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Senate Grills Trump's Health Secretary Pick; Price: Medicaid Not Responding To Needs Of Recipients, Price: No One Will Lose Coverage Under New Health Care. Aired 12:30-1p ET

Aired January 24, 2017 - 12:30   ET

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

CLAIRE MCCASKILL, (D) MISSOURI: -- and I have had a chance to review Congressman's Price's questioning of Secretary Sebelius. And I can assure you Mr. Chairman, it was no bean bag. It was tough stuff. So I think all of this looks different depending on where we're sitting. And I wanted to make that point.

[12:30:22] And as to passing Obamacare without one Democratic vote, we're about to repeal Obamacare without one Democratic vote. This will be a partisan exercise under reconciliation. It will not be a bipartisan effort. And what we have after the repeal is Trumpcare. Whatever is left after the dust settles is Trumpcare.

Now, I know the president likes to pay close attention to what he puts his name on. And I have a feeling, congressman, that even though you keep saying today that Congress will decide, you're not really believing are you, that your new boss is going to -- not weigh in on what we -- what he wants Congress to pass? We're not going to have a plan from him?

TOM PRICE, (R), HHS SECRETARY NOMINEE: We look forward to working with you and other members --

MCCASKILL: And my question is, are we going to have a plan from the president? Will he have a plan?

PRICE: If I have the privilege to being confirmed, I look forward to working with the president and bringing a plan to you.

MCCASKILL: Great. So, the plan will come from President Trump, and you will have the most important role in shaping that plan as his secretary of Health and Human Services, correct?

PRICE: I hope I have input, yes, ma'am.

MCCASKILL: Yes. OK. So whatever Trumpcare ends up being, you will have a role in it. And I think it's really important to get that on the record. Now, when we repeal Obamacare, we're going to do a tax cut. Does anybody in America who makes less than $200,000, are any of them going to benefit from that tax cut?

PRICE: It's hypothetical and you all are the once that --

MCCASKILL: No, no, no, it's not hypothetical. When we repeal Obamacare, there are taxes in Obamacare. And when it is repealed, there is no question that taxes are going to be repealed. I promise you, the taxes are going to be repealed. When those taxes are repealed, will anyone in America who makes less than $200,000 benefit from the repeal of those taxes?

PRICE: I look forward to working with you on the plan and hopefully that will be the case.

MCCASKILL: No, no, no, no. I'm asking, the taxes are in there now, does anybody who makes less than $200,000, pay those taxes now?

PRICE: It depends on how you define the taxes. There many individuals who are paying more than they did prior to that point.

MCCASKILL: No, I'm talking about taxes, taxes that we had Cadillac tax has not been implemented, so that doesn't affected anybody. I'm trying to get at the very simple question and I don't think you want to answer it. That in fact, when Obamacare is repealed, no one in America who makes than less than $200,000 is going to enjoy the benefit of that.

PRICE: As I say, I look forward to -- if I'm confirmed, I look forward to working with you to make certain that that's the case.

MCCASKILL: That's not an answer. So we'll go on. OK. We talked to my office, ending Medicare as we know it, your plan and that you have worked on for years is converting Medicare to private insurance markets with government subsidies, correct?

PRICE: Not correct.

MCCASKILL: Well, we talked yesterday, and we kind of went through this in my office. And by the end of our conversation, you admitted to me, and I'm going to quote you that your plan for Medicare in terms of people getting either tax credits or subsidies or whatever -- however you're going to pay for the Medicare recipients would be them having choices on a private market. And you said, yes, it was pretty similar to Obamacare, with the exception of the mandate. Didn't you say that to me yesterday?

PRICE: That's a fairly significant exception.

MCCASKILL: Well, but these people are old. They don't need to be mandated to get insurance. It's not like a 27-year-old who doesn't think he's going to get sick. You don't need a mandate for people who are elderly. They have to have health insurance. So, the mandate is not as relevant. But didn't you admit to me that Obamacare and private markets is very similar to what you were envisioning for Medicare. Didn't you use the phrase, pretty similar?

PRICE: -- that there are some similarities. I think what I said though was that the mandate was significant.

MCCASKILL: Well, the mandate is significant, I get it in Obamacare. But we don't need a mandate for seniors, would you agree with that? That you don't need to tell seniors they need health insurance? PRICE: What I hope is that, we don't need a mandate for anybody so they're able to purchase the kind of coverage that they want and not that the government forces them to buy.

MCCASKILL: OK. Finally, you want to block grant Medicaid for state flexibility and efficiency, correct?

PRICE: I believe that Medicaid is a system that is now not responding necessarily to the needs of the recipients. And consequently, it's incumbent upon all of us as policymakers to look for a better way to solve that challenge.

MCCASKILL: Are you in favor of block granting Medicaid?

[12:35:02] PRICE: I'm in favor of a system that is more responsive to patients in the Medicaid system.

MCCASKILL: Are you in favor of block granting Medicaid? It's a really simple question, congressman. I mean here's your confirmation hearing for the most powerful job in health care in the country. I don't know why you wouldn't be willing to answer whether or not you're in favor of block granting Medicaid. That's not that complicated.

PRICE: I'm in favor of making certain that Medicaid is a system that responds to patients, not the government.

MCCASKILL: OK. I don't understand why you won't answer that. And I don't have time. I know I'm over. I will probably -- I don't know if we're going to get another round, Mr. Chairman. Should I ask my last question or are we going to get another chance?

ORRIN HATCH, (R) CHAIRMAN, FINANCE COMMITTEE: I'm going to allow additional questions. I hope that not everybody will take the opportunity.

MCCASKILL: OK. I won't disappoint you, I'm sorry.

HATCH: I will not call it a second round though.

MCCASKILL: OK.

HATCH: Let me just on that point say that Obamacare raised taxes on millions of Americans, families across income levels. The Nonpartisan Joint Committee on taxation in may of 2010 analyses identified significant widespread tax increases on taxpayers earning under $200,000 contained in the ACA. And then for example, for 2017, 13.8 million taxpayers with incomes below $200,000 will be hit with more than $3.7 billion, with a "B," in Obamacare tax sites from an increase in the income floor for the medical expense deductions. Obamacare has led to middle class tax hikes without question. It's led to fewer insurance options, higher deductibles and higher premiums. So, I think those are facts that can't be denied.

MCCASKILL: I'll be -- I'll look forward to looking at those facts because somewhere in this mix we've got alternative facts.

PRICE: Well, in just on that --

HATCH: But I think these are right, I can tell you that.

MCCASKILL: Well, I think mine are right.

PRICE: Mr. Chairman, just a point of privilege to respond?

HATCH: Yes, sir.

PRICE: On this point, no alternative facts. The Republicans in last year's Reconciliation Bill cut taxes for one group of people. They cut taxes for the most fortunate in the country. That's a matter of public record. It's not an alternative factor or universe. People making $200,000 and up got their taxes cut. That was in the Reconciliation Bill of the Republicans last year.

HATCH: Well, let's see whose next here. I don't agree with that. But we'll see whose next. Senator Grassley --

UNIDENTIFIED MALE: Cassidy.

HATCH: Oh, Cassidy. Oh, I didn't see it, Senator Cassidy and then senator Grassley.

BILL CASSIDY, (R) LOUISIANA: Thank you, Mr. Chairman. Dr. Price, how are you?

PRICE: I'm well, senator.

CASSIDY: Let's talk a little about Medicaid because we're getting this kind of rosy scenario of Obamacare and of the Republican attempt to replace it. It does seem a little kind of odd. First, I want to note for the record that President Trump has said in various ways that he doesn't want people to lose coverage. He actually would like to cover as many people as under Obamacare, wishes to take care of those with pre-existing conditions and to do it without mandates into lower costs. Those will be your marching orders, fair statements?

PRICE: Absolutely.

CASSIDY: Now, let's go to -- you and I, we talked at a previous meeting. We both worked in public hospitals for the uninsured. And for the poorly insured, folks like Medicaid.

Now, let's just talk a little bit about Medicaid. Why would we see patients on Medicaid at a hospital for the uninsured? If they wanted to see an orthopedic and orthopedist in private practice, does Medicaid pay a provider well enough to cover costs of seeing an orthopedic patient?

PRICE: Oftentimes, it does not. And in fact as you well know, as I mentioned before, one out of three physicians who ought to be able to see Medicaid patients in this nation, do not take any Medicaid patients. And there's a reason for that whether it's reimbursement or whether it's hassle factor or whether it's regulations or the like. But that's a system. It isn't working for those patients. And we ought to be honest about that and look at that and answer the question why and then address that.

CASSIDY: I will note that one. The house version of the ACA passed. And Robert Pear in the "New York Times" wrote an article about a Michigan physician, who -- an oncologist, who had so many Medicaid patients from Michigan Medicare that she -- Medicaid that she was going bankrupt. And she had to discharge patients from her practice.

Now, the ranking members said we can't have alternative facts. I agree with that. And we also know that New England Journal of Medicine article speaking about Medicaid expansion in Oregon about how when they expanded Medicaid in Oregon, outcomes did not improve. So, I suppose that kind of informs you as you as we see -- as you say we need to make Medicaid something that works better for patients.

[12:39:51] PRICE: Absolutely. And we need to look at the right metrics. Just gaining coverage for individuals is an admirable goal. But it is -- it ought not be the only goal. And we must have a goal in health care specially to have keep the patient at the center and realize what kind of care and coverage we're providing for people on the ground, for real people and real lives, and whether or not we're affecting them in a positive way or a negative way. If we're affecting them in a negative way, then again, we need to be honest with ourselves and say, how can we improve that?

CASSIDY: Now, a lot of times there's this kind of conflation of per beneficiary payments to states per Medicaid enrollee and block grants, which to me is a conflation. I'll note that Bill Clinton on the left and Phil Graham and Rick Santorum on right proposed per beneficiary payments some time ago. And it's actually how -- would you agree with this, how the federal employee self-benefit program pays for these federal employees, they pay per beneficiary payment to a insurer, fair statement?

PRICE: Correct.

CASSIDY: Wouldn't it be great if Medicaid worked as well as the federal employees of benefit program in terms of improved outcomes?

PRICE: But, it wouldn't be. In fact when you talk about the Medicaid population, it's not a monolithic population as you well know. There are four different demographic groups within it, seniors and disabled and then healthy moms and kids, by and large. And we treat each one of those folks exactly the same from the Medicaid rules.

CASSIDY: So, when you're pressed on whether, by golly, you believe in block grants, is there any nuance? I don't hear any of the nuances that we're discussing off ward in that question. But frankly you can't address that, are you speaking about per beneficiary payment? Are you speaking about each of those four, one of those four? How do you dice that? New York is an older state demographically. Utah is a very young statement, fair statement?

PRICE: Absolutely. And that -- and those are the things that I think we tend not to look at, because they're more difficult to measure. They're more difficult to look at. But when we're talking about people's lives, when we're talking about people's health care, then it's imperative that we do the extra work that needs to be done to determine whether or not, yes, indeed, the public policy that we're putting forward is going to help you and not harm you.

CASSIDY: Now, let me ask because there's also some criticism of your proposal about health savings accounts. I love them because they activate the patient. I think we're both familiar with the Healthy Indiana Plan where on a waiver they gave folks of lower income health savings accounts and had better outcomes, decreased the E.R. usage. Any comment on that?

PRICE: Just that when people do engage in their health care, they tend to demand more, they tend to demand better services. And individuals that have greater opportunity for choices of who they see, where they're treated, when they're treated and the like, have greater opportunity to gain better health care.

CASSIDY: So going back to not one to have alternative facts if we contrast the experience in Healthy Indiana with the experience in Oregon where a National Bureau of Economic Research I think if I get that acronym correct, published in New England Journal of Medicine found no difference outcomes in those who are fulfilled through a Medicaid expansion program in Oregon, contrast that absence of good effect that you in outcomes, with that and which Indiana attempted to engaged patient to become activated in their own care, E.R. usage actually fell but outcomes improved. I think in our world of standard facts, I kind of like your position. Thanks for bringing a nuanced informed view to the health care reform debate, Dr. Price.

HATCH: Thanks, senator. Senator Grassley.

CHUCK GRASSLEY, (R) IOWA: Two statements before I ask a couple questions. One is, it's kind of a welcome relief to have somebody of your profession in this very important role, particularly knowing the importance of the doctor/patient relationship, because in my dealing with CMS and HHS over a long period of time, I think that the bureaucracy has been short of a lot of that hands-on information that people ought to have.

And secondly, when you were in my office, we discussed the necessity of your responding to congressional inquiries. And you very definitely said you would. I -- tongue in cheek said maybe you ought to say maybe because a lot of times they don't do it. But since you said you would, I will hold you to that and appreciate anything you can do to help us do our oversight.

As a result of oversight, I got a legislation passed a few years ago called a Physician's Payment Sunshine Act. And the only reason I bring this up is because it took Senator Wyden and me last December working hard to stop the House of Representatives from gutting that legislation in the Cures Act that passed. And I want to make very clear that the legislation I'm talking about doesn't prohibit anything. It only has reporting requirements because it makes it very, very -- well, it brings about the principle of transparency, brings accountability.

[12:45:04] And I've got some studies here that we did. And some newspaper reports on them, particularly one about a psychiatrist at Emory University that was not reporting everything that they should report. And even the president of the Emory University came to my office and said, "Thank you for making us aware of this stuff. I want to put those in the record."

But since you're administering this legislation and since Senator Blumenthal and I will think about expanding this legislation to include nurse practitioner and physicians assistant, I hope that I could get your commitment that you will enforce this act the way it was intended to be enforced because even under the Obamacare administration, after we got it passed, it was three years getting this regulations, to get it carried out.

So, effectively, it's only been working for about two or maybe two and a half years. So I would like to -- if you're confirmed, would you and the Department of Human -- Health and Human Services work with me to ensure that this transparency initiative is not weakened?

PRICE: We look forward to working with you, sir. I think in transparency in this area and so many others is vital. Again, not just -- not just in outcomes or in pricing but in so many areas so the patients are able to understand what's going on in the health care system.

GRASSLEY: Thank you.

Now, last one deals with vaccine safety. You're a physician. I believe you would agree that immunization is very important for modern medicine and that we've been able get rid of those smallpox way back in '77, worldwide polio, I think, in 1991, at least in the western hemisphere and all that. So, as a physician, would you recommend that families follow the recommended vaccine schedule that has been established by experts and is constantly reviewed?

PRICE: I think that science and health care has identified a very important aspect of public health, and that's the role of vaccinations.

GRASSLEY: Thank you very much. I yield back my time.

HATCH: Thank you, senator. Senator Stabenow.

DEBBIE STABENOW, (D) MICHIGAN: Thank you, Mr. Chairman. First, I would ask in my consent that a series of stories from individuals at a public forum that was held last week of my colleagues, people concerned about policies that (inaudible) authored in about issues we're talking today that that needs included in the record.

HATCH: Without objection.

STABENOW: Thank you very much. Welcome, Congressman Price, and guest.

PRICE: Senator.

STABENOW: Appreciate our private discussion as well as the discussion this morning. I want to start right out with lots of questions and see if we can move through some things quickly. You said this morning that you would not abandon people with pre-existing conditions, is that basically what you're talking about is high-risk pools, is that one of the strategies that you're thinking about? I've heard that talked about this morning.

PRICE: I think high-risk pools can be incredibly helpful in making certain individuals who have pre-existing illness are able to be cared for in the highest quality manner possible. I think there are other methods as well. We've talked about other pooling mechanisms. The destruction of the individual small group market has made it such that folks can't find coverage that's affordable for them. And one of the ways to solve that challenge is to allow folks in the individuals and small group market to pull together.

In fact, I think we talked about this your office. With the old blue heel model being the template for or individuals who aren't economically aligned are able to pull together their resources solely for the purpose of purchasing coverage.

STABENOW: But let me just stress that for about 35 years we have tried high-risk pools, 35 states had them before the Affordable Care Act. And frankly, it didn't produce great results. In 2011, 0.2 percent of the people with pre-existing conditions, 0.2 percent were actually in a high-risk pool. And the premiums were 150 to 200 percent higher than standard rates for healthy individuals. And they had lifetime and annual limits on coverage and cost states money. So, that was the reality before we passed the Affordable Care Act.

So, let me also ask you, when President Trump said last weekend that insurance was going to be much better, do you think that insurance without protections for those pre-existing conditions or without maternity coverage or without mental health coverage or insurance that would reinstate tax on cancer treatments is better?

[12:50:04] PRICE: Well, I don't know that that's what he was referring to. I think --

STABENOW: Well, he said that, it would be better. And if we, in fact, took away -- if we went to high-risk pools instead of covering people with pre-existing conditions or if we stopped the other coverage we have now, I'm just wondering if you define that as better.

PRICE: Well, let me -- if you'd have to give me a specific --

STABENOW: Well, let me give you --

PRICE: What's better for you may not be better for me or somebody else. And that's the important thing that I'm trying to get across. And that is that patients need to be at the center of this, not government. Should government be deciding these things or should patients be deciding these things?

STABENOW: Prior to the Affordable Care Act, about 70 percent of the private plans that a woman could purchase in the marketplace did not cover basic maternity care. Do you think that that's better, not to cover basic maternity care?

PRICE: I presume that she wouldn't purchase that coverage if she need it then.

STABENOW: She would have to pay more, just as in general for many women, just being a woman with a pre-existing condition. That is the reason why we have a basic set of services covered under health care. So it's just a different way of looking at this. This is something where, sure, if a woman wanted to pay a premium, wanted to pay more, she could find maternity care. We said in the Affordable Care Act, that's pretty basic. And for over the half the population who are women, maternity care ought to be covered.

And let me go to another one. Do you believe mental health services should be a guaranteed benefit in all health insurance plans?

PRICE: I've been a supporter of mental health care inclusion, yes.

STABENOW: So, mental health should be a defined benefit under health insurance plans?

PRICE: I think that mental health illnesses ought to be treated on the same model as other physical illnesses.

STABENOW: I agree with you. On Medicare, and we just spend a lot of discussion, and I have to say also with the nominee for office management and budget also talking today about medicare and social security, I personally believe people on Medicare should be very worried right now in terms of what overall we're hearing. But I did want -- my time is up. I did want, congressman, just to indicate a message from my mom who's 90 years old, who said that, she doesn't want more choices. She just wants to be able to see her doctor and get the medical care that she needs. She is not at all supportive of the idea of Medicare in some way being changed into premium support into a voucher.

So, I'm conveying to you somebody who's getting great care right now and she's not interested in more choices. She just wants to keep her care. Thank you.

PRICE: If I may Mr. Chairman, I would just convey to Medicare population in this nation that they don't have reason to be concerned. We look forward to assisting them and gaining the care and coverage that they need.

STABENOW: Thank you.

HATCH: Thank you. Senator Cantwell.

MARIA CANTWELL, (D) WASHINGTON: Thank you, Mr. Chairman. Congressman Price, sorry we haven't had a chance to talk.

PRICE: I apologize.

CANTWELL: I think, no, I think both of us have tried and it's just a myriad of consequences. PRICE: Weather.

CANTWELL: But I wanted to ask you broadly, I know a lot of my colleagues have been asking you about Medicaid. But what do you think is the rise in Medicaid cost? What is it due to?

PRICE: Well, I think it's multifactorial. I think that we've a system that has many, many controls that are providing greater costs to the provision of the care, that is -- that's being provided. I think that oftentimes we're not identifying the best practices in the Medicaid system, so that patients move through the system in a way that's much more economical and much more efficient and effective, not just from a cost standpoint, but from a patient standpoint. There are so many things that could be done for, especially the sickest of the sick in the Medicaid population, where we could put greater resources and greater individual attention to individual patients.

As you know, in a bell curve of patients in any population, there are those that are the outliers on the high side, where they're -- they -- that the resources spent to be able to provide their care is significant. And if you focus on those individuals, then you oftentimes -- specifically, then you oftentimes can provide a higher level of care and a higher level of quality of care for those folks and a more responsive care for those folks at a lower cost and move them down into the mainstream of the bell curve.

CANTWELL: Okay. Well, you brought up a couple of interesting points. And I want to follow up on that. But specifically, if I started that conversation, I would start with two big phenomenons. One, people living longer, because the longer they live, the more Medicaid they're going to consume. If you're living, you know, 10 or 15 years longer than we've had in the past, they're going to consume more health care, and second, the baby boomer population reaching retirement age.

[12:55:13] Those two things are ballooning the cost of health care in general and, specifically, for the Medicaid population. And I want to make sure I understand where you are, because I feel like the administration is creating a war on Medicaid. And you're saying that you want to cap and control the cost. And what we've already established in the Affordable Care Act are those things that are best practice incentives and ways to give the Medicaid population leverage in getting affordable health care.

So I want to understand if you are for these things. For example, we provided resources in the Affordable Care Act for -- to rebalance off of -- for Medicaid patients off of nursing home care on to community- based care. Why? Because it's more affordable. So do you support that rebalancing effort?

PRICE: I would respectfully, senator, take issue with your description of war on Medicaid, that what we desire and want to do is to make certain that Medicaid population is able to receive the highest quality care. I've cared for thousands of Medicaid patients.

Now, the last thing that we want is to decrease the quality of care that they have access to. And clearly, the system isn't working right now. So moving toward home-based care is something that is -- that is -- if it's right for the patient, it's a wonderful thing to be able to do. And we ought to incentivize that. There's so many things we could do in Medicaid that would provide greater quality of care that we don't incentivize right now.

CANTWELL: We did incentivize it in the Affordable Care Act in your state and about other 20 states actually did it. They took the money from the Affordable Care Act. In fact, Georgia received $57 million in transition to make sure Medicaid beneficiaries got care in community-based care. And it's been able to shift 10 percent of their long-term costs, basically, to that community-based care. So, huge savings, it's working. So, are you for repealing that part of the Affordable Care Act?

PRICE: What I'm for is making certain, again, that the Medicaid population has access to the highest care possible. And we'll do everything to improve that because right now, so many in the Medicaid population don't have access to the highest quality care.

CANTWELL: I would hope you would look at this model, and you'd also look at the basic health plan model which is, again, what I think you're proposing and what the administration is refusing to refute, when the president said, I'm going to protect these things. And my colleague, Senator Sanders brought this up and said, "Are you going to protect this?" And then the White House chief of staff is now saying, "No, no, we are going to basically cap Medicaid spending. It's a problem.

What we want to do is we want to give them leverage in the marketplace. That's what the basic health plan does. That's what the community-based care plan does. It gives them the ability to get more affordable care at better outcomes and is saving us money. So, if you could give us a response. I see my time is expired. Look at those two programs and tell me whether you support those delivery system reforms in the Affordable Care Act.

PRICE: Be happy to.

CANTWELL: Thank you.

HATCH: Thank you, senator. That would end our first round. I'd like to not go through a full second round. But we've got some additional senators here who would like to ask some more. So I guess we'll start with Senator Wyden.

RON WYDEN, (D) OREGON: Thank you, Mr. Chairman. Congressman, I have several ideas on how --

(END VIDEO CLIP)

WOLF BLITZER, CNN ANCHOR: All right, we're going to break away from the hearing momentarily to assess what we've just heard, an important hearing before the Senate Finance Committee, the confirmation process for Dr. Tom Price, the congressman who has been nominated to become the next secretary of Health and Human Services. It's already three hours, Jake, that they've been hearing the testimony, the confirmation process going forward. A lot of Democrats are deeply concerned about this nomination.

JAKE TAPPER, CNN ANCHOR: They are. And they've been really trying to press for specifics in terms of what exactly will be the bill, the legislation that replaces Obamacare after Republicans repeal it. And even just basic opinions. Kellyanne Conway, President Trump's top adviser, has said publicly that they are going to take Medicaid and make it a block grant program, meaning the money instead of going from the federal government to individuals will go to states. And states will decide how to met out that money.

And Congressman Price wouldn't even offer an opinion. Senator Claire McCaskill, Democrat of Missouri, was just asking, are you in favor of block granting Medicaid, and he wouldn't answer the question. Now, being somebody who interviews people, and as are you, Wolf, I -- you can sympathize with the senator and trying to get just a basic answer to the question.

[13:00:01] Are you in favor of this step that President Trump's top adviser, one of them, has said is going to happen. And given that this is something that will affect millions of Americans. I certainly think it's relevant. But the goal for a lot of these hearings is to --