Full Committee Hearing with Health and Human Services Secretary Robert F. Kennedy, Jr.

The committee will come to order. As a key leader in the Trump administration and the Make America Healthy Again movement, you've given a voice to the reality that Americans do not believe that the healthcare status quo works for them. Despite spending $5.3 trillion annually on healthcare, more than six in 10 Americans have at least one, one chronic disease. That has cost us dearly in terms of our health, quality of life, as well as taxpayer dollars. On behalf of the millions of Americans who are demanding better from our health and food systems, and for using HHS as a platform to make America healthy again, our health system is full of misaligned incentives, the most glaring being that reimbursement is concentrated to patients who are already sick and does too little to help Americans stay healthy. Just this week, we held a field hearing in Florida on preventive care where we heard from local medical professionals who, because they are at the forefront of modern medicine, help their patients get back to the basics of a healthy life: nutrition, wellness, exercise, and preventive medicine. It was clear from witness testimony that the movement that you help lead has begun putting lots of thought into how we realign health incentives in support of this goal. It is not just lifestyle choices undermining the health of the American people. Industry consolidation, with huge companies swallowing up various parts of the healthcare system, has helped pad the bottom line of big corporations while doing little to support the health or well-being of working-class Americans. Sixteen years after Democrats promised Obamacare would be the silver bullet for lowering prices, healthcare costs and insurance company profits have never been higher. That's why the Ways and Means Committee is focused on addressing consolidation and vertical integration in the healthcare industry to expand access and lower cost. Earlier this year, we questioned the CEOs of major health insurance empires about how it could be that they are focused on lowering costs for patients and not expanding revenue for themselves when each insurer owns pharmacies, medical providers, and PBM middlemen. It would not surprise you to know they did not have good answers. Soon, we will have the same conversation with large hospital systems that have driven up prices without expanding access to care. That lack of access is especially important for the 60 million rural Americans who have higher rates of chronic diseases and have 43 percent higher mortality rates than urban Americans. We also need to do more to protect access to rural healthcare. I want to thank you for distributing the first installment of funds to states from the $50 billion Rural Health Transformation Program that Republicans enacted in the Working Families Tax Cuts. Rural communities in my home state of Missouri are thrilled to have this program to protect access to care and expand the quality of services offered to patients. I'd ask that you and your department work with Congress to continue stewardship and oversight of those critical funds to transform how healthcare services are delivered to rural Americans. And I hope we can find ways to work together to meaningfully reverse the incentives in healthcare that make it profitable to consolidate access at the expense of rural communities. Another critical priority of your administration is the First Lady's Fostering the Future program. Mrs. Trump joined the Ways and Means Committee yesterday in this very room for a special roundtable featuring two foster youth who shared their stories and highlighted the importance of this initiative to help more foster youth live a life of their own choosing. Members of this committee have introduced bipartisan legislation that complements the First Lady's initiative and represents the most significant reforms to the Chafee Foster Youth program since 1999. We look forward to your partnership in turning these policies into law and then implementing them. We also need to work together to address fraud in our healthcare system. Every dollar stolen by fraudsters, illegal immigrants, and criminals is one less dollar that benefits the American people, including the $60 billion lost in waste, fraud, and abuse in Medicare alone. We must hold the criminals who steal billions from the American people accountable. One has to look no further than the alleged $3.5 billion of Medicare hospice fraud in L.A. County alone to know that this is a massive scandal that is waiting to be uncovered. I applaud your work in helping uncover numerous outrageous examples of fraud and look forward to providing you and the department the tools you need to root it out. I'm glad that the Trump administration is taking proactive steps to lower healthcare costs and expand access to rural communities, and the President's new anti-fraud task force is so important for identifying and prosecuting criminals. I look forward to discussing these issues and others today, and I'm pleased to recognize the Ranking Member Neal for his opening statement.

Thank you, Mr. Chairman. Mr. Secretary, welcome. We share a heritage as sons of the Commonwealth. I was in that audience the day before the presidential election in 1960 as Senator Jack Kennedy finished his campaign in Waterbury, Connecticut, in Springfield, Massachusetts, and that night in Boston, Massachusetts. Twenty-four hours later, he was the President-elect. The joy in our home could hardly be calculated in just comments like this. Stayed up all night for that result. We watched him declare victory the next day, and we were delighted. I passed out pamphlets for your dad when he ran for president in 1968. I was a delegate for Teddy in 1980 when he ran, and I ran his campaigns in Western Massachusetts. Great friends with your brother Joe, your nephew Joe, and your cousin Patrick. Together with witness two days ago when five governors of Massachusetts, Maura Healey, Mitt Romney, Bill Weld, Mike Dukakis, and Deval Patrick all gathered to celebrate the signing of what we believe to be the antecedents of the Affordable Care Act, all very capable people regardless of party. We built in Massachusetts a mecca of healthcare for the world. We're proud of it. It's the gold standard. It has drawn investment. Two days ago, Spain announced another $200 million that they would invest in our hospitals because they are destinations for the world. Our success has been beyond our wildest hope. Boston is the center of healthcare innovation in the world. CDC, NIH, Kendall Square, a fact, the highest concentration of research and development in the world in about an eight-block area. Our colleges, our hospitals, our nurses, our professionals, our advocates, all are extremely proud of what we did regardless of political party, and we don't want to see it dismantled. And by the way, as a footnote, Mr. Secretary, we also like Dunkin' Donuts coffee. We watch daily as the threats to this healthcare system that we have constructed, whether it's talking about measles and vaccinations. We remember what it was like before Dr. Salk's polio vaccine. My mom, who was a devotee of the Kennedy family, she said the way we prevented polio in the 50s was to stay out of fresh water in August. Let me say this: nothing has changed about the science of vaccines. We need people not to be preyed upon by demagoguery, and there should not be a politicization of these very issues. Let me go to some of the contradictions that the administration has made as we talk about budgeting. One trillion dollar cuts from our healthcare system, putting 440 hospitals at risk so that we can have a tax cut for the wealthiest among us, and that's based on tax distribution tables, that's not made up at this moment. Baseless claims about Tylenol and autism. This damage could be catastrophic. The administration's agenda includes obstacles to better healthcare. Costs are sky-high, but that has much to do right now with a lot of issues including tariffs in Iran. We want to push healthy eating for everybody, and I've not met any candidate anywhere who ever said, "Vote for me, I'm for more fraud." That doesn't happen. We want a fair and balanced approach to looking at it. A proposed cut of 12.5 percent to HHS. Let me remind all in this room, and you're going to be familiar with this name, Mr. Secretary, Silvio Conte. He was the Republican member of Congress in the district next to mine. He was the author of the LIHEAP program, and it has worked beyond any objective measurement that we believed at the time. He wanted to make sure that people had an opportunity in the climate of New England to heat their homes during the winter. One hundred fifty-nine thousand families in Massachusetts relied upon LIHEAP last year. Attacking childcare providers and delaying their payments means more parents will choose between the childcare and their paycheck. Families see through podcasts and campaigns. Sixty percent of the American family worries right now about affording healthcare. We should be fixing and repairing the parts of the healthcare system that we want to improve for all members of the American family. We should not be offering just to deflect blame. We should be pointing out this achievement. People should not have to choose between medicine and childcare. We delivered historic relief with Medicare negotiations. We capped out-of-pocket costs and we lowered premiums. We need to come to the aid of the American family at this very difficult time. Republicans need to understand that Americans deserve a fair shake. I'm going to close on the note that I opened with, Mr. Secretary, I think you're well aware of it. What we built in Massachusetts over these years since Senator Kennedy became president, it was done with Republicans and Democrats, but together we're immensely proud of what it was that we achieved and we don't want to see it dismantled. Thank you, Mr. Chairman.

Thank you, Ranking Member Neal. Today's sole witness is the Secretary of Health and Human Services, Robert F. Kennedy, Jr. The committee has received your written testimony and it will be made part of the formal hearing record. Secretary Kennedy, you have five minutes to deliver your remarks and you may begin when you're ready.

Now? All right. Thank you, Mr. Chairman, Ranking Member Neal, members of the committee, thank you for the opportunity to appear before you today to discuss the President's fiscal year 2027 budget request. We stand at a generational turning point. Our children are the sickest generation in modern history and decades of failed policy, captured agencies, and profit-driven systems have caused it. Parents across the country demand change and we are delivering it. We're ending the era of federal policies that fueled the chronic disease epidemic and replacing them with policies that put the health of Americans first. President Trump and I are challenging the status quo and the institutions that defend it as we work to make America healthy again. In just 15 months, HHS has delivered historic wins. We negotiated most favored nation drug prices with 16 of the largest pharmaceutical companies so Americans no longer pay more than other people in wealthy countries for the same medications. We're bringing real transparency to healthcare pricing so patients know the cost of care before they receive it. I used the full convening power of the federal government to bring health insurance CEOs to the table to reform prior authorization. We are cutting red tape, speeding decisions, and demanding transparency. We are also cracking down on waste, fraud, and abuse. This year HHS and USDA issued new dietary guidelines that put real whole food at the center of the American plate. We flipped the food pyramid upside down and sent a clear message to the American people: eat real food. HHS has also opened the door to partnerships with industry, trade associations, nonprofits, and advocacy organizations. More than 50 medical schools have committed to expand nutrition education from an average of just two hours to 40 hours. Food manufacturers are stepping up too; more than 40 percent of the food industry has committed to phase out petroleum-based dyes by year end, and many have already eliminated them. In conjunction with these efforts, FDA approved six natural food colorings derived from fruits and vegetables. Through President Trump's Great American Recovery Initiative, HHS is matching compassion with action to help Americans break the cycle of addiction. At HHS, we are prioritizing patients with ultra-rare diseases and their families and driving faster access to life-saving treatments. We're restoring gold standard science and integrity across the agency. We're protecting children from sex-rejecting procedures that expose them to irreversible harm. We're eliminating outdated and misleading warning labels on hormone therapies used to treat women during menopause. We're strengthening oversight of organ procurement. We're implementing Operation Stork Speed to ensure the safety and quality of infant formula. We're applying the same focus and urgency, as you mentioned, to rural America. The Rural Health Transformation Fund delivers the largest investment in rural health in our nation's history, $50 billion over five years to strengthen hospitals and ensure Americans can access the care they need no matter where they live. Members of Congress on both sides of the aisle have made rural health a clear priority in their conversations with me because every state is feeling the strain of hospital closures, workforce shortages, and gaps in access. HHS announced more than $135 million investment this month to expand rural residency programs and nutrition services. The data is clear: when physicians train in rural communities, they're more likely to practice there. The President's budget puts all these priorities in action. It invests in prevention because preventing disease costs less and delivers better outcomes than treating it. As my uncle President John F. Kennedy said, progress is a nice word, but change is its motivator and change has its enemies. We see those forces clearly: entrenched interests, defenders of a failing status quo, and institutions that put profits ahead of the American people. That resistance underscores the urgency of this moment. We can reverse the chronic disease, improve public health, and lower costs. I stand ready to work with this committee and Congress to seize this opportunity, implement and codify lasting generational reform in American healthcare. For our country, for our children, and for the health of the American people, together we can make America healthy again. Thank you very much.

Thank you. Without objection, each member will be recognized for four minutes to accommodate the Secretary's time. As always, we want to ensure that all members have an opportunity to ask questions of the Secretary. We'll now proceed to the question and answer session, start with Mr. Buchanan. Thank you, with out objection each member will be recognized for four minutes to accommodate the secretary's time. As always we want to ensure that all members have an opportunity to ask questions of the secretary. We will now proceed to the question and answer.

Thank you, Mr. Chairman. And I want to thank Secretary Kennedy and your leadership. It's been incredible. My mindset, the U.S. has spent $5.3 trillion on healthcare and getting sicker as a nation. Six in 10 Americans, 95 percent in terms of Medicare beneficiaries, have at least one chronic disease. Roughly half of the adult population is projected to be obese by the end of this decade. I believe this problem stems from unhealthy and ultra-processed foods, and I applaud HHS and its continued support and leadership on this issue. We must prioritize prevention as the key to reversing trends in heart disease, obesity, and diabetics. I believe the best way to do that is to bend the cost curve is by making sure that people don't get sick in the first place. I like to say to people who are, you need to be the CEO, I read it, of your own health, and I think that's critical. Mr. Secretary, I appreciate our strong partnership in advancing the health of this country. I look forward to continuing to work together to support a healthcare system that values prevention, not reaction. My one couple of questions I've got: together we've accomplished so many things to support health and prevention. For example, we've worked on new food pyramid as real food, cutting the ultra-processed foods. We're also brought back the presidential fitness guides, which I'm excited about. And I guess in terms of what some of the things that we've done, what do you think we could be doing more of in that space in terms of diet and exercise?

Well, the beginning, sorry, flipping the food pyramid and issuing new dietary guidelines was the beginning. When I came into office, I was handed the dietary guidelines that had been developed by the Biden administration. They were 453 pages long. They were incomprehensible. They reflected, they were written by food industry lobbyists and they reflected the mercantile impulses that had driven Fruit Loops to the top of the food pyramid. Fruit Loops isn't even a food; it's just poison. And we brought together the best nutritionists in this country from the best universities all over this country, a dozen of them, who worked 11 months to reform the dietary guidelines and offer for the first time not dogma-based guidelines, but science-based guidelines. Every recommendation is cited and sourced to multiple peer-reviewed publications. That's the beginning. The next part, we have to drive those changes into dietary culture in our country. We are aggressively using the food subsidies program with Brooke Rollins, my partner in this.

Let me mention I've got another question with one minute left, but I'm deeply passionate about promoting access to screening as a way to prevent diseases. Through my personal experience with Alzheimer's and lung cancer, I've become a strong believer in the power of detection and prevention. And I'd like to get just your thoughts and ideas on that in terms of screening, like lung screening for cancer and stuff like that.

Screening for prevention is absolutely critical. We are reforming now the USPSTF, which is the committee that decides on new procedures and interventions that need to get CMS compensation. And that committee has been lackadaisical and negligent for 20 years. We're now bringing new members on who have a clear mission. We're going to have much more frequent meetings. We're going to have for the first time transparency. We're going to, and we're making huge investments at NIH and elsewhere in doing the kind of science that we need to do better screening for Alzheimer's.

Thank you, and I yield back.

Thank you, Mr. Neal.

Thank you, Chairman. Mr. Secretary, fighting fraud is bipartisan here, as I noted earlier in my remarks that nobody ever campaigned with a bumper sticker that said, "Vote for me, I'm for more fraud." So fighting fraud certainly has considerable support across this Congress. And nothing makes me or you or others in this room madder than those who might rip off Medicare. So I think those who commit fraud ought to be held accountable. So let's talk about Lawrence Duran. He perpetrated what at the time was the largest therapy issue related Medicare fraud in history, hundreds of thousands of false claims. He was sentenced to 50 years in prison, and he and other collaborators were ordered to pay back $87 million in restitution. His sentence was commuted by the President. Did the President consult you as we pursue this fraud?

I don't know anything about that case, Congressman.

Fair enough.

I can say this: this has not been, although it's a bipartisan issue and there's bipartisan passion for this issue, the application, the implementation of anti-fraud has not been bipartisan.

Okay, so let me go to the next one, Mr. Secretary. How about Joseph Schwartz? He pleaded guilty last year to bilking taxpayers out of more than $38 million, paid himself millions of dollars along the way. His negligence as it related to nursing homes is well known to all of us. President Trump pardoned Mr. Schwartz. I'm assuming he didn't consult you on that either. If we're going to talk about fraud, it's not the people just at the lower end of the economic scale. If we're going to pursue fraudsters, it's not just the people who might make simple honest mistakes that could be corrected; it's the people at the top that help to perpetuate this fraud. And the administration's position seems to be that it's only the recipients and not the providers that can commit fraud. We are not defending fraud, we're not cheering for it, we're not excusing it. But there needs to be an even-handed approach, including not passing out pardons to people that might be supporters of the administration. So let me on a nice note thank your staff here in front of all for helping me out recently or helping my constituents out on an issue that related to daycare. Your staff came to the aid of a Head Start provider in my district and really helped out 100 families. The problem is that we don't want that to be something that can be completed by senior members of the Ways and Means Committee coupled with a group of administrators who know the problem and have come to the assistance of those who need it. But it shouldn't be that way; it needs to be more universal. And the cuts that are being proposed to these initiatives are not helpful to the American family. I look at these decisions, and if we're going to pursue fraud, Mr. Secretary, it has to be across the board. And we want an even-handed approach to these fraud investigations, including those whose schemes have cost the American taxpayers hundreds of millions of dollars. I yield back my time.

Mr. Smith.

Thank you, Mr. Chairman. Thank you, Secretary, for being here this morning and entertaining our questions. I represent one of the largest land area districts in the country, and most of my constituents live in rural and even remote areas. Agriculture is the engine of our economy in my district, and we're proud of our role in feeding not just America, but the world. Now before I get to my questions, I would like to stress the importance of modern agriculture practices in producing a healthy, affordable, and sustainable food supply. The agriculture industry depends on our standards and regulations being science-driven and risk-based. I do want to say that threatening the availability of technologies could inadvertently lower yields and actually increase the price of food at a time when many Americans are already struggling to make ends meet. So I encourage you to continue to bring farmers and ranchers to the table as you consider matters relating to agriculture. Moving on, I do want to talk about rural health. You mentioned the Rural Health Transformation program. I think that means a lot to so many of our constituents, our communities, our states. The RHT program's notice of funding opportunity recognized the important role of pharmacists in meeting rural communities' health needs. I believe that pharmacists are an underutilized part of our health system. Nearly nine in 10 Americans live within five miles of a pharmacy, making pharmacists among the most accessible health professionals. Because of the broad accessibility, I think there is more we should do to empower pharmacists to help meet rural health needs. That's why I introduced a bill we call ECAPS that would improve access to care for seniors across America by providing Medicare coverage of pharmacist-administered tests and treatment for common illnesses like COVID, flu, and strep. By allowing pharmacists to test and treat seniors for common illnesses, we can make these services more accessible and reduce pressure on emergency departments. Now I do want to ask: what is your approach to improving access to healthcare services for Americans who live in rural and remote areas, and what can we do to ensure Americans in rural areas aren't left behind in our healthcare system?

I mean, as last week I went to Arizona to announce an unprecedented $125 million investment in community health centers, which are serving 39 million Americans, mainly in rural areas around the country, to improve nutrition and also retention of their workforce, which is one of the reasons that so many of the our rural health program, so many parts of it are failing today. We've seen closures of 120 rural hospitals since 2010. It is a crisis when these hospitals close. It doesn't just deny access to healthcare, but those hospitals are economic drivers for their community. They're the highest paid jobs. They're oftentimes the biggest employer. That reason President Trump made the biggest investment in rural healthcare in American history, a $50 billion Rural Health Transformation Fund. Right now, Medicaid gives about 7 percent of its money to rural hospitals. And it's about $20 million a year. Well, we're increasing the flow of federal dollars to rural community healthcare by an extra $10 million a year. So that's a 50 percent rise over the next five years. And it's going to give those hospitals the ability to upgrade their infrastructure, to install telehealth, to move to AI, and to retain workers and do all the other things they need to achieve permanent stability.

I appreciate that. And just in closing, and I just want to note moving to CMMI, Center for Innovation, I appreciate its intent. I do believe it lacks some transparency, and especially when CBO found CMMI's activities increased direct spending by $5.4 billion. So my time has expired, but I would encourage you to take a look at that so that we can make sure that innovation drives cost savings and better outcomes rather than just driving more spending and not positive results. Thank you.

Yes, CMMI has been disastrously, disastrously mismanaged in the past. We are changing that. We're making it the center for innovation that Congress intended it to be.

Thank you.

Mr. Doggett.

Mr. Secretary, since waste, fraud, and abuse has been something of a watchword in this administration, I'm sure that you're familiar with the December 3rd Government Accountability Office response to a request by Chairman Smith, which reported significant agent and broker fraud with the Affordable Care Act, including brokers signing up people who didn't even know they were signed up. As you are aware, last May, under your authority, CMS fully reinstated all 850 brokers and agents who had been suspended back in 2024 because of suspected ACA fraud. Can you guarantee to our committee today that every one of those suspected brokers and agents was thoroughly investigated and found to be innocent of any fraud, any wrongdoing, or criminal activity?

I can tell you...

Can you, sir? Yes or no?

In terms of the...

You can't answer that. That is very troubling, I must say. 850 people accused of fraud suddenly reinstated all at once. Do you know whether any of these suspected fraudsters who were reinstated so swiftly were subject to any additional oversight under your authority? Have there been guardrails that have been put in place to ensure those 850 agents don't continue to commit fraud?

Congressman, I'm a lifelong Democrat, so I was shocked...

I don't care your party affiliation. We're all against fraud.

I was shocked when I came into this agency...

Were you shocked to see that 850 people who were suspended for fraud had been reinstated all at once?

I was shocked to learn that President Biden had directed my agency to stop all program integrity efforts in this agency and focus on enrollment.

I'm taking back my time, sir.

And that's what caused the problem that you're talking about.

President Biden's administration was the one that suspended 850 suspected fraudsters. Your administration was the one that let them all go back to work. Have any of them...

President Biden fired everybody in my agency except for six people who were involved in program integrity, the entire department.

Well, and in fact, under your leadership, you have suspended the very people at CMS who are responsible for overseeing any fraud in the program. But let me ask you with regard to fraud...

We've asked for them to come back. Fraud in any administration...

I understand you want to filibuster, go to the Senate, but would you please try to answer my question, sir? Have there been any new complaints against these 850 brokers?

As I said, I am happy to talk to get my staff to contact...

Question, sir. Have there been any new complaints against these 850 brokers?

As I said, I am happy to talk to get my staff to come and talk to you.

I'm not asking if you're happy to talk. I just want to know the answer to my question. Have there been any new complaints of fraud against these people?

I don't know why those people were reinstated. For as far as I'm concerned, it may be because of a lawsuit. I have to check on that.

Well, I wish you would. Thank you.

I can guarantee you there is no administration...

Reclaiming my time, sir, as it runs out. It is very troubling that the only fraud that Chairman Smith referred to as a smoking gun to deny affordable healthcare credits put the blame on the mother that was trying to protect a sick child, that nothing was done about that and the Secretary still doesn't know much of anything about it. As far as fraud, Paul Wozak is one who had $10 million of wages that he kept some of to buy a $2 million yacht. His mother contributed to the Trump campaign, and he no longer has to pay $4.4 million or stay in prison. Mr. Secretary, I want to know what role you play in the soft-on-crime approach to healthcare fraudsters. Have you recommended that any of these healthcare fraudsters should get pardons or commutations, or did the campaign contribution speak for themselves?

I don't think there's anybody in this country... I don't think there's anybody in this country who believes that this administration is soft on fraud. We're the first administration in history that's going after fraud in the cottage industry...

It's just the fraudsters who have the money and the cottage industry to get themselves pardoned and not even have to restitute what they've taken from those they've defrauded. It's really a disgrace. I'm surprised you would defend it.

It's not a credible story.

It's a fact, sir. It's not a story. It's a fact.

Mr. Kelly.

More fraudsters pardoned than any president in American history.

Your time has expired, Mr. Doggett. Mr. Kelly.

Thank you, Chairman. Mr. Secretary, thanks for being with us today. And as usual, the beatings will continue until morale improves. I did want to just talk about one thing real quickly. I'm really wishing you success in the rollouts of the bridge and balance models expanding seniors' access to weight loss drugs, and as Mr. Buchanan talked about, this is really critical. But at this point in today's hearing, I want to turn my time over to Mr. Schweikert from Arizona. I think he has some, would take more than four minutes for him to go through all the things he wants to ask you. But again, thank you for walking out of where you were into this. I appreciate what you're doing, and your family has always been a hallmark of American service. So thank you so much, Mr. Secretary. Mr. Schweikert.

Thank you, Mr. Kelly. And I appreciate him doing this. Let's actually do some waste and fraud where we have real money. I actually want to talk about what's often referred to as CPAP, the CDPAP, New York health. Let's actually use New York because that's actually what us in oversight have been looking at. Something is wrong when the biggest job creator in New York City over the last few years turns out to be a home visitation program that you all manage. We have some data here that basically says for every 1,000 residents 65 and up in New York State, the whole state, 171 are receiving these stipends, these payments. In New York, if New York itself was actually at the Medicaid population average, it would save $43 billion a year. When we start to actually examine and dive into the numbers, the disproportionate, yes, we have frauds here, frauds there, but we have entire states that seem to be helping this fraud along. What do I do to help a program like this that substantially expanded during COVID that we now have not only New York, but a handful of other states that seem to be using it as a jobs program and not a health program?

Senator, that is a huge problem. New York's, New York State pays on average 80 percent more per capita on Medicaid than any other state. So 80 percent over the average. And part of the reason for that, as you point out, are these waiver programs that the state, many of the states have now applied for and received. In the old days, Medicaid paid for medical procedures. So if you got a hernia operation, we could figure that out at CMS. We could see you had a scar, it was done by a licensed doctor, by a licensed nurse, and we could track to make sure it actually happened. The waivers allow people, family members who are taking care of an elderly parent to get paid for balancing the checkbook, for picking up the groceries, for driving somebody to a doctor's appointment. Today, the biggest job in New York, 650,000 people, the biggest employment niche is home care. These are family members who are getting paid to do things that they used to do as family members for free. And they, and this is ripe with fraud because we have no way at CMS to determine whether they actually performed that duty or not. We don't know whether you drove your grandmother to a doctor's office. So it's an opportunity for fraud, and states are, state corrupt people, fraudsters are taking that opportunity all over the country. And it's one of the reasons that Medicaid doubled during the Biden administration because we are paying for fraud now as much as for medicine.

Thank you, Mr. Secretary. And we get a round two. I yield back.

Mr. Thompson.

Thank you, Mr. Chairman, and thank you for your persistence in getting this hearing scheduled. And Mr. Secretary, thank you for finally appearing before our committee. Mr. Secretary, let's start with an easy one. Do you have a medical or public health degree?

No.

No?

No.

Yet you're overrunning doctors, scientists, and public health experts across our country. Your dangerous conspiracy theories are undermining safe and effective vaccines. Mr. Secretary, I want to echo my friend the ranking member's comments about polio. I remember as a kid, kids older than me in school with me who got polio. They lived with the lasting impacts of that infection for the rest of their lives. I was fortunate to get the polio vaccine. And I was fortunate to never get polio because of that vaccine. And because we're about the same age, I'm sure you have similar experiences. But now you undermine vaccines and are helping make diseases deadly again. Mr. Chairman, I ask unanimous consent to submit for the record this article from the Sacramento Bee about the rising measles cases in California.

With that objection.

Thank you. In 2000, measles were declared eliminated in the United States. And I've got a graph on the behind me that shows that shows that. Under four years of President Biden, there were 514 measles cases in the U.S. Under just one year of President Trump, there are nearly 2,300 cases. Mr. Secretary, kids have died because measles is running rampant under your watch. In large part because President Trump allowed your conspiracy theories to run our public health. Americans need serious leadership grounded in evidence and science. Instead, we have you and this president elevating misinformation and undermining basic public health. HHS should be led by professionals who respect science and data, listen to doctors, and put patients first, not by rhetoric, not by conspiracy, and not by ignoring established medical facts. So today, Mr. Secretary, this is not just about policy differences. It's about whether this department is going to protect the health of the American people or put them at greater risk. Right now, it looks like the latter. Let's not sugarcoat this. Americans are paying more for healthcare, not less. Families are being squeezed at every turn, and instead of relief, they're being handed policies that will make things much worse. You and this administration promised to lower costs. Instead, costs are rising. And you and this administration ripped healthcare away from millions of people. HR 1, the big ugly, big beautiful bill, whatever it's being called these days, cut a trillion dollars from Medicaid. That means fewer doctor visits, delayed care, and more people showing up in already overcrowded emergency rooms. Let's be honest where this leads. People will get sicker, preventable conditions will go untreated, and people will die. Mr. Secretary, you shouldn't be in this office. I yield back the balance of my time.

Mr. Schweikert.

Mr. Secretary, you are actually the first person I've had in my 16 years who's actually willing to have conversations with me on how to have the revolution of lowering the cost of healthcare and help our brothers and sisters be healthy. But I want to go to one that makes the lobbyist community pucker up because every other lobbyist seems to be working on this. These are just some of the MedPAC reports. You pay for them. They basically say Medicare Advantage, Medicare Part C, has a misalignment on the math. We need to come to a final conclusion, are these accurate or the stories I get from the lobbyists accurate, are the insurance companies accurate? Because the latest report says Medicare Advantage comes in at 114 percent of fee-for-service. In 2005, when we set up Medicare Advantage, which I'm a big supporter of a capitated model where you make your profit by helping your brothers and sisters be healthier instead of a model where you make your money by constantly risk-scoring them as sicker. And you saw last year's Wall Street Journal series showing how many people had been scored as being sick and they didn't have that disease, they had never been tested for that disease. 114 percent compared to 95 percent fee-for-service is about $1.75 trillion over 10 years, making it the single biggest misalignment in the federal government. Can I beg of you, and I know you're going to Dr. Oz and others, we need to put everyone in a room, maybe our actuaries, maybe my economists from the Joint Economic Committee who've been working on this for three years. It's a stunning amount of money. How do we use Medicare Advantage, a managed care model, to have your vision of they make a profit because you helped people be healthier? It may require a multiple-year enrollment so there's a payoff for the investment. 31 percent of Medicare spending is diabetes. What can I do to work with you? What can I do to move CMS and HHS to a vision here of healthcare for seniors?

Thank you, Congressman, and I'd love to have those discussions with you. I'll say that the fraud, a part of it is perverse incentives as you pointed out, and part of it is fraud. Medicaid, Medicare Advantage was created as a to end perverse incentives to give us value-based care as opposed to traditional Medicare. And in some ways, it's doing that. In every metric that we look at, people with Medicare Advantage are better off, they're healthier, they're getting treated better, they're more compliant than people who are getting cost or fee-for-fee-for-cost programs. One of the other problems is that one of the major problems is upcoding. And it's just rampant fraud throughout the system as you point out, and we are fixing that now for the first time. And I can tell you that we're already seeing some change in the discrepancy this year. We raised the premiums for or we're proposing to raise the premiums for Medicare Advantage by 2 percent whereas Medicaid, Medicare are going up by 5 percent.

Mr. Secretary, I want to propose a more radical solution of alignment of incentives. Get rid of the risk scoring. I would get rid of the star rating and do those scoring at the beginning and then design a system where as you help the enrollee get healthier, they benefit. I'm almost out of time. I want to thank you and the agency for also starting the things of wearables, the thing you can wear on your wrist, the thing you can wear, the thing and the ability to allow Americans to sort of have their own medical lab attached to them. Now we have to figure out how to allow it to prescribe. And with that, I yield back, Mr. Chairman.

Mr. Larson.

Well, thank you, Mr. Chairman and Mr. Secretary, welcome to the Ways and Means Committee. I want to first associate myself with the remarks of Leader Neal, especially as it relates to the great legacy of your family. There wasn't on my paper route, there wasn't a house whose door I didn't knock on where there was a picture of Pope John the 23rd and John F. Kennedy. That's how deep and incredible influence that the President of the United States, the first Catholic elected, had on generations of people and still every bit as much relevant today as he was in the 1960s. Your family and its legacy of public service deserves always to be acknowledged for the enormous sacrifice and their willingness to serve and to serve in the public interest. What Mr. Neal also pointed out, as my other colleagues, I think you can understand and appreciate the incredible frustration. President Kennedy said that science is the quiet power. And whether it comes to sending a man to the moon or vaccinations, President Kennedy was out front in terms of his belief in government and his belief in making sure that vaccines were provided for the health and well-being of the American people and the children that were all sworn to serve and protect. I would like, Mr. Chairman, if you would, to submit for the record the Connecticut Department of Public Health testimony on the establishment of vaccine standards.

Without objection.

Thank you, Mr. Chairman. I would also, Mr. Chairman, like to submit for the record a stark divide, Americans more confident in career scientists at the U.S. health agencies than leaders.

Without objection.

And I guess that's what it all comes down to when we look at the vaccination process. And I think everybody's entitled to their opinions and views, but we're not entitled to our own facts. And the facts, I think, speak clearly on this. When I confront doctors in my community, they say they're spending more time counseling people about taking their vaccination shots. We know what we were able to do just four years ago. The state of Connecticut braced for what they thought might be an outbreak of measles because a case was reported. But as it turns out, that was the only case, and it was attributed to the fact that people were vaccinated and that's what prevented that. And as Mr. Neal and others have mentioned, whether it's polio or whether it's measles, whatever the case may be, I think you can appreciate how deeply concerned people are about this and how the contrast between what your uncle and the President of the United States said in his beliefs and yours with respect to vaccinations. And with that, I see my time has run out. I'll yield back my time.

Thank you. Mr. LaHood.

Thank you, Mr. Chairman. Mr. Secretary, welcome. I want to get your opinion on the FDA. There's been broad reporting in the press on concerns that and mismanagement and bungled drug reviews at the FDA have chilled investments in life-saving innovative cures and that China is rapidly becoming the recipient of those investment dollars. I also serve on the Select Committee on China. And as we look at how do we win the strategic competition when it comes to investment in innovation, it's very important that we have a vibrant, efficient FDA. And I understand that you aren't involved in those drug review decisions and I intend to take that up with Dr. Markery. But it seems like a squandered opportunity to maintain America's position as the premier destination for investment in medicine and modern technology. Can you comment on that, Secretary?

What I would comment is I acknowledge that Congress is eating our lunch in that that happened during the Biden administration. We are redressing that. We have broken every record for drug approvals. We approved 67 drugs this year, new drugs. We approved, which is a record, we approved 39 new devices, which is a record. We approved 91 new generic drugs, which is a record. We are 100 percent online to make all of our PDUFA deadlines, which does not usually happen. We have dramatically shortened the period from approval from conception to commerce. We just approved two new drugs, two new oncology drugs in record time, one in 45 days. The closest before that was 310 days. The other in 55 days. These are two drugs that are so effective that they can bring people out of hospice. So we are doing, we've moved from two-to-one trials to one-to-one trials where it's appropriate. We're using AI to dramatically shorten the times to approval. We're doing things that no other agency has with greater competence, greater efficiency than any other agency in history. You hear these stories about a drug that's been refused, you read about them in the Wall Street Journal. This week they were talking about a melanoma drug. Every panel within FDA, all the career panels, the career scientists who looked at that drug said it was not effective. The drug maker was told to do a two-arm trial, he did a one-arm trial. And all the people who were tested also received a chemotherapy drug, so we don't know what the effect was. And Marty made the correct decision to not approve that drug, but everybody goes after him because the industry is so powerful, they own Congress, they own the media, and they can beat up Marty Makary because he's trying to do change over there.

Got it. I want to switch subjects. I'm also the chair of the Work and Welfare Subcommittee, which has jurisdiction over foster care and the Chafee programs. Yesterday we had the First Lady here to talk about Fostering the Future, her initiative when it comes to foster care. Can you comment on the role HHS is playing in implementing the Fostering the Future executive order to help improve outcomes for foster youth?

President Trump and the First Lady, who's been extraordinary for us to work with, have said their vision is one family per one child. Right now we have a two-to-one ratio. And part of the reason for that is that the Biden administration was excluding an entire class of people because of their religious beliefs. We and told the states to actually pass laws, instructed them to pass laws refusing families who had religious, certain religious beliefs, mainly Christian religious beliefs, to not be allowed to have children. And that dramatically constricted the pool of available parents. We are changing that. We're also addressing one of the big issues, which is to allow children to stay with their families of origin. One of the biggest drivers of those separations is drug abuse. And we are aggressively going after these issues. And partially as a result of our work, the number of foster children has dropped from 425,000 to 325,000 because there's more kids who were doing early preventative services on and intervening early with parents who have drug addiction problems.

Thank you, Mr. Secretary. I yield back.

Mr. Davis.

Thank you, Mr. Chairman. Secretary Kennedy, thank you, and I too share the admiration of your family's legacy and contributions to the development of this nation. In my district in Chicago, childcare can be hard to find. And when parents can't find childcare, they can't go to work. Last week, President Trump said, and I quote, "The United States can't take care of daycare because we're fighting wars and need to spend our money on those." Do you agree with President Trump that we should cut childcare to pay for his war in Iran?

I don't think that that's what President Trump meant, Congressman, and I appreciate you very much for actually giving me an opportunity to answer your question, which none of your colleagues have done. They've all shut me up and they've talked about science, but science is about debate. So they give a little speech that they can go and market for fundraising, and then they don't allow me to answer the question, and I deeply appreciate the respect that you've shown. In this budget, we were told to make a 12 percent cut across our department because Congress wrote up a $34 to $39 trillion debt. So we're now having to tighten our belt. The two programs that I protected and that Russ Vought protected were the Head Start program. So it is getting no cuts. And incidentally, there have been no cuts to Medicaid. Look at the CBO.

I've got another question that I need to ask. Black women are nearly three times as likely to die from pregnancy-related causes as white women. Yet the Trump administration is undermining Black maternal health from all sides. The GOP slashed over a trillion dollars from Medicaid, which pays for over 40 percent of births in the United States. President Trump just proposed cutting maternal and child health programs by over $800 million. DOGE cuts funds for several research projects that could save countless Black mothers, like the Morehouse School of Medicine research on improving the health of Black pregnant and postpartum women. How can we lower Black maternal health experiences if we're cutting funds for these critical programs? And the administration says that you can't consider race or ethnicity in healthcare.

We are, this administration under my leadership and President Trump's leadership, is doing more to advance maternal health than any other administration in history. There was tremendous duplication in the departments. We had 42 different maternal health services in our department. And we cut some of those and consolidated them. But right now we are investing huge amounts of money in maternal health. We serve 59 million American mothers. Our perinatal program, which is a groundbreaking program, we're now in 220 hospitals, has reduced maternal mortality in those hospitals by 42 percent. Nobody's done that in history.

My time is going to expire, but let me ask you. The community health centers are excellent stewards for the 340B program and have done a great job with them. Now they're burdened with a new model and reporting requirement. Would you consider exempting the health centers from that model of rebate, all of the reporting things that are making it difficult?

I'm happy to talk to you about that. I can say that we are giving, we are increasing the budget for community health services centers in this country in this budget where everything else is getting cut because we understand that they do a better job at treating their patients, and particularly patients in poor communities, than any other system in our country. I just gave another $143 million to them last week in addition to the proposed increase in their budget that are in this budget, proposed budget.

Thank you, Mr. Chairman, and I yield back.

Thank you. Mr. Estes.

Thank you, Mr. Chairman, and thank you, Secretary Kennedy, for being here today. You know, I want to start by commending the Department of Health and Human Services for establishing the MAHA Commission and the Administration for a Healthy America to fight chronic disease and promote healthy living for all Americans. As mentioned earlier, the statistics are staggering, that six in 10 Americans have at least one chronic disease and that 90 percent of our healthcare spending is dedicated to fighting these conditions. We've got to look at ways to reverse this trend and focus on how do we improve wellness. We're strongly supportive of a pivot away from this reactionary sick care towards the preventive maintenance and strategic alignments for particularly rural health. We also need to recognize the importance of patients' access to quality care and availability of providers. A bold vision for a healthy America doesn't work if we can't succeed to support our rural communities with the essential medical workforce and emergency transportation required. In my district in South Central Kansas, institutions like the Kansas College of Osteopathic Medicine and the future Wichita Biomedical Campus are working hard to generate the next generation of doctors that will be supportive for us. Mr. Secretary, air ambulances are an essential lifeline in rural America, and when emergency happens, sometimes those helicopters are often the only way a patient gets to a medical treatment in time. Many of our bases are at risk of closing because the Medicare reimbursement rates haven't been meaningfully updated for a couple of decades. And part of that's because the federal government hasn't been doing its job. Five years ago, the No Surprises Act was required, required the Department of HHS and Department of Transportation to collect those cost and operational data, and to date those rules haven't been finalized. And I wanted to just ask, how can we work together, how can we get HHS and Department of Transportation to work to update those?

I am happy to work with you on that. I can tell you that the No Surprises Act was passed with the best intentions and it was a great law, but it was not implemented by the Biden administration. And those proposed regulations on the No Surprises Act were left to languish. We are now in the final process of finalizing them. And I'm happy to work with your office to talk about the air ambulance problem. These are huge, this is a huge issue, particularly in Alaska. So I hear from them all the time about the same issue. But we've also found a lot of fraud in that area, so we need the kind of audits that you're talking about and the kind of information that you're talking about. We're really interested in that, and I look forward to working with you on it.

Great. Well, thank you. Thank you for all your hard work. One of the things we're also concerned about is the real threat of retirement of so many providers in the physician workforce. And you know, as we look particularly of how that's going to impact patients, particularly in rural communities. Many of the communities lack specialists, and particularly with the number of physicians at an older age in our rural communities. And we're seeing now more and more patients are proximately seeing 50 percent more specialists than in the year 2000. And so I wanted to see if there's things that you're doing in the administration to help ensure that our rural patients can get access to some of this specialty care.

I think one of the most important things that we've done to address that very, very grave problem is the site neutrality rules, which we've recently finalized. And that will end the disparity between what's paid to rural providers and what's paid to urban providers and hopefully dampen the appetite for consolidations, which are destroying rural economies and rural healthcare, and allow them to get a living wage, which they don't have right now.

Right. Well, thank you. Thank you for all your hard work. I yield back.

Ms. Sánchez.

Thank you, Secretary Kennedy. We appreciate your appearance here today. To win the support of skeptical senators during your confirmation hearings, you claimed, and I'm quoting here, "I support vaccines, I support the childhood vaccine schedule." I was skeptical about those comments because prior to your nomination, you espoused numerous disproven theories that childhood vaccines, including the measles vaccines, were linked to autism, death, and other adverse effects. Not surprisingly, we were right to be skeptical of your promise to support the childhood vaccine schedule because at your direction, the CDC removed its universal vaccine recommendations for children covering seven immunizations, including things like flu, COVID, hepatitis A, hepatitis B, and rotavirus. On Fox News last year, you stated, and I'm quoting you again here, "There are adverse effects from the vaccine, it does cause deaths every year, it causes all the illnesses that measles itself causes." A deadly measles outbreak in Texas killed an unvaccinated six-year-old, the first such death in a decade. So simple yes or no question. It's not that we don't want to let you answer, it's that we all have limited time and you have plenty of time to answer questions and you had plenty of time to give testimony at the beginning. So simple yes or no answer will do here. Do you agree with the majority of doctors that the measles vaccine could have saved that child's life in Texas?

It's possible, certainly.

Okay, thank you. I want to look at some very important data. In 2024, under the Biden administration, which apparently seems to be responsible for every ill in the world, in 2024 under the Biden administration, there were 258 cases of measles. And in 2025, under your leadership at HHS, it ballooned to over 2,000. That's a 675 percent increase. And we are now on track to surpass that this year with over 1,600 confirmed cases in just three and a half months. If we project those numbers out for all of 2026, we can expect a whopping 6,400 cases of measles. That's a 2,380 percent increase in a preventable disease. CDC data also shows that about 80 percent of children who died from flu this season were not vaccinated. The anti-vaccine rhetoric you ran on and the anti-vaccine actions you have taken over the last year clearly correlates with the dramatic increases, again, in preventable diseases. As a mother, this horrifies me. Stopping the spread of communicable diseases is one of HHS's primary responsibilities. And a strong public health messaging campaign on the importance of vaccines could have stopped this surge of measles cases as it had in past outbreaks. But I was appalled to learn that the CDC suspended public health messaging on vaccines last February. It ended a successful flu vaccine campaign as well. My question is, did President Trump approve your decision to end CDC's pro-vaccine public messaging campaign?

You've got a lot of misinformation there. First—

No, I'm asking you a question. I would appreciate a response to the question.

Let me respond to the misstatements that you've made.

No, you have other opportunities. I have limited time. Please answer my question.

I only have—you're the only opportunity I have to respond.

Did President Trump approve your decision to end CDC's pro-vaccine public messaging campaign?

Allow me to answer, to respond to a lot of the misinformation.

No, answer my question, please, sir. I have limited time.

There's a global measles epidemic. We've done better in preventing it than any country in the world.

There is no—there is no country that has seen a bigger percentage increase.

That's not true. Mexico has three times our measles and they have one-eighth of our population.

Did President Trump approve your decision to end the CDC's pro-vaccine public messaging?

Canada has double the measles and they have one-third of—one-eighth of our population.

Was that a decision that was made by him? Did he approve that?

We've done better at preventing measles than any country in the world.

Did President Trump approve your decision to end the CDC's pro-vaccine public messaging campaign?

We've done better at preventing—

That's not answering my question. That is not answering my question. And I think you don't want to answer the question because I think you know that you are making terrible, terrible decisions that impact very, very real lives, especially the lives of children. Now, one thing that I find incredible is that you suspended this pro-vaccine messaging campaign, but somehow you're spending taxpayer dollars to drink milk shirtless in a hot tub with Kid Rock, and somehow you think that's a better public health message than informing the public about the importance of vaccines. Really? Really?

Gentlelady's time is expired.

Really? I yield back.

You don't have anything to yield. Mr. Smucker.

Thank you, Mr. Chairman. Thank you, Secretary, for being here today. I'd like to first thank you for your work, thank you for your willingness to do this, thank you for your courage because taking on entrenched systems does take real courage, and I think future generations will thank you for the work that you're doing today. I want to talk just two quick things. You've spoken extensively about the role of diet in preventing chronic disease, and I have two specific policies, bills, that I'm working on that we've talked with the department about, but I'd love to get your public comments about them today. The first is food as medicine interventions, like produce prescriptions, medically tailored meals, which there's growing evidence that they can really improve outcomes for patients with chronic disease. So I think there's a role for these approaches in federal health programs. And of course, you know CMMI is created specifically to test new healthcare delivery models that improve outcomes, lower costs. And I appreciate that under your leadership, CMMI has started to prioritize prevention-focused models. So I've been working on and plan to introduce, actually this afternoon, a bipartisan bill that would test a bundled payment that provides certain chronically ill patients with a comprehensive package: access to healthy produce, nutrition counseling, remote monitoring, with the goal of preventing disease progression and reducing avoidable healthcare costs. Just like to get your reaction to that and love to have the continued support of the department for a policy like that.

I mean, we have the highest chronic disease burden in the world. The congresswoman was talking about the deaths from infectious disease, which are a couple of thousand a year. Ninety percent of the people who die, the three million people who die in this country, die of chronic disease. And nobody's paying attention to this, and all of these members have ignored this for as long as they've been in office. This is the real threat to American health. In fact, during COVID, we had the highest death rate of any country in the world. And when you ask CDC why is that true, they say, "Well, it's because we're the sickest population." The average American who died from COVID had 3.8 chronic diseases. What was killing them, COVID or the chronic disease? We have to understand chronic disease. Infectious disease has a very hard time killing a healthy person. It kills people with chronic disease. And we are—I'm looking forward to, you know, up to 70 percent of type 2 diabetes can be reversed and people can even lose the diagnosis simply by changing their diet.

Well, thank you. I do want to bring up one additional piece of legislation that we're working on. You know, food manufacturers are moving in the right direction due to your leadership on reducing additives, reformulated products, responding to consumer demand for healthier options. There's still a gap, though, in what's generally recognized as safe, or GRAS, pathway where companies can self-determine a substance is safe. They determine that themselves, often relying on their own expert panels with limited transparency into potential conflicts of interest or underlying data. So that's another piece of legislation I'm working on. I think we should establish clear standards for self-GRAS panels, strengthen public confidence in our food supply. Just wanted to get your thoughts. Do you believe reforms like that are—

Yeah, that's absolutely critical. We have finalized in my agency a closing the GRAS loophole, and that regulation is now going through the interagency process. We're a little bit hobbled in what we can do, and Congress can do much more. So my office would love to work with your office on getting a much stronger bill, much stronger regulations. The GRAS loophole has been hijacked by the food industry. And because of that, we have 10,000 ingredients in our food. In Europe, they only have 400. And most of those have never been safety tested. We don't even have a list of them. We have no idea what they are. It essentially allows the industry to put in any chemical they want, any chemical they devise in a lab, into our food without even the slightest regulations. And that needs to be changed if we're going to make America healthy again. I appreciate your help and your leadership, Congressman.

Thank you. Look forward to working with you on that.

Ms. Sewell.

Mr. Secretary, you've made a number of outlandish and, frankly, disturbing comments both before and during your tenure as Secretary of Health and Human Services. I want to draw your attention to one of those times. In a 2024 podcast interview, you suggested that Black children on ADHD medication should be re-parented. You said, "Every Black kid is now just standardly put on Adderall, SSRIs, benzos, which are known to induce violence. And that those children are going to have to go somewhere to get re-parented." There is a lot to unpack in that comment. I know that you've already answered several of the questions I was going to ask, and so I'm just going to rephrase them. Mr. Secretary, you've already admitted that you are not a board-certified physician, and you've already admitted that you did not go to medical school. Have you ever re-parented or parented, I should say, a Black child?

I don't even know what that phrase means, and I doubt that—

Just a yes or no answer.

I doubt that I said that phrase. No, I'm not going to answer something that I didn't say.

You absolutely said it.

Well, I'd like to hear the recording.

So to be clear, sir, I'm just—I'm going to reclaim my time.

Because it doesn't make any sense. I don't even know what it means.

I don't either. That's why I'm asking.

And by the way—

So to be clear, you're not a doctor, you have no medical degree, and you have no formal medical training. And you have never parented a Black child.

As has—as has 24 of the 26 HHS secretaries.

Mr. Secretary, this is my time. And I say to the Chairman, I want to reclaim my time. So you are not a doctor, have no formal medical training, and you've never parented a Black child, and yet you are suggesting that the federal government should take Black children away from their families and re-parent them and send them off to some wellness farm instead of providing them with evidence-based medicine.

You're just making stuff up.

I am absolutely not making this up. Mr. Secretary, in your opinion, what factors should the federal government consider when re-parenting a Black child who has been on ADHD or ADD?

I don't even know what you're talking about, Congresswoman.

Attention deficit—attention deficit disorder and—I don't know what re-parenting means.

I don't know what you're talking about. I don't know what re-parenting means.

I don't either, but you said that.

I did not say that.

Mr. Secretary, for Black families of the United States, the issue of family separation is not new. Our nation has a long and painful history of separating Black children from their families. During slavery, Black children were taken from their parents and sold with no regard for their humanity. And after slavery, Black families continued to face forced separations through Jim Crow laws, discriminatory policing, and child welfare systems that too often assumed that Black parents were unfit. Even today, Black children are removed from their homes at higher rates than white children, not because of their greater harm, but because of long-standing bias and built-in institutionalism. For you to suggest that Black families are not capable of raising their own children is deeply offensive. Sir, you are the Secretary of Health and Human Services for the world's most powerful country, and your words matter. When you suggest that re-parenting Black children, when you sow doubt about the safety of vaccines, and when you promote unproven statements that have no basis in science, you endanger the lives of everyone across this nation. Those children have parents. And to suggest that they have to be re-parented is offensive.

I never suggested that.

Secretary, your words matter. When those words are careless, communities pay the price. When your words are imprecise, they create confusion. And when your words are dismissive, they cause real harm. So you do—you don't have the pleasure because of your position to speak first and think later. Not in this job and not because of your responsibility.

What is it that I supposedly said in 2014?

I expect and the American people expect that you choose your words with sincereness and with seriousness, the seriousness that your position demands. American lives are at stake, and it's time that you start acting like it, sir.

Thank you. Mr. Hern. Mr. Hern. Mr. Hern.

Thank you, Mr. Chairman. It's good to be with you today. Mr. Secretary, thank you so much for—sorry. It's good to have you here today. I really appreciate it. I want to use my time to bring an issue to your attention. Last month, a young man from Oklahoma, Jacob Toe, came to meet me in my office. He told me a story that stuck with me, one that can make a huge difference for children in our country. In 2024, Jacob was in the midst of a custody dispute for his three-year-old son Leonardo, or Leo as they called him. One day, Jacob got the call no parent ever wants to receive. While Leo was in his mother's care, the young boy passed away. Jacob learned that Leo died from an accidental ingestion of fentanyl that was left within the reach of his mother's home. Jacob fought to figure out how this could possibly happen. In doing so, he learned that the drug screening panels used in the child welfare process did not test for fentanyl, which is not detected by standard drug panels. While talking to lawmakers back home, they, like me, were shocked that fentanyl was not already included in the child welfare drug screenings. I believe other states across the country do not realize this gap in care and safety exists. While grieving the death of his son, Jacob decided to get involved. He told his story all around the state of Oklahoma, urging lawmakers to correct this deadly gap in testing and keep kids safe. Thanks to Jacob's effort, last month the Oklahoma State House of Representatives passed Leo's Law in honor of young Leo. This bill requires the Oklahoma Department of Human Services to include fentanyl testing in all child welfare drug screenings where fentanyl use is suspected. This is not an issue that is unique to Oklahoma. Other states, such as California, have followed suit and introduced similar legislation. I'm proud of my home state for leading this charge and even prouder of this young man from Kellyville, Oklahoma, who has turned his unthinkable tragedy into successful advocacy efforts. I commend Jacob, but I know he cannot do this alone. We must do our part and help him ensure that no other child is harmed from fentanyl like his son Leo was. Secretary Kennedy, two things. Will you work with Congress to educate states about this ongoing issue and hopefully get them to introduce laws and figure out how we can work together at the federal level to ensure all states are testing for fentanyl in child welfare drug screenings when necessary?

I will work with your office on that. I think it's a wonderful objective. As you say, it's normally regulated by state law, but we can look at other options.

It would be great to get everybody to do this. I'm sure children are dying across the country. Like I said, even California saw the need to do this and pass their own laws. Now one other question before I go. Substance abuse is one of the leading factors for kids entering foster care and in fiscal year 2024, more than 30 percent of children entered foster care due to substance abuse by their parents. Under your leadership, ACF has expanded access to drug treatment under the Title IV-E child welfare program for parents as part of the Great American Recovery Initiative. What steps can Congress take to build on this administrative emphasis on prevention services?

Well, we've now funded as part of the Great American Recovery Plan a STOMP program where we're working with states, with law enforcement, with detoxes, with rehabs and sober housing to bring together the treatment that has been fragmented and atomized in the past. We also, you know, one of the primary problems with drug treatment is it has the same perverse incentives as we see in the main, in the physical health medical system, which is that people get paid more by keeping the addict addicted. If you go to a rehab and you relapse, that's the best thing that'll happen to that rehab because then you're coming back for a second bite. And we're now working on implementing a model and I actually visited a place in Arizona called Camelback this week that guarantees where they, the rehab after you go there for 30 days or 60 days, will guarantee if you relapse within the next 12 months, you come back for free. And that gives the rehab the incentive to make sure you're going through IOP, that you're getting drug tested, that you're getting psychiatric care, that you're going to 12-step meetings or whatever they need to do to maximize because they're now, their financial incentives are now aligned with the incentive of getting you healthy. And I think ultimately that's where we need to move toward value-based care rather than essentially what's a fee-for-service model.

Great. Thank you, Mr. Secretary. Mr. Chairman, I will not yield back time because I don't have any to yield back. Just to point that out. Thank you.

Thank you, Mr. Hern. Ms. DelBene.

Thank you, Mr. Chairman. Mr. Secretary, I'm glad you're appearing before us today. Under your leadership, CMS recently added new layers of red tape that Medicare patients need to navigate to get the care that they're entitled to. Mr. Secretary, I hope you understand the harm that delaying and denying necessary care can have. Do you remember saying this, quote, "Americans shouldn't have to negotiate with their insurer to get the care they need. Pitting patients and their doctors against massive companies was not good for anyone," end quote. Do you remember?

I don't remember, but I would align with that.

And I'll submit for the record actually a press release from CMS with your quote in that from June 23rd of 2025.

Without objection.

In this case, I agree. Pitting patients and their doctors against massive companies isn't good for anyone. And yet less than a week after you said that, CMS announced the WISER model. The program allows private companies to use AI to review traditional Medicare claims and pays them based on the amount of care they deny. This program went into place in six states across the country, including my home state of Washington. President Trump said multiple times on the campaign trail that he would not cut Medicare, but this program does exactly that. For example, Joanne is a senior from Washington on Medicare. She has a herniated disc that is pinching her sciatic nerve, causing immense pain down the right side of her body. Her doctor prescribed an injection that would help relieve her pain. If it had been prescribed last year, she would have received the treatment, no problem. But because of the WISER model that has been implemented, she's been in intense pain for over six weeks while she waits for approval. She has been using crutches or a wheelchair for over a month now, which is making her arthritis worse, adding to her chronic pain. Since using crutches, she's fallen multiple times, including earlier this week. Instead of simply approving the procedure, Joanne's conditions are getting worse. And Secretary Kennedy, the W in the WISER model stands for wasteful. Do you think that Joanne's treatment, which would allow her to walk and live with less pain that her doctor has prescribed, do you think that's wasteful?

Do you want me to actually answer that question?

Yeah.

I think that that's a terrible outcome. It's one that was not intended by the system, obviously. The problem is there's tremendous waste in Medicaid, there's only five percent of the cases are given prior authorization. In private industry, 30 percent.

This is traditional Medicare now where it's now, this has only been put under prior authorization under your leadership. Now President Trump promised multiple times that he quote "will not lay a finger on Medicare." Given President Trump's promise, did you or the President approve this model, which is now delaying and denying care for people in states like the state of Washington?

Can I answer the question?

Yeah, people are being denied care across our state right now. Very quickly.

And as an example, five years ago, we were paying $250,000 a year for 250 million for skin substitutes. This year, 23 billion. Why? Because there was no prior authorization in the Medicare program.

And now someone like Joanne is not getting her care, it's more expensive for us because Joanne is not getting her care. We have story after story. I can also submit for the record stories of all the people who are being delayed and denied care. It is more expensive for us, it is more expensive for them when they are not getting the care they need. Last year, I sent CMS a letter detailing my concerns about the WISER model. I still have not gotten a response. That was last August. Can you publicly commit to responding to that letter and addressing the concerns of this harmful model?

Yeah, absolutely we will and I apologize for not getting back to you sooner. We have an unprecedented number of communications from Congress. We try to make each one of those.

Well, we don't have you here very often. We have people in my state who are being denied care, who are being hurt based on this policy and there's an indifference to the challenges that they are facing all because of a model put in place for no reason and doing exactly what you said shouldn't happen, which is, again, I quote, "pitting patients and their doctors against massive companies." These are private companies doing this prior authorization. It was not good for anyone. Thank you. I yield back, Mr. Chairman.

As I said, discovering $23 billion with the fraud is not for no reason. And that.

You are hurting patients in our state and other states across the country for no reason and I appreciate you finally responding to the letter. Thank you. I yield back.

Ms. Miller.

Thank you, Chairman Smith. Secretary Kennedy, thank you so much for coming in front of our committee today and for your leadership in improving the health and well-being of the American people. I have two things I'd like to discuss. In my home state of West Virginia, we see some of the highest rates of chronic disease in the country. Coupled with our rural nature and limited access to care, many of these patients are especially vulnerable and face significant barriers to managing their conditions. The first chronic disease that I want to speak about is our patient population that I am focusing on, which is people who are living with chronic kidney disease and the end-stage renal disease. I commend the administration's effort to promote affordability and fiscal responsibility in healthcare. I am concerned, however, that in the case of kidney disease, the current ESRD bundle may inadvertently discourage the development of adoption of new therapies and technologies that could improve outcomes and reduce long-term cost for patients who do rely on life-saving dialysis. The complicated post-TDAPA policy has resulted in promising innovative drugs being pulled from the market entirely or only being accessible by a tiny fraction of the patients. I have a bill called the Kidney Care Access Protection Act and it is a piece of legislation that could expand access to the new treatment options in a way that both encourages innovation and ensures costs remain well-managed for Medicare and taxpayers. As we work together toward better outcomes and cost containment, how is CMS evaluating ways to strengthen incentives for innovation within the ERSD bundle while still maintaining fiscal responsibility?

I mean, I would say that that's the balance that we're all trying to achieve. We are doing everything in our power to maintain the United States as the innovation center for the world. And we want to make it easier to get quick approvals for drugs that actually work. We need to do science on them and we're doing gold standard science and we have depoliticized science at the agencies. I don't know enough about the renal disease aspect in the bundle, but I'm happy to work with you, also get somebody from Oz's team to come over and talk to you directly because I know that that's not an outcome that they would like.

That would be wonderful. The second issue that I wanted to talk to you about is that it is clear that what we eat plays a direct role in our health and quite frankly, many Americans don't eat right. And these poor nutrition choices are a major driver of chronic disease. I believe there's a strong case of expanding access to MNT therapy for targeted and specific groups in Medicare beneficiaries who outcome could actually measurably improve as a result. With that in mind, can you share your perspective on the role medical nutrition therapy should play in improving health outcomes for Medicare beneficiaries and how we can most effectively and responsibly expand to those who would benefit from the most, particularly in the rural and underserved areas?

Yeah, I think, and I've worked with Governor Morrissey about the on this issue. And I think there's nobody at this agency who is not committed to the idea that food is medicine, that it is, and if we wanted to do prevention in this country, we've got to, and end the chronic disease epidemic, we've got to start with food. That's one of the reasons we're pushing nutrition into the colleges, we're pushing it into the hospitals, we're pushing it into the community health centers to make it the central focus of healing and prevention. Oh, I want to work with you in any way that I can to achieve the goals that you're talking about.

Thank you so much. I yield back.

Dr. Murphy.

Thank you, Mr. Chairman. Thank you, Secretary Kennedy.

I don't think your mic is working.

All right. Is it now? It's now. It's working now. Thank you for coming. I want my 12 seconds back. Thank you for coming. You know, we're talking about a little bit about vaccination. I think we ought to talk a little bit about the arrogance of a fellow named Anthony Fauci who came and lied to Congress, lied to the American people, and in my opinion, destroyed the confidence of the American public in the healthcare system. So I think that when we're talking about vaccination, that's number one. Number two is your predecessor, who was not a physician either, led the greatest invasion in this country of 13 to 20 million illegal people coming in this country who were not vaccinated and brought in disease into this country. So let's actually bring facts into that conversation. Second of all, I share some of the concern now about what's happening with our drug delivery system going to China. They are developing a burgeoning industry that is threatening what we do as a as primal confidence, at least in the American pharmaceutical industry, and I think we really, really have to be concerned about that. I think the greatest thing that your administration has done is bring highlighting to the fact that food is medicine. I saw a child in my clinic about six weeks ago that was eight years old that weighed 262 pounds. This is what we're dealing with. This is what the obesity epidemic, and it is sad that the number one drug that is selling now in the country are weight loss drugs. This is endemic, this speaks to the terrible, terrible tragedy that has become the American food industry. So thank you for highlighting that. I want to get back to one thing that is my passion, and that is the cost of care in this country. The cost of care in this country has rise has risen tremendously, in my opinion, primarily because of vertical integration that is caused that has happened in this country, primarily which has been caused by the ACA. That is the number one driver of healthcare costs. We can talk about the pharmaceutical industry, we can talk about the other things. But we a few weeks ago had the arrogance and the vanity of our health insurance industries come in front of this committee and just sit to point fingers otherwise. You convened last summer in July the 70 percent of those who insured in this country, and they said they were going to do better. And I know they gave a report saying they've cut down prior authorizations by 11 percent, but frankly, after 35 years in the healthcare industry, I don't believe a damn word that they say. And until we get the middlemen under control in this country, the number one driver of healthcare costs in the pharmaceutical space is not the pharmaceutical industry, it is the pharmacy benefit managers. It is the middlemen. And until we get rid of this thing that is only present in the United States, we will not drive down healthcare costs. And so I urge you, I urge you to be the hallmark of your administration is to go after what we have created is the vertical integration that is destroying the doctor-patient relationship and bankrupting America. Second of all, I want to talk about the No Surprises Act. To your point, absolutely, a great bipartisan bicameral bill. Your predecessor, of course, went straight and gave all the authority to the insurance companies. I have a bill HR 4710, which puts meaningful enforcement back into this. Right now, our vain and arrogant insurance companies are keeping hundreds of millions of dollars just in their little kitty, which has been appropriated to people who provided the care, but they're keeping it. And so enforcement mechanism, and I understand your administration is working on that. So I thank you with this. And then lastly, excuse me, I applaud the Trump RX. We had Mark Cuban come in and talk to us about what he's doing with cost plus. I applaud the fact that we're trying to get the middlemen out of the system. We're working with the administration and trying to do this with cost plus. I saw a patient, again, about six weeks ago, he changed insurance companies. The pill he had been on for 15 plus years was now close to $1,500. I literally pulled out my phone and went to Cost Plus and it was $15. So I applaud the administration for getting the middlemen out. These are the problems that the American public is facing. You know, we can talk about all the other extraneous issues, but if people can't afford healthcare, that's not access to healthcare. And when you allow 20 million people in the country and you overload hospitals and you overload of healthcare systems, we can't provide care to the American public that is our primal and first duty. So I want to say thank you for what you're doing. You have a tough job. We're here to support you and thank you for your efforts. With that I'll yield back.

Ms. Chu.

Secretary Kennedy, we have a childcare affordability crisis in this country. Working families are having to pay skyrocketing prices, in some cases as much as 40 percent of their income. And too many working parents are having to leave the workforce or turn down job opportunities because they can't afford childcare. This is hurting American families, our workforce, and our economy. During your 2024 presidential campaign, you did a commendable thing. You proposed that the federal government should subsidize 100 percent of childcare costs for families below the poverty line and cap expenses at 10 percent of income for all other families. It's right here in this article from the National Catholic Register. And yet, just two weeks ago, President Trump said, "We can't take care of childcare. We're fighting wars. We can't take care of daycare." Now earlier, you were asked about this and whether you agreed with it and you then you actually didn't answer it. You said, well, I fully funded Head Start. But your agency is illegally withholding childcare from funding from every single state unless they submit a bunch of extra data not required by law. And also the president's budget request for 2027 proposes eliminating 315 million for preschool development grants. Do you agree with eliminating 315 million from preschool development grants?

Those funds are going out, they're not being withheld. You're mistaken about that.

No, this this proposal actually what I said was the elimination of 315 million for preschool development grants. I'm just wondering because it's completely contradictory to what your presidential campaign was. Well, anyway, let me say this. Childcare is one of the top expenses for American families and is becoming increasingly unaffordable. President Trump campaigned on the promise that he would lower costs, but his record while in office has been the exact opposite. He keeps on withholding federal funding for childcare. His reckless tariffs have raised prices on food and everyday goods. Gas prices are also up thanks to his unpopular war of choice in Iran. So remember, Mr. Secretary, you once said for the cost of the Ukraine war, we could make childcare affordable for every family. It's ironic that Trump is doing the exact opposite, not funding childcare because we have wars to fund. It's a slap in the face to every American. And now, I'd like to switch to another topic. Hepatitis B. Today, I'm thinking about my friend, Chi Mui, who was a city council member in my district, San Gabriel, California. Chi did not know that he had hepatitis B until he donated blood. Eventually there was a liver tumor that spread to his pelvic bone. He was on the city council by then and we watched as he grew weaker and weaker and then he became the first Asian American mayor. But he died of liver cancer just one month after his installation. And we think he hung on long enough to reach that milestone only to die at the age of 53. It was beyond tragic. But to think his life could have been saved had he been vaccinated from hepatitis B as a newborn. Secretary, you've done an incredibly harmful thing to our community. You eliminated the mandatory hepatitis B vaccine for newborns and it disproportionately threatens Asian Americans because while we make up seven percent of the population, we account for 60 percent of all hepatitis B cases. It's clear that this administration has no regard for the health, safety, and well-being of Asian American communities as well as communities across the United States.

You want me to reply?

Well, if if that's...

Hepatitis B is a terrible disease. But babies are not at risk unless they've essentially of zero risk unless their mother is infected. For all mothers are tested when they go into the hospital to have a baby. And for all those people who are infected, the the vaccine is still a recommended vaccine. For everybody else, it's available. Parents can assess the risk themselves through informed consent. Insurance will pay for it. We did not remove the vaccine from being insured. And we just believe that Americans should have that choice, that the state should not make that choice for them. Hepatitis B vaccine was not safety tested. It had a four-day test with no placebo. So we don't know what the risk profile is, and parents are allowed to ask that question.

The science is is that it's not simply about choice, it's about whether infants are protected during the most vulnerable period.

Infants are protected, those at risk are protected.

Okay, Mr. Kustoff is recognized.

Thank you, Chairman Smith, and thank you, Secretary Kennedy, for appearing today. If I could, Secretary Kennedy, I represent parts of Memphis, Jackson, Tennessee, you and I have talked about Jackson, Tennessee before, and rural West Tennessee. And I wanted to talk to you about hospitals, particularly in those rural communities. I know that because of the CMS area wage index, we have hospitals that are in primarily rural areas that are being paid less than those in urban areas. During the President's first term, CMS did introduce the low wage index hospital policy, and that did help to reduce that discrepancy. Back on March 26, a few weeks ago, I introduced with Congresswoman Terri Sewell a bill called the Save Struggling Hospitals Act. So it is bipartisan legislation. It aims to keep rural hospitals open by codifying an adjustment to the area wage index to ensure that hospitals in rural and low wage areas receive a fair Medicare reimbursement for the essential services that they provide. I know that you have publicly said before that you support codification of the low wage index hospital policy. I guess I just wanted to ask you, that is something that you still support and you would support being codified?

Absolutely. I wish that we could fix it within the agency, but as you know, the Social Security Act requires that any adjustment has to be revenue neutral. And that means if you take from one area, you have to give to another. If you give to one area, you have to reduce payments to the other. It's a broken system. It needs to be fixed, but only Congress can fix it. And I and my agency will work with you toward that goal.

Thank you, Mr. Secretary. If I could, if I could ask you about peptides. A lot of attention with peptides. We know that about three years ago, the FDA removed 19 peptides from the list that compounding pharmacies could routinely make, and that limited access. Can I get your general opinion on peptides and your agency, your department's plans, if there are any, for maybe mainstreaming peptides?

Well, we returned 12 of those peptides yesterday to the class, to the category one categories so that formulators will now be able to formulate them. Peptides are like supplements. The FDA is only, FDA has authority to require pre-licensing safety studies, pre-marketing safety studies in any drug that claims a specific indication and is mass marketed. If you don't make those claims and you're not mass marketed, then FDA does not require that. So like supplements are not regulated in that way by FDA, peptides are not supposed to be regulated. It's been upheld again and again by the courts. The Biden administration improperly moved them to category three without any evidence of safety. The only justification they have is if there's a safety concern, and there was no science that indicated a safety concern. So it was improper. We have now remediated that by moving them back.

Thank you very much, Mr. Secretary. I now yield back, Mr. Chairman.

Thank you, Mr. Fitzpatrick.

Secretary Kennedy, in a long overdue move, the FDA is finally taking steps to remove petroleum-based food dyes, including Red 40, Yellow 5, Yellow 6, Blue 1, Blue 2, and Green 3 from our food and our medicine starting immediately. These dyes have been unequivocally linked to cancer, to hyperactivity, and to so many other serious health risks. And yet they have been left unchecked and unlabeled for absurdly too long. Secretary Kennedy, beyond commitments from industry and beyond regulation from the FDA, what steps can this legislative body take to make sure that we preserve over the long term cleaner ingredients in our food and our medicine as we look to address the link between these chemicals and the chronic disease epidemic? ingredients in our food and our medicine as we look to address the link between these chemicals and chronic the chronic disease epidemic.

The most important thing that you could do, Congressman, is to close the GRAS loophole. We have regulations now that do everything in our power, my agency's power, to close that loophole. And those are now in the interagency process. So we've completed it within my agency. There are now other agencies that have equities in them and are looking at them. But it doesn't go far enough. And we need to go farther. We need to really make sure that any ingredient in our food is safety tested first. That's what they do in Europe. That's what they do in other nations. That's why they only have 400 ingredients in their food in Europe compared to 10,000 here. And so that we would love to work with you on that legislation. I think it's absolutely critical if we're going to make America healthy again.

Second, I want to address something that is of critical importance to my constituents in Bucks and Montgomery counties in Pennsylvania, pertaining to the chronic disease epidemic, pertaining to the impacts of PFAS and microplastics in our food and our water supply. There is more that can be done at the federal level to address chemicals and toxins in our food and water and elevate how these issues are connected to deteriorating health across our nation. Specifically, the recent joint announcement that HHS and the EPA will be including microplastics in the EPA's contaminant candidate list and launch the ARPA-H program to detect and remove plastics from the human body, I believe to be a positive development in addressing the intersection of toxins in our food and water and the chronic disease epidemic. Secretary Kennedy, could you expand on the agency's efforts to further address microplastics and PFAS contaminants in our food and water supply and how these actions will impact overall health and fighting the chronic disease epidemic?

We're putting $140 million into the STOMP program at ARPA-H to look at, to track. You know, right now, microplastics, the average American has a teaspoonful of microplastics in his brain. Almost one percent of brain volume is now microplastics. That couldn't be a good thing. We know very little about the pathways by which it goes into the brain. There are hundreds of components in microplastics, hundreds of different kinds. Some of them may be benign, other ones we know are hideously toxic. We are going to identify those, we're going to trace the pathways so that we can better regulate them. The other thing that we're doing is moving them to the MCL, to the maximum contaminant list in the Safe Drinking Water Act so that we can now start regulating, establish maximum contaminant levels for both PFAS and microplastics and start regulating them effectively in drinking water. I want to add this, that the amount in our brains has doubled over the past five years. So this is rising exponentially and it is an existential crisis.

Thank you, sir. I yield back, Mr. Chairman.

Thank you. Ms. Moore. Ranking Member Moore.

Thank you so much, Secretary Kennedy. And I just want to join in with the committee and sort of remember the Kennedy family. I remember being nine years old begging my Republican mother to vote for John Kennedy. I don't think he won in Wisconsin, but I do think that your family has made a great impact on this country. I promised to give you easy, comfortable questions if you don't yell at me and hurt my feelings over time. I promise. I just want to thank you for pointing out stuff like the dyes and stuff in food and maybe even the looking at the food pyramid. I think that that's been a very helpful discussion in terms of your making America healthy again. And I'm just going to ask you a question and I hope it doesn't, it's sort of outside of the scope of your service. But how does the cut, the $1.4 billion cut in WIC and the $900 billion cut in SNAP interfere with your Make America Healthy initiative? I know that departments are told they have to cut. Do you think that that will interfere?

Well, am I happy about the cuts? No, I'm not happy about the cuts.

Don't you think it will, I mean, Froot Loops are a lot cheaper than good healthy food.

Yeah, nobody wants to make the cuts. RFK Vote doesn't want to make the cuts. President Trump doesn't, but we got a $39 trillion debt. And that's costing every American child $6,600 a year.

Yeah, I get that. Okay, so it is my time. Thank you. And I am, you know, I'm focusing on children here. You know, you made a beautiful quote that I was not aware of in your testimony. You said, although children may be the victims of fate, they will not be the victims of our neglect. You claim your uncle said that. What uncle were you talking about?

I think that was John F. Kennedy, Jr. President Kennedy.

President Kennedy. Although I just thought it was just classic. And so I just, you know, when we start putting things on the chopping block and cutting stuff, I would have hoped that we would not have started with our children. And I just want to know how that statement, that attribution to President Kennedy fits in with, you know, cutting completely Healthy Start, which is a proven program that has decreased infant and maternal mortality. I don't get it. It just contradicts that whole notion of not neglecting our children. Or firing 20,000 people in your department with consolidations that give technical support and help develop state plans around TANF, the social service block grant. These are the most vulnerable people and kids. I mean, even cutting $43 million out of the free diaper care sort of program. And I just, I'm just making a statement. I'm not asking the question, not confronting you, but I took all these notes while you were talking to other people, so I just had to kind of address them. I am wondering how your Make America Healthy Again program fits in with the National Database for New Hires, a federal database maintained by your office for the purposes of assisting child support agencies. Very sensitive information. And section 453 says that you will only use the data. How does giving that data to ICE support your mission at HHS?

Well, all the things that we do in terms of data sharing comply with the law.

No, this doesn't comply with the law, specifically section 453. I would love to see the General Counsel's memo on this if you wouldn't mind submitting that because it's...

I'm happy, happy to submit it, Congresswoman.

Please. And let the record reflect that he will give us that letter because it is definitely in contravention of our laws. And I want to thank you for your indulgence and thank you for appearing here.

Well, thank you for the respect and the kindness of your presentation.

Thank you, sir.

Mr. Steube.

Thank you, Mr. Chairman. Mr. Secretary, the contrast between the Trump administration and the last administration cannot be more striking. On issue after issue, when your predecessor came before this committee, he was defiant and claimed ignorance. In March 2024, I questioned then HHS Secretary Becerra about the Office of Refugee Resettlement's process for finding replacements, placements, and shelter for unaccompanied migrant children. Of the more than 100 questions submitted by this committee, my question to him about missing children was one of only two questions that your predecessor declined to answer. The Biden administration's open border policies were nothing short of a lethal disaster for our country. Let's be clear about the facts. The Biden DOJ received thousands of allegations of sexual abuse related to unaccompanied minors processed through ORR. Under the Biden administration, ORR permitted individuals with criminal records, no citizenship, and who refused a background check, received custody of unaccompanied children. Over the course of 10 months alone, the agency lost contact with nearly 20,000 unaccompanied children. Under the Biden ORR, case managers failed to perform home studies on more than 95 percent of placements of unaccompanied children. And finally, grand jury testimony in my home state of Florida revealed unaccompanied children were placed in the custody of convicted felons in homes with multiple unknown male occupants. This is unacceptable. Becerra's refusal to even acknowledge the issue when I brought it up to him is disqualifying. That is why I introduced the Stop Gaps Act with Senator Moody that builds up upon the Trump administration's success on securing the border by requiring the ORR to work with state and local authorities to guarantee safe and proper vetting of all individuals and entities before granting them custody of an unaccompanied child. Under the Trump administration, the border is secure, crimes from illegals are being stopped, and there are rigorous standards in place to better protect children. Mr. Secretary, can you speak to the work that your agency is doing to combat our social services being taken advantage of by bad actors and the increased safety of our children?

Yeah, I mean, it was a humanitarian crisis what my predecessor engineered with the Biden administration. They lost 425,000 children. They lost them because they ended verification of sponsors. People were just showing up with fake IDs. There was no genetic testing. There was no income inquiries. There was no ID validation. And we are now in the process of of trying to find those children. We've been able to locate 138,000 of them. They're very, very difficult to find. Many of them have, as you say, have been trafficked. They've they've undergone slavery, sexual abuse. We found one sponsor who picked up 42 child 42 children and their address was a empty container in a parking lot. And there was no effort. And in fact, the administration, Mr. Becerra, specifically ordered people in my agency to end the verification process. They were more interested they they explained that the objective was to move the kids out of of custody as quickly as possible. They made a lot of mistakes. And but now, thanks to President Trump, the amount of unaccompanied minors has dropped by 97 percent. We have beds now for 7,600 unaccompanied minors and only 2,000 of those are filled. We hold them until only until and but until we can completely verify the people who pick them up are actually family members. And that has never happened during the last four years.

Well, thank you for your service to our children and to the unaccompanied minors and the changes that you have made from the previous administration. I yield back.

Ms. Tenney.

Thank you, Mr. Secretary. Really appreciate your service and your great responses today. I just wanted to commend you first for your very sensible position on vaccines. I too am a fan of the greatest tennis player in the world, Novak Djokovic. I see you got to play tennis with him.

I lost, by the way.

Not surprised. Who can? When Javier Becerra, who you... was here, I asked him, I was trying to get a waiver for Mr. Djokovic to be able to play in the US Open at the time, the number one tennis player in the world and and still I would argue the greatest ever. And he described to me that they would not give him a waiver for the because he did not take the vaccine because it was science, although all a lot of other American tennis players were allowed to be there who were not vaccinated. So thank you for your common sense approach to choice and pro-safety as opposed to being anti-vaccine. I'm glad you clarified that today. But I wanted to jump to a really important issue in my district and especially in the state of New York. During the COVID COVID crisis in upstate New York, nursing home residents were isolated from their families for months, sometimes years. And Governor Cuomo disgracefully called it protecting them, but the reality is that people declined rapidly in isolation and in most cases died without a loved one present. That wasn't protection. It was a policy failure of enormous consequence by Governor Cuomo and his administration that cost lives to thousands of seniors, not to mention the deadly nursing home order that he required nursing homes to take COVID positive patients where they didn't have the ability to handle these patients. Sadly, one of those many of those same bureaucrats responsible for carrying out this disastrous policy are still working in Governor Hochul's administration. That's why I, along with my co-sponsor Representative Larson, Fitzpatrick, Panetta on this committee and numerous others, have reintroduced what's called the Essential Caregivers Act, a bipartisan bicameral legislation that guarantees nursing home and long-term care residents the right to in-person access to a designated family caregiver even during a public emergency. It also directs CMS to establish clear uniform safety protocols so visits can continue safely. Families and friends are visitors. They are loving caregivers and they advocate, they catch things maybe that a nurse a nurse or staff would not and cutting them out of the facilities didn't protect the seniors, it actually accelerated their decline. I was wondering because of this this situation and the isolation of so many nursing home residents, which contributed to serious physical and cognitive decline independent of the virus, by the way, given the department's guidance and and generous access for designated caregivers in nursing homes, do you share the view that maintaining family access during emergencies is a patient safety issue and not just a quality of life issue?

Absolutely. And we made a lot of mistakes during the with the countermeasures during the COVID pandemic, including shutting down the schools, shutting down businesses. Those things kill people and it's one of the reasons in my opinion that we had the highest death rate of any nation in the world. We lost 3,000 Americans to COVID for every million population. There were other countries, Haiti, for example, had 14 per million population. Nigeria, 14 per million population. We had 200 times the death rate of other countries. We had 10 times the death rate of Europe. And a lot of it was just because of bad policies that were that were not science-based. And we are not going to do that under my watch. And one of the reasons that I think blacks were more much more likely than most likely to die was because depriving them of access to a family member, their hospitals in their neighborhood already closed, depriving them of access to a family member meant that there was a reduced incentive within the hospital to provide them with the kind of good care that they needed.

And I just my time has expired, but can I just ask you, would HHS support codifying a federal right for essential caregivers and giving them access?

I personally would support that. My agency will work with your staff on looking at your legislation.

Thank you. We appreciate it. Thanks so much for your testimony. I yield back.

Mr. Boyle.

Thank you, Mr. Secretary. I'm over here. Thank you. I'm hoping this can be constructive and have a conversation with you. I have the honor of representing an incredibly brave constituent and proud fellow Philadelphian, Latanya Morrison. Her grandson, Ahmad Butler, tragically died of a rare form of brain cancer at just six years old. Last year, she and her family marched 179 miles on foot from Philadelphia to Washington, D.C. to bring attention to the critical need for childhood cancer research funding. I met her right outside here on the Capitol steps and had a wonderful but also heartbreaking conversation with her and have been working with her and her family since then. Specifically working with her on a proposal called the Ahmad Butler Childhood Cancer Hope for Cure Act to make sure that no grandparent, parent, or loved one has to go through what she and her family experienced and continue to experience this day. That hole in her heart will never go away. So my concern is, and I have no doubt that you have concern for this constituent I just described and all those who particularly have lost a child to to this horrible form of cancer. But at the same time, your administration or you as Secretary in this administration are carrying out hundreds of millions of dollars in cuts to cancer research funding. So I was wondering if you could explain why you're doing that and does that really get us anywhere closer to getting a cure that we all want to cure this horrible disease?

First of all, thank you for sharing that heartbreaking story and you know, the worst thing that could happen to a human being is to lose a child or a grandchild. And it's something that I hope that I never have to experience. And my heart goes out to that family. The one agency that within my agency and the only agency within NIH that actually got a budget boost from our proposal was NCI. And we, you know, were absolutely committed to cancer research and particularly pediatric cancer research. I invite you, Congressman, to call me to tell me if your if there are programs some of our programs were duplicative, so we've moved them around and it looks like there was a cut, but I don't know of any major cancer studies that have been cut. I'm happy to talk to you about it. You reach out to me.

If you could after this sorry, just because you know we're time limited and I have under a minute now. So I appreciate that and if if our staffs could follow up or you and I directly with one another after this. And I would just ask if I could get your pledge, not for me, but for my constituent, if I could get your pledge that you will work with me, my staff, the White House to get the President to declare childhood cancer a national emergency, which would, as you know, help unleash additional resources and really focus the attention that we need on childhood cancer.

Yeah, in in theory, I like the idea. Let's talk about the details. You know, we've already done the President already signed an executive order on pediatric cancers. I was there at the time. I so I need the devil's in the details, but in in theory, I absolutely support that proposal and I'm happy to work with you and your staff on it.

Thank you. And I yield zero time back.

Mr. Chairman, I seek recognition to ask unanimous consent to enter into the record the exact transcript of Secretary Kennedy's remarks that we discussed regarding the reparenting of black children.

Without objection.

Thank you.

Ms. Fischbach is recognized.

Thank you, Mr. Chair. And Secretary Kennedy, I just I'm over here. I know it gets confused. There's lots of us and we're running around a lot and I just want to tell you thank you so much for being here and thank you so much for your willingness to answer questions. I it always amazes me that people even agree to come to these committees because we have you sit there on the hot seat for hours on end. We all get to run around, get coffee, whatever it is, and and the witness is sitting there. So I genuinely appreciate that you're here and that you're answering questions very honestly and frankly.

I just have to not tell me that I had a choice.

[Laughter.] Okay, well then, fair enough.

But I am happy to be here.

Well, thank you very much. And and just so you know, I'm from Minnesota, I represent a rural district and I think you know rural Americans face heightened healthcare challenges. While nationally healthcare is seeing increasing staffing costs, staffing shortages, and increasing wait times, all of these problems are amplified in rural areas where care is already more limited. And I know that we counteracted that with the Rural Health Transformation Program in the Working Families Tax Cut bill last year, and significant funding was to strengthen the healthcare in small towns across across the country. I know in my office and in other Minnesotan offices we sent letters of support to CMS in favor of the application and the funding, but the Rural Healthcare Transformation Program alone is not enough to solve those rural healthcare issues. And so I am wondering if you could just talk a little bit about what's the administration's plan to reduce health disparities in rural areas and what specific actions are you taking to ensure quality and affordable rural healthcare remains a priority within HHS?

I mean, we've already finalized rules for site neutrality. I think that will help. The administration would love to work with Congress on the wage area index, which I think also will help. And then, you know, we are continually we made the biggest investment ever in history on rural healthcare. We're continuing to make additional investments. I mentioned the I think $135 million that I allocated for community health centers last week. And so this is a this is a priority for the President. It's a personal priority for me and, you know, if you have ideas of other things we ought to be doing, we'd like to hear them.

Well, and and Mr. Secretary, I appreciate that because it is such a critical part of and like I said, representing a rural area, healthcare, having the access to that healthcare and I know that Mr. Estes had talked a little bit about specialty care in rural areas, but it is absolutely critical for the survival of our small towns and and the health of our individuals who live there that we have that we have healthcare available. And I think some of our provisions for telehealth and things like that have really moved things forward. But I I just sincerely appreciate the ability that your offer and and the we have worked with worked with the department and so I appreciate that and I'm actually going to yield back 35 seconds.

Thank you. Mr. Moore.

I'll take that 35 seconds if I can. I didn't give it to you. Okay, I understand. Sir, the most important thing you said today in Congress that that Congress has allowed $39 trillion of debt and so that's forced you and your agency and your amazing team, some of which I know are very debt focused, Mr. Andres, that you had to tighten your belt. I just want to say as a as an American and as a member of the Bipartisan Fiscal Forum, I can't thank you enough for doing your part, doing the hard part to be able to find redundancies. You'll get criticized for it, but but it matters and every agency needs to be doing it. So thank you for that. I've mentioned to you in in private how much I appreciate the administration's focus on autism. You may recall my 10-year-old my 10-year-old Winnie is neurodivergent on the autism spectrum. He's the joy of my life. He's the but that's tenfold for my wife and for his younger, older, and twin brothers. And I want to just highlight that I never had a ton of expectation on what we could uncover from scanning the pre-existing research and looking at this. I've always appreciated the administration's focus on this thing though. But I was I was underwhelmed with what we ultimately put out. My wife was hurt and she felt for a split second until we she came to her senses and we we talked about this that there was any way she was responsible. We don't even know if she took Tylenol during her pregnancy, but that that was a hurtful moment for her and I just want to encourage the administration and your team to keep at it. And I think there's there's more we can do here with low expectations. I don't expect much to be able to figure out what the ultimate causes are. That's not an easy thing to do, but I do think there's there's more that we can do and and we can we can build past what I was ultimately underwhelmed with. So again, thank you for the administration's focus and I think we can do more. Regarding something that's very important legislatively, I introduced H.R. 5343, the Insuring Patient Access to Critical Breakthroughs Product Act, which builds on one of the biggest wins from the Trump administration. We didn't fully get it implemented, but the MCIT was a significant policy for Medicare coverage for breakthrough medical devices. This bill requires CMS to provide temporary medical coverage for treatments or devices that receive breakthrough designation from the FDA. If a treatment can meet the FDA's burden of proof of safe and effective and other requirements for breakthrough designation, there's no reason Medicare shouldn't be able to provide temporary medical coverage while CMS completes its review for permanent coverage. And this is a brainchild of the Trump's first administration. We've talked about this. We all agree in principle about this. It's difficult to to move in some cases, but can you update this committee on your efforts to implement a policy like this through any type of executive rulemaking?

I think are we in rulemaking on it? We we will have an announcement soon and we're happy to work with you on it.

This is this is really important and builds on the success from the Trump first administration. There is as I'm learning too, the FDA and CMS they operate in parallel, they operate in tandem and sometimes there's different regulatory constraints that they're going with. We've got to be able to to work through those. And if that's all this ultimately is is just a difference between those two of those those two structures, I mean, this is a good policy that will help improve people's lives and it will keep safe and effective technology from it will enhance safe and effective technology and get that into the into the healthcare system.

Yeah, and I agree with you and you know particularly if it's a temporary if it's a temporary payment that can be revoked that is intended to be temporary, it's not permanent as you know, it's very with a lot of medical devices, it's we find problems with them later.

We had tons of bipartisan support on this committee, some that even didn't support it last time are now on board. It's a it's a great initiative and look forward to working more with you. Thank you. You too.

Mr. Beyer.

Thank you, Mr. Chairman. Mr. Chairman, I'd like to yield such time as he may require to the ranking member, Mr. Neal.

Thank you, Mr. Beyer. Mr. Chairman, I want to make this moment an opportunity to correct the record on the No Surprises Act, which was passed out of this committee with bipartisan support. I wrote that legislation. I know what was in it. And every Republican on this committee at the time sided with me and we passed it out of the committee unanimously and had a big victory on the House floor. Like any new program, it needs some help for sure, but the notion that the suggestion we heard from the Secretary that somehow that it languished under Biden is simply not true. The national issue here before us is still the regulations that were implemented. We created new protections against surprise medical bills for 200 million Americans. Millions of families benefited from what we've done here every single year. This is a victory that Democrats and Republicans on this committee should take credit for and I yield my time back to Mr. Beyer.

Thank you very much, ranking member. Mr. Secretary, the Agency for Healthcare Research and Quality, AHRQ, has been given an essential task by Congress. It's the only federal agency specifically dedicated to improving healthcare delivery for Americans and was actually a Ronald Reagan creation. Making people's experience with healthcare easier and ensuring that taxpayer dollars are spent on effective, affordable, and safe care. But Mr. Secretary, your department's budget justification included $106 million in cuts to AHRQ. The White House budget request was $129 million in cuts. The budget appendix listed $116 million in cuts. The budget also lists more than 250 staff at AHRQ, but widely available reports show that fewer than 100 people remain at the agency. Mr. Secretary, these discrepancies read easily as deliberate misrepresentation or basic accounting errors. Can you clarify how many millions of dollars you intend to take away from research designed to give American access to the best, most affordable healthcare?

Thank you for that question, Congressman. Dr. Klein at who is running it, who is a Yale-educated physician who's running AHRQ, still has hundreds of staff and the agency is operating.

Thank well, let me shift to United States facing a mental health crisis. As you know, nearly a quarter of U.S. adults had a mental illness in the last year reported. 30 percent of high school students. You recently led an agency reorganization. There was a big scare in January where $2 billion was cut from SAMHSA for substance abuse prevention and mental health. There was a bipartisan outcry and it was restored. But there's also this real concern that there's a gutting of SAMHSA. I co-chair bipartisan the House Mental Health Caucus. We'd love to have a bipartisan briefing on the reorganization. We requested that back in December and I'd love for you to commit to a briefing for members in Congress of the Bipartisan Mental Health Caucus on the current status status of the mental health programs at SAMHSA, CDC, and NIMH.

I strongly support SAMHSA. It's a mental health and particularly addiction are priorities for me, strong personal interest, and but also they're national catastrophes. There were termination letters that went out under SAMHSA. That was a mistake. We immediately recalled them within 24 hours and I'm committed to the continuing continuing operations in SAMHSA and happy to meet with you about it.

Very great. Thank you very much, Mr. Secretary. Mr. Chairman, I yield back.

Ms. Van Duyne.

How are you doing today?

I'm great.

I appreciate you being here. And I know a lot of questions have been asked and some of the the accusations have been just outrageous. I have a bunch of stuff I want to ask you about, but clarify. Your qualifications have been called into question because you did not father a Black child. How many different HHS secretaries have had that privilege?

Have had the privilege?

It's a ridiculous question, isn't it? You know the answer? Zero. Do you know how many Democrat-appointed HHS secretaries have had a medical degree?

I think there may have been of the 26 there may...

No, zero. Zero. Not a one.

In history?

Yeah, yeah, not a one.

I think there may have been two with medical degrees.

Yeah, it it there's a lot going on that your office is handling and doing so well and we're so proud of. You know, we had and I'm looking for for for this photo. We had a previous secretary who I asked questions about what was going on with the waste, fraud, and abuse. And I don't know if you recognize this. I asked Secretary Becerra the same question. What's going on at 14545 Friar Street in Van Nuys, California? Does that ring a bell to you at all?

No, I I could guess. But why don't you tell me?

We had over 100 different licenses for for hospices right at this address. And we asked him what he was doing about it, basically nothing. Can you walk through what your office is actually doing on the waste, fraud, and abuse to make sure that we don't see this happen again?

We've already shut down 500 hospices in Los Angeles. And and incidentally, we haven't had one call from Congress or anybody else about complaining because clearly these were fraudulent. A lot of these places you'd say we they'd have they were just invented addresses. They would obtain patient identification or they would pay people. They were going and giving people in poor neighborhoods flat-screen televisions, 600 bucks, and then they would enlist them in enroll them in the hospice and we were paying them $6,000. And the and the interesting thing is almost none of them ever died. Typically, the stay in a hospice is about 18 days. These people stayed forever. Nothing ever happened because they weren't actually there. They were just invented. And it was operated by certain foreign communities, a lot of Estonians and a lot of Armenians and there's an incredibly great Armenian community in Los Angeles and very few of them were involved in this, but the ones that were were making hundreds of millions of dollars out of fraud and just stealing money from us. I think the cost has been about $5 billion.

And it's ridiculous. And I don't think a week goes by where your office is not uncovering further fraud. And what we're finding in California is now they're going after the people who are uncovering the fraud. They're actually trying to make it illegal for some of these journalists to even do their job and uncover it. They're not upset about the fraud, they're upset that it's being uncovered and your office is helping to do that. I had a ton of questions I wanted to ask you about affordability. You know how expensive health care is, not health insurance, but health care, there's a big difference. But like on association health plans, what's your thoughts on that? And I know not everything is going to be within your purview, but what are your thoughts on making more competition in the marketplace?

That's what we need. We need outcome-based care. We need more HSAs. President Trump wants to take the money away from the insurance company. Since Obamacare was passed, in the years after Obamacare was passed, the share price of the insurance companies, the share value went up 1,000 percent. It's still up 300 percent compared to about 150 percent for the S&P 500. And so they are making money hand over fist and the American people who were supposed to benefit, their premiums have not gone down. They had the illusion that they went down slightly. President Trump is actually taking steps that will drive the premiums down and give better quality care to Americans.

I appreciate that very much and I yield back.

Thank you. Now the chair recognizes Mr. Arrington for four minutes.

Thank you, Mr. Chairman. Mr. Secretary, good to see you. Thank you for your leadership and your service to our country. We have the best system and the worst system. I mean we have the best docs and mid-levels, the best facilities and technology, and yet we have the worst, most inefficient system relative to the rest of the developed world when you get to the cost and quality intersection and it just it drives me crazy. I think at the heart of that for me personally, it's a it's market dysfunctions and distortions, right? I think transparency, choice, competition, that's the best way to deliver value for taxpayers and for patients and taxpayers and patients aren't getting their best bang for the buck here. And it's bankrupting the country and it's putting people, families, working families further and further from access to good care for their families and the people that they love. So the current incentive structure is distortionary and it inhibits these forces creating sort of monopoly dynamics, anti-competitive behavior. So I spend most of my time thinking about health care reform with respect to that framing. Some examples. In the world of drug innovation, there's patent abuse where biotech companies are extending the life of their patent without making novel contributions using patent thickets and essentially having these exclusive rights extended and gouging all of us and we're allowing it to happen. I mean I'm quite frankly not putting the incumbent market participants at fault, it's the perverse incentives we've allowed to persist. One simple one for me is this disparity between what we pay hospitals and physician groups for the same outpatient service. And the effects of that are not just higher premiums on seniors in Medicare, higher cost for all of us as taxpayers, but there's a giant sucking sound of independent physician groups and docs into hospital systems leaving us with less choice. So those are just top of mind examples. You are a breath of fresh air. We may have disagreements on how to attack some of these problems, but you have a rare curiosity and objectivity and independence that you bring to the to this leadership, this incredibly important leadership post for our country. And I think the problem with all these distortions is that we have too much special interest, too much incumbent resistance, too much parochial politics, and everyone in this town seems to be captured by it to some extent or to one extent or another. You just seem to have been able to through the fiery furnace of public scrutiny over the years, I don't know what it is, but I love that you can come to this. I believe with all my heart that you just want to do the right thing for the country and for all participants and for especially our patients. Give me in the last 25 seconds your best shot on the monopoly forces and anti-competitive behavior. What are one or two things that you think this body could do to address that and go a long way to make things more affordable for working people in this country?

Thank you very much for those very, very kind and undeserved words. 10 years or 15 years ago, 80 percent of the doctors in our country were independent and 20 percent were corporate. Today 20 percent are independent, 80 percent are corporate and the number that are independent are dropping precipitously because the economic forces that are that are result of these perverse incentives. Site neutrality, which we're fixing, is a key to that. The wage area index, reforming the PBMs. That is one of the most anti-competitive forces out there and we're doing that. You've given me legislation which I'm now looking forward to implementing through the regulatory process. And then we need the FTC to file some cases and it's already doing that in the PBM space. So those are just a few of the of the things that we ought to be doing and thank you for raising all those important issues.

God bless you. Thank you.

Thank you. I remind members that votes have already been called, but we're going to try to work as deep as we can into the hearing while votes are going on. Now I recognize Mr. Panetta from California for four minutes.

Thank you. Thank you, Mr. Chairman. Thank you, Mr. Secretary. Thank you to your staff for being here. As we've heard today, there unfortunately are a number of issues that I believe are causing people to get a little exhausted because they are scared of your agenda and with your leadership. An agenda that is threatening to the health and safety of our nation and the lack of leadership that has led to two major vacancies in your department. At the CDC, Dr. Minneras was fired after only 28 days, reportedly for not going along with your anti-vaccine agenda. But since then, August of last year, the CDC has been without either a director or even an acting director. Now I know you have Jay Bhattacharya overseeing the CDC, but he's also overseeing NIH, managing over 27,000 employees and two campus that's two campuses that sit hundreds of miles apart. Furthermore, at CDC, Doge slashed whole offices resulting in almost 20 percent of its staff either being fired or quitting and there's even been hiring freezes there as well. For most of the past year, you've had people close to you act as proxies and in some cases you've even taken unilateral actions like you did last May when you rolled back COVID-19 vaccine guidance for pregnant women. Additionally, people should be aware that now that after passing the 210 days 210-day statutory limit for temporary leadership at CDC, Bhattacharya can no longer legally perform the full range of director duties. That means that without an acting permanent chief, tasks that congressional statutes explicitly reserve for the CDC director can only be performed by you, the HHS Secretary. That includes policy decisions like adopting vaccine recommendations for the CDC's Immunization Advisory Committee. The Surgeon General post is also vacant. Now I know that Casey Means, a Mahadev devotee with no active medical license and not a practicing physician, had her confirmation hearing two months ago. But she performed so poorly, including her unwillingness to commit to recommending vaccines, that the Senate has not scheduled a vote. That fact and the fact that there is 1,500 cases of measles that have occurred this year throughout the nation, the fact that a recent E. coli outbreak has sickened people, it seems that the Senate is having a hard time with your agenda. I know that the literal holdups of these positions are from the Senate, but it's clear that you and the Senate are having a hard time agreeing on people. The issue is, Mr. Secretary, that without leadership at DHS, if there is a crisis, if there is an outbreak, we lose surveillance. There's delayed recognition of problems, there's low response times, there's mixed messaging, and a loss of real-time guidance. These vacancies hurt America's health and they make Americans less safe. There's some disagreement with you and the White House as well. You've heard of glyphosate, the herbicide, correct, Mr. Secretary?

Yes.

And you called it one of the likely culprits in America's chronic disease epidemic, yet the President ignored your advice and he signed an executive order that bolstered the production of that weed killer. We all know what happens when it comes to your vaccine policy. But according to a recent YouGov poll, nearly three-quarters of Americans believe that vaccines are somewhat safe or very safe. And now the courts seem to be getting tired of your agenda. In March of this year, a federal court paused some new vaccine policies from HHS, including reducing the number of jabs recommended for children and reconstituted a vaccine advisory committee. Mr. Secretary, your stance on vaccines and the vacancies in the public health leadership coincide with a continuing decline of public trust in federal health authorities, something that's only gotten worse with the current administration. We need credible voices when it comes to the health and safety of our nation. We need a CDC director that we can trust, we need a Surgeon General that we can trust, because right now, Mr. Secretary, many, many people in my district and all across the country are having a hard time trusting your agenda. I yield back.

Mr. Feenstra.

Thank you, Mr. Chair and Ranking Member Neal. Thank you, Mr. Secretary, for taking the time to be here today. Greatly appreciate it. Last year, we Republicans passed the Working Family Tax Cuts bill, the largest tax cut in American history. And working alongside with your department, we included $50 billion in rural healthcare transformation programming to create high-quality and affordable healthcare for rural communities. And I'm so proud of our state, Iowa, that's one of the four frontrunners and leaders in advanced care and delivering some of this dollars to our farmers, our families, and our seniors. One of the biggest problems we're having in rural America, rural Iowa, and I'm the leading voice on this, is the diminishing access to maternal healthcare. We have women traveling 50 to 75 miles or more for maternal care. And I understand historically low patient volumes make it feasibly burdensome for small rural hospitals to provide delivery services. But currently less than half of our rural hospitals in the U.S. have labor and delivery services. And they continue to recede every year. Maintaining access to maternal healthcare is incredibly important and vital for rural communities. Can you expand on what we can do and how I can work with your department to to change the tide in this area?

Well, first of all, thank you for raising that issue. President Trump is absolutely committed more than any president we've ever seen. Well, first of all, thank you for raising that issue. President Trump is absolutely committed more than any president that we've ever seen in in preserving rural healthcare. It is a it's in crisis right now. As I pointed out earlier, we've lost 120 hospitals since 2010. And the his investment in the Rural Health Transformation Fund, which you voted for and approved, is the biggest investment in history in rural healthcare. And it's a five-year investment. It increased the influx of federal dollars into rural healthcare by about a 50 percent every year for the next five years. We're also doing other things in my agency to funnel additional dollars to rural healthcare and that includes the $135 million that I signed approved last week for community development health centers, which are primary in rural areas.

So so with that, we also have a shortage of of specialty doctors, whether it be OB-GYNs, whether it be oncologists and stuff like that. Again, come from a rural state of Iowa. Is there anything that we can do to try to keep these specialty care doctors and even family docs in rural America? I mean, it just seems like they're all gravitating to the urban centers. And we're we're having a hard time recruiting family doctors, oncologists, OB-GYNs. Any anything that you can offer, any suggestions that you can offer to help rural America, rural Iowa on that area?

Well, we've just finalized and promulgated the site neutrality rule, which should help. The biggest thing that needs to be done is fixing the wage area index. And that's something that has to come from Congress. We'd love to work with you on that.

Well, thank you. I I appreciate all your department is doing. And Secretary, thank you so much for being here. And I yield back.

Thank you. Ms. Malliotakis.

Thank you, Mr. Secretary. I want to begin by thanking you for your leadership on an issue that is very important to me and so many Americans and that is ending the inhumane and outdated animal testing in this country. Hundreds of thousands of dogs, cats, monkeys, rabbits and other animals remain in captivity for painful and unnecessary procedures, even though studies have shown that animal testing in in medicine frequently fails to accurately predict human conditions. We are seeing real progress by this administration. The NIH is investing $87 million in a new center to develop standardized lab-grown 3D tissue models and has announced that grant funding may be used to support finding homes for retired lab animals. And you've also asked agencies to prioritize non-animal methods. And you've also ordered a review to end the importation of monkeys from Asia for testing. I just want to urge you to stay the course. I'm very happy to work with you to continue to make progress here to end this cruel, costly and antiquated practice. I also want to thank you and the president for working with our New York delegation to fully fund and staff the World Trade Center 9/11 Healthcare Program. My district is home to many first responders. And unfortunately, sadly, they are still suffering from 9/11 related illnesses. So I appreciate your efforts. Also, Secretary Kennedy, in in as you know, one in five adult Americans are currently living with mental health conditions, including over 3.2 million New Yorkers. Timely and convenient access to mental health professionals is essential for individuals to receive the care that they need. We must do more to integrate mental health services in primary care settings. And that is why I've introduced the Complete Care Act, which incentivizes primary care providers to integrate mental health specialists such as psychiatrists, psychologists and substance abuse counseling into their practices and provide a temporary increase in reimbursement to help cover the cost. My question is, is that a piece of legislation, I know this is a priority for you in the administration, is that a piece of legislation that you could potentially support?

Yeah, and we will work with your office on that. And on the animal testing, there's $25 million to NIH in the proposed budget that we've proposed to again find other alternatives to animal testing. We're already doing a lot of work on organoids, on tissue chips, on AI, which actually are more accurate and faster and cheaper than animal testing. So it's part of our larger effort to speed drug approval.

Well, thank you very much. And again, I lend my support to you on however I can help with those efforts. One last issue I do want to bring up is women's health. Recently, the HHS hosted its first ever national conference on women's health. It's an important step in elevating the conversation around women's healthcare access and research that has been chronically underfunded in both the private and the public sector for decades. My question is how does the administration plan to advance its goals of improving health outcomes for women, particularly in underserved areas that have historically faced limited investment and resource constraints?

But you know, part of that for rural areas, the Rural Health Transformation Program hopefully will expand those abilities to treat maternal health. We are putting enormous investments into into maternal health. And I could go through those with you in detail. But there are but we're spending hundred literally hundreds of millions of dollars on it. We've got multiple programs. And I just would mention again our Perinatal Pilot Program, which has reduced maternal it has 220 hospitals that are involved. We provide them protocols for reducing maternal health maternal mortalities. And we have succeeded in those hospitals in reducing maternal mortalities by 41 percent.

Well, I appreciate that. And I don't have a rural area. I do represent New York City, Staten Island and Brooklyn. But we do have a lot of safety net facilities and we'd love for your administration's attention to that as well. Thank you so much.

Thank you. Mr. Schneider.

Thank you. Mr. Secretary, do you know who Alexander Fleming is? He invented penicillin. How about Gerhard Domagk? I guess you're not going to answer. He invented sulfonamide drugs. How about Selman Waksman? Still nothing. Okay. Well, he invented streptomycin, drugs that we use on tuberculosis. Would you agree that these three people helped make people healthier, the medicines they discovered?

I would say yes.

All right. Thank you. What's interesting is all those...

Did you say thalidomide? Did you say thalidomide?

I did not. I said streptomycin. Okay. So European, all of them were born in Europe. Now, Selman Waksman moved to the United States in 1910. He actually left Ukraine because of antisemitism, same time my grandmother did. What unites them is all three won the Nobel Prize. Selman Waksman won it as as an American citizen. Fleming was Scottish, Domagk was German. UK has 29 Nobel Prizes in in medicine and physiology. Germany has 16. The United States has 93. But if you expand it beyond just medicine and now I'm going to focus on the National Institutes of Health. From the National Institutes of Health website, they've identified 174 scientists who have either worked at NIH or done research funded by NIH that have earned them a sole or shared part of 104 Nobel Prizes. NIH has led the world in scientific research leading to extraordinary breakthroughs, changing the lives, not just American lives, but lives around the world for the better, making Americans healthier and people around the world healthier. NIH is the crown jewel of American research. Mr. Secretary, are you familiar with SMA?

SMS?

SMA. SMA is spinal muscular atrophy. So it is a disease that's a progressive rare genetic disease that affects the motor neuron cells of the spinal cord. Children with SMA don't walk, they can't sit up. If they're not treated, 90 percent will die before the age of two. Are you familiar with gene therapies?

Of course.

Okay. Well, gene therapies, do you think it's worth exploring the possibilities for gene therapies like we did in other things at NIH?

We are doing that aggressively. We're putting tens of millions of dollars into it and we are accelerating approval of new...

Well, thank you. I I appreciate that. Because SMA, which is a death sentence for children age two, now has a treatment developed in my district with research support from NIH. Now a drug called Zolgensma that instead of dying at two with this gene therapy, these children are achieving the milestones parents want for their children of sitting up, feeding themselves, even walking. We believe it is a cure that these children will now, instead of dying at the age of two, live out their full lives. And this is the development that is happening because of research at places around the world, in this country, all supported by NIH. And we're here today to discuss a budget that you brought before Congress where you're proposing to shrink NIH funding. The world's premier funder of medical research, shrink it by $5.7 billion. The CBO predicts that this reduction could lead to 50 fewer drugs coming to the market over the next 30 years. Drugs that can cure diseases, save lives, make America healthier again, and you're cutting that funding. You're diminishing science. You're making it harder for Americans to lead. I picked those three people, Fleming, Domagk, and Waksman, because at the turn of the last century, scientists from around the world came to the United States because they were chased out of their countries in Europe. The actions you and this administration are taking are chasing American scientists away from this country and fueling the research and development and drug commercialization in places like China. You are not making Americans healthier, you're making Americans sicker, hurting our economy and making our children's future less prosperous, less secure. You should be ashamed of yourself. I yield back.

As votes have been called, the committee will stand in recess until immediately following the vote series.

Testing 1 2 3, test test 1 2 3, testing.

The hearing will come to order. We will now recognize Mr. Bean.

Thank you very much, Mr. Chairman. Good afternoon to you. Good afternoon Ways and Means, and good afternoon Mr. Secretary. Thank you so much for your patience in being here today. For the record, everybody needs to hear this, for the record, the previous administration didn't have an advanced degree or wasn't a physician, but I'm going to tell you what you did. Under your leadership, great things are happening. You've elevated the talk about let's get healthy so much that just last year, I went to a food production facility in Jacksonville, Florida, Danone, which makes Activia yogurt and Oikos Greek yogurt, Silk, International Coffees. We did a little tour, but before that, their leadership says we're changing all our ingredients. We're going to go ahead and voluntarily remove red dyes. We're matching what our production facility does in Europe to make healthy, and we're doing that voluntarily, so which is exciting. I went last month, you did, and this is voluntarily, all of the medical schools have voluntarily says let's change our curriculum and let's add nutrition and let physicians say that food is medicine. You did that. That was just what happens. And so you've also made the Bean family change our diet too, and we're having a new focus on salads and whole foods. What's next? How can we continue the focus of making America healthy again, Mr. Secretary?

Thank you. Thank you, Congressman Bean, for pointing that out. And I will say this, that in the history of HHS, there have been three medical doctors, one of them appointed by Tom Price out of 26 total, and none of them ever appointed by a Democrat. There's never been a Democrat.

They didn't have the conversation or leadership. You're out there doing it, and I don't think we saw them doing pushups anywhere either. So thank you so much for doing that. How about, I know you're leading the efforts on fraud, we'd love to get our money back. What's next on fraud? What can we do to assist you and your department on making sure that every dollar goes to its intended recipient?

I mean, we're driving the use of AI across all the federal agents of government. We're leading. We now have over 90 percent of reviewers at FDA using AI. We're using it to detect fraud. We've changed the system under the Biden administration. We were paying claims that we knew were fraudulent before we paid them. It was called the pay and chase system.

Yeah. Nuts.

And we've ended that now. So now we look at every claim and make sure that it is not fraudulent.

We have a bill, the Bean bill, it's the DOSE in Spending bill, says let's check. Let's check to make sure that it's done first. So put a good word in me with Secretary Bessent on that bill and we'll do the same here. And then I also want to say, wouldn't it be better if Americans took more control over their health? I've got a bill that lets everybody, or at least a lot more Americans, have their own health savings account so they can start putting dollars in to save for an emergency or a deductible. How important it is that Americans take control of their own health, Mr. Secretary?

It's the only thing that's going to actually get us healthy again. We have to make, as Verne said, every American the CEO of their own health. We have to give them control. We now have these wearables that can actually tell them as they eat what it's doing to their, what the food they're chewing is doing to their glucose levels. We have ended information blocking for the first time in history so every American is going to have access to their own health records on their cell phone.

Mr. Secretary, thank you. You don't have to do this, yet you're in the line of fire because you believe America needs to get healthy. Thank you so much for your leadership. I yield back, Mr. Chairman.

Thank you, Congressman Bean. Mr. Miller.

Thank you, Mr. Chairman, I appreciate it. And thank you, Mr. Secretary, for being here today. I know it's been a long morning and hopefully it'll be almost over soon for you and you've taken a lot of heat on both sides. There's a lot that I could talk about, but you know, every time I go back home, I hear the same thing from our constituents about healthcare prices and costs. And earlier this Congress, I was one of 17 Republicans who decided to vote for the ACA extension because of the situation that I'm just a fundamental believer that I can't personally pull the rug out from underneath our constituents, at least 22,000 of mine, without providing a solution to the problem. And look, I think when it comes to longevity of life and everything you've done to get this country in better shape and health has been absolutely phenomenal. I myself care a lot about my health and what I put into my body and work out and truly believe that what I put into my body in terms of eating, food is medicine. And you are spot on about that. But I would just love to hear from you, you know, and you've been working with us, will you commit to working more with us in Congress in a bipartisan way to make sure that we can find an amicable solution for the healthcare issue that we face in our country? And I just want to go back home and be able to look at, you know, my constituents of the Seventh District, which is Cuyahoga, Medina, Wayne, and Holmes, and soon to be Ashland, and just say, this is what we're doing. Here's the plan. We can bring in more revenues, we can lower the cost, and we can actually make this work for you, something that the other party and Speaker Pelosi said we have to know what's in this legislation after we pass it. And that is unacceptable. And so really just want to hear from you, path forward and working with you. I'd be very grateful.

I mean, in terms of fixing the system, I really think that we need to go to more individual choice and competition. And we need to take the money, and this is what President Trump wants to do, away from the insurance companies and give it to individual Americans to do more direct primary care. If you look at how competitive direct primary care and how convenient it is, there are companies that are offering direct primary care for $100 or less a month and you get 24-hour service and all your medical costs taken care of, absent catastrophic care. And I think we have to, President Trump wants to go to a model like that through HSAs, through catastrophic plan, through expanding primary care. I have to say this, that even after the repeal of the Obamacare extended tax credits, 87 percent of people on Obamacare are paying less than $90 a month. And 50 percent of them are paying $50 a month, approximately $50 a month. But there was huge amounts of money being pumped into it and it was not lowering premiums. It was simply expanding the costs of a system that was going bankrupt. And President Trump has pledged to save Medicaid and Medicare, and Medicaid was going to go bankrupt. And there is no way that we can let that happen and we had to, we have to figure out a way, a plan that actually incentivizes good behavior rather than bad behavior.

I'm with you and I agree with everything you just said. But that's what I would like to start working on with you and HHS and this Congress is a plan, is a framework for the future. I believe that this country is very reactionary and we used to take more action to prevent things from taking place even though we know it's coming our way. I believe that we can work in a bipartisan way to lay out a framework for this country when it comes to healthcare. And Mr. Secretary, you could lead that charge and you'll find this body and this committee to work with you in any way possible. Thank you, Mr. Chairman, I yield back.

Mr. Horsford.

Thank you. I want to bring this conversation back to where I think it belongs, and that's with the people that we are all here to represent. Secretary Kennedy, while you're here, your boss is in route to my district in Las Vegas trying to rebrand the one big beautiful bill. But back home, my constituents aren't buying what President Trump is trying to sell because they're living the real-life consequences of higher cost, less certainty, and real fear about losing their coverage and their access to care. During the majority's field hearing in Las Vegas last year, they shut out the public and brought in a paid actor. I took a different approach. I invited my constituents to share their real stories about what these healthcare cuts would actually mean for them. And what I heard wasn't a matter of politics, but rather of survival. One of those constituents is Deja, a mother of a medically complex child, Shea. Shea was born at 30 weeks. He spent three months in the NICU and came home on an oxygen and feeding tube, one he still depends on to survive today. He needs in-home nursing, specialist, and ongoing care, all made possible by Medicaid. Without it, his family would face inaccessible cost and copays, leaving Shea at risk of failing to thrive. I've also heard from another constituent, Richard, who told me that at the beginning of this year, his marketplace premiums went up $1,700 a month. He said he and his wife are effectively out of the economy. They don't go out, they don't get to go to restaurants, there's no discretionary spending because they're just trying to make sure that he has access to care. So families like Deja's and Richard's, to them the healthcare affordability crisis is real and it's urgent. So let me bring it back to the basics: cost and coverage. What are you doing right now, Mr. Secretary, to lower premiums and to protect coverage for families like Deja's and Richard's?

First of all, I would say, Congressman, that there are no cuts to Medicaid. You look at the Congressional Budget...

What are you doing, Mr. Secretary? That's my question is what are you doing right now? What are your priorities to reduce cost and ensure coverage for the American people?

Well, we have negotiated the lowest drug prices in history and we're implementing those now with the MFN as one of many things that...

And how does that address coverage?

Well, in terms of insurance coverage, we're doing many, many things within the agency. We are... President Trump is right now with his...

What are you doing? You're the Secretary of Health and Human Services. Reclaiming my time. I'm asking about tangible actions and results. To me, the fact that you can't answer a basic question like bringing down cost and coverage, which should be your top priority, not some podcast, but actually addressing the needs of people. Now, like others, I want to make America healthy. I agree with the goal of moving from a sick care system to a true healthcare system focused on prevention. And prevention starts with the basics: clean air, clean water, and reducing exposures to toxins. So I'm struggling to reconcile the reports that some at EPA are working to roll back protections that would increase exposure to heavy metals in drinking water: arsenic, lead, mercury, and chromium. These are toxins linked to cancer, to heart disease, to stroke, and permanent brain damage in children. So just one question: were you consulted on those efforts to roll back those EPA protections, yes or no?

No, I haven't been, but I'm happy to talk to you right now about a long list of things that we're doing to roll back insurance premiums. And I would begin that with skin substitutes. A reform on that is reducing premiums in Medicare by 6 percent this year.

So have you aligned your goals dealing with the reforms to the EPA protections and how that is making people sicker, not healthier? That was my question.

Yeah, I could not answer those questions because it's not in my...

You can't answer the question as the Secretary...

It's not my agency.

You don't coordinate with the EPA, Mr. Secretary? Your department is not involved with rolling back protections that would increase exposure to heavy metals materials even though it affects people's health? Is that what you're telling me, you don't coordinate?

I'd say calm down, Congressman.

Don't tell me when to... look, healthcare is personal to my constituents like Deja and Richard. Your time is over. Do not tell me to calm down. Healthcare is real. And if you can't answer basic questions, then maybe come prepared next time.

I'm answering the question. You don't give me the chance to answer. You haven't given me a chance to answer.

You said you didn't...

I'm happy to answer your question and you cut me off when I started to answer.

You said you did not consult with the EPA.

You started screaming at me.

Okay, the time has expired. We're going to move on.

People scream when they don't have much to say.

You obviously don't have anything to say because you can't even uphold what it is you're doing to reduce cost and coverage.

Give me a chance to answer the question.

Mr. Horsford, your time is over. We're moving on to Mr. Yakym.

It's getting hot in here, Mr. Chairman. Thank you, Mr. Chairman, for holding this hearing today. And thank you, Senator Kennedy, for being here today to highlight the important work that HHS is doing under your leadership. Healthcare is top of mind for Hoosiers, and I regularly hear their concerns about cost, quality, and access to healthcare. During your tenure, HHS has taken significant steps to alleviate these concerns by reducing administrative burden on providers, protecting patients from unapproved compound drugs, and increasing patient access to innovative treatments. Mr. Secretary, under your leadership, HHS has focused on combating fraud and improper payments. That frees up resources for those who need it most. Can you share how you're reducing fraud and protecting taxpayer dollars?

I mean, we've implemented across the department all kinds of... we're now... we're laser-focused on ending fraud. We're doing investigations in Florida on DME, on durable medical equipment. There are now more durable medical equipment companies in South Florida than there are McDonalds. And most of those are almost certainly fraudulent. And in fact, we found a hotel with half a dozen different companies registered to different rooms, all of them selling durable medical equipment that they didn't have. They had no inventories. And as soon as we close in on them, they go back to Cuba. So this is money from my agency that has been stolen by a federal government. The same thing with the hospices in Los Angeles. The same thing with ABA treatments in Minnesota where we put on hold $349 million because it was... because that money we suspect was stolen. And a lot of that money is ending up in Somalia, some of it apparently with Al-Shabaab. So we are... we are being victimized in our country because of the laxity of vigilance by the Biden administration, the deliberate, purposeful suspension of program integrity by the Biden administration. Fraud has become rife without our... across our system. We estimate the cost of it to the American taxpayer is about $100 billion a year. If we stop fraud just in Medicare, we can extend that program for another five years.

That's incredible, Mr. Secretary. And thank you for your efforts to combat fraud and want to continue to work with you on those efforts. Unfortunately, my Democratic colleagues constantly talk about, as it relates to your efforts to combat fraud, they say that you're taking resources away from people that need them. I don't believe that that is the case at all. And would love to hear just briefly from you what efforts you're undertaking to ensure that you're not taking resources away from people who need them, but that you are indeed taking it away from people like Somalia.

I mean, you know, one of the things the Democrats keep saying is that we're cutting Medicaid. The President promised to preserve Medicaid and he's doing that for the people who need it. If you look in last week's Congressional Budget analysis, the increase in Medicaid under the Trump plan is 47 percent over the next 10 years. We're increasing Medicaid, not decreasing it. What we did with Medicaid is we're kicking people off it who were illegally taking it. There were almost three million people who were registered for Medicaid in two states or registered for Medicaid and Obamacare. That's illegal. There were million illegal aliens who were on it. That's illegal.

Thank you, Mr. Secretary. And finally, I just want to talk about just thank you for your quick implementation of the Republican-enacted Rule Health Transformation Initiative. Indiana proudly received $209 million of that money. And also, I'd like to just simply fully associate my remarks today with my colleague Representative Blake Moore as he and I are co-leads on H.R. 5343 dealing with breakthrough medical devices. We are leading a very broad bipartisan letter from multiple committees of jurisdiction to you and to your agency and to Dr. Oz dealing with breakthrough medical device coverage for seniors. This is essential to ensuring that our seniors have the best access to treatments and diagnostic devices because we need to ensure that our seniors get results that they deserve. And so you can expect that letter from me, from my office, and from a number of my colleagues here very soon. I look forward to working with you on that. I look forward to your response. Thank you, Mr. Secretary.

I look forward to replying and to working with you.

Thank you, sir. Mr. Chairman, I yield back.

Thank you. I now recognize myself for questions. 60 million Americans, 20 percent of the U.S. population, live in rural communities and suffer from a lack of access to quality, affordable healthcare. As part of the working families tax cuts, Republicans invested a historic $50 billion in rural healthcare through the Rural Health Transformation program. But for years, we've seen urban hospitals game the system to qualify for benefits Congress has intended for rural facilities. This is absolutely unacceptable. Secretary Kennedy, will you commit to putting in guardrails and to actively engaging with states to prevent the gaming of RHTP to ensure this money goes to truly rural facilities?

Yes, I will. And you know, originally for 340B, for example, there were 90 facilities. It was intended to lower drug prices in poor communities and rural communities. And there were 90 facilities who were approved. Today there are 12,000 and there are 50,000 different offices. And now it's being... because of those lower prices, they're using the lower prices, sometimes, for example, in Virginia, we found a rural hospital that was... where the company that owned it was taking their 340B money, the discounts they were supposed to be giving patients, selling the drug price at full cost and then using that money to build a hospital in an affluent area. Those kind of thefts we're seeing all the time and that's one of the ways that there's this systematic and perverse transfer of wealth from rural America to more affluent areas is happening every day.

So geographically, urban hospitals are abusing a Medicare loophole to reclassify as rural to get higher reimbursements, growing from three reclassified hospitals in 2017 to 435 in 2023. Can I get your commitment to help reverse this practice, prevent these abuses of the Medicare Trust Fund, and protect truly rural communities moving forward?

Yeah, I wish we could do it within my agency, but we need congressional help. It's a complex... it's a complex formula as you can but it's costing us $81 billion a year. It's now about 7 percent of drug prices and it... it's, you know, it's unsustainable.

Thank you. With the epidemic of rural hospital closures, it should be easier for struggling hospitals to serve their rural communities through innovative options like the rural emergency hospital model. To date, only 44 rural communities have converted to this model. I'm fortunate to have two REHs in my district, the only two in the entire state of Missouri. Unfortunately, it took one hospital in my district months working with your office to finally gain approval. Other hospitals may not have time to wait on bureaucratic process. Senator Kennedy, will you commit to improving the approval process for requests for rural emergency hospitals so the designations can proceed in a timely manner?

Yes, I will. And I and Dr. Oz will work with your office to make that happen.

Thank you. There are stark discrepancies in the way Medicare reimburses rural healthcare compared to their urban counterparts. As we know, it is an unfortunate reality that healthcare often follows the dollar, making reimbursement policies not just a financial question, but a life and death concern for growing access to care. I had a medical technology company tell me about a remote monitoring device that they were paid twice as much for in San Francisco than in Missouri. With this discrepancy, it's not a matter of if, it's a question of when rural areas will be left behind because they're going to spend all their resources going to San Francisco, make 80 bucks a month rather than 40 in Southeast Missouri. Will you and the administration commit to working to bring rural reimbursements more in line with the same treatments done in urban settings?

Yes we will and you know we've already addressed some of that discrepancy through our promulgation of the site neutrality rule. We need your help on the wage area index to really correct those disparities.

Earlier, as you noted, the implementation of the No Surprises Act was a disaster under the Biden administration, losing four lawsuits and harming patient access to care. One of the things that frustrates me the most about government agencies is a tendency to ignore the written statutes of Congress. The ranking member raised this a little bit earlier in regards to the No Surprises Act, but the Ways and Means Republicans have requested your department urgently finalize a needed rule that is in line with what we passed out of this committee and what was signed into law. Just last night, months later, I received a response to the letter, but I'd like to ask for a clarification. So will you commit to me now to finalize this rule as it was written by Congress as a top priority for your department?

We're working as fast as we can to finalize that rule now.

That's good. Large consolidated hospitals and health systems have a history of abusing federal health programs to prioritize payments over providing quality care and lower costs for patients. How is HHS championing site neutral reforms, including policies this committee has passed, to ensure that large hospitals aren't overcharging patients and taxpayers?

We've just finished promulgating that rule and I hope that it corrects some of those inequalities.

Thank you. Mr. Suozzi.

Mr. Neal.

Mr. Suozzi, you want to...

Let him give you the time.

No, Mr. Suozzi. We'll take...

I'm going to yield to Mr. Neal.

So let me agree with something you said, Mr. Secretary. Wage index issues based on reimbursement and teaching hospital reimbursements are as you have stated correctly, very complicated undertakings, but generally for a pretty good ascribed purpose. I yield back my time, Mr. Suozzi.

Thank you, Mr. Ranking Member. Mr. Chairman, thank you. Mr. Secretary, thank you so much. It's good to see you. Like many of my colleagues, I have a long history with the Kennedys. I've got a picture in my office of my father campaigning with John F. Kennedy in 1960. It's been a big inspiration to me throughout my entire life. And as you and I have discussed before, when your dad ran for a senator from New York State, he lived in Glen Cove, my hometown where I was the young mayor. And you lived in that home for a little while. And when I was the mayor of Glen Cove in 2007, I invited you to come and speak because you had founded the Riverkeeper about the environmental quality of the Long Island Sound and you really did a fantastic job and made a tremendous impression on people back in those days. And I applaud some of the things that you're doing. I like the idea of going after the food dyes. I like going after microplastics. I like the idea of doing prevention instead of just treatment and going after chronic disease. But I want to just try and find out how you feel about a quote that you made versus a quote that the President recently said. We've heard it a couple times here today. In June of 2024 you said, we've poured our wealth, talking about America, we've poured our wealth into one military operation after another. As a result our nation has decayed from within, an epidemic of chronic disease, a plague of addiction and a historic economic inequality. Now how does that compare, that's your statement running for president in 2024, to what the President just recently said last week. It's not possible for us to take care of daycare, Medicaid, Medicare, all these individual things. They can do it on a state basis. You can't do it on a federal. We have to take care of one thing, military protecting. We have to guard our country. Now how do you square that about your beliefs versus the President's belief? Do you agree with what the President said?

As I said before earlier, the President's budget reflects his commitment to take care. There was no, it's one of the Head Start program is one of the few programs that was spared a cut across the agency of 2.5 percent.

He said we can't do daycare, we can't do Medicaid, we can'... put it this way in practical terms. The President's budget increases the defense budget by $500 billion and it cuts your agencies by $10 billion or more. Now how does that square, especially given your philosophy that you've promoted for decades, that we've got to focus more on taking care of the health of the people of the United States of America and not squander it on foreign military campaigns? How does that jibe?

Well you know the President is making a lot of tough decisions and he's making tough decisions because of problems that he inherited. He didn't make up the glyphosate dependence and 98 percent...

No, I'm talking about the increase... no, I understand that.

He didn't make up the, he didn't create the problem in Iran, that was created by...

I understand that but he's increasing the budget by 500 billion and cutting the healthcare of the people of the United States of America. You say he's not cutting Medicaid, nobody buys that, okay? You say he's not cutting it, we say he is cutting it. He got rid of the premium tax credits. We say that's a major problem for the people of the United States of America.

The Democrats had two chances to extend the premium tax credits and make them permanent.

We just passed it out of the House at the beginning of this year.

And they didn't either time and now you're blaming him for doing...

We just passed it out of the House at the beginning of this year.

The Democrats were in power, control both houses.

Let's not make it about Democrats versus Republicans, Mr. Kennedy. I don't want to do that. I want to be bipartisan, I want to work together, I've applauded you on some of the things that you're doing that are good. But how does it square that he's increasing the defense budget by 500 billion and cutting money for NIH and CDC? The budget, some of the things you talk about the budget and the things he's inherited. He's increased the deficit by more than any administration in the history of America as part of the big beautiful bill. That's not something he inherited. increase the deficit by more than any administration in the history of America as part of the big beautiful bill. That's not something he inherited.

This President has done more to protect public health than any president in history. He's the first one. You guys are the ones that gave us the chronic disease epidemic. We're the unhealthiest population on the face of the earth. This President has done more to protect public health than any president in history. He's the first one. You guys are the ones that gave us the chronic disease epidemic. We're the unhealthiest population on the face of the earth.

You think that all happened in the past four years of the Biden administration? It's you guys? Did that all happen in the past four years of the Biden administration? It's you guys?

It happened, it happened.

It was the Kennedy administration, it was the Clinton administration.

You've been a politician your entire life.

And you've been involved in public life your whole life as well.

Right, well I'm not in elected office.

You've tried to run for elected office, you decided not to do it on many occasions. I followed you very closely, Bobby.

I've never ran for anything until I ran for president.

I know you decided not to at the last minute every time. I followed you very closely.

What does that have to do with it? I'm saying...

You're bringing up the politics, not me.

Time is over, Mr. Suozzi.

Thank you, Mr. Chairman.

Thank you. Mr. Secretary. Mr. Secretary, thank you for appearing before us today. I learned one thing. I always wondered why my mother, my grandmother always had a picture of JFK and the Pope side by side and apparently everyone in Connecticut did that as well in Massachusetts. But it showed how much my family appreciated the Kennedy family. We're glad you're here. And that please be advised that members have two weeks to submit written questions to be answered later in writing. Those questions and your answers will be made part of the formal hearing record. With that the committee stands adjourned.