FY 2027 Budget Request for Health and Human Services

Guess I had to hit that a little harder, hint, hint, didn't work. Um, welcome. Uh, welcome, Mister Secretary, and good morning. Uh, this is our first labor, uh, HHS subcommittee hearing. I'm happy to be here with Vice Chair Baldwin and I. Uh, we have served together for several years on this subcommittee, and I am proud of the work that we did last year. to complete a bipartisan fiscal twenty twenty-six bill. I also want to take a moment to recognize Senators Collins and Murray, who will probably be here later, whose leadership as the chair and vice chair of the full committee made that fiscal year twenty twenty-six bipartisan process possible. Today's budget hearing is a first step in that process for fiscal year twenty twenty-seven. Secretary Kennedy, thank you for being here. I understand this is your fifth of seven hearings, so you should be all warmed up for us. Um, I know that we all share the goal of improving the health of Americans. This hearing is an important opportunity for the subcommittee to hear from you on HHS's budget proposal and better understand your priorities for fifty fiscal year twenty twenty seven. You're now in your second year at the helm of HHS. During your time as secretary, I know you've taken a careful look at every program this committee funds, and I commend you for coming here today with a much more reasonable budget uh request than last year. Congress has a responsibility to ensure that limited taxpayer dollars are always well spent, and I look forward to hearing from you about ways to improve the agency. One of the most important investments we make in HHS is in biomedical research. That is why in fiscal year twenty twenty six Congress provided a four hundred and fifteen uh a four hundred and fifteen million dollar increase for NIH which all of us supported. NIH funded basic research provides hope for American families Extraordinary. when a loved one faces a difficult challenge. New treatments, cures, clinical trials are available because of funding Congress has provided. That record of success is why NIH has long-standing bipartisan support in the Congress. Our nation's support depends on the medical researchers across the country supported by NIH. America has long been the world leader in biomedical research, and I look forward to hearing your proposals of how American can maintain our role as the world leader in biomedical research. It is promising news that overdose deaths across the country are trending downward. But sadly, substance abuse challenges continue to be a problem facing certainly my state of West Virginia and the nation. I appreciate the administration's focus on combating addiction and supporting recovery and I'm grateful for your swift action to reverse the very questionable SAMSA grant cancellations that occurred earlier earlier this year,

Yeah.

so thank you for that. SAMHSA funding has played an important role in West Virginia and I would like to understand how the budget proposal to reorganize substance use prevention and treatment programs into the proposed administration for a healthy America would continue to help fight the scourge scourge of addiction across the nation as you know Congress continues to prioritize programs that support health care access in rural communities CDC data shows that diabetes is more prevalent in rural communities. than in urban areas and rural Americans are much more likely to die from cancer, heart disease, and stroke than urban Americans. We experience these uh realities acutely in my home state, which leads the nation in rates of diabetes and heart disease. Therefore, I appreciate your focus on combating this chronic disease crisis in the US. To help improve physical and mental health outcomes for rural Americas we must continue investing in health our health workforce, and other rural health initiatives that build capacity and strengthen our community institutions. HRSA has been a trusted federal leader on these types of rural health activities for decades. Mm-hmm. Mm-hmm. You have also proposed moving HRSA to the new aha and I would like to learn more about how your budget proposal would invest in rural America. As always, the appropriations process this year will be challenging, but it is my hope that we will once again come together to produce a bipartisan bill that uses our limited resources in the most efficient and effective way to support the health and well-being of all Americans. Finally, I want to note that it took almost nine months to receive responses to this subcommittee's questions for the record on the fiscal year twenty-six request from last year. These responses arrived just last month, far after the statutory requirement of forty-five business days, and more than a month after the FY twenty twenty-six

Um, thank you, Chair Capito, and good afternoon. Uh, this I I I wanna start quickly by putting the HHS budget in a larger context because this is the president's uh budget request. And it makes the administration's priorities clear. More money for war, less money for programs helping Americans here at home. It includes a four hundred and fifty billion dollar or forty-two percent increase in defense spending. And it doesn't even include an expected supplemental funding request for the war in Iran.

Mm-hmm.

At the same time, it slashes funding for the department of Health and Human Services for programs within the jurisdiction of this subcommittee by seventeen billion dollars or about fourteen percent of the overall HHS budget. It cuts funding for biomedical research, combating the opioid epidemic, lowering the cost of heating and cooling bills for Americans, and so much more. Instead of fighting wars of choice abroad, we should be fighting wars against addiction. against cancer, against Alzheimer's disease. And this budget request proposes the opposite. I expect Congress to reject this budget request, just like we did last year, but what I'm more concerned with right now is how the administration is sabotaging important health and human services programs sort of outside of the appropriations and budget process. That's because where this budget proposes cutting and eliminating programs, the administration is currently actively working to cripple them. These are programs that family rely on, families rely on today and support the discovery of new cures and treatments for devastating diseases in the future. For example, the budget proposes a nearly six billion dollar or twelve percent cut to the National Institutes of Health. I'm confident that Congress will reject that. But the issue is what the Trump administration is already doing to decimate America's biomedical research. It's delaying billions of dollars of NIH funding while slashing the number of research grant awards. Last year, NIH awarded two thousand two hundred and thirty-five, or twenty-two percent, fewer new research grants than it did the year before. This included two hundred and sixty, or twenty-one percent, fewer new cancer research grants and four hundred and eleven, or forty-five percent, fewer new grants funded by the National Institute on Aging, the primary funder of Alzheimer's disease research. The NIH, uh, funding has been delayed again this year, first by the White House and now by HHS. In the last fifteen months, the White House and Health and Human Services has has slashed the number of NIH funding opportunities for new grants from the seven hundred to eight hundred issued in a typical year to just eighty-five. This administration has tried out all sorts of excuses for why it's cutting funding for life-saving research or tried to say it's just not true. But the numbers don't lie, and we need to be clear. That's exactly what's happening, and it's an active choice to do it. This administration is making a choice to cut off funding for research and in turn, cut off hope for millions of Americans with life-threatening diseases. HHS is issuing fewer grants and delaying funding for research on cancer, Alzheimer's disease, ALS, diabetes, mental health, and other chronic diseases. And I have fought to stop the long-term damage that this administration is inflicting at NIH. And I'm disappointed that we haven't been able to do more. The budget request also proposes to cut funding for CDC programs by a third. This administration says it wants to eliminate chronic diseases, yet proposes a budget that slashes the chronic disease center at CDC by nearly one billion dollars, or more than sixty-eight percent. Health and Human Services has already fired and forced out thousands of CDC staff and scientists, and as a result, CDC has twenty-six percent fewer employees today than it did fifteen months ago. This includes firing the staff who administer the Safe Motherhood initiative, that helps reduce reduce maternal deaths. eliminating the division of population health that helps increase early detection of Alzheimer's and other dementias and eliminating the office of on smoking and health that reduces tobacco use still the number one cause of preventable death in the United States. If everyone from subject area experts to grant managers have been fired it raises serious concerns about Health and Human Service's ability carry out these and other programs, such as the Bold Infrastructure for Alzheimer's Act, the Pregnancy Risk Assessment Monitoring System, and the Domestic Violence and Sexual Assault Prevention programs. All these are all programs Congress just funded in fiscal year twenty twenty-six in our appropriation bills that we passed just three months ago. The budget also proposes cutting the funding for the agency for Healthcare Research and Quality, otherwise known as AHRQ, by a third and eliminating it as an independent agency. Congress rejected similar cuts last year, but that did not stop HHS from firing a third of AHRQ's staff. As a result, AHRQ is effectively shut down and has not awarded a new grant in over a year and has awarded only a fraction of existing multi-year awards that researchers and patients were counting on. AHRQ won't even respond to questions from researchers about the status of their funding. As one small but important example of what this means, and the absurdity of what is happening, right now Health and Human Services is highlighting on its web site the work of a group of researchers, including one from the University of Wisconsin, studying how to use data, AI, and family engagement to improve the outcomes for children who are hospitalized. The researcher in Wisconsin, Doctor Michelle Kelly, has a grant from AHRQ, but while HHS is touting and promoting her work, she hasn't received the second year funding for her grant, which should have been awarded last August. As a result, she's had to put her trial on pause and stop working with the families of hospitalized children. And AHRQ won't tell her anything about what's going on, derailing promising research and leaving families without answers, all because Health and Human Services has effectively shut AHRQ down, despite the Congress just funding it. The impact of delaying research like this won't be immediately apparent, because it isn't easily measured or quantified. But we will be paying the price for it for decades to come. In this case, it means missed opportunities to improve outcomes for hospitalized children. And this pattern is being repeated thousands of times over across Health and Human Services. The budget request also proposes cutting funding for substance use and mental health programs by over five hundred million dollars, and eliminating SAMSA as an independent agency. This proposal comes even as President Trump issued the quote " Great America Recovery Initiative" in January, which is an executive order to abstence- ostensibly better address substance use disorders nationwide. Just as the President announced that initiative, Health and Human Services tried to abruptly terminate, without any notice or explanation, two billion dollars in funding for twenty-eight hundred SAMHSA grants across the country. For no reason, HHS tried to rip funding away from local communities working to help individual families suffering from substance use disorder or in need of mental This raises deep concerns about this administration's judgment and is yet another example of how its rhetorical, its rhetoric is wildly inconsistent with its actions. This is part of a pattern and in no way do I believe that that was a simple mistake. The budget request also proposes to eliminate title ten family planning programs. And at the same time, Health and Human Services is taking steps administratively to restrict women's access to reproductive health care, including contraception. These are only a few examples of how this administration is crippling the important work that Health and Human Services does. And that is on top of what the President's own Health Secretary is doing to undermine trust in vaccines, including making changes to vaccine recommendations that go against decades of scientific consensus. The changes this administration is trying to implement when it comes to vaccines are putting kids at risk of debilitating, fatal, and completely preventable diseases. Congress should reject this budget request, but that's not enough. This administration continues to act with impunity putting the health and well-being of families across the country at risk. And Congress must stop it.

Well, thank you, S- uh, Senator Baldwin, and our witness today, as I mentioned, is Robert F. Kennedy, Junior, the Secretary of the Department of Health and Human Services. Secretary Kennedy, as I said earlier, thank you for joining us. You have five minutes for your opening remarks, and you can begin. Thank you.

Uh, thank you, Chairman Capito and Ranking Member Baldwin. and members of the committee thank you for the opportunity to appear before you today to discuss the president's fiscal fiscal year twenty twenty seven budget request we stand at a generational turning point our children are the sickest generation in modern history and decades of failed policies captured agencies and profit driven systems caused it parents across the country demanded change and we are delivering it We're ending the era of federal policies that fueled this chronic disease epidemic and replacing them with policies but that put the health of the American people 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 fifteen months, HHS has delivered historic wins. We negotiated most favored nation prices with sixteen of the largest pharmaceutical companies so americans no longer pay more than any other wealthy country in the world for the exact same product made in the same factories we're bringing real transparency to healthcare pricing so patients know the cost before they receive it i use the convening power of the federal government to bring together insurance ceos to the table to reform prior authorization and we're cutting red tape meaning decisions and demanding transparency. We're 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 God, to the American people, eat real food. HHS has al- also opened the door to partnerships with industry trade associations nonprofits and advocacy groups more than fifty medical schools have committed to expand nutrition education from an average of just two hours to forty hours food manufacturers are stepping up too more than forty percent of the food industry is committed to phase out petroleum-based dyes by year-end and many have already eliminated them uh i convened the largest four hundred largest companies in our country to agree to stop information blocking so that by the end of next year and it's already happening people's health records which they own will be available to every american on their cellphone in conjunction with these efforts fta has also approved six natural food colorings derived from fruits and vegetables through president's america 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 driving faster access to life-saving treatments. Restoring gold standard science and integrity across the agency. We're protecting children from sex-rejecting procedures that expose them to irreversible harm. or eliminating outdated and misleading warning labels on hormone therapies that treat women during menopause or strengthening oversight of organ procurement or implementing operation stork speed to ensure the safety and quality of infant formula or regulating television advertising by pharmaceutical companies for the first time since the nineteen seventies or applying that same focus and urgency to rural america rural health transformation fund delivers the largest investment in rural health in our nation's history fifty billion dollars over five years to strengthen rural 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 a hundred and thirty five million dollar investment this month to expand rural residency programs and nutrition services the data is clear when physicians train in rural communities they are much more likely to stay there the president's budget puts all of these priorities in action it invests in prevention because preventing disease costs a lot less than treating it as my uncle president john f kennedy said progress is a nice word a change that's motivator and change has its enemies. We see those forces clearly entrenched interests, defenders of a failing status quo and institutions that put profit ahead of the American people. That resistance underscores the urgency of this moment. We can reverse the chronic disease epidemic, improve public health, and lower costs. I stand ready to work with this committee and Congress

Thank you. Uh, I wanna welcome the uh chair of the full committee, uh, the senator from Maine, Senator Collins, and I'm gonna ask her to start off the questioning. Thank you.

Thank you very much, Madam Chair. Secretary Kennedy, before I get to my questions. I wanna thank you for your efforts in securing the release of the low income home energy assistance program funding, uh, that had been held up and is very important to many of our states. Now, turning to my questions. Yesterday, the Washington Post published a story on NIH grants, which documented a thirty-one percent decline in the number of research projects funded in twenty-twenty-five, that included the word " women". I brought up this exact issue with the NIH Director at a recent hearing before the help committee, because the administration's emphasis on canceling diversity-related grants has resulted in less research aimed at women's health. It is well established that disparities in women's health exist. For example, the incidence of Alzheimer's disease is higher in women than in men, and it is not explainable by the fact that women live longer. than men. There are also disparities within the female population. For example, pregnant women who are black have a higher maternal morbidity rate than white women, while Asian women have a better outcome than white women. Yet, it appears that the administration is looking at these disparities and is not looking at them, is pulling back from these grants instead of figuring out why these health disparities exist and how to address them. I know that your budget request notes the importance of continued investment in maternal health, but how are you going to address other health disparities in women's health? such as the disproportionate burden of autoimmune diseases, Alzheimer's disease, as I've mentioned, if diversity is no longer a criterion in making funding decisions.

Uh, Senator, thank you for that question, we're about to announce in the next coming weeks a major program, major investment by ARPA to study Alzheimer's uh and uh and to focus on new treatments and preventative treatments and ways to reverse alzheimer's um there are many many grants at nih now studying alzheimer's and diabetes we're focusing for the first time on chronic disease and its and its ideology which has been neglected by that agency for many generations we're gonna identify the cause of chronic disease and how to eliminate the exposures that are generating this giant epidemic. Um, we're focusing on maternal health and I can read you a whole list of programs that we're doing on maternal health right now, and you're right, we have the worst maternal health outcomes of any of the Western countries, and black women are two point six times more likely a college-educated black woman is doing it. half time is more likely to die in from maternal uh you know during mater from maternal health mortality and a college educated white women one of the programs we have now is the paranetopilot program where we've enrolled two hundred and twenty hospitals in one year we've dropped the rate of maternal mortality by forty two percent nobody has ever done that before and we're now trying to extend those

i appreciate those efforts uh i still think we have a problem if grants are being scanned for the word women and then clawed back or are not funded so i hope you look more broadly even though i support the initiatives that you mentioned i do wanna move to another issue as you've heard from the subcommittee chair There has been strong bipartisan support on this entire committee for the investment in biomedical research. In fact, it's hard to think of an investment that pays greater dividends to American families than that investment, because it leads to lifesaving and life-en- life-enhancing discoveries. The administration's budget, much to my dismay, once again proposes an arbitrary one size fits all fifteen percent cap on indirect research costs despite the fact that Congress blocked an identical proposal last year that originated with OMB. Such a cap would harm cutting edge research happening at universities and other non-profit laboratories and medical centers across the country, and undermine the foundation for our nation's global leadership in biomedical research and technological innovation. Mister Secretary, rather than continue to pursue a policy that Congress clearly rejected, both sides of the aisle, both chambers, Will you work with us and the research committee to find a better way to increase transparency and accountability that does not come at the expense of crucial biomedical research?

Uh, absolutely. I look forward to working with you, Senator. I would say this, and um, nobody in my agency wants to cut any of these agencies, any of these programs. and i don't think rusfo wants to cut them either we have a thirty nine trillion dollar debt and all of the agencies across the government have been asked to tighten their belt and my agency have been asked to cut twelve percent and all of these cuts are painful um but we are at the cutting edge right now in terms of uh of uh revolutionizing uh biomedical re research in our country we're losing our lunch to china china last year uh fifty percent of the new drugs that were approved were from china it went from three percent of the clinical trials to thirty percent and another thirty percent are going to australia so we're losing our ip we're losing our best researchers we're losing our scientists and we're losing ground in terms of our biosecurity These are all things that we are focused on. We are compressing the um the the the pathways to approval and compressing clinical trials. I think I'm out of time, but uh I will talk more about that later.

Thank you, Madam Chair.

Senator Baldwin.

Thank you, Madam Chair. I I believe I heard you said that I heard you say just now that all departments were being asked to tighten their belts and make cuts. The Department of Defense is being, uh, the b- president's proposal increa- increases that budget by I think it was four hundred and fifty billion dollars. So I just wanna, um, correct the record here. Um, Secretary Kennedy, I do appreciate our recent phone calls to, uh, discuss the fiscal year twenty twenty-six, uh, labor HHS bill and its legal requirement for HHS to restore the press three option on the nine eight eight suicide uh and crisis lifeline specifically focused on LGBTQ youth. Secretary Kennedy, do you commit to restoring the press three option as required under that law?

I do, Senator, and I, you know, I wanna say that President Trump has philosophy that we shouldn't be dividing people, that we should be being inclusive.

But I did hear you just say yes, you do commit to

Yes, we are working on getting it up now.

All right. I will continue to be vigilant until I hear that it has been restored. Um. Switching topics, Mr. Secretary. Is it this administration's goal to reduce the number of women using birth control in this country?

Uh, not that I know of.

OK. Nearly all women in the United States will use contraception at some point in their lifetime. And they deserve to have facts. And I'm deeply concerned by the extreme steps that I've been hearing about this administration taking, including the continued crusade for a national abortion ban. It's been widely reported that EPA is considering testing wastewater from Mifepristone, the drug widely used for medication abortions. Have you spoken with Administrator Zeldin about this effort?

I have not spoken to him specifically about Mifepristone, but I have spoken to him about um the program and urged him to do a uh to conduct a program to look for uh pharmaceutical drug artifacts in our water a lot of that water gets into drinking water it um there's hormones in it there's antidepressants there's all kinds of drugs in it and we have no idea how much or what in fact is that

so you have spoken with administrator zeldin about that general topic cdc also has a wastewater monitoring program that also can be used to track the presence and spread of dangerous infectious diseases at a very localized level. Will you use the CDC's wastewater monitoring program to track the use of Mifepristone?

I have no plans to do that at the moment, Senator.

OK. Um, I'm, uh, I, I care deeply about women's health, safety and choices, and this administration has Tried, as I mentioned in my opening comments, to cut off funding for family planning clinics, has tried to make it harder for women to access birth control, and has reportedly been exploring efforts to monitor the water supply, to track women's use of abortion medications. Turning to another issue, um, the Trump administration's continued undermining of violence.

I've never heard of that. program senator but

that's reassuring

maybe another

uh there's been reporting and so uh i'm i'm sharing that with you uh secretary kennedy do you think that nih should fund less cancer research

no i think they should uh fund more and the budget proposal one of the few agencies that's gotten a raise in the budget proposal is nci

And that uh that increase is less than one million dollars for an institute with a seven billion Which is dollar budget that is a point zero one percent increase. It would not even cover the cost of one additional grant. But Mister Secretary, NIH's own budget documents show that last year the National Cancer Institute funded two hundred and sixty um fewer new cancer research grants. Secretary Kennedy, do you think NIH should fund fewer Alzheimer's disease, uh, uh, research grants?

I think they should be funding more.

Well, NIH's own budget documents show that last year the NIH, um, uh, Institute on Aging, which administers the bulk of NIH's Alzheimer's disease research, funded four hundred and eleven, or forty five percent fewer new grants. And this is the true for every disease in NIH's research portfolio. Um, I am running out. I have run out of time. I hope we might get another round, but, uh, I will, uh, stop at this point.

Thank you. Uh, Secretary Kennedy, by your, um I'm looking at the number of employees. Uh, this is a quick question, I hope. Uh, at the end, uh, uh, by January twenty twenty. twenty twenty five there were ninety three thousand one hundred and fifty three employees at HHS uh there are now seventy four thousand three hundred and thirteen uh so that's a that's a big difference do you feel that uh there has been any um uh abatement of service or quality of service delivery under these conditions

uh i do not uh you know during uh covid my agency grew by thirty eight percent and we are now right sizing and we're in the process now of hiring about twelve thousand more personnel to make sure that we have people uh to do every job but um the the agency was not functioning well when i got there it had presided over the the largest increase in chronic disease in human history so the agency that's supposed to protecting us from chronic disease had failed abysmally

Yeah, at pre-COVID levels it was eighty-two thousand, so it went up eleven thousand uh at uh during COVID. Let me ask you about NIOSH because you know and uh and I know that this is a a uh, uh very important to the coal miners and firefighters of West Virginia. Um, the investment uh for NIOSH it's, you know, for respiratory illnesses uh particularly on the job. The mission is specially trained NIOSH uh employees is not duplicative of any government program if they don't do it it doesn't get done and the benefits don't come towards those who are suffering from black lung so we were able to work together to get four hundred of our niosh employees back in morgantown how would hhs continue to support this important work with a significantly reduced funding levels and also i think uh it's it's going to be folded into other things with cdc i just don't wanna lose the core mission here this is really important

and uh and i i wanna thank you uh your leadership senator in making sure that we got those um those jobs restored and as you know it's an important issue to me i've spent a lot of times in the gold fields and i've spent a lot of time with people who suffer from black line my entire life but also my professional career i represented them in litigation so i'm i'm deeply committed to making sure that we're doing the right thing for them

thank you Thank you. That's important to me as well, and thank you. I mentioned in my opening statement, uh, rural health programs, uh, the budget, uh, proposes to cut one point three billion from current HRSA, a hundred and two, including a hundred and two million from rural health programs and consolidates what's left into the administration for uh administration for healthy America, the AHA initiative. Uh, it also cuts, uh, state offices of rural health, rural hospitalization rural hospital stabilization program, uh, rural hospital flexibility grants, rural hospital provider. You mentioned the, uh, rural health transformation in your opening statement. It seems to go counter to this. What would you say and how is AHA gonna be able to, uh, how does that fit into that and what kind, uh, what kind of future do you see for your rural health programs?

Oh, we're very committed to rural health. Both the sides of the aisle have made it clear to me that priority for all of you um you know prior to the rural health transformation fund we put about seven percent of medicaid dollars went into rural hospitals and rural areas that's about twenty billion dollars a year uh the rural health transformation fund increases that by fifty percent the next five years uh ten billion dollars a year and that is to go to uh to renovate infrastructure rural hospitals to retain front-line personnel to integrate telehealth and ai into their systems to revolutionize them in addition to that i'm always on the lookout for new ways of of assisting rural healthcare last week i went to arizona and announced a hundred and thirty five million dollar program to community development health centers uh which there are uh which serve thirty two million people mainly in rural areas provide nutrition uh but also to provide nutrition infrastructure like kitchens and home gardens etcetera but also to um snacks and lunches uh for rural residency because we know that when doctors train in rural areas thirty percent of them end up staying there and that's one of the big problems with rural health

it is it's a different delivery system and it is hard to attract. I mean, telehealth's great, and we've done a lot together, all of us, to to try to increase telehealth, but it's still, there's still a lot of hurdles. So I will go to Senator Durbin.

Thank you very much, Madam Chairman. Mister Secretary, thank you for being here. In preparing for this hearing, I came to realize we have something in common. Both of us lost our fathers when we were fourteen years old. I remember your loss. I was a second year law student at Georgetown. It broke America's heart, for you and your family.

Well, thank you, Senator.

My loss was similar, in that my father, who was fifty-three years old, died of lung cancer. Two packs of Campbell's a day. And it changed my life, as I'm sure your father's loss changed yours. And so I've taken tobacco pretty seriously, as a member of Congress now, for forty-four years. And the one thing I did, seemed small at the time but maybe has impact behind, and that was to ban smoking on airplanes. Once we raised a question of the danger of second-hand smoke on an airplane, Americans asked the obvious question, well how about a train, or a bus, or an office building, or a hospital, or a restaurant? And we've seen dramatic reductions in tobacco addiction. Still, the reason for moving forward on that was not just to make the situation more pleasant on an airplane, but also to protect children who were smoking and using tobacco products in school. That number is down dramatically. We're told by experts that if we want to save more lives in America, we need to do less. Uh, we need to do more in stopping smoking and have fewer people smoking than we do today. Your report on the state of health in America, I looked through it And it never mentions the words tobacco or cigarette. I think it's such a priority I hope you'll reconsider. And I hope you'll also consider what the tobacco companies have done to this new generation of children. They're now not peddling tobacco successfully, they're peddling vaping, vaping and cigarettes, e-cigarettes. I visit schools in Illinois and the principals pull me aside and say, Senator, what are you doing about this? These kids are doing too much in vaping. Instead, however, your FDA just approved the e-cigarette responsible for igniting this youth vaping epidemic, Juul, and announced plans to permit big tobacco to sell more kid-friendly flavors. This FY twenty-seven budget request would also eliminate the CDC's Office of Smoking and Health. This two hundred and forty-six million dollar program helps adults to quit smoking and make sure that kids have uh fewer chances of ever doing it themselves you tell us they're the sickest generation of children we've had how can vaping make them any healthier

well first of all i agree with you senator and i wanna thank you for the work that you did on uh airplanes and restaurants and um you know i was on a lot of of those airplanes as a kid and it made no sense to me that if you moved that you could smoke in the back but you couldn't smoke in the front cause the smoke was everywhere oh that was extraordinary leadership and i wanna thank you and i wanna thank david kessler who is the fda commission yes he was my partner who did an extraordinary job eh fda and i talked to you about this on the phone that there was a um an fda career staff career scientist have made certain decisions about vaping um there is controversy in my agency because the approval included approval of certain uh the or the request included a request for certain flavors that in my view were directed at children bubble gum and cotton candy the career reviewers have to make a determination because the threshold for tobacco is much higher than it is for drugs they have to make sure not that that drug is safe and effective for a particular individual uh that it's better for society as a whole and i think one of the i don't know about the deliberations there but i know that they had to make a decision based upon the science that vaping was going to reduce tobacco combustible tobacco use that was the scientific findings they had to make i don't know i i don't know the details i've never read the studies but i but that is the process

If I could say this, I want smokers to quit too. If there was something we could have that could have saved my father's life, I would have supported it. But I learned a long time ago, you can't trust big tobacco's promises. In the meantime, we can't risk a new wave of children addicted to this poison. The law is crystal clear. The Tobacco Control Act require requires an e-cigarette manufacturer first prove to the FDA that its product is quote "appropriate for the protection of public health" before it can go on the market. You're an attorney. This is a condition precedent. The law has no special treatment for American vapes or Chinese vapes. If we're serious about protecting kids, I hope he'll reconsider any decision which allows the expansion of e- e- smoking.

Thank you, Senator.

Uh, Senator Kennedy.

Thank you, Madam Chair. Uh, Mr. Secretary, one of the um more beneficial things that I think your agency has done under your leadership in my judgment is to

Uh-huh.

educate the American people about ultra-processed foods. But it's still too complicated. Um.

Uh.

H- how can your department go about uncomplicating it? I mean, the American people are busy. They're busy earning a living. And - and they don't have time to sit down and - and research the definition of an ultra-processed food. Rather than listing all the ultra-processed foods, which of course would invite litigation and consternation and gnashing of the teeth. how can you come up with a with a with a a list of things that people should look for on the label to know if it's ultra-processed. For example, sodium. If it's got more than this amount of sodium, it's ultra-processed. Does that make sense? Do you understand my question?

alright i think it's it's not only a question of i understand but it's a question that i've my agency has put a lot of thought into uh there has been no workable definition of ultra-processed foods before we came in here that's regulatory malpractice um we now have

there has or hasn't

there has not never

well why don't you do it if with respect why don't you do it

we already did it so well our regulations are now on the Oh they've we've developed the the definition within our agency, it's now before the rule gets finalized it's in the a inter-agency process. There are other agencies that have equities like USDA, Department of Commerce, OMB, they have to review our uh proposal and then approve it. And I would say, Senator, in the meantime people should eat real food. So

Bobby, let me stop you, cuz I'm gonna run out of time. Look, he- here's the problem, and I commend you for what you've done. But the American people don't have time to sit down and read a rule of regulation by the federal government. Where I'd like to see you end up on this is not list any particular food items, but say here are the ten, here are ten ingredients that con- that constitute ultra processed food. And if it's got sodium above a certain level, it's ultra processed. If it's got such and such such I mean something real simple that can be communicated. Does that make sense?

It makes a lot of sense and we're doing exactly that. Once we get that definition of ultra processed food, then we're gonna go to mandatory front of package labeling. and it will be a very simple label something like they use across latin america very very successfully red light green light yellow light and so people will be able to see the green light and that's food that's good for you and if they do the red light don't eat it if it's the yellow light you know if it's late at night and you know you're watching the football game

i understand

maybe you can take a take a take a take a cheap day

ok let me stop you i liked the way you headed i'm sorry but my time is limited please continue with that uh it will it will it will be enormously beneficial to the american people your agency across all the sub-agencies grants a lot of grants are all of them do all of them have provisions that overhead is capped at fifteen percent

well those would be the grants to the universities

no your your department issues a lot of grants

yeah

and the agencies under your department is Are all of them, do all of them contain a fifteen percent cap?

They they will contain a fifteen percent cap.

Okay. Uh, finally, this is a question for CMS, Dr. Oz isn't here. An executive order was issued some time ago that says every hospital has to publish conspicuously a list of thirty main procedures and the cost. Most of the hospitals haven't done that. Those that have done it, you have to clicked twenty seven point three times in order to find it on their website. Only twenty seven hospitals have been uh fined for not doing it. Why don't we do why why aren't we doing more? The hospitals are ignoring.

The regulation was passed during the the the last days of the Trump administration. It was not enforced during the Biden administration. We now have promulgated final pro regulations. They're already promulgated. that requires the hospitals not only to post but to certify so they're legally bound by that and there are draconian punishments for them and we've already sent out i think a thousand warning letters

i'm out of time thanks madam chair

thank you thank you mr. secretary

um we're we've been joined by the vice chair of the full committee uh senator murray so i'm gonna go to you next thank you for coming

thank you

thank you very much madam chair and thank you to you and the ranking member for working on a very tough bill last year and doing a good job all the circumstances. It's gonna be even harder this time around and uh we all look forward to working with you, so thank you. Mister Secretary, um I don't think it's any secret that you and I disagree on a lot of things, uh but I think we might actually agree that our taxpayer dollars should be spent here at home not on wars abroad. That's not what the President thinks. He made clear that just before his budget was released he said, and I quote, "we're fighting wars, we can't take care of daycare." And he backed it up with the numbers in this budget. His budget increases war funding by half a trillion dollars. But he does not increase child care funding by a penny.

Mm-hmm.

And it actually slashes funding for preschool programs by three hundred and fifteen million dollars. Now, I I know you don't get to decide defense spending, but I remember our first meeting when you told me that you supported expanding child care access. So I wanted to ask you today, as families everyday costs are getting higher and higher do you think we should be spending money on foreign wars instead of making money uh making child care more affordable for people here at home

but i mean do you senator do you really want me to defend the iran war right now is that the is that what you want me to spend my time playing

i i'm at i'm at

because i can but i i would rather talk about health

no i'm a i'm asking you personally whether you think we should be spending more on foreign wars or on child care

i mean you know the democratic party for the last twenty years has said iran cannot have a nuclear weapon so you know and they've kicked that down the road

well well i don't i don't think you're here to defend that i'm just asking you what happened to child care in this budget um

and so uh uh ok let's talk about child care then instead of the war

well the what's

yeah but the one of the few aid

mr. secretary just so it's clear the reason this budget is gonna be and appropriations is gonna be so hard to write is that the president is requesting a trillion and a half in new funding for defense which cuts our non-defense incredibly.

It's not my department, Senator.

So we're here not able to help our families because of the president's request. So that's that's why we're asking about this. And I I just I think

We're asking about this because we have a thirty nine trillion more debt that somebody else ran up,

I'm asking about this

not this president.

Well, I'm ju- let's put this in perspective. I think this is important. The president spent more on bombs in just the first week of the war in Iran than we spent in an entire year. for parents to afford child care. And I will just say for all of us out here struggling with this and the people we see strugg- struggling we need child care in this country.

Mm-hmm.

And we have to make choices when we make our budget, and the budget that is presented to us makes the choice of a war rather than helping our families here at home, and I think that's important for us to understand from the president. Now, meanwhile, while this budget bankrolls Trump's war agenda, it is al- also cutting crucial lifesaving health investments. It slashes NIH funding by more than five billion dollars, which would mean delayed cures. It means canceled studies. It means no hope for patients who are fighting for their lives. The president seems to be comfortable increasing his war budget by one hundred times that amount. So, I I just want to ask you, did you push back on the NIH cuts to the president when

On

d- on the NIH cuts, did you push back to the president and the White House cutting that much budget

as i said long before the war we were told we need to tighten our belt at this agency uh and as i said before nobody in the agency wants to cut these programs if you end up funding the programs i'll spend the money

but but your budget does

um it's congress's choice about whether to do it or not i it's not my choice we gave you a proposed budget that does what the president wants which is to have

but it but you ok but you

broad cuts across the agents

my my question to you actually was did you push back on the president when he um said he wanted to cut cut nih did you push back in any meeting

uh do you want me to tell you why i think those cuts are justified at at nih

i'd like to hear your rationale

we we've we spend um we are providing now at nih almost eighty percent of the biomedical research on earth a lot of the money there was wasted and i can read you the kind of studies that nih the end is saying studies that nih was doing before i got there we are now recalibrating nih

can you can you what i'm hearing is that women's health is being decimated i'm hearing a lot of the people who are in clinical trials being decimated you just throw out a we're cutting waste and i don't i don't know what you consider waste

uh let me uh let me give you some examples of waste

at nih

yeah at nih eight hundred thousand dollars to the medical um college of wisconsin to study cardio-metabolic impact of gender affirming hormone therapy on trans masculine adults six hundred and fifty thousand to georgia state university an intersectional approach linking minority stressors experienced by transgender and gender diverse adults to alcohol and drug use comorbid mental and physical health outcomes none of the i've got uh hundreds of these

do you

None of them developed the drug.

OK. So I I noticed that you were focusing on gender identity.

None of them did research that told us the cause of a disease.

I know there is a debate in this country, but boy, you are picking on a an agency that funds research, that finds cures every day. There are families, there are doctors, there's providers who are counting on getting the answers to these researchers. And so to me, cutting NIH by five billion dollars just seems to be cutting our families out, cutting hope out, cutting medical research out. We are known in the world for our medical research, and to me, uh, dev- devastating cuts like this mean that we're cutting hope for the future. So you and I disagree on that priority. And, and my time's about up. And I, I just have to say, we have a measles and we have a whooping cough ripping through our communities. We've got trusted vaccines that have been undermined. We have cancer and disease trials that are being appended. Um, we have patients being left without options, researchers pay expenses out of their own pockets. I hear this from them directly. We have grants being frozen, turned on and off. Um, you actually canceled more than a half a billion dollars in cutting edge vaccine research only to fund a dangerous unethical HPV vaccine study and redirected funding from the state of the art vaccine development to replace it with your hand-picked vaccine project that uses technology from the nineteen fifties so the workforce has been gutted, we are seeing cancelling of billions of dollars in substance use, mental health. We see you pausing five billion in public health funding and terminating grants in blue states only. So I just I just have to say here loud and clear, this is hurting public health. It is hurting our families. It's hurting our research. It's hurting the future of the country. And you and I disagree on this priority. Thank you.

Senator Hydes-Smith.

Thank you, Madam Chairman, and certainly thank you for holding this hearing. And I appreciate everything you are doing and thank you for making necessary cuts, where we agree that they are definitely needed. Um. I want to discuss CMS area wage index. I've had so many people come into my office to discuss this. I had two different groups today. It is de-stabilizing hospitals and rural health care. AWI disadvantages rural hospitals because they're locking them into a system that suppresses reimbursement and limits their ability to recruit and retain medical staff and specialists and as you know during Trump's first administration, policy was implemented that helped raise Medicare payments for hospitals in that lower quartile. This policy was huge. for rural health care. But the court-ordered demise of that policy has led to financial distress and recruitment challenges when they are trying to recruit doctors to Mississippi, and they can get so much more for these exact same procedure in other states. This is not a one-time gap. It compounds every year. Hospitals like Forest General, a level two trauma center in Hattiesburg, Mississippi are expected to deliver complex specialist driven care but they're reimbursed as if cost um they're reimbursed as if cost are low absorbing an eight million dollar annual loss due to this disparity and obviously that gap is just unsustainable if this continues it won't just affect one hospital it will weaken the entire nineteen county rural network roughly serving seven hundred thousand Mississippians without immediate changes to AWI methodology, to create a more level playing field, rural hospitals will face an unsustainable future and obviously it's the patients that are going to suffer. Mister Secretary, would it be fair to say that the current area wage index creates a compounding disadvantage for hospitals in persistently low wages states like Mississippi? And how willing is the administration to work with Congress to provide the necessary direction in to appropriately evaluate near-term adjustments in order to provide this much needed needed relief to states that are persistently low awis.

Uh, Senator, before I a- answer that very good question, do you mind if I spend a minute just addressing one of the points that was made by Senator Baldwin?

Sure.

Yeah, yeah, I have authorized funding for half a billion dollars in cancer and another almost another half a billion in a universal flu vaccine so i'm not anti vaccine the five hundred million that we cancelled were for vaccines that don't work and if they did work the end these were for covid vaccines and m r n a we now know does not work for respiratory illnesses these are for vaccines that the industry made almost a hundred billion dollars on why are we financing it if anybody thought it worked the industry would pile in and make it work now on the way it ends and so it's a waste of government money to pay something that the industry won't pay

they did the dice

um but the wage and area index is destroying rural areas in this country and we know it's a problem as you know under the social security act the any changes we make in it have to be budget neutral so if you if you give more to one area you have to take from another and the the the political blowback even if we could do it the political blowback is uh is uh is very loud let me say this the change has to come from congress and we wanna work with you to make changes that we think make sense which means getting more money to rural areas

thank you and uh i think that we just wanted to verify because it will have to come from congress but thank you for your willingness and your commitment to work with us to get there. The uh second question is I have uh a few minutes left. The CDC congressional justification in your budget list of accomplishments related to the CDC Office of Rural Health, which Senator Merkley and I worked to get established in twenty twenty three. But despite this work to benefit the health of rural Americans, the future of the Office of Rural Health is unclear given proposed HHS reorganization plans and the president's fy twenty-seven budget request and this is concerning to a lot of people including me and for stakeholders like national rural health associations so what assurances can you give me and others that the office of rural health will remain within the c. d. c. and that its mission to improve rural health outcomes will remain a priority to you in this administration

i mean our reorganization tries to return cdc to its core mission which is infectious disease and a lot of the programs in cdc we are moving out under the proposal the agency for healthy america the aha agency is this a proposal for congress we're not doing anything unilaterally we uh we've offered it to congress we expect congressional feedback on it we expect a dialogue and there are some things that we may do there are some things that we we won't do all we know is that cdc has not done a good job on chronic diseases which disproportionately impact rural communities in this country the highest diabetes rates cardiovascular uh cancer rates are in rural areas and cdc just is not equipped to handle those and has done a miserable job at doing it and that's why we have the highest chronic disease burden of any nation in the world with CDC presiding over that decline.

Thank you very much for that answer and I'm out of town. I do have another question that I will submit on the nursing shortages that are very concerning to me. Thank you very much.

Thank you, Senator Shaheen.

Thank you, Chair Capito and Ranking Member Baldwin, for holding this hearing today and thank you, Secretary Kennedy, for being here. Um, I'd like to ask you about GAVE, Secretary Kennedy.

About?

GAVE? GAVI,

Oh, god, these.

which I know you unders- you know as a vaccine alliance, it's a public-private partnership that's helped reduce child mortality by half in lower income countries since two thousand. And it's done that by immunizing an entire generation. In addition to helping vaccinate one point two billion, with a B, children, it's the world's leading purchaser of US-produced vaccines. So, GAVE supports American manufacturing jobs, it helps prevent outbreaks from reaching the United States shores, and it strengthens global health security. I think it's one of the clear examples of a win-win investment for the American taxpayer, and yet despite a congressional appropriation of three hundred million dollars in FY twenty-five and twenty-six, GAVE has not received its funding. Funding for GAVE comes from the State Department, which I have a chance to oversee as the ranking member on the senate foreign relations committee. But yet, I'm asking you about GAVE because I understand from those people who have worked on this in the past, that it is your department and you personally who's holding up funding for GAVE. I had a chance to meet with some of the representatives from GAVE last week. And what I understood from that meeting is that If this funding is not released, millions of children will die. In fact, Gave estimates that loss of funding could result in seventy-five million children not receiving routine vaccinations over the next five years. And that will lead to the deaths of more than one point two million children. So, Secretary Kennedy, I ask you, are you willing to release this funding that helps vaccinate millions of children?

um we're in discussions with gavi in the state department gavi has been in transit and and i'll tell you three of our concerns um one is that the money that we give to gavi is fungible gavi has a tremendous amount of money in fact gavi is giving hundreds of millions of dollars to who which we got out of because it was doing such a miserable job oh i wanna i ask them is our money going to use so that you can funnel it to whoo they refused to answer that it's not gonna work

that that is not i i appreciate that you have that concern that is not

yeah i have other concerns too

the conversation that i had with them

although i i i i was not i i believe that there are two other concerns

so i

on their their biggest vaccine is now a d t p vaccine a version of it an old version it was discontinued in this country because it was causing brain injury to one in every three hundred and fifty people according to an NIH study so we discontinued it europe discontinued it they're still giving it to a hundred and sixty one million african and asian children a year and i said to them why don't you use the safer version the D tap vaccine and they said they didn't want to do that

well secretary kennedy perhaps you could appoint somebody from your office who would be willing to work with my office and representatives from GAVE and see if we can settle this problem. Because when one point five million children are at stake, it seems to me like those are issues that we ought to be able to resolve. Uh, I'm out of almost out of time, so I wanna go on to another issue, but can I ask you, are you willing to, um, appoint somebody from your office who can work with us to see if we can resolve those questions?

Uh, yes, I am, Senator.

Okay, thank you. We will be in touch with you. Um, I I wanna talk about diabetes because, Mister Secretary, you've called diabetes a national crisis, and I agree with you. I have a granddaughter who has type one and right now forty-two million Americans are living with the disease, including hundreds of thousands of children. And yet your proposed budget cuts diabetes prevention and research. You're eliminating CDC education programs. You're slashing the special diabetes program for Native Americans by seventy-five percent, despite the disproportionately high rates in those communities. You've terminated a major study on diabetes and dementia, not because of the science, but because of a dispute with Columbia University. You talk about diet and lifestyle, and I agree with you. That's important. But that does nothing for the millions of Americans who are living with type one. That's not done. Based that's not the result of diet and lifestyle so i guess i have to ask you secretary kennedy are those cuts that you've proposed and diabetes are those the result of scientific evidence or is that because you're just trying to cut across the board

well of of course i'm not i don't wanna cut diabetes research you know the dispute with columbia university is on another issue and it's a it's a dispute between the administration

That that didn't answer my question about diabetes, but I'm out of time, so we will uh submit the further questions for the record. Thank you, Madam Chair.

Thank you, Senator, who's dead?

Thank you, Madam Chair. Uh, Secretary Kennedy, thanks for being here today. I wanna talk with you about the three forty B program. Um, it was created in nineteen ninety-two uh by Congress with the noble cause of helping low income patients and safety net providers have the resources to provide care uh cbo and and gao said uh hersa does not collect the data on how hospitals spend the money and it's not uncommon for a hospital system to receive a hundred million to five hundred million dollars out of the program annually and it uh it does not in those cases provide auditable data to know how those dollars are being spent and so i'm uh i just have been concerned as we've talked about affordability and healthcare access is uh uh frankly is the money going to really help the people that the program was designed to assist and um cbo has also found that the program encourages uh behaviors that cost the taxpayers the federal government increase funding so i'm interested in the issue of program uh integrity and auditable metrics and the president's budget includes uh a provision to move the oversight of the free three forty b program from her so to cms and so um uh i think it's important that we understand what's happening with it well how's the money being spent is it going to help the people in the institutions it was designed to help and i and i'm i'm interested to know uh what you think you can do to help make sure that the drugs purchased through the program match the eligible patient uh encounter rather than the current system which largely relies on self-reporting

yeah senator there there's all kinds of problems with the program there's all kind of benefits and there's a lot of hospitals and safety net regions that absolutely rely on that funding source originally it was just for safety net hospitals and for originally there were only ninety entities that were receiving three forty bay today there because of the potential for abuse there's twelve thousand and fifty thousand outpatient offices and i'll give you an example of abuse we found a virginia hospital in a low income area that was charging patients uh was getting uh ninety percent off the list price of the drug charging patients the list price of the drug and then using their profit margins to build a hospital in a wealthy community and another case in new mexico a hospital uh got a cancer drug for a patient the cancer drug cost twenty two thousand seven hundred dollars the cost to them at the discount the three forty p discount was two thousand dollars they charged the patient do twenty two thousand dollars at the the margin and then sued the patient when he couldn't pay oh those are the kind of really horrible abuse that we see in the system but we also see a lot of really good uses by some end

well well there are like the fqhc's and other there are many people who are doing great work under the program but then it it appears as as you listed that there is a lot of abuse under the program

right

how can we use some of the new oversight to try to to try to fix it so that the money goes where it's supposed to go

we yeah i mean it it's a mass and it's in litigation and the pharmaceutical companies are suing and um and the only the only thing that can fix it is congress we are exercising all of our authority but we really uh um you know we we have authority to negotiate but

yeah i'd i'd and i i have one last question i wanna

yeah

too and then but i appreciate that

anyway i look forward to working with you on that

yeah it it so i i hear constantly from you know there's a there's uh uh uh uh a lady in town today who i've come to know very well who lost her son to sexortion and you see all the things that are the terrible things that are happening to kids through through online uh uh exploitation just quickly what can you do what are you gonna do uh uh uh health and human services to try to address this new phenomenon that is that is clearly an epidemic of of of physical health and mental health challenges for kids

yeah it's an epidemic that we don't have much power over um we that has to be regulated by the ftc or by congress we don't really have authority to regulate communications and um uh we can do studies to show how dangerous it is and we're doing those kind of studies now but we really have no capacity

but is it is is there an emerging health crisis that you can think of that is that is

it is

that has come from nowhere that is impacting kids more than this one

well social media is the same thing we don't have the power to regulate it

yes all ok thank you Madam Chair

uh send her shots

thank you Madam Chair, Ranking Member, Secretary good to see you um We just had a series of storms and flooding events. Um, and President Trump just signed a major disaster declaration. In particular, the Kula Hospital has a hundred and five long-term senior care beds, and it's not, uh, any longer operational. Uh, the governor just submitted a, a public, a request for a public health emergency declaration. Do I have your commitment to work together to make sure there's continuity of care, for, for all the people, um, who have been impacted by the floods?

You do, Senator, and we, my staff is already working with the governor's office to make sure that happens as expeditiously as possible.

Thank you very much. Um, I wanna ask you about, uh, glyphosate. Um, I know you have deep experience in this area, so I'm gonna ask you a couple of factual questions, uh, to the best of your knowledge. Does glyphosate cause cancer?

Yes.

Is it healthy for people to be around?

uh i would say no it's not healthy for them to consume

is it safe to use

it means save for does it kill or does it kill weeds it kills weeds and uh

is it safe for humans to use

i would say it's important to minimize consumption of glyphosate as much as possible

you are being uncharacteristically diplomatic about glyphosate i'll just say it that way

i don't think i'm being diplomatic i just said it caused cancer which

ok fair enough

kills people

um you know i didn't vote for you to for confirmation i'm sure you tracking that i got a lot of friends uh back in hawaii uh who supported you um because of issues such as this and they were hurt shocked confused um when you were explicitly in favor of Trump's executive order. And I'll just quote you in a tweet. "I support President Trump's executive order to bring agricultural chemical production back to the United States and end our near total reliance on adversarial nations." I'm just wondering what would you say to those folks who were kind of animated by this idea that we are too reliant on these dangerous chemicals. And then the president does a thing. And obviously you and the president are not generally always on the same page about everything. But this seemed like an opportunity for you to really stand up for your agenda, especially given your successful litigation in this space. And so, just wanted to give you a chance to speak to those people back home who are very animated by by glyphosate but also the the the rest of the uh uh of a sort of uh agenda around reducing our exposure to toxic chemicals

yeah and i i'm glad you asked that question i was very clear with the president about my own displeasure uh with the executive order um the the the president felt it was necessary for national security reasons to actually the proposal came from the pentagon and the and the reason for that is a problem that president trump didn't create which is that ninety seven percent of corn production in our country comes is relied on like for say ninety eight percent of soy production it's about eighty percent of agricultural production according to the industry a hundred percent of that is coming from china you have an adversary that could literally shutdown the american food supply overnight there was another issue which is elemental phosphorus is also produced in the mining process and that also is controlled by congress or by china and it is a critical resource for weapons production

ok um

and so his executive order does not increase the use of glyphosate all it says is we're as long as we're dependent on it we're gonna make it here he's authorized my agency to spend hundreds of millions of dollars to look for alternatives so we can transition off of glyphosate as quickly as possible

ok um just final question when we met in this hearing room last year we talked placebo-controlled trials. Um, I said, and I'll quote myself, you know the placebo-controlled trials are in the existing vaccine approval process. Are you suggesting something different from that? And you said, I do not think it is ethical to go back and test approved vaccines against a placebo. But in December of last year, CDC posted a notice in the Federal Register awarding one point six million dollars to quote, study the optimal timing and delivery of monovalent hepatitis B vaccinations in newborns in Guinea-Bissau, activities that will include con will include conducting a randomized control trial. So there's a contradiction here. I know it was removed from the federal register, but what happened?

Uh it's there's no contradiction. Eh and we hope to go f- forward with that trial. The the hepatitis B vaccine was tested for four days. They were giving to tens, hundreds of millions of kids. it was there was no placebo in that so we have no idea what the risk factors are in guinea-besal they don't give the birth dose they're gonna start giving it in twenty twenty eight uh we asked the government of guinea-besal can we go there with the proper inds all the ethical guidances and give it to fourteen thousand kids a year early

and not give some and and have a placebo group

well we don't well it's not our job to give it to the whole country we can give it to fourteen thousand kids early which helps them

Right, right, but

and then we have placebo group for the first time in history we can actually look at the impact

A placebo group that doesn't get the medicine, this is the thing we talked about before and I thought we were on the same page and I thought the entire medical establishment was on the same page. We may disagree about the efficacy of certain vaccines but we have all agreed all of us that you do not withhold medicine Especially from children.

We're not withholding it. We're giving it to people who otherwise wouldn't receive it.

And then there's a control group that doesn't get the medicine.

Well, they weren't gonna get it anyway.

Yeah, OK.

Nobody in the country was gonna get it.

Well, thank you.

Uh, OK, I'm gonna go to Senator Murphy. We're running up against uh a five minute break at four o'clock, and then we have a vote at four O five. So, Senator Murphy.

Uh, thank you, uh, Madam Chair. Um, we have a uh epidemic of low quality care in our nursing homes today, increasingly because we have a lot of for-profit operators, a lot of private equity owned nursing homes today. It's a it's a real issue. I hear about it all the time in Connecticut. In twenty twenty three, President Biden issues this rule to require minimum staffing in nursing homes. Um, at the beginning of the Trump administration, the administration um, defends that rule, uh, because the industry brought a case against it in court um and then um in the summer of twenty twenty five the industry starts pumping a lot of money into the president's political operation almost four million dollars um they have a meeting with him and then a couple of months later the uh trump administration stops defending the rule uh i understand you're gonna just tell us that there's no connection between the donations and the decision to withdraw defense of the rule. But why side with the industry here? Um, why not side with patients and patient advocates who have been asking for just basic minimum staffing ratios in nursing homes to make sure the patients get the care that they need? What's the reason to withdraw support for that rule?

I mean, I can't tell you whether industry pressure helps weigh president trump i know that he doesn't really give a uh i i will say he he doesn't care about industry pressure normally the real pressure was coming from congressmen and from senators who are in rural areas and i travelled across rural areas and i saw the damage that that rule was gonna cause to rural areas a lot of these rural areas they cannot get people and they'd have to close the nursing home and then the elderly parents would be shipped to a city that is hours away and not be near their families and there was gonna be massive according to what i was being told and what made sense to me there was gonna be massive closures in rural parts of this country of nursing homes these are not owned by private equity

well that's not true there are plenty of nursing homes in rural areas that are owned by by by for-profit

ok not necessarily let me

companies Um, I wanna submit for the record, um, a pretty comprehensive study that shows that that industry argument that there will be undue impact on rural areas actually has no basis in fact. Why? Because we have states that already have minimum staffing rules with big rural constituencies, and there's actually no correlation between increasing staffing ratios and closures in rural areas, if I can introduce that to the record.

Without objection.

Do you have any data? um, that shows that there would actually be impact on rural areas because that's just the argument that's made by the industry in order to avoid industry-wide accountability.

Yeah, you know, I um, I'm happy to provide you with what we have.

OK, I I don't think the data is there, but I'm happy to take that for for the record. Um, second um line of inquiry, uh, Mister Secretary, this MahaPak thing just seems like a moral and ethical mess. Um, you know, this is a pack run by acquaintances and allies of yours. Your face is plastered all over its literature. They advertise that, uh, they are in existence to try to influence you. You said in the outset that your entire mission is to try to take on the, uh, failing status quo, the industries that have profited off of bad medicine. The, the companies that donate to maha pack it's like a who's who of the pharmaceutical industry including a ton of companies that literally have business before you and the whole purpose of maha pack seems to be to interact with you in your office i mean we i don't think we've ever seen this before a political action committee affiliated at the very least with the branding that is central to your persona taking huge amounts of money from the industry Um, again, I know you're gonna say that there's no connection between all these donations and what happens inside HHS, but why do you suspect all of these pharmaceutical companies, I mean it's a, and they're not giving small amounts, they're giving twenty thousand dollars, a hundred thousand dollars to MahaPak. Why are they putting all of this money into MahaPak, if not to try to influence your decision making?

Do you have a single instance where the MahaPak has taken a position that is not consistent with my values i don't run the maha back i have no idea who is contributing to them but

yeah but why do but why do you think just take a guess i mean you know this is happening why do you think that they're contributing i mean this company vivex donated ten thousand dollars to maha when they had a very important case on skin skin substitutes before the agency

well i oh oh ahead and look what we did on skin substitutes we put out a business

uh

eighty percent of the industry

but why do you think these companies are making these huge donations to this product

well i don't well i have no idea what companies are making any donations i've never been told that's the first time i've ever even heard that i have no idea who's giving money to them i don't run it other people run it tell me an instance where they've done something is underhanded or that is against my values

yeah i'll be happy to submit to you and to the committee the instances in which the companies that are making donations to this pack did so at the exact moment that they had business before your agency.

Well, I don't know about their business. I, you know, I I have no idea about that at all. I can tell you that you take a look at what we did with the insiders.

I know, I think it would be better if you told them to shut this thing down, because it just it's it's it's smacks of of of corruption and I just think you'd be you'd be much

You do you have

better served if you just told them to shut that down.

You have a pack senator who supports you? You have a PAC that supports you.

So you'd be much better. Yeah, it doesn't I don't take any corporate donations or any PAC donations. Your friends would be better off not taking these donations either.

So you're good.

Thank you, Mitch.

OK, It's not taking a PAC. I am going to I agree to a four o'clock, five minute break, so we're gonna go ahead and do that. Wait a minute. Be back in four O five. I agree to a four four o'clock, five minute break. I'm sticking to my agreement. Some folks coming in and out because we had that four O five vote. So I'm gonna go to uh Senator Rounds. And then to Senator Merkley.

Th- thank you Madam Chair. Um, Mr. Secretary, first of all, thanks for coming in and visiting with us today. I know you've had a long day already, so I I wanna give you an opportunity maybe to follow up on a couple of thoughts. Uh, I'm gonna start with the three forty B program, and I know that uh Senator Hust had a- asked you some questions with regard to the three forty B, and there's a lot of uh interest in entities out there that that that rely on the three forty B regardless of if it's a good program or not. It funds a lot of local community uh programs. Federal health centers receive some of it. Uh, critical access hospitals receive some of the funding on it but community hospitals really rely on it right now. And I know that i- you've been trying to make some changes on it. Um. The concern a lot of them have is, is that there there's a a a plan right now to transition uh to a a rebate model instead of the current upfront discount and it's got lot of them concerned are you familiar with where that sits right now and have you had any feedbacks uh mister secretary

i i don't know where it sits right now i'm sorry senator i don't know where that sit that proposal sits right now and i am not you know doctor has not raised it with me i don't know how serious it is

ok it it in rural areas it it's a really big deal and it's probably as you know during fly-in time we get lots of the different healthcare organizations in and there's a a big time concern across the rural parts of the country with regard to if the three forty b funding is changed

mmm

that there be some other alternatives and i think all i would ask is is i wanted to bring it up second of all i would just hope that you would be willing to address the concerns that these reforms might disproportionately benefit some pharmaceutical companies to the detriment of some of these these necessary entities that are out there right now that need it in some of the rural areas and I would just ask is I wanted to bring it to your attention but second of all ask if you would work with us to see if before we make these significant changes on it that we recognize just how big of a deal it's gonna be to some of those healthcare facilities

yeah and I and of course we'll work with you but I can tell you we are very conscious of how um important it is for for the population that was built for and that absolutely relies on it the problem is the expansion of the program to some facilities that uh are already doing very well and the abuses that we see in the program but i think everybody wants to continue to support those communities

and i and i think their their concern is is that uh if there need to be reforms made It's simply a matter of they've now grown to the point where they need this particular program or some of them are gonna shut their doors,

Yeah.

and we we've gotta have another alternative for them that will still work for them. And I do just appreciate your your help in addressing those before it becomes uh an item which is in place and the problems start to develop. So, I I appreciate your offer to to look into that with us.

We understand. Thank you.

Thank you, sir. Let me touch base uh uh on another one. Throughout your first year in office, you've made making America healthy again and eating real food a priority. South Dakota farmers and ranchers work tirelessly to produce some of the safest and highest quality products in the world. I've concerns regarding lab-grown cells or cell-cultivated products, attempting to enter the US food system, the US food system posing as meat. One example of these experiments takes pork fat cells grown in a lab and combines them with plant protein this product is sold to consumers at the grocery store as a meatball uh meatball um my question i guess for you is is do you share my concerns with these ultra-processed lab grown fake meat products and with your prioritization of real food how is hhs through the fda monitoring and evaluating the health and safety of these particular types of products

i share your concern senator i probably have an amplified concern and uh you know we're gonna do we're gonna exercise fda's oversight over them there is uh they're gonna have to show us they're gonna have to they're gonna have to get through a lot of skepticism to show that they're safe

thank you sir um nih you've talked a lot about nih today and uh and you've heard some concerns in here with regard to the funding on nih and some of the grants and so forth Mr. Secretary, I I'm as concerned as anybody else about the fact that when we talk about biomedical research and the opportunity to really cure some issues, cancers in particular and others, uh, as these different proposals are out there, uh, I would just hope that we can work together to make sure that those that are really making progress and ways to cure some of these dread diseases, that those are not the ones that are being canceled and that we continue to try to find a path forward to actually not only save taxpayer dollars long-term but actually find a way to improve the quality of life for americans using these uh these programs that might already be in place

yeah i mean jay badajar tells me that he has not canceled a single study with the exception of the hospitals that are violating the executive order that no study of that kind has been canceled and the the the um jama a journal of the american medical association recently did a a report and said that we had canceled three hundred and forty-six grants but when we actually looked at the report the actual number is fourteen and there were good reasons for cancelling those

i just wanted to make sure you had an opportunity to respond to that

yeah

thank you mister mister madam chair and thank you mister secretary

senator markley

uh thank you very much madam chair and thank you mister secretary and uh seven years ago i introduced a a bill that was the most favored nation bill saying americans should get the best price in drugs in the developed world because we spend more as taxpayers on the r and d than any other nation and i think the conversations we've had this is generally uh uh an idea that that you support

absolutely and we did the negotiation with sixteen of the largest pharmaceutical companies and we will be adding more and more drugs to that list but the agreement is we get the lowest prices in the world in the developed world

What I uh uh appreciate that very much, your pursuit of this this vision. Um, we are here in Congress, of course, like to legislate. Uh, we haven't seen these these sixteen agreements in order to understand how we might expand the principles in them. Is it feasible for those to be shared with Congress?

Uh, in, yes, some of the information can be shared. Some of the information is proprietary. um and uh affects business secrets and in that case we couldn't and in fact in the in the ira and the you know on the inflation reduction act where we were ordered to do negotiations with the drug industry there is an n da uh uh uh an n da recommendation in that in that language there is a recognition that some of that information is gonna be proprietary but otherwise well

yeah i i take that point um but i guess because the president has said he'd like to see these agreements codified which i think means put it into law the only way that we here in congress can work on it obviously we're not looking for the the you know the secret formulations or anything that would be proprietary but certainly the drug pricing uh strategy so i'd like to encourage possible to share that so that we could work on that codification

yes senator and i'd like to offer um the uh the guy who did the negotiations chris who is uh who is now um the operational chief of the agency uh to talk directly to you about um how to structure it cause i think he could be very helpful and we can provide you legislative language

cause i think you also have either i don't know if you have or the the president did but also talked about having a set of um proposals uh related to uh i think uh three other areas to try to uh time limited models for medicare part b medicare part d and and medicaid that i think are separate from those sixteen agreements if i understand right also the goal of putting those into law

to put them we're certainly gonna implement them in in part d and in fact the glps go up this summer in in part d um but i'm not sure if that's part of the actual agreement or if it's just cms policy i'm happy to find that out for you

ok because what i'm trying to do is is craft bipartisan support while we have your support the president's support for really comprehensive that no matter where you buy a drug, anywhere in our system, whether it's in Medicaid, Medicare, Veterans Administration, whether it's regular pharmacy, that - that our citizens get the best price. And it would be an incredible uh accomplishment uh to be able to do that, not just with an agreement that is, I'm not sure - the proposal there was for five years, but to actually to create a framework where we can adjust as international prices are are adjusted. And this is our moment, so uh I'm just um I I I'm trying to encourage that that we go beyond the idea of individual drug company agreements or time-limited uh models to try to create a a legislative framework that would ensure uh that uh Americans do get the most favored nation price on all drugs in all places into the future.

Uh, absolutely, and we're very grateful for your leadership, Senator, uh for us. at a at hhs this is you know one of our most important legacies and we wanna make sure that it endures and uh we need it we need the language codified

ok well i guess my core point is without the actual details of the agreements or the other pieces and time will run out very fast on every every four years evaporates uh uh uh quickly so i'm encouraging as much information to be shared as as possible Thank you.

Thank you, Senator Merkley.

Senator Merkley, thank you. Senator Boozman?

Thank you, uh. Thank you, Mister Chairman, and thank you, Secretary, for being here and spending so much time. I know this has been a long day. Uh. As you know, Arkansas is home to the FDA's National Center for Toxicological Toxicology, Toxicology Research, uh, in in Jefferson, Arkansas. During a recent visit I met with the NCTR scientists and discussed their unique regulatory science mission as well as concerns about a potential transfer of the center to CDC. We discussed this uh earlier in the year. You and your staff have been very helpful. Um, I've expressed my opposition to changes that would weaken its distinct and essential capabilities. Um, what I would like is that as the conversation goes forward uh that certainly if you have any updates or uh any changes that are about to occur that we would be allowed to uh to be part of that discussion

that is very important program to us and i expect to continue to support it and will let you know if anything changes

very good thank you very much um over fifty percent of arkansas county's are considered maternity care deserts meaning expectant mothers lack access to birthing facilities or obstetric providers. Data from the Maternal Mortality Review Committees, supported through the CDC's Safe Motherhood Initiative, shows that women in these areas receive less prenatal care and face higher rates of preterm birth. Earlier this year I worked with Senator Bennet to pass the PREEMI Reauthorization Act. to strengthen federal efforts to reduce preterm best deaths, births, preterm births that have complications. Can you clarify how HHS is going to allocate those funds and how the department will continue supporting state-led maternal mortality review committees to ensure care is informed by local data and improves outcome for mothers and infants this is really a a critical uh problem in arkansas fifty three percent of our counties in america lost population last census and as a result uh this is an area that's really really been affected

um we uh yeah i can't specifically answer your question i know that um we have a seven hundred and sixty seven million dollar uh block grant from her so for maternal health and i imagine it's funded through that but i don't know uh but i will i'm happy to work with you on that senator it's an important issue to us and i'm happy to work with your office

yeah if you could get them to look at the state-led maternal mortality review committees i would appreciate it very very much one final thing um uh our our agriculture sector now is in such a difficult situation if you're growing something out of the ground you're losing a lot of money. And because of that, we're doing everything we can to - to help them. Um, I agree with you, the department's a recent initiative encouraging medical schools to implement comprehensive nutrition education training. The Walton School of Medicine is a good example of that in Arkansas. They're taking the lead. So I - I very much believe that, uh, nutrition is so, so very m- important. At the same time, growers in my state and across the country face real challenges. So, can you insure them, insure the American growers that the goals of making America healthy do not unintentionally create barriers to crop protection tools that are already undergoing a rigorous science-based review process at EPA?

Senator,

Will you commit to working with our farmers?

before we issued the MAHA report we had over a hundred meetings with farmers and all the leading farm organizations this country i met with them again last week representatives of all the major farm organizations and we collaborate with them very well they've been very supportive of the maha agenda and um so and i expect that to continue and you know everywhere i go in the country um the reaction that i get from the farm community is very very positive and i'm very grateful for that i know and you know for most farmers they're losing money seven out of ten years and uh and we wanna make sure to keep the farm economy intact we know that maha is dependent on our food production and we we can't afford to lose any more farmers in this country

thank you that's just what we wanted to hear we appreciate it

Senator Reed.

Thank you, Senator Moran. Um, Mr. Secretary, one of your most important duties is to assure the health of the American people, in fact improve it. But the one big beautiful bill seems to be completely antagonistic to your major duty, uh, particularly, uh, in the cancellation of the affordable tax credits, uh, and also the other Medicaid reduction provisions. Already in my home state of Rhode Island ten thousand people have lost their coverage uh the the expected cuts will go up next year thirty thousand more and in private insurance the price is going up dramatically and so uh we know that inevitably many of these people will show up in the emergency room cause that's the only place they have to go and the cost is much higher to us so from a cost standpoint from a protection standpoint from a uh preserving the health of the american people that seems to be the wrong decision so what are you gonna do uh do you approve of this uh reduction of health insurance across america

uh well first of all i would say there is no cuts to medicaid uh congressional budget office you know just issued its report last week on medicaid and the increase in medicaid spending forty seven percent over the next ten years uh there are no cuts nobody is losing medicaid

excuse me we've had already ten thousand people that have dropped their affordable care coverage

uh affordable care yeah

and also as the medicaid cuts roll in it's estimated the state of rhode island next year will lose two hundred million dollars and that is funds in rhode island that is virtually impossible to make up without cutting other key programs. So, you are basically, through the administration, uh, cutting healthcare throughout the United States.

Well, we're not cutting healthcare. Eh

Well, you're cutting access to healthcare.

Uh, well, OK, uh, again, there are no cuts to Medicaid, there, we did not extend the premium tax credits, which were not extended by the Democrats either, during the three times that they had the chance to extend them because they don't actually know

excuse me i i recall that actually we proposed a a vote to extend the uh the court action was defeated

well there was when the democrats were in power and controlled both houses they had three opportunities to permanently extend them and they did not

they expired during the trump administration didn't they

and and there's a good the the money was going to the insurance companies

they expired during the trump administration

the the the stock price of the insurance companies went up a thousand percent um following that its passage because they were getting the money and we were taking money from taxes same people and putting it into reducing the uh giving them the illusion that their premiums were decreasing most people still have it eighty seven percent of the of the people on Obamacare are still getting coverage or ninety six dollars a month or less fifty four percent of them for fifty dollars a month or less uh will be will be people who experience much higher coverage in the upper areas um but

so you don't believe that healthcare coverage has been diminished under the big

we are

beautiful bill that people in my state ten thousand people lost their healthcare insurance thirty thousand will lose it next year

uh as i said people at the upper end will experience much higher premiums we are doing more to lower premiums and to open up new opportunities for low premiums

well how how were you gonna lower premiums if you cut one of the most i think effective means which is the affordable tax credit

we we do it

this means the people working cause they're paying taxes so this is not one of those welfare deals

we do it

and you take it away these people literally cannot afford healthcare insurance and they will end up in the emergency room

we do it by the MFN's by um by transparency which we are implementing for the first time cost share reduction which will reduce uh ten percent the premiums by low premium plans like catastrophic plans direct primary care

i gotta tell you mister secretary if you go out to any state and union and you ask people real people what's bothering them most they'll say well it's affordability and number one or two is healthcare and that's a direct result of the big affordable bill let me change gears for a bit um everyone knows front page news energy costs are going up about thirteen percent across the country uh home heating oil is going up forty four percent and yet once again the administration is trying to zero out LIHEAP LIHEAP is a strongly bipartisan program we all support it around here because it helps people who need the help to survive literally survive the winter and in the south the summers uh it's uh it's it's unconstrable to me that they'd make these cuts why why are you supporting these cuts

i've been involved in lie heap my whole life my brother is the biggest supplier to home heating oil to poor people in new england i go on the indian reservations and people tell me that people will die if we cut lie heap i've spent all the money that has been sent me for lie heap this year and

yeah we uh senator collins and i and senator galsey just had to write you a letter last week get the money out the door this week so your uh sort of enthusiasm spending money wasn't evident

well my enthusiasm has always been an evidence but it was held up in an inter-agency process i spent all ninety percent that i had control over and now i'll spend the remaining ten percent and if congress funds the program i will spend the money

uh

uh well then have you talked to the president about why he wants to zero it out

the the president's looking at thirty nine trillion dollar budget he's gotta cut somewhere everywhere they cut is painful

well i uh it's particularly painful for working people and low income people who don't have access as they did before to healthcare don't have access perhaps this winter to heating systems and i don't think that's the same problems they're seeing down in marlago thank you

peter moore

I'm around. Thank you.

Senator Reed, thank you. Mr. Secretary, thank you for your presence this afternoon. I wanna comment on uh, Senator Rounds' uh conversation with you about three forty B and let you know that there's a bipartisan, three Republican senators, three Democratic senators, including the chairwoman and ranking uh member of this uh committee who have uh come together to try to find a uh path forward on three forty B that makes it solid, works in the way it should, And uh, we would, we, we are working well with your department in that regard. I would ask you if you would ask um, uh, HRSA if they would come brief me and the working group on uh, this issue of the rebate that Senator Rounds raised. If you could uh prod them to provide us with information and have a conversation, uh, we, I'd be grateful.

Oh, God bless you, Senator. I hope you find a solution. I'm glad you're working with the Democrats.

We're trying to make the job easier, sir.

And, yeah, thank you. And I absolutely can get hers to come brave you.

Great, thank you. Um, I was involved in the reconciliation process process last year and particularly worried about small and community w- hospitals, rural health care. Uh, Kansas has, uh, uh, we have about a hundred and thirty hospitals. Ninety of them are probably critical access hospitals. All of them are fragile. Uh, and any change can make a difference, including what happens to three forty B. So it's like every component, every piece of the puzzle, uh, matters in the, in the bottom line of whether or not a hospital has a future. Their doors remain open. One of the things we worked on, uh, with your department and with my colleagues was the Rural Health Transformation Program. Uh, Kansas' uh, made, submitted their application. We've received the, the, uh, pr- approval to proceed. We're using our program to expand primary and secondary prevention programs, secure local access to primary care, build a sustainable workforce, uh, and enable value-based care and harness data and technology. What's the reaction to, by HHS, to the way that, uh, this program, the RHT, is unfolding? Uh, you have an opinion about what's happening yet?

Uh, I don't think, I don't think we could be happier.

OK.

The proposals were outstanding. um they went to blue states and red states i think the top two states uh were texas and alaska and then the third state was california and you know um the the applications were uh were better than we could have imagined uh we're really happy with the program and the money is out the door

we are jealous of those states you mentioned because we're only number six uh but we were pleased with that that opportunity to try to make a difference for the long-term, the immediate. You have to s- you have to stem the flow, the immediate challenge that hospitals face in providing health care with the goal of making sure that when you do that, you create also a long-term opportunity to continue to provide care to the community. And, um, we look forward to - to the evaluation, I guess. There'll be an evaluation based on state standards to make sure our state and others are complying with the plan. And that program will continue to provide Kansans uh and their health care providers with a with a brighter future for the next uh five years. I've I have visited every hospital in Kansas numerous times. Uh, I visited fifty some hospitals last year. And while we'll have a conversation about three forty B or medic care advantage or Medicaid, uh, private insurance, all the components of how uh, dollars, uh, are to be derived in providing health care. The basic bottom line challenge for every hospital I talk to is workforce, the ability to find and hire to employ. It's more challenging in rural areas, but it's a problem everywhere. And I've tried in this job as a United States senator over a long period of time to do all the things I know that would be supportive of investments in that, solving that problem. Support for the National Health Service Corps, HRSA's nursing workforce program, rural residency programs. Direct investment in, in universities, we're using our congressionally designated spending opportunities, in particular to support, uh, workforce training at community and technical colleges, but universities as well, and particularly in the arena of health care. Any university, any community college, any technical college that's trying to meet the health care workforce needs, of health care providers in Kansas, that's the, that's the place we want to try to help invest. Do you have other suggestions what you, the department, or what we as Congress could do to better ensure that there are people who are able, willing, and trained to meet the workforce needs of health care?

I mean, you mentioned most of the programs, I would add the GMA program, which is really an important program for rural hospitals, cuz if we can get um medical grad school graduates to do their residencies there a lot of them are gonna end up staying there uh i just gave a hundred and thirty five million dollars uh to um uh community health centers and and a large part of that is for uh rural residency programs so we know and we know how important these hospitals are to these communities it's not just for healthcare but They're the central economic driver for the communities. They have the, a lot of them the biggest employers. They have the best paying jobs. When they shut down, no business wants to move there anymore, so it's absolutely critical to keep them open.

Mr. Secretary, you said something that I'd highlight, cuz I mostly mentioned about rural and small community health care providers, our teaching hospitals in particular, this topic of teaching, educating residents and fellowships, uh, it is also another reason that, um, federal support, financial stability is important in our largest hospitals as well, cuz that's where we train many of our physicians and other health care providers. Is that true? You agree with me?

I agree.

Yes. Mr. Secretary, thank you.

Thank you very much, Senator Brand.

You're very welcome.

Senator Britt. Thank you, Madam Chairwoman. Uh, Secretary Kennedy, it's great to see you. Thank you so much for being in front of this committee. And um, I know we have a number of things to talk about, so I'll get right to it. I enjoyed my conversation last week with Doctor Casey Maines. I had an opportunity to visit with her and hear about um her vision and, and what she'd like to do as um, you know, in the, in the role of Surgeon General and, and really kind of cementing obviously um choices for, for parents, mothers, um, good products in front of them, so many things that we feel like no one has been willing to And one of the things that I talked with her about was told her I really appreciated her support of stop the scroll. Um, just talking about the negative mental health effects of on children. I mean, it happens obviously across the board, social media-wise, but specifically with children. I think a lot of times we talk about the things that people know, whether it's bullying or sextortion or, um, different things that are happening online. But one of the things I think that we miss and I think that you have focused on is the, the. the health effects and mental health effects that occur from things like lack of vitamin D deficiency, um because the the lack of outside exposure when you have children that are on, right now on devices about seven and a half hours a day, we know they're missing that critical element of of growing up. Um when you're looking at social media too, the the diminishing of real-world socializing skills and the ability to communicate with one another in person um higher rates of anxiety, and weaker physical and cognitive skills. And when, when we're looking at that, I am deeply concerned about those effects, not only on everyone, but especially on the next generation. Uh, can you tell me what does the evidence show about the down downstream impacts of the things that I just mentioned? And what targeted steps would you recommend, whether through congressional action or HHS guidance, school policies, parental empowerment, um, that we can do to reverse that? the trends that we're seeing in our children right now

yeah and thank you for meeting with casey maines casey was um was number one in our stanford medical school graduating class she was a brilliant physician she left uh practice in order to devote her life she saw that our system is broken and that people were coming in because they were eating the wrong stuff they they all were metabolically challenged and that her job was just to patch them up at the end and she decided to devote her life getting americans to change their behavior she is not partisan i hope she gets support from both democrats and republicans she is the most eloquent articulate evangelist for the maha movement she has nothing to do with vaccines never gonna talk about them she just wants to change attitude toward metabolic health in this country and i think she will have a revolutionary effect on this country we don't have much jurisdiction at hhs to alter cell phone use uh we have a maha agenda for the states and we're asking them to pass uh um a retinue of laws uh protect children that they have the power to do that we don't and a lot of that is like continuing medical education uh teach nutrition in schools but one of the primary ones and now fifty percent of the states have adopted it is bell it's bell-to-bell legislation so that in uh high schools and public schools that the cell phones uh are left in the backpack

hmm

and the um the transformation of those schools and i toured a number of them including in loudoun county virginia recently is transformative um the the students support it now i went to a cafeteria the kids were all talking to each other when they were all then looking at their labs the testing scores for the school have gone up the disciplinary problems have gone down the parents love it they say the kids are now learning to drive they're driving without using their cell phones they're coming home and eating dinner with the family without being on the cell phone the whole time and we're doing everything. I'm touring all the states to urge them to uh to pass that legislation, cuz I think it's the best thing that we can do.

Absolutely. I think we we should do more here in Congress. Um, couple of things real quick and we only have a a little bit of time left. Um, nearly fourteen million children in the United States live in food and secure households and roughly one in five children may not have consistent access to enough food. Head Start plays a critical role in providing nutritious meals to low-income children during their most important developmental years. Given the scale of child hunger, what specific steps has the department taken to strengthen and expand Head Start's nutrition services? And do you believe the current level of funding is sufficient to meet those needs?

You know, my family started Head Start and uh, I have a deep nostalgia, but also there are six hundred and sixty thousand kids. in head start the poorest kids in our country it's impact on them is demonstrable it's been shown in study after study um this year uh i've toured a lot of head start facilities since coming into office and the food was appalling it was all ultra processed food uh we just gave it sixty two million dollar in in addition to maintaining um uh the budget at twenty twenty five levels um we are and twenty twenty six levels now for a new budget we we gave sixty two million dollars to head start as a one time investment to make sure that they can build kitchens that they can build a home gardens that they can develop the infrastructure for feed feeding the children right and we're we're requiring them now to provide nutritious food fresh food to their children

wonderful thank you so much i am out of time but i appreciate your service and look forward to continuing to work with you

Thank you, Mister Secretary, that leaves the two of us, I think Tammy had one more question and then I'm gonna bring it down.

Uh, thank you so much, um Madam Chair, I wanted to just correct uh the record or have the full record um uh earlier uh Mister Secretary I believe I heard you say that MRNA vaccines are not effective for respiratory illnesses and

The ads

I wanted to just submit two uh new uh, England Journal of, uh, Medicine, uh, uh, large, uh, clinical trials that show that they are, uh, safe and effective against COVID and RSV. Um, as to my question, uh, Secretary Kennedy in January, HHS, uh, uh, terminated virtually every discretionary grant funded through, uh, SAMHSA. Um, this amounted to roughly two billion dollars in funding for mental health and substance use treatment. and prevention programs. After a very chaotic twenty-four hours, those grants were reinstated. And less than two weeks later, CDC abruptly paused approximately five billion dollars in funding to states to help, uh, bolster public health infrastructure. Those grants were also reinstated within twenty-four hours. A couple weeks later, HHS terminated CDC grants in just four states that happened to have democratic governors did you approve these grant terminations in any of those three cases

uh i did not approve the SAMHSA and and as soon as i the SAMHSA termination notices as soon as i found out about them i reversed them within twenty four hours

and and if you did not approve those SAMHSA grant terminations who did

uh they somebody in the agency you know the agency at that time was in every aspect, every sub-agency was involved in um in reversing the corruption from the Biden administration. So there was so much fraud.

So every discretionary grant, um roughly two billion dollars, uh uh was in that bucket. Um did the White House know about these terminations before they occurred?

I can't tell you.

How did HHS evaluate these grants to determine that they were not aligned with administration policy

uh as i said at the moment i found out about the grant term and it was a mistake it was an overcorrection and that's what happened it was an overcorrection we made a mistake and i reversed it as soon as i found out about it

and the c. d. c. grants that i referenced

i can't talk about those unfortunately senator because those are under litigation

alright thank you

thank you Alright, uh, I have I have one more question that I'm not going to ask but for the record, and that is you mentioned it in part of your uh testimony about young researchers. And there is a concern uh with NIH and the flow of dollars as to whether we're getting the researchers. I guess we're trying uh other countries are trying to poach our young researchers, and I don't think any of us wanna see that happen. So that that's a source of concern for me. So uh that ends our hearing. I'd like to thank my fellow committee members. And uh and for the conversation and thank you in particular, Secretary Kennedy, for any senators who wish to ask additional questions. Questions for the record will be due April twenty eighth. The hearing record will remain open until then for members who wish to submit additional uh materials for the record and this uh, subcommittee will stand and recess and thank you very much.