| Speaker | Time | Text |
|---|---|---|
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unidentified
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Democracy. | |
| Great responsibilities fall once again to the great democracies. | ||
| American democracy is bigger than any one person. | ||
| Freedom and democracy must be constantly guarded and protected. | ||
|
unidentified
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We are still at our core a democracy. | |
| This is also a massive victory for democracy and for freedom. | ||
|
unidentified
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Health care providers, insurance industry representatives, and patient advocates testified on efforts to modernize the U.S. health care system. | |
| The hearing was held by the House Ways and Means Subcommittee on Health and included questions on innovations in medical treatment, the importance of preventative care, and what effects proposed cuts to Medicare and Medicaid could have on patients, researchers, and providers. | ||
| Subcommittee come to order. | ||
| Good afternoon. | ||
| Thank you to our witnesses for being here today to discuss a crucial issue before us, modernizing American health care, creating healthy options, and better incentives. | ||
| Chronic diseases such as cancer and cardiovascular disease are skyrocketing. | ||
| Six in ten Americans have at least one of the two chronic diseases. | ||
| According to partnership to fight diseases, the projected total cost of chronic disease from 2016 to 2030, in terms of Florida anyway, was $3 trillion. | ||
| These statistics are baffling and troubling, and I'm committed to helping lower the cost on some of these deadly diseases. | ||
| This nation's chronic disease epidemic is out of control. | ||
| I, for one, am excited that Mr. Kennedy has put this on an issue at the top of the administration in terms of his vision. | ||
| I'm also very excited to say that this committee is spearheading hearings and markups that will be helpful to lead forward better health results and outcomes of Americans throughout this country. | ||
| Congresswoman alone will represent but govern Evans and Fitzpatrick into introducing legislation to establish a pilot program through Medicare to provide medically tailored meals to seniors. | ||
| I was happy to see that this is important. | ||
| This important initiative was introduced by American Medical Innovation and Investment Act that passed out of this committee. | ||
| Since the last subcommittee hearing, I had the pleasure of meeting with numerous groups committed to fighting these issues, covering the majority of injured lives at 180 million lives. | ||
| Employers are one group that can help make a difference in terms of the chronic diseases. | ||
| In fact, 72% of employers saw reduced health costs after starting a wellness program in their own firms. | ||
| Last week, Congressman Pinelli and I introduced the Chronic Disease Flexibility Coverage Act. | ||
| This important legislation allows for employers who offer high deductible plans coverage for their employees and the options of including pre-deductible coverage for services that treat chronic illness. | ||
| At the end of the day, we can be empowered to take charge of our own health through key flexibilities, including a health savings account that can make a difference. | ||
| We have another skyrocketing crisis on our hands, skyrocketing in terms of diabetics and obesity. | ||
| Over 45 percent of our nation adults are obese, and in fact, 20 percent of the kids are. | ||
| Joint economic committee led by Congressman Swiker is talking the obesity epidemic seriously. | ||
| In fact, in a recent report, the committee found that obesity will result in up to $1.9 trillion in excess medical expenditures and cause the federal government to spend $4.1 trillion over the next 10 years. | ||
| To bring awareness to these issues, Congresswoman Glynn Moore and myself have set up a caucus that are going to focus on this. | ||
| I'd like to thank Congressman Moore for joining me in this critical effort and timing. | ||
| Congressman Smucker also recently launched the Baja caucus to focus on supporting Americans in living long and healthy lives through access to affordable high care foods, which will make a difference. | ||
| These are just some of the many things, great works we're doing is on a bipartisan basis on this committee. | ||
| We are about to hear from a great group of folks who are on the front line in terms of employees and their customers. | ||
| I look forward to working with all my colleagues this Congress to tackle this epidemic. | ||
| I'm pleased to recognize the gentleman from Texas, Mr. Doggett, for his opening statement. | ||
| Thank you so much, Mr. Chairman. | ||
| You know of my respect for you personally and of your interest in this important topic from the subcommittee hearing that you held only a few weeks ago on healthy lifestyles. | ||
| My concern today is that under this new administration, it is the lifestyle of the very rich and famous that seems to be the only thing of concern. | ||
| The health care agenda that is being pursued outside of this hearing room represents the real skyrocketing crisis in this country. | ||
| It's one that will leave Americans less healthy, paying even higher prices, and suffering from preventable diseases. | ||
| Today is not the time for business as usual when nothing usual is happening. | ||
| As we hold this hearing, Republicans are preparing legislation this very week to cut care, to cut significantly in health care, to pay for even more tax breaks for the very rich and famous and multinational corporations. | ||
| Outside the halls of this Congress, the Trump administration continues to deny federal funds to innovative scientific researchers who are developing the miracle cures and cures, treatments and cures that customers need. | ||
| There is a delay in funds to community health clinics that treat vulnerable children and seniors. | ||
| We've seen layoffs, hiring freezes, offers to buy out remaining workers, all worsening what was already a health workforce crisis. | ||
| The conspiracy theorists, nominees to lead the health agencies, threaten the return of polio, measles, and more. | ||
| Important public health data on topics ranging from youth mental health to vaccinations to contraception are disappearing from federal websites. | ||
| In a true McCarthy era type fashion, this administration is developing target lists of workers to fire and banned words that are being prepared on lists on supposedly controversial research topics like women, while apparently it's fine to continue research on men. | ||
| I would appreciate an explanation for the behavior of the unelected man who is illegally infiltrating and dismantling our government. | ||
| It turns out that Trump had more than a concept of a plan, as he described it, for health care. | ||
| He is swiftly executing what is nothing less than a wide-scale siege. | ||
| I've heard from literally hundreds of concerned citizens deeply troubled by this assault on their health care and about the violation of Americans' data privacy. | ||
| Cancer patients that are fighting for their lives who are terrified that the clinical trial they were depending upon has been paused. | ||
| and soon-to-be-approved treatments to be halted. | ||
| Researchers developing those treatments with grant applications indefinitely on hold. | ||
| Labs on the brink of closing and looming layoffs. | ||
| Overburdened VA clinics unable to hire more surgeons, cardiologists, psychiatrists, and other health care patients to care for our vets. | ||
| As Trump, Musk, and the Musketeers continue to ignore the Constitution and the laws, engaging in what one federal judge recently said was the danger of irreparable harm, I would hope that my Republican colleagues would offer some check and help us restore the balance of power. | ||
| Instead, they seem to be enabling this agenda with their silence, confirming his nominees, and readying a bill that will throw nursing home residents out, deny vulnerable children inhalers and EpiPens, and leave pregnant women without any coverage to assure safe and healthy delivery. | ||
| All of this to further enrich Mr. Musk, the fossil fuel executives polluting our planet and our health and the Trump family. | ||
| This particular hearing is well-intentioned and of great interest to me. | ||
| My own daughter, Dr. Lisa Doggett, is board certified in lifestyle medicine. | ||
| It is an important topic, but these choices cannot stop every dreaded disease or accident. | ||
| What will guarantee the worst health outcome is a lack of comprehensive, affordable coverage and inaccessible physicians and nurses. | ||
| I'm eager to see progress on today's topic and so many others, but first, we must stop the severe harm being done by the Trump must-duo. | ||
| I would, Mr. Chairman, also ask to enter into the record a few statements that we've received expressing the same concern I've just voiced: one from the Federation of American Hospitals in support of Affordable Care Act premium tax credits, a statement from Keep Americans Covered in support of the Affordable Care Act credits, a statement from the American Association of Medical Colleges concerned with research funding cuts. | ||
| Finally, letters that we as Ways and Means Democrats have sent to the Treasury Department, the CMS, and the Acting Inspector General since Trump fired the Inspector General at HHS concerning Mr. Musk's alarming infiltration of payment systems and access to Americans' private data. | ||
| And I would offer them at this time. | ||
|
unidentified
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Without objection, so ordered. | |
| Thank you, and I yield back. | ||
|
unidentified
|
Thank you. | |
| I will introduce our witnesses. | ||
| Brooke Teigen is CEO of John Hancock Financial. | ||
| Jay Carlson is OBGYN and clinical chair of the Mercy Clinical Research. | ||
| Marcy Sross is a small business owner and partner at Capital Benefits. | ||
| Leslie Dock is founder and co-chairperson of Protect Our Care. | ||
| Thank you all for joining us today. | ||
| Your written statements will be made part of the hearing record, and you have five minutes. | ||
| If you can try to keep your remarks to five minutes, we'd all appreciate it to deliver your oral remarks. | ||
| Mr. Tingle, if you're ready, go ahead. | ||
| Good afternoon, Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee. | ||
| Thank you for the invitation to participate in today's hearing. | ||
| I am Brooks Tingle, President and CEO of John Hancock. | ||
| While John Hancock offers a range of financial products, I'm here today to talk about life insurance solutions and an innovative approach that we're taking to help our customers live longer, healthier, and better lives. | ||
| Simply put, life insurance companies make money by collecting premiums, investing those premiums, and then at some point down the road, we pay a claim. | ||
| Generally, the longer a customer lives, those funds stay invested and the more the life insurance company stands to earn. | ||
| For this fundamental economic principle alone, life insurers have a vested interest in their customers living longer and healthier. | ||
| Given this incredible alignment in interests between our company and our customers, it occurred to us how very odd it was that the life insurance industry had made virtually no effort to try to help its customers achieve better long-term health outcomes. | ||
| So, 10 years ago, we introduced John Hancock Vitality, a program rooted in behavioral science that offers our life insurance customers tools, resources, incentives, and rewards to help improve their long-term health. | ||
| Here's a quick summary of how it works. | ||
| Customers who choose to participate can download the Vitality app and earn points for simple, everyday activities that correlate with a longer and more healthy life. | ||
| This can include things as simple as daily walks or other physical activity, buying fresh produce, preventative health visits, getting a good night's sleep, and a range of other healthy activities. | ||
| These points add up to a status level in the program, bronze, silver, gold, and platinum. | ||
| And the more points you earn, the higher your status, which drives two important things. | ||
| One, the level of premium discount you enjoy on your life insurance. | ||
| And two, the value of a range of discounts and rewards from a variety of partners in the program, including discounts on healthy foods, fitness gear, and much more. | ||
| We continuously enhance the Vitality program with the latest tools and technology to help our customers understand their health so they can make more informed choices. | ||
| Most recently, we've had a particular focus on innovations in screening and early detection. | ||
| In 2022, we became the first life insurer to partner with GRAIL, offering customers discounted access to their gallery multi-cancer early detection test. | ||
| As a result, many of our customers have learned of a cancer diagnosis earlier than they otherwise would have and hopefully will have better outcomes. | ||
| We appreciate the Ways and Means Committee's unanimous support of the multi-cancer early detection Medicare bill last year and hope it gets over the finish line this Congress. | ||
| The life insurance industry is in an amazing position to engage our customers and help them live longer, healthier, and better lives. | ||
| Whereas others who have a vested interest in the health of Americans, like health insurers, employers, and many others, may have relationships with individuals that last only a few years, our relationships with our customers average decades. | ||
| Indeed, not long ago, we paid a claim where the individual had been a customer for 99 years. | ||
| This gives us the opportunity to realize the long-term financial benefits of investments in things like prevention and early detection. | ||
| The life insurance industry should want to see improved long-term health outcomes and is in a unique position to help achieve those outcomes. | ||
| So, we've been doing this for 10 years now. | ||
| What have we learned? | ||
| First, and I think most importantly, properly designed programs can result in improved health outcomes at the population level. | ||
| Second, education is important, but combining it with incentives and rewards makes for even better outcomes. | ||
| Next, there continues to be an amazing amount of progress in personal health technology, and that's a critical part of success in this area. | ||
| And lastly, on a bit of a fun note, gamification really works in this space. | ||
| So there are many other learnings, including the important role of behavioural science I'm happy to share during the question and answer period. | ||
| At John Hancock, we have seen firsthand the transformative power that an organization can have when it comes to empowering customers to make small but increasingly meaningful changes in their day-to-day lives. | ||
| As we know, most health care is spend today is for treatment. | ||
| We are excited to be investing in prevention and early detection, which in the long run can save the government and others significant money. | ||
| We share the subcommittee's vision and look forward to working together in the common pursuit of helping Americans live longer, healthier and better lives. | ||
| Chairman Buchanan, Ranking Member Doggett, and members of the subcommittee, thank you for your time this afternoon and I welcome your questions. | ||
| Thank you, Dr. Carlson. | ||
| You're now recognized. | ||
| Thank you, Chairman Buchanan, Ranking Member Doggett, and distinguished members of this committee for the opportunity to be here today. | ||
| My name is Jay Carlson. | ||
| I'm a board-certified gynecologic oncologist and currently serve at the St. Louis-based Mercy Health System as the medical director of their oncology service line and the clinical chair for Mercy Research. | ||
| I'm a founding member of Mercy's Center for Precision Medicine, or what I might refer to as CPM, during this presentation. | ||
| Mercy is the 15th largest health system in the U.S. | ||
| It's a community-based system, primarily in Missouri, with hospitals and clinics in Illinois, Kansas, Oklahoma, and Arkansas, with about 5,000 practicing providers. | ||
| It serves almost 3.6 million patients in the state of Missouri alone. | ||
| It is Mercy's strategic goal to use the best-in-class genomic testing and artificial intelligence to screen and detect at-risk patients earlier in their disease course. | ||
| To support this strategic initiative, Mercy established a Center for Precision Medicine to serve as the subject matter expert on genomic testing and the implementation of state-of-the-art screening. | ||
| One example of our screening initiative is a program focused on hereditary cancer risk. | ||
| This risk is linked to an autosomal dominant mutation, which means that first-degree relatives have a 50% chance of inheriting that same deleterious mutation. | ||
| These mutations and their transmission make a single patient's issue a family problem. | ||
| The significance of this becomes evident when some of these mutations are associated with a 40 to 80 percent lifetime risk of cancer. | ||
| The screening tool for discerning who should be tested are based on well-established guidelines with the National Comprehensive Cancer Network, and typically these are covered by insurance when NCCN criteria are met. | ||
| The NCCN has also identified heightened screening tests or prophylactic surgeries that can be performed for these patients to reduce or mitigate their risk for a similar cancer. | ||
| Because of its complicated nature, a lot of health systems do not have a coordinated system-wide effort for these patients who are at exceedingly high risk of cancer. | ||
| To support this effort, Mercy completed website development that gives patients access to a hereditary cancer screening tool and then digitally hands the at-risk patients off to that CPM team. | ||
| We also send out smart techs to patients that link back to that survey and, again, to the CPM team if they have a problem. | ||
| The patients identified to have a deleterious mutation are further handled by the CPM team for counselling and testing and coordination of their care until they're ultimately handed back to their primary care providers. | ||
| Mercy also has an integrated vendor for genomic assays that's made it much easier for our providers to order these genomic tests and track their results. | ||
| In the last two years, our oncologists have Tripled their utilization of these genomic tests to drive targeted therapy for oncology patients. | ||
| Mercy has also implemented the broad multi-cancer early detection test that's already been previously endorsed and reviewed by this committee. | ||
| Therefore, I'm not going to speak to the test, but really our implementation of this test across a big health care system. | ||
| We knew that to implement this, that we needed to have provider education and patient education, and that that deployment would also rely on the Center for Precision Medicine team. | ||
| We felt that this was an important test for our community because some of our hospitals are close to the Coldwater Creek community, a community in North St. Louis County that's associated with a higher risk of cancer from their radioactive waste being stored there. | ||
| So we put on virtual educational meetings with providers to review the science. | ||
| We developed an extensive patient-facing website for the MCD test. | ||
| We developed a separate intranet for our providers to supplement their education. | ||
| And then we leveraged our AI algorithms to identify a high-risk cohort of patients. | ||
| We've been using this for targeted marketing. | ||
| We've been using this process for two years and approximately 3,000 patient provider referrals as well as more than 9,000 self-referrals through the website. | ||
| For those that receive a positive test, we have virtual same-day review with myself and two other providers and providers, excuse me, for patients that are treated within our health care system. | ||
| Their diagnostic evaluations were completed in a meeting of 15 days. | ||
| A couple closing comments. | ||
| The current approved screening tests have been available for years. | ||
| They're well ingrained in medical training and practice. | ||
| We believe that these screening tests of the future will be much more complicated, frequently involved a combination of AI and some type of omics assay, making them clearly different than our historical standards. | ||
| As we've already experienced, many providers will be unfamiliar with these potential tests in their science and the use of predictive algorithms behind them. | ||
| By engaging the precision medicine team, we were able to offer these services as a concierge lift to our providers and that that CPM team bridged the knowledge deficit and became the content experts. | ||
| In summary, Mercy continues to explore new tests and services that combine the science of genomics with the new benefits of AI and deploy them at scale to aid in the screening, the accurate diagnosis, and the precision treatment of our patients to improve their overall quality of care. | ||
| Thank you and look forward to your questions. | ||
| Thank you, Ms. Strauss. | ||
| You are now recognized. | ||
| Chairman Buchanan, Ranking Member Doggett, and members of the committee, thank you for the opportunity to testify today on behalf of millions of small business owners across America who, like me, are passionate about building stronger, healthier communities. | ||
| My name is Marcy Strauss, and I'm a small business owner and benefits consultant in Des Moines, Iowa. | ||
| I've worked with small businesses for over 20 years, helping them navigate the complex world of health care benefits and designing the best possible benefits packages to keep their employees healthy and their business competitive. | ||
| My journey is personal. | ||
| I am a mom of three incredible kids, Sid, Ella, and Libby. | ||
| My twins were diagnosed with a neuromuscular disease at age seven. | ||
| My entire perspective on health care changed. | ||
| I learned firsthand that health care is not just about having an insurance card. | ||
| It is about access, affordability, and getting the right care at the right time. | ||
| I've had to fight for my children's care as a mother, and I've had tough conversations with small business owners who want to do the right thing for their employees but are struggling to afford coverage. | ||
| And this is the real problem. | ||
| Small businesses and patients are at the bottom of the health care decision-making process. | ||
| In our current system, industry and government bureaucracies hold all the cards, while the rest of us are left limited choices, skyrocketing costs, and little transparency. | ||
| Small companies are being priced out. | ||
| They pay nearly twice as much for health care as large companies. | ||
| In my home county, family premiums in the small group market have increased 85 percent in eight years. | ||
| Across the country, small business participation in the small group market has dropped nearly 50 percent since 2014. | ||
| Today, only 30 percent of small firms provide health benefits down from almost 50 percent in 2000. | ||
| Employers are being squeezed out, and employees are left with fewer options. | ||
| Yet, small businesses play a critical role in building a healthier America. | ||
| Nearly half the private workforce is employed by a small business, and these businesses contribute nearly half the country's GDP. | ||
| When employers have more flexibility and better options, they do not just offer coverage, they drive healthy outcomes. | ||
| They implement wellness programs, encourage preventive care, and create workplace environments prioritizing health. | ||
| With the right reforms, tools, and flexibility, small businesses are uniquely positioned to help American communities get healthier. | ||
| HSAs, for instance, give employees more control over their health care decisions and help reduce costs. | ||
| Many young workers prefer HSA-qualified plans. | ||
| This helps to reduce premium costs and out-of-pocket maximums for individuals. | ||
| Congress should expand eligible expenses to allow more people to participate in holistic wellness services, increase HSA contribution limits to match out-of-pocket maximums, and allow Medicare beneficiaries to continue contributing so they have more control over their health care expenses. | ||
| When people have more control and more choices, they make healthier decisions. | ||
| ICRAs are another great tool. | ||
| ICRAs allow small businesses to offer affordable, flexible benefits by helping employees purchase their own insurance. | ||
| However, to realize the full potential of ICRAs, we need to expand these arrangements and ensure employees have access to a wider range of affordable plan options. | ||
| Congress should consider tax credits or similar incentives for small businesses that offer ICRAs to encourage private investment in employee health coverage and allow for contribution offset to help keep employers competitive and reduce the amount of subsidies paid by premium tax credits. | ||
| Direct Primary Care DPC is another example of how we can refocus the system on wellness and prevention. | ||
| DPC reduces costly emergency visits and improves employee and family outcomes. | ||
| Under current federal law, patients cannot use their HSA funds to pay for these memberships. | ||
| Congress should allow individuals to use their HSA to pay for these expenses. | ||
| Lastly, transparency and policies like hospital site-neutral payments will help provide price certainty. | ||
| Prices are hidden, inflated, and impossible to compare. | ||
| Employers and individuals deserve to know what they are paying for. | ||
| Greater transparency would drive competition, lower costs, and allow employers and employees to make better, more informed choices. | ||
| I have seen discrepancies in claims prices between $250 and $900, depending on who the payer is. | ||
| This is a contributing factor in the rising health care costs. | ||
| The best solutions will not come from Washington, but from communities across the country. | ||
| They just need the tools. | ||
| I appreciate the opportunity to share my perspective today and hope we can work together on solutions that promote healthy options and better outcomes while truly addressing the rising costs of health care. | ||
| These are meaningful first steps we can take to empower people and businesses to make the best decisions for themselves, but we still have more work to do. | ||
| Thank you, and I look forward to answering your questions and working together to achieve this vision. | ||
| Thank you, Mr. Desh. | ||
| You are now recognized. | ||
| It's dark up here. | ||
| Doc, you're now recognized. | ||
| I just learned. | ||
|
unidentified
|
Distinguished members of the committee, thank you for my name is Leslie Dock, and I am the founder of Protect Our Care. | |
| Before founding Protect Our Care, I was a senior advisor and counselor to the Secretary of Health and Human Services and also our department, the HHS Ebola coordinator. | ||
| I also served in senior leadership at Walmart as a member of their global team where I became deeply familiar with purchasing health care for over 1.4 million employees at America's largest private employer. | ||
| At Protect Our Care, we believe that access to quality, affordable, and equitable health care is key to America's health and the single most important prevention tool that we can provide this country. | ||
| The American people agree. | ||
| No matter where they live or work or who they voted for, the American people want health care to be more affordable and more accessible. | ||
| About 80% of Americans in polling tell us that they believe the government spends too little or just the right amount or about the right amount on health care, including about 70% of Republicans. | ||
| Fewer than one in five voters thinks the government should spend less. | ||
| Yet the reconciliation proposals currently under consideration in Congress would increase health care costs and take away coverage for millions, including our neighbors in nursing homes, children, individuals with disabilities, and people who take care of their children or elderly parents. | ||
| These cuts would devastate families in order to pay for tax breaks for billionaires and wealthy corporations and line the pockets of big drug companies. | ||
| If lowering the deficit is the rationale for these cuts, then the simplest and most popular solution would be to rein in these massive tax breaks and not destroy our health care system. | ||
| Proposals before Congress would cut over $2 trillion from Medicaid, which provides health care to over 72 million people, including 6 in 10 nursing home residents, 30 million children, 15 million adults with disabilities, and 14 million adults with mental illness. | ||
| These people have nowhere else to go. | ||
| Medicaid serves as a lifeline in rural communities. | ||
| It keeps rural hospitals open. | ||
| And any cut in Medicaid will blow significant holes in state budgets, whether they be in blue states or in red states. | ||
| Interestingly enough, just if we look at the members of the Republican members of this committee, over 2 million people in your districts rely on Medicaid for their health care. | ||
| An overwhelming majority of Americans, including 69% of Trump voters, oppose cuts to Medicaid. | ||
| Two in three Americans say they know someone who benefits directly from Medicaid, and that includes and is similar to 38% of Trump voters tell us that they know somebody in their family or a close friend who relies on Medicaid for their health care. | ||
| If Congress takes away existing ACA tax credits, over 20 million people will see their premium go up an average of 90 percent, and 5 million people will lose their insurance altogether. | ||
| Banning Medicare from negotiating for lower drug prices and gutting the other prescription drug savings in the IRA will increase costs for over 53 million seniors. | ||
| This year alone, 11 million seniors are expected to save an average of $600 thanks to the annual out-of-pocket cap limits. | ||
| And the newly negotiated lower drug prices will save seniors $1.5 billion and taxpayers $6 billion in just the first year alone. | ||
| But now Congress is considering these proposals for reconciliation just as the administration takes on a number of ill-fated and ill-designed initiatives. | ||
| They are halting spending for community health centers, gutting NIH funding, pushing out record numbers of government staff, and removing reliable scientific medicine that doctors and others rely on from government websites. | ||
| The chaos and withholding of funding has led to disruptions in care across the country. | ||
| And it is attacking NIH, which is the envy of the world, for the role it plays in developing cures for patients and the economic impact it has across the country. | ||
| In the last 10 years, 354 of the 356 drugs that were approved in the United States were somewhat due to the work that NIH did on them. | ||
| The attack on vaccines that's promised by RFK if he is confirmed as health secretary will result in a resurgence of preventable diseases and cost lives. | ||
| Americans expect their leaders to lower costs, expand affordable health care, and protect public health, not to do the opposite, not to take it away, not to make it more expensive. | ||
| Recently, the press has reported that a number of Republicans in Congress are concerned about these cuts. | ||
| I hope we can work together to defeat these reckless proposals currently under consideration. | ||
| Thank you. | ||
| Thank you for your testimony. | ||
| Now we'll proceed to QA this session, and I'll go first. | ||
| Mr. Dingell, I wanted to touch base with you on some things. | ||
| I think you had mentioned, I read, you get 20 million customers, 10,000 employees. | ||
| That's got to have a huge impact, I would think. | ||
| And, you know, my thought is we're spending $4.2 trillion. | ||
| It's 20% of the economy already, and our results are worse than most countries in the world. | ||
| We've got to find a way where we all work together, industry along with the government and everything else. | ||
| The government can't just do it by itself. | ||
| But I guess, give me your thought in terms of productivity of your employees, the difference it's made in terms of your customers. | ||
| And I think you've got my sense of what you said. | ||
| You've got a win-win. | ||
| It's good for the employees, it's good for the customers, and it's also good for you guys. | ||
| And so it pays for itself. | ||
| That's just me thinking about it, but you could tell me. | ||
| But give us a better sense of employees as well as customers. | ||
| And like I said, 10,000 employees and 20 million customers. | ||
| Thank you for the question. | ||
| It's a great point. | ||
| And as a leader of a company where our interests are so aligned with our customers, it's honestly a great privilege. | ||
| And I can assure you, I don't know who here has life insurance, but if you own life insurance, aside from your friends and family, let me assure you, no one wants you to live a long, healthy life more than I do and more than our industry does. | ||
| And for that reason, we've chosen to invest in our customers' long-term well-being and, as you point out importantly, our employees as well. | ||
| So I mentioned it in my introductory comments. | ||
| We offer this program called Vitality to our customers. | ||
| We offer also a version of that program to our employees. | ||
| I mentioned that we offer the gallery multi-cancer early detection test to our customers. | ||
| We also offer that to our U.S.-based employees at a discount. | ||
| So it's important for productivity purposes with employees in the short term, engagement, understanding of our mission and purpose to bring these things to our employees, not just our customers. | ||
| But your point about public-private partnerships and not being all just the government, or frankly, all just industry. | ||
| But it's a great example where a company has the ability to sort of monetize better health outcomes. | ||
| And our industry is unique that way. | ||
| If people live longer, we make more money, I can tell you that. | ||
| And instead of just hoping for that outcome, we plow a bunch of money into it. | ||
| I'll give you one example right quick. | ||
| We offer a healthy food savings program in our program. | ||
| We offer our customers 25% off fresh fruits and vegetables at over 61,000 grocery stores nationwide. | ||
| That's an investment for us. | ||
| But we make that investment because of the importance of nutrition and because we know in the years that follow, we'll see better health outcomes. | ||
| Thank you. | ||
| Let me mention, Mr. Carlson, you talked about prevention. | ||
| You see where there's some things we do a pretty good job in general with in terms of medicine, but there's other areas like lung cancer. | ||
| We could probably do a much better job in terms of screening. | ||
| Give us your thoughts on screening and the difference it makes. | ||
| It sure seems to me, someone said quite a few years ago, always stuck with me. | ||
| He said, people that have their first heart attack, 50% never see the next day. | ||
| Now, whether you can get that through a screening process or something, there are a lot of other things you can, like lung cancer. | ||
| We're sure we lose maybe 10% of people that get screening in terms of lung cancers. | ||
| It's about all you hear about 10 or 15 percent, but there could be a lot more positive impact if we had more screening for everybody. | ||
| So, thank you, Chairman Cannon. | ||
| I agree with what you've said. | ||
| As it turns out, picking lung cancer, we've actually inserted some barriers into the lung cancer screening program. | ||
| Specifically, lung cancer screening requires a shared decision-making and an astestation by providers that typically requires that patient to make a second trip in to see the provider. | ||
| And that barrier is huge, both on the provider who has other patients and other things to be tracking, but also the barriers of the transportation toxicities and other components with that patient making a second trip in. | ||
| So, lung cancer in particular, that is something administratively that potentially you could help with, that if they have the smoking history and meet the criteria, you know, eliminate the shared decision-making, eliminate the provider having to do an astestation in order to get it covered by Medicare. | ||
| An easy thing to do. | ||
| Mr. Doggett, you're recognized. | ||
| Thank you, Mr. Chairman. | ||
| Thanks to all of our witnesses. | ||
| You know, where I come from, we always say that everything is bigger in Texas, and that often rings true with our excellent cancer research centers and treatment and our innovative medical research. | ||
| But outrageously, it's also true because of Governor Greg Abbott's obstruction and support from his Republican enablers that we have the unfortunate distinction of more uninsured people, more uninsured children than any place in the country. | ||
| This deplorable situation worsened over the last two years when Governor Abbott's administration denied over 2 million Texans who had been receiving coverage access to a family physician, often solely as a result of his administration's administrative eras. | ||
| In my hometown of Austin, about half of all the children that are able to access care at the Children's Hospital, at Jell Children's Hospital, rely on Medicaid. | ||
| About half of all the births in my hometown are covered by Medicaid. | ||
| And nearly 300,000 mothers across the state are enrolled in Medicaid. | ||
| For over 700,000 Texas seniors and individuals with disabilities who require long-term care and assistance in affording their medications, they get that through Medicaid. | ||
| That's their lifeline. | ||
| Even after all of the disastrous mistreatment and disinterest in those individuals with Medicaid in Texas, there are still 3 million children that are counting on it, a total of 4 million in all. | ||
| I had one of those families contact me this morning. | ||
| A mother concerned about her son Sam, who has Down syndrome and relies on Medicaid, is hoping to continue his educational opportunities but will require professional care. | ||
| Mr. Doc, you referred to some of these challenges across the country, but what will be the effect of significant efforts to defund Medicaid in order to provide these giant tax breaks for Elon Musk and his buddies on people like Sam and his family? | ||
| Can you speak into the microphone again? | ||
|
unidentified
|
First I want to just thank you for all the leadership you've provided on the issue of health care throughout your time in Congress and to note that I think I have over 25 members of my family in your district. | |
| Oh, they're very important. | ||
| I didn't know that, but I'm delighted to hear it. | ||
|
unidentified
|
I'm not sure. | |
| Now, unfortunately, the rest of this message is a little bit more dire. | ||
| We are about to take away health care from 72 million Americans who need it the most. | ||
| People who rely on it for preventative care, people who rely on it to give birth, people who rely on it to stay healthy and to see a doctor. | ||
| They are all at risk, and for no reason except a desire to fund these tax breaks for the richest among us. | ||
| It's important to think of these people as individuals. | ||
| That's a big number, 72 million people. | ||
| But if you think of them one family at a time, and you know the anxiety that they face when they're sick, when they can't afford to go to a doctor when they know they need to, all the time incubating these diseases, in a sense, within their family, so that the only time they can go to a doctor is when they go to the emergency room. | ||
| That tears people apart. | ||
| I think we all know that health care is the kitchen table issue around America, because if you get sick or your parents get sick or your children get sick, that's all you ever think about. | ||
| And compound that with knowing that you can't afford to go to a doctor. | ||
| And think of the hell that everybody in that situation finds themselves. | ||
| And now 72 million more Americans, a high percentage of them, will find themselves in that condition. | ||
| And that's an outrage. | ||
| The University of Texas in Austin ranks number 14 in the entire world for interdisciplinary science. | ||
| It's one of the top recipients of grants from the National Institutes for Health. | ||
| There are many aspects there, but you mentioned your prior work with Ebola, where we had some success. | ||
| I know there's another outbreak within the last few months in Uganda. | ||
| What threats do you foresee for the University of Texas and for our families with these attacks on science and public health research? | ||
|
unidentified
|
Well, we should just start again with the numbers. | |
| So Texas will lose $300 million in NIH funding under this new proposal. | ||
| That came without any warning, out any planning, and makes no sense. | ||
| $300 million less research being done in the state of Texas, which, as you said, is one of the leaders across the board, has some of the best medical schools and research institutions in the country. | ||
| There is no way they can make that up. | ||
| And that means a significant cut in research. | ||
| I also want to say about my time with one of my jobs at Ebola was to make sure it never came from West Africa to the United States. | ||
| Let me tell you who helped us there. | ||
| CDC and USAID. | ||
| They traveled to those countries. | ||
| They lived with sick patients, and they helped reduce the rate of Ebola in that country. | ||
| When it came to one of my jobs, was to sleep with a buzzer underneath my pillow. | ||
| So if somebody came in with a fever off an airplane from Africa, a CDC unit would go out and meet them and see if they caused a threat. | ||
| And then we developed a vaccine, and who do you think helped us on that? | ||
| NIH and WHO. | ||
| So we are dismantling, through these cuts, the entire structure that kept America safe from Ebola in that outbreak in 2014. | ||
| Thank you very much for your testimony. | ||
|
unidentified
|
I now recognize Mr. Smith. | |
| Thank you, Mr. Chairman. | ||
| Thank you to our witnesses as well. | ||
| I think topics such as this are appropriate for us to be discussing. | ||
| I think it's especially important that we look at the status quo and really examine the results. | ||
| Are we satisfied with what government intervention has delivered with a litany of prohibitions and mandates and ACA or Obamacare, whatever, however one wishes to title that act of Congress that promised a lot and delivered very little. | ||
| In fact, it just kind of shifted around who pays how much. | ||
| I don't think health outcomes are any better. | ||
| Certainly the expansion of Medicaid roles or putting folks on Medicaid and saying that they're covered by insurance isn't exactly accurate. | ||
| I think the American people want us to have vigorous discussions here and really have an exchange of ideas on how we can actually lower the cost of health care, make it more affordable, make it more accessible. | ||
| We know that telehealth can deliver quite a bit, but now we've seen some lapsed timelines that make that less accessible. | ||
| I'm especially concerned when I hear from constituents who lost their health insurance due to Obamacare. | ||
| We should be very sensitive to scenarios like that. | ||
| In fact, I think of a constituent, I believe she lost her health insurance a total of three times because of empty promises of the ACA. | ||
| If we're serious about really addressing the cost of health care, I think we buckle down and look at innovation, what innovation can deliver in terms of new methods for health care and truly increasing access for health care treatment, hopefully prevention, certainly. | ||
| But I think that the numbers are staggering when you see what tasks are ahead of us and that chronic disease impacts some 129 million Americans, more than half of adults in our country. | ||
| That should get our attention in a big hurry. | ||
| But I'm very concerned when patients tell me that they don't feel the flexibility that they would like to have in terms of pursuing treatment and accessing care. | ||
| I know that a lot of Americans appreciate health savings accounts and the flexibilities that that can perhaps offer. | ||
| Mrs. Strauss, when the small business owners you serve are looking at the options available for their employees, how important do you believe it is for them to have a variety of flexible options, such as the HSA? | ||
| Well, HSAs have become quite popular over the last several years. | ||
| And for us, we pretty much put an HSA-qualified plan in with every one of our group benefits that we write. | ||
| So the majority of our employers are offering multiple choices to include the high-deductible health plans that are HSA-qualified. | ||
| There are definitely things that we can do to expand the HSAs to allow people to use them around more preventive and wellness. | ||
| So for us right now, if there were things more holistic types of treatments that would be approved through the HSAs, that would be one way to get people to shift and save money to help to pay for things like healthy meals that are being prepared. | ||
| I've had some success even having things like Pelotons approved through an HSA due to the fact that we've had a provider putting somebody on a weight loss program and making sure that that is part of that program. | ||
| So an HSA is the most important thing right now as far as that younger generation goes. | ||
| They actually really enjoy their HSA benefits. | ||
| Typically with those plans you see lower premiums, lower out-of-pocket maximums. | ||
| Right now the maximum contribution limits for an HSA is still extremely low. | ||
| We probably see out-of-pocket maximums around $9,000 and right now you can only contribute $4,300 into your HSA. | ||
| So we would love to see those limits increase to match out-of-pocket maximums and then also, like I said, just be able to allow some of these holistic types of treatments in addition to your normal traditional eligible expenses. | ||
| Thank you. | ||
| And in closing, I want to say that I hope we can work together to look at really examine our policies in terms of the effectiveness. | ||
| I know we heard some concerns about folks resorting to the emergency room for their main access to care. | ||
| And that's obviously not a good situation, but yet our policies through mandates and prohibitions basically encourage that. | ||
| So I think we can do better. | ||
| The American people expect us to do better. | ||
| And I look forward to the continuing conversation. | ||
| Thank you. | ||
| Mr. Thompson, you're recognized. | ||
| Thank you, Mr. Chairman, and thank you to the witnesses for being here today. | ||
| I think it's important that we work across the aisle to make sure that Americans have access to what they need to live healthier lives. | ||
| Sadly, we're seeing the current administration doing the exact opposite. | ||
| This administration announced cuts of $4 billion a year from the NIH research funding. | ||
| How are you supposed to find cures for cancer or new Alzheimer's treatment if research funding is chopped? | ||
| Mr. Chairman, I ask unanimous consent to enter into the records statements from the American Brain Coalition, the Association of American Cancer Institutes, and the Association of American Medical Colleges that state and point out that funding cuts will halt life-saving research projects, seed America's leadership on scientific breakthroughs, and hurt our economy. | ||
| You know, Mr. Kelly, our colleague on this committee, and I have legislation that incentivizes private companies who fund neuroscience research in partnership with academia and nonprofit research institutes. | ||
| The administration's cuts would result in less opportunity for public-private partnerships like this one and throttle critical mental health research. | ||
| UC Davis in my district does incredible work with NIH funding. | ||
| They've developed diagnostic tools and treatment for individuals with autism, designed personalized medical approaches for cancer patients, studying the significance of critical research for Alzheimer's research, and develop new ways to restore speech for ALS patients. | ||
| And that's just a few of the things they do, and that's just in my district. | ||
| NIH research around the country has produced tangible results from Nobel Prize-winning innovations in gene editing to breakthroughs in cancer treatment. | ||
| And NIH funding also positioned us to quickly develop the Trump COVID vaccine. | ||
| This administration wants to cut funding through the entire health care spectrum, from research to treatment. | ||
| Proposed cuts to Medicaid, discussed by some of my friends on the other side of the aisle, pose a great threat to patient coverage and hospital funding. | ||
| Cuts to Medicaid would devastate rural communities through hospital closures and service cuts. | ||
| And when hospitals in rural areas close or end services, patients in those rural areas have to travel many miles further to get the care that they need. | ||
| When patients can't easily access health care services, as you all know, they don't get the routine preventive care they need, and then they end up in the ER to get more expensive emergency treatment. | ||
| Patients, especially rural patients, get sicker, and we should be clearly aware of that. | ||
| Mr. Doc, if we cut NIH and Medicaid funding as has been proposed, could you please explain how that would impact patients' ability to receive the health care they need? | ||
| Use your microphone, please. | ||
| First, I think it's important to note that we all agree that the cost of health care is too high. | ||
| There are ways to bring down the cost of health care, to improve our outcomes. | ||
| That's not in question here. | ||
| But the first step for anyone in the journey is to be able to see a doctor. | ||
| So they can get treatment early. | ||
| They can be diagnosed. | ||
| If they're pre-diabetic, they get instructions on how not to turn into a diabetic. | ||
| So there is absolutely no way to reduce this disease burden and the cost of it if people can't see a doctor. | ||
| So that's, I think, a stepping stone, a critical first step that people ignore at their peril. | ||
| Does anyone on the panel think that by chopping funding to this extent to NIH for medical research, do any of you think that's going to make Americans healthier? | ||
| Mr. Chairman, I yield back. | ||
| Mr. Hearn, you're recognized. | ||
| Mr. Chairman, thank you. | ||
| And for the record, President Trump has said that he has no intention and would not support cutting benefits to Medicare and Medicaid recipients. | ||
| Mr. Chairman, thank you for holding this hearing and thank you to our witnesses being here. | ||
| I'm excited to start this Congress off talking about how we can all support a healthier America. | ||
| All of us here have heard many times about the effects of chronic diseases, both on the individual and in the economy. | ||
| Employer-based health insurance covers about 55% of Americans, with about 72% of employees receiving medical benefits from their employer. | ||
| This is a huge population and a space where employers can get creative in how they support a healthier workforce. | ||
| Health is a huge predictor in productivity, and it is in everyone's best interest to invest in and support a healthy population. | ||
| As a former employer myself, I know what it's like to want the best for my employees and what it takes to offer an attractive benefits package, with health care coverage being one of the most sought-after benefits. | ||
| Not only does a robust health package give employees a sense of security knowing that they have coverage, but it also gives them the tools to be proactive in their health with access to regular preventive care. | ||
| I also know that the government and the regulatory environment tend to make it harder on employers to take care of their employees and prevent them from offering their employees a real choice and type of coverage that works best for them. | ||
| I've experienced firsthand and heard from many small business owners on the struggles they face when it comes to offering a robust health insurance package. | ||
| The small group market is crumbling and the cost of offering their employees health care coverage is just becoming too high and rising premiums unsustainable for both parties. | ||
| It is our responsibility as the federal government to work with their business owners to understand what is going wrong and come up with creative solutions to fix it. | ||
| I was happy to see that this was a point of priority in President Trump's first term with the creation of individual coverage health reimbursement arrangements, also known as ICRAs. | ||
| The use of ICRAs has continued to rise with the ICRA adoption increasing by 29% between 2023 and 2024. | ||
| And in fact, 83% of those newly offered offering ICRAs were businesses offering health coverage for the first time. | ||
| That's why I introduced the Choice Arrangement Act last Congress codifying this type of coverage option into law. | ||
| While I'm proud that legislation got passed out of the House last year, I'm always looking for ways to improve this idea and help employers take up this option. | ||
| Mr. Strauss, thank you for coming and thank you for your testimony and taking the time to explain to us the struggles small businesses are facing when it comes to offering health care coverage. | ||
| I want to highlight what you said in your testimony about how a one-size-fits-all federal mandate limits flexibility and the mention of ICRAs being a good option for employers. | ||
| Could you explain some of the regulatory barriers that small businesses are seeing when trying to offer ICRAs? | ||
| Yes, thank you for the question. | ||
| ICRAs are a great tool and I think the more we focus on options, regardless if that's individual or employer-based situations, options are the key here. | ||
| So we want to stop taking things away and continue to expand the things that we do have. | ||
| ICRAs, right now, one of the biggest challenges that we see with some of our employers is it's one or the other. | ||
| So if you're going to go ahead and put an ICRA plan in place, an employer has to contribute at a pretty high level to offset subsidies in the marketplace. | ||
| And so an employer doesn't want to do something that's going to actually disrupt employees' coverage and access to affordable health care. | ||
| And so what I think would be a really great solution are there's tax incentives. | ||
| I know Indiana has started to put tax incentives for employers that are offering ICRAs. | ||
| And then some sort of an offset. | ||
| So for instance, if they've got an employee that might receive a $350 subsidy through the marketplace, but really that employer is only able to contribute $200, they can actually contribute the $200 and then allow that reduced premium tax credit on the government side of things. | ||
| Today, if they only contribute $200, that member can get no subsidy through the marketplace. | ||
| And so you can see how sometimes that's challenging for employers, especially small employers, because these are people in their communities that they're trying to take care of. | ||
| So I actually think we would be able to find a bigger space for them if we had some of these other regulatory changes to the ICRAs. | ||
| I know that most employees want their coverage through their employer. | ||
| That is the number, like the second thing that any employee comes when they're coming and looking for a job. | ||
| It's their pay and then it's benefits. | ||
| So a lot of these employer benefits, the premiums are the same in the small group market as they are in the marketplace. | ||
| And the marketplace provides a subsidy where the employer is trying to compete with large employers. | ||
| Their premiums are twice as much as a large employer is. | ||
| So it really makes a very uneven playing field for those small employers to continue to contribute to their communities, but then also compete in the market today. | ||
| So again, I think ICRA is a really great place for us to expand and just continue to offer options and choices for people. | ||
| Thank you for your expert testimony. | ||
| I really appreciate it. | ||
| I yield back. | ||
| Ms. Chu, are you recognized? | ||
| Mr. Dak, there are three questions I wanted to ask you. | ||
| Now, for weeks, I've heard concerns from hundreds of constituents across my district in Southern California. | ||
| People are worried about their health data being accessed by unelected billionaires like Elon Musk. | ||
| They're fearful that Republicans will gut Medicaid and strip away their access to the care they need to survive just to fund tax breaks for the ultra-wealthy. | ||
| And when the Trump administration announced their plans to illegally freeze federal funding late last month, I received frantic calls from community health centers in my district who were unable to access the funds they needed to pay their staff as a result. | ||
| And now Republicans have agreed to let President Trump slash $4 billion from NIH funding under the guise of capping administrative costs. | ||
| Dr. Garcia Okaña, an NIH-funded researcher at City of Hope, reached out to my office yesterday to share that this change threatens his vital work to cure diabetes. | ||
| Diabetes affects 38 million Americans. | ||
| And by slashing NIH funding, we're not just cutting research, we're undermining any hope for future breakthroughs that could save lives. | ||
| So Mr. Dak, the topic of this hearing is about creating healthy options. | ||
| Does slashing funding for research into diabetes, which affects 38 million Americans as well as other chronic diseases, make us healthier? | ||
| Why or why not? | ||
| Certainly does not make us healthier. | ||
| It certainly puts people at greater risk. | ||
| NIH has developed some very innovative tools, as you said, for diabetes. | ||
| They are the source of most of the research going forward in that space, and now we're gutting it. | ||
| It's also important to remember that the best treatment for diabetes is not to get diabetes. | ||
| And so that means that a lot of people, my wife's a nutritionist, she sees patients who are pre-diabetic or their glucose levels are high. | ||
| Why does she see them? | ||
| Because they have a doctor they can go to. | ||
| Okay, thank you. | ||
| Question two. | ||
| I'm deeply concerned about Republicans' plans to cut Medicaid, our nation's largest source of health coverage, and which covers half of all long-term care, including nursing homes, for the elderly and disabled. | ||
| And they want to cut it by $2 trillion, also that can extend tax breaks for the wealthiest Americans. | ||
| And one of their proposals to strip Medicaid coverage is by having them dismantle Medicaid for those who can't document a certain number of work hours or prove their eligibility more frequently, which could lead to devastating losses in those who get coverage. | ||
| And I think about places like my district, where we've just had these horrifying wildfires. | ||
| And are they saying then that those who are in this situation who can't document their work hours aren't deserving of Medicaid? | ||
| So, Mr. Dark, the topic of this hearing is about creating healthy options. | ||
| Does slashing Medicaid make us healthier? | ||
| No, it makes us sicker. | ||
| At least it makes more people vulnerable. | ||
| Well, then, let me go on to my last question, which is, I'm deeply concerned about the Trump administration's removal of over 8,000 health-related web pages that contain vital treatment guidelines, including those related to HIV prevention, sexually transmitted infections, and birth control. | ||
| These actions directly impact the ability of physicians to provide quality care and put public health at risk. | ||
| One of the most alarming actions has been the removal of the Office of Research on Women's Health website, an essential resource and the only federal office dedicated to women's health. | ||
| And that's why I led dozens of my Democratic colleagues in sending a letter to NIH demanding that these websites be restored immediately. | ||
| Mr. Dark, the topic of this hearing is about creating healthy options. | ||
| Does removing websites on vital treatment guidelines make us healthier? | ||
| Absolutely not. | ||
| And doctors around America rely on that information to treat their patients, to be up to date on the latest tools and techniques. | ||
| Once again, this just makes people sicker and more at risk of disease and death. | ||
| And in fact, how could they help us? | ||
| They could help, first of all, by just putting those back into business, stop this craziness with NIH, and then go ahead and increase their work on exploring and developing new tools and new drugs for women. | ||
| And also, what we know happened, you know, before the Affordable Care Act was in place, you could charge women more for health care just because they were women. | ||
| So that's the world some want to go back to, and that's just wrong. | ||
| Thank you. | ||
| I yield back. | ||
| Mr. Fitzpatrick, you're recognized. | ||
| Thank you, Mr. Chairman. | ||
| Thank you all for being here. | ||
| Incredibly, six in ten Americans have at least one chronic disease, many more than one. | ||
| For example, cardiovascular disease, diabetes, cancer, obesity, just to name a few. | ||
| Moreover, about two-thirds of U.S. adults are overweight or obese. | ||
| Last Congress, Representative Kelly and I, along with many of our colleagues on this committee, introduced the bipartisan Personal Health Investment Today Act, also known as the FIT Act, which would enable individuals to use up to $1,000 per year to cover physical activity-related expenses. | ||
| Exercise is medicine. | ||
| This would promote public health and spark economic growth at the same time. | ||
| According to a 2024 report done by the Health and Fitness Association, legislation like the FIT Act or its analogous companions could help prevent up to a half a million chronic disease cases annually. | ||
| It would save over $12 billion in health care costs and create well over 200,000 new jobs. | ||
| Mr. Chairman, I'd like to submit this report to the record. | ||
| Thank you. | ||
| Mr. Tingle, in your experience, can you speak to the benefits of these healthy living programs, wellness activities, and the impact it can have not only for the prevention of chronic disease, but also for long-term health, as well as saving money in our health care system? | ||
|
unidentified
|
Thank you for the question. | |
| I'm happy to speak to that. | ||
| I mentioned in my introductory remarks that we've been offering this vitality program for 10 years now. | ||
| So we have a great deal of data to support what you're saying in terms of engaging people, providing incentives, education, incentives, support, and even rewards, as I mentioned, for undertaking greater levels of physical activity. | ||
| We're not trying to turn all of our customers into marathon runners. | ||
| It's not about that. | ||
| It's meet people where they are. | ||
| Take a few extra steps a day, be a bit more physically active, likewise on the nutrition front. | ||
| But engaging people the right way supportively over a long period of time with clever incentives and rewards can indeed change long-term health outcomes, which is good for everyone involved. | ||
| You know, I'm struck by how much discussion there is about treatment. | ||
| It's understandable. | ||
| We all want good treatment, but we simply, our view is, and our intention is to spend a lot of time and investment in prevention and early detection. | ||
| To that point, sir, transitioning to preventive care, prevention and early diagnosis are critical. | ||
| I think everyone here would agree in helping people live longer and healthier lives. | ||
| However, America invests less than 3% of health care spending on preventative service. | ||
| Dr. Carlson, like so many on this committee, my family has been personally impacted by cancer. | ||
| I personally am encouraged about innovations in multi-cancer screening, as well as the opportunity to detect so many cancers much, much earlier. | ||
| Can you tell us, sir, what it means to you as a physician to be able to treat at an earlier stage of cancer compared to late-stage cancers and the impact this has specifically on patient survival rates? | ||
|
unidentified
|
Thank you for the question. | |
| There's no doubt that treating an early diagnosis is going to be less expensive and with better outcomes. | ||
| No question. | ||
| Lastly, I want to address the role that employers can play in promoting health and wellness amongst their employees. | ||
| Myself and my colleagues on this committee, it's a bipartisan bill, introduced the bipartisan Health Out-of-Pocket Expense or HOPE Accounts Act, which would be a tool for employers to offer tax-preferred savings to help individuals save and pay for prevention and wellness through a portable health savings or HOPE account, even if they do not have a high-deductible plan. | ||
| Ms. Strauss, as a small business owner, could you discuss the benefits of flexible coverage options, the role employers can play to help their employees take charge of their own health and their own wellness? | ||
|
unidentified
|
Yes, thank you for the question. | |
| Anytime that we look at getting in front of wellness and prevention, we need tools to do that. | ||
| And right now, with the health care costs the way that they are, we have these tools like an HSA, but there's constantly barriers in them in the fact that, for instance, in order to have an HSA plan, you have to have a high-deductible health plan. | ||
| Well, in my world today, guess what? | ||
| Every single plan is a high-deductible health plan. | ||
| Some have co-pays, which eliminate HSAs from being able to for employees to be able to take HSA accounts out. | ||
| So for me, I think we should just remove the barriers completely and allow everybody to have access to health savings accounts. | ||
| And it shouldn't really matter if you're on a traditional copay plan or you're on that high-deductible health plan. | ||
| So So, again, options are the key. | ||
| The more we can actually put them in charge of their own health, they're going to start making choices that are going to be better for them long term. | ||
| So, the preventive benefits, opening those up for eligible expenses as well is another really big thing because we all know people are turning to more holistic options these days, and they are wanting, there's more of an appetite today to try and be on that preventive side versus trying to come from behind and finding solutions. | ||
| We live in a sick care system today, and we need to make changes to make sure that we are really looking at this from that holistic point of view and giving people those tools. | ||
| So, I'm a huge proponent of those regulation changes with HSAs, and I think that that would be a really good step forward for allowing people to take control of their own health care. | ||
| Well said, Ms. Strauss, I thank the panel for their time. | ||
| I yield back, Mr. Chairman. | ||
|
unidentified
|
Mr. Evans, you're recognized. | |
| Thank you, Mr. Chairman and Ranking Member Dargett. | ||
| Over the past several years, I've been inspired by the advocacy of committed health care professors in my district. | ||
| In my conversation with them, I'm reminded of my first introduction to the health care system when I was only 13 years old working for the Philadelphia Rolling Hill Hospital. | ||
| I know this access to affordable health care is essential for every American. | ||
| Unfortunately, this new Musk administration, we are already seeking a tax on our health care system, planting the seeds of a public health crisis. | ||
| Meanwhile, Republicans on the Hill continue to threaten the Affordable Care Act, the critical improvement to Medicare, Medicare, and Democrats through the Inflation Reduction Act. | ||
| Make no mistake, nothing about the Republicans are working towards efficiency. | ||
| It is pure destruction. | ||
| Americans see this health care providers operating with the constant fear the care and patients desperately need will be away. | ||
| Mr. Dorry, I'd like to ask you a question: Can you list some of the increased out-of-pocket Americans might experience if Republicans on the Hill take down the Affordable Care Act or Inflation Reduction Act? | ||
| Yes, and there are many, and they're expensive. | ||
| Let's start with drugs, where the Inflation Reduction Act capped out-of-pocket expenses for seniors at $2,000 a year and allowed them to smooth those out over the course of the year so they could pay them when they could afford to pay them. | ||
| That would be gone if the IRA is repealed. | ||
| The ACA also guarantees certain preventative services to be covered by employers and in the marketplace at no cost. | ||
| Cancer screening, opioid treatment screening, those are now free for people. | ||
| Vaccines, free for people. | ||
| Those would be gone, those protections. | ||
| And that's only the beginning of the list. | ||
| I have another question to you. | ||
| In my district, we have several hospitals with high pushes of patients that use Medicare or Medicare. | ||
| If these hospitals are no longer operating due to Republican Medicare or Medicare cuts, these patients will lose access to affordable care. | ||
| Can you please elaborate on how these low-income payer-mixed hospitals rely on Medicare and Medicare to keep these doors open? | ||
| Because Medicare and Medicaid are the only way that people can afford to go to those hospitals. | ||
| And hospitals without patients are not a viable enterprise. | ||
| They need demand in order to support the investments that they make. | ||
| And without people being able to afford to go, they simply have to shutter. | ||
| And that's been the story with rural hospitals around America. | ||
| I'd like to thank you, Mr. Chairman. | ||
| Ms. Miller, you're recognized. | ||
| Thank you, Chairman Buchanan and Ranking Member. | ||
| And thank you all for being here today. | ||
| 1.2 million people in West Virginia have at least one chronic disease, and 527,000 people have two or more chronic diseases. | ||
| In a state of only 1.7 million people, these numbers are staggering and concerning. | ||
| Not only are they alarming from a public health perspective, but they also worry me from a fiscal perspective. | ||
| Patients with multiple chronic diseases cost the health care system more money to treat and cost West Virginia more than $10 billion annually in medical costs. | ||
| The most common sense way to help combat the chronic disease epidemic is through education, screening, and prevention. | ||
| I specifically focus much of my work on kidney disease, and I recently became the co-chair of the Congressional Kidney Caucus with my fellow Ways and Means member Susan Delbene. | ||
| Chronic kidney disease is also known as the silent killer because it can progress for years without any symptoms. | ||
| If left unmanaged, chronic kidney disease will progress into end-stage renal disease. | ||
| And this disease can only be handled by surgery or continual dialysis. | ||
| Dialysis is extremely expensive for the federal government and very taxing for patients. | ||
| ERSD affects only 1% of Medicare beneficiaries, but it accounts for 7% of Medicare spending. | ||
| Managing dialysis can be particularly difficult for patients in rural areas. | ||
| Just finding transportation to the nearest dialysis facility and then spending several hours on the machines, the travel, the treatment, it's very burdensome for people who don't feel very good anyway, and they're living in rural communities. | ||
| While increasing access to services such as home dialysis can help patients manage their disease, life can be made much easier if a physician or a nephrologist can identify a patient with chronic kidney disease early on. | ||
| Dr. Carlson, you know firsthand that early screening can reduce costs and improve outcomes for patients. | ||
| Could you speak about how early screening can affect long-term health outcomes for patients with a chronic disease? | ||
| Yes, ma'am. | ||
| Thanks for the question. | ||
| So again, there is great evidence that says that early diagnosis, early intervention is going to have improved outcomes at less cost. | ||
| Chronic kidney disease is present in about 15% of adults and about a quarter of those then also have a family history. | ||
| And our next-gen sequencing, these genomics assays, are widely utilized for pediatric nephrology but are rarely used in adult nephrology. | ||
| I think that for chronic kidney disease in particular, that there should be a migration, a broader adaptation of some of the genomic assays that would be available for those patients to identify them and allow that earlier intervention. | ||
| Thank you. | ||
| I've worked on legislation with Congresswoman Terry Sewell called Chronic Kidney Disease Improvement in Research and Treatment Act, and it expands the Medicare annual wellness benefit to include kidney disease screening. | ||
| It also increases access to the Medicare kidney disease education benefit, which will enable physicians to teach their patients about managing their disease and any combatities they may have. | ||
| A recent study shows that compared to urban areas, rural communities have higher rates of cancer, higher rates of late-stage cancer diagnoses, higher cancer deaths. | ||
| And the urban-rural gap is not getting better. | ||
| It's steadily widening over the last decade. | ||
| Rural areas also have lower reported rates of cancer screenings for colorectal, breast, and cervical cancer. | ||
| Dr. Carlson, given your experience, can you tell us more about why rural communities are struggling with cancer? | ||
| So, thank you for the question. | ||
| A large footprint for mercy is in that rural community. | ||
| And there are a lot of barriers, really, one of them being transportation just to get in that make it a challenge. | ||
| The rural community can sometimes be a little bit uneducated, and that so that we appreciate the work that you've done in educating those patients. | ||
| But I think some of it's also trying to figure out how to incentivize those patients that, regardless of where they live or their financial situation, we push them to get in. | ||
| And some of the predictive algorithm work that we've done, we identify patients. | ||
| And if you knew that your risk for colon cancer was 10 times higher than the average patient, it might push you to get the bowel prep and get a colonoscopy done. | ||
| And so, those types of things, I think, in addition to the other incentives that you've listed, will help incentivize the patient to take greater control of their own care. | ||
| Thank you, and I yield back. | ||
| Mr. Davis, you're recognized. | ||
| Thank you, Mr. Chairman, and I want to thank all of our witnesses. | ||
| I've been in the health care space for a long time, and I'm absolutely convinced that robust research is essential if we are to find solutions to our health care problem. | ||
| That's the only way that we can find in a real way the causes of disease, causes of illnesses, and what's the most effective and best approach to finding treatment of cure. | ||
| Therefore, I'm amazed that the Trump-Musk administration would downplay research and propose cuts as a part of their health policy. | ||
| It seems to me that this approach is designed to make Americans more sick than more well and decrease rather than increase the quality of their lives. | ||
| As a black legislator whose pre-Congress profession was in health care, I cannot sit by and ignore the effort of the Trump-Musk administration and my Republican colleagues to reduce health care. | ||
| It is dangerous and shameful to undermine and defund research on the health differences of women and people of different races, ethnicities, and abilities. | ||
| I ask the question, how can we make federal health policy and not talk about the differences among us that affect our health and the effectiveness of treatment? | ||
| If this is our approach, this is not modernizing health care. | ||
| It is retrofitting it to a time that I seriously hoped we'd put behind us. | ||
| How do we promote health when we cripple health research? | ||
| Just the one Trump administration proposal to slash the indirect cost of research seeks to destroy about $9 billion in scientific health research. | ||
| The University of Illinois system stands to lose $67 million from this one decision. | ||
| The gut-in of health research does nothing to make America healthier. | ||
| Further, the Republican idea with cutting Medicaid to pay for tax cuts for millionaires is appalling. | ||
| Among children in foster care, about 97% of them have Medicaid. | ||
| So when you slash Medicaid, you hurt foster youth and make Americans less healthy. | ||
| And to think of cutting federally qualified health centers or reducing the drug discounts that they receive for their low and moderate income patients is off the chart. | ||
| And forcing the premium tax cuts to expire would increase insurance cost in my district by about 150 to 200 percent. | ||
| And in Illinois outside of Chicago, like in my district, by over 300 percent. | ||
| Mr. Daunt, can you talk about how sabotaging the ACA harms health care? | ||
| I don't think I could say it any better than you just did, Congressman. | ||
| You cannot be healthy in America if you can never see a doctor. | ||
| You cannot be healthy in America if you, when you know you're not feeling well, you still stay home and do nothing about it. | ||
| That's not prevention. | ||
| The ACA, for example, cut the uninsurance rate amongst black and Latino Americans in half. | ||
| When people have health insurance, they can get preventive services. | ||
| And I would like to even associate myself with the remarks of Mrs. Miller, Congressman Miller, but the fact is that if you can't afford to go to a doctor, you're not going to benefit from these preventative services. | ||
| So if you kick people off their insurance for no reason except to put more money in the pockets of the rich and the drug companies, you're just going to deny care, preventative care, and chronic care to people. | ||
| So none of this makes sense, just to be clear. | ||
| Thank you very much, Mr. Chairman. | ||
| I yield back. | ||
| Dr. Murphy, you're recognized. | ||
| Thank you, Mr. Chairman. | ||
| Thanks for holding this very, very important committee hearing. | ||
| A lot of things that are being said are just simply not true. | ||
| Let's look back at when a lot of the American disease started in this country. | ||
| A lot of it, you know, guess what? | ||
| Education starts. | ||
| Education starts in the home. | ||
| Guess where good eating starts? | ||
| Good eating starts in the home. | ||
| Guess what destroyed the family in 1965 with the Great Society programs, which now are blowing up in our face, blowing up in our face. | ||
| You know, COVID was a horrible thing that happened to this world, and by the way, it did come from the lab. | ||
| We knew that all along. | ||
| But COVID showed us some things in the American health care system that were really stressors to it. | ||
| We looked at our supply chain that was not great. | ||
| But it also showed us sometimes the hubris of physicians. | ||
| We now have a great deal of vaccine hesitancy because of one particular physician because he showed hubris and arrogance. | ||
| We're now having people not being vaccinated who should be vaccinated because they weren't being told the truth about things. | ||
| So spare me what we're going to have to deal with. | ||
| It's okay for us to question medicine. | ||
| This is what's happened always. | ||
| You put 10 doctors in a room, you're going to get four different opinions. | ||
| So we talk about NIH funding. | ||
| NIH has run amok. | ||
| They do wonderful work, but there has been no accountability. | ||
| Look at Yale, look at Harvard, look at Scripps. | ||
| All fine because they didn't do what they were supposed to be doing. | ||
| So spare me a little bit, guys. | ||
| Good research. | ||
| If you're a good researcher, by God, you're going to continue the research. | ||
| But if you're doing nonsense, which is happening sometimes, it's time to kiss that goodbye. | ||
| So we will continue to do wonderful things with our health care system. | ||
| But by the way, I just would remind all my colleagues, we are dying in debt. | ||
| And it is okay for the parents to come in the room and look at the checkbook and see where we're spending money correctly. | ||
| Period. | ||
| So I'll get back. | ||
| And again, I want to talk about chronic disease because it is so critically important. | ||
| I walk through my hospital because, guess what? | ||
| I still see patients and I still round. | ||
| And the fact of morbid obesity that is rampant, that leads to so much disease, end-stage renal disease, cardiac disease, foot disease, you name it. | ||
| Where are we going to attack this? | ||
| Where is it going to come from? | ||
| It starts in the home. | ||
| It starts in the home. | ||
| And how we deal with these things, sugary drinks, bad foods, when we add 400 calories to the SNAP program, just pure calories, it does no good whatsoever. | ||
| We need kids out off their phones. | ||
| We need them out exercising. | ||
| We need them eating good food. | ||
| Dr. Carlson, we live in a world that, you know, I've seen an explosion in technology in the last decade. | ||
| 30 years in my medical career, the next decade has been exceedingly wonderful for cures. | ||
| But we have a problem. | ||
| It's called a money problem. | ||
| And we can't pay for everything. | ||
| I look at my younger partners now and there's not a new test they don't like. | ||
| But guess what? | ||
| We don't have enough money. | ||
| So please help me explain how we balance this when we look at genetic tests, when we look at all these things that if we had an unlimited checkbook, we could do. | ||
| But we don't. | ||
| So how do we balance having wonderful technology and being able to pay for it? | ||
| Thank you, Dr. Murphy. | ||
| So I wish I had the crystal ball for that one. | ||
| I think one of the big approaches that we've taken is to get better value out of the testing that we're doing to try to focus on the high-risk patients. | ||
| And that for our health system, we've got 15 years of electronic medical records, and it's all cloud-based today, so that we have a tremendous capability to do amazing analytics with that. | ||
| Then besides that, health care is really not health. | ||
| Health care, as you know, is fixed best to treat acute illnesses, not manage long-term type of problems. | ||
| And so another approach that we're taking is to leverage with partners that while we have the expertise in health care, there are great companies out there that have great expertise in AI and how to leverage the data that we have to try to get better value for our patients. | ||
| Right, and I agree with that completely. | ||
| The ACA gave coverage, but it didn't give health care. | ||
| Our costs of health care have skyrocketed. | ||
| And I look at the number of patients I see that are on government assistance, and sadly enough, you know, we have to double-book and triple-book those. | ||
| You can't get people to show up until it's too late. | ||
| Yeah, they can see a doctor because there are appointments to be made, but if they don't show up, guess what? | ||
| They don't get their health care. | ||
| And, you know, looking at things like Medicaid for fraud, waste, and abuse, when I see a 35-year-old guy that's on Medicaid the rest of his life because he has a little back pain, I'm sorry. | ||
| I see the waste, fraud, and abuse every day. | ||
| And it is okay to come in and reset and look at things. | ||
| That's what adults do, and that's what we're doing. | ||
| Thank you, Mr. Chairman. | ||
| I yield back. | ||
| Ms. Teddy, you're recognized. | ||
| Thank you, Mr. Chairman, and thank you to the witnesses for this very important discussion about health care. | ||
| And I come from one of those states where we have among the most expensive, most difficult health care systems. | ||
| And I also come from a family business background. | ||
| My businesses, you know, we were one of the very first in our region to provide health care to our employees because we were competing to get the best employees against a lot of government and quasi-government entities. | ||
| We know how expensive it's become over the years, especially since the ACA was passed. | ||
| Our health care costs to provide for our employees have skyrocketed. | ||
| The numbers are just outrageous. | ||
| And most businesses, especially small businesses, really struggle to find a way to get health care. | ||
| And we view our employees as members of our family. | ||
| We want them to have access to health care. | ||
| We want them to have a 401k. | ||
| We want them to have a good job. | ||
| We want them to spend time with their families. | ||
| We want a quality of life where we're providing them. | ||
| And we used to have a wonderful health care plan. | ||
| You could have a cafeteria, an assortment of all kinds of wonderful things. | ||
| You could have a health care. | ||
| You could have counseling, optical, everything. | ||
| And now it's so expensive that we can barely provide them with the basics they need. | ||
| And our premiums are extremely high. | ||
| Our deductibles are outrageously high. | ||
| And we're seeing this real problem across the small group market, especially with the small business owners that are most of my business. | ||
| Most of the people in my district in upstate New York go to work in a small business. | ||
| They don't work for a large company. | ||
| And so the average is about 129 percent over the last 20 years. | ||
| That's an average. | ||
| I would venture that it's closer to 300 or 400 percent probably in the small business industry and especially in places like upstate New York where we don't have a lot of large city opportunities. | ||
| But one of the things that we need as a group, small businesses particularly, is we need flexibility and we need the ability to be able to provide some kind of affordability to our employees. | ||
| And one of the things that we've been able to do that is through health savings accounts, which have become more and more difficult, but it gets us around that one-size-fits-all possibility. | ||
| And then we also have individual coverment high reimbursement or health reimbursement arrangements, which also help us with our consumers and with our employees. | ||
| So we want to find ways to make sure that we can have those things provided so that we can be competitive. | ||
| And this Congress, I think that we should codify and expand these ICRAs, so-called ICRAs, simplifying regulations and providing tax incentives to encourage the adoption of these things for small businesses, even those that aren't under the ACA mandate. | ||
| I did introduce the Small Business Flexibility Act last Congress. | ||
| We're going to reintroduce it. | ||
| It requires the IRS to notify small businesses about the availability of these so-called ICRAs, qualified small employer health reimbursement arrangements as well. | ||
| And then the small business health care tax credit is available to employers with 25 or fewer employees. | ||
| These are people that don't have to comply with ACA but care so much about their employees. | ||
| They want to give them an opportunity. | ||
| And I think health savings accounts are great. | ||
| I'd love to see us get away from the mandates. | ||
| Let's expand eligibility. | ||
| Let's increase contribution limits, allow more for our small employers who really care about their employees to make sure that they get access to affordable and also quality health care. | ||
| That's the big problem. | ||
| I know Dr. Murphy just mentioned. | ||
| Everybody gets an insurance card now, but nobody gets quality health care, you know, or few do. | ||
| And we want to make sure we have those options. | ||
| I do want to talk to Ms. Strauss because you are an NFIB representative. | ||
| Thank you so much for what you do. | ||
| We love NFIB. | ||
| Our company's been a member for over 40 years. | ||
| You really help our small businesses. | ||
| And I wondered, you discussed actually the individual coverage health reimbursement plans, HSAs, health savings accounts. | ||
| Where are you? | ||
| How can we do more of this? | ||
| What can we do as a Congress? | ||
| We've introduced some bills. | ||
| Could you just give us a little bit of your background on what we could do to help our small business community get access to health care for their employers? | ||
| Employees. | ||
| Yes, thank you for the question. | ||
| So I think that the great thing that's come from probably the challenges that small employers have gone through since the ACA was enacted is the fact that they are resilient and innovative. | ||
| And so we are always, as an independent agent, we sit down with our employers and work to look outside of the box on solutions that we can bring to the table that not only provide the preventive health side of things, but then also help them to navigate their benefits to make sure they feel like benefits for them. | ||
| So one of the things that I haven't had a chance to discuss today are direct primary care providers. | ||
| Right now, you can basically pay a membership fee to have access to a direct primary care provider. | ||
| However, you cannot run those fees through your HSA account. | ||
| So if that was something that was an eligible expense, I think that would be one of those preventive wellness benefits that employers could really wrap their arms around and give a much higher level of care to their employees. | ||
| Direct primary care providers are your medical home. | ||
| So that is the one provider or provider team that employees actually work with. | ||
| They can do telehealth if they want to. | ||
| They can text with their providers. | ||
| These providers will come in and do work site programs for them, do immunization workshops. | ||
| And so giving them the ability to work with somebody, then it actually helps them have more confidence in their health care journey. | ||
| So if somebody is dealing with a chronic disease or some sort of a condition that might be new, they can actually work with these teams to set up these programs to make sure that they know where to go for the lowest cost imaging in their area. | ||
| They will actually do prescription management with them. | ||
| So if they're prescribed a medication but there's a better alternative, then they would be able to go through that and help them with that. | ||
| They actually look at the specific health insurance plan, but then they take it a step further. | ||
| So this would just help give better access to people to really manage and engage in their health care. | ||
| I think my time's run out, but I appreciate it. | ||
| I love the direct primary care program. | ||
| Thank you for what you do. | ||
| Appreciate it. | ||
| Thank you, Mr. Horsford. | ||
| You're recognized. | ||
| Thank you very much, Chairman Buchanan, and to the ranking member. | ||
| I look forward to working with you and all the members of this committee on improving the health care outcomes for all of our constituents. | ||
| And I think this is a very important hearing and it comes at a critical time, especially as we're hearing a lot about making America healthy again. | ||
| Regardless of political affiliation, I think that we all can agree that the U.S. health care system should prioritize the health of its enrollees above all else. | ||
| And I believe that the only way to achieve that goal is to make sure that as many people as possible have access to affordable health care, not less. | ||
| That's why I'm proud to have worked with my colleagues, Democratic colleagues last Congress to pass both the American Rescue Plan and the Inflation Reduction Act, which included both the critical enhancement to the Advance Premium Tax Credit. | ||
| Not a subsidy, a tax credit. | ||
| In my district, over 27,000 constituents rely on the financial support provided through the Advanced Premium Tax Credit, APTC for short. | ||
| This has allowed them to afford their health insurance. | ||
| This credit gives ACA Marketplace, commonly known as Nevada Health Link back in Nevada, enrollees access to lower health care premiums and makes health insurance more affordable for working families. | ||
| Before the passage of the American Rescue Plan and the Inflation Reduction Act, the average marketplace premium in my district was $514 per month. | ||
| After the expansion, it was just $145. | ||
| That's a savings of nearly $425 per month. | ||
| That's real money that Nevadans have been able to put towards groceries and rent, gas, or other essentials, while also not having to worry about their health care. | ||
| Mr. Doc, do you think that allowing the expanded APTC to expire would promote healthy living and options? | ||
| I didn't hear you. | ||
| I was trying to say it so loud. | ||
| Absolutely not. | ||
| So instead of working with House Democrats to extend this critical lifeline, my colleagues on the other side are prepared to let it expire, choosing instead to pay for tax cuts for billionaires and big corporations and taking away a tax credit that helps the majority of my constituents and others. | ||
| Letting the APTC expire literally will cause millions to lose their health insurance and nearly 20 million working people will see their health care costs rise. | ||
| These aren't people who my colleague referred to as not eligible. | ||
| I think this is what we have to get. | ||
| These are working people who should be able to afford access to affordable health care. | ||
| In my district alone, a 40-year-old making $31,000 would see premiums rise 165%, and a 60-year-old couple making $82,000 would see 180% jump. | ||
| Mr. Doc, can you outline the real-world impact on working families allowing the APTC to expire? | ||
| Congressman, it's exactly what you said. | ||
| People simply would lose their coverage. | ||
| They will not be able to see is in the emergency room when it's far too late to get them really healthy or to give them a healthy lifestyle. | ||
| It's very clear. | ||
| And I think if I may say that this conversation that we've been having that says we have to make health care more affordable, that's true. | ||
| But taking health care away from people and making their premiums unaffordable should not be part of that strategy. | ||
| So I just want to close by also raising this issue that the current administration, the Trump Vance administration, just issued its federal funding freeze memorandum on January 27th, which included an impact to community health centers in North Las Vegas. | ||
| went and visited Hope Christian Center, a federally qualified health center, to understand directly the impacts of that funding freeze. | ||
| Mr. Doc, while this issue may fall slightly outside the jurisdiction of the committee, how does jeopardizing the sustainability of vital health programs align with the goal of making Americans healthy again? | ||
| It does exactly the opposite. | ||
| It's going to keep America sick. | ||
| Mr. Chair, I look forward to us coming together. | ||
| I know you and I have talked. | ||
| We have more in common than we don't. | ||
| Let's work together to address the health care needs of all of our constituents. | ||
| That's my commitment. | ||
| I yield back. | ||
| Mr. Moore, you're recognized. | ||
| Thank you, Chairman Buchanan, for hosting this hearing today. | ||
| Health care costs continue to climb for Americans of all stripes. | ||
| We've talked about that in various facets today. | ||
| I know that both the majority and the minority agree on this and sometimes a different approach to how to go about doing it. | ||
| I'm here to offer and talk about what I think is a proven success story within the health care market and hope to be able to dive into that. | ||
| Right now, so we're health care costs actually are outpacing inflation and GDP growth. | ||
| Right now, one in three Americans cannot cover a $400 emergency expense with cash. | ||
| Last week, I introduced, I reintroduced, because we did it last Congress too, and got some headway and we've had some really great co-sponsorships on this, the Health Out-of-Pocket Expense Act, or HOPE Act. | ||
| This would create a tax advantage accounts and would create tax advantage accounts to enable Americans of millions of Americans to save for health care costs through both individual and employer contributions. | ||
| This would help working families to manage out-of-pocket costs and save for future medical care. | ||
| Mrs. Strauss, thinking of the long-term implications if patients continue to forego that care due to basic costs, what are those? | ||
| How would you categorize those long-term implications? | ||
| And how can health care dedicated savings vehicles like HSAs and HOPE accounts address this? | ||
| And again, I bucket those two together. | ||
| HSA accounts have proven to get broad support and have penetrated many different states, my state being one of them. | ||
| Hope accounts allow for individuals that are on regular premiums that aren't high-cost, higher-income people, lower-income Americans, to be able to take advantage of this. | ||
| Would you share a little bit, I feel how that would help? | ||
| Yeah, I think that, again, more options and just expanding the regulations around those HSA accounts are always going to have a positive impact. | ||
| We talk a lot about education. | ||
| When I sit down with my employer groups, I want to make sure employees know how to use all of the benefits that they have and the tools that they have. | ||
| And so with the cooperation of employers, a lot of times employers want to contribute into the health savings accounts, which then actually incentivizes the employees to go ahead and participate as well. | ||
| So those HSA accounts are huge benefits. | ||
| Right now they are regulated to a point that not everybody has access to them. | ||
| So the expansion in the HOPE Act is exactly something that I think would be helpful for people. | ||
| I think that it still takes education. | ||
| It takes that opportunity for an employer and those independent agents like myself to make sure that people really understand what these benefits can do for them and how they can manage their health care and get ahead of these things versus waiting until there's already a problem. | ||
| The way the health care costs are today, if we're not saving for that rainy day, we will not have the money to pay a $9,000 out-of-pocket maximum if we get hit with something catastrophic out of the blue. | ||
| HSAs have been applied to more high-deductible plans. | ||
| Anytime in the policymaking world that you have a big idea, the fact that you've got years and years and years to look to typical HSAs and say, these have been successful, let's apply it to a new population of people. | ||
| This will be applied to lower-income individuals, people with regular premium plans. | ||
| And this opens up something that we've already seen success. | ||
| Apply it to a new population where I'm confident we'll continue to see that success. | ||
| That's like a perfect storm for a policy aspect. | ||
| And so we look forward to keep driving this forward. | ||
| Thank you. | ||
| And I do think, sorry, I think that in those specific situations, that's a huge help because a lot of times that population can barely afford their portion of the insurance premiums. | ||
| So they don't feel like they have the additional funds to put into an HSA. | ||
| So that does open that up and give them that opportunity. | ||
| Thank you so much. | ||
| Dr. Carlson, let me just draw one quick stat. | ||
| Diagnostic lab testing accounts for just 3% of spending, yet informs almost 70% of medical decisions. | ||
| We held a hearing in Research Park at the University of Utah at a laboratory, a working lab. | ||
| It was going on right behind us. | ||
| Could you share how important clinical labs are to patient care, and can you expound upon the AI model that Mercy has used and how it's increased your ability to find diseases? | ||
| Thank you for the question. | ||
| So diagnostic labs are a little bit different than screening labs, but yet they're extremely important. | ||
| You know, the screening labs are trying to cast a broad net the diagnostic labs and procedures, because there's also imaging, you know, breast MRI, for instance, that can help nail down a lot better, with better accuracy, what is going on. | ||
| Those are critical to the overall workflow and process. | ||
| Again, what we've tried to do is to leverage some screening tools, and I'll use breast cancer as an example, that by taking a survey, one can really sort out whether they're at increased risk that they would benefit from more than just a mammogram, but perhaps a breast MRI, also done on an annual basis, and that they have a lot greater sensitivity for picking up early breast cancers with that. | ||
| So the combination of both the screening test and the diagnostic test are extremely important. | ||
| Thank you, Dr. Carlson. | ||
| I yield back. | ||
| Mr. Kostoff, you're recognized. | ||
| Thank you, Mr. Chairman, and thank you to the witnesses for appearing today. | ||
| And I want to thank all of you for your expertise. | ||
| In my opinion, in November, the American people gave Congress a mandate. | ||
| One of the mandates, and it's not just a slogan, is to make America healthy again. | ||
| I think that's the purpose of this hearing. | ||
| If I could, Dr. Carlson, first with you, and you've certainly talked about it in your opening statement about the multi-cancer early detection test. | ||
| You talked about it. | ||
| Mr. Tingle talked about it in his opening statement also. | ||
| Specifically, as it relates to the test offered by GRAIL, which is fairly new on the market, can you talk about your experience at Mercy using this test? | ||
| How often is it by choice? | ||
| Is it something referred by the physician and the experience that you've had once those results come back? | ||
| Thank you for the question. | ||
| So in the last two and a half years, we've had about 3,000 physician referrals for evaluation and screening for that test and over 9,000 patients that came in through our website with interest in that test. | ||
| We wanted to do that test because we had patients in our footprint that were getting that test through concierge providers or providers not affiliated with Mercy and with very little understanding or education around the utility of the test, the sensitivity, the possibility of false positives, etc. | ||
| And so we put together really a standardized workflow to streamline that counseling to patients and to providers so that again we tried to add value for that test. | ||
| The other thing that we did was review our entire database of patients and sort out who was the highest risk and had a targeted marketing campaign towards those patients at highest risk. | ||
| We've had 27 positive signals with 22 cancers and only seven of those cancers had traditional screening test capabilities. | ||
| So there are a lot of benefits. | ||
| There's a lot of promise. | ||
| I would think one potential negative is the false positives and the concern that that would give to the patient. | ||
| Is that something that you've seen at Mercy? | ||
| So we have seen the false positives. | ||
| I can think of about four false positives, but we give great emphasis in that counseling prior to the test around that. | ||
| And one of the things that GRAIL has done a great job of is offering free testing in surveillance, meaning that if you have a false positive, we don't just stop there. | ||
| We go through that diagnostic evaluation, but then we go beyond that and we'll retest them or re-screen them with another multi-cancer early detection type test, the same one at three or six months and then potentially again, and that the company recognizes the patient's anxiety around that false positive test and has supported those at no cost to the patient. | ||
| Thank you, Dr. Carlson. | ||
| Mr. Tingle, if I could with you, because you also talked about these early cancer detection tests in your testimony, you talked about the GRAIL test. | ||
| I think you also mentioned, if I'm pronouncing it right, PRENUVO that does the full-body MRI scans. | ||
| Are those tests tests that John Hancock offers to policyholders at your cost or reduced cost, or how do you handle that based on the policyholder? | ||
| So thank you for the question. | ||
| We're very excited about a lot of this technology and innovation. | ||
| Again, early detection is key. | ||
| It varies by test. | ||
| The gallery test, for example, we offer to all of our vitality customers at a discount. | ||
| That discount ranges between 50 and 100 percent for our customers. | ||
| PRENUVO is a $500 discount. | ||
| So essentially, we educate our customers that these innovations are out there. | ||
| We don't compel people to take them, but we educate them about them and make them available at a lower cost. | ||
| Just out of curiosity, what do you do with the data that you receive from those tests? | ||
| It's a great question. | ||
| We actually don't get the data back. | ||
| We did not want to, even though we wouldn't do anything with it, we didn't want to have any chilling effect on a customer who might think, geez, if I take the test, my insurance company is going to find out and they're going to raise my premiums or drop my policy. | ||
| And of course, we wouldn't do those things, but we didn't even want to have the fear of that. | ||
| So we intentionally do not get the data. | ||
| If one of our customers wants to access GRAIL's gallery test, it's strictly between them and GRAIL. | ||
| We give them a discount code that they use. | ||
| Some customers have chosen to come forward to us and say, hey, I want you to know that you saved my life. | ||
| And I can tell you the most meaningful moments of my career, which is getting pretty long now, have been to stand face to face with real people who have said, I'm only here today because I happened to buy a life insurance policy with you and because you happened to offer me this gallery test. | ||
| And quite frequently now we have those customers come forward. | ||
| But unless they come forward to share their story with us, we don't get that data. | ||
| Thank you. | ||
| I yield back. | ||
| Ms. Sanchez, you recognized. | ||
| Thank you, Chairman Buchanan, for holding this incredibly timely hearing. | ||
| And I agree that we should be having serious discussions about how Republicans are making America healthy again, or actually not. | ||
| On February 7th, the Trump administration announced $4 billion in cuts to critical biomedical research funding for academic research institutions. | ||
| This funding pays for chronic disease research related to heart disease and diabetes. | ||
| And all states could lose millions of dollars from these cuts. | ||
| Just my home state of California alone could lose more than $800 million. | ||
| Missouri could lose up to $131 million. | ||
| And Texas could lose over $300 million. | ||
| Life-saving biomedical research and jobs are not partisan issues. | ||
| They affect all of our districts. | ||
| On January 27th, President Trump temporarily paused federal grants, which pay to keep community health center doors open. | ||
| Nationally, 35% of community health center patients are likely to have a chronic condition. | ||
| In my district, 88% of community health center patients are covered by public insurance or are uninsured. | ||
| Now I'd like to read some of the Republican proposals on Medicaid, the primary health insurance for 72 million people. | ||
| Number one, establishing per capita caps on state Medicaid funds, which would amount to a $900 billion cut. | ||
| Number two, adding Medicaid work requirements, which ADDS regulatory, which pardon me, which adds regulatory burden, and that's a $100 billion cut. | ||
| Number three, limiting states' ability to collect health care-related taxes. | ||
| Texas, Alabama, Missouri, California all collect three or more provider taxes. | ||
| This would be equivalent to a $175 billion cut. | ||
| Mr. Doc, according to the CDC, high rates of morbidity and mortality are related to limited access to affordable health care, often in states that have failed to expand Medicaid. | ||
| Notwithstanding the assurances that Trump is not going to cut Medicaid, could you please describe the potential consequences for people with chronic conditions if Republicans move forward with any of the Medicaid cuts that I just described? | ||
| But also to point out the ultimate consequence of all of these cuts. | ||
| They're all designed to kick people off of Medicare. | ||
| The only way you get the cuts is if you take away their insurance. | ||
| So these are all have this, they all funnel into the same result, which is they're designed to kick people off of Medicaid and take away their coverage. | ||
| You take away their coverage, bad things happen. | ||
| And what are the bad things that happen to those people that lose their Medicaid coverage? | ||
| Well, they die. | ||
| They die. | ||
| So death is the ultimate outcome. | ||
| What would also happen to these folks if we also failed to renew the ACA enhanced premium tax credits? | ||
| And I just want to say thank you for mentioning that women used to pay more for the same health care plan as men, because I was the one that added the provision to the ACA that took that away. | ||
| But what would happen if we failed to renew the ACA enhanced premium tax credits? | ||
| It's the same story, just with different sets of people. | ||
| People who are working hard, people who can afford part of their premiums, but they can't afford the whole drill, they'll lose their health care coverage as well with the same results. | ||
| And we shouldn't forget Robert F. Kennedy, even though most of that drama is occurring on the other side of this building. | ||
| But he wants to pause research into infectious diseases. | ||
| And so he's another culprit who's about to be in charge. | ||
| Which would down the line ultimately cause deaths. | ||
| Yes. | ||
| How would Medicaid cuts impact families who need long-term care? | ||
| In a very, very difficult way for them, both for those families who are trying to keep their loved ones at home so they can live with dignity and rely on that home health care, and those who have to go to nursing homes to be able to afford that. | ||
| So you've got a huge percentage of America's seniors and families dependent on Medicaid for that. | ||
| Thank you. | ||
| And I would note that most family caregivers are women, and they often have to either leave the workforce or cut back hours or not take promotions in order to care for family members that need long-term care. | ||
| You know, I'm very interested in working with Republicans to improve our health care system and to support family caregivers. | ||
| And that's why I have worked on a bipartisan basis to champion family caregiving tax credit to support families who need long-term care. | ||
| I similarly ask my Republican colleagues to preserve Medicaid for their constituents and to urge the administration to preserve NIH funding for the millions of patients, families, and researchers in their states. | ||
| Improving Americans' access to health care will make Americans healthier. | ||
| Thank you. | ||
| And I yield back. | ||
| Mr. Bean, you're recognized. | ||
| Thank you very much, Mr. Chairman. | ||
| A very good afternoon to you and good afternoon, Ways and Means Health Subcommittee. | ||
| Thank you, Mr. Chairman and Ranking Member Doggett for letting me wave on and be a part of the excitement of making America healthy again. | ||
| Let's go back 50 years. | ||
| 50 years ago, in the middle of the 1970s, the Vietnam War was coming to an end. | ||
| DISCO had taken America by storm. | ||
| And at the same time, the United States was spending just chump chain. | ||
| $74 billion is what we were spending on health care. | ||
| It was estimated only 12% of Americans had a chronic disease. | ||
| You can see pictures of people at the beach in the 70s. | ||
|
unidentified
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It seems like everybody was skinny. | |
| Fast forward 50 years ago today, we're sick. | ||
| America is sick. | ||
| We're overweight. | ||
| In spite of spending 60 times, we now spend $4.5 trillion on health care, and we've never been sicker. | ||
| 42% of Americans now have two or more chronic diseases. | ||
| 12% have five or more. | ||
| Good gravy. | ||
| So we can't just say our same old playbook of just throwing money at the problem with thinking what kind of outcomes we're going to get. | ||
| The American public cannot afford to continue spending the trillions of dollars on health care while still being one of the sickest industrialized countries on the planet. | ||
| We invest, as a country, 3% of health care expenditures on prevention. | ||
| However, every health expert will agree that if we prioritize preventive care, we can reduce the cost of prevented diseases while driving costs down. | ||
| Congress should be focused on ensuring that we get better outcomes so that the taxpayers' dollars that we spend will go a little bit long way. | ||
| I was a banker for many years, and I knew that if people had skin in the game, the outcome was much better. | ||
| And I think health care is the same way. | ||
| If we allow them more flexibility and more freedom, Ms. Strauss, you have mentioned a health savings account could be such the key to turning America's loose on solving their own health care problems. | ||
| So, in your testimony, you discuss HSAs as a powerful tool for empowering patients to take charge of the health care. | ||
| What do we need to do, Ms. Strauss? | ||
| What do we need to do to encourage more Americans to seek out these tax-advantage arrangements, which is a win-win for them and for us as taxpayers? | ||
| What say you, Ms. Strauss? | ||
| Thank you for the question. | ||
| So, I am so excited that I keep getting the opportunity to talk about HSAs. | ||
| We in the industry and the insurance industry have recognized the benefits of these accounts for a long time, but again, there are so many restrictions around them that it does make it challenging for people to be able to participate. | ||
| So, I personally think that you should be able to have an HSA for any health care plan that you have. | ||
| If you are taking that step to make sure that you're saving money for your own health care, that's going to be a positive outcome for anybody that wants to participate. | ||
| The education, I think, is really huge in making sure that employees actually understand the investment options. | ||
| You know, these accounts actually roll over from year to year, and so, unlike the FSA or the flexible spending accounts, you can continue to increase that fund year after year. | ||
| So, that also allows for opportunities to invest your money when you get to a certain amount, and then that's like a retirement investment. | ||
| I'm sold. | ||
| I am sold, but what about primary care? | ||
| I know you've talked about primary care, and you've got a partner. | ||
| If somebody partners with primary care, they get better results. | ||
| Is that true, Ms. Strauss? | ||
| Yes, it's absolutely true. | ||
| And I think a lot of this could be achieved even through our normal provider system. | ||
| But unfortunately, some of the hospital systems that are set up don't allow direct primary care to really be happening. | ||
| So, unfortunately, we've had to look for solutions outside of that. | ||
| We have an actual direct primary care provider in our area, but then we also have one that works out of Kansas City on a virtual basis. | ||
| And so, it still gives that direct primary care. | ||
| So, there's a lot of flexibility and innovation. | ||
| I hate to rush, but it looks like partnering with a medical quarterback, so to speak, that we can get more yardage and put our health in the end zone. | ||
| Mr. Tingle, real quick, you are giving away prevention services. | ||
| What's your can't be money? | ||
| What's your biggest obstacle to getting members and others to join you in detecting health challenges early? | ||
| One barrier is honestly a lot of our customers, when they go to their primary care physician and say, hey, my life insurance company offered me this gallery test, the doc, and I love primary care physicians, but a lot of them say, oh, don't bother, it's still early and it false positive, false negative. | ||
| So, we run into some resistance there. | ||
| And then, frankly, our industry just needs to continue to serve more people. | ||
| Thank you. | ||
| Thank you. | ||
| Mr. Chairman, thanks again. | ||
| I yield back. | ||
| Thank you. | ||
| Mr. Beyer, you recognize. | ||
| Mr. Chairman, thank you very much, and thank all of you for being here. | ||
| The whole notion of making America healthy again, I think we all agree with. | ||
| And I think we're all disturbed with how much money we spend and how poorly we do relative to so many other nations. | ||
| I agree with my friends that so much of it has to do with primary care and the shortage of primary care physicians in America. | ||
| The notion that so many young doctors I know come out with so much medical school debt that they have to go to the higher-paying professions, go be an orthopedic surgeon or a brain surgeon, rather than the primary care and the pediatricians we so desperately need. | ||
| I've long been interested in creating healthy options and better incentives to tackle chronic disease in America. | ||
| And despite the good things we've heard today from Dems and Republicans, I'm really concerned that the Trump-Musk-Vance administration is the staunchest ally that chronic disease has ever had. | ||
| You've got Robert F. Kennedy Jr. to be health secretary, who actively for years and years has undermined existing cures and treatments, whose entire ethos has been to eliminate vaccines and discredit established medical practice, all because of these quack and widely debunked theories. | ||
| So, Mr. Doc, does attacking scientifically supported existing cures and treatments, does that actually create healthy options and address chronic diseases? | ||
| I don't think so. | ||
| And on top of these attacks to existing treatments, the current administration is already attacking future treatments and cures. | ||
| Mr. Chairman, I ask that a letter I lead with 90 of my colleagues asking the administration to stop its attacks on NIH clinical trials and cancer research be entered into the record. | ||
| Without objection, so ordered. | ||
| Thank you, Mr. Chairman. | ||
| Because now the Trump-Vance-Musk Administration is championing chronic disease in the lab. | ||
| The administration illegally froze funding for NIH. | ||
| It hampered key clinical trials and critical meetings. | ||
| It disrupted purchasing orders. | ||
| It froze hiring, and it stopped the development of new treatments. | ||
| NIH is mission-critical. | ||
| Every day of that research is delayed because communications, funding, or hiring a shutdown means one less critical trial or one fewer cure that could save someone's life. | ||
| And now the administration is particularly targeting NIH funding that universities receive. | ||
| This is a threat to economies across the country and to my own Virginia's preeminent research institutions like Virginia Tech. | ||
| Mr. Chairman, again, I ask that a letter I received from Virginia Tech be entered into the record about what these attacks mean for one of our nation's top tech universities. | ||
| Without objection. | ||
| Thank you, Mr. Chairman. | ||
| While a court order has stopped this unlawful action, it's limited to states that were party to the complaint. | ||
| So our Virginia Attorney General, Miaris, is currently more focused on suing private businesses for ideological reasons than Virginia's well-being, and as such was not a party to the suit. | ||
| So Virginia Tech is still impacted by this unlawful action. | ||
| And other researchers studying chronic disease have fared no better. | ||
| In granting NSF's National Science Foundation awards, the administration has explicitly targeted research containing the word systemic, shutting down any research into the persistent health, social, and economic factors which are the leading causes of chronic disease. | ||
| And while new research dries up, the administration is ending public access to existing databases that help health care professionals track the prevalence of chronic diseases and care for people already living with these conditions. | ||
| So Mr. Doc, again, does attacking new science and researchers dedicated to finding new cures and treatments create healthy options and address chronic disease? | ||
| It does not. | ||
| Thank you. | ||
| And now, the Trump-Musk Vance Administration has more plans to keep momentum going for chronic disease. | ||
| As Mr. Doc described, the administration is already planning to make it harder for millions of Americans to afford their health care and prescription drugs. | ||
| We've heard numerous times that Republicans plan to roll back the Inflation Reduction Act, which means killing out-of-pocket caps and direct Medicare pharmaceutical negotiations that are already bringing down drug costs that seniors with chronic conditions will benefit from. | ||
| And we know they don't plan to extend the Affordable Care Act's advanced premium tax credits, which makes affordable health care much more affordable for folks with chronic conditions. | ||
| And we also know that they want to roll back the Affordable Care Act completely, which means kicking people off their health insurance, and allowing back the predatory insurance practices that can be used to deny coverage to people with chronic conditions. | ||
| We all should remember what it was like in 2010-2009. | ||
| So, Mr. Doc, does eliminating these federal efforts that lower prices and increase access to care create healthy options and address chronic conditions? | ||
| I wish I could have a different answer, but the answer is no, they do not. | ||
| Yeah, well, thank you for letting me make the case that we're not moving in the right direction for all these things. | ||
| And then finally, to pay for tax cuts for the wealthy, which we'll do here in this committee, they're pushing to cut America's family benefits under the SNAP program, supplemental nutrition, and by targeting Medicaid and eliminating, I believe, the Medicaid expansion. | ||
| Cutting SNAP to pay for tax breaks for the rich is going to squeeze more families' pocketbooks, despite lots of evidence showing it helps families purchase healthier food, spend more on health-promoting activities, and lowers the impact of chronic disease. | ||
| You already know that when you undermine Medicaid, it's going to disproportionately affect people with chronic conditions. | ||
| This is a recipe for disaster, and I just ask that we resist this in every way we can. | ||
| Thank you very much, Mr. Chairman, and I yield back. | ||
| Sewell, you're recognized. | ||
| Thank you, Mr. Chairman. | ||
|
unidentified
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I want to thank all of our witnesses on this panel today. | |
| You know, I represent Alabama's 7th congressional district, which includes the Black Belt of Alabama, a rural part of Alabama, and access to quality, affordable care is a problem. | ||
| And frankly, one of the biggest problems that we have is access to primary care physicians, but also transportation, getting folks to a primary care doctor for prevention. | ||
| So I've focused a lot of my time here in Congress on trying to solve that issue. | ||
| And, you know, there's nothing better than early prevention. | ||
| I think all of us would agree that the cost of end-of-life is really expensive. | ||
| One particular cost of end-of-life is cancer. | ||
| And I think cancer has affected all of us. | ||
| And when one gets a cancer diagnosis, you hope that the next words are, and we caught it early. | ||
| And so often that is not the case. | ||
| My mother, Nancy Gardner-Sewell, died of pancreatic cancer eight weeks from diagnosis to death. | ||
| It was very, well, it was a tragedy for our family. | ||
| But in my effort to turn my pain into passion, I have tried to figure out what is out there that can give early detection a shot. | ||
| And these multi-cancer early detection screens are critically important. | ||
| That innovation so often has come from NIH and NSF-based research. | ||
| And we as taxpayers pay for that. | ||
| And we should have access to that. | ||
| So I wanted to support innovation, but at the same time, we get some pushback from folks who think that that innovation is not worthy of actually being eligible for Medicare. | ||
| And so, Dr. Carlson, I know that you spoke so passionately about it. | ||
| My co-sponsor, Jodi Arrington, and I have introduced H.R. 842, a Medicare multi-cancer early detection screening bill that Jodi Arrington, my Republican colleague, filed last year and named it after my mom, which was very sweet. | ||
| And the point is that my mom was living a very vibrant life. | ||
| She was on the city council. | ||
| She was very involved in having been a former librarian, very involved in having mobile units to give books to children who live in the black belt. | ||
| And this really interrupted her life. | ||
| She was 82, and I know my brothers and I are worried that this now is a part of our family history and family tree. | ||
| And the costs right now for these multi-cancer early screens are very expensive. | ||
| And it's only available to those who can afford it. | ||
| And I don't think that that's right. | ||
| And so I'm proud of this bill. | ||
| And in fact, the bill got over 300 co-sponsors, bipartisan support last Congress, 65 Senate co-sponsors. | ||
| And we are looking to file it again. | ||
| We simply ran out of time to get it across the finish line. | ||
| But I want to thank the chairman of the House Ways and Means Committee, Jason Smith, for really helping me get this before this committee, and it unanimously passed. | ||
| So my question to you, Dr. Carlson, is why is it so expensive? | ||
| And would you actually talk about the barriers to actually getting this as a Medicare covered expense? | ||
| And we know that age is a factor, and our bill would start at 65 in order to reduce the cost. | ||
| I would love for it to start even sooner. | ||
| But can you talk to us about why you value this particular type of screen and what you see as the big impediments? | ||
|
unidentified
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Thank you, Congresswoman. | |
| And I've followed the progress with your bill, and it's been amazing and well needed. | ||
| You made a couple of comments, though. | ||
| One has to do with just access in general. | ||
| And we had a lot of flexibility added to telehealth during the pandemic. | ||
| But the way that it appears to be scheduled is that a lot of that flexibility is due to expire on March 31st, 25. | ||
| And I don't understand that. | ||
| I don't think patients were harmed by that. | ||
| I think that they were helped by it. | ||
| Well, I think that telehealth has really gotten bipartisan support. | ||
| And I really hope that this committee will use its influence to make sure that it is extended. | ||
| And I actually think it will be extended. | ||
|
unidentified
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Very good. | |
| So then on the actual multi-cancer early detection tests, as you're probably also aware, there is a Medicare-supported clinical trial underway right now to really try to give some stronger evidence for that. | ||
| And we'll kind of compare those outcomes to be sure that we've got the right value there, because that's really what we're talking about, that outcome at whatever cost. | ||
| And I think that the other thing that will help change the cost is that there's probably four other companies out there developing a similar type of test, perhaps not for 51 cancers, but would cover the top 12 cancers or the top eight cancers. | ||
| Isn't it true that if we do reimburse for Medicare that what would happen is more innovation in the space? | ||
| I think about how with colon cancer, we fast-tracked, this Congress fast-tracked it and made it reimbursable. | ||
| And all of a sudden, we went from a screen in a doctor's office to now you can go to CVS and get Cologuard right off the shelf. | ||
| So is it true that we would spur innovation by doing that? | ||
|
unidentified
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I agree with that, that it would definitely, you know, it's following the money. | |
| And if the money is there, that that innovation will follow. | ||
| Well, I want to thank you, Mr. Chairman, for indulging me. | ||
| I'd look forward for our committee continuing to lead the way on this and would urge a hearing at the Energy and Commerce Level Committee as well, since we have dual jurisdiction for the multi-cancer early detection bill. | ||
| Thanks so much. | ||
|
unidentified
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I'll yield back. | |
| Let me just say we want to thank all of you. | ||
| As someone that's been in business 30 years before I got here, we first got a small company we started out, my wife and I, we paid, and then we maybe went to 100 employees, 500 employees, but a lot of employees, thousands of employees. | ||
| But we paid for everything and everybody. | ||
| This was back, man. | ||
| I don't want to date myself too much, but this was back a while. | ||
| We had Blue Cross Blue Shield. | ||
| Today is you pay about half. | ||
| And I chaired the chamber in our area, Sarasota, the chamber for Florida. | ||
| We had 130,000 businesses in that. | ||
| Most businesses in our state, most states, are 25 employees or less, 15 employees or less. | ||
| That's who we're talking about. | ||
| And the reason I brought that up, we would pay for everybody. | ||
| Today, We pay for half. | ||
| And that's true of a lot of businesses today. | ||
| And that's one of the biggest challenges. | ||
| And then the other thing I just think in terms of the preventive cost, when I looked at it as kind of chairing this committee, I wanted to, yeah, we need to do what we can to support people, but we also got to get people to invest in themselves. | ||
| Be the CEO of your own health. | ||
| We don't have enough money, in my opinion, to pay everything. | ||
| $4.4 trillion is what we're spending for health care. | ||
| And that's why I'd like to see more companies, more individuals try to be more selective. | ||
| A lot of the food that we eat, frankly, I say it is garbage. | ||
| And we've got to do a better job of doing that. | ||
| I've got 10 grandkids, 10 and under. | ||
| And they'll say, Papa, you can't drink that diet of Coke. | ||
| I've got to hide it and go get some orange juice. | ||
| But my point, I'm not picking on any one thing. | ||
| But today, families are a lot more, the ones that afford to be or are more sophisticated. | ||
| They're looking at labels and they're looking at content and they're trying to be smarter about what they're giving their kids. | ||
| And when you've got 20% obesity with your children, we never had that when we were all growing up or the ones in here are a little bit older. | ||
| So it's not just about looking at one or two things. | ||
| There's a lot of factors. | ||
| And I'm jumping around in terms of small business, but we've got to find a way to come together and work towards getting people healthier. | ||
| And people, in my sense, have to be a little bit more responsible and taking responsibility for their own health. | ||
| There's not enough money to go around. | ||
| One thing I try to do for the last 20, 30 years, every January, I get a full physical. | ||
| I think that goes a long ways in terms of trying to, in terms of the preventative things. | ||
| So if you've got something, you can catch it early. | ||
| You've got a trend line, but there's things that we can do and should do. | ||
| If everything's reactionary, in other words, you know, you've got to get the heart disease, you got to get the cancer, then you find out. | ||
| But how about finding out beforehand? | ||
| So I just want to throw a couple of things out there myself. | ||
| You can tell I'm a little bit passionate about it. | ||
| But I'd like to submit for a record a letter from the Academy of Nutrition and Dietitians supporting the Chronic Disease Flexible Coverage Act. | ||
| And then I'd like to thank our witnesses for appearing before us today. | ||
| Please be advised that members have two weeks to submit written questions to be answered later in writing. | ||
| Those questions and your answers will be made part of the congressional record. | ||
| With that, the subcommittee stands adjourned. | ||
| Thank you. | ||
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