yeah. I appreciate that. I've had the privilege of visiting some IHS facilities in the state of Wisconsin and in -- in a couple facilities that were doing remarkable work.

And it appears to me that what we haven't done, and I look forward to getting -- if I'm confirmed, getting into this area within the department itself, that what we haven't done is identified best practices within the IHS system itself and shared those and incentivized the ability to move that kind of activity that is providing high quality care for -- for individuals in that system in certain areas and making certain that we're able to extend that across the country and the IHS.

THUNE: Well, we look forward to working with you on that. I think best practices is a good place to start and -- and obviously those have not been employed in a lot of facilities in -- in our state.

In 2009, CMS issued a final rule that required all outpatient therapeutic services to be provided under direct supervision. Every year since then, the rule has been delayed either administratively or legislatively for critical access in small and rural hospitals.

And I've shared with you -- with you this as well. In my state, obviously, we have a lot of critical access hospitals, a lot of very rural areas, big geography to cover. And sometimes, difficult to get providers out to these areas. So, the question is, if confirmed, will you work to permanently extend the non-enforcement of this regulation in these hospitals in order to remove this regulatory burden?

PRICE: I look forward to working with you on it, Senator. I think there are areas from a technological standpoint that we are missing the boat, especially in our rural areas and the critical access hospitals. There's -- in every other industry out there, the -- the information technology age has arrived and is -- and is moving across the land with -- with rapid speed and has done so.

However, it seems that in health care, we put roadblocks up to the expansion of technology, especially into the rural areas. And we ought to be incentivizing that so that, again, the patients are able to receive the highest quality care. It's possible now, for example, in our state, if -- if you're an individual who's suspected of having a stroke, you go to a critical access hospital in a rural area, it's possible by tele-medicine to be able to access one of the -- one of the world's foremost specialists in stroke treatment by tele-medicine at the University Health Center.

So, that -- that's improving the lives and care of patients across our state and I think there's so many things that we can do that would mirror that kind of technological expansion.

THUNE: Thank you.

[12:05:01] One final point I'll make, because my time's expiring, but I know you probably have been questioned already a good amount about what happens next with respect to replacing Obamacare.

I would simply say that I hope that we can work with you in -- in beginning to shift a lot of the -- giving the states, I guess I would say, more flexibility when it comes to designing plans that work in -- in our states. I think one of the problems that -- that we've had with this, is there's just too much dictation from Washington D.C. and too much one size fits all. And that's something I think that most -- most states would probably agree with, and certainly I think most providers would agree with as well.

So, we look forward to working with you and designing programs that get that flexibility to our states, and put them more in charge of -- of -- of some of these issues in a way the removes that power from Washington D.C., where I think too many of the problems have been happening.

Thank you Mr. Chairman.

PRICE: Looking forward to it.

HATCH: Senator Casey.

CASEY: Thank you Mr. Chairman.

Dr. Price, good to be with you again, thank you.

PRICE: Thank you.

CASEY: I wanted to ask you a couple of questions that center, principally on children and individuals with disabilities.

First, with regard to children, I think if we're doing the right thing, as not only as a government, but as a -- as a society, if we're really about the business of justice and if we're really about the business of growing the economy, we should invest a lot and spend a lot of time making sure that every child has health care.

The good news -- despite a lot of years of not getting to that point, not moving in the right direction -- the good news is we've -- we've made a lot of progress. The Urban Institute in a April 2016 report -- I won't ask to -- I won't ask the report to be made part of the record, but I'll -- I'll read a line from this Urban Institute report, uninsurance among children, 1997 to 2015, dated April 2016, said as follows on page three, it said that the "Decline in children's uninsurance rate occurred at a relatively steady pace and includes a significant drop following implementation of the Affordable Care Act's key coverage provisions from 7.1 percent in 2013 to 4.8 percent in 2015," unquote.

So that's a -- that's a significant drop, 7.1 to 4.8 is millions of kids have health insurance today that would not have it, absent the Affordable Care Act and including the Medicaid provisions as well. That 4.8 percent uninsured rate for kids is an all time low. That means we're at a 95 percent insured rate across the country for children.

Kaiser Foundation, a separate authority tells us that even with that -- even with all that progress in the last couple of years, and even -- even some progress before that, we still have more than 4.1 million children uninsured. Would you agree with me, first of all, that we should get that number down -- the number of uninsured children?

PRICE: I think that throughout our population, we ought to identify individuals who are uninsured and strive to make certain that they gain coverage.

CASEY: And you'd agree with me with regard to children, especially.

PRICE: Everybody in the population, but are children are -- are -- are precious and are our future.

CASEY: Great. And just with regard to children, now that we have that number -- we know the number that we've arrived at, we know the percentage, will you commit -- if you're successful in your confirmation -- to maintain or to even reduce that uninsured number even further. In other words, that you will be able to commit to us today that that -- the number of uninsured children will not increase under your -- during your time as secretary, were you to be confirmed. And the percentage of uninsured will not increase while you're secretary?

PRICE: Our -- our goal is to decrease the number of uninsured individuals in -- in -- in the population age under 18 and over 18.

CASEY: Well, I hope you maintain that because that's -- I think that's going to be critically important. The reason I ask that -- that question is not just to validate that as a -- as a critically important goal for the nation, but it's -- your answer seems to be contrary or in conflict what -- with what you have advocated for as a member of the house of Representatives, not only in your individual capacity, but as chairman of the Budget Committee.

CASEY: We -- looking at now for reference, a -- an op-ed by Gene Sperling. You know who Gene Sperling is? He was head of the Council of Economic Advisors to two presidents, both President Clinton and Obama. Chair of that National Economic Council -- I should say is the proper title.

[12:10:02] In a -- in an op-ed on Christmas Day, the fifth paragraph, here's what he said in pertinent part, referencing you and your budget proposals. He said, quote, "together," meaning the two -- the two areas of policy that you've have a -- have a long record on, full repeal of ACA and block granting of Medicaid, which we now know is Trump administrations policy, quote "Would cut Medicaid and the Children's Health Insurance Program funding by about $2.1 trillion over the next 10 years, a 40 percent cut," unquote.

How can you answer the questions that I just asked you about, making sure that that number of uninsured children doesn't get worse under your tenure? If that is the case with -- with regard to your policies -- the effect of what your policies would be, and now apparently contrary to what was said during the campaign. That's now the policy of the Trump administration to block grant Medicaid.

PRICE: Yeah, with -- with respect to both you and to Mr. Sperling, it's because you all are looking at this in a silo. We don't look at it in a silo. We believe that it is possible, to imagine, and in fact put in place a system that allows for greater coverage for individuals. In fact coverage that actually equals care.

Right now many of those individuals -- the ACA actually increased coverage in this country. It's one of the things that it actually did. The problem is that a lot of folks have coverage, but they don't have care. So they've got the insurance card, they go to the doctor, the doctor says this is what we believe you need and they say I'm sorry I...

CASEY: A cut of a trillion dollars -- a combined cut of a trillion dollars that would adversely impact the Children's Health Insurance Program and the Medicaid Program is totally unacceptable I think to most Americans, Democrat, Republican or otherwise.

PRICE: And you're looking at that in a silo. You're not looking at what the reform and improvement would be.

CASEY: We'll -- we'll see the rebuttal to what, not only Gene Sperling has -- has said, but a whole long line of -- of public policy advocates and experts. And I think the burden for you sir, is to make sure that you fulfill your commitment to make sure that no children will lose health insurance coverage while you're a secretary.

PRICE: I Look forward to working with you.

HATCH: OK. Senator Heller.

HELLER: Thank you Mr. Chairman.

And Dr. Price thank you for being here today and thanks for your patience in working with us throughout this confirmation process.

HATCH: If you put your mic on, is it on?

HELLER: It is on. I'll lean a little forward. Mr. Chairman, as you can imagine, I committed to ensuring that all Nevadan's have access to high quality and affordable health insurance. I have a letter here that came to my attention, January 10th from the Nevada legislature. The letter comes directly from our majority leader of the State Senate and our speaker of the Assembly. And they're good questions, five questions obviously they want to get the same answers that all of us want here.

We have in about 88,000 Nevadans who have health insurance through the health exchange, 77,000 Nevadans who are eligible for federal tax credits, 217,000 Nevadans receive health care coverage under Medicaid expansion, basic questions.

Mr -- Mr. Chairman, if I may, can I submit these questions to the record, on the record and also if I may, ask Dr. Price if he would respond to this particular letter, to these legislators. Again I think they're very good questions.

HATCH: Without objection.

HELLER: Also if I may add, if you could CC the governor also, I think the governor also would like answers to these questions and I think you're in a great position to answer these particular questions.

PRICE: Thank you sir.

HELLER: Thank you. If I may, can I get your opinion on the Cadillac Tax?

PRICE: I think the Cadillac Tax is -- is one that has made it such that individuals who are gaining their coverage through their employer may be -- there may be a better way to -- to make it so that individual's getting their coverage through their employer are able to gain access to the kind of coverage that they desire.

HELLER: The Cadillac Tax would affect about $1.3 million Nevadans; school teachers, union members, senior citizens and there's some disagreement as to whether or not these individual's are wealthy or not. There's some of this committee that believe that the $1.1 trillion tax increase in Obamacare does not affect the middle class. Do you agree with that?

PRICE: I think it does affect the middle class.

HELLER: I do too. Do you believe that school teachers are wealthy?

PRICE: Everybody has their own metric of what wealthy is and everybody -- and some people use things to determine what wealth that aren't the greenbacks and...

HELLER: I would argue that most school teachers don't think they're wealthy.


Do you think most union members are wealthy? PRICE: I doubt that they think they're wealthy.

HELLER: Yeah, I would -- I would agree with that.

Do you think that most senior citizens are wealthy?

PRICE: Most senior citizens are on a fixed income.

HELLER: They would argue that they're not wealthy. And that's my argument on this particular tax. In fact, Obamacare as a whole, as it -- it's just another middle class tax increase of $1.1 trillion. I guess my request and question for you is, is that if I can get your commitment to work with this committee, work with myself to -- and -- and the Treasury Secretary to repeal the Cadillac Tax?

PRICE: Well, we'll certainly work to make certain that that those who gain their coverage through their employer have the access to the highest quality care and coverage -- coverage possible. In -- in a way that makes the most sense for individuals from a financial stand point, as well.

HELLER: Does the Cadillac Tax make the most sense?

PRICE: As I mentioned, I think there are other options that may work better.

HELLER: And do you believe that it is an increase -- a health insurance increase to middle class America?

PRICE: I do.


I want to go to Medicaid expansion for just a minute. Nevada was one of the 36 states that chose to expand eligibility for Medicaid. We went from, I think, the enrollment went from 350,000 to over 600,000. And, I guess, the concern and I think it's part of the letter that I gave to the Chairman as whether or not that will have an impact, and what we're going to do to see that those individuals are impacted.

I -- probably the biggest question that we have for you today is what are we gonna do about those that are part of the Medicaid expansion and how that's gonna impact them.

PRICE: Yeah, again, as I mentioned to -- to a question on the other side, I believe this a policy question that needs to worked out through -- through both the House and the Senate. We look forward to working with you and others if I'm able to be confirmed.

And -- and making certain that individuals that are currently covered through Medicaid expansion, either retain that coverage, or in some way have coverage through a different vehicle, but every single individual ought to be able to have access to coverage.

HELLER: Dr. Price, thank you. Thank you for being here. Mr. Chairman, thank you. PRICE: Thanks, Senator.

HATCH: Thank you. Senator Warner?

WARNER: Thank you, Mr. Chairman.

Good to see you again, Dr. Price.

PRICE: Thank you.

WARNER: Let me start out on a -- something we discussed in my office. One of the issues I've been working on since I've been governor, I've been working very closely with your friend, Senator Isakson on, is the issue of, how we as Americans address the end of life and sort through those issues. I think, we both shared personal stories on that subject.

Senator Isakson and I have legislation that is -- we call it the Care of Planning Act that does not remove anyone's choices. It simply allows families to have those discussions with their health care provider and religiously faith leader if needed -- are desired in a way to prepare for that stage of life.

This year CMS, took a step by introducing a payment into the fee schedule to provide initial reimbursement for providers to have these conversations with them, as again I mentioned a multi-disciplinary case team. Yet also ran a pilot program that allowed hospice type benefits to be given to individuals who are still receiving some level of curative services call the Medicare Care Choices.

I believe it's very important that we don't go backwards on these issues and I think, we talked about we may be the only industrial nation in the world that hasn't had this kind of adult conversation about this part of life -- again and not about limiting anyone's choices. But would you, if you're confirmed, would you continue work with Senator Isakson and I and others on this very important issue?

PRICE: I look forward to doing so.

WARNER: And not be part of any effort to, kind of, roll back those efforts that CMS have already taken?

PRICE: I think it's important to look at the broad array of issues here. And one of the issues is liability, and I can't remember whether we discussed that in your office, but the whole issue of liability surrounding these conversations is real. We need to be talking about it openly and honestly and -- and working together to try to find a solution to just that.

WARNER: I would concur with that, but I also think that this is something that more families need to take advantage of. On Friday January 20th, the president -- President Trump issued an executive order that says federal agencies, especially HHS should do everything they can to quote, "Eliminate any fiscal burden of any state, on any state or any cost, fee, tax, penalty or regulatory burden on individuals and providers". Dr. Price, if -- if you're confirmed in this position, will you use this executive order in any way to try to cut back on implementation or -- or following the individual mandate before there is a replacement plan in place?


PRICE: I think that, if I'm -- if I'm confirmed, then -- then -- it -- I'm humble enough to appreciate and understand that I don't have all the answers and that the people at the department have incredible knowledge and an expertise.

And that the -- my first action within -- within the department itself, as it relates to this, is to gain that insight, gain that information so that I -- so that whatever decisions we could make with you and with governors and -- and -- and others can be the most informed and intelligent decision possible.

WARNER: I'm not sure you answered my question.

I just -- what I would not want to see happen as we take (inaudible) -- I understand your concerns with the Cadillac Tax. I know there are concerns about -- you and others have raised about the individual mandate. There are some that are concerned about the income tax surcharges. It's just remarkable to me, and this is one of the reasons why I think so many of us are anxious to see your replacement plan, that the president has said we want insurance for everybody. He wants to keep the (inaudible) of pre-existing condition. He wants to keep on their policies until 26.

And it seems like there's at the same time a rush to eliminate all the things that pay for the ability to have -- for Americans to have those kind of services. And I would just want your assurance that you wouldn't use this executive order, prior to a legal replacement, to eliminate the individual mandate, which I would believe helps actually shore up the cost coverage and the shifting of costs that are required in an insurance system.

PRICE: Yeah. No, I -- I -- a replacement, a reform, an improvement of the program, I -- I believe is imperative to be instituted simultaneously or at -- at a time...

WARNER: But you will not use this executive order as a reason to kind of, in effect, bypass the law prior to a replacement in place?

PRICE: Our commitment is to carry out the law of the land.

WARNER: I want to use the last of my minutes to go on. I know you've been, in the past, a strong critic of the Center for Medicare and Medicaid Innovations, CMMI. I believe in your testimony last week, you saw great promise in it. To me, if we're going to move towards a system that emphasizes quality of care rather than simply quantity of care, we've got to have this kind of experimentation. There is one such program, the Diabetes Prevention Program, that last year CMS certified that it saved money on a per beneficiary basis. And I know my time's running out, so let me just ask these questions. I think they can probably be answered yes or no. Do you support CMMI delivery system reform demonstrations that have the potential to reduce spending without harming the quality of care?

PRICE: The second clause is the most important one. I support making certain that we deliver money -- that we deliver care in a cost effective manner, but we absolutely must not do things that harms the quality of care being provided by patients.

WARNER: But if part of that quality of care, and I'd agree with you, would mean bundled and episodic payment models that actually move us towards quality over volume, would you support those efforts?

PRICE: For certain patient populations, bundle payments make a lot of sense.

WARNER: And if these experiments are successful, would you allow the expansion of these across the whole system?

PRICE: I -- I think that -- that what we ought to do is -- is -- is allow for all sorts of innovation, not just in -- in -- in this area. There are -- there are things I'm certain that haven't been thought up yet that -- that would actually improve quality and delivery of health care in our country and we ought to be incentivizing that kind of innovation.

WARNER: Well, I would simply say, Mr. Chairman, that CMMI seems to be one of the areas where I'd like to have seen more but I think it's a -- it's a model and a tool we ought to not discard. Thank you.

HATCH: Thank you, Senator.

Senator Scott.

SCOTT: Thank you, Mr. Chairman.

Dr. Price, good to see you again. South Carolina (ph) launched the nation's first statewide pay for success project with Nurse Family Partnership with the use of Medicaid funds. Twenty percent of the babies born in South Carolina are born to first time, low-income mothers. We also have a much higher than average infant mortality rate. Nurse Family Partnership is an evidence-based and has already shown real results, both in the health of the mother and the babies, but also in other aspects of the mother's life, such as high school graduation rates for teen moms and unemployment rates.

What are your thoughts on incorporating a pay for success model to achieve success metrics?

PRICE: Well, it sounds like a great program that is -- actually has the right metric, and that is the quality of care and the improvement of -- of lives. And -- and as you state, if it's having that kind of success, it -- it probably ought to be put out there again as a best practice for other states to look at and try to model.

SCOTT: Yes, sir. Thank you.

I believe you were the director of the Orthopedic Clinic at Grady Memorial Hospital in Atlanta?

PRICE: I was.

SCOTT: You just mentioned something that I think is very important. I believe Grady Hospital had the highest level of uninsured Georgians. You talked about having coverage, but really not access. Can you elaborate on how your experience at Grady may help inform you and direct you as it relates to the uninsured population?

PRICE: Well, I -- it was an incredible privilege to -- to work at Grady for the number of years that I did. And we saw patients from all walks of life and many, many uninsured individuals and they come with -- with the same kinds of concerns, the same kinds of challenges that every other individual has and there's -- and one of the big -- they have an additional concern and that is, is somebody going to be caring for me? Is somebody gonna be able to help me?

And that's why it was so incredibly fulfilling to be able to have the privilege of working at -- at Grady and -- and assisting people at a time when they -- when they were not only challenged from a health care standpoint, but challenge from a concern about whether or not people were gonna be there to help them.

SCOTT: Yes, sir. I know that you're aware of the Title 1 of The Every Student Succeeds Act. It's -- allows for the population of head start to have access to resources. It seems to me that would be imperative for the secretary of HHS and the secretary of Education to look at ways to synergize your efforts to helping the underprivileged student -- underprivileged child.

Can I get your commitment that you'll look for ways to work with the secretary of Education where it makes sense to help serve those students? Do we have head start under you and other programs under ESA. It'd be wonderful for us to take the taxpayer in one hand, the child in the other hand and look for ways to make sure they both win.

PRICE: Yes, you've identified an area that is a pet peeve of many ours, and that is that we don't seem to collaborate across jurisdictional lines, not just in Congress, but certainly in -- in -- in the administrative side. So I look -- I look forward to doing just that and -- and having as a metric, how -- how are the kids doing?


PRICE: Are they actually getting the -- the kind of one service and education that they need? Are they improving, are we just being custodians, are we just parking kids in a spot? Or are we actually assisting and improving their lives and -- and -- and able to demonstrate that? And if we're not asking the right questions, if we're not looking at the right metrics, then we won't get the right answer that allows us to either expand what's actually working or to modify it and move it in a better direction.

SCOTT: I think that's one of the more important parts of -- of your opportunity in this position, is looking at those kids. And you know, as well as anyone, as a doctor, that those ages -- before you ever get into before, you know, pre-K, pre-kindergarten, the development of the child through those first three or four years are powerful opportunities for us to direct one's potential so that they maximize it and sometimes we're missing those opportunities.

We think that somehow the education system will help that child catch up, but there are things that have to happen before they ever get in the education system. So I thank you for your willingness to work in that direction.

My last question has to do with the employer sponsored health care system that we're so accustomed in this country, that provides about 175 million Americans with their insurance.

In my home state of South Carolina, of course, we have about 2.5 million people covered by their employer coverage. If confirmed as HHS secretary, how would you support American employers in their effort to provide effective family health coverage in a consistent and affordable manner? Said differently, there's been some conversation about looking for ways to decouple having health insurance through your employer.

PRICE: I -- I -- I think the employer system has been absolutely a remarkable success in allowing individuals to gain coverage that they otherwise might not -- not gain. I think that preserving the employer system is -- is imperative.

That being said, I think that there are -- there may be ways in which individual employers -- I've heard from employers who say if you just give me an opportunity to provide my employee the kind of resources, so that he or she is able to select the coverage that they want, then that makes more sense to them. And if that works from a voluntary standpoint for employers and for employees, then it may be something to look at.

SCOTT: That would be more like an HRA approach where...

PRICE: Exactly.

SCOTT: ... employer funds an account and the employee chooses the health insurance, not necessarily under the umbrella of the employer specifically.

PRICE: Exactly. And gains the same tax benefit.

SCOTT: Yeah.

Thank you, Mr. Chairman.

HATCH: Thank you, Senator.

Senator McCaskill.

MCCASKILL: At the risk, Mr. Chairman, of being way, way away from you and you being someone I have worked with and respected greatly, I do want to gently correct something in your opening statement. The first nominee of President Trump that this Senate considered was

confirmed by a vote of 98 to 1. I would not consider that a partisan vote. The second nominee of President Trump was confirmed by a vote of 88 to 11. Once again, I would not consider that a partisan vote.

So I really do think we are all trying to look at each nominee individually. And I have had a chance to review Congressman Price's questioning of Secretary Sebelius and I can assure you, Mr. Chairman, it was no beanbag. It was tough stuff.