President's Proposed FY 2027 Budget Request for Health and Human Services

The committee will come to order. Today we meet to discuss the President's fiscal year twenty twenty-seven budget for the US Department of Health and Human Services. And thank you, Secretary Kennedy, for joining us. Mister Secretary, last year during your nomination hearing, I noted our health care system was on an unsustainable, dysfunctional path. As costs for patients and taxpayers soared, outcomes and access continued to decline. I suggested these challenges presented an opportunity to chart a better way, a better way forward. Although much work remains, we have made significant progress. For too long, Medicaid's financing and pragmatic oversight was on autopilot. Coupled with pandemic-related increases in costly regulations under the previous Medicaid spending, and hear this, doubled between twenty nineteen and twenty twenty five. The working families' tax cuts took significant steps to realign our health care system, strengthening access for those in need, putting patients back in charge of their care, and providing overdue reforms to curb waste, fraud, and abuse. The law prohibits coverage of certain non-citizens under federal health It removes Medicaid beneficiaries who are deceased, enrolled in multiple states, or own a home worth over a million dollars. It also requires individuals who are able to work or volunteer or go to school to do so, to be able to be eligible for Medicaid, a requirement that mirrors similarly intended safety net programs. These common sense reforms, along with policies to prevent financing gimmicks, will save taxpayers hundreds of billions of dollars and insure Medicaid's long-term sustainability, ensuring the program's dollars reach those for whom it was intended. Under the working families' tax cuts, Americans will keep more of their hard-earned money and have greater control over their health care. The law expands access to health savings accounts so that patients do not, patients, not insurance companies, can choose the health care that is right for them. Individuals with high deductible health plans can also rely on telehealth services without meeting minimum out-of-pocket payments. Republicans also made a historic fifty billion dollar investment in rural health care through the Rural Health Transformation Program. Beginning this year, all fifty states are receiving funds from the program, which will be used to bolster workforces, invest in connected technology, and promote preventive health interventions. Working in partnership with Ranking Member Wyden, the finance committee delivered on our commitment to bring transparency and accountability to the prescription drug supply chain through pharmacy benefit manager reforms. The bipartisan law will end perverse incentives for PBMs to steer patients toward higher-cost drugs and vertically integrate pharmacies. Our work to address anti-competitive consolidation is just beginning, and I look forward to continuing these efforts with Ranking Member Wyden and all members of this committee. On a bipartisan basis, we also extended Medicare coverage of telehealth and hospital at-home services. insured Medicare Advantage plans maintain accurate provider directories, and removed Medicaid barriers to high-quality specialized health care for children. These extraordinary accomplishments will expand choice and lower costs for all Americans. Mister Secretary, under your leadership, HHS has also taken sizable steps to fix the failures in our health care system that frustrate both patients and providers. Together with the private sector, the administration is breaking down the bureaucratic obstacles that for too long have been accepted as the norm. HHS is reducing health insurers' cumbersome overuse of prior authorization which routinely delays care delivery. Through Trump Trump R X, patients can shop for lower-priced versions of their drugs, covered especially by those that are not covered by many insurance plans. I appreciate your commitment to making America healthy again, by empowering patients with the tools and information they need to create a healthier future. Under your leadership, the department has focused on addressing root causes and prevention of illnesses. Now, Medicare is becoming a system that invests in the whole person, in lifestyle interventions, and in medical s- and our medical schools are providers with the education to deploy these services. Thank you for that. Mister Secretary, I look forward to learning more about how we can work together to build on the progress we've made in the last year to put patients at the center of our health care system. And now I recognize ranking member Wyden for his opening remarks.

Thank you very much, uh, Mister Chairman. Today we gather to discuss Donald Trump's health care blueprint for the coming year. Robert Kennedy came into the office of Health Secretary with sweeping promises of restoring the public's trust in government and making Americans healthy again. Now, as the Trump campaign pollsters flail about trying to cover up Robert Kennedy's devastatingly unpopular anti-vaccine policies, I believe the witness We'll try to have it both ways. He'll serve up enough fakery this morning to help Senate Republicans ignore the real harm that's being caused, while twisting the truth enough so he can go back to pushing anti-vax policies that make kids sick when he's out of the hearing room. The rank hypocrisy of the Trump administration on health can be summed up in a sentence. Goodies for those at the top while American families get sicker and poorer. While Donald Trump and the uh secretary are cozying up to insurance executives by handing over more than twenty billion dollars and throwing consumer protections in the trash, Oregonians now play Russian roulette with their health care, actually trying to figure out how they can go without insurance until they qualify for Medicare because they can't afford higher a c a premiums. When Donald Trump cuts the sweetheart deals with the big pharma executives, rural America continues to struggle, often because Republicans have made the largest cut to healthcare in American history. What these communities are seeing now, I believe, is only a beginning of how things are gonna get worse when the cuts Republicans have hidden And I've never seen this in all my time in public service, hiding the details until after the election. Time and again when Republicans are put in charge of Americans' health care, there's a never-ending flood of benefits for special interests while American families get left further behind. Nothing illustrates the Trump-Kennedy hypocrisy on health more than their approach to prescription drugs. Donald Trump spent the last year hosting executives from the big pharma companies In the Oval Office, he boasted of so-called deals to bring down the price of medicine. The details, the important facts about these deals are totally secret. My staff spoke with each company involved in these deals. The only thing that's clear is the list of goodies that the company's got in exchange. Robert Kennedy is here this morning and he's going to ask Congress to codify these sweetheart deals. Sight unseen. Let me repeat that. People in Congress aren't gonna see the details about these deals. So while the American people wait for their costs at the pharmacy to go down, the administration touts Trump R X, which actually offers higher prices for drugs than what most people can get through their insurance. There is no bigger fraud on the planet when it comes to drug costs than Donald Trump. Meanwhile, Robert Kennedy has presided over the biggest cut to Americans' health care in history, a choice that's already kicked Americans off their care, forced hospitals to close, and caused health care workers to lose their jobs. Since Republicans passed that law, my staff has been thoroughly cataloguing every hospital, every clinic, and every health care provider that has shut their doors, reduced services, or laid off staff. So we have the receipts. There have been over a hundred and seventy closures and service reductions across thirty-four states. Nearly seventy-five hundred health care workers have lost their jobs across twenty-four states. These health care providers cited the impossible financial challenges caused by the Republican Medicaid cuts. Mr. Chairman, I'd like to uh enter into the record our analysis.

Without objection.

Now, I recently held a forum with health care workers at home in rural Oregon, in a place where Donald Trump got better than seventy percent of the vote. What I heard there underscores the reports that are coming in from around the nation. Health care providers are walking an economic tightrope, and these communities can't afford to lose the services they're providing. So, Mister Chairman, I'd like to enter into the record submissions from five states, including Oregon, as well as news articles from around the country that confirm the catastrophe that is playing out on the ground of states

Without objection.

Mister Kennedy is the most senior and influential health care official in the country. When it comes to vaccines, Robert Kennedy has used this once in a lifetime platform to make parents doubt themselves and doubt their doctors. Ninety percent of Americans infected with measles during this unprecedented outbreak mostly kids, have not been vaccinated. It is no coincidence that it comes as the person in charge of our country's health care lays out propaganda about vaccines, all on the taxpayer dime. The secretary has duck bobbed and weaved without taking responsibility of saying what needs to be said. Vaccines save lives in America. They keep kids from getting sick. And yet the secretary won't say it. in plain in plain straightforward terms. He's repeatedly lied before the Congress. First, he lied to me about his trip to Samoa. As chairman, I'd like to enter into the record a report by the Guardian and the Associated Press, disclosing emails between State Depart officials State Department officials that make it clear that the secretary was traveling to the island nation to promote his anti-vax views.

Without objection.

Second, he lied to Congresswoman Terry Sewell by denying that He said black children should be reparented if they receive treatment for ADD and ADHD. And he's continued to lie about the Republican cuts to Medicaid, claiming that there have been no cuts. That is an absurd claim that would get him laughed out of any room in rural America, where public officials and health care providers gather to make agonizing choices about payment cuts at this moment. These lies and misrepresentations underscore Why? As you know, Mister Chairman, I asked Robert Kennedy to testify under oath the last time he came before the committee. Regardless of whether or not he's taken the oath, he ought to remember that you can't lie to Congress. It's a crime. Our witness is going to tell the committee this morning that Democrats are interested in protecting the status quo. Nothing could be further from the truth. The nation's health care system is broken. That's only gonna get worse with the Republican cuts that the secretary has been cheerleading Right now, Democrats on this side to a person are leading an effort to reimagine health care for American families so it is more affordable, more simple, and less beholden to the corporate interests that Republicans empower at every single opportunity. My own take is is if the secretary was serious about making America healthier again, he'd be working with us on dealing with these issues rather than going to the side of big insurance

thank you and with that mister secretary we turn it over to you for your opening statement

great chairman great both thank you ranking member and members of the committee thank you for the opportunity to appear before you today to discuss president trump's proposed twenty twenty seven budget for hhs first i'd like to take a moment to express my deepest condolences to your colleague senator mark warner over the recent loss of his daughter madison my thoughts and prayers with him and his family we stand at a generational turning point our children of this generation and modern history and decades of failed policies captured agencies and profit driven systems caused it parents across this country demanded change and we are delivering it We're ending the era of federal policies that fueled the chronic disease epidemic and replacing them with policies that put the health of 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 drug prices with sixteen of the largest pharmaceutical companies so that Americans no longer pay more than other people in wealthy countries for the exact same medications. Or bringing real transparency to healthcare pricing so that patients know the cost of care before they receive it. I used the full convening power of the federal government to bring health insurance CEOs to the table to reform prior authorization, and I brought the four hundred largest tech companies together. and information blocking so that for the first time americans will be able to get their own health records which they own on their cell phones we are cutting red tape speeding decisions and abandoning transparency we're also cracking down on ways fraud and abuse this year hhs and usda issued new dietary guidelines that put real whole food at the center of the american plate We flipped the food pyramid upside down and sent a clear message to the American people, eat real food. HHS has opened the door to partnerships with industry, trade associations, and nonprofits, and advocacy groups. More than fifty medical schools have committed to expand nutrition education from an average of two hours to forty hours. Food manufacturers are stepping up too. More than forty percent of the food industry has committed to phase out petroleum-based dyes by the end of the year and many have already eliminated them. In conjunction with these efforts, the FDA approved six natural food colorings derived from fruits and vegetables. Through President Trump's Great American Recovery initiative, HHS is matching compassion with action to help Americans break the cycle of addiction. At HHS we are prioritizing patients with ultra-rare diseases and their families driving faster access to lifesaving treatments. We're restoring gold standard science and integrity across the agency. We're protecting children from sex rejecting procedures that expose them to irreversible harms. We're eliminating outdated and misleading warning labels on hormone therapies used by women during menopause. We're strengthening oversight of organ procurement. We are regulating television advertisements for pharmaceutical industry is something the Democrats have been asking for for generations. We're implementing operation stork speed to ensure the safety and quality of infant formula. We're applying that same focus and urgency to rural America. The Rural Health Transformation Fund delivers the largest investment in rural health in our nation's history, fifty billion dollars over five years. Strengthen rural hospitals and ensure Americans can access the care they need no matter where they live. HHS has also last week 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're far more likely to stay and serve there. The president's budget puts all these priorities in action. It invests in prevention because preventing disease costs less than treating it. As my uncle President John F. Kennedy said, " Progress is a nice word, uh change has its but change is its motivator and change has its enemies." We see those forces clearly entrenched interest, defenders of a failing status quo, and institutions that put profits ahead of the American people. The resistance underscores the urgency of this moment. We can reverse chronic disease, improve public health, and lower costs. I stand ready to work with this committee and Congress to seize this opportunity to implement and codify lasting generational reform in American health care for our country for our children and for the health of the American people together. We can make America healthy again. Thank you, Mister Chairman.

Thank you, Mister Secretary, and um I believe that your effort and focus on making America healthy again and helping us to focus on nutrition and prevention and healthy lifestyles is one of the most significant things that you have done, among the many that you've described in your testimony. In that context, uh, in your testimony you identified nutrition as a bedrock of health. and one of the primary levers for treating and preventing chronic disease. You also emphasize that it's imperative for our nation's health care providers to be equipped to incorporate nutrition into patient care. Securing commitments from more than fifty medical schools to provide at least forty hours of nutrition education is an incredible start. Uh, I don't think it was very long ago that there was probably very little nutrition taught in medical school. And now we are encouraging that to be a focal point. How does HHS plan to build on this progress by securing additional commitments for medical schools and expanding nutrition education into other key areas, such as residency training, medical licensing and continuing medical education?

Uh, thank you very much, Chairman. We are we're expanding the number of medical schools. There's already many, many others that have signed on since the original Um, we are working with the states, more than a half the states on a more legislative plan, more than a half the states have already required passed legislation requiring nutrition education and continuing um medical education. Um, we uh we have and we've now uh issued notices to all the hospitals in America that they must start serving nutritious foods in the hospitals um something that you know the food before that was has been appalling they're giving diabetic patients jello and custard and and a soda drink and we're if they wanna continue to get medicaid medicare dollars they need to change that now um and then we're driving good nutrition through the wick program through snap through um through school lunches through the indian tribal services and other federal subsidies programs as well

oh thank you very much i want to i will just tell you that i for one deeply appreciate that strong focus on helping us get focused on nutrition it was a a sad thing that that uh our society had not focused on it as well as it should have until now Republicans established the Rural Health Transporta- Transformation Program in the Working Families Tax Cut Act to strengthen and modernize our nation's rural health care delivery system. We do have a problem in the rural health care system. And with this funding, we are hoping that states will be able to implement comprehensive strategies that not only expand preventive, primary, maternal, and behavioral health services, but also create new

Um, the states the the applications from the states were really extraordinary. we were astonished how resourceful and imaginative they are um among i think the most common applications were to uh to improve or to uh to maximize the use of ai in diagnostics in health delivery and uh and also just in billing and and uh and management of the systems um the a lot of the money is being spent on telehealth which is going to bring deliver rural healthcare to um many to areas that are particularly remote in this country places like wyoming alaska and many others where they where uh where healthcare just simply is not accessible a lot of the applications for for residency programs and for worker recruitment and retention and then just a lot were for and badly needed infrastructure repairs. We've lost more than a hundred and twenty hospitals in rural areas since twenty ten. And it's a crisis when they lose that hospital, they're not just losing access to to proximate health care, they're also uh losing the greatest economic driver in many of these communities. These are in many cases the greatest employer, they have the highest pay for their workers and when they close businesses stop moving to the area so it's absolutely critical that we keep those hospitals open and that's why this plan raised by fifty percent the amount of the infusion of federal dollars that is flowing to rural areas in this country

thank you very much my time's expired and i wanna try to stay at these five minutes so i'm trying to set a pattern here for the rest of the committee And uh I had questions on telehealth and innovation and A I as well as waste, fraud and abuse. You you anticipated many of those in your answers. Thank you very much. Senator Wyden.

Thank you, Mr. Chairman. Mr. Secretary, it sure looks to me like the president is working very hard to muzzle you on the issue of the vaccine question. It is very clear you weren't mentioned at the State of the Union uh address, uh the pollsters that the president has. found that eighty percent of all voters support the childhood vaccine for measles and hepatitis b. But at the same time, your hand-picked people at HHS voted to end the universal recommendation of a hepatitis b vaccine for every newborn. So my question to you is, we are seeing with measles, we are seeing with vaccines, a problem all over the country, and putting infants at risk like this is so dangerous that a court even blocked your new policy from taking effect. Why would you be doing something that is so awful for kids on this vaccine issue? I know it's been your life work, but you promised that you'd do differently when you came for your confirmation hearing.

Uh, Senator, we, under my leadership, handle the measles, uh, outbreak better than any country in the world. It is a global outbreak. Mexico three times the amount of measles and they have one third of our population. Canada has twice the number of measles, has one eighth of our population. We had about, we have seventeen hundred case this year. Twenty-two hundred last year. Uh, Europe had thirty-three thousand last year and a hundred and twenty-seven thousand the year before. There are populations that don't want to vaccinate. Mennonites do not want to vaccinate. They have not vaccinated since seventeen ninety seven. It has nothing to do with me. I have not visited Mexico or Europe. I had nothing to do with the measles outbreak here. We have limited our outbreak more better than any country in the world, because I've talked to Doctor Abbott or Governor Abbott regularly. I talked to Governor McMaster. We send the uh the uh uh epidemic intelligence services into their regions when they need it immediately. and we give them the help we can to end the pandemic. There are gonna be people who don't vaccinate. The vaccination levels dropped during COVID because people stopped trusting the American government. I am here to restore that trust.

All I can tell you is that in America today, when a baby is born, doctors give the baby a hepatitis B vaccination on day one. With hepatitis B, we're talking about a serious lifelong uh illness that leads to liver failure and liver transplants there is no cure. And as of December, you're still appointing people who are trying to undermine that policy. That's not in the interest of families, and that's why the president's pollsters are telling them to isolate you and keep you from talking about it. But I'm telling you, we're gonna make sure that the truth gets out. I'm gonna move on now to this drug price.

Uh that's a mischaracterization of the president.

I'm gonna move on. I'm asking the questions, Mr. Secretary, I'm moving on now to the pricing question in the disclosure of these deals. Um these secret deals with pharmaceutical companies set up a never-ending flood of goodies for big pharma. You take Pfizer for example, the day after Pfizer's CEO stood in the oval office with Trump the company's stock prices soared through the roof. Pfizer's gonna get a blanket exemption from Trump's drug tariffs, and all of Pfizer's drugs are exempt from Trump's latest fake scheme to ally align Medicare prices with those in other countries. So it doesn't seem to me that the American people get a whole lot, you know, from uh from this and every democratic member of our committee is demanding that you disclose the deals the specifics the public's got a right to know about something of this kind of consequence and every single democrat he up here wants to see this as a transparency issue. Now yesterday you indicated to my colleague Senator Merkley that you would give out some information about the deals, but not the real information that would indicate if the deals are so good, why is the trump administration trying to hide them? So my question to you is, yes or no, this is a yes or no question, reflecting the interest of our colleagues up here. Will you commit to releasing your written agreements with the pharmaceutical companies tomorrow?

No, I will not, and I can explain why. Those agreements contain proprietary information and trade secrets. When you passed the Inflation Reduction Act, and ordered me to negotiate with the pharmaceutical companies, you put in a provision that required NDAs, because nobody's gonna come to the table with me if I start releasing proprietary information. You seem to be saying, we were paying the highest prices for drugs You seem to be arguing, " Now now we're paying the lowest. We've dropped IVF by eighty-three percent. We've dropped GLP's by eighty-nine percent. Insulin, the COPD drugs, the asthma drugs of the American people, now they're paying the lowest costs in the world rather than the highest." And you wanna go back on that? You can do this better than us. We did it because you wouldn't act. You have a lot more power to negotiate than we do. Why don't you just go do it? Well,

We we we we are.

you've been promising to do it for twenty years and you've never done it.

We are gonna do it, mister secretary, we are gonna do it, but when you try to hide the information on consequential issues that you're doing on these Trump Rx things, it makes it harder for us to make marketplace forces. You're in bed with big pharma.

You're telling me you don't have secret agreements here

Thank you, sir.

and secret meetings here in Congress all the time, every day?

Senator Scott.

Thank you. Uh, good morning.

Good morning.

Secretary Kennedy, I wanna start off by thanking you for everything that you, HHS, CDC, uh, did, truly an incredible job helping South Carolina, my home state, throughout our measles outbreak. South Carolina has experienced the largest outbreak in US history since measles was declared eliminated more than two decades ago. From the calls you made to our governor, to the countless weekly calls between CDC and South Carolina's Department of Public Health staff, to the CDC staff being deployed to the upstate, I know without a question, we would not be on the right side of this outbreak without your leadership and without your help. And South Carolina is indebted to your leadership, and we really appreciate that.

Thank you, Senator.

I am very hopeful that in just a few days, on April twenty sixth, we can declare the outbreak long and gone as long as there are no new cases. That is a big deal for a state that has been suffering for months, months, through this challenge. Thank you. It is thanks to your leadership and the leaderships of the folks that I mentioned from CDC to the HHS to our folks on the ground that this day has finally come. While it is hard to find positives, it's really hard to find a silver lining through this process. If we did, it is early detection matters a lot. The more time we spend on figuring out how to get ahead of it, the better off we will all be uh in the future. That is why last month I, along with several of my Senate colleagues, introduced a Predict Act to strengthen and expand wastewater surveillance. When someone is infected with a virus like measles or the flu, they shed viral material, often before they even are aware that they are sick. CDC helped work through the sequencing of positive wastewater samples from twenty wastewater sites testing for measles in South Carolina. This critical work highlights the best kind of government. one that works in the background, on prevention, and saving lives using smart science. It is an idea that should reach every single community across the country, not just a handful of communities who have the resources to deploy. By utilizing these tools and monitoring the spread of disease early, public health officials can see an outbreak coming days or weeks before hospital admissions begin to rise and take steps to intervene in mo- moments when time is truly of the essence. Americans deserve a public health system that sees threats coming before they become emergencies, and the Predict Act brings us one step closer to that reality. Secretary, as we look forward to lessons learned from this outbreak, can you please commit to working with me on wastewater surveillance such as the predictor

absolutely

absolutely did they hear me

yes i heard you yeah

absolutely senator thank you for your kind words about the uh management of the measles and uh um i had a i just had a wonderful inter inter change of series with governor mcmaster and i wanna thank all the uh the health department in south carolina for the hard work they did with cdc to end the outbreak i absolutely will work with you on the predict act it is something that is very personally important to me to have more wastewater surveillance um and we are also putting three hundred and twenty five million dollars in this budget into a new bio-threat radar system that will integrate with the uh microbial a surveillance or wastewater treatment plan to detect pathogens as soon as they emerge in our country and elsewhere in the world.

That's really important because, yeah, with your new system, the Bile Threat Radar System, uh, it strengthens outbreak detection, and I think it would be a perfect fit for us to take this predict act and put it under that umbrella, so to speak.

I look forward to working with you, Senator.

Thank you very much. For those unaware of South Carolina's uh the negative impact of measles, it was the largest outbreak, uh hundreds upon hundreds, nearly a thousand cases. Uh and it was a response, all of government response, where we saw HHS, CDC, the secretary working together. I know we have disagreements around this uh dais, but when you need help, and they show up, and it's effective, you should take the time to say thank you.

Thank you very much, Senator.

Thank you. Senator Bennett.

Thank you, Mister Chairman, thank you, Mister Kennedy, for being here again. For decades, parents in this country were able to send their kids to school without worrying about whether they could come home with a dangerous case of the flu, or a dangerous case of the measles, as my colleague from South Carolina is saying. Last year we saw the largest number of children uh die from the flu in in modern history. Are you familiar with that, Mr. Secretary?

Uh, yes, I am.

And and and have you told President Trump about that, that last year was the largest childhood death of of flu in America in modern America?

Well, that's one of the reasons that FDA just approved two new vaccines for, um, influenza A and influenza B.

Because because you you would agree that last year was the worst year on in terms of flu deaths in modern history, not in the old day, not in those

Right. In the in the old days we were having hundreds of thousands of people.

in the You're right, I of course. Uh, and I do agree that eighty-nine percent of the children who died from flu were unvaccinated.

I don't know the exact number.

That is the exact number, uh, Mister Kennedy, and and, uh, it was, you know, I think of interest to a lot of people in America that you took down the, um, the communications from HHS on the flu, the importance of getting a vaccine, when you first became the secretary. And I just wondered whether you regret having done that. Um, you're now saying that you're approving vaccines for the flu.

I I approve lots of vaccines. I've spent a billion dollars, authorized a billion dollars, developing new vaccines, including a universal flu vaccine.

So are you, you know,

The flu vac- I think the last year the flu vaccine had a, uh, something like a twenty percent efficacy. So, having these single antigen,

Actually, that

having these single antigen vaccines is not serving the public interest. The Cochrane collaborations, as they say, simply don't work.

So For the record, Mister Secretary, then I assume you no longer believe that the flu vaccine is destroying children's brains, that there's zero evidence that the flu vaccine prevents any hospitalizations or any deaths. Because today you're here agreeing that the vast majority of kids that died from the flu were people without vaccines, and you're saying that you're now approving vaccines.

We're making sure that we follow this, I mean, Senator.

Well, I th I hope you'll follow the science, because that's what put us in the position thirty years ago essentially having measles declared, um, uh, at an end in the United States of America.

Well, I many nations have lost their elimination status,

And I like

including Canada,

I'm sorry?

the UK, mmm, a lot of Europe this year, because of the outbreak, and the outbreak has nothing to do

Yeah. I mean, I I would hope that the Un- Oh, I know you said the outbreak has nothing to do with you. That was your answer to to s- Ron Wyden.

Oh.

chair uh you're the head of the agency you're the head of the agency

my agency has no jurisdiction over Canada Mexico the UK Austria

that's I would agree with that I would agree with that we are I think everybody on this dais believes that the United States of America ought to be leading in these matters that's why we're so discouraged by your cuts to NIH because that's gonna make it harder for us to lead that's why we are so discouraged by your cuts to Medicaid that are making impossible to invest in rural America. That's why we should start

There are no cuts to Medicaid, Senator, as you know. There's no cuts to Medicaid.

There's no, I don't

There's a diss- the congressional budget

That's absolutely That is abs- Mister President, that

The congre- look at the congressional budget office this week. They say we are increasing Medicaid spending by forty-seven percent

They have not Yeah, as as this week

over ten years. That's not a cut, except in Washington.

As Well, OK, you can you, it is a cut when it comes to the rural hospitals all over America that are having to close because of the Medicaid cuts, and those are real dollars.

They were closing before I came in here,

Mister Mister Kennedy, did you let me let me just ask you,

now they're not closing.

do you realize that last year the United States had the highest number of measles cases in thirty years, that the that the last time we had more than that was before,

The whole world did.

that measles yeah,

The whole world did.

we were the leader, Mister Kennedy.

We still are. We have a ninety-two percent vaccination rate.

We n-

We have the h one of the highest vaccination rates for measles on Earth.

Do you, so, are you taking the position? Let me ask you. Are you taking the position as your CDC director has taken that the measles vaccine is vital to keeping American ch- peop- children healthy in this country? Are you taking that position today? That has not been your position.

Uh, that's my position. I we promote the measles vaccine.

Thank you, Mr. Chairman. That is, that will be, I hope I hope you'll go out to America and promote this,

I mean, I I've always said

the idea that you have nothing to do with this,

The measles vaccine affects measles in ninety seven percent of the people who take it.

is dead wrong.

I've always said that. That's what the science says.

We wou- I would ask you to please underscore it because there's a reason that we are having these outbreaks, Mister Chairman, and that is the misinformation that's been propagated. If you would have a change of view, that's excellent. Let's get it out there to the American

Senator Langford.

Hey, Mr. Chairman. Shikini, good to see you again. Uh, thanks for your work on this. Uh, you have been one that has spoken out often on vaccine issues and to be able to provide clarity in this area, and so, uh, appreciate your engagement on this so much lately. I wanna talk to you about, little bit about pharmacy benefit managers. Uh, this has been an issue that we've talked about before, you and I, and that we talk about often around this dais. Uh, we have now passed a piece of legislation that de-links the compensation between the price uh, for pharmacy benefit managers and the price of the drug, which I think is exceptionally helpful, uh, to be able to work towards the consumer, the any willing pharmacy, uh, which PBMs have been fighting to destroy, are independent pharmacies around my state and around the country. We're losing more than one pharmacy a day now around the country, often because of what PBMs are actually doing to them in the compensation structure and the way they do the scoring on this.

Mm-hmm.

Uh, so I appreciate that. That law has now been passed. You all are in the process of implementing that. Uh, we wanna continue to be able to work with your team on the implementation, any questions that your team may have, or that, any way that we can actually help in the process. We wanna be able to stay engaged on this, cuz this has been a passion area for us, uh, for quite a while and it has been a real interest for you as well. Uh, uh, Senator Maggie Hasen and I, we have a piece of legislation that takes another step, uh, on this, dealing with the pharmacy benefit managers. And that is this issue of tiering, uh, that has been out there. Uh, now your team has put out a clear statement. Uh, say there's an expectation that when a drug is released in the biosimilar, the generic level, it's actually put on that tier to be sold. But you and I both know that's not happening. You have said it, we're trying to make it clear in law as well to be able to give you the reinforcements, uh, that you need on that to be able to say, when a generic or biosimilar is put out there, it needs to be put on that lower tier cost, and not put up on the more expensive brand cost, because that will ultimately drive the generic out of business. the brands know that we wanna be able to push back against that. So I I would ask only for your help and your team's help on technical assistance to make sure that we get this language right uh so that whenever we can get this passed on the tiering issue uh we can actually get that enforced as quickly as possible.

Yeah, and thank you, Senator Lanford, for your leadership on this issue that's been a long time coming. It's a bipartisan issue. Everybody knows the problem. I think the biggest fix, as you pointed out, was de-linking the uh the compensation to the p b m s from the list price of the pharmaceutical which which created the first incentive of having them choose they're supposed to be looking out for our interest but the higher cause the highest cost pharmaceutical would get at them the most profit so they were giving us a higher cause rather than lower cause there's a couple of the p b ms

right

that have now alright well sigma David Gordani has uh I think taken a lead in in expanding transparency, so the industry has a template for doing this, but we need uh we need to keep working on this to make sure that uh that they're actually to the extent they're working in in the system that they're doing what they were meant to do, which is to lower costs for consumers rather than raise it.

Right. Yeah, that that's our target as well. I've told the PBM companies Hey, I'm not opposed to your company. I'm just opposed to you trying to shut down my independent pharmacies and raising the prices of consumers. Uh, that that's the biggest issue that's out there on that. We wanna get lower price and greater access on this, not less and less on it. Uh, I wanna I wanna switch to a subject you and I have not spent a lot of time talking about, but it's continuing to be able to rise, and that's the issue of assisted suicide. Uh, we now have three states, California, Colorado and Vermont, that disability groups are filing charges against some of the assisted suicide laws, because it seems to target those with disabilities, and the Americans with Disability Act passed in nineteen ninety, uh, that act has worked to be able to protect those with disabilities, not incentivize them to take their own life. And so this is an ongoing conversation on this, and I think my question for you today is, is HHS engaging, some of these lawsuits are out there among states right now, and I know you're not engaging in the lawsuits, what is HHS doing to be able to protect those with disabilities that may be targeted by these assisted suicide laws.

i mean i to me i i think those laws are important and we see in canada today i think it's the number one cause of death is assisted suicide and as you say it targets people with uh with um disabilities and um and people who are struggling in their lives

yeah

and I don't think we can be a moral society. We can't be a moral authority around the globe if that becomes institutionalized throughout our society. So I'm happy to work with you in whatever way we can.

Great. Great, love to have the help on that. We've now seen a rise of people with eating disorders that are giving access to assisted suicide and this is just wrong in a multitude of ways. One quick statement, we'll follow up on this in writing on it. Uh, Oklahoma is still pursuing the title ten dollars that the Biden administration took away from my state of Oklahoma because we would not promote abortion in the state. So they removed title ten funding from us. It's about nine billion dollars on that. We'll follow up with your team on that one as well, but we're still trying to be able to get access to those dollars the Biden administration tried to punish my state.