▶ 0:21:57e e
▶ 0:22:46I was wondering you all budy I'm right the subcommittee come to order good afternoon thank thank you for to our Witnesses for being here today to discuss a crucial issue before us modernizing American healthc care creating healthy options and better incentives chronic diseases such as cancer and cardiovascular disease are skyrocketing six and 10 Americans have at least one of the two chronic diseases
▶ 0:23:17according to partnership to fight uh uh diseases the projected total cost of chonic disease from 2016 to 2030 in terms of Florida anyway was $3 trillion these statistics are baffling and troubling and I'm committed to helping lower the cost on some of these dead deadly uh diseases this nation's chronic disease epidemic is out of control I for one I'm excited that Mr Kennedy has put put this on issue at the
▶ 0:23:47top of the administration in terms of uh his vision I'm also very excited to say that this is committee is spearheading hearings and markups that will be helpful to lead forward better health results and outcomes of Americans throughout this country congresswoman uh alone will represent MN EV Evans and Fitzpatrick into uh introducing legislation to establish a pilot
▶ 0:24:17program through Medicare to provide uh medically tailored meals to seniors I was happy to see that this is important this important initiative was introduced by American Medical Innovation and investment act that passed out of this committee since the last subcommittee hearing I had the pleasure of meeting with numerous groups committed to fighting these these issues covering the majority of injured lives uh at 18 180 million lives employers are one group that can
▶ 0:24:48help make a difference in terms of the chronic diseases uh and in fact 72% of employers saw reduced Health cost after starting a wellness program in their own firms last week Congressman penelli Panella and uh I introduced the chronic disease flexibility uh coverage act this important legislation allows for employers who offer High deductible plans uh coverage for their employees and the options of including pre-
▶ 0:25:18uh deductible coverage for services that treat uh chronic illness at the end of the day we can be empowered to take charge of our own health through key flexibility including health savings account that can make a difference we have another skyrocketing crisis on our hands of skyrocketing in terms of diabetics obesity over 45% of our nation adults are obese and and in fact 20% of the kids are joint economic uh committee led by Congressman schwier is is is
▶ 0:25:48talking the Obesity epidemic seriously in fact uh in a recent report the committee found that obesity will result in up up to 1 .9 trillion in excess medical expenditures and caus the federal government to spend 4.1 trillion over the next 10 years to bring awareness to these issues congresswoman Gwen Glenn Moore myself uh have set up a caucus that are going to focus on this I'd like to thank Congressman Moore for joining me in this critical
▶ 0:26:19effort and timing Congressman smucker also re uh recently launched the Maha caucus to focus on supporting Americans and living long and healthy lives through access to Affordable High care Foods uh which will make a difference these are just some of the many things great works we're doing is on a bipartisan basis on this committee we are about to hear from a great group of uh F folks are on the front line in terms of employees uh and their customers I
▶ 0:26:49look forward to working with all my colleagues this Congress to T tackle this epidemic um I'm pleased to recognize the gentleman from Texas Mr dogget for his opening statement thank you so much Mr chairman uh you know of my respect for you personally and of your interest in this important topic from the subcommittee hearing that you held only a few weeks ago on Healthy Lifestyles uh my concern today is that under this new Administration it is
▶ 0:27:19the lifestyle of the very rich and famous that seems to be the only thing of concern the healthc care agenda that is being pursued outside of this hearing room represents the real skyrocketing crisis in this country it's one that will leave Americans less healthy paying even higher prices and suffering from preventable diseases today is not the time for business as usual when nothing usual is happening as we hold this hearing Republicans are preparing legislation
▶ 0:27:49for this very week to cut care to cut significantly in healthcare to pay for even more tax breaks for the uh very rich and famous and multinational corporations outside the halls of this Congress the Trump Administration continues to deny federal funds to Innovative scientific researchers who developing the miracle cures and cures treatments and cures that customers need uh there is a delay in funds to community health clinics that treat
▶ 0:28:19vulnerable children and seniors we've seen layoffs hiring freezes offers to buy out remaining workers all worsening what was already a health Workforce crisis the conspiracy theorist nominees to lead the health agencies threaten the return of polio measles and more imparting Public Health Data on topics ranging from youth mental health to vaccinations to contraception are disappearing from federal websites in a true McCarthy
▶ 0:28:50era type fashion uh this Administration is developing Target list of workers to Fire and banned words that are are being prepared on lists on supposedly controversial research topics like women while apparently it's fine to continue research on men I would appreciate an explanation for the behavior of the unelected man who is illegally infiltrating and dismantling our government it turns out that Trump had more than a concept of a plan
▶ 0:29:20as he described it for healthc care he is swiftly executing what is nothing less than a widescale Siege I've heard from literally hundreds of concerned citizens deeply troubled by this assault on their health care and about the violation of Americans data privacy cancer patients that are fighting for their lives who are terrified that the clinical trial they were depending upon has been paused and soon to be approved treatments to be halted researchers developing those treatments
▶ 0:29:51with grand applications indefinitely on hold Labs on the brink of closing and looming layoffs overburdened VA clinics unable to hire more surgeons cardiologists psychiatrists and other health care patients to care for our vets As Trump musk and the Musketeers continue to ignore the Constitution and the laws engaging in what one federal judge recently said was the danger of irreparable harm I would hope that my Republican colleagues would
▶ 0:30:21offer some check and help us restore the balance of power instead they seem to be enabling this agenda with their silent confirming his nominees and readying a bill that will throw nursing home residents out deny vulnerable children inhalers and epipens and Lead pregnant women without any coverage to assure safe and healthy delivery all of this to further enrich Mr musk the fossil fuel Executives polluting our planet and our health and the Trump family this particular hearing is
▶ 0:30:51well-intentioned and of great interest to me my own daughter Dr Lisa doet is board certified in life style medicine it is an important topic but these choices cannot stop every dreaded disease or uh accident what will guarantee the worst Health outcome is a lack of comprehensive affordable coverage and inaccessible Physicians and nurses I'm eager to see progress on today's topic and so many others but first we must stop the severe harm being done
▶ 0:31:21by the Trump musk Duo I would Mr chairman also ask to enter into the record a few statements that we've received expressing the same concern I've just voiced one from the Federation of American hospitals in support of Affordable Care Act premium tax credits a statement from keep Americans covered in support of the Affordable Care Act credits a statement from the American Association of medical colleges concerned with research funding Cuts finally uh letters that we as way and means Democrats have
▶ 0:31:52sent to the treasury Department the CMS and the acting Inspector General since Trump fired the Inspector General at HHS concerning Mr musk alarming infiltration of payment systems and access to Americans private data and I would offer them at this time without objection so ordered thank you and I yield back thank you I will introduce our Witnesses Brooks Tean is CEO John Hancock Financial Jay Carlson uh is OBGYN
▶ 0:32:22and clinical chair of Mercy clinical research Marcy SOS is a small business owner and partner at Capital benefits lesie Doc is founder and co-chair uh person of uh protect our Care thank you all for joining us today your written statements will be made part of the hearing record and you have five minutes if you can try to keep your remarks to five minutes we'd all appreciate it to deliver your oral remarks uh Mr tangle you you if you're ready go
▶ 0:32:52ahead good afternoon chairman banan ranking member doget and members of the sub sub commmittee thank you for the invitation to participate in today's hearing I am Brook stingle president and CEO of John Hancock while John Hancock offers a range of financial products I'm here today to talk about Life Insurance Solutions and an Innovative approach that we're taking to help our customers live longer healthier and Better Lives simply put life insurance companies make money by collecting premiums investing those premiums
▶ 0:33:23and then at some point down the road we pay a claim generally the longer a customer lives those funds stay invested and the more the life insurance company stands to earn for this fundamental economic principle alone life insurers have a vested interest in their customers living longer and healthier given this incredible alignment and interests between our company and our customers it occurred to us how very odd it was that the life insurance industry had made virtually no effort to try to help its customers
▶ 0:33:53achieve better long-term Health outcomes so 10 years ago we introduced John Hancock Vitality a program rooted in Behavioral Science that offers our life insurance customers tools resources incentives and rewards to help improve their long-term Health here's a quick summary of how it works customers who choose to participate can download the Vitality app and earn points for simple everyday activities that correlate with a longer and more
▶ 0:34:23healthy life this can include things as simple as daily walks or other physical activity buying fresh produce preventative health visits getting a good night's sleep and a range of other activities these points add up to a status level in the program bronze silver gold and platinum and the more points you earn the higher your status which drives two important things one the level of Premium discount you enjoy on your life insurance and two
▶ 0:34:54the value of a range of discounts and rewards from a variety of Partners in the program including discounts on healthy foods Fitness Gear and much more we continuously enhance the Vitality program with the latest tools and Technology to help our customers understand their health so they can make more informed choices most recently we've had a particular focus on Innovations in screening and early detection in 2022 we became the first life insurer to partner with Grail
▶ 0:35:25offering customers discounted access to their Gallery multi-cancer early detection test as a result many of our customers have learned of a cancer diagnosis earlier than they otherwise would have and hopefully will have better outcomes we appreciate the ways and means committee's unanimous support of the multi-cancer early detection Medicare Bill last year and hope it gets over the Finish Line This Congress the life insurance industry is in an amazing position to engage our customers and help them live longer
▶ 0:35:55healthier and Better Lives whereas whereas others who have a vested interest in the health of health of Americans like Health insurers employers and many others may have relationships with individuals that last only a few years our relationships with our customers average decades indeed not long ago we paid a claim where the individual had been a customer for 99 years this gives us the opportunity to realize the long-term Financial benefits of investments in things like prevention
▶ 0:36:25and early the life insurance industry should want to see improved long-term Health outcomes and is in a unique position to help achieve those outcomes so we've been doing this for 10 years now what have we learned first and I think most importantly properly designed programs can result in improved Health outcomes at the population level second education is important but combining it with incentives and rewards makes for even outcomes next
▶ 0:36:55there continues to be an amazing amount of progress in personal health technology and that's a critical part of success in this area and lastly on a bit of a fun note gamification really works in this space so there are many other learnings including the important role of Behavioral Science I'm happy to share during the question and answer period at John Hancock we have seen firsthand the transformative power that an organization can have when it comes to empowering customers to make small but increasingly meaningful changes in their day-to-day lives
▶ 0:37:26as we know most both Health most healthc care spent today is for treatment we are excited to be investing in prevention and early detection which in the long run can save the government and others significant money we share the subcommittee's vision and look forward to working together in the common pursuit of helping Americans live longer healthier and Better Lives chairman banan ranking member doet and members of the subcommittee thank you for your time this afternoon and I welcome your questions thank you Dr Carlson uh you're recognized thank you chairman
▶ 0:37:56banan ranking member doet and distinguished members of this committee for the opportunity to be here today my name is Jay Carlson I'm a board-certified gynecologic oncologist and currently serve at the St Louis based Mercy Health System as the medical director of their oncology service line and the clinical chair for Mercy research I'm a founding member of Mercy's Center for precision medicine or what I might refer to as CPM during this presentation Mercy's the 15th largest health system in the US it's a community based system primarily in Missouri with
▶ 0:38:27Hospital and Clinics in Illinois Kansas Oklahoma and Arkansas with about 5,000 practicing providers it serves almost 3.6 million patients in the state of Missouri alone it is Mercy's strategic goal to use the best-in-class genomic testing and artificial intelligence to screen and detect atrisk patients earlier in their disease course to support this strategic initiative Mercy established a center for precision medicine to serve as the
▶ 0:38:57subject matter expert on genomic testing and the implementation of state-of-the-art screening one example of our screening initiative is a program focused on hereditary cancer risk this risk is linked to an autosomal dominant mutation which means that first-degree relatives have a 50% chance of inheriting that same dilar mutation these mutations and their transmission make a single patient's issue a family problem
▶ 0:39:28the significance this becomes evident when some of these mutations are associated with a 40 to 80% lifetime risk of cancer the screening tool for Discerning uh who should be tested are based on well-established guidelines with the national Comprehensive Cancer Network and that typically these are covered by Insurance when nccn criteria are met the nccn has also identified heightened screening tests or prophylactic surgeries that can be performed for these patients to reduce or mitigate
▶ 0:39:58their risk for a similar cancer because of its complicated nature a lot of Health Systems do not have a coordinated systemwide effort for these patients who are at exceedingly high risk of cancer to support this and effort Mercy completed website development that gives patients access to hereditary cancer screening tool and then digitally hands the atrisk patients off to that CPM team we also send out smart Texs to patients that that link back to that survey
▶ 0:40:28and again to the CPM team if they have a problem the patients identified to have aarius mutation are further handled by the CPM team for counseling and testing and coordination of their care until they're ultimately handed back to their Primary Care Providers Mercy also has an integrated vendor for genomic assays that's made it much easier for our providers to order these genomic tests and track their results in the last two years our oncologists have utilized excuse me have tripled their utilization
▶ 0:40:59of these genomic tests to drive targeted therapy for oncology patients Mercy's also implemented the broad multi-cancer early detection test that's already been previously endorsed and reviewed by this committee um therefore I'm not going to speak to the test but really our implementation of this test across a big Health Care System we knew that to implement this that we needed to Pro have provider education and patient education and that that deployment would also rely
▶ 0:41:29on the center for uh Precision medicine team we felt that this was an important test for our community because some of our hospitals are close to the coldw Creek community a community in north um St Louis County that's associated with uh a higher risk of cancer uh from their radioactive waste being stored there so we put on Virtual educational meetings with providers to review the science we developed an extens of patient facing website for the McD test
▶ 0:42:00we developed a separate internet for our providers to supplement their education and then we leveraged our AI algorithms to identify a high-risk cohort of patients and we've been using this for targeted marketing we've been using this process for two years and approximately 3,000 patient provider referrals as well as more than 9,000 self-referrals through the website for those that receive a positive test we have virtual same day review uh with myself and two other providers and providers
▶ 0:42:30excuse me for patients that are treated within our health care System um their diagnostic evaluations were completed in a meeting of 15 days a couple closing comments the current approved screening test have been available for years they're well- ingrained in medical training and practice we believe that these screening tests of the future will be much more complicated frequently involved a combination of AI and some type of omix asset making them clearly different than our historical standards as
▶ 0:43:00we've already experienced many providers will be unfamiliar with these potential tests or science and the use of predictive algorithms behind them by engaging the Precision medicine team we were able to offer these Service as a coner lift to our providers and that that c CPM team bridged the knowledge deficit and became the content experts in summary Mercy continues to explore new tests and services that uh combine the science of genomics with the new new benefits of AI and deploy them at scale to Aid in
▶ 0:43:30the screening the accurate diagnosis and the Precision treatment of our patients to improve their overall quality of care and thank you and look forward to your questions and thank you Mr Russ you you are now recognized chairman M Buchanan ranking member doit and members of the committee thank you for the opportunity to testify today on behalf of millions of small business owners Across America who like me are passionate about building stronger healthier communities my name is Marcy Strauss and I'm a small business owner and benefits consultant
▶ 0:44:01in De Moine Iowa I've worked with small businesses for over 20 years helping them navigate the complex world of healthcare benefits and designing the best possible benefits packages to keep their employees healthy and their business competitive my journey is personal I am a mom of three incredible kids Sid Ella and Libby my twins were diagnosed with a neuromuscular disease at age seven my entire perspective on Healthcare changed I learned firsthand that Healthcare is not just about having an insurance card it is about access
▶ 0:44:31affordability and getting the right Care at the right time I've had to fight for my children's care as a mother and I've had tough conversations with small business owners who want to do the right thing for their employees but are struggling to afford coverage and this is the real problem small businesses and patients are at the bottom of the healthcare decision-making process in our current system industry and government bureaucracies hold all the cards while the rest of us are left limited choices skyrocketing costs and little transparency
▶ 0:45:02small companies are being priced out they pay nearly twice as much for healthcare as large companies in my home County family premiums in the small group Market have 85% in eight years across the country small business participation in the small group Market has dropped nearly 50% since 2014 today only 30% of small firms provide health benefits down from almost 50% in 20 employers are being squeezed out and employees are left with fewer options
▶ 0:45:32yet small businesses play a critical role in building a healthier America nearly half the private Workforce is employed by a small business and these businesses contribute nearly half the country's GDP when employers have more flexibility and better options they do not just offer coverage they drive healthy outcomes they Implement Wellness programs encourage pre preventive care and create workplace environments prioritizing health with the right reforms tools and flexibility small businesses are uniquely positioned to help
▶ 0:46:02American communities get healthier hsas for instance give employees more control over their Healthcare decisions and help reduce costs many young workers prefer HSA qualified plans this helps to reduce premium costs and out-of-pocket maximums for individuals Congress should expand eligible expenses to allow more people to participate in holistic Wellness Services increase HSA contribution limits to match out-of- pocket maximum and allow Medicare beneficiaries to continue contributing so they have more control over their healthare expenses
▶ 0:46:33when people have more control and more choices they make healthier decisions rcas are another great tool rcas allow small businesses to offer affordable flexible benefits by helping employees purchase their own insurance however to realize the full potential of rcas we need to expand these arrangements and ensure employees have access to a wider range of affordable plan options Congress should consider tax credits or similar incentives for small businesses that offer Ras to encourage private investment in employee health coverage
▶ 0:47:03and allow for contribution offset to help keep employers competitive and reduce the amount of subsidies paid by premiums ta premium tax credits direct primary care or DPC is another example of how we can refocus the system on wellness and prevention DPC reduces costly emergency visits and improves employee and family outcomes under current federal law patients cannot use their HSA funds to pay for these memberships Congress should allow individuals to use their HSA to pay for these expenses lastly transparency in policies
▶ 0:47:33like Hospital site neutral payments will help provide price certainty prices are hidden inflated and impossible to compare employers and individuals deserve to know what they are paying for greater transparency would drive competition lower costs and allow employers and employees to make better more informed choices I have seen discrepancies in claims prices between $250 and $900 depending on who the payer is this is a contributing factor in the rising health care costs the best Solutions will not come from
▶ 0:48:03Washington but from communities ac across the country they just need the tools I appreciate the opportunity to share my perspective today and hope we can work together on solutions that promote healthy options and better outcomes while TR while truly addressing the rising costs of Health Care these are meaningful First Steps we can take to empower people in businesses to make the best decisions for themselves but we still have more work to do thank you and I look forward to answering your questions and working together to achieve this Vision thank you Mr D you are now
▶ 0:48:34recognized doc doc you're you're now sorry you're now just distinguished members of the committee um thank you for uh inv pull pull it closer to you sorry my name is lesie Doc and I am the founder of protect our care I before founding protect our care I was a senior advisor and counselor to the Secretary of Health and Human Services
▶ 0:49:05and also our department the HHS Ebola coordinator I also served in senior leadership at Walmart as a member of their Global uh Team where I became deeply familiar with purchasing healthc care for over 1.4 million employees at America's largest private employer at protect our care we believe that access to quality affordable and equitable able Healthcare is key to America's health and the single most important prevention tool that we can provide this country the American people agree no matter
▶ 0:49:36where they live or work or who they voted for the American people want Healthcare to be more affordable and more accessible about 80% of Americans in in polling tell us that they believe the government spends too little or just the right amount or about the right amount on Healthcare including about 70% of Republicans few few than one in five voters thinks the government should spend less yet the reconciliation proposals currently under consideration in Congress would increase
▶ 0:50:06health care costs and take away coverage from Millions including our neighbors in nursing homes children individuals with disabilities and people who take care of their children or elderly parents these Cuts would devastate families in order to pay for tax breaks for billionaires and Wealthy corporations and line the pockets of big drug companies if lowering the deficit is the rationale for these Cuts then the simplest and most popular solution would be to rein in these massive tax breaks and not
▶ 0:50:36destroy our health care System proposals before Congress would cut over two trillion dollars from Medicaid which provides Healthcare to over 72 million people including six in 10 nursing home residents 30 million children 15 million adults with disabilities and 14 million adults with mental illness these people have nowhere else to go Medicaid serves as a Lifeline in rural communities it keeps rural hospitals open and any cut in Medicaid
▶ 0:51:06will blow significant holes in state budgets whether they be in blue States or in red States interestingly enough just if we look at the members of the Republican members of this committee over two million people in your districts rely on Medicaid for their health care an overwhelming major majority of Americans including 69% of trump voters oppose cuts to Medicaid two and three Americans say they know someone who benefits directly from
▶ 0:51:36Medicaid and that includes and is similar to 38% of trump voters tell us that they know somebody in their family or a close friend who relies on Medicaid for their health care if Congress takes away existing ACA tax credits over 20 million people will see their prium go up an average of 90% And 5 million people will lose their altogether Banning Medicare from negotiating
▶ 0:52:07for lower drug prices and gutting the other prescription drug Savings in the ira will increase costs for over 53 million seniors this year alone 11 million seniors are expected to save an average of $600 thanks to the annual out of pocket cap limits and the newly negotiated lower drug prices will save seniors $1.5 billion and taxpayers $6 billion in just the first year alone but now Congress is considering these
▶ 0:52:37proposals for in reconciliation just as the administration takes on a number of ill- fated and ill-designed initiatives they are halting spending for community health centers gutting NIH funding pushing out record numbers of government staff and removing reliable scientific medicine that doctors and others rely on from government websites the chaos and withholding of funding has led to disruptions in care across the country and it is attacking
▶ 0:53:07NIH which is the Envy of the world for the role it plays in developing cures for patients and the economic impact it has across the country in in the last 10 354 of the 356 drugs that were approved in the United States were somewhat due to the work that NIH did on them the attack on V vaccines that's promised by RFK if he is confirmed his health
▶ 0:53:37secretary result in a Resurgence of preventable diseases and cost lives Americans expect their leaders to lower costs expand affordable health care and protect Public Health not to do the opposite not to take it away not to make it more expensive recently the Press has reported that a number of republicans in Congress are are concerned and about these Cuts I hope we can work together to defeat these Reckless proposals currently under consideration thank you thank you for your testimony now we'll
▶ 0:54:08proceed to Q&A this session and uh I'll go first uh Mr Dingle I wanted to touch base with you on some things uh I think you had mentioned I read you got 20 million customers 10,000 employees that's got to help a huge impact I would think and you know my thought is is we're spending $4.2 trillion uh it's 20% of the economy already and our results are worse than most countries in the world
▶ 0:54:38we've got to find a way where we all work together industry along with the government and everything else the government can't just do it by itself but I guess give me your your thought in terms of productivity of your employees the difference that's made uh in terms of your your customers and I think you've got my sense of what you said you got a win-win it's good for the employee it's good for the customers and it's also good for you guys and uh so it pays for itself I'm that's just me
▶ 0:55:08thinking about it but you could tell me but give us your you know a better sense of employees as well as customers and like I said 10,000 employees and 20 million customers thank you for the question it it's a it's a great point and you know as a leader of a company where our interests are so aligned with our customers um it's honestly a great privilege and and I can assure you
▶ 0:55:38I don't know who here has life insurance but if you if you own life insurance aside from your friends and family let me assure you no one wants you to live long healthy life more than I do and more than our industry does and for that reason we've chosen to invest in our customers long-term well-being and as you point out importantly our employees as well so I I mentioned it in my introductory comments we offer this program called Vitality to our customers we offer also a version
▶ 0:56:09of that program to our employees I mentioned that we offer the gallery multi-cancer early detection test to our customers we also offer that to our us-based employees at a discount so it's important from producct for productivity purposes with employees in the short term engagement understanding of our mission and purpose to to bring these things to our employees not just our customers but your point about public private Partnerships and not being all just the government or frankly all just industry
▶ 0:56:39but it's a great example where a company has the ability to sort of monetize Better Health outcomes and our industry is unique that way if people live longer we make more money I can tell you that and instead of just hoping for that outcome we plow a bunch of money into it I'll give you one example right quick we offer a healthy food Savings Program in our program we offer our customers 25% off fresh fruits and vegetables at over 61,000 Grocery stores nationwide that's an investment for us but we make
▶ 0:57:09that investment because of the importance of nutrition and because we know in the years that follow we'll see better health outcomes thank you let me mention Mr Carlson uh you talked about prevention uh you see where there's some things we do a pretty good job in general with in terms of medicine but there's other areas like lung cancer we probably do a much better job in terms of screening
▶ 0:57:40uh what give us your thoughts on screening and the difference it makes it sure seems to me I someone said quite a few years ago always stuck with me he said people that have their first heart attack 50% never see the next day now whether you can get that through a screening process or something there are a lot of other things you can like lung cancer where I'm sure we lose maybe 10% of people that they get screening in terms of lung cancers it's about all you hear about 10 or 15% but there could be a lot more
▶ 0:58:10positive impact if we we had more screening for everybody so thank you chairman Canan I agree with uh with what you've said um as it turns out picking lung cancer um we've we've actually inserted some barriers into the lung cancer screening program specifically lung cancer screening requires a shared decision making and an estation by providers that typically requires that patient to make a second trip
▶ 0:58:40in to see the provider um and and and that barrier is huge both on the provider who has other patients and other things to be tracking um but also the the the barriers of the transportation toxicities and other components with that patient making a second trip in um so lung cancer in particular there that that is something administratively that potentially you could help with that that if they have the smoking history and meet the criteria um you know eliminate the shared decision
▶ 0:59:11making eliminate the the the provider having to do an estation in order to get it covered by Medicare um an easy thing to do Mr doet you're recognized thank you Mr chairman thanks to all of our Witnesses you know where I come from we always say that everything is bigger in Texas and that often Rings true uh with our excellent cancer research centers and treatment and our Innovative medical research but outrageously it's also true because of Governor Greg Abbott's obstruction and
▶ 0:59:41support from his Republican enablers that we have the unfortunate distinction of more uninsured people more uninsured children than any place in the country this deplorable situation worsened over the last two years when Governor Abbott's admin Administration denied over 2 million Texans who had been receiving coverage access to a family physician often solely as a result of his administration's administrative erors in my hometown of Austin about half of all the
▶ 1:00:11children that are able to access Care at the Children's Hospital at jel Children's Hospital rely on Medicaid about half of all the births in my hometown are covered by Medicaid and nearly 300,000 uh mothers across the state are enrolled uh in Medicaid for over 700,000 Texas seniors and individuals with disabilities who require long-term care and assistance uh and affording their medications they get that through
▶ 1:00:42Medicaid that's their Lifeline uh after even after all of the disastrous mistreatment and disinterest in those individuals with Medicaid in Texas there are still 3 million children that are carrying that are counting on it a total of four million in all I had one of those families contact me this morning a mother concerned about her son Sam who has Down syndrome and relies on Medicaid is hoping to continue his educational opportunities but will
▶ 1:01:12require Professional Care uh Mr doc you referred to some of these challenges across the country but what will be the effect of significant efforts to defund Medicaid uh in order to provide these giant tax breaks for Elon Musk and his buddies uh on people like Sam and his family can you speak into the microphone again that the uh first I want to just thank you for all the leadership you've provided
▶ 1:01:42on the issue of Health Care throughout your time in Congress and to note that I think I have over 25 members of my family in your District they're very I know that but I'm to be represented by you um now unfortunately the rest of this message is a little bit more dire um we are going about to take away Healthcare from 72 million Americans who need it the most people who rely on it uh for preventive care people who rely on it to give birth people who rely on it to stay
▶ 1:02:12healthy and to see a doctor they are all at risk and for no reason except a desire to fund these tax breaks uh for uh the richest Among Us it's important to think of these people as individuals that's a big number 72 million people but if you think of them one family at a time and you know the anxiety that they face when they're sick when they can't afford to go to a doctor when they know they need to all the time incubating
▶ 1:02:43these diseases in a sense within their family so that the only time they can go to a doctor is when they go to the emergency room that tears people apart I think we all know that healthc care is the kitchen table issue around America because if you get sick or your parents get sick or your children get sick that's all you ever think about and compound that with knowing that you can't afford to go to a doctor and think of the hell that everybody in that situation finds themselves and now 72 million
▶ 1:03:13more Americans a high percentage of them will find themselves in that condition and this will and that's an outrage the University of Texas in Austin ranks number 14 in the entire world for interdisciplinary science it's one of the top recipients of Grants from the National Institutes for health uh there are many aspects there but you mentioned uh your prior work with Abola where we had some success I know there's another outbreak uh within the last
▶ 1:03:43few months in Uganda what threats do you foresee for the University of Texas and for our families with these attacks on science and public health research well we should just start again um with the numbers so Texas will lose uh $300 million doar in NIH funding under this new proposal that came without any warning without any planning and makes no sense $300 million less research being
▶ 1:04:13done in the state of Texas which as you said is one of the leaders across the board has some of the best medical schools and research institutions in the country there's no way they can make make that up um and the that means you know a significant cut in research I also want to say about my time with one of my jobs in Neola was to make sure it never came from West Africa to the United States let me tell you who helped us there CDC and US Aid they traveled to
▶ 1:04:43those those countries they lived with a with with six PA sick patients and they help reduce the rate of Ebola in that country when it came to one of my jobs was to sleep with a a buzzer underneath my pillow so if somebody came in with a fever off an airplane with the from Africa a CDC unit would go out and meet them and see if they caused a threat and then we developed the vaccine and who do you think helped us on
▶ 1:05:13that NIH and wh so we are dismantling through these cuts the entire structure that kept America safe Ebola in that outbreak in 2014 thank you very much for your testimony and now recognize Mr Smith thank you Mr chairman thank you to our witnesses as well I I think a topics such as this are appropriate for us to be discussing I think it's especially important that we look at the status quo and
▶ 1:05:44really examine the results are we satisfied with what government intervention has delivered with a Litany of prohibitions and mandates and uh the ACA or Obamacare whatever however one wishes to title that act of Congress that promised a lot and delivered very little in fact it just kind of shifted around who pays how much I don't think Health outcomes are any better certainly
▶ 1:06:14the expansion of of Medicaid roles or putting folks on Medicaid and saying that they're covered by Insurance isn't exactly accurate um I I think the American people want us to have vigorous discussions here and and really have an exchange of ideas on how we can actually lower the cost of healthcare make it more affordable make it more accessible we know that tellah Health can deliver uh quite a bit but now we've seen some lapsed uh timelines uh that uh make that
▶ 1:06:45less accessible um I'm especially concerned when I hear from constituents who lost their health insurance due to Obamacare we should be very sensitive to scenarios like that in fact I think of a constituent I believe she lost her health insurance a total of three times because of empty promises uh of the ACA um if we're serious about really addressing the cost of healthc care I think we buckle down
▶ 1:07:15and look at Innovation what Innovation can deliver in terms of new methods for health care and truly uh increasing access uh for Health Care treatment hopefully prevention certainly but I think that the numbers are staggering when you see what uh tasks are ahead of us and that chronic disease um impacts some 129 million Americans more than half of adults in our country
▶ 1:07:45that that should get our attention in a big hurry but I'm I'm very concerned when patients tell me that they don't feel the flexibility that they would like to have in terms of pursuing treatment and accessing care I know that a lot of Americans appreciate health savings accounts and the flexibilities that that can perhaps offer uh M Mr Strauss when the small business owners you serve are looking at the options available
▶ 1:08:15for their employees how important do you believe it is for them to have a variety of flexible options such as the HSA well HS have become quite popular um over the last several years and for us we pretty much put an HSA qualified plan in with every one of our group benefits that we write so the majority of our employers are offering multiple choices to include the high deductible health plans that are HSA qualified there are definitely things that we can do to expand the hsas
▶ 1:08:46to allow people to use them um around more preventive and wellness so for us right now if there were things uh more holistic types of treatments that would be approved through the hsas um that would be one way to get people to shift and save money to help to pay for things like healthy meals that are being prepared um we I've I've had some success even having things like pelons uh approved through an HSA due to the fact that we've had a provider putting somebody
▶ 1:09:16on a weight loss program and making sure that that is part of that program so an HSA is the most important thing right now as far as that younger generation goes they actually really enjoy their HSA benefits uh typically with those plans you see lower premiums lower out-of-pocket maximums um right now the maximum uh contribution limits for NH HSA is still extremely low uh we probably see out- of- pocket maximums
▶ 1:09:47$99,000 and right now you can only contribute 4,300 into um your HSA so we would love to see those limits increase to match out- of pocket maximums um and then also like I said just be able to allow some of these holistic uh types of treatments in addition to your normal traditional eligible expenses right thank you and and in closing I I want to say that I hope we can work together to look at really examine our policies in terms of the effectiveness I I know we heard some concerns
▶ 1:10:18about folks uh resorting to the emergency room for their main access to care and that that's obviously not a good situation but yet our policies through mandates prohibitions basically encourage that so I think we can do better the American people expect us to do better and uh I look forward to the continuing conversation thank you Mr Thompson you recognized thank you Mr chairman and thank you to the witnesses for being here today I think it's important that we work across the aisle to make sure
▶ 1:10:48that Americans have access to what they need to live healthier lives sadly we're seeing the current Administration doing the exact opposite this Administration announced cuts of $4 billion a year from the NIH uh research funding how are you supposed to find cures for cancer or new Alzheimer's treatment if research funding is chopped Mr chairman I ask unanimous consent to enter into the records statements from the American brain
▶ 1:11:18Coalition the association of American cancer institutes and the association of American Medical colleges that uh State and point out that funding Cuts will halt life-saving research projects seed America's leadership on scientific breakthroughs and hurt our economy you know Mr Kelly our colleague on this committee and I have uh legislation that incentivizes private companies who fund Neuroscience research
▶ 1:11:49in partnership with Academia and nonprofit research institutes the administrat ation Cuts would result in less opportunity for public private Partnerships like this one and throttle critical mental health research UC Davis in my district does incredible work with NIH funding they've uh developed diagnostic tools and treatment for individuals with autism designed personalized medical approaches for
▶ 1:12:19can cancer patients is studying the significance U of critical research for Alzheimer's research and developed new ways to restore speech for ALS patients and and that's just a few of the things they do and that's just in my district NIH research around the country has produced tangible results from Nobel prize winning Innovations in gene editing to breakthroughs in cancer treatment an NIH funding also
▶ 1:12:50positioned us to quickly develop the Trump covid vaccine this Administration wants to cut funding through the entire Health Care Spectrum from research to treatment proposed cuts to Medicaid discussed by some of my friends on the other side of the aisle pose a great threat to Patient coverage and Hospital funding cuts to Medicaid would devastate rural communities uh through Hospital closures and service cuts and when
▶ 1:13:20hospitals in rural areas close or end services patients in those rural areas have to travel many miles further to get the care that they need when patients can't easily access health care services as you all know they don't get the routine preventive care they need and then they end up in the ER to get more expensive emergency treatment patients especially rural patients
▶ 1:13:50get sicker and we should be clearly aware of that uh Mr doc if we cut NIH and Medicaid funding as as has been proposed could you please explain how that would impact patients ability to receive the health care they need use your microphone please the uh first I I think it's important to note that we all agree that the cost of healthcare is too high
▶ 1:14:20there are ways to bring down the cost of healthcare to improve our outcomes that's not in question here but the first step for anyone in the journey is to be able to see a doctor so they can get treatment early they can be di diagnosed if they're pre-diabetic they don't have they get instructions on how not to turn into a diabetic so there is absolutely no way uh to reduce this disease burden and the cost of it if you people can't see a doctor so that's I think a a stepping stone
▶ 1:14:51a critical First Step that people ignore at their Peril if do does anyone on the panel think that by uh chopping funding to this extent to NIH for medical research do do any of you think that's going to make Americans healthier Mr chairman I yield back Mr Hearn you recognized Mr chairman thank you and for the record president Trump
▶ 1:15:21has said that he has no intention and would not support cutting benefits to Medicare and Medicaid recipients Mr chairman thank you for holding this hearing and thank you to our Witnesses for being here I'm excited to start this Congress off talking about how we can all support a healthier America all of us here have heard many times about the effects of chronic diseases both on the individual and in the economy employer-based health insurance covers about 55% of Americans with about 72% of employees re receiving medical benefits from their employer
▶ 1:15:52this is a huge population and a space where employers can get creative and how they support a healthier Workforce health is a huge predictor in productivity and it is in everyone's best interest to invest in and support a healthy population as a former employee myself I know what it's like to want the best for my employees and what it takes to offer an attractive benefits package with healthc care coverage being one of the most sought-after benefits not only does a robust health package give employees a sense of security knowing that they have coverage
▶ 1:16:22but also gives them the tools to be active in their health with access to regular preventive care I also know that the government and the regulatory environment tend to make it harder on employers to take care of their employees and prevent them from offering their employees a real choice and type of coverage that works best for them I've experienced first hand heard from many small business owners on the struggles they face when it comes to offering a robust health insurance package the small Market small group Market is crumbling and the cost of offering their employees health care coverage is
▶ 1:16:52just becoming too high and Rising in premiums unsustainable for both parties it is our responsibility as the federal government to work with their business owners to understand what is going wrong and come up with Creative Solutions to fix it I was happy to see that this was a point of priority in president Trump's first term with the creation of individual coverage Health reimbursement Arrangements also known as rras the use of rras has continued to rise with the ikra adoption increasing by 29% between 2023
▶ 1:17:23and 2024 and in fact 83% of those newly offered offering IAS were businesses offering health coverage for the first time that's why I introduced the choice Arrangement act last Congress codifying this type of coverage option into law while I'm proud that legislation got passed out of the house last year I'm always looking for ways to improve this idea and help employers take up this option Mr Strauss thank you for coming and thank you for your testimony and taking the time to explain to us the
▶ 1:17:53struggles small businesses are are facing when it comes to offering healthc care coverage I want to highlight what you said in your testimony about how a one-sized fitall federal mandate limits flexibility and the mention of rcas being a good option for employers could you explain some of the regulatory barriers that small businesses are seeing when trying to offer Ras yes thank you for the question um Ras are a great tool and I think the more we focus on options regardless if that's individual
▶ 1:18:23or employer-based situations options are the key here so we want to stop taking things away and continue to expand the things that we do have RAs um right now one of the biggest challenges that we see with some of our employers is it's one or the other so if you're going to go ahead and put an icra plan in place an employer has to contribute at a pretty high level to offset subsidies in the marketplace and so an employer doesn't want to do something that's going to actually disrupt employees
▶ 1:18:54coverage and access to Affordable Health Care and so what I think would be a really great solution are there's tax incentives um I know Indiana has started to put tax incentives for employers that are offering Ras um and then some sort of an offset so for instance if they've got an employee that might receive a $350 subsidy through the marketplace but really that employer is only able to contribute $200 they can actually contribute the 200
▶ 1:19:24and then allow that reduced premium tax um credit on the government side of things today if they only contribute $200 that member can get no subsidy through the marketplace and so you can see how sometimes that's challenging for employers especially small employers because these are people in their communities that they're trying to take care of so I actually think we would be able to find a bigger space for them if we had some of these other um regulatory changes to the rcas um I know
▶ 1:19:55most employees want their coverage through their employer that is the number like the second thing that any employee comes when they're coming and and looking for a job it's their pay and then it's benefits so a lot of these employer benefits the premiums are the same in the small group Market as they are in the marketplace and the marketplace provides a subsidy where the employer is trying to compete with large employers their premiums are twice as much as a large employer is so it really makes a very
▶ 1:20:25uneven playing field for those small employers to continue to contribute um to their communities but then also compete in the market today so again I think icas are a really great place for us to expand and just continue to um offer options and choices for people thank you for your expert testimony I really appreciate it I you back is you you recognized uh Mr Dak there are three questions I wanted to ask you now for weeks I've heard concerns from hundreds of constituents across my district District in Southern
▶ 1:20:55California people are worried about their Health Data being accessed by unelected billionaires like Elon Musk they're fearful that Republicans will gut Medicaid and strip away their access to the care they need to survive just to fund tax breaks for the ultra wealthy and when the Trump Administration announced their plans to illegally freeze Federal funding late last month I received frantic calls from community health centers in my district who are unable to access the funds they needed to pay their staff as a
▶ 1:21:25result and now Republicans have agreed to let president Trump slash $4 billion from NIH funding under the guise of capping administrative costs Dr Garcia Oka and NIH funded researcher at City of Hope reached out to my office yesterday to share that this change threatens his vital work to cure diabetes diabetes affects 38 million Americans and by slashing NIH funding we're not just
▶ 1:21:56cutting research we're undermining any hope for future breakthroughs that could save lives so Mr Dak the topic of this hearing is about creating healthy options does slashing funding for Research into diabetes which affects 38 million Americans as well as other chronic diseases make us healthier why or why not certainly does not make us healthier it certainly puts people at greater risk NIH is developed some very Innovative
▶ 1:22:26tools as you said for diabetes they are the source of most of the research going forward in that space and now we're gutting it it's also important to remember that you know if you the best treatment for diabetes is not to get diabetes and so that means there a lot of people my wife's a nutritionist she sees patients who are pre-diabetic or their glucose levels are high why does she see them because they can they have a doctor they can go to okay thank you question two um I'm deeply
▶ 1:22:56concerned about Republicans plans to cut Medicaid our nation's largest source of health coverage and which covers half of all long-term care including nursing homes for the elderly and disabled and they want to cut it by $2 trillion dollar also that can extend tax breaks for the wealthiest Americans and one of their proposals to strip medicate coverage is by having them uh dismantle medicate for those who can't document a certain number of
▶ 1:23:26work hours or prove their eligibility more frequently which could lead to devastating losses in uh in those who get coverage and I think about uh places like my district where we've just had these horrifying wildfires um and are they saying then that uh those who are in this situation who can't document their work hours aren't deserving of Medicaid so Mr doc the topic of this hearing is about
▶ 1:23:56creating healthy options does slashing Medicaid make us healthier no makes us sicker and least makes more people vulnerable well then let me go on to my last question which is I'm deeply concerned about the Trump administration's removal over of over 8,000 health related web pages that contain vital treatment guidelines including those related to HIV prevention sexually transmitted infections and
▶ 1:24:27birth control these actions directly impact the ability of Physicians to provide quality care and put Public Health at risk one of the most alarming actions has been the removal of the office of research on Women's Health Website an essential resource in the only federal office dedicated to women's health and that's why I led dozens of my Democratic colleagues and sending a letter to NIH demanding that these websites be restored immediately uh Mr Dak the topic of this hearing
▶ 1:24:57is about creating healthy options does removing websites on vital treatment guidelines make us healthier absolutely not and doctors around America rely on that information to treat their patients to be up to date on the latest tools and techniques once again this just makes people sicker and more at risk of of disease and death and in fact how could they help us they could help first of all by just putting those back uh into business stop this craziness with
▶ 1:25:27NIH uh and then go ahead and increase their uh work on exploring and developing new tools and new drugs for women and also what we know happen you know before the Affordable Care Act was in place you could charge women more for health care just because they were women so that's the world some some want to go back to and that's just wrong thank you I yeld back Mr Fitzpatrick you're recognized thank you Mr chairman than thank you all for being here incredibly six in 10 Americans
▶ 1:25:58have at least one chronic disease many more uh than one um for example cardiovascular disease diabetes cancer obesity just to name a few moreover about two-thirds of us adults are overweight or obese last Congress representative Kelly and I along with many of our colleagues on this committee introduced a bipartisan personal health investment today act also known as the fit act which would enable individuals to use up to $1,000 per year to cover physical activity related expenses
▶ 1:26:28exercise is medicine this would promote public health and Spark economic growth at the same time according to a 2024 report done by the health and fitness Association legislation like the fit act or its analogous um companions could help prevent um up to a half a million chronic disease cases annually it would save over 122 billion in health care costs and create over well over 200,000 new jobs uh Mr chairman I'd like to submit this report uh to the
▶ 1:27:00record thank you uh Mr tingle in your experience can you speak to the benefits of these Healthy Living programs uh Wellness activities uh and the impact it can have not only for the prevention of chronic disease but also uh for long-term Health as well as saving money in our healthcare system thank for the question I'm happy to speak to that we we I mentioned in my introduction remarks that we've been offering this Vitality program for 10 years now so we have a great deal of data
▶ 1:27:31to support uh what you're saying in terms of engaging people providing incentives education incentives support and even rewards as I mentioned uh for undertaking greater levels of physical activity we're not trying to turn all of our customers into marathon runners it's not about that it's meet people where they are take a few extra steps a day uh be a bit more physically active likewise on the nutrition front um but engaging people the right way uh supportively
▶ 1:28:01over a long period of time with clever incentives and rewards can indeed change long-term Health outcomes which is good for everyone involved you know I'm I'm struck by how much discussion there is about treatment it's understandable we all want good treatment but we we simply our view is and Our intention is to spend a lot of time in investment in prevention and early detection to that point sir uh transitioning to preventive care prevention and early diagnosis are critical uh I think everyone here
▶ 1:28:32uh would agree uh in helping people live longer and healthier lives however America invests less than 3% of healthcare spending on preventative Service uh Dr Carlson uh like so many on this committee my family's been personally impacted by cancer um I personally am encouraged about Innovations and multi- cancer screening uh as well as the opportunity to detect uh so many cancers much much earlier can you tell us sir what it means to you as a physician
▶ 1:29:02uh to be able to treat at an earlier stage of cancer compared to late stage Cancers and the impact this has uh specifically on patient survival rates thank you for the question there's no no doubt that treating uh an early diagnosis is going to be less expensive and with better outcomes um no question lastly I want to uh address the role that employers uh can play in promoting health and wellness amongst their employees uh myself and my colleagues on this committee
▶ 1:29:32uh it's a bipartisan Bill uh introduced the bipartisan Health outof pocket expense or hope accounts act which would be a tool for employers to offer tax preferred savings to help individuals save and pay for prevention and wellness through a portable health savings or hope account uh even if they do not have um a HED ible plan uh Miss Strauss um as a small business owner could you discuss the benefits of flexible coverage options
▶ 1:30:03the role uh employers can play to help their employees take charge of their own health and their own Wellness uh yes thank you for the question um anytime that we look at getting in charart in in front of wellness and prevention uh we need tools to do that and right now with the healthc care costs the way that they are we have these tools like in HSA but there's constantly barriers in them in the fact that for instance in order to have an HSA plan you
▶ 1:30:33have to have a high deductible Health Plan well in my world today guess what every single plan is a high deductible health plan some have co-pays which eliminate hsas from being able to um for employees to be able to take uh HSA accounts out so for me I think we should just remove the barriers completely and allow everybody to have access to health savings accounts and it shouldn't really matter if you're on a traditional co-pay plan or you're on that you know High deductible Health Plan um so
▶ 1:31:03again options are the key the more we can actually put them in charge of their own health they're going to start making choices that are going to be better for them long term so um the preventive benefits uh opening those up for eligible expenses as well is another really big thing because we all know people are turning to more holistic options these days and they are wanting that there's more of an appetite today to try and be on that preventive side versus um you know trying to come from behind and finding Solutions we live in a sick
▶ 1:31:33care system today and we need to make changes to make sure that we are really looking at this from that holistic point of view and give giving people those tools so I'm a huge proponent of um those regulation changes with hsas and I think that that would be a really good step forward for allowing people to take control of their own Healthcare well said Mr Rous I thankk the panel for their time I Y back Mr chairman yeah Mr Evans you recognized thank you Mr chairman and ranky M dget
▶ 1:32:04over over the past several years I've been inspired by the advocacy of of committed healthc care professors in my district in my conversation with them I've been reminded of my first introduction to the healthc care system when I was only 133 years old working for the Philadelphia Rolling Hill hospital I know these this access to Affordable Health Care is essential for every American unfortunately this new must Administration
▶ 1:32:34we are already seeking a tax on our health care System planting the seeds of a Public Health crisis meanwhile Republicans on the hill continue to threaten the fal Care Act the critical Improvement to Medicare Medicare and Democrats through inflation reduction and make no mistak nothing about the Republicans are working towards efficiency it is pure destruction Americans see this health care providers
▶ 1:33:05are operating with the fear the care and patience desperately need will be away Mr D I'd like to ask you a question can you list some of the increase out of pocket Americans might experience if Republicans on the hill take down the affordable K act or inflation reduction act yes and there are many and they're expensive
▶ 1:33:35um let's start with drugs where the inflation reduction act capped outof pocket expenses for seniors at $2,000 a year and allowed them to smooth those out over the course of the year so they could afford so they can pay them when they could afford to pay them that would be gone if the IRA uh is repealed uh the ACA also guarantees certain preventative Services to be covered by employers and in the marketplace at no cost cancer screening
▶ 1:34:06opioid treat screening um those are now free for people vaccines free for people that those would be gone those protections and that's only the beginning of the list I have another question to you in my district we have several Hospital hospitals with high portions of patients that use Medicare or Medicare if these hospitals are no longer operating due to Republican Medicare Medicare Cuts
▶ 1:34:36these patients will lose access to Affordable Care can you please elaborate on how these low-income pair mixed hospitals rely on Medicare Medicare to keep these doors open because Medicare and Medicaid are the only way that people can afford to go to those hospitals and hospitals without patients are not a viable Enterprise they need a demand in order to support the Investments that they make and without um people being
▶ 1:35:06able to afford to go they simply have to shudder and that's been the story with rural hospitals around America I'd like to thank you Mr chairman M Miller you recognized thank you chairman Buchanan and ranking member uh and thank you you all for being here today 1.2 million people in West Virginia have at least one chronic disease and 527,000 people have two
▶ 1:35:36or more chronic diseases in a state of only 1.7 million people these numbers are staggering and concerning not only are they alarming from a public health perspective but they also worry me from a fiscal perspective patients with multiple chronic diseases cost the Health Care System more money to treat and cost West Virginia more than 10 billion dollar annually in medical costs the most
▶ 1:36:06common sense way to help combat the chronic disease epidemic is through education screening and prevention I specifically Focus much of my work on kidney disease and I recently became the co-chair of the Congressional kidney caucus with my fellow Ways and Means member Susan Del Ben chronic kidney disease is also known as the silent killer because it can progress for years without any symptoms if left unmanaged
▶ 1:36:36chronic kidney disease will progress into end stage renal disease and this disease can only be handled by surgery or continual dialysis dialysis is extremely expensive for the federal government and very taxing for patients ersd affects only 1% of Medicare beneficiaries but it accounts for 7% of Medicare
▶ 1:37:07spending managing dialysis can be particularly difficult for patients in rural areas just finding transportation to the nearest dialysis facility and then spending several hours on the machines the travel the treatment it's very burdensome for people who don't feel very good anyway and they're living in rural communities while increasing access to services such as home dialysis can help patients manage their disease life can be made much easier
▶ 1:37:37if a physician or a nephologist can identify a patient with chronic kidney disease early on Dr Carlson you know firsthand that early screening can reduce costs and improve outcomes for patients could you speak about how early screening can affect long-term Health outcomes for patients with a chronic disease yes ma'am thanks for the question so um again there's great evidence that says that early diagnosis early intervention is going to have improved
▶ 1:38:08outcomes at less cost chronic kidney disease is present in about 15% of adults and about a quarter of those then also have a family history uh and um our next gen sequencing these genomics assays are widely utilized for Pediatric Nephrology but are rarely used in adult Nephrology I think that for chronic kidney disease in particular that that there should be a migration a broader adaptation of some of the genomic assays that would be available for those
▶ 1:38:38patients to identify them and allow that earlier intervention thank you I've worked on legislation with congresswoman Terry Su called chronic kidney disease Improvement in research and treatment act and it expands the Medicare annual Wellness benefit to include kidney disease screening it also increases access to the Medicare kidney disease education benefit which will enable Physicians to teach their patients about managing their disease and any
▶ 1:39:08co-orbital morbidities they may have a recent study shows that compared to urban areas rural communities have higher rates of cancer higher rates of late stage cancer diagnosis higher cancer deaths and the urban rural Gap is not getting better it's steadily widling over the last decade rural areas also have lower reported rates of cancer screenings for col rectal breast and cervical cancer Dr Carlson given your
▶ 1:39:39experience can you tell us more about why rural communities are struggling with cancer so uh thank you for the question a large footprint of uh for Mercy is in that rural community and they have um there are a lot of barriers really that that uh one of them being Transportation just to get in um uh that um that make it a a challenge the rural community um can sometimes be a little bit uneducated um
▶ 1:40:09and and that uh so that we appreciate the work that you've done in in educating those patients but I think some of it's also trying to figure out how to incentivize those patients um that regardless of where they live or their financial situation that we push them to get in and some of the predictive algorithm work that we've done um we identify patients and and if you knew that your risk for colon cancer was 10 times higher than the average patient it might push you to get a um the ball prep and get a colonoscopy done and
▶ 1:40:39and so those types of things I think in addition to the other incentives that you've listed uh will help incentivize the patient to take greater uh control of their own Care thank you and I yield back Mr Davis you recognized thank you Mr chairman and I want to thank all of our Witnesses I've been in the healthc care space for a long time and I'm absolutely convinced that
▶ 1:41:10research is essential if we are to find solutions to our health care problems that's the only way that we can find in a real way the causes of disease causes of illnesses and what's the most effective and best approaches to finding treatment are a cure therefore I'm
▶ 1:41:40amazed that the Trump Administration would downplay research and propos cuts as a part of their health policy it seems to me that this approach is designed to make Americans more sick than more well and decrease rather than increase the quality of their
▶ 1:42:11lives as a black legislator whose prec Congress profession was in health care I cannot sit by and ignore the effort of the Trump musk Administration and my Republican colleagues to reduce Health Care it is dangerous and shameful to undermine and defund research
▶ 1:42:41on the health differences of women and people of different races ethnicities and abilities I asked the question how can we make federal health policy and not talk about the differences among us that affect our health and the effectiveness of treatment if this is our approach this is not modernized in health care it is retrofitting
▶ 1:43:12it to a time that I seriously hoped we'd put behind us how do we promote Health when we research just the one Trump Administration proposal to slash the indirect cost of research seeks to about billion dollar in scientific health research
▶ 1:43:42the University of Illinois system stands to lose $67 million from this one decision the gut in of health research does nothing to make America healthier further the Republican idea with cut in Medicaid to pay for tax cuts for millionaires is appalling among children
▶ 1:44:12in foster care 97% of them have Medicaid so when you slash Medicaid you hurt Foster Youth and make Americans healthy and to think of cutting federally qualified health centers or reducing the drug discounts that they receive for their
▶ 1:44:43low and moderate income patience is off the chart and forcing the premium tax cuts to expire would increase insurance cost in my district by about 150 to 200% and in Illinois outside of Chicago like in my district by over 300% Mr D can you talk
▶ 1:45:13about how sabotage in the ACA harms Healthcare I don't think I could say it any better than you just did Congressman you can can not be healthy in America if you can never see a doctor you cannot be healthy in America if you when you know you're not feeling well you still stay home and do nothing about it that's not prevention the ACA for example cut the insur uninsurance rate among black and Latino Americans in half when people have health insurance they
▶ 1:45:43can get services and I would like even associate myself with the remarks of Miss Miller but Congressman Miller the in but the fact is that if you can't afford to go to a doctor you're not going to benefit from these preventive services so if you kick people off their insurance for no reason except to put more money in the pockets of the uh rich and the drug companies you're just going to deny care preventative care and and chronic care to people so none of this makes sense just to
▶ 1:46:13you know to be clear Dr Murphy you're recognized thank you Mr chairman thanks for holding this um very very important uh committee hearing a lot of things that are being said are just simply not true um let's look back and when a lot of the American disease started in this country um a lot of it you know guess what education starts education starts in the home guess where good eating starts good eating starts in the home guess what destroyed the family 1965 we
▶ 1:46:43had the Great Society programs which now are blowing up in our face blowing up in our face you know covid was a horrible thing that happened to this world and by the way it did from the lab we knew that along but Co showed us some things in the American Health Care system that were really stressors to it we looked at our supply chain that was not great but it also showed us sometimes the hubris of Physicians we now have a great deal of vaccine hesitancy because of of one particular physician because he showed huis and arrogance
▶ 1:47:14we're now having people not being vaccinated who should be vaccinated because they weren't being told the truth about things so I spare me what we're going to have to deal with it's okay for us to question medicine this is what's happened always you put 10 doctors in a room you're going to get four different opinions so we talk about NIH funding NIH has run a Muk they do wonderful work but there has been no accountability look at Yale look at Harvard look at scripts all fine because
▶ 1:47:44they didn't do what they were supposed to be doing so spare me a little bit guys good research if you're a good researcher by God you're going to continue the research research but if you're doing nonsense which is happening sometimes it's it's time to kiss that goodbye so we will continue to do wonderful things with our health care System but by the way I just would remind all my colleagues we are dying in debt and it is okay for the parents to come in the room and look at the checkbook and see where we're spending money correctly period
▶ 1:48:15so I I'll get back and I again I I want to talk about chronic disease because it is so critically important I walk through my hospital because guess what I still see patients and I still Round And the fact of morbid obesity that is rampant that leads to so much disease and Stage renal disease cardiac disease foot disease you name it where are we going to attack this where is it going to come from it starts in the home it starts in the home and how we deal with these things sugary drinks
▶ 1:48:45bad foods when we add 400 calories to the to the snap program that are just pure calories it does no good what whatsoever we need kids out off their phones we need them out exercising we need them eating good food um Dr Carlson we live in a world that uh you know I've seen an explosion in technology in the last decade 30 years in my medical career next decade has been ex exceedingly wonderful for cures but we have a problem it's called a money problem
▶ 1:49:16and we can't pay for everything I look at my younger Partners now and there's not a new test they don't like but guess what we don't have enough enough money so please help me explain how we balance this when we look at genetic test when we look at all these things that if we had an unlimited checkbook we could do but we don't so how do we balance having wonderful technology and being able to pay for it thank you Dr Murphy um so I wish I had the crystal ball for that one um the uh I think one of the
▶ 1:49:46big approaches that we've taken is to get better value out of the testing that we're doing um to try to focus on the high-risk patients um and and that uh for our health system uh we've got 15 years of electronic medical records and it's all cloud-based today so that that we have a tremendous capability to do amazing analytics with that then besides that Health Care is really not Health
▶ 1:50:16um healthc care as you know is is fixed best to treat acute illnesses not um not manage long-term type of problems and and so another approach that we're taking is to leverage with Partners um that while we have the expertise in health care there are great companies out there that have great expertise in Ai and how to leverage the data that we have to try to get better value for our patients right and I
▶ 1:50:46I agree with that completely the ACA gave coverage but it didn't give healthc care our costs of Health Care have skyrocketed and I look at the number of patients I see that are on government assistance and sadly enough you know we have to double book and triple book those you can't get people to show up until it's too late yeah they can see a doctor because they appointments to be made but if they don't show up guess what they don't get their health care and you know
▶ 1:51:17looking at things like Medicaid for fraud waste and abuse when I see a 35-year-old guy that's on Medicaid the rest of his life because he has a little back pain I'm sorry I see the waste Fraud and Abuse every day and it is okay to come in and reset and look at things that's what adults do and that's what we're doing thank you Mr chairman I'll you'll back Miss Tenny you recognized thank you Mr chairman and thank you to the witnesses for this uh very important discussion about healthc care and
▶ 1:51:47I come from uh one of those states where uh we have among the most expensive most difficult health Care Systems and I also uh come from a family business background my my business is uh you know we were one of the very first in our region to provide Health Care to our employees because we were competing to get the best employees against a lot of government uh and quasa government entities uh we know how expensive it's become uh over the years especially since the ACA was passed our healthc care uh costs for to provide
▶ 1:52:17for our employees have skyrocketed uh the numbers are just out outrageous and most businesses especially especially small businesses really struggle to find a way to get Healthcare and we view our employees as members of our family we want them to have access to healthcare we want them to have a 401k we want them to have a good job we want them to spend time with their families we want a quality of life uh where we're providing them and we used to have a wonderful health care plan you could have a cafeteria assortment of all kinds of wonderful things you could have a health care uh you could have counseling Optical everything
▶ 1:52:47and now it's so expensive uh that we can barely provide them with the basics they need and our our our premiums are extremely high our deductibles are outrageously high and we're seeing this real problem across this uh the small group Market especially with the small business owners that are most of my business most of the people in my district and Upstate New York go to work in a small business they don't work for a large company and so the average is about 129% over the last 20 years that's an average I would venture that it's closer to three or 400% probably
▶ 1:53:18in the small business industry and especially in places like Upstate New York where we don't have a lot of large city opportunities but one of the things that we need as as a as a group small businesses particularly is we need flexibility and we need the ability to be able to provide uh some kind of affordability to our our uh to our our employees and one of the things that we've been able to do that is through health savings accounts uh which have become more and more difficult uh but it gets us around that one siiz fits-all uh possibility and
▶ 1:53:48then we also have individual cment High reimbursement or health reimbursement um Arrangements which also help us with our custo with our consumers and with our employees so we want to find ways to make sure that we can have those things uh provided so that we can be competitive and uh this this Congress I think that we should codify and expand these IAS so-called EAS simplifying regulations and providing tax incentives to encourage the adoption of these things for small businesses even those that aren't under the ACA mandate
▶ 1:54:19uh I did introduce the small business flexibility act last Cong we're going to reintroduce it uh requires the IRS to notify small businesses about the availability of these so-called rras uh qualified small employer Health reimbursement Arrangements uh as well and then the small business healthcare tax credit is available to employers with 25 or fewer employees these are people that don't have to comply with ACA but care so much about their employees they want to give them an opportunity and uh you know I think health savings accounts are great I'd love to see us get
▶ 1:54:49away from the mandates let's expand eligibility let's increase contribution limits allow more for our small employers who really care about their employees to make sure that they get access to to Affordable and also Quality Health Care that's the big problem I know Dr Murphy just mentioned everybody gets an insurance card now but nobody gets Quality Health Care you know or few do and we want to make sure we have those options I do want to talk to uh Miss Strauss because you are an nfib representative thank you so much for what you do we love nfib our company's been a member for over 40
▶ 1:55:19years you really help our small businesses and I wondered you discussed actually the individual coverage Health reimbursement plans hsas health savings accounts where are you and how how can we do more of this what what can we do as a congress we've introduced some bills could you just give us a little bit of your background on what you could we could do to help our small business Community get access to healthcare for their employers employees yes thank you for the question so I think that the great thing that's come from probably the challenges that small
▶ 1:55:49employers have gone through um since the ACA was enacted is the fact that they are resilient and Innovative and so we are always as an independent agent we sit down with our employers and work to look outside of the box on solutions that we can bring to the table that not only provide the preventive um Health side of things but then also help them to navigate their benefits to make sure they feel like benefits for them so one of the things that I haven't had a chance to discuss today are direct Primary Care
▶ 1:56:19Providers um right now you basically pay a membership fee to have access to a direct primary care provider however you cannot run those uh fees through your HSA account so if that was something that was an eligible expense I think that would be one of those preventive Wellness benefits that employers could um really wrap their arms around and give a much higher level of care to their employees drug Primary Care Providers are your medical home so
▶ 1:56:49that is the one provider or provider team that employees actually work with they can do tella Health if they want to they can text with their providers um these providers will come in and do work site uh programs for them do immunization uh workshops and so um giving them the ability to work with somebody then it actually helps them have more confidence in their health care Journey so if somebody is dealing with a chronic disease or some sort of a condition that might be new um they can
▶ 1:57:19actually work with these teams to set set up these programs to make sure that they know where to go for the lowest cost Imaging in their area they will actually do prescription management with them so if they're prescribed a medication but there's a better alternative then they would be able to go through that and help them with that they actually look at the specific health insurance plan um but then they take it a step further so this would this this would just help give better access to people to really manage and engage in their
▶ 1:57:50Healthcare I think our my times R out but I appr appreciate it I love the direct Primary Care program thank you for what you do appreciate it thank you Mr Horford you recognizing thank you very much uh chairman bu Canon and to the ranking member I look forward to working with you uh and all the members of this committee on improving the health care outcomes for all of our constituents um and I think this is a very important hearing uh and it comes at a critical time especially as we're hearing a lot about making
▶ 1:58:20America healthy again regardless of political affiliation I think that we all can agree that the US Health Care System should prioritize the health of its enroles above all else and I believe that the only way to achieve that goal is to make sure that as many people as possible have access to Affordable Health Care not less that's why I'm proud to have worked with my colleagues Democratic colleagues last Congress to pass
▶ 1:58:50both the American Rescue plan plan and the inflation reduction act which included both uh the critical enhancement to the advanced premium tax credit not a not a subsidy a tax credit in my district over 27,000 constituents rely on the financial support provided through the advanced premium tax credit aptc for short this has allowed them
▶ 1:59:20to afford their health insurance this credit gives ACA Marketplace commonly known as Nevada Health Link back in Nevada enroles access to lower health care premiums and makes health insurance more affordable for Working Families before the passage of the American Rescue plan and the inflation reduction act the average Marketplace premium in my district was $514 per month
▶ 1:59:50after the expansion it it was just $145 that's a savings of nearly $425 per month that's real money that nevadans have been able to put towards groceries and rent gas or other Essentials while also not having to worry about their health care Mr doc do you think that allowing the expanded APC to expire would promote healthy living
▶ 2:00:20and options I didn't hear you I was trying to say it so loud absolutely not so instead of working with house Democrats to extend this critical Lifeline my colleagues on the other side are prepared to let it expire choosing instead to pay for tax cuts for billionaires and big corporations and taking away a tax credit that hurt that helps the majority of my constituents and
▶ 2:00:50others letting the APC expire literally will cause Millions to do to lose their health insurance and nearly 20 million working people will see their health care cost rise these aren't people who my colleague referred to as not um eligible I I think this is what we have to get these are working people who should be able to afford access to Affordable healthare
▶ 2:01:21in my district District alone a 40-year-old making $31,000 would see premiums 165% and a 60-year-old couple making $82,000 would see10 uh% jump Mr Mr doc can you outline the real world impact on Working Families allowing the APC to expire Congressman it's exactly what you said
▶ 2:01:51people said simply would lose their coverage they will not be able to the only doctor they'd be able to see is in the emergency room when it's far too late uh to uh to get them really healthy or to give them a healthy lifestyle that's it's very clear and I think if I may say that this conversation that some we've been having that says we have to make health care more affordable that's true but taking Health Care away from people and making their premiums unaffordable is not should not be part of that strategy so I just
▶ 2:02:21want to close by also raising this issue that the current Administration the Trump Vance Administration just issued its Federal funding freeze memorandum on January 27th which included um an impact to community health centers in North Las Vegas I uh went and visited uh Hope Christian Center a federally qualified Health Center to understand directly the uh impacts of that funding freeze uh Mr
▶ 2:02:51doc while this issue may fall slightly outside the jurisdiction of the committee how does jeopardizing the sustainability of vital health programs align with the goal of making Americans healthy again does exactly the opposite it's going to keep Americans sick Mr chair I look forward to us coming together I know you and I have talked we have more in common than we don't let's work together to address the healthcare needs of all of our constitu you got my commitment I yield back
▶ 2:03:22Mr Moore you recognized thank you chairman panon for hosting this hearing today um healthcare costs continue to climb for Americans of all Stripes we've talked about that in various various facets today uh I know that both um majority and the minority agree on this and sometimes a different approach to how to go about doing it I'm here to offer and talk about what I think is a proven success story within the healthare market uh and hope to hope to be able to dive into that right now so we're healthcare costs actually
▶ 2:03:52are outpacing inflation and GDP growth right now one in three Americans cannot cover a $400 emergency expense with cash last week I introduced I reintroduced because we we did it last Congress too we got some got some Headway we've had some really great co-sponsorships on this the health out-of-pocket Expense Act or hope act this would create a tax advantage accounts it would create tax advantage accounts to enable Americans of millions of Americans to save for healthc care costs through both individual and employer cont contributions
▶ 2:04:22this would help Working Families to manage out-of-pocket costs and save for future Medical Care Mrs Strauss um thinking of the long-term implications if patients continue to forgo cost to to forgo that care due to due to basic costs uh how what are those what how would you categorize those those um long-term implications and and how can Healthcare dedicated savings Vehicles like hsas and hope accounts address this and again I I I I bucket
▶ 2:04:53those two together HSA accounts have have proven to get broad support and have have have penetrated many different states my state being one of them hope accounts allow for individuals that are on regular premiums that aren't high cost higher inome people lower income Americans to be able to take advantage of this would you share a little bit how you feel how that would help yeah I think that again more options in just expanding the regulations around those HSA accounts are always going to have a positive
▶ 2:05:23impact um we talk a lot about education uh when I sit down with my employer groups I want to make sure employees know how to use all of the benefits that they have and the tools that they have and so with the um cooperation of employers a lot of times employers want to contribute into the health savings accounts which then actually incentivizes the employees to go ahead and participate as well so um those HSA accounts are huge benefits um right now they are regulated
▶ 2:05:53to a point that not everybody has access to them so the expansion in um The Hope Act is exactly something that I think would be helpful for people um I think that it still takes education it takes that opportunity for an employer and those independent agents like myself to make sure that people really understand um what these benefits can do for them and how they can manage their healthare and get ahead of these things versus waiting until there's already a problem um the way the healthcare costs are today if we're
▶ 2:06:23not saving for that rainy day we will not have the money to pay a $99,000 out of pocket maximum if we get hit with something catastrophic out of the blue hsas have been applied to more High deductible plans anytime in the policymaking world that you have a big idea the fact that you've got years and years and years to look to typical hsas and say these have been successful let's apply it to new population of people this will be applied
▶ 2:06:53to lower income individuals people with regular premium plans and this opens up something that we've already seen success apply it to a new population where I confident we'll see we'll continue to see that success that that's like a perfect storm for uh a policy aspect and so I look forward to keep driving this forward thank you and I do think sorry I think that in those specific situations that's a huge help because a lot of times that population can barely afford their employ their portion of the insurance premiums so they don't
▶ 2:07:24feel like they have the additional funds to put into an HSA U so that does open that up and give them that opportunity thank you so much um Dr Carlson let me just throw out one quick stat Diagnostic lab testing accounts for just three% of spending yet informs almost 70% of medical decisions we were um we held a hearing in in in the in Research Park of the University of Utah at a laboratory a working lab it was going on right behind us uh can you share how important clinical labs are to Patient Care and can you expound
▶ 2:07:54upon the AI model that Mercy has used and how it's increased your ability to uh find diseases thank you for the question so diagnostic labs are a little bit different than screening Labs but yet they're extremely important you know that the screening Labs trying to cast a broad net um the diagnostic labs and procedures because there's also Imaging you know breast MRI for instance that can help nail down uh a lot better with better accuracy um what is going on those those are critical uh
▶ 2:08:24to the overall workflow and process um again what um what we've tried to do is to leverage uh some screening tools and I'll use breast cancer as an example um that by taking a survey um one can really sort out whether they're at increased risk that they would benefit from more than just a mamogram but perhaps a breast MRI also done on an annual basis and and that they have a lot greater sensitivity uh for for picking up early breast cancers with that so
▶ 2:08:54the the combination of both the the um screening test and the diagnostic tests are are extremely important thank you Dr Carlson i y back Mr kof you're recognized thank you Mr chairman and thank you to the witnesses for appearing today uh and I want to thank all of you for your expertise in um my opinion in November the American people gave Congress a mandate one of the mandates and it's not just
▶ 2:09:24a slogan is to make America healthy again I think that's the purpose of this of this hearing if I could Dr Carlson first with with you and you've you've certainly talked about it in your opening statement about the multi-cancer early detection test you talked about it Mr tingle talked about it in in uh his opening statement also um specifically as a relate to the test offered by
▶ 2:09:55Grail uh which is fairly new on the market can you talk about your experience at Mercy using this test um how often is it by is it by choice is it something referred by The Physician and the experience that you've had once those results come back thank you for the question so um in the last two and a half years years we've had about 3,000 physician referrals for
▶ 2:10:25evaluation and screening for that test and and over 9,000 patients that came in through our website with interest in that test we wanted to do that test uh because we had patients in our footprint that um we're getting that test through coner providers or providers not affiliated with mercy and with very little understanding or education around the the utility of the test the sensitivity the the possibility of false uh positives Etc and so we put
▶ 2:10:55together really a a a a standardized workflow to streamline that counseling uh to patients and to providers so that again we tried to add value um uh for that test the other thing that we did was review our entire database of patients um and and sort out who was the highest risk and had a targeted marketing campaign towards those patients at highest risk risk we've had 27 positive signals with 22 Cancers
▶ 2:11:26and only seven of those cancers had traditional screening test capabilities so there are a lot of benefits there's a lot of promise I would think one potential negative is is the false positive and the concern that that would give to the patient is that something that that you've seen at Mercy so we have seen the false positives I can think of about four false positives but we give great emphasis in in
▶ 2:11:56uh that counseling prior to the test around that um and um one of the things that Grail has done a great job of is offering free testing in surveillance meaning that if you have a false positive we don't just stop there we go through that diagnostic evaluation but then we go beyond that and and we'll retest them or rescreen them with another multi-cancer early detection type test the same one at three or six months and and and then potentially again and that the company recognizes
▶ 2:12:26the patients's anxiety around that false positive test and has supported those at no cost of the patient thank you Dr Carlon Mr tingle if I could with you because you you also talked about these early cancer detection test and your testimony you you talked about the uh Grail test I think you also mentioned if I'm pronouncing it right Peno that does the full body MRI scans are those tests test that John Hancock offers to uh policy holders
▶ 2:12:57uh at your cost or reduce cost or how do you handle that based on the policy holder so uh thank you for the question and we're very excited about a lot of this technology and Innovation uh again early detection is key um there it varies by test the gallery test for example we offer to all of our Vitality customers at a discount that discount range is between 50 and 100% for our customers prenuvo is a $500 discount uh so essentially we educate
▶ 2:13:27our customers that these Innovations are out there we don't compel people to take them but we educate them about them and make them U available at a lower cost just out of car what do you do with the data that you receive from the from those tests it's a great question we we actually don't get the data back we we did not want to even though we wouldn't do anything with it we didn't want to have any chilling effect on a customer who might think gez if I take the test
▶ 2:13:57my insurance company's going to find out and they're going to raise my premiums or drop my policy and and of course we wouldn't do those things but we didn't even want to have the fear of that so we intentionally do not get the data if one of our customers wants to access uh gr's Gallery test that's strictly between them and Grail we give them a discount code that they use some customers have chosen to come forward to us and said Say Hey I want you to know that you saved my life and I I can tell you the most meaningful moments of my career which is getting pretty long
▶ 2:14:28now uh have been to stand face to face with with real people who have said I'm only here today because I happen to buy a life insurance policy with you and because you happen to offer me this Gallery test and quite frequently now we have those customers come forward but unless they come forward to share their story with us we don't we don't get that data thank you I yield back Miss Sanchez you recognized thank you chairman banan for holding this incredibly timely hearing and I agree that we should be having serious discussions
▶ 2:14:58about how Republicans are making America healthy again or actually not on February 7th the Trump Administration announced 4 billion dollars in cuts to critical biomed research funding for academic institutions this funding pays for chronic disease research related to heart disease and diabetes and all states could lose millions of dollars from these Cuts just my home state of California alone could lose more than $800 million Missouri
▶ 2:15:28could lose up to 131 million and Texas could lose over $300 million life-saving biomedical research and jobs are not partisan issues they affect all of our districts on January 27th president Trump temporarily paused federal grants which pay to keep Community Health Center doors open nationally 30 35% of Community Health Center patients are likely to have a chronic condition in my 88%
▶ 2:15:59of Community Health Center patients are covered by public insurance or are uninsured now I'd like to read some of the Republican proposals on Medicaid the primary health insurance for 72 million people number one establishing per capita caps on State Medicaid funds which would amount to a 900 billion cut number two adding Medicaid work requirements which adds regul which pardon me which adds regul
▶ 2:16:29regulatory burden and that's a hundred billion do cut number three limiting State's ability to collect healthcare related taxes Texas Alabama Missouri California all collect three or more provider taxes this would be equivalent to $175 billion cut Mr doc according to the CDC High rates of morbidity and mortality are related to limited access to Affordable Health Care often in states that have failed to expand Medicaid
▶ 2:17:00not withstanding the insurances that Trump is not going to cut Medicaid could you please describe the potential consequences for people with chronic conditions if Republicans move forward with any of the Medicaid cuts that I described but also to point out the the ultimate consequence of all of these Cuts they're all designed to kick people off of Medicare the only way you get the cuts is if you take away their insurance so these
▶ 2:17:30are all have this they all funnel into the same result which is they're G they're designed to kick people off of Medicare Medicaid and take away their coverage you take away their coverage bad things happen and and and what are the bad things that happen to those people that lose their Medicaid coverage well they die they die so death is ultimate yes outcome um what would also happen to these folks if we also failed to renew the ACA enhanced premium tax credits and I just want to say
▶ 2:18:01thank you for mentioning that women used to pay more for the same health care plan as men because I was the one that added the provision to the ACA that took that away but um what would happen if we failed to renew the ACA enhance premium tax credits it's the same story just with different sets of people uh people who were working hard people who can afford part of their premiums but they can't afford the whole drill they'll lose their health care coverage as well with the same results and we shouldn't forget Robert F Kennedy
▶ 2:18:31even though that most of that drama is occurring uh on the other side of this building but you know he wants to u pause uh Research into infectious diseases and so he's another culprit who's about to be in charge which would down the line ultimately cause yes um how would Medicaid Cuts impact families who need long-term care in a very very difficult way for them uh both for those families who are
▶ 2:19:01trying to keep people their loved ones at home so they can live with dignity and rely on that home healthare and those who have to go to nursing homes to be able to afford that so you've got a huge percentage of America's seniors and families depended on Medicaid for that thank you and I would note that most family caregivers are women and they often have toat either leave the work Workforce or cut back hours or not take promotions in order to care for family members that need long-term care you know I'm very interested in working with Republicans to improve
▶ 2:19:31our Health Care system and to support family caregivers and that's why I have worked on a bipartisan basis to Champion family caregiving tax credit to support families who need long-term care I similarly ask my Republican colleagues to preserve Medicaid for their constituents and to urge the administration to preserve and funding for the millions of patients families and researchers in their states improving Americans Access to Health Care will make Americans healthier thank you now y back
▶ 2:20:02Mr Bean you recognized thank you very much Mr chairman a very good afternoon to you and good afternoon Ways and Means Health subcommittee uh thank you Mr chairman and ranking member doet for letting me wave on and be a part of the excitement of uh making America healthy again uh let's go back 50 years 50 years ago uh in the middle of the 1970s the uh Vietnam War was coming to an end disco had taken America by storm and at the same time the United States was spending just
▶ 2:20:32chump chain $74 billion is what we were spending on Health Care uh it was estimated only 12% of Americans had a chronic disease uh you can see pictures of people at the beach in the 70s it seems like everybody was was skinny uh fast forward 50 years AG uh 50 years ago today we're sick America is sick we're overweight in spite of spending 60 times we now spend
▶ 2:21:02$4.5 trillion dollar on healthc care and we've never been sicker 42% of Americans now have two or more chronic diseases 12% have five or more good gravy uh so we can't just say uh our same old Playbook of just throwing money at the problem with thinking what kind of outcomes we're going to get the American public cannot afford to continue spending the trillions of dollars on Healthcare while still being one of the sickest industrialized countries
▶ 2:21:33on the planet we invest as uni as a country 3% of Health Care expenditures on prevention however every health expert will agree that if we prioritize preventive care we can reduce the cost of prevented diseases while driving cost Congress should be uh focused on ensuring that we get better outcomes so that the taxpayers uh dollars that we spend will uh we'll go a little bit long way I was a banker for many years and
▶ 2:22:03I knew that uh if people had skin in the game the outcome was much better and I think healthc care is the same way if we allow them more flexibility and more freedom uh Mr TR you have mentioned a health savings account could be such the key to to Turning America's loose on solving their own health care problems so in your testimony you discuss hsas as a powerful tool for empowering empowering patients to take charge of the healthc Care uh what do we
▶ 2:22:33need to do miss Strauss what do we need to do to encourage more Americans to seek out these tax advantage Arrangements which is a win-win for them and for us as taxpayers what say you m Strauss thank you for the question um so I am so excited that I keep getting the opportunity to talk about hsas um we in the industry and the insurance industry have recognized the benefits of these um accounts for a long time but again there are so many restrictions around them that
▶ 2:23:03it does make it challenging for people to be able to participate so I I personally think that you should be able to have an HSA for any health care plan that you have if you are taking that step to make sure that you're saving money for your own health care that's going to be a positive outcome for anybody that wants to participate um the education I think is really huge in making sure that employees actually understand the investment options um you know these accounts actually roll over from year to year and so unlike the FSA
▶ 2:23:33or the flexible spending accounts you can continue to um increase that fund year after year so that also allows for opportunities to invest your money when you get to a certain amount and then that's like a retirement investment I'm sold I am so but what about primary care I know you've talked about primary care and you've got a partner if somebody uh partners with primary care they get better results is that true M stuss yes it's absolutely true and I think a lot of this could be achieved even through our normal provider system but
▶ 2:24:04unfortunately some of the hospital systems that are set up don't allow direct Primary Care to really be happening um so unfortunately we've had to look for Solutions outside of that um we have an actual direct primary care provider in um our area but then we also have one that works out of Kansas City on a virtual basis and so it still gives that direct Primary Care uh so there's a lot of flexibility and Innovation I hate to rush but it looks like uh partnering with a a medical quarterback so to
▶ 2:24:34speak that we can get more yardage and uh put our health in the end zone Mr tingle real quick you are giving away Prevention Services what's your can't be money what's your biggest obstacle to getting members and others to join you in uh in detecting uh CH health challenges early uh one barrier is honestly the uh a lot of our customers when they go to their primary care physician and say hey my life insurance company offered me this Gallery test the dock and I love primary care physicians but a lot of them say oh don't bother
▶ 2:25:04it's still early and false positive false negative so we run into some resistance there and then frankly our industry just needs to continue to serve more people and thank you thank you uh Mr chairman thanks again I yield back thank you Mr berer you recognize Mr chairman thank you very much and thank all of you for being here I um the whole notion of making America healthy again I think we all agree with and I think we're all Disturbed with how much money we spend and how poorly we do
▶ 2:25:34relative to so many other nations um I I agree with my friends that so much it has to do with primary care and the shortage of primary care of physicians in America the notion that so many young doctors I know come out with so much medical school debt that they have to go to the higher paying Prof professions go be an orthopedic surgeon or a brain surgeon um rather than the primary care and the pediatricians we we so desperately need um I've long been interested in creating healthy options and better incentives to tackle chronic disease in America
▶ 2:26:04and despite the good things we've heard today from U Dems and Republicans I'm really concerned that the Trump musk V Administration is the staunchest Ally that chronic disease has ever had You' got Robert F Kennedy Jr to be Health who actively for years and years has undermined existing cures and treatments whose entire Athos has been to eliminate vaccines and discredit established Medical Practice all because of these Quack and and widely debunk theories
▶ 2:26:35so Mr doc does attacking scientifically supported existing cures and treatments is that actually create healthy options and address chronic diseases I don't think so and on top of these attacks to existing treatments the current current Administration is already attacking future treatments and cures Mr chairman I I asked that a letter i' lead with 90 of my colleagues asking the administration to stop its attacks on NIH clinical trials and cancer research be entered into the record without objection so ordered thank you Mr chairman because
▶ 2:27:05now the Trump Vance musk Administration is championing chronic disease in the lab the administration legally froze funding for NIH it hampered key clinical trials and critical meetings disrupted purchasing orders it froze hiring and stopped the development of new treatments NIH is Mission critical every day that research is delayed because Communications funding or hiring is shutdown means one less critical trial or one fewer cure that could save someone's life and now the administration is particularly targeting NIH
▶ 2:27:35funding that universities receive this is a threat to economies across the country and to my own Virginia's preeminent research institutions like Virginia Tech Mr chairman again I ask that a letter I received from Virginia Tech be entered into the record about what these attacks mean for one of our nation's top Tech universities well objection thank you Mr chairman while a court order has stopped this unlawful action is limited states that were party to the complaint so our Virginia attorney general Mi is currently more
▶ 2:28:05focused on suing private businesses for ideological reasons than Virginia's well-being and as such was not a party to the suit so Virginia Virginia Tech is still impacted by this unlawful action and other researchers studying chronic disease feared no better in granting an NSS National Science Foundation Awards the Administration has explicitly targeted research containing the word systemic um shutting down any Research into the persistent Health social and economic factors which are the leading causes of chronic disease
▶ 2:28:36and while new research drives up the administration is ending public access to existing databases that help healthc Care Professionals track the prevalence of chronic diseases and care for people already living with these conditions so Mr doc again does attacking new science and researchers dedicated to finding new cures and treatments create healthy options and address chronic disease does not thank you and now the Trump muskans Administration has more plans to keep momentum going for chronic disease as Mr doc described the administration
▶ 2:29:06is already planning to make it harder for millions of Americans to afford their health care and prescription drugs we've heard numerous times that Republicans plan to roll back the inflation reduction act which means killing out of pocket caps and direct Medicare Pharmaceutical negotiations that are already bringing around drug costs that seniors with chronic conditions will benefit from and we know they don't plan to extend the Affordable Care acts Advanced premium tax credits which makes Affordable Health Care much more affordable for folks with chronic conditions
▶ 2:29:37we also know that they want to roll back the Affordable Care Act completely which means kicking people off their health insurance and allowing back the predatory Insurance practices that can be use to deny coverage of people with chronic conditions we all should remember what it was like in 2010 2009 so Mr doc does eliminating these Federal efforts that lower prices and increase access to care create healthy options and address chronic conditions I wish I could have a different answer but the answer is no they do not yeah well thank you for letting me make the
▶ 2:30:07case that we're not moving in the right direction for all these things and then finally to pay for tax cuts for the wealthy which we'll do here in this committee they're pushing to cut America's Family benefits under the snap program supplemental nutrition and by targeting Medicaid and eliminating I believe the the Medicaid expansion cutting snap to pay for tax rates for the rich is going to squeeze more fam's pocketbooks despite lots of evidence showing it helps families purchase healthier food spend more on health promting activities and lowers the impact of chronic disease you already
▶ 2:30:37know that when you undermine Medicaid it's going to disproportionately affect people with chronic conditions this is a recipe for disaster and I just ask that we resist this in every way we can thank you very much Mr chairman you back you recognized thank you Mr chairman I want to thank all of our Witnesses uh on this panel today uh you know I represent Alabama's 7eventh congressional district which includes the black belt of Alabama um a rural part of Alabama and access to quality affordable care is a
▶ 2:31:07problem and frankly uh one of the biggest problems uh that we have is access to Primary Care physics but also Transportation uh getting folks to a primary care doctor uh for prevention uh so I focused a lot of my time here in Congress on trying to solve that issue H and you know there's nothing better than early prevention I think all of us would agree that the cost of Li of end of life is really expensive
▶ 2:31:37um one particular cost of end of life is cancer and uh I think cancer is affected all of us and when one gets a cancer diagnosis you hope that the next words are and we caught it early uh and so often that is not the case uh my mother uh Nancy Gardner Su died of uh pancreatic cancer eight weeks from diagnosis to death it was very um well it was a tragedy for our family
▶ 2:32:08but in my effort to turn my pain into passion I have tried to figure out what is out there that can give early detection a shot and these multi-cancer early detections screens are critically important that Innovation so often uh has come from NIH and NSF uh based uh uh research and we as taxpayers pay for that and we should have access to that um so I wanted to support
▶ 2:32:39Innovation but at the same time I am uh we get some push back from folks who think that that Innovation uh is not worthy of actually uh being uh eligible for Medicare and so um Dr Carlson I know that you spoke so passionately about it um my co-sponsor Jody Arrington uh and I have introduced um HR 842 um a multi a Medicare multi-cancer early detection screening bill
▶ 2:33:09that Jody Arrington U my Republican colleague filed last year and named it after my mom which was very sweet uh and the point is that my mom was living a very vibrant life she was on the city council she was very involved uh in having been a former librarian very involved in having mobile units to give books to children who live in the black belt uh and this really interrupted her life she was 82 uh and I know
▶ 2:33:40um my brothers and I are worried that this now is a part of our family history and family tree and the cost right now for these multi or early screens are very expensive and it's only available to those who can afford it uh and I don't think that that's right and so I'm proud of this bill and in fact the bill uh got over 300 co-sponsors bipartisan support last Congress um 65 Co Senate co-sponsors uh and we are looking
▶ 2:34:10to file it again we simply ran out of time to get it across the finish line but I want to thank um the uh chairman of the house Ways and Means Committee uh Jason Smith for uh really helping me get this uh before this committee and it unanimously passed so my question uh to you Dr Carlson is why is it so expensive and would you actually um talk about the barriers to actually getting this uh uh as a as a Medicare covered
▶ 2:34:40expense and we know that um age is a factor and our bill would um start at 65 uh in order to reduce the cost I would love for it to start um even sooner uh but can you talk to us about why you um value this particular type of screen and what you see as the big um impediments thank you congresswoman and I've followed the progress with your bill and and it's been amazing and and well needed you made a
▶ 2:35:10couple of comments though um one uh has to do with just access in general um and we had a lot of flex exibility added to tell a health during the pandm um but the um the the way that it appears to be scheduled is that a lot of that flexibility is due to expire on March 31st of 25 and I don't understand that I I I don't think patients were harmed by that I think that they were helped by it well I think that
▶ 2:35:41uh B that tella Health has really gotten by partisan support and I really hope that this committee uh will uh use its in fluence to make sure that it it is extended and I actually think it will be extended very good so then on on the actual multi-cancer early detection test um as you're probably also aware there is a u a Medicare uh supported clinical trial underway right now um to really try to give some stronger evidence for that and we'll kind of
▶ 2:36:11compare those outcomes to be sure that we've got the right value there because that's really what we're talking about that outcome at whatever cost and and um uh and I think that the other thing that will help change the costs is that there's probably four other companies out there developing similar type of test perhaps not for 51 cancers but would cover the top 12 cancers or the top eight cancers that that isn't it true that if we um do reimburse from Medicare um that what would happen is more innovation
▶ 2:36:42in the space I think about how um with colon cancer we fast-tracked this this Congress FastTrack and made it uh reimbursable and all of a sudden uh we went from a screen in a doctor's office to now you can go to CVS and get colard right off the shelf so is it true that we would spur Innovation by I agree with that that it would definitely you know it's following the money and and if the money is there um that that Innovation will follow well I want to thank you Mr chairman for uh indulging
▶ 2:37:12me uh I look forward for our committee continuing to lead the way on this and would urge uh a hearing at the uh energy Commerce level uh committee as well since they have we have dual uh jurisdiction for the uh multi-cancer early detection Bill thanks so much you back forun yeah uh let me just say I want to thank all of you um it's someone that's been in business 30 years before I got here we first got a small company we started out my wife and I
▶ 2:37:42we paid and then we maybe went to 100 employees 500 employees but a lot of employees thousands of employees but we paid for everything and everybody this was back man I don't want to date myself too much but this was back a while we have Blue Cross Blue today uh is you you pay about half and I chaired the chamber in our area Sarasota state uh the chamber and uh for Florida we had 130,000 businesses in that most businesses
▶ 2:38:13in our state Most states are 25 employees or less 15 employees or less that's who we're talking about and wayson I brought that up we would pay for everybody today we pay for half and that's true of a lot of businesses today and that's one of the biggest challenges and then the other thing I just think in terms of the preventive cost when I looked at this as kind of chairing this committee I wanted to yeah we need to do what we can to support people but
▶ 2:38:43we also got to get people to invest in themselves be the CEO of your own health we don't have enough money in my opinion to pay everything $4.4 trillion do is what we're spending for health care and that's why I like to see more companies more individuals try to be more selective a lot of the food that we eat frankly I say it is garbage and we've got to do a better job of doing that I've got 10 grandkids 10 and under and they'll say papa
▶ 2:39:14you can't drink that Diet Coke I got to hide it and go get you know some orange juice but my point I'm not picking on any one thing but today families are a lot more the ones they afford to be or you know are are more sophisticated they're looking at labels they're looking at content and they're trying to be smarter about what they're giving their kids and when you got 20% obesity with your children we never had that when we were all growing up or the ones in here a little bit older so there's L it's not just about
▶ 2:39:44looking at one one or two things there's a lot of factors and I'm jumping around in terms of a small business but we've got to find a way to come together and work towards getting people healthier and people my sense have to be a little bit more responsible and taking responsibility for their own health because there's not enough money to go around one thing I try to do and for last 20 30 years every January I get a full physical I think that goes a long ways in terms of trying to in terms of the preventive things so if you've got something
▶ 2:40:14you can catch it early you got a trend line but there's things that we can do and should do do if everything's reactionary in other words you know you you got to get the heart disease you got to get the cancer then you find out but how about finding out beforehand so I just want to throw a couple of things out there myself you can tell I'm a little bit passionate about it but uh i' like to submit for a record a letter uh from The Academy of nutrician and dietitian supporting the chronic disease flexible coverage
▶ 2:40:45uh coverage act and then I'd like to thank our Witnesses for appearing before us today please uh be advised that members have two weeks to submit written questions to be answered later in writing those questions and your answers will be made part of the the Congressional Record without uh with that the subcommittee stands adjourn thank you