Hearings to examine certain pending nominations.

The Senate Health, Education, Labor and Pensions Committee will please come to order. And I thank everyone for appearing today and for your service to our country. We've got some serious health issues right now in the United States. High rates of mental health conditions, substance use disorder, widespread chronic disease, the worst measles outbreak the United States has seen in over thirty-five years, leaving thousand six sick. County coroners have confirmed measles in Pennsylvania and measles as the cause of of death of three people, one more still being evaluated. And this is in the light of measles being a vaccine preventable disease. No one should be hospitalized, much less die. By the way, CDC apparently is working on a definition of death by measles, Someone said we haven't had to work on that for decades because no one has died from measles. And now we have people dying from measles. That's gonna be a terrible legacy for this administration. When I practiced medicine in Baton Rouge, I treated patients suffering from vaccine preventable diseases. One of whom I've talked before, had to ship off for a liver transplant. Um, unfortunately she lived, but it never would have happened if she'd been vaccinated. by by back by the way back then the vaccine wasn't mandatory it was as we said uh how do we put that um what's the big

i recommended strongly right

no it was um a dual uh mutual decision making which is a term we're hearing more of now as i remember that helicopter taking off to take her to a liver transplant an eighteen year old with a failing liver shared decision making to suffer from any disease is awful But to suffer suffer one which is avoidable, that's even worse. Misinformation and misguided policies are leaving children and adults unprotected against disease that we know how to prevent. Let's be clear. Vaccines are overwhelmingly safe and effective, and they do not cause autism. It's not a matter of opinion, it is a scientific fact. The executive order that breaks up the childhood vaccine schedule means children have to get more, not fewer shots. It will increase hesitancy and make children less safe. Two of my colleagues on my downed dais, Marshall and Tuberville have spoken about how many shots kids have to make. Um, uh, I think they overstated it, but the point is, if you break up a vaccine, they get more. That's going in the wrong direction. And it deeply concerns me to see politicians giving medical advice, which has zero scientific backing. Scaring mothers into delaying or even altogether skipping their child's vaccine is wrong, and it makes America sicker, not healthier. We need leaders who are unbiased, who make decisions based on science, not politics or ideology, and who are committed to protecting children's health. Mister Klump, you said recently, and it was music to my ears, if there's one issue that shouldn't be partisan in our country, that should not be red or blue, they're right, it is health. We should all agree. Your background as Chief Counselor at the Department of Health and Human Services and Director of the Center for Medicare and Deputy Administrator of CMS gives you a unique insights and managerial experience which will be useful as you oversee the process and operations at HHS as Deputy Secretary. Doctor Westlake, with your leadership we successfully passed my HALT-Fentanyl Act, protecting Americans from fentanyl-related substances. Drug overdoses, largely driven by fentanyl and other synthetic opioids, are the leading cause of death among young adults eighteen to forty-five. Another leading cause of death for teens and young adults is suicide. But it's not just limited to young people. One in five adults reportedly experience mental illness of some sort. More than half do not get treatment. These are children, parents, friends, neighbors, or loved ones. Doctor Westlake, I appreciate your commitment to addressing these issues. and I look forward to working with you to implement the mental health reforms I championed in the twenty-first century Cures Act. Um, I'm I'm confident that you will continue to champion and pro- and promote pro-patient policies as Assistant Secretary for Mental Health and Substance Use. Doctor Sapphire, if confirmed as Surgeon General, you will be the nation's doctor. Americans will look to you for clear medical guidance. I look forward to hearing how you plan to restore confidence in public health and assure the American people that our institutions are making science-based decisions rooted in data not speaking off the top of someone's head. Now, by the way, I don't have all the answers. None of us have all the answers. It is OK to challenge perceived wisdom. But you pose a research hypothesis you scope the question in an unbiased and scientific valid manner, and then you engage in rigorous data analysis. And then you publish in a peer-reviewed journal results regardless of what it shows. That is responsible leadership and appropriate scientific discovery. Declaring things contrary to evidence to be unsafe and to be the cause of something, for example, the cause of autism, especially when those claims have repeatedly and thoroughly been debunked. And then gaslighting anyone who calls you out by saying, I'm quote, just asking questions. And then declaring that anyone who pushes back against you is corrupted by industry. That is not gold standard science. It is not radical transparency. It isn't restoring trust. It is not leadership. It is performative. It is irresponsible. it damages our country and we have four people in Pennsylvania reportedly dead because of that sort of activity. With that, I recognize Senator Baldwin.

Thank you, uh, Mister Chairman, and welcome to all of our nominees today. We are here to hear from, uh, Chris Klump, who has been nominated to be Deputy Secretary of Health and Human Services. Doctor Nicole Safire, who has been nominated to be Surgeon General. and Doctor Timothy Westlake from Wisconsin, uh, who has been nominated to lead SAMSA. Thank you all for being here. I look forward to your testimony and the conversation we will have to follow. The United States faces multiple public health challenges, and we need leaders who will stand up for science. The United States is currently facing a severe measles outbreak. with nearly thirty-three hundred cases across forty-seven jurisdictions, including about one hundred and sixty cases in my home state of Wisconsin. This is the most serious outbreak of measles in the last thirty years. Many of these cases are children, and the spread of the disease could have been avoided by vaccination. While I appreciate the assistance of CDC Secretary Kennedy spent his career spreading vaccine conspiracy theories and is now undermining public health officials' ability to respond to the outbreak. We need leaders at HHS who understand and affirm the long-standing scientific consensus that vaccines are safe and effective. We also faced a severe outbreak of food-borne illnesses this summer, which sickened more than twelve thousand people. This outbreak was almost certainly made worse by the administration's cuts to the very HHS programs that track food-borne illnesses and parasites. Meanwhile, the administration continues its attacks on public health including by needlessly creating chaos and uncertainty for grant recipients. These recipients are people in our communities who provide care to individuals with addiction, work towards the next big medical advancement, and improve the quality of health care for Americans and much more. At the Agency for Health Care Research and Quality, or AHRQ as it's known, the agency that studies how to make health care safer. One hundred and fifty research projects were abruptly cut off this year, including research on improving children's health. At SAMSA, the administration abruptly and without notice terminated one point nine billion dollars in funding for substance use and mental health programs across this country before reversing that decision under public pressure. At NIH there continues to be significant delays in funding opportunities and grant awards which are disrupting lifesaving biomedical research. The Trump administration is is injecting politics into the NIH grant-making process in unprecedented ways. Decisions about what research is funded are being made by political appointees whose credentials are fealty to the president instead of scientific experts. The NIH has also entered into an inter-agency agreement to transfer potentially billions of dollars that Congress allocated for medical research to the Department of Defense. The Department of Defense received one hundred and fifty billion dollars in the, what the president calls his, big beautiful bill. Others call it different names. Uh, meanwhile, NIH funding has been effectively flat for the last two years. Despite that, the administration is raiding funded funding intended for infectious diseases, cancer, and Alzheimer's disease research, and is instead sending that money to the Department of Defense, while they wage a war that nobody wants. Not only is the administration attacking public health, but they seem dead set on eliminating Head Start, the program that provides affordable child care for hundreds of thousands of families. Since illegally withholding funding from the program last year did not do the trick, the administration has proposed a rule that would eliminate the very standards that Head Start families rely upon. This rule would ultimately s- shut down head-start centers and make it harder for families to find quality care and early learning opportunities. On top of all of these attacks, Americans are still facing a health care affordability crisis, spurred on by the Republican cuts to Medicaid and the Affordable Care Act. Uh, an estimated fifteen million Americans will lose their health insurance coverage, Thanks to Donald Trump's big ugly bill, health insurance premiums have skyrocketed because Republicans refuse to extend the tax credit that helps people afford their health care coverage. The administration has also finalized a rule that will increase costs, decrease quality, and cause two million more Americans to lose coverage next year in the Affordable Care Act marketplace. Americans want real solutions to the health care They wanna know that their children are not gonna fall victim to a preventable disease because secretary Kennedy changed the childhood vaccine schedule or their insurance no longer covers the full cost of vaccination. They wanna know that they can afford comprehensive and accessible health care. They wanna know that their public health leaders have their best interests in mind. not the interests of the insurance industry or pharmaceutical manufacturers. They wanna know that decisions are made based on science, and not subject to political interference. We have had nominee after nominee come before this committee and pledge to stand up for science and follow the law, rather than the whims of Secretary Kennedy. Yet I have seen little evidence that once confirmed, these leaders abide by those commitments and do more than fall in line. Americans want leaders who will stand up for them and for the truth. And that is what I will be looking for from all of you today at this hearing. I look forward to your testimony today and our further discussion. Thank you again.

Thank you, Senator Baldwin, I'll now introduce, uh, Mister Klump and then we'll introduce each as, uh, just before their, their opening statement. We are joined today by Mister Chris Klump, he previously, uh, he currently serves as Chief Counselor at HHS and previously served as Director of the Center for Medicare and Deputy Administrator of CMS. He is the founder of Collective Medical, a health technology company focused on real-time care coordination and data exchange. He previously worked at Bain Capital and Bain and Company, and served as Commissioner on the Utah Digital Health Services Commission. He received his undergraduate degree from Brigham Young University and an MBA from Stanford. I look forward to hearing from you, sir. Thank you for joining.

Chairman Cassidy, uh, uh, Senator Baldwin, distinguished members of the committee, thank you for considering my nomination to serve as Deputy Secretary of the United States Department i am very grateful to president trump for this nomination to secretary kennedy for his trust in me and to my fellow public servants uh across h. h. s. and c. m. s. for their dedicated service most importantly i thank my wife elise and our four young children who are here today for their love and sacrifice uh this journey began in part because we wanted to teach them about the americans who had come before us to answer the call to serve and we're profoundly grateful for the privilege of now doing the same Health care became personal to me long before it became my profession. When I was thirteen, I lost my mother to cancer. Following an experimental treatment for severe rheumatoid arthritis that was triggered by my birth, there had been a medical error that led to a side of the mutation. I was young, grieving, and angry for a time, and I carried a chip on my shoulder about health care. At the same time, my father, a physician, was teaching me something very different. that being a healer is among the highest callings, and that to care for someone in a moment of vulnerability is an extraordinary privilege. Those two experiences lived side by side in me, an understanding of how profoundly our health care system can fail people, and an equally powerful uh, appreciation for the good that dedicated healers can accomplish. Years later, as a missionary in Eastern Europe, I saw a suffering where health care lagged far behind ours. That experience deepened my faith and clarified my purpose, to be my brother's keeper and to draw people closer to God. Together, those experiences made HHS's mission deeply personal to me, preventing harm, alleviating human suffering, and helping healers save lives. I did not become a physician. Instead, I found my calling in growing and building organizations that empower good people to do extraordinary things. Across business and public service, I have been entrusted with increasingly consequential opportunities to earn trust and exercise judgment on behalf of others. Those experiences taught me that leadership is ultimately an exercise in stewardship. The need for that stewardship is urgent. Nearly one in five dollars in our economy goes to health, yet three in four adults live with a chronic condition. Too many Americans are sick. Too many struggle to obtain care. we cannot afford to confuse more health care with better health. Often the best and least expensive care is the care we never need, because we remain healthy. Those realities then define our mission. First, we must make America healthier by preventing chronic disease, restoring trust, and asking and answering difficult questions. Second, we must make health care more affordable, accessible, and effective by rewarding better outcomes and replacing incentives third we must make hhs operate with excellence by giving public servants clear missions modern tools appropriate authority and accountability for results as deputy secretary my responsibility would be to translate mission into execution by ensuring that the policies technology people processes and results and resources align around results leading medicare in helping oversee hhs operations has reinforced that government makes progress when it sets clear objectives, empowers talented people, measures results, and follows the evidence. Operational excellence, then, is how policy becomes service. I approach these challenges with optimism. HHS is full of extraordinary leaders, healers, scientists, innovators, caregivers, and public servants. Our task is to unleash this extraordinary capacity against the greatest healthcare challenges that face our nation. That demands humility. It demands sound judgment. And it demands careful stewardship. Leadership begins with earning trust, listening, confronting difficult facts, respecting differing perspectives, acting with integrity always, and accepting responsibility. Leaders come and go, but institutions do and should endure. The test of stewardship, then, is not what we inherit but what we leave behind. A healthier America is not partisan aspiration. It is a national obligation. We may disagree profoundly about policy, but we should c- share that goal. If confirmed, I will work constructively with this committee, tell you candidly what I believe to be true, respect Congress's authority, and work toward those shared ends. Confirmation by the Senate is itself an extraordinary act of trust. And if fortunate enough to receive that trust, I will work every day to earn it. And I hope our children, and those who come after them, will look back on this chapter and see that we answered the call. Together, all of us, with integrity, competence, and civility, and left them a healthier country. Thank you. I look forward to our conversation today.

Thank you, sir. Uh, next we are joined by Dr. Nicole Sapphire. Uh, she is a board-certified diagnostic radiologist, author, former Fox News medical contributor, and host of the iHeart Radio podcast, Wellness Unmasked. She currently serves as Director of Breast Imaging at Memorial Sloan Kettering, Mon Mon Monmouth?

Monmouth.

Monmouth, Monmouth? I'm sorry. Um, she she is an attending physician at Memorial Sloan Kettering and an Associate Professor of Radiology at Weill Weill Cornell Medical College. I felt a little bit like Kim, thought I was disrespecting, you know, you know, not pronouncing it correctly, but uh Doctor, Doctor Sapphire received her medical degree from Ross University School of Medicine, and completed her residency at Maricopa, Integrated Health Systems, and a fellowship at the Mayo Clinic. Thank you ma'am, for, for being here and please proceed.

Thank you, Chairman Cassidy. Senator Baldwin and other distinguished members of the committee, I am grateful to be sitting before you today. I am thankful to President Trump for trusting me with the opportunity with this nomination and for Secretary Kennedy in supporting that. i'm very happy that i have been surrounded by friends, family and colleagues, and internally grateful for their support during this confirmation process, several of which are with me today. uh It is the honor of my life to be considered for the role of Surgeon General of the United States. But i come before you today as a physician, a long time advocate for prevention, and someone who has spent much of her career communicating with the American public about their health. Patient care prevention and communication, are what I hope to bring to this role if confirmed. For nearly fifteen years, I have worked full-time as a board-certified radiologist with advanced training in oncologic and breast imaging, caring for patients during some of the most vulnerable moments of their lives. Every day I sit face-to-face with patients and families, delivering difficult diagnoses and guiding them through uncertainty. One of the hardest parts of my job, it's not interpreting the images, it's not doing the biopsies, it is sitting across from someone and telling them that they have cancer. No training or textbook fully prepares you for that moment. And over the years, I have told this news to my friends, to my colleagues, and various other members of my community. These interactions have taught me that good medicine isn't only about diagnosing and treating disease. It is about listening to people. It is about earning their trust and giving them information they can actually use. That physician-patient relationship shaped how I think about medicine, and it's what first drew me to patient-centric advocacy. Years ago I put into practice by advocating for breast density notification legislation just that. I had seen what a difference catching disease early can make, and realized the most powerful thing you can do for a patient is arm them with information. And in this case, that dense breast tissue both raises the cancer risk, but also makes cancer harder to find on a mammogram. Now, it was not at the time an uncontroversial position to take, and as a young physician, that was scary for me. I had a lot of people with more experience, who we're pushing back. But that fight, and its eventual adoption as national policy, taught me that our health system advances when we're willing to challenge complacency, and have honest conversations, even uncomfortable ones. Empowering patients with accurate information about their own health is never the wrong decision. My commitment to prevention predates the current national conversation around it, including in my twenty twenty book, Make America Healthy Again. I have long believed that we spend too much time and resources treating chronic disease after it takes hold and not enough time helping Americans reduce their risk before illness begins. And unfortunately, we're seeing the consequences of that imbalance right now. Rising cancer rates in people under fifty, cardiovascular disease, that remains the number one killer, but also is largely preventable in lots of cases. Rising infertility rates and mental health crises, particularly among young people. My approach to health is not complicated. We should treat illness when it occurs, but we also need to do a far better job of helping people stay healthy in the first place. That is the same conviction that animates the President and the Secretary's focus on chronic disease and the Make America Healthy Again agenda. That we cannot build a health system focused only on treating disease, we have to help Americans live healthier lives before disease takes hold. The same skills that matter in an exam room, listening, building trust, explaining risk, and complicated information clearly, become even more important when the audience is the American. public, the entire country. For a decade, I have specialized in translating complex, fast-evolving medical information on various media platforms into content that millions of Americans can understand and use, including during the uncertainty of the global pandemic. I realized then how badly this country needs public health communication that is straightforward and grounded in the best evidence available. Honest about what we know, honest about what we don't know, and humble enough to say when something once considered settled no longer is. During COVID-19, confusion, politicization, and the dismissal of reasonable questions did lasting damage to public trust in our institutions. And regardless of party, that could should concern us all. If confirmed, restoring that trust would be one of my highest priorities. Also during the COVID pandemic, I saw what the men and women of the US Public Health Service Commission corps are capable of. Watching thousands of officers deploy to hospitals, nursing homes, tribal communities, and other underserved regions throughout the country left me profoundly inspired by their professionalism, experience, and sense of duty. If confirmed, I would be honored to serve alongside them. My years as a physician have kept me grounded in the needs of patients and families. My work in prevention has convinced me that we must do more to help Americans live healthier lives. And my years of communicating directly with the public have prepared me to explain complex topics in a way that they can understand. If confirmed as Surgeon General, I would bring those experiences together in the service of the President's mission to make America healthier. Thank you for your time and consideration. I respectfully ask for your support, both in this committee and on the Senate floor, and so that I may have the honor of serving this country. And I look forward to your questions today.

Thank you. Next, we're joined by Doctor Timothy Westlake. Dr. Westlake is a board-certified ER doc with more than twenty-five years of experience practicing community emergency medicine. He currently serves as chief of staff for SAMHSA and has extensive experience addressing the opioid and fentanyl crisis at both the state and federal level. Dr. Westlake helped develop the fentanyl-related substance scheduling framework for Wisconsin, which inspired federal policy permanently enacted through my whole fentanyl act. He also served as the chair of the Wisconsin Medical Examining Board. Dr. Westlake received his undergraduate degree from the University of Wisconsin, his medical degree from the Medical College of Wisconsin, and completed emergency medicine residency at Eastern Virginia Medical School. Sir, thank you for being here and we look forward to your testimony,

Great, thank you.

your statement.

Good morning, Chairman Cassidy. Senator Baldwin, it's good to see you all, uh, distinguished members of the committee. Thank you for the opportunity to appear before you today. Uh, receiving President Trump's nomination to serve as the Assistant Secretary for Mental Health and Substance Use at the Department of Health and Human Services, is the honor of my lifetime. If confirmed to lead the Substance Abuse and Mental Health Service Administration, I'll be humbled by the opportunity to work with this committee to ensure that every American struggling with mental illness or addiction has a path to treatment, lasting recovery, and a meaningful life. Until five months ago, and for more than twenty-seven years, I worked as an emergency physician and EMS medical director in my own community, serving on the front lines, treating people in their most vulnerable moments. and at times bearing witness to incomprehensible suffering. So many of these moments have stayed with me. I remember watching families who've loved ones cycle between addiction, overdoses, mental health emergencies, treatment, jail, and homelessness. The anguish left behind by overdose, suicide, and the devastating collateral damage of untreated substance abuse and mental illness. In fact, my good friend, Lori Bedora, is sitting behind me. Her son, Arjan, is the inspiration of the Halt Fentanyl Act. He was an altar server with my two daughters and struggled with addiction. I resuscitated him on his second overdose, sec- second to last overdose. We showed him a body bag, hoping to warn him of the dangers of the disease. He got into treatment and was clean for six months, until an overdose led his family to seeing him zipped up in a body bag for the last time. i have also had the privilege of serving wisconsin and our country by leading policy reform efforts addressing the prescription opioid and fentanyl crisis that work has given me the distinct honor of collaborating with leaders committed to confronting this devastating public health scourge i want especially thanks senator chairman cassidy for his leadership on the halt fentanyl act and senator baldwin from my home state of wisconsin for her work and leadership on title nine of the comprehensive addiction recovery act in twenty sixteen along with other acts that she's uh taken part in. Both are important pieces of legislative efforts in the fight against opioid abuse, and I'm grateful to have had the opportunity to contribute to them. My commitment to this work is not only professional, it's personal. I've been in recovery myself for twenty-nine years. This lived experience has shaped the physician, policymaker, husband, father, and person that I am today. It has taught me that behavioral health cannot be reduced to science or policy alone. Science matters. Evidence matters. But so do compassion, faith, family, human connection, and the belief that people can heal. Like so many others working in this space, this work is a calling for me. I thank God every day for my family, and that I'm, sorry, living a life of purpose. Far too many Americans across the country share these mental health and addiction challenges. They are struck trying to navigate broken systems. And they are not receiving the care needed to get well and build a life in recovery. These people deserve a champion in their corner who believes in the human spirit and the ability to heal. Who understands the importance of faith and connection in being in building a meaningful life. And who will lead with the experience that recovery is not an abstract policy objective. And I believe that person is me. If confirmed, I will work with states, tribes, and territories to build a system that works. Where people are supported the moment they seek help, when that window of opportunity is open. No gaps in care, no stalling out and starting over, no one left to navigate the complex systems alone. We go back to the fundamentals of good medicine, combining science and compassion, and connecting Americans to healthcare that works. We should leave no stone unturned in pursuing effective treatment, the right care for the right person, at the right time, for the right amount of time. A vision moving from chemical coping to human connection, and from a pill culture to a purpose culture. We do this by recognizing the powerful roles that family, faith, purpose, and community play in recovery. I wanna build a culture where recovery is not merely possible, but expected and celebrated. Where the chronic disease of mental illness and addiction will be understood and treated with the same diligence as any other deadly chronic disease. Where the principles of recovery and connection, grow to extend beyond the healthcare system and into our workplaces and communities. I believe it's SAMHSA's responsibility to listen to the people giving the care at the bedside, to listen to the states, the communities, the health systems, the tribal nations, and to help make available resources, evidence, tools, and support needed to achieve these goals. This is not a one-size-fits-all approach to government and medical care. There's not one system that will work for every community. But there are standards that we can highlight and best practice models that we can elevate and barriers that we can break down. We must continually evaluate and reevaluate whether our programs are working and reaching the people who need them. And measure the outcomes that really matter, true healing and recovery from disease. Our success cannot continue to be defined simply by dollars spent and programs administered. It must ultimately be reflected in whether more Americans are able to heal, recover, rebuild their lives, restore their families, strengthen their communities, and rediscover purpose and meaning. If confirmed, I will partner with this committee to bring hope and healing to the American people. I firmly believe that my life's work, my faith in God, and my family have brought me here before you today. I would be deeply honored and humbled to receive your support and lead this agency, and I look forward to answering your questions.

Thank you, Doctor Westlake. Um, I really enjoyed all of your opening statements. Uh, Doctor Westlake, you spoke repeatedly of purpose. And I thank you for having the purpose to serve our fellow American. doctor sapphire i noted i outlined in your i underlined in your thing uh noted a very difficult time thing can be to speak to patients i'm a physician and at least three of us here or four of us uh with doctor marshall we've had that experience of speaking parents want clarity on immunizations you would be the nation's doctor charged with messaging what would be your message to a parent regarding vaccines? And I only have a few minutes, so be tight.

Chairman Cassidy, I appreciate the question, and I thank you for your time on the phone and also meeting with me in person, and I understand how important that this topic is for you and also the American public. Um, like you as a physician, I see every day. I talk to patients, when I tell them they have cancer, there are some patients in that moment, they are ready to start treatment. Anything I recommend, they are ready to do. And then I also have patients who, they can't even comprehend that I have told them they have cancer yet, and they need more time and they need more conversation. Both of these patients deserve my compassion, and I will adapt and meet them in the moment that they need.

So if she asked you, the mom asked you specifically, and obviously this is topical, "Does the MMR vaccine cause autism?", what do you say?

Well humbly I don't know what causes autism, but I have not seen reputable evidence that would suggest that vaccines cause autism.

Can you tell the parent, I assume you've reviewed the literature,

Certainly.

that there is no credible evidence that vaccines cause autism?

Certainly, I have not seen any evidence presented to me that is reputable or respectable.

There's a little bit of a wiggle room there,

Oh, I'm sorry.

and I'm so sensitive to this,

OK.

because I've had wiggle room from people sitting there, as Senator Baldwin said, who later used that wiggle room to do things which are quite contrary.

OK.

Do you, I assume you've reviewed the literature. Would you feel comfortable communicating with clarity? Because when you spoke about the COVID vaccine and the need for clarity, not not oh well, well, well, but no, clarity. Are you up to saying to the American people, well, let me ask you, is the MMR vaccine extremely lethal, as the president said?

Chairman Cassidy, I cannot speak to what the president has said,

If you cannot say.

but I as as a physician, I can tell you that I do not believe the MMR vaccine to be lethal. I believe the MMR vaccine is our greatest tool for combating measles and AIDS.

That's great. That's great music. And does it cause autism?

I do not believe childhood vaccines cause autism.

And should a parent be vaccinating her child for with the MMR?

I think that the recommendation is to combat what we are seeing right now, the best tool we have to combat these infections, to save the most lives, and to also create population herd immunity, is vaccination against the MMR. I appreciate that the president is trying to reach the vaccine hesitant people who are wanting more answers or who are concerned that there are too many

Let me stop you for a second.

doses.

I'm not sure that you reach people who are vaccine hesitancy by feeding into untruths. The way to dispel confusion is not to sow more confusion. The way is to say, no, it does not cause autism. And frankly, even, well, I've never seen any evidence for it, suggest that there might be evidence out there, but you just are not briefed on it. That's a little bit of an equivocation.

I I understand what you're saying. I do not believe that there is reputable evidence that shows this causation of childhood vaccines and autism. What I can say is that I believe vaccines save lives and they are one of the strongest tools in our arsenal. when it comes to public health.

So going back to

And as a communicator, and I believe that that is one of the things that I bring to this administration, is my experience communicating with patients, but also the American public, is working with the administration.

Let me, yeah, I'm almost out of time. So you've mentioned again, very effectively about the need to prevent chronic disease. But if a child is infected with Hepatitis B at the child's birth or right after, they have a ninety-five percent chance of becoming a chronic

Chairman Cassidy, Chairman Cassidy, you're speaking to someone who tells people they have cancer every day, you're speaking to someone who tells people they have cancer every day and the Hepatitis B vaccines, and the Hepatitis B vaccines are one of the most tangible ways we have to prevent one of the most tangible ways we have to prevent cancer. And that is something that I absolutely am always excited about, because it is so hard to prevent cancer in so many patients. I support universal hepatitis B vaccination. And looking at areas in the country, it has been widely effective, specifically in Western Alaska. Senator Murkowski knows the most about this, that they led the world in pediatric liver cancer cases.

But it is. So should we have, should we re should we do away with the recommend recommendation of a birth dose of hepatitis?

In the United States, the most tried and true way to prevent hepatitis B infection and effectively lower hepatitis B associated illness is universal birth dosing and that is what is worked here in the United States.

OK, and it is effective, so therefore should it be recommended?

I do believe that that is what is tried and true. I understand it can be a nuanced conversation and some parents have concerns that they can have with their pediatrician but in the United States,

It's not a mandate, they can walk out with it.

we have the most evidence showing universal birth dose vaccination to be safe and effective.

But that stops short of saying that it should be recommended.

Well, based on, just based on our data that that uh the overwhelming recommendation should be, this is what we have shown is tried and true. I'm open to future discussions about it, but at this point the data that we have is based on the universal birth dose. And being someone in academic medicine, I believe in evidence-based medicine. And that's all I have right now, is that the universal birth dose has been the most effective policy here in the United States for reducing infection.

Doctor um Doctor Senator Baldwin.

Thank you, Mister Chairman. Um, Mister Klump and Doctor Westlake, I uh met with each of you uh on July twenty-third and August third respectively. Um, one of the issues that I discussed in each of those meetings was um the uh pride that I have in uh authorship uh of the bipartisan nine eight eight bill that uh allows um uh people in mental health crisis or uh who are uh considering suicide to uh get the help they need. And when we set that up, stood that service up, um we realized there were certain populations that were more vulnerable to uh suicide. Uh veterans have a press one option to get uh care and uh specialized uh response from people who say have walked in their boots before and understand maybe the trauma that they have been exposed to we also had a press three option for lgbtq youth that experience um higher rates of suicide that was abruptly cut off more than thirteen months ago by this administration And the reaction of this committee and the appropriations committee that I also sit on was to write into law that they, we must restore those services. As of today, those services have not been restored. There are two weeks left in this fiscal year. Yet in our appropriation bill, we directed the department to restore these services. I don't wanna see any more LGBTQ youth in body bags either. Nothing has happened since our conversations, respectively on July twenty third and August third, to restore the press three option. So I would like to hear from each of you who are currently in positions to make things happen, why they haven't, and what you will do to immediately comply with federal law and restore these services. Mister Klum? first you and then mister west doctor wesley

thank you senator baldwin thank thank you senator baldwin um i appreciated the candor i wasn't aware of that issue before we met uh uh with respect much has happened since that conversation and i believe our office has updated yours as well at least so i'm told um uh you're right the uh contract uh uh uh was not active uh it was recompeted mmm mmm uh my understanding and i'll defer to my colleague uh because it's his agency and he'll be able to speak with more clarity Uh, but a contract has been awarded, I am told it will be affected before the end of the fiscal year, with the press three functionality specifically. I was very grateful that you brought it to my attention. We immediately dug into that issue.

Well, doesn't mean that people can press three right now.

I understand.

And we have two weeks left in this fiscal year. Doctor Westlake.

First of all, Senator Baldwin, I wanted to thank you for all your efforts on behalf of nine eight eight. I think nine eight eight has been shown with over thirty million calls to be a a supremely effective way of treating suicide suicide to me i've seen what happens when people try to kill themselves and kill themselves and adolescents do that and so um what um i was not at the agency when that when that happened i came on board five months ago um i think a lot of what you're seeing is is the uh bureaucratic silos and the way that the grants workout and the and the bids get re-competed to the network and the subnetwork the one of the reasons i wanted to come into government was to help make things more efficient

how would you cut through that

i i don't know i would have to look i don't know what i'm trying to learn what the systems are that are impeding the progress of of of uh action to happen throughout the entire government and so but i but i i can assure you that that the call volume did not drop when that when that press threw in a way that the people that are doing that that are on the operators on board are are culturally competent and that you know the the service will be restored based on the appropriations levels

on that topic of cultural competence can you both uh uh mister klump and and doctor wesley commit to ensuring that nine eight eight counselors serving these youth will not be subject to gag orders, uh or uh limitations in the language they can use based on any executive orders that have been signed by this president.

Senator Baldwin, I'm underwear of of any such uh request of our our team members. They should be free to engage those who are struggling in crisis in any way they can to reach those individuals. Suicidal ideation is a critical issue in our country. Our responsibility as caregivers, our responsibility, the department, is to wrap our arms around those individuals, to meet them where they are, to shower them with love, to support them, and to help them restore to a place of health and happiness and joy.

That restore these services. Uh, I have further uh questions, but my time has expired, so I will hope either for a second round or questions for the record.

Dr. Marshall.

Yeah. Well, thank you, Chairman. I'll start with Mr. Klump. There was a rumor that when you arrived, they were still using punch cards in the technology department. Uh, Cold Ball, Fortran, whatever it was called, where were we, where are we now, and where will we, what what do you need to take us to the next level?

So you're not far off. Uh, as a, a healthcare technologist, uh, uh, the state of technology in the Department of Health and Human Services, uh, maybe made a little part of my soul die each day. Uh, but we're getting our arms around it, is the good news. Um, I'll give you some examples, maybe just one, for the sake of time. Uh, while running, uh, the Center for Medicare, uh, we have two programs, Medicare Advantage and Original Medicare. We're responsible for paying claims in Original Medicare.

Yep.

We pay a billion and a half dollars a day of claims. And we do that on a system that runs on those old green screen terminals, written in cobalt, that's a little over fifty years old.

Yeah.

And I showed up and said at the end of the first month, " Hey, I'd like to see uh the financials uh and and you know kinda show me how we did and where we're spending money and i'd like to see some metrics, ED visits per thousand, inpatient visits per thousand, you know basic things you might wanna see if you run the largest health plan on the planet and uh and and we weren't able to produce those metrics uh the closest we got was well some of that will be available uh next year uh for the medical or Medicare trustees board meeting that's unacceptable uh it prevents us from making faster, more nimble policy decisions it prevents us from attacking fraud, waste and abuse to maximize every dollar that should go to our beneficiaries. And so we have brought in extraordinary talent, some of which is in this room. Uh, uh, with your support, including, um, in the requested budget from the president, that's been approved, we're able to fund these extraordinary transformative technology projects, so that we don't just shovel more money out the door, assuming healthcare will get better, but we spend wisely the money that you appropriate to us, and we get more value for each dollar spent.