House Committee Hearing Transcript on Coronavirus: Feb 26 Hearing

Dr. Burgess: (00:00) Vigilance and rapid response efforts. Mr. Secretary, let me just say I was so heartened, I think it was four Fridays ago when you came on the air and said there was a limit to people being able to come into this country from China. And I thought that was important that the administration say that and I believe that is one of the central things. My thesis is that is one of the central things and has provided us at least a little breathing room as this virus erupts around the world. We're fortunately not as affected as some other countries. Now it's incumbent upon us to make sure we utilize that time wisely. Certainly The Pandemic Call Hazards Preparedness Act, which was a worked on by this subcommittee in the last Congress and finally passed at the beginning of this Congress. Important piece of legislation. I would have liked for us to have done real time hearings updating. Dr. Burgess: (00:50) Are we doing what was intended with that bill? Is the stockpile responding appropriately to the authorizations that we made? And this is the type of information rather than the political rhetoric back and forth that we've heard. This is the type of information I think would be helpful and indeed reassuring to the American people. Dr. Burgess: (01:10) You can't ignore the fact that what's happened to the markets. Today we're grateful that they've seemed to have rebounded a little bit. But look, we all know China has not been forthcoming with information and it is that uncertainty that I believe is driving one of the negative forces driving the market. Mr. Secretary I appreciate you being here today. We'll have multiple questions for you. I certainly look forward to your testimony. Thank you. I yield back. Anna Eshoo: (01:34) The gentleman yields back. I want the ranking member to know the following. On January 30th I requested that the following week that we have a hearing on the coronavirus with the heads of the agencies. The secretary leaned in and said, "I head up the effort and I want to be there with that team." And here we are today. So this is not something Dr.Burgess that we have just casually overlooked or ignored. That is far from the fact. I now would like to recognize the Chairman of the full committee, Mr.Pallone for his five minutes. Mr. Pallone: (02:17) Thank you, Chairwoman Eshoo. Today's hearing serves two critical purposes. First, we will examine the Trump administration's proposed budget for the Department of Health and Human Services for fiscal year 2021. And second we'll get a crucial update on the administration's ongoing response to the coronavirus. I am disappointed, though not surprised, that the Trump administration budget proposal completely contradicts the healthcare promises that the president repeatedly makes to the American people. When it comes to ensuring the American people have access to affordable and quality healthcare, the Trump administration has failed them and this budget proposal continues that record. Two years after showering the wealthy and large corporations with major tax breaks, the president's 2021 budget proposal slashes $100 billion from the Affordable Care Act, 500 billion from Medicare and more than 900 billion from Medicaid over the course of 10 years. And the president also wants to make it easier for States to take away people's coverage, undermine their care, and cut critical benefits. Mr. Pallone: (03:21) And this puts the health and wellbeing of tens of millions of children, parents, pregnant women, and people with disabilities at risk. Medicaid is a lifeline for millions of working class families and it's unconscionable that the president wants to cut it to pay for tax cuts for millionaires. Mr. Pallone: (03:37) Now, these budget cuts also fly in the face of President Trump's own words. He promised that as president, he would not cut Medicare or Medicaid. And he promised in The State of the Union address earlier this year that he would continue to protect the more than 130 million Americans with preexisting conditions. But as Secretary Azar knows, this administration is now suing in the federal courts to strike down the ACA and all of its consumer protections. Mr. Pallone: (04:03) Overall, President Trump is proposing a 12% cut to the HHS's budget, one of the largest cuts to any federal agency. The devastating cuts don't end at Medicare, Medicaid, and the ACA. The president's proposal cuts the National Institutes of Health by 3 billion and the Centers for Disease Control and Prevention by 675 million. And keep in mind that this is the very agency that is now responding to the coronavirus. Mr. Pallone: (04:29) And I'm also concerned by the proposal to move tobacco regulation out of the FDA's authority altogether. Instead, the administration would create a new untested agency to oversee tobacco products while we're in the midst of a youth tobacco epidemic. After years of regulatory uncertainty, the Tobacco Control Act clearly and unambiguously ensured that FDA would regulate tobacco products for the protection of public health. But over the last decade, the agency has worked to develop the expertise workforce and scientific basis to effectively regulate these products. So I'm concerned that this proposal would only serve to further politicize tobacco regulation by stripping away FDA sound, scientific and evidence based approach and replacing it at the whims of political appointees. And it's nothing more than a gift, frankly, to big tobacco companies. Mr. Pallone: (05:19) Now let me just move to the second topic at hand. After we discussed the budget, we'll ask questions of the secretary and other top public health officials on the administration's efforts to address the coronavirus outbreak. It is critical that we get an update on the scale of the outbreak, it's repercussions in the US and how we can work together to ensure the safety of all Americans. I think we have one of the strongest public health infrastructures in the world and it's more than capable of coming to an effective solution. And we should be supporting that system with all available resources. So again, Madam Chair, I thank you and I think, well I actually have time left if anybody wants it. Everybody gets time? Or should? Does anybody want my time? I guess not. All right, thanks a lot. I yield back. Anna Eshoo: (06:07) Gentleman yields back. Pleasure to recognize the ranking member of the full committee, Mr. Walden for his five minutes for his opening statement. Mr. Walden: (06:14) Thank you Madame Chair. Good afternoon. And Mr. Secretary, thank you for being here today. It's not the first time we've seen you, although here I think this year probably. But certainly we appreciate the work you and your team have done dealing with the coronavirus. I think I've been in every one of the round tables and hearings that you and your team have provided for this committee and other committees. Mr. Walden: (06:36) Chairman Pallone and I were the co-moderators of the first one in the Visitor's Center where every member of Congress was invited. And I was at the last one and I was at the Situation Room at the White House before the break. I think you all have been very forthcoming with the facts and for whatever reason we haven't had a hearing here, maybe you wanted to wait until this one. But I think it is important that we hear from you and the team that you're leading. And I think it's important to recognize the work that Mrs. Brooks did on reauthorizing, The Pandemic Call Hazards Preparedness Act in the last Congress. We had big fights about that but thank goodness it's in place because it's designed to do exactly what we're encountering today. Have a lead person in the administration that is you, that is designated by the president and a team ready to go. Mr. Walden: (07:32) And so I guess I've been to enough of those briefings that I saw a members yawning at some point in those "closed door briefings" because we're hearing it for the third time now. Now we're gone a week and a lot's changed. And we know what's happening in China is probably worse than we're being told. And I think the big issues there are supply chain as well as public health. Mr. Walden: (07:55) We know it is spreading around the world and we're trying to cope. And we know and you've warned us and Dr. Foushee has warned us and others this could well mutate. But that doesn't mean in the world it can well expand. We should be ready for that. But as Mr. Pallone said, we have a terrific public health system here in the United States. A lot of that is driven at the local level and it's important that we have those communication links in place so that when we identify something, somebody coming in through an airport, the local health officials know about it at home and we're able to deal with it. And I think it is good to get this out in the public. I would just point out that we will hear from you and the CDC, FDA and [Asper 00:08:45] and NIAID to give us an update on the Sidecar Hearing. Mr. Walden: (08:52) We have had now 80,000 confirmed cases worldwide? 2,700 deaths, the outbreaks become a significant global health concern. Yesterday Italy announced 300 individuals had been affected by the coronavirus, 11 had died. There's still much we do not know about the outbreak and so we'll learn more I guess after this budget hearing. But it is essential that we do everything we can and provide you the assistance. And I know in the meetings I've been in with everybody else on this committee that that was there to attend you've made it clear. If you need more money, you'll ask us and we've made it clear. If you need more money, tell us and we'll work with you. Now we will want to get the specifics obviously, but I know you've set up a supplemental request for I think a total of about two, a little over $2 billion, two and a half. Some of that's reprogramming, some of it's additional money. And no sooner had that left your office then some politicians were on the air criticizing you for not asking for enough. And so we'll be interested to get your response to that. Mr. Walden: (09:55) I do think it's also essential to look at perspectives in terms of what Americans are facing today with the traditional flu. And that we've probably lost, 10,000 or more Americans have died from the annual flu. And we have vaccines for that, treatments for that and so we have to think about that as well and practice good public health. I was in Japan with a couple other my colleagues on the committee and you can't go anywhere in Japan without the hand sanitizer being squirted in your hands. And it was a good lesson I think for all of us, but we had to be doing a little bit more of that here and we'd probably help with the traditional seasonal flu and spread of other diseases. And so there's a lot we can learn from you. There's a lot we can learn from your team and we'll look forward to hearing from you directly on that, on the record here in the public. So that Madame Chair I yield back. Anna Eshoo: (10:52) The gentleman yields back. I now would like to introduce our witness for today's first panel. One person, one person alone, the nation's Secretary of Health and Human services. Welcome to Secretary Azar. You certainly are familiar with the lighting system around here. So you are now recognized for five minutes for your statement to the committee. Thank you for being here. Secretary Azar: (11:22) Thank you very much. Chairwoman Eshoo, Chairman Pallone, ranking members Walden and Burgess. Thank you for inviting me to discuss the president's budget for fiscal year 2021. I'm honored to appear before the committee for budget testimony is the HHS secretary for the second time. Especially after the remarkable year of results that the HHS team has produced. With support from this committee, this past year we saw the number of drug overdose deaths decline for the first time in decades. Another record year of generic drug approvals from FDA. And historic drops in Medicare Advantage, Medicare part D and Affordable Care Act exchange premiums. Secretary Azar: (11:59) The president's budget aims to move toward a future where HHS's programs work better for the people we serve. Where our human services programs put people at the center and where America's healthcare system is affordable, personalized, puts patients in control and treats them like a human being and not like a number. Secretary Azar: (12:18) HHS has the largest discretionary budget of any non-defense department. Which means that difficult decisions must be made to put discretionary spending on a sustainable path. The president's budget proposes to protect what works in our healthcare system and make it better. I mentioned two ways that we do that. Secretary Azar: (12:37) First, facilitating patient centered markets and second tackling key impactable health challenges. The budget's healthcare reforms aimed to put the patient at the center. It would, for instance, eliminate cost sharing for colonoscopies, a lifesaving preventive service. We would reduce patient's costs and promote competition by paying the same for certain services regardless of setting. The budget endorses bipartisan, bicameral drug pricing legislation. And I want to thank this committee for your bipartisan work to pass legislation such as the Creates Act to cut patient costs and save taxpayer dollars through lower drug prices. The budget's reforms will improve Medicare and extend the life of the Hospital Insurance Fund for at least 25 years. Secretary Azar: (13:23) We propose investing $116 million in HHS's is initiatives to reduce maternal mortality and morbidity. And we proposed reforms to tackle America's rural healthcare crisis, including tele-health expansions, and new flexibility for rural hospitals. The budget increases investments to combat the opioid epidemic including SAMHSA's state opioid response program. This successful grant program grew out of this committee's creation of the state targeted response grants in the Cures Act. And we were pleased to work with Congress to provide flexibility on the SOR grants for states to address stimulants like methamphetamines. Secretary Azar: (14:02) We request $716 million for the president's initiative to end the HIV epidemic in America by using effective evidence-based tools. Thanks to support from Congress, we've already begun implementation of the initiative. The budget reflects how seriously we take the threat of other infectious diseases such as the novel coronavirus by prioritizing the funding for CDCs infectious disease programs and maintaining investments in hospital preparedness. As of this morning we still had only 14 cases of the novel coronavirus detected in the United States involving travel to or close contacts with travelers. Coming into this hearing, I was informed that we have a 15th confirmed case the epidemiology of which we are still discerning. Three cases also exist among Americans repatriated from Wuhan. And 42 cases exist among American passengers repatriated from the Diamond Princess Cruise ship in Japan. Secretary Azar: (15:04) While the immediate risk to the American public remains low there is now community transmission in a number of countries including outside of Asia, which is deeply concerning. We're working closely with state, local and private sector partners to prepare for mitigating the virus's potential spread in the United States as we expect to see more cases here. On Monday, OMB be sent a request to make at least two point $5 billion in funding available for preparedness and response including for therapeutics, vaccines, personal protective equipment, state and local public health department support and surveillance. I look forward to working closely with Congress on that proposal. Secretary Azar: (15:44) This year's budget aims to protect and enhance American's wellbeing and deliver Americans a more affordable, personalized healthcare system that works better rather than just spends more. I look forward to working with this committee to make that common sense goal a reality. Thank you very much. Anna Eshoo: (16:01) Thank you Mr. Secretary and we'll now move to member questions. And I will recognize myself for four minutes, which will be of the limit for questions to the secretary. Mr. Secretary we know that on February 24th the acting director of OMB, what was requested the appropriation of $1.25 billion for emergency funding for the virus. Is that what you requested of OMB? Secretary Azar: (16:40) So the actual total supplemental authorization would be 2.5 billion. We proposed- Anna Eshoo: (16:45) I know but the new- Secretary Azar: (16:46) ... that to be covered. Anna Eshoo: (16:47) ... funding is 1.25. Secretary Azar: (16:48) I do want to emphasize as I've told the appropriators, that was meant as a suggestion of a way to fund half of it. But if Congress decides there are other approaches, we're not wed to that. Anna Eshoo: (16:58) And what exactly does that cover? And is it anticipatory? Now yesterday the CDC said essentially we need to be prepared for a much larger spread of this virus in the United States. So is what has been requested in emergency funding to cover a broader plan? Or is it on the figures that you just gave us? Secretary Azar: (17:33) So it is to cover expenses that we believe are appropriate for 2020. So this would go through the end of 2020's fiscal year. And then we would work with appropriators on any adjustments to 2021 appropriations in the weeks and months ahead as we continue to learn on a daily about the spread of the disease. Core investments, first surveillance, expanding our surveillance system for novel- Anna Eshoo: (17:55) I have some other questions. Secretary Azar: (17:56) Oh sure. But I'm happy to walk you through [crosstalk 00:17:58] the- Anna Eshoo: (17:57) Right and I read the entirety of your printed statement. I want to turn to the status of drug pricing policy proposals. If you could just say yes or no, it would be great. Have you finalized a policy ending drug rebates to middlemen in Medicare? Secretary Azar: (18:16) We did not move final with that role. Anna Eshoo: (18:19) Okay. Have you finalized a policy tying drug prices to the lower costs as a reference pricing? Secretary Azar: (18:26) We had an advanced notice of proposed rule making, so that was not an actual formal proposal yet. Anna Eshoo: (18:31) Have you finalized a proposal to make drug manufacturers put list prices in television advertising? Secretary Azar: (18:37) We did and much to their shame, the pharma industry sued and Congress has not passed explicit authorization for that list price requirement in the statute that I wish they would do. Anna Eshoo: (18:46) Are you planning to finalize or pursue any of these policies in the near future? Secretary Azar: (18:50) We plan to finalize as soon as we can. The importation program implementing section 804 of the Food, Drug and Cosmetic Act to allow low cost importation from Canada. Anna Eshoo: (19:00) You know that the house past HR3. You also know that the president said that we're going to negotiate, negotiate, negotiate, so hard. Something like that. "We're going to negotiate like crazy." Do you support direct negotiations? Secretary Azar: (19:19) We do not support HR3 because we don't believe the negotiation framework in there is either a negotiation or actually practical and implementable. And it also just has no chance of passing in the Senate. The bipartisan package of Grassley Wyden is struggling even to get to the floor there. Anna Eshoo: (19:34) Well HR3 caps out of pocket, as you know, prescription costs for seniors. Do you support the capping out of pocket costs for them? Secretary Azar: (19:44) We have an important opportunity here. Bi-partisan- Anna Eshoo: (19:47) Yes or no? Secretary Azar: (19:47) ... to cap- Anna Eshoo: (19:47) Yes or no? Secretary Azar: (19:47) ... out of pocket spending and reduce what seniors- Anna Eshoo: (19:49) Yes or no? Secretary Azar: (19:49) ... are paying part D. So yes we do. Anna Eshoo: (19:52) Okay, good. Well, I think that I've asked all, let me just. Well HR3 also limits drug price hikes to inflation. Do you support the inflation caps? Secretary Azar: (20:08) So that is part of the Grassley Wyden package also in the Senate and we- Anna Eshoo: (20:12) Do you support it? Secretary Azar: (20:12) ... we've made clear that that's a package we can support. It's not the only bipartisan package, but the price inflation penalties in part D and B are acceptable to us as a means of getting list prices under control. Anna Eshoo: (20:26) Thank you, my time is expired. I now would like to recognize a ranking member of the subcommittee for his four minutes of questions. Dr. Burgess: (20:36) Thank you. Secretary, in December of 2018 the president signed two important bills into law that addressed maternal health and maternal mortality. The first bill representative Jaime Herrera Beutler's Preventing Maternal Deaths Act established grant program for states to establish or expand maternal mortality review committees. Dr. Burgess: (20:57) The other bill Improving Access to Maternity Care Act required health resources at H HRSA to identify maternity care, health professional target areas. So how have you used these bills? How is your agency building on the success of those two laws to ensure access to quality maternity care and prevent more maternal mortality? Secretary Azar: (21:19) First, could I thank you for your leadership on immunosuppressive drugs? I hope you saw that we put in the budget what you've long advocated for in terms of that coverage. Dr. Burgess: (21:27) Yes you may say thank you. You're welcome. Secretary Azar: (21:30) On maternal mortality also the work of Congress really focusing on this critical issue. Too many women are dying other in childbirth, or postpartum. And so we have made this a serious part of the president's agenda with $116 million initiative with the $74 million increase that focused on improving prevention, quality improvement, postpartum health and improving the data collection on that. So a four part strategy that we look forward to working with Congress on coming out of the budget. Dr. Burgess: (22:01) Well I thank you for that. Republicans of this subcommittee in 2017 sent your predecessor, Secretary Price a letter asking for HHS to update and release The Pandemic Influenza Plan, and previously had not been updated since 2005. Can you describe how you are using The Pandemic Influenza Plan as a guide in preparing for your response to this current outbreak of coronavirus? Secretary Azar: (22:30) So as you know, I was one of the architects of the original pandemic plans back in the Bush administration. That work is foundational, that's what has set up our entire state, local and federal preparedness program for any type of viral outbreak like this. And so it's really it is the blueprint for how we are operating today, including my role leading through the emergency support function eight under the national response plan. Which is the doctrine that we've had in place now for 15 years. Dr. Burgess: (23:00) Let me just say, this committee did do work on HR3 last October. There was concern from many of us that the negative effects on innovation and development would really be profound. And now we find ourselves confronted with this coronavirus outbreak where we know we need new antivirals we know we need new vaccines, we know we need new monoclonal antibodies to help people who become ill. Can you just speak to the fact of is innovation still important? Because we heard several times in the subcommittee and in the full committee that maybe innovation wasn't so important as getting cheaper drugs into people's hands. Secretary Azar: (23:41) Innovation is vitally important and that's why two of the key legs of the supplemental request are to develop vaccines and therapeutics for this novel virus. One of the challenges with HR3 is the sheer amount of money it would pull out of the system. And I'm not a believer that if you pull any money out of the drug industry, it's catastrophic or impossible. But the sheer amount would materially impact the bringing forward of drug therapies for Alzheimer's, for arthritis. Just go through the list of therapies that you need to incent or you won't get them. Dr. Burgess: (24:12) Yeah. And you know, interestingly enough, the Alzheimer's drugs that was withdrawn a year ago I'm reading is now getting a new look at different dosing schedules. And again, work like that, that's not going to happen if we don't value innovation. Secretary I thank for being here and certainly look forward to the second part of this hearing. I yield back. Anna Eshoo: (24:35) Barda biodefense budget has also been cut. Glad to recognize the chairman of the full committee for his four minutes of questions. Mr. Pallone: (24:45) Thank you Chairwoman Shoo. Mr. Secretary, I thank you for appearing before our subcommittee today. But I continue to be upset by the Trump Administration's decision to ask the court to strike down the ACA in the Republican lawsuit that is seeking to declare the entire law invalid. Mr. Pallone: (25:05) If the district court ruling is upheld and the Trump administration will be responsible for the largest coverage loss in US history. Over 20 million Americans would lose their coverage, raising consumer costs and making life saving healthcare unaffordable for American families. And it would eliminate protection for preexisting conditions, adversely impact the Medicare program and end Medicaid expansion. Mr. Pallone: (25:28) So I've sent you three letters now, including one in April of last year requesting any analysis, study, assessment, reports regarding the potential impact if the entire ACA is found to be unconstitutional. And for almost two years now, I have repeatedly asked for any documents relating to any contingency plans in place in the event the ACA is found unconstitutional. Only last week I received a one and one and a half page response that answers none of my questions, frankly. And the documents produced so far to the committee answer none of these questions. Mr. Pallone: (26:02) So I'd like to submit to Madame Chair my letters and the department's response in the record. I'd ask, unanimous consent. Speaker 1: (26:11) So order. Mr. Pallone: (26:12) So really, I've got two and a half minutes here, Mr. Secretary. I think the American people have the right to know what the administration's contingency plans are given the president asking that this entire law be declared invalid. Maybe you just have to answer yes or no. We'll see. I only got two minutes. Secretary has the department conducted an analysis to evaluate the impact on individuals with preexisting conditions and their access to affordable health insurance if the ACA is found unconstitutional? Yes or no. Secretary Azar: (26:43) Of course it's not going to be left just like that. We would replace with something that would actually deal with preexisting conditions. And what- Mr. Pallone: (26:51) [crosstalk 00:26:51] And have you done any kind of contingency plans that what would happen if the court struck down the ACA? Yes or no? Secretary Azar: (26:58) We're always considering different options, but it will depend on the nature of any ultimate court decision, if it even agrees with strike. Secretary Azar: (27:03) But it will depend on the nature of any ultimate court decision if it even agrees with striking down all or part of the ACA. Mr. Pallone: (27:04) All right. It doesn't sound like there is such a thing. Has the department conducted an analysis to evaluate the impact on premiums and access to coverage in the individual market, particularly for individuals with preexisting conditions if the ACA is found unconstitutional, yes or no? Secretary Azar: (27:22) Well, it depends on what would be struck down, whether all of it's struck down, part of it, or none of it. We are years, possibly, away from a final court decision [crosstalk 00:27:29]. Mr. Pallone: (27:29) All right. Well, let me issue this. Are there any contingency plans to ensure that the 20 million people who are covered under the ACA do not lose coverage? Anything at all? Any contingency plan? Secretary Azar: (27:39) Well, we have been emphatic that we are changing nothing about how we administer this program during the pendency of the litigation. And at the time that there... If there is a final court decision striking down all or part of it, it will depend on the context of that decision and the politics, frankly, of who is in Congress and what we can work with to ensure that [crosstalk 00:27:57] conditions. Mr. Pallone: (27:57) I'm trying to... It sounds like the answer is no, that you don't have anything yet. I would just like a commitment from you, basically, to respond to my request to provide any documents to the committee that relate to contingency plans in the event that the ACA is struck town. Can you give me that commitment? Secretary Azar: (28:17) I'm sure you will understand that deliberative process regarding potential legislative proposals are some of the core of the internal executive department's functions. Mr. Pallone: (28:25) So it sounds like the answer is no. Well, I just think that it's unfortunate, because our oversight responsibility is to make sure that in the event we have this terrible situation, that there is some kind of contingency plan, and I don't think you have it. So I don't believe the administration has any kind of comprehensive plan to address the fallout that will occur if this Republican suit is successful in court. Thank you, Madam Chair. Anna Eshoo: (28:58) The gentleman yields back. The chair recognizes the ranking member of the full committee, Mr. Walden, for his four minutes. Mr. Walden: (29:07) Thank you Madam Chair, Mr. Secretary. Again, thanks for being here. I want to make a couple of points. One is on the opening day of of this Congress, I led the effort on the House floor now in the minority trying to move an effort to protect people with preexisting conditions pending this lawsuit's decision. Congress could act. This House could move legislation to put into law certainty to protect people with preexisting conditions, in addition to the laws that are already on the books dealing with preexisting conditions, but my colleagues have chosen not to do that. So they could, and we would probably find common ground here on a preexisting severability language. There's a lot that could be done here. Second, it was the congressional budget office, independent, nonpartisan, that said, I believe, eight to 15 new medicines would never be invented because of HR 3, Speaker Pelosi's partisan drug pricing bill. As you said, that could be a cure for Alzheimer's. It could be a cure for the coronavirus. We don't know. Mr. Walden: (30:15) And that's just the first 10 years. The further out you look, the more future innovation will be lost. California Life Sciences said upwards of 85% of what they invest in would go away. 80,000 US jobs, 80,000 is what California Life Sciences said. We'd lose the R & D, we'd lose the innovation. Now, no president I've been around, Republican or Democrat, has ever leaned in harder on these issues of cost of care than President Trump. And I was with you and him when he announced the effort to get transparency in the hospital system. And before we got from the news conference at the oval office, I believe the hospitals had sued you. Is that correct? Secretary Azar: (30:55) I believe it is, yes. Mr. Walden: (30:56) Yeah. And you talked about the drug disclosure and advertising, and what happened there? Secretary Azar: (31:03) Rather disgustingly, the pharmaceutical industry sued us to conceal their list prices from their consumers. Mr. Walden: (31:09) And so then I want to talk about Medicare part D. We were all working together on this committee, which we have a great reputation of doing. Occasionally we fight and that's all right. We know it. But we were working together to cap the out of pocket costs for seniors under Medicare part D and modernized Medicare part D, when all that unfortunately came to an abrupt halt, driven, I'm going to say, from the Speaker's office. Those discussions ceased. But we agreed that we needed to cap out of pocket costs. We put that in our bill HR 19. They put that in their partisan HR 3. But we all agree that it's time to cap the out-of-pocket costs for seniors in Medicare. Does the administration support capping the out-of-pocket costs for seniors and Medicare? Secretary Azar: (31:55) Absolutely. Mr. Walden: (31:56) Did the administration oppose HR 3? Secretary Azar: (32:00) We do oppose HR 3. Mr. Walden: (32:01) Did the administration support the concepts of HR 19 or alternative? Secretary Azar: (32:06) We support the elements of it, absolutely, including the notion of capping out-of-pockets and saving seniors money. Mr. Walden: (32:12) One of the big issues we've dealt with here, or tried to, is the high cost of insulin, not just for seniors but for others. But in our alternative HR 19 that was all bipartisan legislation, we capped cost of insulin, I believe, at $50 a month was the maximum. Does the administration support that concept? Secretary Azar: (32:36) I believe so, yes. Mr. Walden: (32:39) So going forward, are you hopeful that Congress, the administration can get together on a plan the president can sign that can become law that would actually reduce the costs of pharmaceutical drugs in America without driving innovation away? Secretary Azar: (32:59) Yes. I have said the administration is the most flexible party here. Republicans, Democrats, Senate, House, get list prices under control, lower out-of-pockets, and give the drug plans the real incentive to get drug prices down. Mr. Walden: (33:09) HR 19 contains about 80 or 90% of the Wyden-Grassley bill. We think we're with you. We think we can get there if we can just put the partisan weapons away. Thank you, Mr. Secretary. I yield back. Anna Eshoo: (33:24) Gentleman yields back. A pleasure to recognize the gentleman from New York, Mr. Engle for his... Is it four minutes? Speaker 2: (33:31) Yes. Anna Eshoo: (33:32) Four minutes of questions. Eliot Engel: (33:34) Thank you, Madam Chair. Secretary Azar, the State of New York was extremely disappointed to hear that CMS has denied the state's request for a renewal of its delivery system reform incentive payment program, known as DSRIP. When the program was first approved, CMS and HHS insisted that New York include targets for the state's Medicaid program that would incentivize providers to move away from fee for service toward value based payments. New York's healthcare community has made progress doing just that, receiving double digit reductions in preventable hospital readmissions while saving the federal government billions of dollars. The request for additional time and continued investment of those savings in district was to move closer to exactly what CMS and HHS had been saying the federal government wants everyone to be doing. So in light of that, why would CMS and HHS want to stop supporting these successful efforts to achieve the very goals that the Trump administration has been saying that it has for healthcare? So will your department commit to meeting with the State of New York to discuss how these reforms are sustained into the future? I'd like a yes or no answer if I could get it. Secretary Azar: (34:46) Yes. I'm not familiar with that particular program, but you're right. We do support value based transformation in our programs. I don't know the particulars of why CMS has had difficulty with New York, but yes, we'll be happy to sit with New York. Eliot Engel: (34:58) Okay. And I'd be happy to sit with you as well and discuss it. Mr. Secretary, we've mentioned it here. Other members have mentioned it here. You know it far too well that Americans are suffering from the current epidemic of skyrocketing prescription drug prices. My constituents always tell me they're having to make unconscionable choices between paying for food or filling a lifesaving prescription such as insulin. The House has taken bold, decisive action to lower drug prices through HR 3, which provides a common sense solution to this crisis by allowing the government to negotiate drug prices. That's a policy which the president supported as a candidate in 2016 saying, and I quote, "When it comes to negotiate the costs of drugs, we are going to negotiate like crazy." That's from the president. Eliot Engel: (35:49) The administration has yet to deliver any meaningful solutions for the health crisis. In May 2018, your department released a blueprint to lower drug prices, but many of those policies failed to materialize or provide minimal relief to patients. Other ideas such as the international pricing index has been shelved. Despite these failures, President Trump claims to have reduced drug prices when in fact a recent report showed that on average drug prices increased by over 5% at the start of this year. Mr. Secretary, can you commit to me today that you will deliver on the president's promise to negotiate drug prices? I'd like a yes or no also. Secretary Azar: (36:29) So we support bicameral, bipartisan legislation that would get through, and there are many principles in HR 3 the president is supportive of, but it has to pass both houses of Congress. And at the moment, HR 3 doesn't have a chance of seeing the light of day in the Senate. And so we need to work together to see if something can get through both chambers. Eliot Engel: (36:46) Well, I'm sure if the president asked Mitch McConnell to put it on the agenda, he would. Secretary Azar: (36:52) I don't think so. Eliot Engel: (36:52) There are plenty of things that we've passed in this House that unfortunately the other body hasn't done, and the president seems to be right along with it. So I just think it's another example of the administration's broken healthcare promises to the American people. I just think that we need to get those prices of drugs down, and we need to have not empty rhetoric but by true facts. And I yield back the balance of my time. Anna Eshoo: (37:21) The gentleman yields back. I'm pleased to recognize the gentleman who was the former chairman of the full committee, Mr. Upton of Michigan, for his four minutes. Fred Upton: (37:33) Thank you, Madam Chair. Mr. Secretary, welcome big time. So as you know, this committee on an unanimous vote passed 21st century cures, cures as we call it. When I was chair, we expedited the approval of drugs and devices, and I would suspect strongly that your testimony that we had a record number of generic approvals is a direct result because of what this committee did. We also added some $45 billion in health research over a 10-year span. And frankly we asked the question of the agencies as we worked on this legislation, "What is it that we could do to help you make sure that we hit these targets of faster approvals, drugs, and devices?" So whether it was the FDA, the CDC, and others, the NIH, obviously they gave us an answer and we delivered. Fred Upton: (38:27) And at the end of the day, for this crisis, we are going to find a vaccine to solve coronavirus. I know that we are. And I'd like to think that what we did in this committee and then passed on the House floor will be a direct result of that. And frankly it prompts all of us, I think, to ask the questions of what more can we do to get on a faster pace to find that vaccine and that cure? In fact, as you may know, Diana DeGette and I are again working on a 2.0 cures bill where we can take these three years since President Obama signed the bill into law and ask those questions to see what constructively we can do, so that all hands are on deck. And I know, don't have to ask you, I know that you will help us with ideas to do that. Fred Upton: (39:16) Question that I have is a containment in the first is the very first step in responding to any outbreak of coronavirus. We've seen that around the world now. And statements from yesterday indicate that the CDC said it really isn't if but when it gets to larger numbers here in the United States. I've always believed in the adage that if you're going to do something, better do it right the first time because you're not going to find a second, and you want to make sure that... Pay me now or pay me later. So we need to have the right numbers as it relates to fighting this terrible disease. Is the two and a half billion, is that a floor? Is that a suggestion, the two and a half billion that you were saying? Secretary Azar: (40:05) Yes. We have described the request as at least $2.5 billion for 2020 money, and then work on 2021 money as we see the situation develop over the weeks and months ahead. Mr. Walden: (40:16) I know that we're waiting to see the precise details of where it's going. Are any of those dollars envisioned to include the contingency of what China has done as it relates to regional quarantines? Secretary Azar: (40:32) No, we don't. We don't envision that as a kind of practical step here in the United States that we would, as Dr. [Messinier 00:40:39] spoke about yesterday in the event that we had community level outbreaks, which might be small, just a town, a city. If we had that, we would take the pandemic playbook, which is community-based mitigation steps social distancing. It is very rare that those types of cordon sanitaire efforts around cities, they are effective. They usually provoke more panic and cause people to actually leave and spread. Now, China is a different government and culture than we have here. Mr. Walden: (41:13) Of the 14,000 Americans that have died this flu season, do you know what percentage of those were not vaccinated? Secretary Azar: (41:21) I do not have the numbers. Historically, our youth who die tend not to have been vaccinated, which is a real tragedy. Mr. Walden: (41:27) The last question is, have been any query of those 55 Americans who currently had been diagnosed with the coronavirus? Did any of them have the flu vaccine, do you know? Was that question asked of any of the 55? Secretary Azar: (41:43) I don't know that that would have been asked. We don't of course have any evidence that the flu vaccine would have any properties related to the novel coronavirus, but I don't know if that was asked as part of intake for the patients. Mr. Walden: (41:54) Okay. I yield back. Anna Eshoo: (41:56) Gentleman yields back. It's a pleasure to recognize the gentlewoman from California, Ms. Matsui, for her four minutes of questions. Doris Matsui: (42:04) Thank you, Madam Chair, for holding this important hearing, and welcome, Mr. Secretary. Before I get into my line of questioning, I do want to express my deepest concerns about the Medicare, Medicaid, and other cuts included in the budget at a time when we're dealing with the coronavirus outbreak and addiction crisis and a lawsuit that threatens ACA protections for preexisting conditions. The administration's cuts to critical safety net programs target the most vulnerable in our communities and aim to further road access to vital healthcare services. We should be prioritizing primary comprehensive care, particularly in the mentally ill and people with addiction. I believe mental health is the area where we have an opportunity to work together and make progress. Mr Secretary, I appreciate the department's strong support of the certified community behavioral health clinic Medicaid demonstration. Doris Matsui: (42:59) As you know, Representative Markwayne Mullin and I are working to further scale the program with our bipartisan legislation, the Excellence in Mental Health and Addiction Treatment Expansion Act, for the eight states currently participating in the excellence demonstration. We have studies showing that quality mental health services, outpatient care, and addiction treatment provided at these facilities are saving lives and money. People are avoiding jails and emergency rooms, instead getting the comprehensive care they need in their communities. We have 11 additional states that are ready to participate in an expanded excellence program. Our bill has a bipartisan group of ADA cosponsors who support this full expansion, and House has already voted to extend the program longer term. Doris Matsui: (43:47) I was very pleased to see that the budget this year explicitly endorses extending this excellence demonstration, and I believe we do all agree, Mr. Secretary, that adequate Medicaid resources around substance abuse treatment are essential to fighting the opioid and addiction epidemic. Mr. Secretary, I have a question. Under the leadership of Chair Deloro $200 million are made available to HHS in FY20 to help states prepare for eventual participation in the excellence demonstration. How does HHS plan to obligate these resources? Secretary Azar: (44:24) First, thank you for your personal leadership on the certified community behavioral health center issue. You're right, the data is showing really positive results today, so thank you for that. In terms of your work with Chairwoman Deloro, SAMSA is now accepting applications from states for these grants to increase access to and improve the quality of community mental and substance use disorder treatment services through the expansion of the CCBHCs, and the deadline for states to apply is March 10th Doris Matsui: (44:54) Okay. Thank you. The positive impacts of the demonstration make it clear that there's room to improve mental health and addiction care in this country by scaling this program. In California, our county hospitals, public academic medical centers, and public children's hospitals rely upon financial arrangements that leverage public funds and partnerships as essential means providing health care to the most underserved communities and patient populations in the state. I have concerns about the administration's recent proposal to eliminate the sources of funding, particularly settlement payments. I worry that if finalized, the Medicaid accountability rule would destabilize a whole system of care provided under Medicare. Medicaid supplemental payments are an integral component of total Medicaid reimbursement that providers rely on for adequate reimbursement and financial stability. Mr. Secretary, have you weighed the restrictions on supplemental payments against the adequacy of these base payments? Are there plans to make any corresponding adjustments to base payments for these providers? Secretary Azar: (45:59) So we're hearing the very important feedback from you and others about that regulation, and we want to take that in as we look at how and whether to finalize at CMS on the relationship of these inter-governmental transfers to supplemental payments, and also if there are ways we can work with states to restructure payments in a way that would be consistent with the law. So we want to work with the states, not be adversarial to them on this. Speaker 2: (46:21) Okay. Thank you, Mr. Secretary. And I yield back. Anna Eshoo: (46:25) Gentlewoman yields back. A pleasure to recognize Mr. Shimkus of Illinois for his four minutes of questions. John Shimkus: (46:32) Thank you, Madam Chairman. Thank you, Mr. Secretary, for being here. Coronavirus is a novel pathogen, as a lot of us know, but in your testimony you also mentioned emerging microbial threats. And Madam Chairman, I ask to submit in the record this news release from the World Health Organization on the 17th of January, 2020. Anna Eshoo: (46:56) So ordered. John Shimkus: (46:58) And in the 114th Congress I joined with Gene Green on what we called the Adapt Act. Last Congress, it was Tony Cardenas and I with the help of the now chairman of the subcommittee, Anna Eshoo, who joined, and technical assistance by HHS on what we call the Revamp Act. And it's an attempt to address how, if you have these antimicrobial resistants, how public funding may not be the only way you can address this. Can you talk about that challenge? Secretary Azar: (47:32) Yeah. I'm very concerned about the drug development around antimicrobial resistance in terms of creating a sustainable market. We've had actually tremendous success from the efforts you've led and the Congress has led and Barta at my agency have supported. We've supported development of 16 novel anti-bacterial projects. I believe three have actually come to market. What we're finding, though, is there's a market failure question here where you're basically asking a company to develop a drug, but then not to have it used much. And that's not a usually sustainable business model. So I've actually commissioned my team to work on how can we possibly solve that, is that more like a bioterrorism chemical countermeasure, and the approaches that we need there. Quite concerned about [crosstalk 00:48:17]. John Shimkus: (48:16) And that's what we've tried to do legislatively, and at some time one was the tradable vouchers debate, which I think still should have legs, especially in this concern of, as you put it, trying to have something on the shelf that you don't want to use. That's the key. Scott Peters and I are also working on legislation that we call Ending the Diagnostic Odyssey, and it is an attempt to help DNA sequencing so that when there's a disease or some event, you don't have to test, test, test. You can go just through the sequencing aspect of that. Any thoughts on, or comments of what you all may be doing that we don't know about in trying to push more DNA identification? Secretary Azar: (49:11) So I've not studied that particular issue. We're happy to get back to you on that. It certainly is at the fore right now as we deal with novel coronavirus and have the CDC diagnostic, but also hope that commercial innovators will develop physician bedside diagnostics for rapid insight testing. John Shimkus: (49:30) Yeah, and this is timely, obviously it's timely because of the threat that we're all concerned about now, but it's also rare disease week and a lot of that community is looking for this as a novel way, especially on what we call that diagnostic odyssey where they just... And we see that with people who are struggling with just types of cancer and trying to identify the right treatment early, versus what I would say sometimes is a trial and error method that is very damaging to the health of the patient. And I, with 30 seconds left, I wanted to just briefly, and it's been asked a little bit before, you all do support Medicare D reform, is that correct? Secretary Azar: (50:15) Oh, absolutely. It's a real opportunity for seniors. John Shimkus: (50:18) And how would reform lower patient out-of-pocket costs? Secretary Azar: (50:21) Well, you would cap catastrophic payment, the limit at $3,100 so a patient would never pay more than $3,100. And then, at least the Grassley-Wyden Plan, the senior could actually opt into a program where they would pay no more than $258 a month for their drugs, no matter what their expenses are. John Shimkus: (50:38) Amen. Anna Eshoo: (50:42) Gentleman yields back. The gentleman from Maryland, Mr. Sarbanes, is recognized for his four minutes of questions. John Sarbanes: (50:49) Thank you, Madam Chair. Secretary Azar, you certainly know that the popularity of e-cigarettes has recently led to an unprecedented surge in youth tobacco use, and it's bringing back with a vengeance the tobacco epidemic in this country we've worked so hard to curb. It shows why we have to improve the law, and something that this committee has been working on. Unfortunately, the Trump Administration is now proposing, as I understand it from the budget, removing FDA's oversight of tobacco products in favor of an untested agency that will take years to get off the ground, which threatens to set us back even further. I'm perplexed that the administration would decide to do this, remove FDA's authority, alter the agency's public health mission, which includes making "tobacco related death and disease" part of America's past, not America's future. And by doing so, ensuring a healthier life for every family. John Sarbanes: (51:45) This latest move is kind of breathtaking. It makes no sense. It's a crazy thing to do by the administration, which unfortunately hasn't taken significant action against big tobacco as more of our nation's youth are becoming addicted. In January, after heavy lobbying from big tobacco as we understand it, and the vaping industry, and listening to partisan political consultants like Trump campaign manager Brad Parscale, the administration reversed course. And we were on a trajectory where we thought everybody was on the same page. The administration reversed course, announced a policy which failed to ban all flavored e-cigarettes, allowing popular menthol cartridges to stay on the market and allowing all flavored disposable e-cigarettes and open tank e-cigarettes to proliferate through our nation's school yards, which is exactly what they're doing. And I'm concerned that removing this authority from the FDA, which is a part of the proposal, could lead to even more loopholes and more industry influence. John Sarbanes: (52:51) My question is this: When formulating the budget proposal to remove the FDA's tobacco oversight authority, did you, your agency staff, White Housee staff or staff of the office of management and budget, speak or meet with any lobbyists or other representatives of the tobacco industry, or for that matter, public political operatives who work for or are contracted by the president's reelection campaign? Secretary Azar: (53:16) Well, I certainly can't speak speak for others. I'm not aware of any such a deliberations. The idea was that if we move the tobacco center out from under FDA first, if it were a politically appointed, a presidential appointed Senate confirmed leader, they'd be more accountable to Congress. Second is a direct report to me or whoever is secretary elevating the role of tobacco control there. It is always been a little bit of an odd connection. FDA is about safe and effective, whereas the tobacco center is about regulating a product that is undeniably bad, and so there's a- John Sarbanes: (53:48) It doesn't make any sense, does it? Secretary Azar: (53:50) Well, of course, that's subject to Congress if it was something- John Sarbanes: (53:53) We're at the height of that, we're at this tipping point on this epidemic, when it comes to vaping. I mean, there does reside, however you want to carve- John Sarbanes: (54:00) ... however you want to sort of carve up what you consider the appropriate mission of the FDA to be, there certainly exists, resides within FDA now, significant expertise and experience in terms of dealing with this issue. Why you would propose at this moment in time when this epidemic risks, in a sense, overtaking the dimensions of the previous tobacco epidemic that we saw in this country by zeroing out that authority and moving it to an untested new agency, which by the way, I think would be more susceptible to political influence of the kind I was just recounting than it is now. It doesn't make any sense to me. I urge you to reconsider that. We are in the midst of this crisis, and we have to use every tool available to us here in the government to respond to it. With that, I yield back. Anna Eshoo: (55:01) The gentleman yields back. There is five minutes and 22 seconds left on the clock. Any member that would like to leave to vote when we get to, you can leave now. When the clock goes to zero, they will hold the vote open for those that have not arrived from our subcommittee, and at that point we'll take a 20 minute break, but now I'd like to recognize the gentleman from Kentucky, Mr. Guthrie, for his four minutes of questions. Congressman Guthrie: (55:33) Thank you, Mr. Secretary. I look forward to getting into the coronavirus. I'm going to do that in my second round of questions. The SUPPORT Act we passed last year included my bill, the Comprehensive Opioid Recoveries Act, to establish treatment centers that offer FDA approved medication assisted treatments, all of them comprehensively. Currently, SAMSHA has the grant application open for entities to apply, and I'm glad HHS is moving fast and implementing the program. But my question is how is HHS implementing other parts of the SUPPORT Act, and does HHS conduct any oversight on how the funds are actually being used? Secretary Azar: (56:07) So first, thank you for the SUPPORT Act and it is so comprehensive. We actually established a SUPPORT Act implementation leadership committee to track all of the different work streams needed under the SUPPORT Act. It's really enhancing our work across all five elements of our strategy on opioids, so we're driving forward making progress on the opioid epidemic. The overdose deaths are down for the first time in decades as a result of our collaborative bipartisan efforts here, and we're implementing and using the SUPPORT Act authorities, so thank you for those. Congressman Guthrie: (56:38) Okay, thank you. Also in 2018 Congress passed my bill, the bipartisan BOLD Infrastructure for Alzheimer's Act. Can you please provide an update on how this law has been implemented across the country? Secretary Azar: (56:50) So with that act, if I could get back to you in writing on that. I don't have all the details on that particular program. I apologize, but if I can get back to you. Congressman Guthrie: (56:59) Okay. Thank you. Then this is kind of technical from my role as ranking Republican on the ONI sub committee for this committee. This committee and ONI conducted extensive oversight, cybersecurity at HHS, including through technical audits conducted by JAO of cybersecurity controls at HHS operational divisions. I said it's very technical. Last Congress's subcommittee on oversight and investigations held a closed hearing in part because HHS failed to properly identify and address certain vulnerabilities. We recently received preliminary results from the most recent audit of another HHS agency, though I can't go into details in this setting. My question is does HHS have a point person who coordinates corrective actions on cybersecurity among all HHS agencies? If so, will you direct that person to continue to work with the committee on improving enterprise cybersecurity at HHS and ensuring that mitigations applied in one setting are consequently applied through all of HHS? Secretary Azar: (57:59) Yes, yes we do. Our chief information officer, Jose Arietta, who works directly with me absolutely is in charge of those issues. If I could go back to your previous question, I had misheard on the BOLD Act. Congressman Guthrie: (58:11) The BOLD Act, yes. Secretary Azar: (58:12) I apologize on that. For fiscal year 2020, CDC will have two funding opportunities to carrot actions under the BOLD Act. First, there'll be the public health programs to address Alzheimer's disease and related dementias. Second, there will be the Health Centers of Excellence to Address Alzheimer's Disease and Related Dementias. We expect both of those funding opportunities to be out in the coming month. For FY 2021, the president's budget for CDC includes $3.493 million dollars to continue to support these Alzheimer's activities. Congressman Guthrie: (58:45) Good, because by 2050, that's when I'll be 86 I believe. They believe it's going to be an estimated a trillion dollars spent on Alzheimer's disease. Not only is it devastating to the individual who has it, the family that cares for that person, but also it'd be devastating to the deficits and the budget of our country, so this is something very important. Thanks for your leadership and effort, and I appreciate working with my colleagues here to move the BOLD Act forward and address it. I yield back. Anna Eshoo: (59:13) Gentleman yields back. Pleasure to recognize the gentleman from New Mexico, Mr. Lujan, for his four minutes. I'll wait right here with you, and then we'll run over. Congressman Lujan: (59:22) Thank you, Madam Chair. Secretary Azar, when Donald Trump was running for office four years ago, he famously said that he wouldn't cut Medicaid. He didn't say it once or twice, but claimed it at least five separate occasions that he would not cut Medicaid, but in reality, no president and no administration in the last 50 years has done more to undermine Medicaid than Donald Trump. In fact, his first major legislative effort to repeal the Affordable Care Act would have ended Medicaid as we know it and put the healthcare of 70 million Americans at risk. If my colleagues from the other side of the aisle want to protect people with preexisting conditions, they should drop the lawsuit. That could happen tomorrow. After President Trump failed to cut Medicaid legislatively, he decided to try the same thing administratively, even though the law clearly does not allow it. Secretary Azar, there's been some misreporting that the block guidance is limited to adults in the expansion population, but under the administration's guidance, states could block grant Medicaid for more than just expansion adults. Isn't that true? Secretary Azar: (01:00:28) Congressman, I don't believe that's the case. I'll ask the CMS administrator to get back to you on that, but my understanding was that it would be an optional demonstration for adults only, and that it would actually not affect coverage for our most vulnerable, our pregnant women, children, elderly adults, people eligible on the basis of disability. But I'll ask Administrator Verma to get back to you on that, because that is not my understanding. Congressman Lujan: (01:00:52) Let me jump into this. I'm glad that you pointed that out, because I believe that there is a concern here, and I hope that you would agree with me, if that's your understanding that you do something about it. Mr. Secretary. Because the Center on Budget points out that people that are low income parents, women who are pregnant and people with disabilities who are covered through Medicaid expansion could be included in what I will describe as the president's illegal block grant guidance. Is that something that you would agree with? If that's the case, would you stop it if in fact the guidance does allow for those vulnerable populations to be discriminated against? Secretary Azar: (01:01:30) I have been under the view that it does not affect coverage for our most vulnerable populations. It doesn't allow them to strip benefits, strip eligibility. Essential health benefits have to be covered. You can't change eligibility. You can't cap or limit enrollment. Congressman Lujan: (01:01:43) Mr. Secretary, if I may, just for clarification because it sounds like we're on the same page. Secretary Azar: (01:01:49) What you're saying, I'm not ... The concerns you're expressing. I don't believe are in the HOA, but we'll get back to you on. Congressman Lujan: (01:01:56) Mr. Secretary, let me ask you this pointed question. If in fact the president's Medicaid block grant program does allow for those folks to be thrown off and get caught up in this, will you stop it? Secretary Azar: (01:02:07) Well, we're not going to approve plans that allow people to be thrown off because it can't change eligibility. You cannot change eligibility. It's not part of the program. Congressman Lujan: (01:02:13) Let me ask the question one more time, because it sounds like you're getting there. Mr. Secretary, if in fact, vulnerable populations like pregnant women families, those that are disabled are subject to this rule where they can be block granted, will you stop it? Secretary Azar: (01:02:34) I will not approve a plan that that removes coverage for our most vulnerable citizens. Congressman Lujan: (01:02:41) That's enough for me. You said you will not approve a plan. Secretary Azar: (01:02:42) I will not approve with very low income parents, children, pregnant women, elderly adults or people eligible on the basis of disability should not be removed, should not be affected in terms of their Medicaid coverage is what I'm informed, I'll get back to you from Administrator Verma to confirm all of those details. I to make sure that I'm right on that, but that's been my understanding of the HOA program. Congressman Lujan: (01:03:04) What I'm looking for is assurance that if what my comments are associated with being consistent with the Center on Budget points out, you in fact will not approve that plan and you will not allow for Medicaid block grant cuts, devastating cuts go into place that will be subjected to pregnant women families and those with disabilities. Secretary Azar: (01:03:27) The categories that I mentioned before, ones that I do not believe are subject to it and plans should not be approved if they would harm eligibility for those individuals. Congressman Lujan: (01:03:35) So if the Center on Budget's assessment is correct, you will not allow that to go in effect? Secretary Azar: (01:03:40) I do not believe their assessment or description of the program is correct, and I've said to, I don't expect that I would approve any plan that would harm our vulnerable populations. It is the healthy adult opportunities under Medicaid expansion, but we'll get you any clarification on that afterwards. Congressman Lujan: (01:03:56) Well, thank you. Secretary Azar: (01:03:56) Thank you for raising that to me. Congressman Lujan: (01:03:57) There's a reason that most of us in this Congress have opposed Medicaid block grants. These are devastating programs. It's another effort to undermine Medicaid and to continue to cut the program, which President Trump promised he would not. This is another example of where he is, and with that, I yield back. Anna Eshoo: (01:04:15) The committee will now recess for approximately 20 minutes, so hold on to your seats while you stand up and stretch and we race over and come back. It sounded like the secretary said yes, Ben Ray. (silence). Audience: (01:04:29) [inaudible 01:04:28]. Speaker 3: (01:04:29) Hey, Andy. You want me to do the robo? Audience: (01:04:29) [inaudible 01:13:49]. Speaker 3: (01:04:29) Yeah, right. Someone has to. Well, somebody [inaudible 01:14:10]. Audience: (01:04:29) [inaudible 01:14:12]. Speaker 3: (01:04:29) Yeah, hold on too. Audience: (01:04:29) [inaudible 01:14:25]. Speaker 3: (01:15:26) Yeah. I'd say it looks like [inaudible 01:15:26] so I can check it out. Yeah, just go check it out. Audience: (01:15:29) [inaudible 01:15:35]. Speaker 3: (01:15:29) Okay, I'm good. Audience: (01:15:29) [inaudible 01:16:13]. Ms. Kelly: (00:00) Pay to provide postpartum coverage for a full year and Congress appropriated and president Trump signed into law 12.5 billion in funding for the CDC to study gun violence. Yet your administration seeks to slash funding to and block grant Medicaid, implement more restrictive eligibility criteria for Medicaid recipients and completely zero out funding for gun violence research. Secretary, are you aware yes or no, that the budget contains a proposal that would allow States to impose an asset test on pregnant women in Medicaid? It's pages 112 to 113 of the HHS budget in brief. Hon. Azar: (00:42) I'd want to look at that and get back to you on that. I'm not aware of that particular provision. Ms. Kelly: (00:46) Okay. Hon. Azar: (00:47) We do have the proposal as similar to what you just mentioned for Medicaid that would allow States an option to cover pregnant women for one year after birth if they're suffering from substance use disorders. That's another part of the maternal mortality initiative. Ms. Kelly: (01:01) Yeah, that proposal will cut Medicaid funding by 2.2 billion. That's because it will cause a lot of people including pregnant women to lose their Medicaid coverage. So, maybe you can't answer that. Hon. Azar: (01:14) So, that's a spending provision. The one I just mentioned would, it would actually expand... Right now they can only get 60 days coverage postpartum. This would allow that coverage for up to a year as a state option in a non budget, neutral way, I believe. Ms. Kelly: (01:26) Well, my time is up. Ms. Eshoo: (01:28) Gentlewoman's time is expired. That legislation that we took up here is awaiting floor approval of the gentle woman has been a leader on this for long before the rest of the members even knew that we had this horrible statistic in our country. Last but not least, the gentlewoman from Florida, Ms Caster for her two minutes. Ms. Castor: (01:50) Thank you, Madam chair. Mr secretary, the administration is urging the federal courts to strike down the Affordable Care Act in its entirety, including the protections for more than 130 million Americans who have a preexisting health condition. I think my neighbors back home would want me to relay to you how dangerous that is. How angry they are about it. They do not want to return to the days when insurance companies could discriminate against them if they had asthma, a cancer diagnosis, some other preexisting condition. They don't want to return to the days where an insurance company can cancel them if they get sick. And I think the coronavirus now highlights the importance of consistent health insurance coverage that has a floor of essential health benefits and it really shines the light on these junk plans. Your department has finalized a rule to expand the short term limited duration junk plans. They're not required to cover preexisting conditions. You acknowledged that in your last budget hearing in front of this committee and a couple of studies have come out recently. A Georgetown Health Policy Institute study. One commissioned by Leukemia and Lymphoma Society that highlights the abuses here. Is the department conducting any oversight on the abuses of these junk plans? The abuses in marketing, false promises. Are you conducting oversight of the- Hon. Azar: (03:32) So, the short term limited duration plans are off exchange. And so, we don't actually regulate- Ms. Castor: (03:36) Could you just say yes or no quickly, because the time is short? Hon. Azar: (03:38) We don't regulate them directly, they're subject to state insurance regulation. Ms. Castor: (03:44) So, it's hands off. You said we're going to promote these junk plans and you're not conducting any oversight. Is that true? Yes or no. Hon. Azar: (03:51) They are subject to state insurance regulation as individuals- Ms. Castor: (03:54) And you don't check in with the state and monitor the abuses and the junk plan market that are raising costs on everybody and excluding preexisting conditions? Thank you. Hon. Azar: (04:03) So, we do not regulate state insurance commissioners. Ms. Eshoo: (04:09) Gentlewoman yields back. Let's take a five minute break and the staff can reset the witness table and then we'll resume. Thank you. The subcommittee on health will come back to order. What we're going to do is we're not going to have our witnesses do their formal public statements. We have them all in the record. We thank you for them. I've actually read them and I'm sure my colleagues have as well. What I just want to do quickly, out of respect to each, is to just give a quick introduction and then we'll go to members with their questions. And first of all, thank you for being here. I think that the United States of America is so blessed to have, I think, the finest public health professionals in the entire world and there's a reason why the world looks to us, because we have you and your expertise. So, Dr [inaudible 00:00:12:01], thank you to you. Just, America can't live without you, really. Ms. Eshoo: (12:09) Dr Hahn, welcome to you. I think this is the first time that you're before the committee and we'll make it really pleasant for you. We won't do to you what we did to the secretary. Mr secretary, welcome back to the table. Dr [inaudible 00:00:12:27], welcome to you and to Dr Redfield from the CDC, thank you for being here and thank you collectively for what you've done to help to brief the Congress during this. Now, is it my turn to ask? Okay, let me start obviously with the coronavirus. I started out earlier today saying that confusion is the enemy of preparedness. I do not put confusion at the doorstep of Dr [inaudible 00:13:12], Dr. Hahn, Dr [inaudible 00:13:22], and Dr Redfield. I think that you have done an excellent job in advising, briefing the Congress and for the work that you're doing. I think we have some problems with the administration because the professionals say one thing and then there's confusion on the other side. Ms. Eshoo: (13:36) I hope that something else will happen too in that briefings be held in public so the American people can hear you. I hope as we move through this challenge that the American people will come to know you the way we do and that we elevate the level of confidence and trust that I know you can engender, but I don't think it's there now. There's confusion. Markets are roiling, it's not only because of confusion, but there are many matters at hand but you, the scientists, the doctors, the American people couldn't be better served. So, thank you to you for your especially important service right now. What I want to get to, Dr Hahn, let me start with you, is our drug supply. Are manufacturers being forthcoming with the FDA about potential shortages? Dr. Hahn: (14:48) Madam chairman, thank you for the question. We, we are being very proactive in our discussions with manufacturers. As you know, drug manufacturers are required to report to us when there are potential disruptions. Ms. Eshoo: (15:00) And how far in advance do they let you know that there will be a shortage? Dr. Hahn: (15:05) Typically, those conversations occur in real time. What we've done is- Ms. Eshoo: (15:10) I know that. I think usually all of our conversations are in real time. I'm saying, in a trajectory of time, if they were talking to you today, would they be able to tell when the shortage would begin? How much runway do we have? Example, China and manufacturing, so we have problem with that. Dr. Hahn: (15:38) So, just as an example, I can tell you that drug manufacturers are required to tell us when there's a potential disruption to the drug supply. When the applicants apply to the FDA, they might provide, for example, five different manufacturers for the precursors to the drug and then five manufacturers for the actual final drug form. Ms. Eshoo: (15:58) Let me ask you this. If the coronavirus outbreak is continuing three months from now and I pray that it isn't, what do you estimate the American drug supply will be? Have you done forward leaning- Dr. Hahn: (16:12) We have looked at this. There are 183 prescription drug manufacturers in China. 20 are sole source from China. That's both precursors as well as the final drug form. We've reached out to all of these manufacturers and we have no shortages to those sole source drugs. It's the redundancy, madam chairwoman, that's most important and if we have redundancy, then we can shift to other manufacturing sources. Ms. Eshoo: (16:37) Yesterday, the FDA said, you mentioned this, the 20 drug products that are either solely sourced there for their active ingredients or finished drug products from China, can you share that list with us or is that proprietary? Dr. Hahn: (16:55) That's a proprietary list. We are internally compiling lists associated with all the questions that we've been asking the manufacturers. Ms. Eshoo: (17:03) Dr Redfield, how many coronavirus tests can the U.S. conduct as of today? Dr. Redfield: (17:10) How many cases? Ms. Eshoo: (17:11) How many tests can our country conduct as of today? Dr. Redfield: (17:17) I would have to get back to you with the exact number. Ms. Eshoo: (17:19) Okay. I teased, but I was serious. Secretary Azar, we have some deep cuts to these agencies, the people that you're sitting with, and it was mentioned by I think the ranking member that the budget was printed and it couldn't be changed because of the print and all of that. I think secretary Azar, the $200 million cuts at BARDA, $700 million in cuts at CDC and $3 billion out of NIH. Are you willing to reconsider that, given what our country is facing and what the American people need day in and day out from these agencies? They are the essentials. Hon. Azar: (18:08) The proposals to the budget do not impact our ability to do the novel corona response. The CDC budget actually has $135 million increase in the fields of infectious disease- Ms. Eshoo: (18:18) Do you think in other words, they deserve these cuts, these are healthy cuts, this is good for them and it's good for our country? Hon. Azar: (18:25) You asked me about impact related to novel coronavirus. These will not impact functioning related to that and of course we have the emergency supplemental request on top of that. Ms. Eshoo: (18:36) Well, if you wrote it in December, how do you know that? Hon. Azar: (18:40) Because the changes that we make in the budget are not related to categories that will impact our ability to do the novel coronavirus response. Ms. Eshoo: (18:47) So, there's nothing to reconsider? Hon. Azar: (18:49) I don't believe there is in terms of the existing budget proposal, we have emergency supplemental adding to accounts that we think are relevant. Ms. Eshoo: (18:55) Today is February 26th, 2020 and I certainly hope you're right, but I think that we're shortchanging the American people. This time to recognize Dr. Burgess, the ranking member of the subcommittee. Mr Burgess: (19:12) I think the chair would just point out, we are the United States House of Representatives. All spending bills originate in the United States House of Representatives. So, it's certainly well within our power to provide the level of spending that you all request. The House is just now doing its budget several months after the administration did its budget. I will be testifying to the budget committee tomorrow. I think if people have concerns, they ought to bring them up to the budget committee. I just hope we will actually have a budget debate and vote on a House budget because we haven't in several previous years, but I do want to thank the panel for being here today. This is critically important. The chair is correct that people do need to see and this needs to be public. That's why we have hearings because hearings are on the record and are public, which is why several weeks ago I suggested we have this hearing and I'm glad we're having it today. Mr Burgess: (20:03) Secretary Azar, just you were testifying on the budget before. You did take some questions on the issue of the Office of Refugee Resettlement. Just off the topic of corona. Can I say, I have been fortunate enough to visit a number of your facilities provided by Office of Refugee Resettlement and I think we are fortunate to have the men and women who are working in those facilities. And would you just please convey to them my thanks because I do think they do a good job and we would be much the worse without them. Hon. Azar: (20:34) I will and that will mean a great deal to them. Thank you. Mr Burgess: (20:36) Dr. Hahn, you and I had talked a little bit somewhat earlier about the supply chain and the active pharmaceutical ingredients that we import from overseas and the fact was that there was an adequate stockpile as this story began to evolve several weeks ago. To the extent that you can tell us, how are things looking now as far as the stockpile that companies have available, as far as the active pharmaceutical ingredient? Dr. Hahn: (21:11) Thank you representative Burgess. As we discussed before, we've received no reports of shortages and found no shortages in prescription drugs coming from China, and we have discussed this with manufacturers and pharma companies and adequate supplies currently exist. Mr Burgess: (21:26) So, can I just offer this observation, and I've been on this subcommittee for a long time, and we've had this discussion in other guises, in other times and if there's ever any silver lining to this cloud, it may be that we recognize that we need to bring some of that manufacturing back within our own shores. So that we have the responsibility for those active pharmaceutical ingredients And I know this is something the president is focused on and part of his rebuilding of America. Mr Burgess: (22:01) This is, I think, work that this subcommittee has done in the past. I think it's something that we really need to take very seriously. We had some hearings on continuous manufacturing a few weeks ago and I think that is another aspect of this where perhaps some attention to the continuous manufacturing. But main thing is make it here, so we're not dependent on a sole source from another country, whether it be in difficulty from an infection or just simply out of sorts with the United States at the time. It does jeopardize our people and I do think we need to recognize that. And again, that's not a criticism of this panel. We have known about that on this subcommittee for a long time and it's just we haven't acted. Now, perhaps we will. Dr. Redfield, I would like to ask you, and we've heard several times the World Health Organization was able to finally get into China and assist them and now that report is going to be coming back. Are you satisfied with the level of interaction that you've had with your Chinese counterparts, because the CDC itself was not allowed to go in, is that correct? It was only as part of the World Health Organization? Dr. Redfield: (23:10) We were able to have a representative on the [inaudible 00:23:15] team that went to China to do the investigation. I've had regular conversations with my counterpart, the head of the CDC in China. We've had good exchange of scientific information. We do have a CDC office in Beijing, China that's there and they continue to have good interactions with those colleagues. Mr Burgess: (23:37) So, you think there is working with the state and local folks? Dr. Redfield: (23:41) There's good scientific interaction between us. Mr Burgess: (23:43) And Dr Hahn, let me just come back to you for a moment, and thank you for the work you're doing on getting a laboratory developed test, that is critical. They can't all be done at the CDC. We're going to have to be able to get those tests done rapidly in the field for our people on the front lines. But to the extent that, is there any evidence that there's any hoarding behavior going on with things like personal protective equipment or pharmaceuticals? Is that something about which we need to become concerned? Dr. Hahn: (24:14) In terms of the supply for... Mr Burgess: (24:16) Yes. Dr. Hahn: (24:16) Yeah, we have reached out to manufacturers and we're aware that spot shortages can and have occurred, however, currently we know of no overall shortage related to PPE. However, this is a very dynamic situation, as I mentioned at yesterday's press conference, that we are likely to see some pressure, particularly on the demand side here. We're working very closely with manufacturers on this. Mr Burgess: (24:41) Okay. Is there anything you can do to not prohibit but prevent hoarding activity by people who might just be buying up equipment? Dr. Hahn: (24:49) Well, the department has led an all department effort to communicate to providers and hospitals regarding this issue and we have recommended following CDC guidelines with respect to the use of particularly respirators where it seems to be the most pressure. Mr Burgess: (25:03) Okay. Thank you. Ms. Eshoo: (25:06) Gentleman's time has expired. It's pleasure to recognize the gentlewoman from Colorado, Ms DeGette for her five minutes of questioning. Ms. DeGette: (25:14) I thank the chair for including some of the other subcommittees in this, as four of the five of you well know, we've been having hearings in the oversight subcommittee for years on these issues. It's what keeps me up at night. The most recent hearing we had was on December 4th about seasonal flu and pandemic flu and lo, here we are. And what I'm concerned about is we're still not any more prepared than we were on December 4th and so that's what I want to talk about. Back in 2015, we had a national blueprint for bio-defense. Some of you recognize this- Ms. DeGette: (26:03) Fat or 2015 some of you recognize this document are now colleague Donna Shalala had your job, Mr Secretary and in this blueprint for defense, what they did was they said, we need to have... In case we have some kind of a pandemic, we need to have a clear line of authority to make these decisions. Are you aware of that Mr Secretary? Hon. Azar: (26:26) I wasn't aware of Secretary Shalala's recommendation and- Ms. DeGette: (26:28) But, are you aware of this blueprint. Hon. Azar: (26:31) Or the blueprint, I wasn't aware of? I was [crosstalk 00:26:33] that recommendation. Ms. DeGette: (26:33) So this is what I want to ask you because I just got back from Japan on Monday. And so we were really looking at the Diamond Princess Incident and here's what I was concerned about is you had all these people sitting in this Petri dish of a ship for a long time. The CDC said that people should not be flown back to the US from that ship. Ms. DeGette: (26:59) And then apparently the CDC was overruled by the state department. So here's my question. You're the chairman of the president's task force on the novel coronavirus, who's in charge? Are you in charge? Hon. Azar: (27:13) I'm in charge, but in Japan, the deputy chief of mission, who is the Sharjah de Faire, who made that decision has full authority of the president of the United States when in a foreign country. Ms. DeGette: (27:23) That's the problem. Hon. Azar: (27:24) No, that [crosstalk 00:00:27:24]- Ms. DeGette: (27:24) Well, yeah, it is and I'll tell you why that's the problem because you're the head of the panel. The health experts are saying you shouldn't be flying these people back in, and then there's another agency that basically, overruled what you said. If we have an outbreak in the United States, there are a number of other agencies that are going to have other interests and I'll just give you a couple of examples. Ms. DeGette: (27:50) The State Department, which we just dealt with, HHS, is you, the State Public Health Departments, the various other agencies, who is in charge of the final verdict? Is it you? Hon. Azar: (28:09) It depends on the circumstances. If it's- Ms. DeGette: (28:10) That's not going to work, if we have a pandemic. [Crosstalk 00:28:09]. Hon. Azar: (28:12) If it's in a foreign country, the ambassador of the president is the final word on representing the United States interest in that country. Ms. DeGette: (28:18) So what happened is they flew back in, 14 Americans, maybe more, who were infected with the Coronavirus. That's why someone needs to be in charge. And you know what? I think it should be you. Hon. Azar: (28:34) With respect, I want to, the Deputy Chief Of Mission had a very difficult decision to make there as they- Ms. DeGette: (28:39) I understand that. I don't need you to explain that to me. What I'm saying is this goes along, there needs to be someone who can overrule Homeland Security and State who can make these decisions for the American public based on public health and I'm hoping we can have some more hearings to talk about that. Hon. Azar: (28:57) I appreciate that. Ms. DeGette: (28:57) Dr Redfield, I want to ask you because the Chairwoman Eshoo, asked you the question about the lab tests and you said you didn't know how many lab tests are available. Do we have lab tests that will accurately test for the Coronavirus? Dr. Redfield: (29:14) Yes. Ms. DeGette: (29:15) Okay. Now, what I heard was they're limited and people have to send their tests to the CDC to be tested. Is that right? Dr. Redfield: (29:25) Presently, there's 12 jurisdictions that have the test up and running, nine of- Ms. DeGette: (29:30) 12 jurisdictions throughout the United States? Dr. Redfield: (29:30) Throughout the United States. Ms. DeGette: (29:33) And so people can send their tests there? Dr. Redfield: (29:35) They send their tests there. Ms. DeGette: (29:38) And when are we going to be able to put that everywhere? Dr. Redfield: (29:41) Well, we're working cooperatively with- Ms. DeGette: (29:43) I'm asking you. When are you going to be able to put that everywhere? Dr. Redfield: (29:48) I was trying to say- Ms. DeGette: (29:48) Do you know? Dr. Redfield: (29:49) We're working with the FDA now, we're hoping that later this week our test will be such that the first one can go, all the laboratories that [inaudible 00:29:58] can execute the current test on the modification that we do with the FDA. Ms. DeGette: (30:02) Okay. Dr Fauci, I know you're working on developing a vaccine. If we gave you more money, could we develop a vaccine more quickly? Dr. Fauci: (30:14) We would need more money to take it for the next step. We're in a phase one right now and we're okay. When we get to- Ms. DeGette: (30:20) How much more money? How much more money? Dr. Fauci: (30:24) For- Ms. DeGette: (30:24) I think you could probably get my partners in consensus. That would give you the money. Dr. Fauci: (30:28) Yeah. How much would you need for it to get it over the hill? Ms. DeGette: (30:32) Yeah, mm-hmm (affirmative) Dr. Fauci: (30:33) About 140 million. Ms. DeGette: (30:36) 140 million. Hon. Azar: (30:37) And Congresswoman, if you wouldn't mind to the emergency supplemental would actually dedicate $1 billion for vaccine. Just that's part of the detail we'll be working with the committee on. Ms. DeGette: (30:47) Okay. I just want to say one more thing because my time is up and I know that Congresswoman Schakowsky is going to ask you some questions about the supplemental. I just want to say that even minority leader McCarthy today said we need at least $4 billion and we shouldn't be shifting money away from Ebola and other diseases into trying to deal with this Coronavirus. We need to work on all fronts at once. And I thank you for your comment and I yield back. Ms. Eshoo: (31:15) Gentlewoman's time is expired. The gentleman from Kentucky, Mr. Guthrie is recognized for his time. Mr. Guthrie: (31:23) Thank you Madam Chairman. Thank you for all being here. And just so everybody knows, we've been having these meetings if they're not been formal hearings, bipartisan with several of you over time. And I remember when we first started meeting about this might have been Dr Fauci, who said it, I don't want to put words in your mouth if you didn't, but we are going to prepare for a pandemic. Mr. Guthrie: (31:39) That's what the American people expect us to do. We're going to prepare for a pandemic, we're going to put things in place for pandemic and hope and pray that it never comes, but we're going to get ready. And as we prepare for it, people are going to see things, hear things and maybe react that this pandemic is imminent when it may not be because we're doing what we're supposed to do. The other thing is I know the White House, the administration needs to reassure markets and market places where we are and where we stand. Mr. Guthrie: (32:06) And for everything that I've heard previously and what Larry Kudlow has said is not inconsistent is where we are. But I know that the CDC came out and talking about the pandemic to be ready for it. And Secretary Azar, if you'd like to explain this. Mr. Guthrie: (32:20) I know the CDC warn that Americans should, and I'll quote, "Prepare for community spread in the United States and should be ready for," quote, "Significant disruption." And would you explain what that means, and what it means to the average person, what that means? And what's the most important message you would like for the American people to know about the current state of America and the Coronavirus? Hon. Azar: (32:39) Our messaging from the president through to the career officials at the CDC has been consistent, but it's striking a balance. America's risk is low at the moment. That could change quickly. We are working to keep that risk low, but we have always been transparent that we expect more cases in the United States with a rapidly spreading virus, especially with what we've seen. Hon. Azar: (33:01) For the average American, there's no change in their behaviors except what we always would advise, which is practice good public hygiene, washing your hands appropriately, coughing into your arm, not touching your face with unwashed hands and appropriate preparedness activities at home. And you can go to cdc.gov for normal advice for flu seasons, hurricanes and others. Hon. Azar: (33:23) Good preparedness, good thoughtfulness at home. We're trying to be very transparent to people of the risks we face, even if we're at a low risk situation now so people aren't surprised so that they know what we're dealing with and what uncertainties we're dealing with. Mr. Guthrie: (33:39) Thank you. And so Dr Fauci and Dr Redfield for 50 days, we've learned much about the Coronavirus but much is still unknown. What is the current, as well, I know people want to know at home, what is the current scientific consensus about the transmissibility and infectiousness of the virus? And how long once you're infected will you be infected? How long can you pass it on? And what are the other remaining known unknowns? What are the things you know that you'd like to know the answer to? With Dr. Fauci and Dr Redfield or Dr Cadillac, if that's in your world. Dr. Fauci: (34:10) First of all, we know it's very transmissible virus. There are some viruses that are not efficient in going from human to human. What we learned early on, and we are convinced now given what we've seen in China and other countries, that it's a highly transmissible virus. That's the first thing. The second thing, when you say how long a person is infected after they get infected, that's something that's still up in the air and the way you get the answer to that is you try and isolate virus, what we call shedding for a period of time. Dr. Fauci: (34:43) And we know that there are individuals who are actually able to transmit when they are without symptoms, before they get symptoms. What we don't know yet, and I think we're going to get information from the group including the CDC individual and one of my people who was in China with the WHO group, what the extent of that transmissibility is from an asymptomatic person. Is it minor part of the driving of the outbreak? Or is it significant? That's going to be a very important thing that is currently an unknown. And I'll Bob, you want to take off? Dr. Redfield: (35:20) I concur with Dr Fauci. I think the biggest challenge we have right now is what is the relative infectivity whether before you get sick, are you more infectious before you get sick? Or are you more infectious after you get sick? We are tracking these patients that we do have in this country to see how long they actually have a virus that can be isolated from their respiratory secretions. Dr. Redfield: (35:45) It's probably going to be longer than many of us originally anticipated. I think at this stage we have an individual's out about 18 days from the time they initially actually got sick. So I think these are key questions and we continue to try to get the data to answer them. Mr. Guthrie: (36:01) So are there other things that you are looking to know that you know that you don't know that you're trying to find the answers to? Dr. Redfield: (36:07) I think one of the other areas from the CDCs point of view is try to understand the methods of transmission. Is it all respiratory transmission? Through droplets? Is there a fomite transmission? For example, can this virus survive on certain surfaces long enough for somebody else to come down and put their hand down and then touch their face? It's not clear right now what the relative components of say droplet transmission is to fomite transmission. Mr. Guthrie: (36:33) Thank you. My time's expired. I'll yield back. Ms. Eshoo: (36:38) The gentleman yields back. Where are we? Oh, I see. The gentlewoman from Illinois, Ms Shakowsky is recognized. Ms. Shakowsky: (36:48) Thank you. As all of you know, the World Health Organization has declared the Coronavirus outbreak, a global health emergency and our administration now has declared it a public health emergency. Secretary Azar, we've talked about this, you've heard about the Trump administration asked Congress for just $2.5 billion to combat a disease that the CDC's director Nancy Messonnier warned, could severely disrupted daily life, and could cause severe illness in the United States. So, in that request you did not, as I understand include, were not specific about surveillance for testing kids that actually work because not all of them have, and for treatment. Instead you suggested robbing $500 million from the United States response to Ebola epidemic, which actually still is raging in places. So I find it in comprehensible that you're asking for a mole hill when what we really need is a mountain of support here. Secretary Azar, yes or no. Do you agree with the president of the United States that, "The Coronavirus is very much under control in the United States," un-quote, and will quote, "Go away," un-quote, by spring. Hon. Azar: (38:27) He did not say the last part that you just said. He said, we hope it will go away with warmer weather. I hope everybody here would hope it would go away with warmer weather. The virus in the United States has been in a contained situation to date, but that can change. As Dr. Messonnier said, we expect more cases and we expect that we will see at least limited community transmission of the virus in the United States. Ms. Shakowsky: (38:54) Let me ask you another question. My hometown of Chicago reported the first human to human transmission of the Coronavirus in the United States and though the Illinois and Cook County and Chicago Department Of Public Health have expertly, I would say handled over our two Coronavirus cases. They have not received any reimbursement or financial assistance for the work they've done. Ms. Shakowsky: (39:25) I just met with the Director Of Public Health in Chicago who said they're spending $ 150,000 per week to respond to this. Will you, will the United States, be able, in the $2.5 billion be able to help local and state health officials who have already spent lots and lots of money trying to deal with us? Hon. Azar: (39:52) So yes, that is actually part of the supplemental request is to fund state and locals in addition to the 675 million FAP money they already have received for many years. Illinois of course received each year $16.3 million for exactly these activities, but we want to give additional funding through the supplemental request for those activities. Ms. Shakowsky: (40:13) Well that's really good news. Thank you. Secretary Azar, will your $2.5 billion be enough to help healthcare workers in hospitals and nursing homes or the home care workers who have to care for quarantined individuals? Hon. Azar: (40:32) In what respect are you asking? Ms. Shakowsky: (40:34) Well, I mean- Hon. Azar: (40:34) Is it salaries? Because they're already paid. I'm just curious. I want to... If there are elements we need to add to our request we'll be glad to work with congress on that. Ms. Shakowsky: (40:40) There may be a lot of additional costs that people that work in hospitals and they may have to hire more people. Is there any help that's going to be for staffing? Hon. Azar: (40:50) Would you mind if Dr Kadlec responds, Congresswoman? Hon. Kadlec: (40:53) I can just part of your question, ma'am, and that is a $350 million is dedicated for personal protective equipment that could be used by healthcare workers in many different settings. So we have that. We're stockpiling that to make it available. Should communities need that in addition to what they have on hand. Ms. Shakowsky: (41:11) Okay. Let me just finally say this. Last week, 45 of my colleagues and I sent a letter to President Trump and what we were talking about is are we going to be guaranteed on affordable treatments or vaccines that are developed? We're concerned that private pharmaceutical companies may end up having a role in this and raising the costs beyond the point that people could well afford it. Hon. Azar: (41:40) We absolutely share your passion around ensuring affordable access to medicines, but the private sector must have a role in this. We will not have a vaccine. We will not have therapeutics without the private sector candidates that they and we will have to invest in. Ms. Shakowsky: (41:53) We have paid for all of the R&D so far, right? Hon. Azar: (41:57) No, that's not accurate. For instance, the Gilead has a product remdesivir that was originally NIAH funded basic research, I think, out of university of Alabama, but they've carried forward with development. Moderna is using Dr Fauci's [crosstalk 00:42:12]- Ms. Shakowsky: (42:12) My time has expired, but if I could just reaffirm then you're saying it will for sure be affordable for anyone who needs it? Hon. Azar: (42:19) I'm saying we would want to ensure that we work to make it affordable, but we can't control that price because we need the private sector to invest. The priority is to get vaccines and therapeutics and price controls won't get us there. Ms. Eshoo: (42:31) The gentlewoman's time is expired, Mr. Secretary, thank you. I now recognize the gentleman from Michigan, former chairman of the folk committee, Mr Upton. Mr. Upton: (42:43) Thank you, Madam chair. I've got a couple of questions I hope to run through and I guess the first question ought to be directed at... First of all, thank you all 24/7 and for the briefings that we've had over the last couple of weeks as well. I guess this had to be directed first to Dr Redfield. There's a report just published now in the last hour or two apparently there's a Daily Newspaper in Korea called the Jungang Daily and they reported that there is a Korean Airlines flight attendant who serviced a number of flights between LAX and Seoul and she was confirmed to have coronavirus. They're not sure where she got it. Mr. Upton: (43:24) There's some suspicion that she had also worked a flight to Israel with that apparent tourist group that came from Korea there in the previous week. What do you know about this? Is there some communication? I hope you know something, but I know that it's a recent news, but it was published Tuesday in Korea. It's Thursday now, so just wondering what you might know about this? Dr. Redfield: (43:49) I can say that I haven't been briefed on that, sir. Normally what we would do if we had confirmed cases, obviously- Mr. Upton: (43:56) This is a Korean woman. Dr. Redfield: (43:57) Yeah, so. Mr. Upton: (43:58) 24 years old. Dr. Redfield: (43:59) Yeah, so that would be, we are interacting. We actually sent someone yesterday to embed in the Korean CDC to help facilitate communications between Korea, CDC, and our CDC, but I can tell you I haven't been briefed on that specific situation, but I will look into it and get back to you. Mr. Upton: (44:17) Okay. Second question... Does anyone else know anything more? Dr Fauci, I know that China did publish, thank goodness, the genetic sequence, which has allowed the rest of the world to try and pierce the bubble here. Moderna Therapeutics is one of the companies, I think throughout Massachusetts that is actually working on, I want to say a phase one, but I may be wrong. Dr. Fauci: (44:48) Yes. Mr. Upton: (44:51) If it's successful? How long? What can you tell us? Dr. Fauci: (44:57) We're working with the company Moderna on the vaccine platform called Messenger RNA. We're working at our vaccine research center, and we did exactly as you said, as soon as the sequence was put on a public database, we pulled the gene out for the spike protein, which is the protein that you want to make an immune response against. Dr. Fauci: (45:16) There are several steps in that, that determine the success or failure of what you're doing. And we've been able to successfully express it in this particular platform that we're going to use for a vaccine. We have shown that it's immunogenic in mice and very soon within the next month and a half to two, it's going to go into humans- Mr. Upton: (45:37) [crosstalk 00:45:37] week. Dr. Fauci: (45:37) And in a phase one study. But I think people need to appreciate because there's often misunderstanding. A phase one study we'll say was three months from the go, which was about a month and a half ago. Dr. Fauci: (45:49) It'll take about three months or four to determine if it's safe and induces the kind of response that you would predict would be protective. Once you get there, it relates to the question that I was asked before, then you go to a phase two study. The phase one study has 45 people. A phase two study has 100 or maybe even low thousands of people. Dr. Fauci: (46:13) That would take at least a six or eight months to show that it works. So from the time you push the button to go, to the time you even know it works, it's about a year to a year and a half. Then as the Secretary said, you have to partner with pharmaceutical companies to make millions and millions and millions of doses, which could also extend the time. Mr. Upton: (46:35) And that would be a vaccine? Or a remedy? Dr. Fauci: (46:38) That would be a vaccine to prevent infection. Mr. Upton: (46:42) Okay. Last question I have and I'll save this for Secretary Azar, a couple of weeks ago my colleague Debbie Dingell and I sent a letter to the administration. You were copied on it as it relates to the supply chain of companies with operations in China, specifically [inaudible 00:47:02] province. A lot of us are concerned about products that are made there. Mr. Upton: (47:06) Auto state, Michigan, we've got a lot of different things that are there. I know Apple, as an example, they fessed up, their stock price collapsed and led to the market trouble that we had this week. What type of outreach... Have you initiated outreach to companies large and small, particularly on the shortage questions as well? Because they may not want to tell you what they might know. So where are you all on that? Hon. Azar: (47:44) So as chair of the task force, we've directed a whole of government outreach to manufacturers and suppliers across not just healthcare but everywhere and Dr Han and Dr Kadlec have led the effort with regard to pharmaceutical, generic, and biologic, and device manufacturers in China and that's what Dr Han was reporting on earlier, the results of that outreach. Hon. Azar: (48:03) I'm very proactive as you know with drugs they have to report to us potential shortages, device, we don't yet have legislation on that so we're proactively probing that system. As he reported we don't yet know of any potential shortages, but we're on that because we share your concern about the risks there. Mr. Upton: (48:19) But just to follow up... Is Secretary commerce, are they working at other things? Other than beyond just drugs and devices? Hon. Azar: (48:26) Yes. Yes. With their regulated entities and their major manufacturing entities, they're working to gather information about potential shortages as they might impact the economy. The National Security Council, the National Economic Council are leading those efforts. Mr. Upton: (48:40) Thank you. Yield back. Ms. Eshoo: (48:41) I appreciate what Mr Upton raised overall, but certainly the last part of it, the whole issue of our dependence on China and that 90% of the American people take generics and that those generic drugs are manufactured in China and to a lesser degree in India, but China controls the global market on the API, the active pharmaceutical ingredients. Ms. Eshoo: (49:11) But I met with Dr Kadlec after, I think it was the classified briefing. He came to my office. What I wanted to know was do we have an inventory? Do we have an inventory of who the manufacturers are? Are any of these plants shut down? I know we asked questions about how long they can manufacture until they can't and because drug shortages are a part of this whole problem with the supply chain, but when I met with Dr Kadlec, we don't have that inventory. Ms. Eshoo: (49:51) Is that in place now, Mr Secretary. Hon. Azar: (49:53) Actually I believe that's what Dr Han briefed you on earlier. Ms. Eshoo: (49:57) We do have a inventory? Hon. Azar: (49:59) We reached out to the manufacturers. We have to do that proactively because there are not requirements, for example, state of operations that are required to report to us. Ms. Eshoo: (50:07) But if we inspect manufacturing plants, don't we know who they are? Hon. Azar: (50:12) Yes we do. Ms. Eshoo: (50:12) Don't we have a list of them. Hon. Azar: (50:13) Yes we do. Ms. Eshoo: (50:14) We do? Hon. Azar: (50:15) Yes we do. Ms. Eshoo: (50:16) What's the difference between that and the question I ask then? Hon. Azar: (50:18) So we have a list of manufacturers that have been given to us by pharmaceutical companies who manufacture both precursor product and final drugs in China, but there may be five or six for each of these drugs and they might be in different countries. Ms. Eshoo: (50:36) I see. All right. The gentleman from Massachusetts, Mr. Kennedy is recognized for his five minutes. Mr. Kennedy: (50:41) Thank you. I want to thank you all for being here. Thank you for being willing to be before this committee. I have some differences with some of you up there on our healthcare policy, but I'm grateful for your presence here and I wish you all success, so good luck to you and good luck to us all. First off, a bit of just rapidly, sir. Dr Redfield if you can. Mr. Kennedy: (51:01) I've got a two year old and a four year old and a lot of other parents of young children are nervous about this. Can you just give me a real quick answer as to parents of young kids, is there anything we people should be doing at this point or should be concerned about? Dr. Redfield: (51:15) Yeah. I want to echo what the Secretary said at the current right now, the risk to the American public is low and we would argue that they go on with their life. Our containment strategy has been quite successful, with that said, what was said also is that in light of what's happened in Korea, Republic of Korea and Italy, and Iran, and Japan, and we've seen how fast this virus can move we are encouraging people again, to just think about being prepared. Mr. Kennedy: (51:45) Okay. Part of being prepared is trying to make sure that there's as much as clear communication as to what we are confronting and how government is structured to be ready for this and to meet this challenge. I do think it's obviously, some of my colleagues have noted that despite calls to strengthen our country's pandemic preparedness, this administration- Mr. Kennedy: (52:03) ... despite calls to strengthen our country's pandemic preparedness, this administration did dismantle the federal government's pandemic response chain of command, including leadership structure at the White House through the National Security Council's Global Health Security Unit. So when you flash forward to this year and the coronavirus starts spreading throughout the world, there have been reports of this task force and Mr. Secretary, you indicate that you are in fact the head of it. I would ask just if you can to the greatest extent possible communicate what that structure looks like so that people can have some understanding as to what is backing that up. You don't have to do it now, but just as you can just to get that information out would be helpful to all of us. Mr. Kennedy: (52:35) Doctor, so moving on a bit though to try to make sure that there is not just a structure put in place, but that communication is in fact clear. Mr. Secretary would take a bit of an issue with the fact that the message is consistent. I think the message from you all up here, this panel, so far has been pretty consistent. I do have an ABC News story here that I'm going to enter for the record which quotes the president from saying directly, that is quote, "A problem that's going to go away." End quote. The President is also quoted by saying quote, "The virus we're talking about having to do, you know a lot of people think it goes away in April with the heat as the heat comes in. Typically that will go away in April. We are in great shape though." End quote. Dr. Fauci, Does this go away in April with the heat? Dr. Fauci: (53:24) The history of respiratory viruses such as influenza and other coronaviruses tend to diminish and almost disappear as you get into the summer. That's just something that happens. Every year we see that with influenza. However, underline however, this is a new virus, so we don't know what this virus is going to do. If it acts like influenza, the heat will actually make it diminish in its impact, but we have no way of knowing how it's going to act. Mr. Kennedy: (53:54) And I would say that there's different temperature gradients across this country by April. Fair enough? Dr. Fauci: (54:02) [inaudible 00:54:02] and also in different hemispheres because when we're having cold weather, others are having warm and vice versa. Mr. Kennedy: (54:08) Thank you. He's also stated that we are quote, "Very close to a vaccine." End quote. But Doctor you just laid out that best case scenario, we're still 12 to 18 months away roughly, is that right? Dr. Fauci: (54:19) Correct. Mr. Kennedy: (54:21) He said, Congressional staff briefed folks yesterday in a press conference, said quote, "It's not a question of if but rather a question of when and how many people this country will have severe illness." Almost at the exact same time the President was saying that quote, "It's going to work out fine." End quote. A problem that's going to go away. Dr. Redfield, does the CDC agree that this is a problem that is going to go away without an intervention? Dr. Redfield: (54:49) I think it's important to recognize that from time to time new pathogens come from animals and get into the human species. Clearly this is one of those times when we've got a new respiratory pathogen that is come into the human species. And I think it's prudent to assume that this pathogen will be with us for some time to come- Mr. Kennedy: (55:11) Dr. Kadlec. Dr. Redfield: (55:11) And as Tony said, we don't know the cycle of it. We don't know how it's going to, if it's going to be impacted by humidity and heat, but I think we should assume that this virus is going to be a virus that we're going to be challenged with similar to the other viruses that we have that are respiratory. Mr. Kennedy: (55:30) Doctor, thank you. I've got 10 seconds left for the rest of the panel. Yes or no? Agree with Dr. Redfield. Mr. Kadlec? Mr. Kadlec: (55:34) I support Dr. Redfield's view. Mr. Kennedy: (55:38) Mr. Secretary? Secretary Azar: (55:40) The President's expressing confidence, this team, the public health infrastructure in this country, state and local, that we can deal with this. We will prepare for this. We will work together on this. He's trying to call a public that we see in China, panic can be as big of an enemy as virus in these situations. And so there is always that balance. Mr. Kennedy: (55:57) Mr. Secretary, I don't want a panic over this either. The stock market's crashing, he's trying to stop a stock market. He's not trying... He's outright contradicting everything that you all have just said. Outright contradiction. Secretary Azar: (56:08) I think he's expressing confidence in- Mr. Kennedy: (56:10) With no medical basis for it. That's what you've just explained to us. Come on sir. Secretary Azar: (56:15) He's expressing that the American people need to take a breath here, that there's no change to anyone's daily life from this, that the country has a plan. We have pandemic plans, there's a playbook for this and we're executing against that. But we have to be realistic also and transparent that we will have more cases. Mr. Kennedy: (56:34) And sir, as head of the head of HHS, do you agree with the President's statements as I quoted, "The virus that we were talking about having to do, you know that it will go away with the heat." Speaker 1: (56:43) We got to go, we got to go. Chairwoman Eshoo: (56:44) The gentleman's time has expired. Do you want to answer that quickly? No, I didn't think so. You're doing a great job for the President, Mr. Secretary. It's a pleasure to recognize the gentlewoman from Indiana, Ms. Brooks for her time. Ms. Brooks: (56:58) Thank you Madame Chairwoman. And thank you all so very, very much for being here and for your work day in and day out on behalf of not only our country but on behalf of the world. And I'd like to remind my colleagues that in November of '19 the United States of America was ranked number one in global health security, a global health security index conducted by John Hopkins of 195 countries. We are leading the world. Now, that doesn't mean that we can't always continue to improve and that's what PAHPRA, which was passed, signed into law in June, did. It actually took care. It focused on vulnerable populations like children, like the elderly. We added a lot of new things to that. Ms. Brooks: (57:38) One of the things though that I am concerned about is the flexibility of the funding and whether or not we introduced an infectious disease rapid response reserve fund. 85 million was put into that fund. We have 705 million in strategic national stockpile fund. We have all of these. How much flexibility is there or do we need to give you more authority Mr. Secretary very quickly to have more flexibility to be able to not focus on Congress, having to do supplementals all the time. How much more flexibility do you need? Secretary Azar: (58:12) Well the infectious disease rapid response fund has been critical for us. The flexibilities in the strategic national stockpile, critical to us, the emergency supplemental, the most flexibility that you could give us there as we deal with the situation as it evolves. We would appreciate that also. The challenge with setting up longterm funding mechanisms that are indefinite is they can become slush funds for any other priority as opposed to concrete real public health emergencies. I think that's always been the challenge Ms. Brooks: (58:40) And if you find that you need more funding for any of these funds, will you come back and ask for more funding? Secretary Azar: (58:46) Absolutely, and I want to emphasize the 2.5 is at least 2.5. It's for 2020 only and we will come back if we need more and we will work with Congress if Congress wishes to give more. Ms. Brooks: (58:56) Dr. Kadlec, with respect to those strategic national stockpiles, which I believe you oversee in conjunction with the CDC, is that correct? Mr. Kadlec: (59:04) Yes ma'am. Ms. Brooks: (59:05) What is the status of our strategic national stockpiles? Which can you quickly say what those are? Mr. Kadlec: (59:12) Sure. It's a variety of countermeasures that deal with chemical, biological, radio, nuclear capabilities as well as for pandemic influenza. We have a supply of personal protective equipment that we have on hand. We have sent out a solicitation to get more, but the answer is we have a whole range of things- Ms. Brooks: (59:28) And these are undisclosed locations throughout the country, are they not? Mr. Kadlec: (59:32) That's correct. Ms. Brooks: (59:32) And at this point is the strategic national stockpile sufficiently funded? Mr. Kadlec: (59:38) Ma'am, I think the thing is, is at this point I'm in light of what the requirements are, we've been given at least in terms of what is in the supplemental request, another $400 million. That would be a great benefit to help us address any kind of shortfalls for this event. Ms. Brooks: (59:52) Last week when I was home, I learned from a local public health official in Indiana that an individual from this county had traveled from China and interestingly enough had come through the Chicago airport. And the Chicago airport officials notified this public health official, said this person is coming home to quarantine, which I thought... And she appeared at this individual's home within 24 hours of that person coming through the Chicago airport. I thought that was awesome. It was excellent that that kind of coordination happened. How did that happen and is that happening all across the country? And this individual is going to cooperate with the local health official, provide their temperatures for a couple of weeks. Is this happening all across the country? Mr. Kadlec: (01:00:39) Yes. Ms. Brooks: (01:00:40) And how many do you have... Who at the airports is notifying local health officials? Mr. Kadlec: (01:00:45) So what happened when the original travel restrictions were put in for China and Hubei, if you were coming into the United States, American citizen or a family member, or a permanent resident, in Hubei you were required to go into 14 days of quarantine. That quarantine could have either been institutional or that quarantine could have been in your home working with the health departments. And that's really how we've operationalized. Mr. Kadlec: (01:01:11) But if you'd been from China, the requirement was that when you came through you were screened, you were given an education card, provided you had no symptoms, telling you about the risk and what the symptoms are and the contact information with your local health department. And you in conjunction with your local health department were going into what we called voluntary monitoring and isolation, and that woman that you gave the example was did exactly as we instructed and they were instructed as they went through Chicago O'Hare airport. Ms. Brooks: (01:01:42) And so actually it was my local public health official that was incredibly impressed that she had received this information. The young man and his family are monitoring. Madame Chairwoman, I'd like to enter into the record, CSIS produced a report in November of '19 about US global health security, making sure we're ending the cycle with a number of recommendations. You and I serve on that commission. Would ask that that be entered into the record. Chairwoman Eshoo: (01:02:06) So ordered. Ms. Brooks: (01:02:07) With that I yield back. Chairwoman Eshoo: (01:02:08) Gentlewoman yields back. The gentleman from California, Mr. Ruiz, is recognized for four minutes. And for those that are left, there's an agreement that it's four minutes because the panel is getting nervous about time, so let's honor that. Okay? Thank you. Mr. Ruiz: (01:02:26) Thank you for being here today. I want to discuss a very important issue for local agencies and I know many other members are hearing as well. That's funding and reimbursement for monies that our counties and public health departments have spent upfront to help fight the spread of the coronavirus. I'm a disaster trained emergency physician, public health expert, and in disaster or epidemic preparedness, rapid reimbursement is a matter of readiness capacity. I think we can all agree that a lot is being asked from the public health infrastructure in our states. They're stepping up, they're coordinating, they're doing the right thing. Mr. Ruiz: (01:03:05) On January 29 a flight carrying 195 Americans from Wuhan China was diverted in March Air reserve base in Riverside County. The County that my district is in. Riverside County responded efficiently and was effective in monitoring and quarantining all of these passengers for 14 days. Over 40 County officials worked on this project. In addition, the county supplied food, transportation, quarantine supplies, screening, housing, a mobile health clinic, emergency management standby and support services for ambulance. All told these efforts are estimated a little over a 1.3 million dollars. And while that flight quarantine is over, the broader response continues in Riverside and in communities across the country. Mr. Ruiz: (01:03:45) So receiving rapid reimbursement is critical to capacity readiness in the future. If you drain resources without replenishing them, you won't have necessary resources to fight this public health crisis, such as bedside diagnostics, personnel en masse, just to name a few. And also having the resources to create preparedness plans, quarantine plans, et cetera, in the case of rapid transmission of this virus in the future. So I want to ask a question. Dr Redfield, what are the funds that are available to reimburse state and local officials for their efforts responding to Corona virus? Dr. Redfield: (01:04:20) I'll defer some of this to the Secretary, but I think he said in the supplemental, a substantial portion- Mr. Ruiz: (01:04:25) Okay, so you're telling me... The last time we spoke, you identified somebody in your staff, mentioned a few, now you're saying those funds don't exist, we need to pass the supplemental to reimburse counties. Is that what I'm hearing from you? Secretary Azar: (01:04:40) So we have the [FEP 01:04:41] which funds California at $41 million a year, but the supplemental has requested $757 million from CDC- Mr. Ruiz: (01:04:46) Wait, so which- Secretary Azar: (01:04:48) Which would have in that the state, the state and local funding- Mr. Ruiz: (01:04:51) Are there funds right now that counties can apply for? Secretary Azar: (01:04:53) No, there are not. Mr. Ruiz: (01:04:54) There are no funds- Secretary Azar: (01:04:55) No additional to the emergency funds that they get each year for these activities. Mr. Ruiz: (01:05:01) All right. Secretary Azar: (01:05:02) That's what the [inaudible 01:05:02] is for. Mr. Ruiz: (01:05:02) Well, we're definitely going to work on that and that's an issue, right? Because we are under the impression that there were, and rapid reimbursement is a matter of readiness capacity. If we don't rapidly reimburse, our local agencies will not be ready to deal with a potential rapid spread of the virus. Dr. Kadlec, Dr. Redfield, yes or no, can we get a commitment from you both here today that you will reimburse these expenses by local municipalities for the cost associated with containing the spread of the coronavirus? Dr. Redfield: (01:05:33) Well, we're clearly going to work to see how to get that done. Mr. Ruiz: (01:05:36) Okay, so that's not a commitment. Kadlec? Mr. Kadlec: (01:05:39) I think the thing is is we're committed to basically work with you to do that. Mr. Ruiz: (01:05:44) We need to reimburse because especially in rural areas where they don't have the resources, they don't have the hospitals, the quarantine spaces, the ability to get them the supplies over to those areas. You're putting them in vulnerable situations if you don't respond. Dr Redfield, since 2008 local and state health departments have lost nearly a quarter of their workforce. Does this affect our nation's ability to mount and sustain a response? Dr. Redfield: (01:06:08) I think it's one of the key core capabilities that we need to continue to improve for our public health ability. That is the data and data modernization, which you all have helped with last year, the laboratory capacity to build it and keep it fluid as you see with the current diagnostic test. And the third most important one is the workforce to build that workforce. Mr. Ruiz: (01:06:28) Listen, work within that team, be consistent, no discrepancy. Discrepancy breeds anxiety. That brings panic. Okay. All right. Chairwoman Eshoo: (01:06:37) The gentleman's time has expired. I wanted to get a commitment so that these agencies don't lose the money that they're losing. You're asking them to promise you even beyond where the cuts are, so I'd be happy if that could happen, but we've got... The Congress has a job to do to restore the money in these agencies. These cuts are really shameful. They really are. And when we have such premier agencies, people at the top that know what they're doing, and they're being cut. And the Secretary's telling us, said, "Well, we did 1.5 billion. Everything is going to be fine." I don't think so. Dr Bucshon from Indiana. Dr. Bucshon: (01:07:23) Yeah. Thanks for the five minutes. I appreciate it. No, four minutes. I'm just kidding. I mean in reference to the funding, I just want to, I mean the Congress provides funding for the agencies and a budget proposal is a budget proposal no matter which President it comes from. So I'm not too worried that this Congress won't provide the appropriate level of funding and I understand also that additional funding, if we could quickly bring up the supplemental and pass that, that clearly in my opinion would help. Secretary Azar and all the people at this table do their job and get money to everybody. Dr. Bucshon: (01:07:56) The other thing is, I just want to comment briefly on the criticism of the president and what he has said. If the President of the United States comes out and incites a panic in the United States and incites a worldwide panic, and I see the role of the President as different than mine or secretary Azar's or others. And even though the President says what he says, I do think having a calming effect in a situation like this is appropriate and allow the professionals behind the scenes to do their jobs. I just wanted to say that. And- Secretary Azar: (01:08:30) And if I could I, I agree entirely. I think the President's role has been actually critical and keeping the country calm in this situation. He's expressed the levels of doubt and uncertainty with his words that we have, but also tried to be reassuring to the American public as we also try to be transparent about what the risks are coming forward. We all have different roles to play here, as you said. And the President's is a very important one, guiding towards balance, maturity and calm in addressing a public health emergency. Dr. Bucshon: (01:08:59) I would agree. I mean, if the President came out and incited a panic, he'd be criticized for that. So I guess, we had this unprecedented containment strategy when things were in China. Now that we know we've had problems with person to person transmission in Italy and South Korea and maybe other places, does that change our current containment strategy. And Dr. Redfield, maybe you can address that or... Dr. Redfield: (01:09:24) Yeah, I would say first that we are maintaining aggressive containment. I want to say that of all the strategies we've used in this multi-layer strategy, the most important one that we have is an astute medical and public health community in the United States. Of those 14 cases originally that were diagnosed, all but one, only one was picked up by the screening. So we're now moving obviously to educate the American medical and public health community that it's not just China we have to worry about now. We have to worry about certain places of Italy and Iran and whether it's Republic of Korea. So we're continuing with that and we're continuing to look at our travel alerts. We've put a travel alert to level three now for Korean, level two now for Italy, Iran, and Japan. So trying to let the American public know this may not be the time to go to those areas. Dr. Bucshon: (01:10:13) Okay, great. And again, Secretary Azar, you have anything to add to that? Okay. For again Dr. Redfield, as far as the testing goes, the CDC, 12 other public health laboratories, have the testing. But I guess they had some difficulty with the third reagent in the test. And can you further explain the problems with the test and have those problems been resolved? Dr. Redfield: (01:10:34) So first the test really measured three different, let's just say three different nucleic acid pieces. And one of them had a control, the third one had a control, and in that control there was low level contamination. There was never any question about whether the test could tell positive or negative. It just had a group of individuals that we had to say, "We didn't know." Dr. Bucshon: (01:10:57) Okay. Dr. Redfield: (01:10:58) And those samples again were at CDC. CDC's continued, we've doubled... I found out where it's 350 to 500 samples a day. When the question was asked earlier that we're running right now- Dr. Bucshon: (01:11:09) So the problem has been resolved basically? Dr. Redfield: (01:11:10) Problem's being resolved. We work with the FDA and we have a fix that's supposed to be operationalized this week. Dr. Bucshon: (01:11:16) One other quick thing. Have you guys conducted disease modeling for potential COVID-19 outbreak in the US? Dr. Redfield: (01:11:23) We do have modeling groups. It's a global modeling group that's looking at a variety of different models and that's in process. As Tony said earlier, there's still a number of things we don't quite know about this virus to make those models available for prime time, but we are working at- Dr. Bucshon: (01:11:39) You're working on it. Okay. Thank you very much. I yield back. Chairwoman Eshoo: (01:11:43) The gentleman yields back. I think that concludes the questions that we have for you today. Thank you to each one of you, Mr. Secretary, you've been here for many hours and you know, throw a punch, take a punch, right? But we're all here for our fellow Americans. For our fellow Americans. And I think if there's anything that's come out of this today, we want facts, we want to bring the temperature down, we want to bring the fear factor down, and anything and everything that you can do in order to achieve that as we move on with Dr. Fauci's work with larger distribution of the diagnostics through the CDC in partnership with what we have across our country, is going to go a long way. So thank you to each one of you. I'm not going to adjourn. You can get up and leave while I read a very long record of items that need to be placed- Speaker 2: (01:12:51) Thank you Chairwoman. Chairwoman Eshoo: (01:12:53) Into the record. Thank you. God bless you and your work on behalf of the American people. Thank you. Chairwoman Eshoo: (01:13:01) All right, I'm going to request a... I have a unanimous consent request to enter the following documents into the record. Chairwoman Eshoo: (01:13:10) A June 28th letter from four House committees to HHS and CMS regarding the case Texas vs the United States. Chairwoman Eshoo: (01:13:18) A December 20 18th letter from four House committees to HHS and CMS regarding the case Texas vs the United States. Chairwoman Eshoo: (01:13:28) An April 20 19th letter from five House committees to HHS and CMS regarding the case Texas vs the United States. Chairwoman Eshoo: (01:13:37) A February, 2020 letter from HHS in response to the April, 2019 joint letter from five House committees regarding the case Texas vs the United States. Chairwoman Eshoo: (01:13:53) The committee actually is still in order. I wanted the witnesses to be able to leave, but if anyone wants to gab, take it into the side room so that I can read these into the record. Please. Chairwoman Eshoo: (01:14:06) February, 2020 letter from HHS and response to the April 20 19th joint letter from five House committees regarding the case, Texas vs the United States. Chairwoman Eshoo: (01:14:17) An October 20 19th Washington post article entitled Trump campaign urges White House to soften proposed flavored vape ban unquote. Chairwoman Eshoo: (01:14:29) An October 20 19th bicameral letter to HHS from two Congressional committees regarding the increased number of uninsured children in the United States. Chairwoman Eshoo: (01:14:39) A June 20 19th letter from the energy and commerce committee examining HHS's administration of the Medicaid program. Chairwoman Eshoo: (01:14:48) A statement from Johnson & Johnson regarding the company's response to the coronavirus outbreak. Chairwoman Eshoo: (01:14:54) A statement from the American Society for Microbiology regarding the coronavirus outbreak. Chairwoman Eshoo: (01:15:01) A February, 2020 article from BioCentury entitled quote, Biopharma Industry Academics Push Back Against Demands for Price Controls on COVID-19 Countermeasures, unquote. Chairwoman Eshoo: (01:15:16) A January, 2020 Wall Street Journal opinion piece entitled quote, Pharma to the Rescue, unquote. Chairwoman Eshoo: (01:15:24) Are there any objections? Speaker 3: (01:15:26) No objections. Chairwoman Eshoo: (01:15:26) Without objection so ordered and the Committee will now, Subcommittee will now adjourn. Thank you everyone. Speaker 4: (01:15:34) Exactly. Then I do all that shit. There's like [inaudible 01:15:46].