| Speaker | Time | Text |
|---|---|---|
| Down to the Department of Education. | ||
| This president is undermining an important role that the federal government fulfills. | ||
| I will tell you that more than 60 Republicans voted against eliminating the Department of Education last Congress. | ||
|
unidentified
|
We need to keep the pressure up on those 60 members of Congress and fight tooth and nail to save. | |
| You can watch the rest of the Democrats' comments at c-span.org. | ||
| going to leave them to take you live to the confirmation hearing for Dr. Mehmet Oz to serve as administrator of Centers for Medicare and Medicaid Services here on C-SPAN. | ||
| And the confirmation hearing for President Trump's pick to lead the Centers for Medicare and Medicaid Services expected to begin here shortly. | ||
| If confirmed the nominee, Dr. Mehmed Oz would oversee Medicare, Medicaid, and private insurance plans at healthcare.gov. | ||
| Combined, those programs provide health insurance to about half of all Americans. | ||
| According to NPR, Dr. Oz favors Medicare Advantage. | ||
| It's a privatized version of Medicare and has made the case for a single-payer-like system he called Medicare Advantage for All. | ||
| The confirmation hearing for President Trump's pick to lead the Centers for Medicare and Medicaid Services expected to begin here soon. | ||
| According to NPR, Dr. Oz favors Medicare Advantage. | ||
| It's a privatized version of Medicare. | ||
| A little bit more about the nominee as well, Mehmed Oz. | ||
| He's a cardiothoracic surgeon. | ||
| He ran for the Senate in Pennsylvania as a Republican in 2022, but lost his bid. | ||
| He first became known as a regular guest on the Oprah Winfrey Show. | ||
| Again, just expecting this hearing to begin soon here on C-SPAN. | ||
| The committee | ||
| will come to order. | ||
| This is the hearing for Dr. Oz to be the director of the Centers for Medical and Medicaid Services, the CMS Administrator. | ||
| Dr. Oz, my staff and I have enjoyed working with you and your team throughout this committee's rigorous vetting process, and I appreciate your candor and responsiveness. | ||
| You have provided significant amounts of documentation to substantiate your tax return positions and followed all of the applicable law. | ||
| You have met the same due diligence standard that has applied to every nominee in every previous administration. | ||
| And I'll say once again, I believe that the Finance Committee has the most thorough and rigorous vetting process of any committee. | ||
| You have gone through that vetting process and have proven yourself to be an outstanding nominee worthy of this nomination. | ||
| I again thank you for your cooperation throughout this exacting process and for conducting yourself with kindness and professionalism. | ||
| I look forward to continuing our work together. | ||
| For those outside of Washington, CMS can seem like a bureaucratic black box, largely removed from everyday challenges facing patients and clinicians. | ||
| Dr. Oz, you offer a wealth of first-hand experience and expertise, having studied, practiced, and taught as an accomplished physician. | ||
| In short, you understand how D.C. legalese looks on the ground and how policy plays out in practice. | ||
| This is exactly the mindset we need for a CMS administrator. | ||
| From our discussions, you also clearly recognize the importance of this role and the programs that CMS manages, along with the tremendous responsibility that taking the helm of this entails. | ||
| As the world's largest health insurer, CMS sets health care coverage and payment policies for tens of millions of Americans and their providers. | ||
| Medicare currently enrolls more than 68 million Americans. | ||
| Medicaid and the Children's Health Insurance Program, or CHIP, compromise close to 80 million, and more than 24 million consumers have selected individual market plans. | ||
| Over the course of the next 25 years, analysts project the Medicare-aged population will grow by an additional 47%, further underscoring the high stakes of CMS policymaking. | ||
| Ensuring sustainable and stable and proactive rules of the road for these programs will necessitate a collaborative and constructive approach. | ||
| Medicare seniors deserve better prescription drug affordability, along with stronger access to pharmacists and doctors. | ||
| This committee has taken steps to achieve these goals on a broad bipartisan basis, and we look forward to working with you to advance those measures. | ||
| This includes pharmaceutical benefit manager reform or PBM reform, a stated priority for President Trump. | ||
| Your background also offers the ideal experience for guiding efforts to reform our broken clinician payment system, an issue that you understand from both a policy standpoint and a pragmatic perspective. | ||
| Modernizing federal health care programs will require rethinking our outdated approach to treating the symptoms rather than the underlying causes of chronic disease. | ||
| Equipping providers with the training to employ a diverse array of interventions, from nutrition and lifestyle changes to cutting-edge drugs and devices, will save lives and taxpayer dollars. | ||
| Technological advancements like telehealth also offer an opportunity to reshape health care delivery in rural communities, including in Idaho, where access to basic services remains challenging. | ||
| Medicare Advantage's market-driven benefit structure provides seniors with more timely access to these and other novel approaches to care. | ||
| Its successes should serve as a model for other federal programs. | ||
| Similarly, Medicaid's essential safety net coverage relies on a balance between state-based flexibilities with key patient protections. | ||
| Based on our conversations, I'm confident your experience as a physician serving Medicaid beneficiaries will be an asset to CMS. | ||
| I look forward to learning more about your vision today about how we can work together to strengthen our health care system for patients, providers, and taxpayers. | ||
| Thank you again, Dr. Oz. | ||
| And I now recognize our ranking member, Senator Wyden, for his opening remarks. | ||
| Thank you very much, Mr. Chairman. | ||
| Our nominee would oversee the Centers for Medicare and Medicaid Services and be responsible for the health and well-being of over 160 million Americans. | ||
| Now, once again, finance committee investigators start the process by bringing the receipts. | ||
| Dr. Oz is the second Trump nominee to come before the committee this year with a record of dodging Medicare and Social Security taxes. | ||
| This tax loophole hurts Medicare and has benefited Dr. Oz by $440,000 in the last three years. | ||
| Now, the doctor will testify about his concern for Medicare's well-being, yet he is unwilling to pay the same taxes that millions of Americans pay out of every paycheck. | ||
| So what that means is the person who's nominated to run Medicare thinks that it's acceptable to not pay his taxes into Social Security and Medicare like nurses and firefighters do out of every paycheck. | ||
| That's number one. | ||
| Number two, the nominee has been a big promoter of private for-profit health insurance that too often displays little interest in protecting older people who enroll in these plans. | ||
| And I have seen it as the former director of the Oregon Gray Panthers. | ||
| So on our side, we're especially concerned that seniors signing up for these plans are being lured by deceptive marketing and too good-to-be-true benefit packages. | ||
| Then they get walloped by business practices that often delay and deny care. | ||
| When he ran for the Senate, Dr. Oz proposed putting all seniors into private Medicare Advantage plans, leaving traditional Medicare, which serves almost half the Medicare population. | ||
| Those folks, their coverage would just wither on the vine. | ||
| Traditional Medicare. | ||
| Dr. Oz has demonstrated no interest at all in improving traditional Medicare for the 34 million Americans that count on this program. | ||
| That'll be a big priority for us going forward. | ||
| Dr. Oz has made a lucrative career out of advertising these for-profit insurance options, targeting seniors with shady marketing tactics on his television program. | ||
| He even went so far as to sign up to be an insurance salesman himself. | ||
| Dr. Oz has used this program to promote some of the most ludicrous wellness grifting that I've heard about to date. | ||
| green coffee extract, raspberry ketones, supplements for cancer prevention. | ||
| Several weeks ago, this committee heard a slew of similarly misleading claims from another unqualified Trump nominee. | ||
| Now our country is facing the biggest measles outbreak in decades while the Trump administration touts the benefits of cod liver oil and terrifies parents about vaccinating their kids. | ||
| Meanwhile, Donald Trump, Elon Musk, and congressional Republicans are gearing up to deal the biggest blow to Medicaid in history. | ||
| These cuts to Medicaid are going to be devastating for adults and those with disabilities. | ||
| It could destroy care and nursing homes as we know it, and it's going to mean ripping health insurance away from millions of families struggling to get by. | ||
| So if confirmed, Dr. Oz is going to be responsible for executing whatever destruction is brought down on the Medicaid program by the cuts Republicans are preparing to make. | ||
| He would be responsible for the premium hikes for families who purchase their own health insurance through the Affordable Care Act. | ||
| Dr. Oz would be in charge of these programs. | ||
| He'd be calling the shots about what gets cut and what stays. | ||
| He'd be the one to allow or stop any attempts by Elon Musk and his Doge Brigade to control Medicare and Medicaid payment systems. | ||
| Meanwhile, Republicans and those like Dr. Oz are all too happy to ignore the predatory tactics for for-profit insurers that they use to deny and delay care for patients who are trying just to get decent and good quality care. | ||
| Families across the country want to know that their health care is going to be protected and that premiums are affordable. | ||
| Instead, Republicans march ahead with plans to take an axe to health insurance. | ||
| They want to put for-profit insurance companies and private equity firms that make money off denying and delaying coverage in the driver's seat of America's health care. | ||
| That's not what the American people voted for. | ||
| It's not what they deserve. | ||
| Based on the evidence I've just laid out, the American people have a variety of reasons to believe Dr. Oz will be fully on board with the Trump and Republican effort to cut Medicaid and to coddle the for-profit insurance companies. | ||
| Today's hearing is an opportunity for Dr. Oz to show the committee otherwise. | ||
| Thank you, Mr. Chairman. | ||
| Thank you, Ranking Member Wyden. | ||
| In a moment, we will give Dr. Oz the opportunity to share his opening statement, but before he does, I want to provide a short introduction. | ||
| A graduate of Harvard College, the University of Pennsylvania, and Horton Business School, Dr. Oz was a faculty member and full professor at Columbia University College of Physicians and Surgeons before the age of 40. | ||
| He led the Columbia University Surgical Labs, where he pursued cutting-edge solutions to heart disease, published hundreds of original peer-reviewed papers, and wrote 16 books, half of which became New York Times bestsellers. | ||
| In 2003, Dr. Oz and his wife Lisa founded HealthCorps, which emulates the Peace Corps by putting recent college graduates into high schools around the country to teach diet, fitness, and mental resilience. | ||
| Of course, many also know him from the Dr. Oz show, where he discussed health and wellness strategies and received several Emmy awards. | ||
| Dr. Oz, before giving you your opening statement opportunity, I have four obligatory questions that we ask all nominees who come before this committee. | ||
| First, is there anything that you are aware of in your background that might present a conflict of interest with the duties of the office to which you've been nominated? | ||
| No. | ||
| Next, do you know of any reason, personal or otherwise, that would in any way prevent you from fully and honorably discharging the responsibilities of the office to which you've been nominated? | ||
| No. | ||
| Third, do you agree without reservation to respond to any reasonable summons to appear and testify before any duly constituted committee of Congress if you are confirmed? | ||
| Yes. | ||
| And finally, do you commit to providing a prompt response in writing to any question addressed to you by any senator of this committee? | ||
| Yes. | ||
| Thank you. | ||
| And Dr. Oz, as you begin, or before you begin, you are certainly welcome to introduce your family. | ||
| You might recognize them. | ||
| They're sitting behind me, this whole slew behind me is the family. | ||
| One couldn't get here because of a baby at home. | ||
| But my wife, Lisa, right there, I should point out I married her in the wisest decision of my life 40 years ago. | ||
| And if I can just come close to being that insightful when I'm administering Medicare confirmed by this committee, then I think it at least begin to battle some of the challenges we will face. | ||
| Thank you. | ||
|
unidentified
|
Please proceed. | |
| Chairman Grapo, Ranking Member Wyden, thank you very much for inviting me to appear in front of this committee today. | ||
| I've met with everybody on this committee at one point or another, and I'm hoping some of those conversations will inform the committee hearing. | ||
| I want to thank President Trump for his passionate desire to make America healthy again and for nominating me to support that vision. | ||
| I want to thank Secretary Kennedy for having the confidence in my capacity to make a meaningful and measurable difference in the health and well-being of the American people. | ||
| Let me start off with one simple premise. | ||
| All great societies, all great societies, protect their most vulnerable. | ||
| And I would argue we are a great people. | ||
| With that in mind, I commit to doing whatever I can, working tirelessly to ensure that CMS provides Americans with access to superb care, especially Americans who are most vulnerable. | ||
| Our young, our disabled, and our elderly. | ||
| For me, this commitment has been a lifelong passion. | ||
| My physician father, when he came here, when he immigrated, saw America as a beacon of hope, a land of opportunity where everyone's decisions mattered. | ||
| That imbued me a confidence that I mattered, that I had agency. | ||
| For example, I was a student athlete at Harvard, Senator Wyden, like you. | ||
| That was the original Make America Healthy Again concept, that you just would work hard, play hard, eat well, and watch your body thrive. | ||
| But because of my experience in college, I was surprised when I matriculated at the University of Pennsylvania in medical school that there was no nutrition class. | ||
| So because I thought I had agency, I ran for school president. | ||
| I won, and I created that class. | ||
| I became, as well, a student at the Wharton Business School. | ||
| And while there, I learned the skills necessary to manage large organizations like at CMS, where we have nearly 7,000 folks, hardworking career civil servants, and 40,000 outside contractors involved with the delivery of our services. | ||
| Next, I began my career at Columbia University. | ||
| And for those of you who don't know where Columbia the Medical School is, it's in uptown Manhattan in an area called Spanish Harlem. | ||
| At the time I was training, it was the murder capital of the world, an area heavily populated by Medicaid patients. | ||
| And I saw firsthand how our services, our health care system, underserved these communities. | ||
| So I went to work. | ||
| I began developing high-tech solutions, life-saving medical breakthroughs, ranging from mechanical hearts to the Mitra clip, which is a small device you can put into the heart without stopping the heart that fixes heart valves and it saves lives. | ||
| In one large study, 50% reduction in death at half the price. | ||
| Those are the kinds of advances that I wanted to be involved in. | ||
| But I also pushed for low-tech solutions, like getting my patients to use preventive strategies, healthier lifestyles, in order to recover from the heart surgery that I was often performing on them. | ||
| And then Lisa, my wife and I, started Health Corps, which is a teen foundation which has touched the lives of millions of Americans over the last 20 years. | ||
| Senator Bennett working in schools, as we discussed in your office, tirelessly trying to get young, energetic kids to play a role, college graduates, in the well-being of kids just a few years younger than teenagers. | ||
| And all along, I was working hard to publish what I found. | ||
| In fact, publishing hundreds of peer-reviewed academic articles in some of our top journals, a bunch of New York Times best-selling books, as Senator Grapo mentioned. | ||
| And all of these culminated in the creation of the Dr. Ra Show. | ||
| We hosted health advocates from all walks of life, and we did it well, which is why we won 10 Emmy Awards for outstanding work over the 13 years of the program. | ||
| I share my story with you for a simple reason, to highlight that everything I have done in my life, educationally and professionally, has prepared me for this precise moment in time, which I believe offers a monumental opportunity and a challenge for us at CMS. | ||
| My TV audience has heard me say this many times, but many of you are too busy to watch television, so I'll repeat it, that I believe that a physician has a responsibility to tell patients what they need to know, even if the message is uncomfortable. | ||
| So here's some painful truths that should concern everyone in this room. | ||
| I'll list them quickly. | ||
| Healthcare expenditures are growing 2% to 3% faster than our economy. | ||
| Not sustainable. | ||
| The Medicare Trust Fund will be insolvent within a decade. | ||
| That's the 2.9% taken out of your paycheck. | ||
| Medicaid is the number one expense item in most states, consuming 30% of those state budgets. | ||
| And that's crowding out essential services like schools and public safety that many of you have spent your careers trying to develop. | ||
| A health care cost per person in this country is twice that of other developed nations. | ||
| So it's not just about the money. | ||
| We're already putting twice as much money into the system. | ||
| Why is it costing us so much? | ||
| Because of chronic disease. | ||
| And those chronic diseases, and we made it easy to be sick in America, are linked to poor lifestyle choices, and they drive three-quarters of the $1.7 trillion that CMS spends a year to support Americans' health. | ||
| 43% of Americans are obese. | ||
| That's the major driver of those lifestyle chronic morbidities. | ||
| That's quadrupled since I was in college. | ||
| More importantly, we're twice as obese as Europeans. | ||
| We're nine times as obese as the Japanese. | ||
| And three-quarters of our young people cannot even qualify for military service. | ||
| Our maternal mortality rate, and I want to hammer this point home because we talked about it and Senator Hassan, we talked about this. | ||
| Well, she slipped out, but she was there a second ago. | ||
| It puts us in dead last place behind 50 other countries, maternal mortality rate, women dying during childbirth. | ||
| Medical errors, number three cause of death in America. | ||
| These are some of the reasons why our life expectancy is now five years shorter than comparable countries. | ||
| This public health crisis threatens our national security. | ||
| Why? | ||
| Because it adds to the national debt that is defeating us from within, crowding out other essential services. | ||
| And we are, in addition, witnessing fellow Americans suffering needlessly, which I believe is a moral failing. | ||
| As a heart surgeon, I can attest that the most expensive care we give is bad care. | ||
| You pay to do the wrong thing, you pay to fix what was done wrong, then you pay to deal with all the complications. | ||
| It's immoral, it's wrong, and it's expensive. | ||
| We have a generational opportunity to fix our health care system and help people stay healthy for longer. | ||
| That's why President Trump wants to love and cherish Medicare and Medicaid, because he believes every American should get the care they want, need, and deserve. | ||
| Now, to achieve this mission, CMS should work with Congress to find efficiencies that can help stabilize our insurance markets, which will make it easier and more affordable for Americans to adopt healthy lifestyles. | ||
| I would argue, I know you all agree, America is too great a nation for small dreams. | ||
| So here's some three, some big ideas. | ||
| I'm going to limit it to three so I can get to the questions that I want to pursue if I'm confirmed by the Senate. | ||
| First, we should empower beneficiaries with better tools and more transparency so the American people can better navigate their health as well as dealing with the complex health care system we have created for them. | ||
| As an example, I think President Trump's executive order on transparency shifts power to the American people. | ||
| Let's make America great again and make it healthy again by informing people so they can be in charge of their well-being. | ||
| Second, we should incentivize doctors and all health care providers to optimize care, but we have to do that with real-time information while they're taking care of patients and within their workflow. | ||
| Artificial intelligence, I believe, can help. | ||
| It can liberate doctors and nurses from all the paperwork, which, by the way, is as much time they spend on paperwork as taking care of patients. | ||
| They should focus on patients. | ||
| It's better use of their time. | ||
| And third, let's be aggressive in modernizing our tools to reduce fraud, waste, and abuse. | ||
| This will stop unscrupulous people from stealing from vulnerable Americans and extend the life of the Medicare Trust Fund. | ||
| I ask your permission to start sprinting after these goals so together we can provide access to better care, deliver better outcomes, and make America healthy again. | ||
| I look forward to your questions and I pray for your support. | ||
| Thank you, sir. | ||
| Thank you, Dr. Oz. | ||
| As I mentioned in my opening statement, your background and experiences bring a fresh perspective to the role of CMS. | ||
| Administrator, as an accomplished physician, you have first-hand experience not only with the bureaucratic nature of federal government payment programs, but also the impact of chronic disease, as you've discussed in your statement. | ||
| I'd be curious if you would just expand a little more on your vision for CMS and how you would integrate nutrition and lifestyle-based interventions into our health care system. | ||
| Senator Grapo, when I walked into your office, you gave me an Idaho potato chip. | ||
| You also gave me a large potato, but that's where those potato chips came from, and nothing else was added. | ||
| If you look at the ingredient list, it was a potato and a little bit of salt. | ||
| You also had yogurt in your office, which was low-fat, flavored, and I would argue not as healthy. | ||
| The average American has a difficult time making that choice. | ||
| And we'll often incentivize products that aren't as healthy for the American people, which is confusing. | ||
| One of the points that I mentioned at the end of my opening comment was that if we gave people in their hands tools, resources that are useful, not information, but tactics and support teams that could work with them to improve their well-being, many would take advantage of it. | ||
| I pointed out obesity, which is 43%, and that's not overweight, that's obesity. | ||
| Those folks want to lose weight. | ||
| There are many reasons they don't, but part of the reason they don't is they don't have support teams built around them. | ||
| They don't have lifestyles advice that they can implement into their life day in and day out. | ||
| For anyone in this committee who was able to go running or exercising for 20 minutes yesterday, you probably did the equivalent of reducing $100 billion of expenses for Medicare and Medicaid just by being active. | ||
| If Americans would do that every day, that's what we'd experience. | ||
| But we haven't done that. | ||
| One tactic that I believe will work quite effectively is if we can get real-time information from physicians and other health providers taking care of patients and using that real-time information, give feedback to people who are worried about their well-being. | ||
| That's when they're more likely to use that advice. | ||
| That tool would allow them to both call an expert if they needed that resource. | ||
| We'd provide them tools to do that. | ||
| We'd reimburse some of the healthy lifestyles that would be generated by these interactions. | ||
| And we'd make them an active participant in their well-being. | ||
| I think that dramatically changes the power dynamic. | ||
| It makes the American people feel like they actually can be the world experts on their well-being. | ||
| Thank you. | ||
| I very strongly agree with your focus in these comments on lifestyle-based interventions that can actually help people help themselves to get much more healthy. | ||
| And I'm also interested in how you might reform our payment programs to become more efficient to serve both patient lives and to save both patient lives and taxpayer dollars. | ||
| So when I sat with Senator Wyden last night, he asked about a similar issue, which is pre-authorization. | ||
| We spent about 12% of the CMS budget on bureaucratic processes, the administration of the program. | ||
| And most of that money is taken by middlemen in ways that I don't think need to be true in the long term. | ||
| I believe we have the power right now with technology that didn't exist three or four years ago to automate a lot of these processes. | ||
| And pre-authorization is a good example. | ||
| There are about 15,000 procedures that go through pre-authorization. | ||
| Insurance companies, in aggregate, probably have 5,000 they'll list, but they only have to have about 1,000 in order to truly make a difference and make sure that the right procedures are done in the right way. | ||
| We should be able to create an experience for physicians and patients so that we know almost immediately if what they're going through is requiring a pre-authorization, and if it does, what do they actually do to qualify for it? | ||
| That could be instantaneous. | ||
| By doing this rapidly, we cut out several percent of administrative costs, deal with the intense frustration the American people have with pre-authorization, which was raised by many members of this committee. | ||
| And we actually improve the care of people without costing or taking money out of the system. | ||
| Those are the kinds of advances I believe we can champion. | ||
| Thank you. | ||
| That concludes my questioning. | ||
| We have a vote on, and so I'm going to step out and go, well, that's probably why you've seen a number of the members slip out. | ||
| Senator Wyden will go next, and then Senator Grassley, and hopefully I'll be back by then. | ||
| So thank you. | ||
| Thank you, Mr. Chairman. | ||
| Dr. Oz, I was listening carefully to your remarks, and you talked about cherishing Medicaid. | ||
| And I think that's a very good sentiment. | ||
|
unidentified
|
So I want to ask about how we're going to do that. | |
| Will you agree this morning, since you want to cherish Medicaid, to oppose any cuts to the Medicaid program? | ||
| And I want a yes or no, because we all agree that we need to do more to fight fraud and such matters. | ||
| But what I want to know, yes or no, is since you cherish Medicaid, will you agree to oppose cuts in the Medicaid program? | ||
| I cherish Medicaid and I've worked within the Medicaid environment quite extensively, as I highlighted practicing at Columbia University. | ||
| That's not the question, Doctor. | ||
| The question is, will you oppose cuts to this program you say you cherish? | ||
| Time's short. | ||
| I want to make sure that patients today and in the future have resources to protect them if they get ill. | ||
| The way you protect Medicaid is by making sure that it's viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to actually use Medicaid. | ||
| Records show that I asked a witness who said he cherishes this program, will you agree to oppose cuts? | ||
| And he would not answer a yes or no question. | ||
| Let me ask you about rural communities because they get hit by Medicaid cuts if they go through like a wrecking ball. | ||
| I mean, it is going to be devastating to rural America. | ||
| We've got a lot of senators who care about this. | ||
| The Oregon County with the highest share of residents who get their health insurance through Medicaid is Malheur County on the border with Idaho. | ||
| By the way, this is an area that Donald Trump won in the election by 70 percent. | ||
| So, because I want you to be able to do more to actually cherish Medicaid and help people, I'd like to invite you this morning to come visit Malheur County if you're confirmed and see what this really means to rural communities. | ||
| I've had more than 1,100 of these town hall meetings, and we'd make you the guest at one if you're confirmed. | ||
| Will you come? | ||
| If confirmed, I commit to visiting with you if you'll teach me your jump shot. | ||
| I like that part, but I'd like to know: will you come to Malheur County? | ||
| I can make sure there's a basketball. | ||
| I promise you, I will be with you in Mount County or everywhere you wish to travel within Oregon. | ||
| Okay, first 60 days so we can do it while it really counts when these cuts are being debated? | ||
| If you don't mind, I just want to ask somebody within CMS what the rules are, but if I'm allowed to do it, I'll be there in 60 days. | ||
| All right, good. | ||
| Let me ask you now about how we're going to rein in Doge. | ||
| Because people often say that, you know, I'm a privacy hawk, and I like that. | ||
| But the fact is, everybody in the Senate is a privacy hawk because of Doge, because we are very troubled about the prospect of Doge going in there to this treasure trove of health care data that has all the information on these patients. | ||
| What are you going to do to do more to protect them? | ||
| Because right now, we know nothing, let me repeat that, nothing from this administration about how they are going to protect the patients. | ||
| And we have asked and asked some more. | ||
| What are you going to do if confirmed to protect people against overreach by Doge on health care? | ||
| Senator Wyden, I, like you, have not been involved with Doge. | ||
| I am only reading in the papers and keeping up the news in that fashion. | ||
| I have treasured building teams my whole career. | ||
| The first thing I am going to do is confirm... | ||
| So you have talked to no one in the administration about Doge to date? | ||
| No. | ||
| No. | ||
| Didn't talk to Secretary Kennedy? | ||
| No. | ||
| Never talked to him? | ||
|
unidentified
|
Okay. | |
| Go ahead, please. | ||
| I know that in order to run a large organization, you have to get people excited about going to work. | ||
| They have to see the vision that you have, and there's a fine line between vision and hallucination. | ||
| Other people have to see it for it to be a vision. | ||
| So I intend to spend my first precious few weeks in the agency, if confirmed, speaking to the staff, raising morale, getting people excited, and addressing what's going on with Doge. | ||
| I will know a lot more if I'm confirmed. | ||
| Do you think this ought to be a priority issue for you if you're confirmed? | ||
| Is Protect doing more to protect privacy at Doge? | ||
| I'd like to know more what's going on with privacy at Doge. | ||
| I've read the CMS homepage. | ||
| The website says that only people who have gone through a training program are allowed to see the records and they can only read the records. | ||
| I've got one last question. | ||
| Do you believe in a nursing home there should be a registered nurse available around the clock 24-7? | ||
| The reason I ask this is because that is the rule that is coming up, but there's going to be an effort to roll it back. | ||
| So do you think we ought to have nursing homes without nurses? | ||
| Senator Whiten, as you know, it's a complicated question. | ||
| We thought we need a nurse in a nursing home. | ||
| Not too complicated. | ||
| I actually think we need a nurse who will work in a nursing home. | ||
| And in many nursing homes, that's become a problem. | ||
| So I believe we can provide quality of care equivalent to having a nurse in that nursing home using tools and technologies, including telemedicine. | ||
| I want to be flexible enough so that we deal with a massive crisis that we spoke about briefly yesterday, that we have a lot of people aging. | ||
| In the opening statements, it was pointed out that we're going to go from 68 million people on Medicaid to 90 million people on Medicaid over the next decade. | ||
| So I want to ensure, and if it's confirmed, I would like to focus on this issue. | ||
| My time has expired. | ||
| I would only say that right now the proposal gives rural communities five years to come into compliance. | ||
| So I think we can get this done. | ||
| But if you're confirmed, I hope you won't take the nurses out of nursing homes because there's going to be an effort in the Senate to do that, and I'm going to be opposed to it. | ||
| Senator Grafling. | ||
| I've got six issues, no questions. | ||
| At the end of my issues, you can either agree or disagree or not say anything, whatever you want to do. | ||
| I've been working to hold pharmacy benefit managers accountable to lower prescription drug costs. | ||
| I expect you to work with us to hold these powerful drug middlemen accountable and support rural pharmacists. | ||
| Last year, there were at least three bills introduced on pharmacy benefit managers with a total of about 65 senators. | ||
| So this is a big issue in the United States Senate. | ||
| On rural health care, I expect you to protect and support access to rural health care to help achieve this. | ||
| I believe CMS should take the following actions right away. | ||
| Fill the open slots in the rural community hospital demonstration program. | ||
| Distribute the new physician residency slots to rural hospitals as the law requires. | ||
| Ensure that rural emergency hospital program, which is a program I got passed five years ago, is working for rural communities. | ||
| I've had a big interest in kids with exceptional needs. | ||
| I expect you to take action to improve care and reduce red tape for kids with complex medical needs. | ||
| This includes working with states so that they can establish health homes for these kids, as my bipartisan ACE Kids law enabled. | ||
| Transitional health plans is the fourth one. | ||
| Since 2013, CMS, under President Obama, Trump, and Biden have issued what's called non-enforcement memos to allow transitional health plans to be maintained. | ||
| About 35,000 Iowa farmers and small business owners have maintained these health insurance coverage with these plans for over a decade. | ||
| This is the health insurance that was purchased after Obamacare became law, but before it was implemented, and I would expect you to keep access to these health programs. | ||
| On the subject of waste, fraud, and abuse, improper payments in our major health care programs have averaged $122 billion annually over the past five years. | ||
| I'm the author of a major and more recent updates to the federal government's most powerful tool in fighting fraud. | ||
| That's the False Claims Act. | ||
| Since Its enactment has brought $78 billion of taxpayers' money lost to fraud back to the Federal Treasury. | ||
| CMS with the Justice Department must aggressively go after waste, fraud, and abuse and empower whistleblowers, which brings this to the attention of most of the people that are following up on the enforcement of the law. | ||
| My last one is oversight. | ||
| In other words, the congressional responsibility of oversight to see that the president faithfully executes the laws, allows us to hold bureaucrats accountable to the rule of law and helps keep faith with taxpayers. | ||
| I expect CMS to provide timely and complete responses to congressional oversights. | ||
| And you've answered that question for the chairman of the committee. | ||
| When you were in my office, I said you should have said maybe instead of yes, because then you don't turn out to be a liar like we found over the last 20 or 30 years with the people that have answered that question. | ||
| So I want you to listle whistleblowers. | ||
| You don't know what's going on down in the bowels of that big bureaucracy you have, and you need a culture because you can't keep track of every whistleblower. | ||
| You need a culture that will make sure that middle management will pay attention to things that are brought to their attention by whistleblowers and get things corrected. | ||
| Then they don't have to come to me to get correction made. | ||
| Now you can either answer any way you want to. | ||
|
unidentified
|
You've got 58 seconds. | |
| I'll use all 15 seconds. | ||
| Yes, and maybe. | ||
| Only because you said to say maybe when you asked me about responding to your notes, because the reality is we may not get to every note, but every single member of the committee has brought up the fact that CMS has not been responsive. | ||
| So directionally, we want to make sure you hear back from us and not just the committee. | ||
| My hope, and I believe this is a firmly held reality by many folks on the outside, they don't think they can speak to CMS. | ||
| They don't know where we're going. | ||
| The private sector can't. | ||
| The American people can't. | ||
| Our beneficiaries don't know what's going on. | ||
| We mail pieces of paper to people. | ||
| It costs us $350 million a year to do that. | ||
| Has anyone ever read their Medicare mail? | ||
| It's just not riveting reading. | ||
| I believe we can do a much better job by telling the American people what we're going to do, to the point that you actually could imagine us having what most industries do, which is a developer conference, where you go out and tell industry what you need, tell the American people what you can offer, communicate with them in a frequent and consistent fashion using digital tools. | ||
| And I believe, based on our conversation, that the biggest advice that I might take from you is look down in the depth charts of CMS for the people who are willing to tell you the truth about what's going on. | ||
| Don't talk to the head person or the second below them or the third below them. | ||
| Go down four or five levels to where people really are willing to tell you the truth because they're frustrated. | ||
| And that's where we'll be able to make a massive improvement in the culture of the organization. | ||
| Senator Camwell. | ||
| I'm going to defer to my colleague who I voted already and he hasn't. | ||
| So I'm going to just defer to him and then I'll go next. | ||
| Or after my comments. | ||
|
unidentified
|
Mr. Chairman, let me just say to the staff, the ranking member allowed me to take over for him, which I may never give up this battle while he's going, but I do want to say that Senator Camwell has been kind enough to allow me to go next. | |
| My colleague from New Hampshire has said that I can, and then hopefully she'll be the next Democrat. | ||
| And I just want to make sure that that's where we are. | ||
| Dr. Oz, thank you for your visit to my office. | ||
| Thank you for your willingness to serve. | ||
| It is, I have to say, a refreshing moment to hear Somebody in the finance committee hearing room talk about the challenges of our existing system of health care. | ||
| I mean, our existing system is twice as expensive as any other system in the industrialized world. | ||
| Our life expectancy, you said five years, it may actually be six years shorter than our other countries around the world. | ||
| And if you're African American in our country, on average, your life expectancy is 12 years shorter than other countries around the world, which is a staggering fact. | ||
| I can't think of anything more at war with our sense of self than that, honestly. | ||
| In all those other countries that we're talking about, there is universal health care, you know, and parents don't have to struggle every day as they do in Colorado with where they're going to even get primary care for their child, where they're even going to get mental health care for their child. | ||
| Those two things, I think, especially if you accept your view that primary care is important, how people eat is important, and how we think about our health is important. | ||
| It's really important for people to have access to medical care. | ||
| And every year that goes by, people at home in Colorado, I think, as I told you in our office, feel there's more scarcity, more scarcity, more scarcity. | ||
| Whether that's a rural hospital closing or whether it's an insurance company not allowing them to get their reimbursement or whether it's drug prices going up so high that seniors are forced to spend their retirement debating pharmacies about whether or not they can fill their prescriptions every single day. | ||
| That's how people in the richest country in the world are dealing with this. | ||
| And because you said in my office and said in your opening statement that you were concerned about the poorest people in the country and the most vulnerable people, it would seem to me the place we wouldn't want to start is by throwing the poorest people off the only insurance that they have, which is Medicaid. | ||
| And so I think there's a lot of, you know, we've heard a lot of debate over the years about fraud, waste, and abuse in Medicaid. | ||
| Every system needs to be reformed. | ||
| Every system in America needs to be reformed. | ||
| But do you or do you not oppose the Medicaid cuts that so many people in the administration have said that they support? | ||
| What is your position on these Medicaid cuts? | ||
| I enjoyed our visit very much. | ||
|
unidentified
|
Thank you. | |
| And I want to come back to what you did before you took this position, which is as superintendent of the Denver school system. | ||
| You were acutely aware of some of the problems that exist just nutritionally in giving those kids what they need to function. | ||
| I think it's a belt and suspenders response. | ||
| We need to invest especially in the care of young people because that's probably 40% of young people in America are on Medicaid. | ||
| They're mothers. | ||
| They're disabled. | ||
| Those are groups that we should be investing into. | ||
| And Senator Husson, when I was in your office, you brought up the story of a young woman who had been suffering from inflammatory bowel disease, lost her job because she couldn't work, and then lost her insurance. | ||
| How do we get her back on her feet to work again, which she was able to do? | ||
| We do that, and we do the same thing in our school systems. | ||
|
unidentified
|
Yes. | |
| We do this, and we do it in our school systems and for folks on Medicaid by making sure it's not just about throwing money at them. | ||
|
unidentified
|
I understand. | |
| I don't think they feel like there's money being thrown at them. | ||
| They are in a, that's the last thing. | ||
| If we lived in a world where there are money being thrown at the poorest people in America to get health care, that would be an interesting case. | ||
| That's not the case. | ||
| The case is that they are barely able to get medical services for themselves and their families. | ||
| And so I would just say, I am sure, Dr. Oz, that you would believe that any parent thrown off insurance would do whatever it is they could, and their kid got sick, would do whatever it is they could to get their kid in front of a doctor. | ||
| Would you agree with that? | ||
| Yes, I would. | ||
| And because of that, I think it's very important for us to all deal with the fact that if we pursue Medicare, Medicaid cuts that the administration is proposing, and people have to get care for their kids, they will, and they will get that care, as I think you believe, in often a hospital setting, which will be the most important expensive place they could go to get the care. | ||
|
unidentified
|
So we're out of time. | |
| I think it is very unclear at this moment what the administration is planning on doing because the president said over and over and over again different things on this question of Medicaid. | ||
| But I hope very much that we can find a way to work together to make the system a better system than the one that we have, and that the approach is not to throw the most vulnerable people off the only care that they have. | ||
| Thank you, Dr. Oz, and thank you, Mr. Chairman. | ||
| Thank you. | ||
| Senator Cantwell. | ||
|
unidentified
|
And thank you, Senator Campwell. | |
| Thank you. | ||
| Thank you, Senator Bennett. | ||
| Thank you, Dr. Oz. | ||
| Thank you so much for the visit in our office. | ||
| And I wanted to put up, you know, not we're not into an i gotcha as much as a long-term commitment, apparently, that you have from 2009, I think, that every American should have coverage. | ||
| And that was probably on a visit to Seattle. | ||
| So we appreciate that. | ||
| In continuing the line of questioning that my colleague just had, you know, Medicaid in the Medicaid expansion, you believe in the Medicaid expansion that was done under the Affordable Care Act? | ||
| For some states, it made sense. | ||
| For some, it didn't. | ||
| I think that's a good example of how states should pick a path to take care of their most vulnerable, but they have to have a plan. | ||
|
unidentified
|
Well, wait. | |
| But the states that didn't have a plan, what plan did they have? | ||
| As we discussed in your office, with the Affordable Care Act, they have an opportunity to expand Medicaid or they could use other tactics. | ||
| As you know, 10 states haven't expanded. | ||
| I know, but you're saying that's okay? | ||
| As long as they have a plan to address their challenges of dealing with the underserved populations. | ||
| What plan? | ||
| These multiples. | ||
| Well, look, I don't have the numbers right in front of me, but I'll get those. | ||
| I guarantee you. | ||
| They have lots of people unserved. | ||
| And as my colleague just said, that oftentimes exacerbates the cost onto hospitals in more expensive care instead of getting coverage. | ||
| You and I talked about this concept of bundling up the working population at 150 percent, you know, above the Medicaid rate, as New York has done, as Minnesota has done, as now other states are trying to do, and creating that incentive juxtaposed to the exchange. | ||
| Do you believe in that concept? | ||
| Well, we discussed in Washington State how you had a very innovative program before the Affordable Care Act that actually seemed to make sense to me as you described it. | ||
| I've not studied it in detail, but I like the idea that there are multiple different approaches to moving people from Medicaid, if they're able to get off Medicaid, into the workforce. | ||
| And to do that, you have to support them in order to afford insurance. | ||
| So some transition process, if you're able to get off Medicaid to get you onto a private insurance company, prevents the gaps in care that often do result in extraordinary expensive admissions. | ||
| Saying something else that I hope my Republican colleagues will listen to. | ||
| I'm asking you if you believe in a virtual bundle delivered by the private sector getting access to that as a way to reduce the exorbitant payments on the silver plans. | ||
| That's what I'm asking. | ||
| It's a detailed question that I do have to research a bit. | ||
| And if confirmed, I look forward to following up with you on that because I think in your office, some of the ideas we discussed, including that one, are promising ways that would allow people the flexibility to choose what type of insurance they want if they're starting to work. | ||
| And it financially doesn't make sense to get off Medicaid yet. | ||
| And if they are able to get above the poverty level, which is, you know, is $16,000 a year for a single individual, it's not much money. | ||
| You have to have ways for people making slightly more than that to feel confident that they're protected. | ||
| Well, I think the American people want to know just from your nomination and from this process that we're going to go through, what is it that Republicans believe? | ||
| If they're saying next year, which I think the President is saying, we're going to cut off all of those silver plan subsidies. | ||
| I'm saying I at least want to hear from you whether you believe that bundling those people up into a virtual bundle, I think is what you called it in my office, and allowing them to have that market power is an idea that you agree with. | ||
| Senator Cat, well, I look forward, if confirmed, with this committee, to researching that in detail. | ||
| It's a promising enough idea that if you'll take me into your office again, I would love to visit you with it. | ||
| Okay, well, definitely my vote will be predicated on this. | ||
| So I can't wait till after you're confirmed. | ||
| I need you to think about this because, look, you're coming with the ability to be an advocate here. | ||
| So we want to know what you're going to be an advocate for. | ||
| And all my colleagues are going to want to know, are you going to cut Medicaid? | ||
| We want to know that from everybody. | ||
| We want to know, are you going to cut Medicaid? | ||
| We don't believe in cutting Medicaid. | ||
| It's 1.8 million people now in the state of Washington. | ||
| It is basically the number of people in my state who are getting maternal care from this is an exorbitant. | ||
| The number of kids getting care from this is high. | ||
| 47% of kids in my state receive insurance from Medicaid. | ||
| And we have population centers of our entire state that are well above 50% Medicaid Medicare populations. | ||
| So how do you deliver health care to Central Washington when it's that level? | ||
| So we want to know whether you're going to commit to concepts. | ||
| If you don't like some aspects of the Affordable Care Act, you should say which ones you don't like. | ||
| Thank you very much. | ||
| But I hope that you will learn that the affordable care expansion of Medicaid work and virtual bundles that give consumers more clout also work. | ||
| Thank you. | ||
| Thank you. | ||
| Senator Lankford. | ||
| Mr. Chairman, thank you. | ||
| Dr. Ross, thanks for going through the process on this. | ||
| You've been very outspoken for years for the health of Americans and for Americans taking better care of themselves and for us finding out how to be able to do that better as a nation. | ||
| So I appreciate the work that you've done on this. | ||
| You and I have visited already on several of these issues, but I want to be able to probe a little bit farther. | ||
| The pharmacy benefit manager issue has been one this committee has taken up in a bipartisan way. | ||
| We spent a significant amount of time last year as a committee. | ||
| We passed overwhelmingly a pharmacy benefit manager bill out of this committee. | ||
| We tried to be able to get it actually to the floor. | ||
| Senator Schumer didn't ever bring it to the floor last session, then tried to get crammed into a last-minute bill on the end of the floor and didn't fit. | ||
| With all that, the problems still remain on this. | ||
| Some of them CMS can take care of, some of them this committee has to be able to take care of as well. | ||
| We've got to be able to finish that work. | ||
| That has been nonpartisan work here to be able to get done. | ||
| 450 independent pharmacies closed last year, more than one a day. | ||
| Most of those pharmacies, if you went and talked to them, they would say the breaking point was what pharmacy benefit managers are doing. | ||
| That is mostly rural health care and the access to that pharmacist in those rural areas all over the country is lost and people are going to have to mail it in because the PBM makes more money to be able to do that. | ||
| That's a major problem. | ||
| There has been a rule out there for CMS, the non-interference rule, that has created a challenge for CMS to be able to engage. | ||
| What is it that you feel like you're going to need as far as authority to be able to engage on the issue of PBMs and thoughts that you may have on that? | ||
| Senator Lankburg, you had remarkable and deep insights in the PBMs, and I appreciate taking time to learn about them because although they do provide an important service, taking the medications from the pharmaceutical company that's created the product and putting it into the pharmacy system, or as you point out, mailing it directly to patients, they also create a pricing spread. | ||
| And that's where some of the problems occur. | ||
| The lack of transparency into what goes on when that pill leaves the pharmaceutical company and ends up in your home is where a lot of the money is made. | ||
| And so I think if we can bring or insist on complete and radical transparency in what's going on with our drug markets, it would help CMS tremendously because it would allow us to understand, for example, is there spread pricing going on where those pharmacies that are going out of business are paid a much lower number than people are charged for the medications that they're getting and then paid for by the U.S. government or other sources. | ||
| Those are a problem. | ||
| It's also an issue, as you know, if the actual rebates that are given, which is part and parcel of the PBM system, an archaic but widely used approach, if those rebates are actually fully rebating the monies that's being saved by the negotiations done by the PBMs. | ||
| And I don't think anyone in this room, and hopefully no one watching, would ever think of doing a transaction where they didn't have a little bit of insight into what everyone else in the party was involved in, how much money they were going to make as a result of the negotiated result. | ||
| And we, I believe, in order to protect the American people, and President Trump has been very clear on this, want to reduce the cost of medications to our government and to the American people, the copay. | ||
| That's not happening right now, and we can do better. | ||
| And the PBMs are one way of affecting that change. | ||
| Yeah, we certainly can. | ||
| The rural health care and the provision of that is a challenge. | ||
| It is a challenge all over the country. | ||
| And there are occasionally folks in Washington, D.C. or in urban areas that don't think as much about rural America. | ||
| Those of us that live in rural America and those families that we know firsthand know they also have heart attacks. | ||
| They have babies. | ||
| They have lives and struggles and emergency situations. | ||
| They need access to health care. | ||
| They also need someone to be able to talk to to say, hey, I've got a question about drugs and about the interactions and what this looks like. | ||
| That's their local independent pharmacist, often on that. | ||
| One of the areas the PBMs has been particularly bad on is this issue about tiering, where brand name drugs will come out. | ||
| They'll give a rebate if the generic that's going to compete against them will go on the branded tier. | ||
| That drives up the cost for American taxpayers. | ||
| It drives up the cost for the federal government. | ||
| It is a big issue on that. | ||
| The latest studies that came out said more than half of the generic drugs are actually on the wrong tier. | ||
| That's an issue that we need to be able to address legislatively, but it's also an issue that I think CMS can also engage with directly on that. | ||
| So I look forward to that conversation the days ahead of how we can actually do that. | ||
| I want to bring up one other issue. | ||
| We have a shortage of nurses around the country. | ||
| President Biden's CMS put out a new rule saying to long-term care facilities, nursing homes, other facilities that they have to have 24-hour care for a RN that's in that location. | ||
| Now, that sounds like a great idea, unless you're in a town of 5,000 people and there's just not another nurse that's available to be able to do that. | ||
| So the real result of that is it's going to close rural nursing homes all over the country on this. | ||
| This is an action that the Biden administration CMS took directly on this. | ||
| This will be an issue that you'll have to be able to address soon on that. | ||
| I would ask only that you come back and review that because we'd like to keep rural nursing homes and long-term care facilities open and available for those families, not have them closing and just tell them in rural America, drive 200 miles with your family to get access to care. | ||
| Senator Lankford, thank you for raising that. | ||
| It's an issue that I have spoken about with community groups quite a bit in preparation for this meeting. | ||
| If confirmed, I pledge to come back to you with my thoughts. | ||
| Senator Wyden brought up the exact same issue from the other perspective. | ||
| So I appreciate the arguments that are being waged here. | ||
| They're thoughtful ones that deserve more attention, and it'll be one of the earlier things I focus on. | ||
| Thank you. | ||
| Thank you, Mr. Chairman. | ||
|
unidentified
|
Thank you. | |
| Senator Cassidy. | ||
| Dr. Oz, I'll overlook the fact that behind you are some of my former staff members who have been stolen by the department from my department. | ||
| You're well trained, sir. | ||
| I'll overlook that. | ||
| Prior authorization, you're a provider. | ||
| You know how sometimes care delayed is cared denied. | ||
| Speaking to a surgeon in Florida who said if he had gotten the prior off like that, the surgery would have been less expensive, the rehab shorter, the patient's outcome better. | ||
| Your thoughts, your provider, what do we do about prior off issues in the Medicare Advantage program? | ||
| Senator Cassidy, thanks for your years of service to your patients and to the clinics that you've helped run and create, as well as service in the Senate. | ||
| And I've enjoyed our conversations, numerous ones, about broad health care policy. | ||
| This issue of pre-authorization is epoxy on the system. | ||
| We spend 12% of the health care budget on administrative costs. | ||
| Pre-authorization is misused in some settings. | ||
| There needs to be a mechanism to confirm that procedures are worthwhile. | ||
| But I'll offer some ideas on how this might work. | ||
| And if confirmed, I'd love to push some of these ideas and share them with other members of the committee. | ||
| There are about 15,000 procedures that could have pre-authorization. | ||
| They represent most of the things that are done. | ||
| Not just operations, but medications that are given, et cetera. | ||
| Insurance companies today use pre-authorization for about 5,500 of those procedures. | ||
| But interestingly, not all insurance companies focus on the same things. | ||
| And even within the idea of the procedure that's being pre-authorized, the criteria for accepting it are also all over the place. | ||
| So it's very difficult to automate that. | ||
| And so it tends to be misused because it stalls the process, as your physician colleague in Florida pointed out, makes it more expensive. | ||
| And we're spending money, wasting money, trying to do a process that should be automated. | ||
| I would argue we could limit the number of pre-authorized procedures to 1,000, be very clear. | ||
| If you're going to have a knee replacement and you can bend your knee more than 120 degrees, you don't get to get the knee replacement or whatever number you want to put in there. | ||
| And then if we know those numbers ahead of time, like a credit card appropriate, you know, credit card approval doesn't take you three months. | ||
| You know immediately whether the transaction is approved or not. | ||
| We will be able to do something similar so that pre-authorization could happen rapidly. | ||
| Let me ask you this then, because my docs will be so frustrated because they have previously gone through step therapy with the patient to get them, okay, this medicine didn't work, this medicine didn't work, this one didn't work, now this one finally does. | ||
| They change plans and they're being asked to go through step therapy once more, therefore giving the patient a valley of lack of response until they get to where they already know they should be. | ||
| Thoughts? | ||
| Senator Cassidy, that is one of the most frequent complaints I hear from physicians. | ||
| Patients see it on the other side, which is, I can't get the treatment. | ||
| I'm in agony. | ||
| I'm in pain. | ||
| I really know what works for me, but no one will give it to me, even though I have insurance. | ||
| I'm part of Medicaid. | ||
| I'm a beneficiary. | ||
| I should be allowed to get access to this medication, which I'm told is in the plan, and yet it gets slowed down. | ||
| This is a place where it's a matter of competency. | ||
| This is not a Republican-Democrat issue. | ||
| If we can do the job that's been assigned to us at CMS in a competent fashion and revisit some of the assumptions we've taken for granted for decades, that's being a good one, and use technology that today could help us. | ||
| Because we have AI support tools, navigation systems that could pretty quickly adjudicate whether you should have to wait even a day to get the medication that will get you out of pain or even a week for the procedure that you should be allowed to have, it'll take a lot of the angst out of the system for the American people. | ||
| I mean, the health care executive. | ||
| I'm with you on that. | ||
| I've got limited time. | ||
| Let me ask you one more thing, or a couple more things, hopefully. | ||
| There are local determinate decisions, a regional determinate decision. | ||
| And Medicare is supposed to cover something unless it is said not to be covered. | ||
| I'm told that there are MA plans which are reversing that and saying they will only cover something if there is a positive determination that it should be. | ||
| I'm told this by pain doctors who say, wait a second, I can get the patient back to work, that sort of thing. | ||
| Any awareness of that? | ||
| Any thoughts of that? | ||
| I'm not aware that that was happening. | ||
| I'll bring that up to you. | ||
| Lastly, we're both fans of MA plans, whatever the shortcomings, but there's some evidence they're getting anywhere from 106 to 120 percent of a group of similar Medicare patients who are not enrolled in MA. | ||
| And now, as we look at the trust fund going insolvent and our budget deficit expanding, is this a place you would look? | ||
| And if so, how would you look in terms of getting better value for the dollar? | ||
| So, the MedPAC assessments have revealed what you just shared: that we're actually apparently paying more for Medicare Advantage than we're paying for regular Medicare. | ||
| So, it's upside down. | ||
| And I think there are ways for us to look, for example, at the upcoding that's going on that's happening systemically in many systems, in many programs, to make sure that people are being appropriately paid for taking care of sick patients, but not for patients who aren't ill. | ||
| So, for example, if someone's showing up at your home to figure out if you have a small plaque in your carotid, because they're going to charge a lot more for the care of your plaque, which they're not actually going to do anything for, that's wrong. | ||
| And I think we have numerous tools, but part of this is just recognizing there's a new sheriff in town. | ||
| We actually have to go after places and areas where we're not managing the American people's money well. | ||
| And if we can do that effectively, and both of us, I think, agree that there are opportunities to do that that are massive in scope, but they're also important emotionally for the program. | ||
| You want people to have confidence in the program. | ||
| The employees administering the career, employees administering Medicare and the beneficiary should all feel the system is working for them. | ||
| On the upcoding, we're out of time. | ||
| Thank you, Mr. Chair. | ||
| Senator Merkley and I have a bill, the No Upcode Act, that actually achieves that. | ||
| So I think you're going to be confirmed, and we'll discuss that with you at a later date. | ||
| Thank you. | ||
|
unidentified
|
Thank you. | |
| Senator Hassan. | ||
| Well, thanks, Mr. Chair, and welcome, Dr. Oz. | ||
| Congratulations to you and your family on your nomination. | ||
| First question that I'm asking of every nominee for this administration: if directed by the President to take action that would break the law, would you follow the law or follow the President's directive? | ||
| The President would never do that. | ||
| That's absurd. | ||
| And it's a disappointing answer. | ||
| Now, the Medicaid program covers over 70 million Americans, and the Congressional Budget Office has now confirmed that the Republican budget plan would require taking away Medicaid coverage for millions of people. | ||
| In New Hampshire, the Republican budget could take away health insurance from as many as 30,000 children. | ||
| Do you support the Republican budget plan that terminates the health coverage of millions of Americans, including as many as 30,000 children in my state? | ||
| Senator Hazard, I've not seen the details of a House bill that says that. | ||
| I look forward to examining it with great care if confirmed by this. | ||
| So let me ask it another way. | ||
| How many children losing health insurance would be acceptable to you? | ||
| I don't want children losing health insurance. | ||
| Well, then you're going to need to reject the Republican budget plan. | ||
| You and I did talk about maternal health crises. | ||
| Medicaid covers 40% of births in America, 50% of all rural births. | ||
| So will you commit to preventing any cuts to Medicaid that will deny moms health care coverage? | ||
| I am very focused on maternal health care. | ||
| It's one of the metrics that our nation, I think, should be judging itself on. | ||
| We do have to make investments. | ||
| I believe in maternal care in order to provide better sources. | ||
| So will you make sure that there are no cuts in the Republican budget plan that would deny coverage to pregnant moms and moms postpartum? | ||
| Senator Hassan, I have to be more knowledgeable about what's happening within CMS. | ||
| I don't have any idea where the money is going to be. | ||
| Let me be really clear. | ||
| The Medicaid cuts are draconian in the Republican plan. | ||
| The CBO has said that it will lead to significant cuts, and the cuts will likely lead to 10 states losing their Medicaid expansion coverage. | ||
| So let's move on to another issue. | ||
| Last week, the Trump administration put out a list of federal offices to close, including the only office in the North Country of New Hampshire where seniors can enroll in Social Security benefits and Medicare in person. | ||
| If confirmed, will you work to ensure that seniors can continue to enroll in Social Security and Medicare benefits in person in Littleton, New Hampshire? | ||
| I don't know about why there was a decision to remove this center in northern New Hampshire, but I do believe seniors will be better treated if they can see someone in person. | ||
|
unidentified
|
Right. | |
| So do you think they'll be better or worse off in rural areas of my state if they have to drive 100 miles to the next closest office in New Hampshire to receive assistance with Medicare enrollment? | ||
| Well, one of the changes that I believe we have to make within Medicare in general is to modernize the way we communicate with our beneficiaries. | ||
| It's not just about in-person visits. | ||
| There should be a continuous, frequent, weekly even discussion that goes on that we send out that if beneficiaries want to process, they can. | ||
| If we can't communicate with our seniors and their families digitally, we're giving up a huge opportunity. | ||
| Well, guess what? | ||
| Some of the plans that I'm hearing from the other side of the aisle are going to cut the efforts to bring broadband and internet to this exact area of my state. | ||
| It's not just that some seniors don't want to use digital access. | ||
| In a lot of rural America, they can't. | ||
| So we need to have offices that are open, staffed, and accessible. | ||
| Now, let's move on to another issue. | ||
| In 2012, you enthusiastically recommended several supplements for weight loss on your television show, including a substance called green coffee extract, which we now know was fraudulently marketed. | ||
| For the record today, can you confirm that you no longer believe that green coffee extract is a miracle weight loss drug? | ||
| I never said that medication was a miracle weight loss drug, but I am. | ||
| Can you confirm that this was fraudulently marketed and green coffee extract is not a miracle weight loss drug? | ||
| Yes or no? | ||
| Yes. | ||
| Okay, so let's go on to you promoted a supplement called Raspberry Ketones, claiming that it is, quote, a number one miracle in a bottle to burn your fat. | ||
| That's your quote. | ||
| Will you confirm for the record today that you no longer believe raspberry ketones to be a quote miracle in a bottle? | ||
| There are many things I said on the show. | ||
| I take great pride in the research we did at the time to identify which of these worked and which ones didn't. | ||
| Many of them are still being researched like the green coffee bean extract that you just mentioned. | ||
| So how much were you paid to promote these supplements? | ||
| The television show was distributed by Sony Corporation. | ||
| How much were you paid to promote the supplements? | ||
| I was paid nothing to promote the supplements. | ||
| But you promoted them on your show and there was something called a Dr. Oz effect. | ||
| You would mention them and the sales would go way up. | ||
| That was written about by the press. | ||
| That was not something that I would talk about on the show. | ||
| I will just go on the record that you have been nominated to run the largest health programs, the set of largest health programs in the United States of America. | ||
| And it seems to me you are still unwilling to take accountability for your promotion of unproven snake oil remedies to millions of your viewers. | ||
| And that's really concerning. | ||
| Thank you, Mr. Chair. | ||
| Senator Whitehouse. | ||
| Dr. Oz, over here. | ||
| As we spoke about when you visited, I want to talk about some Rhode Island issues, because Rhode Island has a very fundamental issue, which is that between 2018 and 2023, which is the most recent years for which we have data, Rhode Island hospitals were paid less than nearby Massachusetts and Connecticut hospitals by a margin of over 20%. | ||
| The margin of underpayment for Rhode Island hospitals compared to hospitals across the border ranged from between 20% and 28%. | ||
| As a doctor, I think you pretty well understand that if you've got two hospital facilities that are less than an hour apart from each other and that are in the same regional health care market, and one is paid 26% less than the other, you have created a massive and harmful distortion. | ||
| Rhode Island has been on the losing end of that distortion for years, and I am sick of it. | ||
| So I'm flagging that for you right now. | ||
| One of the potential ways out is the AHED program, because a fee-for-service billing is going to screw Rhode Island, and we can't fix that. | ||
| The way to do that is to get out of fee-for-service and to a value-based program. | ||
| We just heard that the AHED program is going to continue forward. | ||
| I'm delighted about that. | ||
| You and I are going to be in touch about making sure that Rhode Island's AHED program competes fairly with Connecticut's AHEAD program because they work off a cost basis. | ||
| And our cost basis has been suppressed by 20 to 28% lower payments. | ||
| You can't pay your nurses. | ||
| You can't pay your cleaning crews. | ||
| You can't pay your phlebotomists the same amount when your revenues are 26, 28% below your competition. | ||
| And let me just add to this by pointing out, you know this area, right? | ||
| You practiced in Boston. | ||
| I went to school in Boston, but I practiced in New York. | ||
| Okay. | ||
| So from going to school in Boston, you probably know that Rhode Island's hospital complex in Providence includes Rhode Island Hospital, which is the only level one trauma center in southeastern New England, the only level one pediatric trauma center in southeastern New England, the only verified burn center in Rhode Island, an academic medical center, a teaching hospital, has a pulmonary hypertension center, | ||
| and obstetrics and a NICU are at women infants. | ||
| It is a node of connected buildings that provides extremely high-level care. | ||
| If a president is in Martha's Vineyard and gets hurt, Rhode Island Hospital Trauma Center is where they're taken. | ||
| They fly right over St. Anne's Hospital in Fall River to get to our hospital in Rhode Island because we made the investment in level one trauma care. | ||
| St. Anne's Hospital that they flew over would be paid 20 plus percent more for the same services while delivering none of those options. | ||
| So I'm going to be on you like a ferret to get this fixed. | ||
| It is totally unfair. | ||
| Bacchus Hospital is probably a 25-minute drive into Connecticut from Westerly Hospital in Rhode Island. | ||
| It's probably a 25-minute ride from our trio of world-class hospitals. | ||
| Rhode Island has ropediatric and women infants to St. Anne's Hospital, just out 195. | ||
| And for the same service, we get paid 20 to 28 percent less than in those hospitals. | ||
| I am so sick of CMS right now, it just makes me infuriated. | ||
| For years, CMS has sat idly by, looked at that payment differential, and said, oh, what a pity. | ||
| Too bad. | ||
| We're not going to do anything about it. | ||
| And we tried to fix it through the AHED program. | ||
| Oh, well, maybe, but I don't think so. | ||
| So we really need to get this fixed. | ||
| It is wrong, and it is really dislocating health care in Rhode Island. | ||
| We have doctors moving over the border to take advantage of better payments. | ||
| We have a fight for staff when we have to compete with other hospitals within the same commuting range that get better payments. | ||
| So I have 10 seconds left. | ||
| I'll leave it at that. | ||
| You heard a lot from me when you came to sit with me. | ||
| You heard a lot from me today. | ||
| I'm going nowhere on this. | ||
| In the years I've been fighting it, not once has any person at CMS ever been able to provide any excuse or any justification for it. | ||
| None. | ||
| They don't even try to justify it. | ||
| They just don't give a red hot damn about this incredible unfairness that is dislocating and warping our health care system. | ||
| So if you'd like to respond briefly, please do. | ||
| I suspect I'll hear you look forward to working with me on it. | ||
| Well, I did a little homework after the office visit, the thrashing that I experienced. | ||
| It's thrashing CMS, not you. | ||
|
unidentified
|
You're not responsible for this yet. | |
| It does seem to require a statutory solution. | ||
| However, the AHED program is a promising potential opportunity. | ||
| I don't know enough about how the reimbursement would be altered, but I did want to point out that I went back and looked at the numbers that you shared with me. | ||
| And it's interesting that how they were calculated. | ||
| Again, it was driven by a congressional formula. | ||
| But Senator Sanders, for example, he's paid 25% less than you. | ||
| So if you think Rhode Island has it bad, Vermont's really that way below the average. | ||
| So I think there are opportunities to revisit that. | ||
| And I think that's probably something with your passion will probably be revisited by this chamber. | ||
|
unidentified
|
Thank you. | |
| Well, you and I will be talking about it. | ||
| Thank you very much, Mr. Chairman. | ||
| You're welcome. | ||
| Senator Daines. | ||
| Senator Whitehouse, I was going to say you're the self-appointed chairman of the newly minted ferret caucus. | ||
| It's quite interesting. | ||
| So anyway, Mr. Chairman, thank you. | ||
| Dr. Roz, it is good to see you here. | ||
| Ferret is an underappreciated animal. | ||
| We have him out in Montana, too. | ||
| It's Ferrets. | ||
| I very much enjoy meeting with you, Dr. Roz, and having a really great discussion talking about the innovation and the experience you bring to this job is almost unprecedented. | ||
| You're exactly the right person at the right time to take over this huge responsibility. | ||
| I want to talk for a minute about Hyde. | ||
| As you know, President Biden took several actions during his term to expand abortion access and travel for abortion using taxpayer dollars in many ways, including through the Medicaid program, which is explicitly in violation of the Hyde Amendment. | ||
| Let me say it even more clearly: it's in violation of the law. | ||
| If you're confirmed, will you commit to upholding the Hyde Amendment and ensuring that our federal health care programs are not providing abortions on the taxpayers' dime? | ||
| Senator Denis, I appreciate very much taking time with me. | ||
| You're another original Maho person because you're able to haul that elk, I don't know how far, in the backlands of Montana. | ||
| The answer is very simple: yes. | ||
| The Hyde Amendment has been around for a long time, and CMS should obey the rule and fund accordingly. | ||
| Thanks, Dr. Roz. | ||
| I want to talk about Medicare coverage for new technologies and innovation. | ||
| During President Trump's first term, he spearheaded efforts to ensure that seniors could have access to innovative medical devices through the Medicare program. | ||
| The Biden administration repealed these efforts and replaced them with the TSAT rule, which provided a pathway to expedited coverage for a limited number of innovative medical devices. | ||
| However, the rule requires new clinical evidence for eligible devices, which can be duplicative for innovative technologies that have invested in robust clinical trials. | ||
| The question is: would you consider addressing this limitation that the Biden administration placed or create a coverage pathway for innovative devices with existing strong clinical data? | ||
| Senator, yes. | ||
| I think we lose a major opportunity when we create ambiguity in how devices are not just created safely, but also marketed wisely. | ||
| And so, the gap between when the FDA says this is a good product that can save lives and when the American people, beneficiaries of Medicare or Medicaid programs within the states, are able to access those. | ||
| And I'll use the Mitra clip as an example. | ||
| The Mitra clip, just as a reminder, was the device, I wrote a patent on it early on, but it's a device that was created with smart engineers and eventually received CE mark, which is European approval for sales in 2008. | ||
| It took five more years for the U.S. FDA to approve the device that would save lives, it turns out, with clinical trials proving this and save money at the same time. | ||
| But despite that fact, it took another seven or eight years for CMS to fund patients getting this device if they're dying in heart failure with a leaky valve. | ||
| So we wasted a lot of money. | ||
| We maybe lost some lives because of it, and all because we had a regulatory apparatus that was not transparent. | ||
| I believe we can do better. | ||
| And to your point, we should make it easier for industry to create life-saving tools by aligning when the FDA approves a product with when CMS begins to fund it for beneficiaries, because that's our job, to provide the best quality care to the American people who are on Medicare, Medicaid chip, and even the exchanges. | ||
| And these tools should be used. | ||
| Appreciate your expertise in the area, Dr. Roz. | ||
| I want to shift gears here and talk about Montana rural health. | ||
| And yes, I did pack that elk out, and yes, that is a workout to pack an elk out and quarter it and walk miles back to the pickup. | ||
| I believe rural health is a key component of America's health care conversation. | ||
| It's really important in my frontier home state of Montana. | ||
| It's distance, it's weather, workforce shortages, service line erosions, or just a few of the difficulties we face in Montana as they try to access health care. | ||
| Given the challenges of rural health care, how could CMS support the expansion of telehealth services? | ||
| And I recognize telehealth is not just one silver bullet, but it's an important tool in the overall tool chest to help us provide better access. | ||
| What are your thoughts on ways we could ensure that health care can be more accessible to these rural populations? | ||
| Well, as you know, this House has Congress has a responsibility to extend telehealth widely throughout the nation, as it was during COVID. | ||
| I think part of the opportunity for telehealth is to link it to large institutions in those areas. | ||
| So, an institution, a big one, let's say in Salt Lake City, might be able to be a telehealth partner to a rural health clinic in Montana. | ||
| So, it's not just that they pick up the phone when you call. | ||
| It's not someone in another country far away that's answering the cry for help. | ||
| It's someone from an institution that knows your protocols. | ||
| Maybe they've shared theirs. | ||
| You have a sympatico, a relationship that goes beyond just what's on the streamed in signal. | ||
| And that is how we'll build telemedicine, telepsychiatry, which is for mental health services, vital in places like Montana, especially where we have many people who are suffering from undiagnosed mental health illnesses. | ||
| And there's no place to go in a consistent fashion to get those therapies. | ||
| It is a major focus of mine, and if confirmed, it's one of the areas that I think will be able to make major inroads because there are no opponents to this. | ||
| Dr. Os, thank you. | ||
| Thank you. | ||
| Thank you. | ||
| Senator Johnson. | ||
| Hey, Mr. Chairman, Dr. Oz, welcome. | ||
| Sorry I've had to go bop in and out, so I haven't heard all your testimonies. | ||
| Sorry if I repeat. | ||
| A number of years ago, I held an event in Oshkosh with about two or three dozen doctors. | ||
| And I just, very open-ended question. | ||
| I said, What is your evaluation of the biggest problem we have in medicine today? | ||
| And to a doctor, they stated Medicaid. | ||
| I was shocked. | ||
| It's not really the question I'm asking right now. | ||
| If I have time, I'll get back to that. | ||
| But I did want to talk a little bit about Medicaid because I think one of the problems we have here is we keep referring to Medicaid as one thing, but it's really Medicaid, and then it's Obamacare. | ||
| Okay, so I think all of us want to help people who can't help themselves. | ||
| We certainly want to provide health care for disabled individuals and moms and children. | ||
| We want to help people. | ||
| We don't want to cut their benefits. | ||
| But Obamacare, when it arrived on the scene, all of a sudden we're paying more for single, able-bodied, working-age adults. | ||
| And from my perspective, that has allowed states to really gain the system with provider taxes, all those types of things. | ||
| When we met, I didn't talk about my budget ideas here. | ||
| How if we take a look at pre-pandemic spending levels and inflate them by population growth and inflation, we could be saving a lot of money because we're spending a lot of dollars above and beyond what we spent in the past plus inflation. | ||
| Let me just give you some numbers on Medicaid. | ||
| Obama in 2014, the first year of Obamacare, total Medicaid spending was $301 billion, and $24 billion of that was the new Obamacare. | ||
| Inflated, that'd be $431 billion. | ||
| This year, we're spending about $600 billion. | ||
| The last good year we have for spending is 2023, where they break out, and that's a problem, too. | ||
| You can't get information. | ||
| You know, my staff had to get quarterly and add them up together to figure out what the Medicaid expansion of the Obamacare was in 2023, is $131 billion. | ||
| So it went from $24 billion in 2014 to now $131 billion. | ||
| And what would be inflated from Obama's number, $431, we're spending about $600 billion. | ||
| So I kind of want you to just comment on what has been the impact of Obamacare, Medicaid expansion, and anybody who is concerned about disabled children having access to Medicaid ought to be concerned of this new benefit to able-bodied working-aged adults that are now allowing states to game the system and draining the federal coffers and making it more difficult to maintain benefits for disabled individuals. | ||
| And the people that Medicaid was truly designed to help, by the way, with a shared responsibility so states would actually try and control the process. | ||
| Because right now too many states, I'm looking across the dais here, too many states are gaming the system and could care less about eligibility and in fact are siphoning off Medicaid dollars for illegal immigrants, for example. | ||
| Open up to you. | ||
| Senator Johnson, I think I could probably start most effectively where you started, which is those physicians speaking to you about what they were most frustrated by. | ||
| It is a concern to me that doctors don't like Medicaid because they don't get paid in their minds. | ||
| And because of that, they try to avoid getting Medicaid patients. | ||
| So most physicians will take care of a certain percentage of patients in their practice for free. | ||
| It's a calling of the art form. | ||
| Historically, doctors always took care of patients who didn't have resources for free. | ||
| But then we also have the Stark laws, right? | ||
| And there are Stark laws that can also limit the role that they play in owning facilities, which is a whole separate discussion point that I know we've touched on in the past. | ||
| But the ability of physicians to take care of people who don't have resources, which is partially compensated by Medicaid, is not infinite. | ||
| And so when you expand the number of people on Medicaid without improving the resources required for those doctors to take care of those patients, you stretch resources very thinly for the people for who Medicaid was originally designed. | ||
| As you highlighted, our young, our pregnant women, our vulnerable populations that are disabled. | ||
| These elder people don't have resources, the dual eligible populations. | ||
| They cannot be compromised. | ||
| So we have to make some important decisions to improve the quality of the care. | ||
| Again, we've talked about the fact we're spending twice as much as any other developed country. | ||
| So we are putting resources into the system. | ||
| I don't think we're getting value for those resources. | ||
| And some of the areas that I'm hoping I can work together with members of this committee and have confirmed with other senators as well is to ensure that we have wise, effective modernization approaches to deal with the numbers you just highlighted. | ||
| Because the rapid expansion of required monies for Medicaid is far beyond what was ever envisioned when the ACA was originally passed. | ||
| And it's one of the areas we can do better. | ||
| On the other hand, Medicare part D, the pharmaceutical part of it, the drug component, that's actually done better. | ||
| So there are ways for government to do this well. | ||
| And I think I maybe speak for many folks here that our biggest enemy is nihilism, is a lack of hope that we can fix what's going on at CMS. | ||
| I am very confident, and I do believe that we have a generational opportunity to seismically shift the way we deliver health care services so that we don't have the highest mortality rate for women delivering babies amongst the top 50 countries in the world, that we're not having folks falling through the cracks wrongly, immorally in our system. | ||
| And I think being wise about those maneuvers can allow all of us to proudly stand up and say we are the great society. | ||
| And like all great societies, we take care of our most vulnerable. | ||
| Well, thanks for your willingness to serve. | ||
| Thank you, Mr. Chairman. | ||
| Thank you. | ||
| Senator Cortez-Masto. | ||
|
unidentified
|
Thank you, Mr. Chairman and to our Ranking Member. | |
| Dr. Oz, good to see you again. | ||
| Thank you for taking the time to visit with me in my office and welcome to your family. | ||
| Let me start with this question. | ||
| There's a couple, men and woman. | ||
| They're married. | ||
| They have a daughter. | ||
| They're both working, working hard every day, but their daughter has a rare disease. | ||
| Unfortunately, the only way they can afford her medical care and treatment is with the help of Medicaid. | ||
| Would you think that this couple should be taken off Medicaid? | ||
| As you describe it, no. | ||
|
unidentified
|
And that's a bulk of the people that I hear from every day that need Medicaid. | |
| It's not what some of my colleagues are talking about, these people milking the system. | ||
| It is true, hardworking families that need help, because you've said it earlier, health care in this country is just too costly. | ||
| There's not enough access. | ||
| It's not affordable, and we've got to do a better job of addressing it. | ||
| But until we do, we can't kick people to the curb when they need help for their kids in this instance. | ||
| Let me also address something else here, which I just find offensive in so many ways. | ||
| As my colleagues looking across the aisle at, I see two of my colleagues sitting between me and Ben Ray. | ||
| Would you I don't even know my colleagues know this. | ||
| Do you know how many Medicaid fraud units actually exist in the states to go after Medicaid fraud and prosecute for abuse? | ||
| You don't. | ||
| I don't. | ||
|
unidentified
|
So it's in, so you should know, because there are 53. | |
| There are 53 Medicaid fraud units. | ||
| They cover every state, District of Columbia, Puerto Rico, and the U.S. Virgin Islands. | ||
| And in 2024, they recovered $1.4 billion in fraud. | ||
| Now, granted, most people, and I have not even heard this from my colleagues, that fraud was provider fraud. | ||
| That was provider fraud. | ||
| So I am all about addressing waste abuse and fraud, but let's be real here in how we do it and make sure we're not kicking this couple and their needs for their daughter off of Medicaid because we have some concept which is false about who it is actually benefiting. | ||
| I also want to jump back here real quick. | ||
| Senator Lankford, he has concerns about nursing homes closing in rural America. | ||
| So do I, absolutely. | ||
| In rural Nevada, I have concerns. | ||
| But I also like to note that cutting Medicaid the way that my colleagues and Republican leadership want to do, which they are proposing, would also close nursing homes in rural America, including in Nevada. | ||
| It would close hospitals and it would close clinics. | ||
| So that is something we have to keep in mind. | ||
| And the reason why I bring this up is because, like Senator Lankford said, in my state, if they don't have it in rural Nevada, they are driving four hours to get it somewhere else. | ||
| That's ridiculous. | ||
| And that's why I support your conversation around telehealth. | ||
| I think it's important. | ||
| Senator Davids and I support it together. | ||
| It's bipartisan support. | ||
| We need it. | ||
| We need to make it permanent. | ||
| There's so much that needs to be done to address health care. | ||
| And one of the things that I want to bring up is the ACA tax credits. | ||
| We currently have in Nevada the lowest uninsured rate in our nation's history, thanks in part to the ACA marketplaces, which helped over 24 million get coverage last year, many with tax credits to lower their premium costs. | ||
| If Republicans refuse to work with Democrats to extend these credits, costs will skyrocket and people will lose coverage. | ||
| In Nevada alone, 85,000 people could see hikes or thousands of dollars forcing them to drop their insurance. | ||
| And the health insurance market will destabilize. | ||
| So, Dr. Oz, if confirmed, do you agree that Congress must extend these tax credits to prevent massive premium hikes and coverage losses for working families? | ||
| Senator, if confirmed, I need to learn more about the specifics of how much additional resource is required and for what parts of the system. | ||
| But directionally, I like the idea of having transition programs to get folks who are able to work but are on Medicaid for whatever reason. | ||
| They have a family member that's ill, they've fallen ill and lost their job and lost their insurance. | ||
| It's wise for us as a nation, as we take care of them, to get them back on their feet and then transition them to programs where they can actually afford the insurance. | ||
| If you can't afford the insurance, you just go without coverage. | ||
|
unidentified
|
So can I stop you there? | |
| Because now your assumption is that it is people who are not working that are accessing Medicaid. | ||
| And I just told you there's a good segment, over 66% or more, that are actually working and getting this benefit. | ||
| So I would hope that you would keep that in mind as you go back to study this issue. | ||
| And I would want you to study all of the facts because we don't want to harm people that we are actually providing an essential benefit to, and they are working. | ||
| They are working. | ||
| My time is up. | ||
| Thank you. | ||
| Thank you. | ||
| Senator Tillis. | ||
| Thank you, Mr. Chair. | ||
| Dr. Ayas, thank you for the time that we spend in the office. | ||
| How many members you meet with? | ||
| I met with every single member except Senator Sanders, who I caught in the elevator coincidentally yesterday. | ||
| But he's been on my show, so I had met him before. | ||
| Well, I appreciated the time. | ||
| I thought we had a very good discussion and we covered most of the topics that I needed to to convince me I was going to support your nomination. | ||
| You and I spent a fair amount of time geeking out over organization change. | ||
| And give me an idea of how you're going to spend your first 90 days. | ||
| Your advice actually took to heart, and it was directed at how do you lead a large organization. | ||
| So there's, first up, the whole broader idea of what's the shared vision? | ||
| Where do we want to head? | ||
| And as a group, if we can get people excited about their jobs, they'll show up, not just show up physically, but emotionally. | ||
| You also cautioned me that I should look beneath the leadership to what people in the rank and file, maybe three or four levels down, are thinking and saying about the organization, because they have remarkable wisdom and often they're not heard. | ||
| So these are the career officials. | ||
| There are almost 7,000 people at CMS. | ||
| So it's a lot of folks that we want to talk to. | ||
| CMS has another interesting dynamic, which is it's got about 40,000 contractors that it does the work through. | ||
| So we want them to feel the same pride of authorship for what comes out of CMS. | ||
| You want them to believe that the charge they've been given is a sacred one to take care of our most vulnerable. | ||
| And because it defines who we are, it's something that we cannot skirt in any way. | ||
| I think you can be an enabler. | ||
| And all of my experience with enterprise transformation, the best ideas came from the organization, not consultants. | ||
| We just got their recommendations elevated and then we created sustainable change. | ||
| And I think you have to get resources out outside of the agency to get the best of all the ideas inside of the agency. | ||
| It's counterintuitive. | ||
| I do have a question for you. | ||
| If confirmed, as we're going through and trying to do all the enterprise efficiencies that the Doge effort is after, when you're confirmed, I strongly believe that Senate-confirmed leaders of agencies have to be at the helm. | ||
| They have to be the ones. | ||
| It will undermine your ability to manage your organization if they think there are two different ways or two different bosses, for example. | ||
| Doge makes a lot of sense, but pretty quickly, all of that has to be operationalized in a way that you, the leader of CMS, can manage and execute. | ||
| Do you agree with that concept? | ||
| I agree. | ||
| I'm a heart surgeon. | ||
| You don't go to the OR with two surgeons. | ||
| One person has their name on the chart. | ||
| It's an ongoing discussion point at Columbia that in your time of need, you don't want to be surrounded by intellectuals. | ||
| You're going to be surrounded by people of action. | ||
| So, one person goes in there when there's a bleeder, they decide what stitch to place. | ||
| They put their finger on the hole. | ||
| They deal with those issues because they're the one that's responsible to the family. | ||
| When I was Speaker of the House in North Carolina for four years, and I had a lot of people coming up to me recommending health care, proposing legislative fixes, I told them all the same thing: don't come to me unless you have an idea for obviously maintaining current outcomes. | ||
| But unless you have an idea that reduces costs, improves outcomes, or increases access. | ||
| If you have one of them, I may be interested. | ||
| If you have two of them, you've definitely got my attention. | ||
| If you have three of them, we're going to get the bill passed. | ||
| And we did. | ||
| And we worked on the Medicaid program in North Carolina. | ||
| We did not allow Medicaid to get expanded under Obamacare when I was there because we had to clean up the mess that I inherited. | ||
| And then the subsequent speaker did expand Medicaid, and I think it's working pretty well. | ||
| I did have a question on there were a couple of people. | ||
| By the way, I complimented Senator Whitehouse on Ferret being after you like a ferret. | ||
| We all need to be after you like a ferret. | ||
| I used to have a ferret named Garrett. | ||
| Actually, I just realized I got a staff named Garrett. | ||
| But I like the analogy. | ||
| We need to be after you because it's interesting in these questions that are being, everybody's frustrated with Medicaid, right? | ||
| Everybody thinks we can do some work on Medicare. | ||
| But this has been a bipartisan failure to really modernize and make leaner and put more money in patient-facing operations. | ||
| We've got to have less money in all the plumbing. | ||
| And so I just want a commitment from you. | ||
| Within your first 90 days, would you be willing to host a meeting on your turf with any of the members of the finance committee that would like to see your vision for enterprise transformation for CMS? | ||
| Senator Tillis, I would welcome the opportunity to host members of this committee and other interested parties. | ||
| In fact, I need your help. | ||
| And let me just speak to one issue since you brought it up, and your expertise historically had been enterprise transformation. | ||
| There are probably 150 people who control health care in America, and they don't really want anything to change. | ||
| This is not an accident that we're here. | ||
| In Tennessee, Marshall, you know, I could just. | ||
| Well, I'm going to be sensitive to everybody's time, but that's why I'm going to give you a copy of this book. | ||
| Do you remember this book? | ||
|
unidentified
|
Yes. | |
| I'm going to give copies for a lot of my colleagues. | ||
| It's called Who Moved My Cheese. | ||
| It's a story of a maze that you're going to find yourself in at CMS. | ||
| And there are two types of people that are going to be in that maze: Sniff and Scurry, who were the mouses who figured out where the cheese was and they embraced change, and him and Ha. | ||
| They were the little people in the maze who just resisted any idea of change. | ||
| But, ladies and gentlemen, all the frustrations we have, whether Democrats are in control, we're complaining about it, or Republicans in control, they're complaining about it, are structural problems where we need to set politics aside and enable a leader to fix it. | ||
| There have been capable Democrat nominees and Republican nominees that were never given a chance. | ||
| So we want to move the cheese. | ||
| We want to produce better outcomes. | ||
| We want to do it at a lower price point, and we want more people to have access. | ||
| And clearly, anybody who needs Medicaid should be on it. | ||
| The only thing, we're not talking about caregivers, we're not talking about sick people, we're not talking about people with a diagnosed behavioral health problem. | ||
| We're talking about people that we do want to provide Medicaid for, if they can't afford it, but work so that they actually get the benefit and the freedom that comes from a job. | ||
| That's all we're asking about. | ||
| All these other things are insane. | ||
| We're probably only talking about a single-digit portion of the population. | ||
| And if we keep on playing those games, we're going to have a problem. | ||
| I hope you're there for change. | ||
| Thank you. | ||
| God bless you, sir. | ||
| Senator Warren. | ||
| Thank you, Mr. Chairman. | ||
| So Dr. Oz, if confirmed, you would oversee Medicare coverage for more than 66 million Americans. | ||
| Now, nearly half have traditional Medicare, where the federal government provides health care coverage directly. | ||
| The other half are on Medicare Advantage, where the federal government pays a private for-profit insurer to administer the health benefits instead. | ||
| And surprise, surprise, the privatized Medicare costs a whole lot more. | ||
| So let's talk about the top trick that Medicare Advantage insurers use to gouge taxpayers, upcoding. | ||
| I understand Senator Cassidy started on this this morning, and I just want to dig a little deeper. | ||
| In Medicare Advantage, taxpayers give insurers a set amount per patient. | ||
| The more diagnoses or the more codes the patient has, the higher the payment. | ||
| Now, in theory, this covers higher costs for sicker patients, but insurance companies get the money for the codes, not actually for the services they do or don't deliver. | ||
| So Medicare Advantage insurers have figured out that if they can add a bunch of fake diagnoses that they don't actually have to spend money treating, they can really boost their profits. | ||
| One example, last year the Wall Street Journal identified 66,000 Medicare Advantage patients diagnosed with diabetic cataracts who had already gotten cataract surgery. | ||
| Now, that is, as you know, anatomically impossible. | ||
| So Dr. Oz, insurers pocketed an extra $178 million in taxpayer money last year thanks to just this one fake diagnosis. | ||
| Does that sound like Medicare fraud to you? | ||
| Senator Warren, I appreciated you spending time with me in your office. | ||
| The answer is yes. | ||
| It's anatomically impossible. | ||
| And I'll give you one more example. | ||
| Okay. | ||
| Which is sending someone to your home, which you brought up in the office. | ||
| If you're going to say it, I won't say it, but you pointed out something that's very real, which is if you send someone to someone, if an insurance company sends someone to your home, there's probably a reason for it. | ||
| And so if they're doing ultrasounds to look for minor atherosclerotic plaques, which is not really something that needs to be treated, and most Americans have, it's primarily done to upcode you, which has two problems. | ||
| One, it's cheating because you're able to charge more for those patients, but then people who truly have limb-threatening peripheral vascular disease who have that box checked in their care, those companies, insurance companies, don't get paid more. | ||
| Those doctors don't get reimbursed more for doing what is ethically correct. | ||
| So it doesn't just help the scoundrels who are stealing from the vulnerable. | ||
| It's actually hurting the people trying to take care of those vulnerable populations. | ||
| In fact, let's talk about how bad that upcoding is that comes from the home visits. | ||
| HHS Inspector General found that in 2022 alone, United Health used these home visits to add about $2.3 billion worth of diagnoses, diagnoses that led to absolutely no treatment. | ||
| And I take it you think that sounds like fraud as well. | ||
| We are, I think, as an agency aware of this. | ||
| I haven't been in there yet, but if confirmed, this will be one of the topics that is relatively enjoyable to go after because I think we have bipartisan support. | ||
| I love hearing this. | ||
| So upcoding is a scandal. | ||
| And overall, we know that Medicare Advantage overpayments cost at least $83 billion in a single year. | ||
| So $83 billion, remember that number. | ||
| Last month, Republicans in the House passed a budget framework that sets up $88 billion in annual cuts to health care, Medicaid funding for seniors in nursing homes and for people with disabilities who have home health aid and more. | ||
| So, Dr. Oz, I have a simple question. | ||
| If you have the choice, would you rather cut waste fraud and abuse by a Fortune 50 health insurance company in Medicare Advantage or cut funding for Medicaid, which covers half of all seniors in nursing homes and one in three of America's children? | ||
| My goal is to improve the health care of the American people. | ||
| And as you create the argument, the former sounds like a more rational way to do that. | ||
| I appreciate that. | ||
| You know, I am happy to work with Republicans to go after waste, fraud, and abuse, but let's cut out waste fraud and abuse where it actually occurs, like up coding in Medicare Advantage. | ||
| Republicans cutting health care for seniors and for babies and for people with disabilities, while the waste and the fraud just roll right along for a multi-billion dollar insurance company is sickening. | ||
| And I will fight that every step of the way. | ||
| Thank you, Dr. Oz. | ||
| Thank you. | ||
|
unidentified
|
Thank you. | |
| Senator Blackburn. | ||
| Thank you, Mr. Chairman, and welcome. | ||
| We are delighted that you are here and look forward to having you move out of this committee, be confirmed on the floor, and get over to CMS and get busy to work. | ||
| You have quite a job in front of you, and I appreciate the time that you gave when you came to visit with me. | ||
| As we discussed changes to health care delivery, transparency, electronic health records, all of that is not going to happen here in D.C. | ||
| It's going to happen in places like Nashville, Tennessee. | ||
| And individuals that are entrepreneurial in their new starts in their companies that are addressing so many of these delivery and access issues. | ||
| And as you've heard, there's great frustration with Medicare, Medicaid, the fraud that exists. | ||
| There's frustration with entities like CMMI that can't do their job and they need to either get to work or they need to be shuttered and that money used elsewhere. | ||
| And there is frustration with coding. | ||
| I would remind my colleagues that it is the American Medical Association that supports many of them, that is responsible for coding. | ||
| And it is time, I agree, to simplify that system. | ||
| And I know you have thoughts on that. | ||
| And I look forward to your being able to tackle that issue. | ||
| Senator Blackburn, I enjoyed our visit, particularly highlighted the reality that everyone should be aware of that Nashville has become the health care finance capital of the country with a lot of very innovative souls making major advances in health care. | ||
| We want to empower those kinds of companies to start playing a role with the development of better services for Americans and also cost savings for the American people by building a better mousetrap. | ||
| To do that, they have to know where we're headed. | ||
| The first thing you learn in hosting, whether it's a television show or a garden party, is telling your guests where they're going. | ||
| And I don't think CMS has done that adequately. | ||
| I'm hoping that, if confirmed with strong leadership, we'll be able to message very clearly where we need help and where there are opportunities for us to do better. | ||
| By engaging the private sector wisely, I think we can challenge some of the incumbents, get some wise insurgent ideas to be seen and tested. | ||
| CMMI has a history of failed projects, but I think with strong leadership, it will do very well. | ||
| Well, let's hope that they do. | ||
| I do want to talk with you about the low-wage index. | ||
| As I mentioned to you, we've had 16 hospital closures over the last decade in Tennessee. | ||
| 13 were in rural areas. | ||
| The first Trump administration put a fix on this, and then the Biden administration let it expire. | ||
| No guidance, no direction, and it was like our rural hospitals just had the rug pulled out from under them. | ||
| Can I get a commitment from you that you will indeed address this disparity? | ||
| You have my commitment, if confirmed, to address broadly what we have to do with rural health care in America. | ||
| It's not just hospitals, as we discussed in your office. | ||
| There are some great institutions, 300-bed hospitals built in 1970 that really shouldn't be a 300-bed hospital anymore, even though it is the only place to get care in that area. | ||
| We have to provide a better solution for the people in those areas, a financially viable one for the community, and one that actually protects the state coffers. | ||
| If Medicaid is consuming a third of the budget in Tennessee, which is approximately what it is doing, it's crowding out schools, it's crowding out infrastructure, it's crowding out education, I mean, services that are valuable for folks around the state, and we're eating ourselves from the inside out by not dealing with this wisely. | ||
| And you've heard several of us mention Medicaid funding and concerns there with the fraud that exists in Medicare and Medicaid programs. | ||
| And every time someone defrauds one of these programs, whether it is on providing care or receiving money that is not theirs, it really hampers the ability to get care to people that need it. | ||
| Another area of fraud that we've noticed is the non-U.S. nationals that are crowding into the program and individuals that are illegally in the country that are receiving Medicaid benefits that ought to be going to U.S. citizens. | ||
| Will you work with us on cleaning up these roles and moving them out of the program? | ||
| I look forward to ensuring that the determination of Medicaid eligibility is done accurately and honestly. | ||
| Same for Medicare. | ||
| I saw an article yesterday highlighting what California has been able to accomplish, taking money from federal coffers to fund exactly the programs you're describing within their state. | ||
| It's a smart move if you're a state that can pull it off, but it's not the right thing for the American people because we're all in this together. | ||
| Thank you. | ||
| Yelby. | ||
|
unidentified
|
Thank you. | |
| Senator Smith. | ||
| Thank you, Chair Crapo, and welcome, Dr. Oz, and to your family for joining us. | ||
| And I want to just note thanks to my colleague, Senator Blackburn, for her focus on rural hospitals and rural health, which I is concerned that I share. | ||
| Dr. Os, I want to talk a bit about artificial intelligence in health care and technology. | ||
| You've expanded on the many potential uses of AI and technology for delivering health care. | ||
| And I agree that we need to make the best use of technology to improve access to high-quality care. | ||
| And in fact, I think we learned a lot from the pandemic in terms of, for example, advances in telehealth. | ||
| And that is important to not forget those lessons. | ||
| But so I'd like to spend my time just getting a better understanding of your thinking on the role of AI and health care delivery. | ||
| So let's start with this. | ||
| Let's start with how health insurance companies are using AI to make decisions about prior authorization decisions. | ||
| Could you talk a bit about that? | ||
| How do you think or do you think that AI should be used in prior authorization decisions? | ||
| Senator Smith, I enjoyed visiting with you and thank you for sharing some of your ideas at that time. | ||
| And this is a good place to start. | ||
| AI can be used for good or for evil. | ||
| And it, to a large extent, depends on who's using it for what purpose. | ||
| I think AI could play a vital role in accelerating pre-authorization. | ||
| One reality in the healthcare system right now is the average insurance company has about 3,000 procedures that they use, they rely on pre-authorization from, but they're not the same 3,000 procedures. | ||
| So if you switch insurance companies, you may move from one that used to pre-authorize a knee replacement, the new one doesn't. | ||
| So I would argue that to use AI wisely, we would make a decision, which is we're only going to pre-authorize 1,000 procedures. | ||
| Everything else just should get done. | ||
| Because it's only 1,000 where there's a concern. | ||
| And this, I'm sorry to interrupt you, but what I think you're referring back to what you said earlier, which is that we use pre-authorizations too much. | ||
| And I think I heard you say that earlier. | ||
| But I want to dive in on this a little bit more because there have been reports and lawsuits that have alleged that AI has been used by three of the largest Medicare Advantage insurers to determine how long patients can stay in hospitals, denying those claims, kicking people out of hospitals or even out of step-down clinics when they're not able to take care of themselves at home. | ||
| And this is a big concern. | ||
| I think my view is that a human needs to have a final say in these decisions that insurance companies are making. | ||
| And I'm wondering if you would agree with that. | ||
| I agree with you. | ||
| If I can add just one more layer, this sounds like our conversation in your office. | ||
| I think that we should be using AI in the agency to be able to tell what insurance companies are doing with their AI. | ||
| The best way to detect bank fraud is not a person looking at whether a fraudster is going in to steal money because most of us aren't thinking about fraud. | ||
| So you're not very good at detecting it. | ||
| So if we see that there's something being done, for example, inappropriate use of AI or inappropriate denial of services with AI, we should be using AI within the agency to identify that early enough that we can prevent it and we should do it real time, not six months down the line. | ||
| Use it as a tool to address whether an insurance company is using prior authorization inappropriately. | ||
| And protect the American people. | ||
| They should actually know what that AI is telling us, so they should also feel empowered to push back when they don't think it's right. | ||
| So here's another example in the time that I have. | ||
| You've talked about using AI to augment care, especially in Medicaid where we have serious shortages of mental and behavioral health care providers, I think. | ||
| Dr. Oz, how should AI programs be deployed to support patients that are experiencing mental health challenges? | ||
| After I was nominated, I started spending a lot of time looking at technologies just to understand what could be the future. | ||
| And after meeting with a lot of the leaders in artificial intelligence and seeing a lot of different demonstrations, I can attest to you that we are months away, not years away, from having AI tools that could have a conversation with someone that you care about, pick up subtle details about how they feel emotionally about a problem, whether they're going to follow through with dealing with it. | ||
| Do they really understand what the doctor or nurse told them? | ||
| All of this is going to become part of the fabric of how we expand services. | ||
| And this is not about removing doctors. | ||
| I agree with your first premise that humans have to be involved, but an internist who's capable with decision support and a little bit of help from AI dealing with the intake could see twice as many patients. | ||
| I'm making that number up. | ||
| We don't know that for sure, depending on the severity of the illness, but see a lot more patients in order to get through the day, and that's better resources for everybody. | ||
| So here's the concern that I have with this, because I think sometimes this is not transparent to patients. | ||
| And that, to me, is extremely important. | ||
| It's been documented that there are chat bots out there that have been advertised as providing social and emotional support and even representing themselves in one case as a real licensed mental health providers when they're not. | ||
| And we have documented that some of these bots have actually encouraged, in some cases, suicide or self-harm or even violence. | ||
| And addressing this misuse of the technology seems to me of grave need to our society. | ||
| It's a well-identified problem. | ||
| AI should worry us all, but I do believe it's a tool that, if used appropriately, and I think Congress will have to play a role in making sure we do that wisely, could help a lot of Americans and certainly will help the provider groups. | ||
| But we have to be able to put guardrails around its appropriate use. | ||
| I'm out of time. | ||
| Thank you, Mr. Chair. | ||
|
unidentified
|
Thank you. | |
| Senator Marshall. | ||
| Thank you, Chairman. | ||
| Welcome, Dr. Oz, Lisa, family. | ||
| Thanks for being here to support your husband and your dad. | ||
| It means a lot to us. | ||
| I'm glad they're still here. | ||
| Yeah, they're still here. | ||
| So welcome, Dr. Oz. | ||
| Just kind of a big picture question. | ||
| Why did you go into medicine, and what are some of the highlights or the most rewarding parts of your career? | ||
| I don't think there's a joy greater than looking a patient in the eyes and recognizing both of you that you're there for each other, that nothing will get in the way of you providing the best care possible. | ||
| It's not that there won't ever be problems, but you'll be there emotionally supporting them. | ||
| And if you've been gifted with teachers, as I was, that could educate me about how to take care of patients, you get to watch them get better and feel a joy inside your heart that can't be matched. | ||
| I don't believe in another field. | ||
| It's why my son Oliver, this one over here, is going into medicine. | ||
| I think it's why I went into medicine because I saw my father go into the hospital and do things like putting needles in people, which that looks painful, but the patients would smile and thank him for it. | ||
| Paradoxically. | ||
| And that's why I think it's also appropriate for physicians as you have and other physicians on this committee, Dr. Cassidy, to enter government because we're trained to tell people things that they need to hear but aren't pleasant. | ||
| But that's how you get the system to work better. | ||
|
unidentified
|
Thank you. | |
| You know, everyone's giving you advice up here. | ||
| I get to give you one piece of advice. | ||
| You need more nurses at CMS. | ||
| Nurses solve problems. | ||
| They understand where the patients are, so encourage you to more nurses. | ||
| But beyond that, my grandma always said if you have your health, you have everything. | ||
| And America doesn't have her health right now. | ||
| 60% of us have a chronic disease. | ||
| Several people pointed out this country is spending multiples more than other countries do to take care of our sick. | ||
| There's not enough sick care out there to save Medicare and Medicaid. | ||
| You and I came here to save Medicare and Medicaid, but part of that is making America healthy again so that we don't have to do as many heart bypasses and give as much insulin and diabetic type of drugs. | ||
| What is your prescription for America? | ||
| How do you work with Medicare and Medicaid patients to help America become healthy again? | ||
| If I ask beneficiaries about Medicare, most people don't really know much about what we could do for them. | ||
| They know about the payment issues, but they don't appreciate that the incentives around the payments drive a lot of the decisions. | ||
| You know that because in your practice you saw that firsthand. | ||
| But it is remarkable outside of medicine how it looks like an opaque box. | ||
| If we incentivize wise moves by patients and their providers, their doctors, nurses, and I agree with you, the acting administrator of CMS is a nurse. | ||
| So it's in capable hands if something happens to me. | ||
| But the deeper promise that we should all be making to America is we're going to make it easy for America to do the right thing when it comes to their health. | ||
| Some of these decisions are not difficult. | ||
| Some of them need to be simplified and some of them need to be reminded frequently. | ||
| And Senator Wyden and I had spoken about this a little bit, the idea of giving incentives to patients is an idea that I think is a worthy one, especially for Medicaid beneficiaries. | ||
| If people don't feel like it matters what they do, if they don't think they have agency over their future, that their getting up in the morning doesn't really make the world a better place, then they're not going to take proactive steps to reduce their diabetes or another action that would dramatically reduce their life expectancy and their cost to the health care system. | ||
| So I think there's a lot of opportunity for us to do this, and we should be innovative and explore ideas. | ||
| And I think there's an ecosystem we can build together to gender that kind of enthusiasm from people on the outside of medicine who want to make it better. | ||
| We have got to challenge the incumbents in the system to have new ideas bubble to the top so we can pick the winners based on competent competition. | ||
| We're not going to save Medicare and Medicaid unless we make America healthy again. | ||
| I'm going to talk just a second about maternal care. | ||
| Came to this body on the other side of the Capitol, and people were talking about maternity mortality then. | ||
| We were seeing a big spike in it. | ||
| And I asked people why, what, how come? | ||
| And we didn't have an answer. | ||
| So thanks to my A-plus staff, we funded a study. | ||
| And not surprising to me, the number one killer of women, pregnant women, delivered that year after is actually suicide and fentanyl poisoning overdose. | ||
| We don't need to study it more. | ||
| We need action. | ||
| Early access to prenatal care would be the other action point as well. | ||
| So look forward to continuing to work. | ||
| Half of our patients, half the patients I delivered were Medicaid patients. | ||
| They need access to care, and we also need to stop the flow of fentanyl. | ||
| My last question, though, speak briefly about how price tags and health care savings accounts turn patients into consumers again and how that might actually help save Medicare and Medicaid. | ||
| Senator, I appreciate your leadership in the Make America Healthy Again movement, both in the Senate but also outside of the Senate, being an advocate for it years before it was in vogue. | ||
| There's a lot we can do with health savings accounts. | ||
| We could even investigate new ways of using them. | ||
| Maybe they should be part of your estate and passed on to your children because so many families don't really have anything to pass on and it would incentivize behaviors even at the end of life. | ||
| But I think there's an opportunity for us to give consumerism, give the power of the purse back to the American people, especially if they're beneficiaries on Medicare, and let them make the wisest decisions they can. | ||
| They got to that age by making some good decisions. | ||
| And so we might as well let them keep going. | ||
| Yeah, here we go. | ||
| Thank you. | ||
| I yield back. | ||
| Senator Luhan. | ||
|
unidentified
|
Thank you, Mr. Chairman. | |
| Dr. Oz, as I shared with you, New Mexico now has 33 people with confirmed cases of measles. | ||
| Cases have now spread to a new county in New Mexico. | ||
| One New Mexican has died of measles, a child. | ||
| In West Texas, the South Plains of Texas, 223 cases. | ||
| Child has unfortunately died in the state of Texas. | ||
| My question is simple. | ||
| Yes or no, do you believe the measles vaccine is safe? | ||
| Yes. | ||
| Yes or no, do you believe the measles vaccine is the most effective way to protect against infection? | ||
| It is, but if I could mention, as we discussed last night, and I think it's important to remember, CMS really should not be opining its own opinion or sharing its own thoughts on vaccines. | ||
| Our job is to follow the rules. | ||
| So if the CDC is making decisions about the use of a vaccine, and that's what's agreed on by the experts there, my job, if it confirms, is to make sure we pay for those vaccines, seniors and for children. | ||
| Now, my colleagues and I have written twice to the Secretary of Health and Human Services to do more to address measles. | ||
|
unidentified
|
There's not been a response. | |
| The same question asked of you today: if confirmed, would you respond to letters from members of this committee? | ||
|
unidentified
|
I appreciate your strong response. | |
| Yes. | ||
| It might surprise the American people that Senator Kennedy or Secretary Kennedy said the same thing. | ||
| So, Mr. Secretary, if you're watching today, respond to the damn letter. | ||
| People are dying. | ||
| I'm going to get back to the questions, Dr. Oz. | ||
| The next question I had was to ask how many people need to die before the administration takes it seriously. | ||
| I'm not going to ask you that. | ||
| But I would like to enter into the record an article from The Atlantic detailing the story of a Texas father who just lost his daughter to measure, Mr. Chairman. | ||
| Without objection. | ||
| Now, Dr. Oz, I believe Medicaid is on the chopping block because of the Republican budget. | ||
| And, Mr. Chairman, I would like to ask to enter into the record the Republican budget resolution which passed on February 25th, 2025, a letter from the Congressional Budget Office March 5th, 2025, and an article from the Kaiser Family Foundation explaining the congressional budget letter from March 7, 2025. | ||
| Without objection. | ||
|
unidentified
|
Dr. Oz, I'm going to give these to you. | |
| Because you were asked a question earlier about cuts to Medicaid. | ||
| Not being aware, and I believe your response was something along the lines of not being aware of what House Republicans did. | ||
| Here's some material to read that explains what just happened. | ||
|
unidentified
|
So I'm going to share this to you as well. | |
| That's why I entered it into the record. | ||
| Now, Dr. Oz, rural hospitals are in dire straits. | ||
| We've heard from Democrats and Republicans today. | ||
|
unidentified
|
Now, they rely on Medicaid to stay afloat. | |
| Now, yes or no, do you support Medicaid cuts when they will lead to rural hospital closures? | ||
| I don't want rural hospitals to close unless we have a better option. | ||
| But if I could offer a thought here, this is a good example where maybe there's an innovative approach that might work. | ||
| I have been talking to hospital systems, and one idea that comes up in rural systems is they don't feel like they've got a partner that maybe is a larger academic center or a bigger institution that might have resources for them to do best practices exchanges. | ||
| So imagine a rural hospital in central New Mexico, maybe around Mesa Verde, where you actually can have a partner that's in Phoenix or Salt Lake City or Dallas, and that could be your partner hospital. | ||
| So when you need telemedicine services, they're there. | ||
| They're not just there digitally. | ||
| They've been there. | ||
| They know the institution. | ||
| They know the people. | ||
| They develop a camaraderie that allows them to thrive. | ||
| We have to revisit how we deliver rural care in America. | ||
| We can't depend on 100-bed hospitals that do one delivery a day to provide state-of-the-art care. | ||
| So I share your concerns about losing these institutions. | ||
| I think we should look at additional alternatives to make them strong. | ||
| But Americans in rural areas, and I have heard it, even in my office visits from every single one of the senators in large rural constituencies. | ||
| So, Dr. Oz, I'll ask a follow-up to Dr. Cassidy's question, or I'm sorry, to Senator Tillis's questions in conversation. | ||
| Dr. Oz, will you stand against changes that will lower health outcomes to the programs that you will oversee? | ||
| Yes. | ||
|
unidentified
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Should physicians or insurance companies dictate the care that a patient receives? | |
| I'm sorry, should insurance companies should physicians or insurance companies dictate the care that a patient receives? | ||
| Physicians. | ||
|
unidentified
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I appreciate that. | |
| I agree with that. | ||
| Yes or no, will you continue to defend Medicare drug pricing negotiation programs in court? | ||
| It's the law. | ||
| I'm going to defend it and use it. | ||
|
unidentified
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Yes or no? | |
| Will you commit to the process of negotiating prescription and drug prices in Medicare? | ||
| I'm going to look, as the President has instructed me to already, for every single way that we can reduce drices. | ||
| And there are lots of options available. | ||
| I feel compelled to pursue every one of them. | ||
| I'll ask you one more time because I think I heard it, but I'll give you another chance. | ||
|
unidentified
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Yes or no, will you commit to the process of negotiating prescription drug prices in Medicare? | |
| Senator, it's one of many approaches I want to use. | ||
|
unidentified
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I appreciate it. | |
| I thought you might say yes a second time, but it's not yes or no from you. | ||
| That's fine. | ||
| Yes or no, do you believe that health care decision? | ||
| Well, I already asked that one, Dr. Oz. | ||
| Look, as we get through all of this, I have a series of questions that I have put together, not coming into this committee for, based on Senator Hassen's questions. | ||
|
unidentified
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I'll submit them into the record. | |
| I have a lot of concerns in these spaces. | ||
| I won't get to it now. | ||
| I appreciated having a conversation with you. | ||
| I'm very concerned of this back and forth of my colleagues saying that they're going to not cut Medicaid or cut it when Republicans are voting for it. | ||
|
unidentified
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Those are the realities. | |
| And as I shared with you, Dr. Oz, one thing that I've learned about Washington, D.C., the way that this place works better is when people keep their word and people are honest. | ||
| The American people want honesty. | ||
| If it's bad news, they'll take it. | ||
| And they're going to be stronger on how they're going to respond to it. | ||
| But when they get lied to and they think something's coming or they're going to be protected or a mom with a kid with cancer thinks they're going to have care and then it gets taken away like that, then what? | ||
|
unidentified
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Just own up. | |
| If that's what you want to do, own up to it and admit it. | ||
| But stop lying to the American people is what I keep saying to all my colleagues. | ||
|
unidentified
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Anyone that will listen. | |
| God bless you and your family. | ||
| I appreciate you being here today. | ||
| Thank you, sir. | ||
| Senator Warnock. | ||
| Thank you, Brother Chairman. | ||
| Dr. Oz, welcome to you and your family. | ||
| Congratulations on your nomination. | ||
| I enjoyed our conversation the other day and finding out the friends that we have in common. | ||
| My home state, Dr. Oz, the state of Georgia, is not only one of just 10 states in the country that still has not expanded Medicaid. | ||
| It also has the dubious distinction of being the only state, the only state in the country, where the limited number of families who do qualify for Medicaid are required to regularly complete bureaucratic paperwork to prove that they're still working the minimum number of hours to get health care. | ||
| State officials call it Georgia Pathways to coverage. | ||
| I call it Georgia Pathways to Nowhere. | ||
| The program is allowed under the state's Medicaid waiver, which is up for renewal this year. | ||
| And if confirmed as head of CMS, you would be responsible for approving or denying the state's application to renew this onerous paperwork requirement. | ||
| Dr. Oz, I'm not going to ask you, really, I'm not going to ask you to prejudge the state's renewal application. | ||
| That wouldn't be fair. | ||
| You need to see it. | ||
| But since you would oversee Medicaid if confirmed, yes or no, do you believe that families should have to complete government paperwork every single month to prove that they're working just to get health care when they're sick? | ||
| Senator, I appreciate your question. | ||
| I enjoyed visiting with you. | ||
| My wife, who went to Union Theological for a while, different time than you, I brought her as a support staff. | ||
| Good. | ||
| That gives me comfort. | ||
| Yes or no? | ||
| The answer to me is I am in favor of work requirements, and I don't believe we should. | ||
| Do you think a family should have to fill out paperwork every month just to get health care? | ||
| I don't think you need to use paperwork to prove a work requirement, and I don't think that should be used as an obstacle, a disingenuous effort to block people from getting on Medicaid. | ||
| However, I believe we would both probably agree that there's value in work, and it doesn't have to be going to a job. | ||
| It could be getting education. | ||
| It should be showing that you want to contribute to society. | ||
| Frankly, you could volunteer at Ebenezer Baptist Church, where I did a show with you once. | ||
| That would, for me, fulfill the requirements. | ||
| You'll never get any pushback from me about the value of a work ethic and the purpose that work provides, which is why I think people ought to have health care so they can get back to work. | ||
| Very often they can't get back to work in Georgia because they can't get the health care. | ||
| Let me give you an example. | ||
| There is a woman in Dalton, Georgia, that I got to know a while ago. | ||
| Her name is Heather Payne. | ||
| She's a traveling nurse. | ||
| And, you know, as a traveling nurse, some jobs were better than others. | ||
| Sometimes she had health care, sometimes she didn't. | ||
| She was among those folks who were in the gap. | ||
| She couldn't afford private insurance, but she wasn't poor enough to get conventional Medicaid. | ||
| So her health challenges and the unpredictable nature of her work as a traveling nurse made it impossible for her to meet Georgia's onerous work verification requirements to get Medicaid. | ||
| She found out she had had a series of strokes. | ||
| She had to save the money to see a neurologist. | ||
| And then she found out she'd had a series of strokes. | ||
| Took a long time to be able to afford to go. | ||
| And now she's in the gap. | ||
| And she can't meet Georgia's onerous work requirements. | ||
| Do you think Heather Payne, a traveling nurse who spent her career providing health care to others, do you think she deserves Medicaid or not? | ||
|
unidentified
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Yes. | |
| Thank you. | ||
| I agree with you. | ||
| And since we agree, I think that the Medicaid waiver that you will be responsible for reviewing, I think that Medicaid waiver, in fact, I know it, it says that Heather does not deserve Medicaid. | ||
| Let me tell you about another Georgian. | ||
| Amanda left her two jobs in New York and moved to Warner Robbins, Georgia to become a full-time caregiver for her 84-year-old father, Thomas. | ||
| Taking care of her father has become a full-time responsibility for Amanda. | ||
| He's 84 years old. | ||
| She's taking care of him, which means he's not in a nursing home, by the way. | ||
| She's taken on that responsibility. | ||
| But with all of this, she doesn't have time to hold a full-time job that meets the state's strict work requirements, and she has no income to cover her own health care costs should she get sick. | ||
| Dr. Oz, do you think Amanda deserves Medicaid? | ||
| From what you're describing, yes. | ||
| These are the opportunities we have to make the system better. | ||
| If we both agree that people should be trying to get off Medicaid if they can, we should be able to create a system where we can track that because there's the twin paradox, which I think we touched on in the office. | ||
| Two brothers are at home. | ||
| One's working every day, flipping burgers, making minimum wage. | ||
| Maybe he's cobbling together $16,000, $17,000, puts him right above the poverty level. | ||
| And the other brother doesn't bother working because he'll have the exact same coverage if he doesn't work. | ||
| We want to make both of them want to move up the ladder. | ||
| Like every small businessman, what's their goal? | ||
| To become a big businessman. | ||
| So look, you and I have the basis, I hope, for a meaningful conversation. | ||
| Georgia's pathways to coverage is a roadblock to care. | ||
| They've literally gotten, I don't know, 6,000 people, I think, the last time I checked. | ||
| And we got over 500,000 people in the gap. | ||
| So I'm going to give you a softball. | ||
| If you're confirmed, will you work with me and will you keep Amanda and Heather in mind as you consider whether or not to renew Georgia's waiver, which I think is fueled with unnecessary and onerous work requirements, paperwork, filling out paperwork every single month? | ||
| Will you keep these two people in mind? | ||
| That's the question. | ||
| Heather and Amanda should be in all of our minds and many others like them. | ||
| I look forward to working with you. | ||
| Maybe if you invite me down on a Sunday, I'll come to church with you. | ||
| Thank you very much. | ||
| You're invited any Sunday. | ||
| You can't preach, but you can come. | ||
| Senator Welch. | ||
| Thank you very much, Mr. Chairman. | ||
| Welcome, Dr. Oz, and welcome to your family. | ||
| The big concern I have about our health care system is it costs too much. | ||
| It's a real disgrace that we spend the most and get the least. | ||
| I mean, so many other countries, with all the problems they may have with their health care system, citizens are not anxious. about whether they can afford the care that they need. | ||
| Here, that's not the case. | ||
| And one of the big problems is that private equity, pharmaceutical pricing power, device manufacturer, pricing power, consolidation in the industry, all of this has made the cost of health care brutal. | ||
| It's brutal on taxpayers. | ||
| It's brutal on employers. | ||
| In Vermont, we have a lot of small employers. | ||
| They're paying sometimes $40,000 for a family plan for their employees. | ||
| They can't afford that. | ||
| And it's brutal, obviously, on individuals. | ||
| So I believe a major responsibility that you would have in your job would be to fight the excessive charging. | ||
| I'll ask you a little bit about pharmaceuticals, but you said you're going to pursue that. | ||
| You know, in his first term, President Trump said he favored a reference price for drugs. | ||
| So, you know, we're paying three, four, five times for the same drug that they buy in Canada or in Europe. | ||
| Would you support reference pricing so that we don't get ripped off compared to everybody else, even though we do the research? | ||
| Senator Welsh, thank you very much for taking time to meet with me before this event and for that question. | ||
| President Trump has been very clear that he wants me to reduce drug prices, not just that the government pays, but also for beneficiaries. | ||
| International reference pricing is a way of doing that. | ||
| All right. | ||
| Here's what I think we all need. | ||
| We have got to get a fair price, and it's not a fair price when we're paying six or seven times what they're paying for, the same thing in France or in Canada or wherever else. | ||
| Okay, so I'm just going to stop here but say that is absolutely top of mind. | ||
| President Trump has indicated a concern about this, and I hope you follow through. | ||
| Second, Medicare Advantage, it sounds good, but it's an incredible ripoff in some cases. | ||
| The Wall Street Journal did an expose, incredible investigation about what United Healthcare did. | ||
| And what it did, what it found is that they packed diagnoses. | ||
| It was to their advantage to have a person seeking Medicare Advantage to have numerous diagnoses that really didn't necessarily require treatment. | ||
| They provided doctors and nurses with checklists of possible diagnosis, their patients, and they paid them bonuses for completing these checklists. | ||
| So they'd pay a doctor or a nurse more if when they examined me, they found more things wrong with me. | ||
| And this resulted in about $84 billion excessive overpayment in Medicare Advantage plans, these practices. | ||
| It's going to be your job to crack down on that. | ||
| Are you going to have any tolerance for that kind of ripoff from our insurance companies? | ||
| No, I think you've identified a place where a system which was inferior a good one. | ||
| Medicare Advantage is a community health focused. | ||
| I understand that. | ||
| I just want to stay. | ||
| I don't mean to interrupt, but I just want to stay on this. | ||
| We cannot afford to have the health care system be taken over for private profit when it doesn't provide good service at an affordable price for our citizens. | ||
| Do you agree with that? | ||
| I agree, and I think the upcoding in Medicare Advantage programs has become the best example of this out there, and it's something that is addressable, and I pledge have confirmed, and I will go after it. | ||
| All right. | ||
| You're a very nice person. | ||
| I don't want you to be nice when it comes to dealing with this stuff. | ||
| All right. | ||
| So put that nice guy stuff behind you. | ||
| That's Oprah. | ||
| I'll be surgery. | ||
| But we need a fighter. | ||
| No, I'm serious about this. | ||
| We just can't afford this. | ||
| You know, another thing that's happening in health care is private equity. | ||
| One of the things that you said is that physicians should be free from corporate ownership. | ||
| I'm sure you say that as a physician deep in your soul because you know it's about you helping a patient. | ||
| And now private equity is owning a significant percentage of doctor practices. | ||
| And private equity has made 352 acquisitions in 2010. | ||
| In 2020, 10 years later, it's 937. | ||
| And what they do is they downsize, squeeze, and put the total emphasis on profit instead of patient care. | ||
| Is that private equity invasion of the health care space of concern to you for patient well-being and cost? | ||
| The one point I'd like to make is, as you point out, doctors who used to be generally completely free of corporate ownership, over the last decade, the doctors that are free practicing has gone from 70% to 30%. | ||
| So now most doctors are owned by a large insurance company, a hospital system, private equity. | ||
| We have to have a mechanism to disrupt the incumbents. | ||
| The only way to go after the big guys is to have smaller people who are willing to put money into initiatives that could conflict with their or go after their business models. | ||
| Private equity is one of the ways you can do that. | ||
| Yes, it could be misused. | ||
| Absolutely agree with the point that it's been abused. | ||
| This is an opportunity, too. | ||
| All right, thank you. | ||
| Here's my hope, because we can't measure this now, but we've got a starting point. | ||
| And my expectation is you'd be able to come in in six months, let's say, and report on whether there's progress on all these things, squeezing out the ripoff in private equity, squeezing out the ripoff in Medicare advantage, and having lower drug prices. | ||
| So I yield back, Mr. Chairman, and I thank you for the little extra time. | ||
| Thank you, Senator. | ||
| Thank you, Senator Young. | ||
| Dr. Oz, great having you here. | ||
| I enjoyed our office meeting. | ||
| And one of the things that I find so refreshing about your nomination and the general approach to health care that I think the administration is taking to make America healthy again is looking at the big picture before you dive into the details. | ||
| And one point of emphasis of yours, and I know of others in the administration, is making sure that we get a hold of chronic disease more effectively. | ||
| We have Americans that just for too long have not been getting the right care at the right time, and it makes our country unhealthy, and importantly, it also makes our health care a heck of a lot more expensive in the end. | ||
| So if we just do things more smartly, as opposed to the way it's always been done because there are entrenched interests, we can really, we can make people healthier, and we can spend less money on the things that could be done a lot more efficiently. | ||
| So I'm just going to ask you about prevention and chronic disease and what reforms, if confirmed, that you think we should make to existing federal programs that you'll have oversight over to include a stronger emphasis on prevention and early intervention for chronic diseases. | ||
| Senator Young, thank you for hosting me in your office. | ||
| I went back and watched Hoosiers, by the way. | ||
| And I would love to take you up on the offer to sneak into the Senate gym when the time comes, if I'm confirmed. | ||
| The question you asked is fundamentally important to how we can make the money we're spending on health care work in America. | ||
| I don't think spending twice as much as every other country is enough if we're more than twice as sick as every other country. | ||
| And so the real question is, what's our obligation, each and every one of us? | ||
| I think it is our patriotic duty to be healthy. | ||
| First of all, it feels a heck of a better. | ||
| It's the right thing for your family. | ||
| You want to walk your daughters down the aisle. | ||
| You want to do the things that age allows you, including being a wise arbitrage of what's happening in society. | ||
| But it also costs a lot of money to take care of sick people who are sick because of lifestyle choices. | ||
| It's different if you're born with a defect that requires an operation. | ||
| Often those are fixable issues. | ||
| People don't want to be liabilities, to your point. | ||
| People want to be assets. | ||
| And they want to realize their full human potential. | ||
| And if three-quarters of them can't serve in the military when they're young, how many are going to be vital when they're older? | ||
| And I think this sort of culminates in the bigger messages. | ||
| What do you have in your fingertips that you could do? | ||
| One thing that CMS can do is incentivize wiser moves. | ||
| As an example, in Medicare Advantage, most beneficiaries have some type of a food allowance, but there's no real advice on how to use that money wisely. | ||
| And we don't work with the private sector, maybe supermarkets, to provide better food support with that money if that's what the beneficiary decides. | ||
| We don't have to order people to eat healthy. | ||
| We have to make it easier for them to be healthy. | ||
| Even exercising a few minutes a day will have a massive impact. | ||
| There are people in the audience behind me who've done some of the pioneering work showing lifestyle reverses things like heart disease. | ||
| The fact that medications are at times useful, but sometimes not for problems like heart disease and even Alzheimer's, where there was a large study recently showing that you could arrest the progression of disease. | ||
| This is wonderful. | ||
| Doctor, I'll be chairing the health subcommittee on this committee, the Senate Finance Committee, over the next couple of years. | ||
| So I look forward to working with you on some of those priorities so that we can make people healthier again. | ||
| Certainly creating an atmosphere in which people can make themselves healthier. | ||
| I don't have a lot of time here, so I'm going to run through some things. | ||
| Innovation in health care strikes me as one of the most obvious ways for us to bend the proverbial cost curve down and help make people healthier. | ||
| One of the things that I've emphasized is the importance of getting faster coverage through the FDA for emerging technologies. | ||
| I had some legislation on this over the last couple of years here in Congress. | ||
| Will you commit to working with me on this issue? | ||
| Should you be confirmed? | ||
| Senator Young, yes. | ||
| Indiana is a hotbed for devices, and you know I feel strongly about making sure meds get the best care. | ||
| Next quick thing, artificial intelligence. | ||
| Can you give me 20 seconds, if confirmed, how are you going to ensure that CMS's policies and programs foster an environment that encourages adoption and full utilization of this amazing potential technologies coming online? | ||
| Senator Young, the folks who are desirous of bringing AI into the mainstream of public health in this country need CMS as a partner. | ||
| We have to make it easy to get the high-quality data in a protected fashion if beneficiaries desire it. | ||
| If we provide it, they will build it. | ||
| Last thing, thank you. | ||
| I have emphasized in recent years that every committee of Congress ought to be a national security committee. | ||
| Believe it or not, the health care portfolio is now a national security portfolio. | ||
| We have China stealing our intellectual property and leveraging health technologies for their warfighters. | ||
| And so I would just encourage you, because I believe you're going to be confirmed. | ||
| I think we'll have an opportunity to work together to also periodically reflect on the important national security implications of your post. | ||
| And I thank you very much and your family for your desire to serve in this capacity. | ||
| Thank you, sir. | ||
| Thank you, Senator Cornyn. | ||
| Dr. Oz, I don't believe in accidents. | ||
| And I think maybe we were all very fortunate that you're not sitting on this side of the dais, but you're sitting on that side of the dais, because I think what you will be able to do in your new capacity will outstrip anything you might be able to do as a legislator. | ||
| And I'm excited about your nomination and the opportunities that will provide. | ||
| The General Government Accountability Office, well, let me premise this. | ||
| You said that there were people, and I'm interested in knowing their names, 150 people who don't want anything to change in terms of our health care system. | ||
| I'll ask you a written question so you can provide us those names. | ||
| I'd like to know who they are. | ||
| But I will tell you there are people in Congress that don't want anything to change when it comes to our health care delivery system. | ||
| That includes presumably $521 billion in fraudulent payments for our entitlement programs, including Medicare and Medicaid, $2.7 trillion in improper payments over the last two decades. | ||
| I presume when they criticize some of the suggestions for reform, that means they don't want that to change either, and it must change. | ||
| We are at $36 trillion in debt. | ||
| We're paying more money on interest on the national debt than we are on defense. | ||
| That's unsustainable and in a very, very dangerous world. | ||
| I know you will agree. | ||
| So let me talk to you about something that I think you're uniquely qualified to address, and that is preventative care and keeping people healthy. | ||
| Part of the problem is, you know, we talk a good game when it comes to health care, but then Congress has policies, particularly in our farm bill, with the food stamps, the snack programs, where we subsidize people eating and drinking exactly the wrong kinds of foods in order for them to stay healthy. | ||
| And then we consider we come up with a shot, which will presumably help you lose weight, and we say, well, maybe we ought to subsidize that too. | ||
| It just strikes me as crazy. | ||
| So what can we do to incentivize the health care community? | ||
| Because right now we don't do it. | ||
| We pay doctors and hospitals to treat people when they're sick, if it's coded by HHS or CMS. | ||
| What can we do to incentivize the health care community to help people stay healthy longer and avoid chronic disease and the pain and misery and expense that go along with that? | ||
| Senator Corner, I appreciate all the help you've given me throughout my career and your kind words. | ||
| When I called a good friend after the nomination who had been involved in the campaign, he said, it's just like we planned it out. | ||
| It is remarkable that although we all agree that value-based plans and programs should be the foundational way that we incentivize doctors, nurses, and others' hospital systems to deliver care, we make it difficult to use those plans. | ||
| We use third parties as intermediaries who often charge so much that they take away the benefit of the value-based program to begin with. | ||
| But at its very core, physicians need support. | ||
| Everyone providing care needs support to be able to do what you just said. | ||
| Giving patients advice on lifestyle takes a lot longer than telling them to take a pill. | ||
| Doing surgery on people pays so much more than giving them advice about how to avoid operations that it's difficult to imagine anyone not doing the wrong thing in that model. | ||
| I remember early in my career, I was asked to help develop the advertising plant for a New York Presbyterian hospital. | ||
| I was practicing, and they wanted to talk about new technologies and this and that. | ||
| I said, That's not the question patients ask. | ||
| Patients want to know when you offer them heart operations, do I really need it or not? | ||
| That's the first question. | ||
| And we don't reimburse that question's answer, which is what we should be doing. | ||
| I believe, and we've been asking questions back and forth about AI, that we can use technology, information technology, artificial intelligence in particular, to provide more of that infrastructure support so that when the physician talks to you, the main thing they say is, I endorse what you just heard about a lifestyle change for you in particular, based on your background, any history we have on you, and all the other places that the health care system has touched you. | ||
| For much of this to happen, we have to know who you are. | ||
| So, one idea that I think will come up eventually is this concept of how we can tell which patients have been in which centers, all that interoperability of information and transparency, safely shared with you, the patient, I think will arm you with a bit more motivation to take charge. | ||
| And for people who are recalcitrant, as Senator Wyden has been talking about for more than a decade, I do think reward systems could be beneficial. | ||
| Well, there's so much more I want to talk to you about, and we'll do that after you get confirmed. | ||
| But let me just say that if there, if modern medical science can devise a shot or a pill which will give me the self-discipline to exercise on a regular basis and to eat a healthy diet, I want to be first in line for that shot. | ||
| Unfortunately, I don't think that shot or that pill exists. | ||
| So, we need you to use the bully pulpit because you're a great communicator. | ||
| I believe you can be a tremendous asset to communicating to the American people the importance of doing some of the things that will make their life happier and healthier. | ||
| Thank you. | ||
| God bless you, sir. | ||
| Senator Scott. | ||
| Thank you. | ||
| Todd Ozex for being here. | ||
| Good to see you again. | ||
| Certainly, I'm excited about your process here. | ||
| I'll go along with John Cornyn there. | ||
| If there is such a shot that makes you want to exercise more, I may have to wait until this generic brand comes out to be able to afford such a shot because that should be really, really expensive for a short period of time. | ||
| But to that point, I'm not going to ask you to comment on it, but my theory is that we have a lot of a long conversation about how expensive drugs are these days. | ||
| But at the same time, we should have a similar conversation about how when drugs hit the generic market, they drop precipitously in price, and it's that way forever. | ||
| So, I would hate to, for the lack of a better way of saying it, shortchange the American people by focusing on the original sticker price without having the value proposition long-term over the ultimate cost of a drug when it's in the generic forms. | ||
| I do think we're not really having a serious conversation with the American people about the fact that 94% of the morbidities that we face every day are on a generic medicine, and that because of that, you can go to Walmart or Publix or wherever you go and get a 30-day regimen for four bucks or $10. | ||
| And that value proposition that we bring to the American people because of patent protection is really important, though we very rarely focus on the back end that lasts for a lifetime and the front end that lasts for five to 12 years. | ||
| And we probably need to figure that out. | ||
| But ultimately, protecting that patent protection is really important from my perspective. | ||
| Not necessarily need to hear your thoughts on it yet, but I am hoping that you will commit to coming to South Carolina, having a conversation with my folks in South Carolina about the job that you are going to have. | ||
| Is that a commitment you'll make? | ||
| A commitment. | ||
| My roommate from college is from Greenville, South Carolina, so it's a good excuse to see him, too. | ||
| Well, I hope he's not a tiger. | ||
| Anyways, he's a tiger. | ||
| As a Game Dog fan, I knew he was. | ||
| There's something about that thin air in Greenville that causes people to be a Clemson fan. | ||
| For those of us listening to us, it is just a joke. | ||
|
unidentified
|
I just lost several votes there, by the way, so I'll move on. | |
| I want to say thank you for the compassion that was woven into your opening statement. | ||
| We are both men of faith, and I think those of us from a faith background share the philosophy that we find embedded, at least in the Bible in Matthew 25, that we have a responsibility to help those in certain categories, whether it's the widow or those folks suffering and going through challenges. | ||
| I think it's really important for us as a nation to embed that ethos in our approach to solving problems as a nation, especially for the most vulnerable. | ||
| And your opening statements reflected that kind of compassion that I think we desperately need to see more of on our national screens around the country. | ||
| To that end, the sickle cell anemia challenge that you talked about when you met with our staffs, thank you for bringing it up without having to be prompted to it. | ||
| I do think that CRISPR technology as we know it today is going to transform medicine as we know it tomorrow. | ||
| I'd love your thoughts on that, and I hope that you have a commitment in your new position to move forward with some of the cell and gene therapy access models that we're talking about, making it affordable for people stuck in Medicaid or Medicare, or not stuck, but on Medicaid or Medicare. | ||
| Well, Senator Scott, thank you for bringing sickle cell anemia and similar CRISPR solutions into the forefront. | ||
| There's a lot that we have benefited from that is only there because we've incentivized innovation. | ||
| And so sickle cell anemia, a disease which I've taken care of patients with because they often develop problems with organs that require surgery, is a crippling problem that causes a lot of pain and then you die, but you spend a lot of money on the way. | ||
| And there's a treatment, let's just say it costs a million dollars. | ||
| It's roughly the number that I'm hearing. | ||
| That if we could offer these young children, often of African American descent, this treatment, then they would be cured. | ||
| So I think there are ways for us to amortize that cost to save the child's life and reap the benefits of them not being in the hospital, running up big bills while they die in pain. | ||
| That seems to me a pretty good investment. | ||
| We just have to get our minds around the idea of paying a million dollars to save someone's life and demonstrating that if it works, that the drug company should get paid over a period of time to make up for the fact they made a massive investment to build that solution. | ||
| Those are the kinds of innovations that I think we could bring to bear, where you could actually imagine medications only being reimbursed if they provide a benefit that we all agree is true over time. | ||
| And just to the earlier comment, because you brought up faith in the broader issues, the oldest hospital that I'm aware of that still exists is in Cairo. | ||
| And this hospital historically would take patients in. | ||
| You wouldn't pay for care because you're sick. | ||
| You don't have money. | ||
| When you left the hospital, they would give you money. | ||
| It's the opposite. | ||
| Why? | ||
| Because when are you going to have the least amount of money? | ||
| When you're sick and you're getting better. | ||
| So they would actually give you something to get going again. | ||
| I think those are the kinds, at least metaphorically, ideas we want to support to get people back on their feet again and then make them feel obliged, responsible, because it is a shared responsibility to be our health system to do what they can to stay healthy so the system works for everybody. | ||
| I know that I'm out of time, but I'll ask my last question and ask for a yes or no answer, if that's okay with you, Chairman. | ||
| Yes, go ahead. | ||
| Thank you, sir. | ||
| During one of the silver linings, if there was a silver lining during COVID, and it's really hard to think of that catastrophic occurrence having any silver linings, if there was a silver lining in COVID, it was the development and the acceleration of telemedicine. | ||
| And I think it's going to save millions, if not trillions, of dollars over time. | ||
| I hope that you are committed to doing as much investigation as necessary to make sure that telemedicine is not just here to stay, but that it is embraced and adopted throughout our country wherever it is practical to be used. | ||
| I pledge that if confirmed, I'm going to pursue telemedicine. | ||
| I think it's essential, especially in our rural areas. | ||
| Thank you, sir. | ||
| Thank you. | ||
| Dr. Oz, we are almost there. | ||
| Senator Wyden has one more question for you, and then he'll give a brief wrap-up statement, and then I will give a wrap-up statement, and we'll be able to. | ||
| Thank you, Mr. Chairman. | ||
| Dr. Oz, I wanted to ask a question about something that has really been part of your wheelhouse, as far as I can tell, for decades, and that's the insurance sector, and particularly marketing abuses. | ||
| And I go way back to the days, you know, when insurance salespeople would sell five or six policies to a senior citizen. | ||
|
unidentified
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Traditional Medicare stuff wasn't worth the paper it was written on, and I came to Congress, and Bob Dole, I didn't think even knew my name, we got it fixed. | |
| But the abuses continue. | ||
| And I'd be interested in your thoughts about what you think the biggest abuses are now. | ||
| And then I'm going to ask you, I make this half of my question, a quick response in terms of what you're going to be dealing with if confirmed. | ||
| What do you think the biggest abuses are right now in the private insurance sector? | ||
| Medicare Advantage sales. | ||
| Such as. | ||
| I mean, give me an example of. | ||
| There's brokers that get involved in churning policies so they get you to switch from policy to policy. | ||
| We should potentially consider whether you need to re-elect Medicare Advantage every year and potentially offer multi-year programs for seniors because that would save some of the money that the brokers are taking out of the middle. | ||
| Some brokers do a great job, some don't. | ||
| We probably have too many. | ||
| I think there are ways for us to ensure that that marketing process works better for the folks involved. | ||
| But it's also what the Medicare Advantage plans also do with the monies that they use to incentivize the American people, the 32, 33 million people on Medicare Advantage to come into their programs. | ||
| And we should examine whether some of that money should be reimbursed to the American people to ensure that Medicare Advantage does not cost more than fee-for-service Medicare. | ||
| I'll have some additional questions for the record on this, but let me leave you with a thought. | ||
| We finally got some rules that have been put in place really in the last few years. | ||
| There's probably going to be a big effort because the Trump administration has been talking about rolling back a lot of the health standards. | ||
| I want to get a sense before we vote on which ones that you would be sympathetic to if anybody tries to do that, because I think that is a sure bet in terms of what's coming, that there will be some sleazy operators. | ||
| We both know that there's some good people out there, but there's some sleazy operators, and I think they're going to push for a rollback in some of the rules that have been adopted recently. | ||
|
unidentified
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And I want your assessment of that. | |
| Thank you, Mr. Chairman. | ||
| All right. | ||
| Thank you, Senator Wyden. | ||
| And Dr. Oz, thank you again for appearing before us today. | ||
| There is no doubt that you are qualified to serve as the next administrator of the Centers for Medicare and Medicaid Services. | ||
| And I look forward to voting in favor of your nomination and am urging all of my colleagues to do the same. | ||
| With that, I remind my colleagues that the deadline for submitting any questions for the record, and you will get some more questions to answer, is 5 p.m. on Wednesday, March 19th. | ||
| So, for my colleagues, the deadline is 5 p.m. on Wednesday. | ||
| The Finance Committee stands adjourned. | ||
|
unidentified
|
Thank you. What do you think? | |
| It was good to get it. | ||
| Let's get a picture together. | ||
|
unidentified
|
Do you have two questions? | |
| Do you have a phone? | ||
| Yes. | ||
| Do you want a five? | ||
| No, no. | ||
| I want you. | ||
| I want to go with it. | ||
| Yep. | ||
| Here. | ||
| I have it. | ||
| I'm going to get the beat. | ||
| Do you want to get the beat? | ||
| Do you want to get the beat? | ||
| You can get the beat. | ||
| Do you want to get the beat? | ||
| You can get the beat. | ||
|
unidentified
|
Thank you. | |
| Thank you so much. | ||
| Everyone sit down. | ||
| Okay, okay. | ||
| And how do you come here? | ||
|
unidentified
|
It's perfect. | |
| Robin, can you get in here? | ||
| Come on, I touch your guy with the phone. | ||
| Down there, they walk over here. | ||
| You know, all these, all these folks are over here. | ||
|
unidentified
|
You too. | |
| Yeah, bless you. | ||
| Thank you very much. | ||
| Thank you. | ||
| All right, so we're just finished setting up finance to the meeting. | ||
| Just finished the Senate Binance Committee hearings actually in this room. | ||
| Somebody just walked out. | ||
|
unidentified
|
One question that I've always got asked at every show by the guests is: how did I do? | |
| So, how did I do, Lisa? | ||
|
unidentified
|
Perfect. | |
| That's never a person. | ||
| She ever says that. | ||
| Give my wife back. | ||
|
unidentified
|
Where's she going? | |
| 10 out of 10. | ||
| How many thumbs up? | ||
| How many people? | ||
|
unidentified
|
All the thumbs. | |
| You're great, then. | ||
| All right. | ||
| And what's more important? | ||
| What does Rachel and Rebecca think? | ||
|
unidentified
|
Excellent. | |
| That's a good idea. | ||
| Thank you very much. | ||
| We'll have more live coverage later today when President Trump speaks at the Justice Department about immigration and crime amid mass layoffs and demotions at the department. | ||
| Watch live at 3 p.m. Eastern here on C-SPAN. | ||
| And at 4, Minnesota Governor and former Vice Presidential candidate Tim Walz holds a town hall in Des Moines, his first in a series of town halls in Republican districts. | ||
| We'll have that live on C-SPAN, C-SPAN Now, our free mobile app, and online at c-SPAN.org. | ||
| Mr. Speaker, on this historic day, the House of Representatives opens its proceedings for the first time to televised coverage. | ||
| Since March of 1979, C-SPAN has been your unfiltered window into American democracy, bringing you direct, no-spin coverage of Congress, the Supreme Court, and the White House. | ||
| Is this Mr. Brian Lamb? | ||
|
unidentified
|
Yes, it is. | |
| Would you hold one moment, please, for the president? | ||
| It exists because of C-SPAN founder Brian Lamb's vision and the cable industry's support, not government funding. | ||
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Your gift today preserves open access to government and ensures the public stays informed. | |
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| Every contribution matters. | ||
| And thank you. | ||
| And a live view of the U.S. Senate, where lawmakers are expected to vote in the 2 o'clock hour, Eastern Time, on advancing a House-passed Republican bill that would keep the federal government running through September. | ||
| Funding for the federal government expires at midnight tonight. | ||
| Senate Democratic leader Chuck Schumer has decided to vote in favor of the measure, saying while the CR bill is very bad, the potential for a shutdown has consequences for America that are much, much worse. | ||
| President Trump posted this on Truth Social. | ||
| Congratulations to Chuck Schumer for doing the right thing. | ||
| Took guts and courage. | ||
| The big tax cuts, LA fire fix, debt ceiling bill, and so much more is coming. | ||
| We should all work together on that very dangerous situation. | ||
| A non-pass would be a country destroyer. | ||
| Approval will lead us to new heights. | ||
| Again, really good and smart move by Senator Schumer. | ||
| This could lead to something big for the USA, a whole new direction and beginning. | ||
| Meanwhile, New York Times reporter Kenneth Vogel posted that the Democratic group that launched the push to get President Biden to drop out of the 2024 race is now focusing on pushing Senator Schumer out of his leadership post as a result of his support for the spending bill today. | ||
| You can watch gavel-to-gavel coverage of the Senate on C-SPAN 2. | ||
| C-SPAN, Democracy Unfiltered. | ||
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| We'll get to your thoughts in a minute. | ||
| You'll recall Republicans control the upper chamber 53 to 47. | ||
| They need Democratic votes to get this stopgap funding bill across the finish line. | ||
| Eight Democrats would have to join with the Republicans to send this continuing resolution to the president's desk. | ||
| That is because Republican Senator Ram Paul of Kentucky has already said he'll vote against it. | ||
| Last night, the Senate Minority Leader, Chuck Schumer, leader of the Democrats in the chamber, went to the Senate floor and said that he would vote for it. | ||
| The headline in Associated Press this morning: Schumer to advance GOP funding bill, unwilling to risk government shutdown as deadline nears. | ||
| Here's a little bit from the Democratic leader. | ||
| President Trump and Republican leaders would like nothing more than to pull us into the mud of a protracted government shutdown. | ||
| For Donald Trump, a shutdown would be a gift. | ||
| It would be the best distraction he could ask for from his awful agenda. | ||
| Right now, Donald Trump owns the chaos in the government. | ||
| He owns the chaos in the stock market. | ||
| He owns the damage happening to our economy from one end of the country to the other. | ||
| The stock market is crashing. | ||
| Consumer confidence is plummeting. | ||
| Donald Trump is hoping for a shutdown because it will distract from his true agenda, delivering massive cuts to the rich, paid for on the backs of American families. | ||
| He wants to gut Social Security, hollow out Medicaid, slap taxes on consumer goods through his reckless trade wars. | ||
| In a shutdown, we would be busy fighting with Republicans over which agencies to reopen, which to keep closed, instead of debating the damage Donald Trump's agenda is causing the American people. |