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unidentified
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| Dr. Mehmet Oz, former talk show host and President Trump's nominee to serve as administrator of the Centers for Medicare and Medicaid Services, testified at his confirmation hearing before the Senate Finance Committee. | ||
| He responded to lawmakers' questions on Medicaid, prescription drug costs, maternal health care, and rural health care. | ||
| It's about two hours, 40 minutes. | ||
| 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 DC 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 Health Corps, 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. | ||
| Some of 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 healthcare 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 HealthCorps, 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, is 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 are 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 as 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 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 from 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 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. | ||
|
unidentified
|
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. | ||
| 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. | ||
| The 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 Mauhure 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 Mauhure 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 Cow County or everywhere you wish to travel within Oregon. | ||
| 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 elucidation. | ||
| 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 by this committee. | ||
| 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 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. | ||
| I 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 dealing with opening. | ||
| 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, it's 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
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You 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. | ||
| 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 comment. | ||
|
unidentified
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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 scabble 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. | ||
|
unidentified
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And because you said in my office and said in your opening statement that you're 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 would, and 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
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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 Hesson, 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. | ||
| 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
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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
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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 Cantwell. | |
| 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, 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 don'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. | ||
| I'm 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 Catwell, 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. | ||
|
unidentified
|
Thank you. |