▶ 0:16:08I said I just can't find The subcommittee will come to order. I thought it was interesting yesterday to hear the secretary mentioned that in the next four years he hopes everybody has devices and different things. So it's exciting to hear about that and I think it's the it's the future in my opinion. Everybody has maybe a different opinion but I think you'll wait and see. There's a big turning point. Uh good morning. I want to thank you for to our witnesses for being here today to discuss the important issues that I'm excited about.
▶ 0:16:38the power of digital health data. The the the US is spending more than on health care than ever before. Five trillion annually, but Americans across the country are still getting sicker and sicker.
▶ 0:16:53The US has a larger share of people with chronic diseases compared to other countries and more than twice as many Americans with obesity and uh concerningly chronic uh diseases chronic diseases make up eight out of 10 top causes of death for the US. Approximately 20% of US children are obese. 30% of young adults are disqualified from the service uh due to obesity and 40% of adults are obese.
▶ 0:17:24My first point was 20% of children are obese. While these statistics are alarming, we live in a time where America Americans have access to better technology and more health information than ever before to truly be the CEO. I like this phrase of your own health, taking more responsibility. This new technology can help patients in many ways from encouraging healthier life lifestyles and preventing chronic diseases to better managing uh treatments at home.
▶ 0:17:51For example, wear wearable devices provide useful health data like sleep and stress information to inform medical care and lifestyle changes for diabetics alone. Wearable can improve treatments adherence uh and reduce health care costs by as much as 29% which would be great.
▶ 0:18:11Another technology, remote patient monitoring, which I'm excited about hearing about that, more about that, allows physicians to observe uh vital patient data in real time where the patient is, wherever the patient is located. Studies have shown that remote patient monitoring reduces the risk of hospital remission by 76% and can lower the cost by up to $10,000 per patient. Access to health data has also helped reduce uh health costs for employers.
▶ 0:18:41In fact, 72% of employers saw a reduction in health care cost after starting a employee wellness program that promotes physical activity. uh the potential to lower health care costs and improve outcomes, only 36% of adults are wearing uh devices. Seniors are six times less likely than the younger people are today.
▶ 0:19:07I hope we can uh address those differences, encourage more widespread use of technology that can improve health. At the cutting edge of health technology is the promise of artificial intelligent AI to uh better analyze patients data and improve workflow for for uh health care providers. With 25% of new health care investment focus on AI technology 25% we are finding new applications every day.
▶ 0:19:36For example, new I new AI technology can aid providing documentation follow-up visits resulting in 60% improvement in work life and balance for health care providers. However, as more digital health data is created and utilized within the health care system, we must also take care to ensure technology is accurate and patients data is protected. That's key.
▶ 0:20:03I look forward to discussing these challenges and opportunities with our witnesses today. I'm I'm encouraged to work with my colleagues to reverse chronic diseases by harnessing the power of digital health data. Uh I'm pleased to recognize the gentleman and my good friend from Texas, Mr. Dogget for his opening statements. Well, thank you, Mr. Chairman, and for this hearing on innovation. Uh I know we'll get insights as I've already seen in the written testimony.
▶ 0:20:30Uh this is certainly a topic uh that is close to home for me since uh my hometown of Austin continues to be a tech hub that's full of innovative startups, biotech companies, and a growing presence from some of the major uh multinational tech companies. Across the street from my Austin office is Capital Factory led by my friend Josh Bear. uh a local co-working space and accelerator program for cutting edge technologies uh bringing investors and creative entrepreneurs together.
▶ 0:21:01Austin's becoming a health tech leader thanks to innovative companies and collaboration with the Dell Medical School, multiple University of Texas departments and the Army Futures Command. I applaud the innovative work that we will hear about today. It's helping to improve health care and transform transform the delivery system to be more effective and efficient.
▶ 0:21:24Uh while we all want the latest and greatest technologies uh treatments and cures for our neighbors, for our families when they're in need, we simply cannot have a conversation about innovative health care without talking about access to it. to the estimated 16 million Americans that are about to lose their access to health care and the millions more who will face increased premiums and potential hospital and pra and physician practices that will have to close.
▶ 0:21:54There's not anything beautiful about the one big beautiful bill. Uh the effort to force it through this Congress right up to July 4th presents real problems for healthcare. Uh this crisis I believe is preventable like so many of the health care complications that result in increased emergency visits when our neighbors have no way to access health care and are forced to wait until the very last moment to get help.
▶ 0:22:21Whether it's high blood pressure that leads to a heart attack or stroke, a diabetic who uh eventually uh foregoes insulin and faces amputation, or an uninsured, impoverished woman like one my own doctor daughter once treated or undetected breast cancer until the symptoms become so severe that little can be done to help.
▶ 0:22:44For Texans, Medicaid is a lifeline for three million children, twothirds of our nursing home patients, and nearly a million adults with complex disabilities. About half the babies born at the Dell Children's Hospital, and half the children that are seen there uh are relying on Medicaid.
▶ 0:23:05Under the big ugly bill, burdensome new requirements that have been rushed through this committee and the House uh will take effect in just a few months and they will result in fully qualified individuals losing their access to a family physician. Deep funding cuts to safety net hospitals will result in closures, particularly in rural areas and communities losing the one place they can receive health care. In a new analysis that I would ask unanimous consent to put in the record, Mr.
▶ 0:23:34Chairman, uh this is from the Congressional Budget Office last night directed to the committee on budget. It projects the states will respond to these terrible federal funding cuts by quote reducing provider payment rates, reducing the scope or amount of optional services, and reducing Medicaid enrollment.
▶ 0:23:56For 24 million Americans receiving care because of the Affordable Care Act marketplace plans, enormous enormous premium spikes are about to occur within the next six months. Unless the tax credits that were enhanced keep these plans affordable and stop the Trump sabotage provisions that are also included in the so-called big beautiful bill. An estimated 8.2 2 million Americans, including 1.7 million of my fellow Texans, will lose their access to a physician.
▶ 0:24:27For these folks, the Republican objective of repealing Obamacare, which has gone through this committee over more than a decade again and again and again, has finally been achieved. Their Obamacare is being Indeed, the the price of this bill is so high, so very high that Medicare, a program that Trump and Republicans promised to preserve, will face a $500 billion cut beginning on October 1st.
▶ 0:24:55Each year, for the next decade, the amount of debt that is being added to our country, trillions of dollars of debt, each year, every single health care provider that accepts Medicare will face a 4% pay cut instead of a pay increase. to recognize the cost of medical practice each year for the next decade.
▶ 0:25:16That is a big cut and it's at a time that many physicians are struggling to keep their practices open and consolidation and private equity buyouts are diminishing care. And especially for those newly retiring Americans, the difficult task of finding a physician who will accept Medicare is sure to become even more difficult. There's great innovation occurring. We're about to hear about more of it.
▶ 0:25:41Often with the support of taxpayer research funding, we have a responsibility to ensure that every American receives the benefit of these technologies can access them. And to do that, we must protect their access to health care. I look forward to the discussion, but I will say and apologize in advance to you, Mr.
▶ 0:26:00chairman and to our witnesses if I'm a bit of a jack in a box this morning because the House Budget Committee is considering this very matter at the same time and uh there is a meeting uh concerning President Trump's unconstitutional war on Iran also occurring. So Mr. Thompson will be helping on the Democratic side. But thank you very much our miss. Thank you. Thank you Mr. Chairman. Thank you. Thank you. I will now introduce the witnesses. Dr.
▶ 0:26:29Kristen Holmes is the global head of human performance and principal scientist. Whoop. Jo Josh Feltz is president of Winchester Metals Inc. Andrew I'm g just say ski uh is my wife's Polish name suddeny so I try to get that took me a long time to get that. U is the CEO and co-founder of coach Care. Dr.
▶ 0:26:53Kheart uh is Jackie Carr is the chief medical officer and vice president of clinical informative and epic uh systems. Sabrina Colette is the research professor and co-director at the center of on health insurance reform at Georgetown University. Thank you all for being here today. Your written statement will be made part of the record. Each of you will have five minutes to deliver your oral remarks. Dr. homes.
▶ 0:27:21Uh you may you you may go when you're ready. Good morning, Chair Buchanan, Ranking Member Dogget, and esteemed members of the health subcommittee. I'm Dr. Kristen Holmes, principal scientist and global head of human performance at Whoop, a leading American wearable health platform. I guide the science that powers health and performance optimization for our users. Before joining Whoop, I was a two sport athlete at the University of Iowa.
▶ 0:27:45I competed for seven years on the US national field hockey team and later served as head coach of Princeton University's field hockey program, leading the team to 12 Ivy League titles in 13 seasons and securing the first NC2A championship in Ivy League field hockey history. At my core, I'm a coach, a scientist, a mom, and someone who has witnessed firsthand the transformative power of datadriven guidance and unlocking human potential.
▶ 0:28:09I believe that proactively managing health at the individual level is our quiet covenant with life. A responsibility we carry not only for ourselves but for each other. When we empower the individual with insight into how their body is responding to inputs and the general demands of life, we create conditions that make resilience possible. The kind that safeguards us and those around us from adapting to a lower level of mental, physical, and emotional functioning.
▶ 0:28:39When adults lack the tools to manage their own health, it becomes increasingly difficult to foster healthy habits in the next generation. We must empower individuals with insights into their own health to not only improve personal well-being, but also lay the foundation for a healthier future for our children. Today, I will illustrate how we have harnessed real world data to enhance American resilience. While my examples stem from BOP, they underscore a broader truth.
▶ 0:29:06Health technology and wearable devices are poised to reshape healthcare outcomes, reduce chronic disease rates, and lower overall health care costs. But ultimately, this isn't about about health trackers. It's about data. For the first time in human history, we have population level insights from millions of data points on sleep, cardiovascular health, recovery, activity, and behavior.
▶ 0:29:29Our mission is to generalize these findings so any human who is interested can follow a path to better health. At Whoop, we believe health insight should be available daily, not just annual checkups. A prime example is our daily recovery score grounded in peerreview science. The score is linked to performance outcomes coaches and athletes care about. But during our company's 13 years in operation, we've discovered these data and insights are not just squeezing efficiencies out of the very best athletes in the world.
▶ 0:29:59The greatest impact is on everyday Americans who use our product. I can say with 100% conviction that for many of the everyday James and Joe's, Whoop has been astronomically life-changing and in many cases lifesaving. Building on this momentum, we launched Healthspan. Based on decades of longevity science in collaboration with Buck Institute, we offer users a very precise lens into their pace of aging, making behavior change both accessible and actionable.
▶ 0:30:30Whoop has also contributed to significant health break public health breakthroughs. In collaboration with West Virginia University Medical, we identified potential digital biomarker for preterm birth. During CO 19 pandemic, studies with Harvard and Central Queensland University demonstrated anomalies in nightly respiratory rates could detect infections up to two days prior to symptom onset. Whoop data has also provided operationally relevant insights into psychological resilience among US Army soldiers.
▶ 0:30:59We've been able to quantify the effects of call on acute care surgeon burnout. We were the first to publish wearable-driven analyses of cardiovascular and behavioral changes following GLP-1 initiation. These published studies are among the hundreds enabled by Whoopers underscoring its transformative impact on health research. Looking forward, Whoop is bridging biometric awareness with clinical insight. Our upcoming advanced labs feature will integrate key blood biomarkers with continuous wearable data.
▶ 0:31:27This fusion will create a dynamic real-time picture of both physiological and biological health. We're launching health economics and outcomes research starting with two corporate pilots. Industrywide data suggests wellness initiatives return a $150 to $6 for every dollar invested. Our study will quantify the impact of whoop to help reduce chronic care costs and foster a healthier workforce. All this progress depends on forward-thinking policy.
▶ 0:31:52Frameworks like the 21st century cures act and the FDA's general wellness guidance have allowed companies like Whoop to innovate. It is vital Congress preserves and expands these innovation zones. Wellness insights that help people manage their health must remain consumer accessible. In summary, wearable biometric data is transforming from novelty to necessity. Whoop and other wearables are shifting care from reactive to proactive, episodic to continuous.
▶ 0:32:19With smart policy, we can truly put America we can truly put health at America's at people's fingertips, helping Americans live longer, healthier lives. Our society and national security depend on it. Thank you for this opportunity. I look forward to your questions. And thank you, Mr. Phelps. You're recognized. Good morning, Chairman Cannon, Ranking Member Dogget, and members of the subcommittee. Uh, thank you for having me here today and allowing me to share my story. My name is Josh Phelps. I'm the president of Winchester Metals.
▶ 0:32:48We're a third generation family-owned uh steel distribution, processing, and fabrication small business located over in Winchester, Virginia. Uh our company roots actually can be traced back to my great-grandfather who in 1917 fled persecution in Russia and started a new life and a new business here in America, ultimately settling uh in my hometown of Winchester. But today, I'm here to share how small businesses can implement wellness programs to proactively improve the health of their teams.
▶ 0:33:15For more than 25 years, I've been responsible for managing our company's health insurance plan. And as anyone involved in this endeavor will tell you, it can be a long, tedious, uh, depressing six or eight weeks each fall until the plan is finalized and you get to present it to your team. I've experienced firsthand how confusing, expensive, and unpredictable this process can be. Um, especially for businesses in the small group market with limited options. Each year, it's the same frustrating exercise. You request a few proposals. You negotiate for some marginal savings.
▶ 0:33:44Then you just brace yourself for the premium increases. Employer sponsored insurance remains the largest source of health coverage in the US covering about 160 million Americans. And this is why most businesses, regardless of size, need to find a way to offer some sort of health benefits to compete for talent um in their marketplace. But here's a disconnect. Health coverage is not the same as health care. And neither is it the same as health. The people we employ, with whom we likely spend more time each week than our own families, deserve to be healthy and enjoy life fully.
▶ 0:34:14Employers can and should be playing a larger role in promoting healthy teams. About a decade ago, I decided to stop simply reacting to rising costs and started thinking proactively about employee health. I was frustrated with the wellness programs offered by commercial insurance carriers, which usually consist of little more than some questionnaires and online videos in exchange for maybe a deductible discount. These programs rarely addressed root causes of poor health or helped individuals form new and healthy habits. My own decadesl long personal passion for health and wellness helped shape our company's new direction.
▶ 0:34:43I partnered with a local health coach to customize a wellness initiative for our team. We host monthly voluntary 30inut on-the-clock sessions to teach practical health concepts like how to read a nutrition label, understanding portion sizes, ways you can cook meals at home, um, and recognize the impact of exercise on mental health among other topics. We've never required participation. We've never tracked results or added pressure. Instead, we focused on creating a culture of curiosity, empowerment, and long-term habit change. We have some friendly competitions.
▶ 0:35:14Uh we do step challenges. We did a no sugar challenge. I'm right now wearing a continuous glucose monitor. We're seeing how everybody does on tracking their glucose uh control. Um so, we do things like that in order to just encourage participation and make it kind of fun. A couple years ago, we added another layer where we started partnering with a local direct primary care practice. We now fully cover the cost of direct primary care membership for any employee who chooses to have that option. About half of our covered employees now have chosen that option.
▶ 0:35:41And to my knowledge, no one who has ever made that switch has ever switched back to a traditional direct primary care physician. Um, it's been a game changer. The relationship based care that these uh that DPC provides is really second to none. I get asked a lot by other small businesses, how do we measure success in this program? And the truth is that we don't. Um, not in the traditional sense. Insurance carriers, especially small groups like ours, we don't get access to a lot of data. So, I can't really uh have any metrics to measure against.
▶ 0:36:08Um, and then if you change providers for cost savings year after year, you might lose those historical trends. But what's the importance of a wellness program like ours is is prevention. And you can't measure things that don't happen. Uh what's the value of a heart attack that never happens? Uh what's what's the value of someone not getting type two diabetes? Uh what's the value in someone not missing work or family time because they're ill? And we hear these stories all the time. People change their grocery shopping habits. People start meal prepping at home. People start uh home workout with their family or their spouse.
▶ 0:36:39These things, while not measurable, are invaluable. In 2021, I co-founded a podcast called Healthy Team Healthy Business where we encouraged and helped other small business owners navigate this idea of wellness programs and their businesses. Uh we've interviewed a variety of health professionals, um including mental health, physical health, uh financial health, all those topics we cover. Programs like the one I talk about work because they're flexible, community based, and tailored to our small workforce. We're not looking for mandates.
▶ 0:37:08Uh we'd like some new tools like some of the wearables you're going to hear about today. But ultimately empowering employers and employees to focus on health and not just health coverage is what really is going to make the difference uh in our national health picture. I appreciate the opportunity to share with you today and I welcome your questions. Thank you. Thank you, Mr. Z. You're recognized. Good morning and thank you chairman Buchanan, Ranking Member Dogget, and distinguished members of the health subcommittee.
▶ 0:37:36I'm honored to speak with you today regarding the role that remote patient monitoring plays in empowering patients by collecting, analyzing, and displaying digital health data to patients and to their care teams. Whether you prefer the adage, measure twice and cut once, you can't change what you don't measure, or what gets measured gets done, it is clear to make America healthy again, we must start by taking the measure of the patient.
▶ 0:38:06My name is Andrew Zangalowski. I am co a co-founder and the chief executive officer of Coachare and I'm a founding member of the remote monitoring leadership council. For more than 10 years, Coach Carare has offered remote patient monitoring technology to independentlyowned physician practices. We are an extension of the clinical staff and we focus on achieving improved clinical outcomes, practice efficiency, patient satisfaction and a lower total cost of care.
▶ 0:38:36The remote monitoring leadership council is a collaborative of seven innovative companies operating across all 50 states and collectively offering the majority of remote patient monitoring services being delivered to Americans today. Members of the committee, thank you for taking the time to discuss the importance of digital tools as part of our healthcare future. Each of you have constituents benefiting from RPM as we sit here today.
▶ 0:39:02And each of you have independent physicians living or working in your districts that rely on remote patient monitoring to treat their patients and to retain their independence. While delivering highquality RPM is complex, at its core, RPM is a simple and common sense service. For decades, physicians have instructed patients with hypertension to buy a blood pressure cuff, take their measurements at home, and keep a log.
▶ 0:39:31They have been instructed to bring that log back to their next appointment, usually 6 or 12 months in the future. RPM technology repres represents a simplification and enhancement of this common practice. We ship to the patient connected FDA cleared medical grade devices to track vitals. We use FDA cleared devices to ensure that the data we receive is valid for use making life or death clinical decisions.
▶ 0:39:58We also pull data from consumer grade wearables such as those that Secretary Kennedy discussed during yesterday's House Energy and Commerce Committee hearing to provide context. While we can't use consumer products to make medical decisions, we can benefit from the additional context that they provide. The data captured by these devices is transmitted to our software, analyzed, and presented both to the patient and to their care team.
▶ 0:40:26This allows nearrealtime interventions often avoiding the emergency room and preventing cost costly hospitalizations. Hypertension is called the silent killer for a reason. The first symptom a hypertensive patient usually experiences is a heart attack. We are going to talk a lot today about the dollars and cents of digital health. And I thought it important to take a moment to acknowledge that we are also talking about life and death.
▶ 0:40:55These catastrophic and costly outcomes are avoidable by monitoring the patient and using the data we collect to titrate medications and adjust lifestyle factors in near real time. We are going to talk a lot about primary prevention today, but we should not discount the importance of tertiary prevention. We cannot ignore the more than half of the adult population in the United States who already have at least one chronic Members of the committee, I have good news.
▶ 0:41:24RPM is incredibly inexpensive. I can monitor a patient for 50 years for the cost of an ambulance ride and a few days in the hospital, which is unfortunately a near certainty if we do not manage these chronic conditions. Across a cohort of 450 patients suffering from advanced chronic heart failure that Coach Care manages, we reduce the hospitalization rate from to 1.7%.
▶ 0:41:53When applied across the more than six million Americans diagnosed with CHF, a similar reduction in hospitalization rate would save $24 billion annually. We believe RPM is a flagship example of harnessing the power of digital health because without patients and providers having vital and valid data at their fingertips, neither can be an active participant in ensuring better outcomes and money will be wasted.
▶ 0:42:18Additionally, leaders in the RPM space are moving toward models that leverage AI to fully realize the potential of the voluminous patient data captured through RPM. AI is helping to detect conditions sooner, lessen the burden of paperwork, and support clinicians in making optimal care decisions. Actions from CMS to specifically support data and technology costs are crucial to unlocking the potential of advanced data capabilities like AI alongside RPM.
▶ 0:42:46We urge the committee to work with the industry to modernize RPM payment to ensure continued expansion of this proven digital health tool while safeguarding program integrity. Medicare cuts unrelated to the performance of RPM have continued ranging from 7% for treatment related services to an astounding 33% for technology related services. RPM providers, particularly small providers who operate on tight budgets, are reaching a breaking point.
▶ 0:43:16I appreciate the subcommittee's attention to this very important topic and the opportunity to testify. Yeah, thank you. We're trying to keep the remarks to five minutes. Everybody's got somewhere they're need to go. We want to get everybody, you know, as best we can. Um, thank you, Dr. Gearart. You're you're Chairman Buchanan, Ranking Member Dogget, and members of the committee. Thank you for the opportunity to testify today. My name is Jackie Ghart.
▶ 0:43:43I'm a practicing family physician and chief medical officer at Epic, a health IT company based in Verona, Wisconsin. Epic creates software used by hospitals and health systems in all 50 states. Many of you and your constituents are already using Epic using the My Chart app on your phone. Through my chart, you can see test results, schedule appointments, or even sync data from wearable devices.
▶ 0:44:07We've been connecting device data since 2012, and we're among the first to integrate with Apple Health Kit in 2015. Connecting patients, clinicians, and their data isn't just convenient, it improves care. When I was seeing obstetric patients in my practice, I cared for mothers with postpartum hypertension, a serious condition that can lead to seizures or even death. These patients had to come into my clinic every day for blood pressure monitoring.
▶ 0:44:34Now I'm able to prescribe a connected blood pressure cuff that syncs through Apple Health, allowing me to monitor things remotely. This prevents ER visits, reduces costs, and provides critical support for patients in rural and underserved communities who otherwise would have faced long drives and limited access. That kind of early innovation laid the foundation for what's possible today. Today, Generative AI is improving care in ways that are both practical and powerful.
▶ 0:45:04It helps draft clinical notes based on my conversations with patients, giving me more time to connect with them face to face. For example, at Reed Health in Indiana, this reduced physician documentation time by 86%. And at John Mir Health in California, this decreased physician job turnover by Moreover, AI can suggest appropriate orders, summarize complex care, and surface insights on the patient.
▶ 0:45:34It even simplifies prior authorization by searching the chart in a matter of seconds to find the documentation insurers require. And sometimes it catches what otherwise might be missed. At the Christ Hospital in Ohio, AI reviewed routine chest X-ray reports for incidental findings that could have been That led to over a 100 cases of lung cancer being detected earlier.
▶ 0:46:00While the national average for early detection is 27%, they are identifying it early in 70% of cases, saving lives through timely follow-up. As one of my colleagues put it, AI is the best resident I've ever had. But our goal isn't to recreate a resident. It's to assist physicians with tools that anticipate, guide, and elevate care. Another advancement we're working on is the seamless flow of data to ensure clinicians have the complete picture of their patients health.
▶ 0:46:31Through interoperability, health systems used Epic to exchange more than 700 million patient records to inform treatment. In this last month alone, half of those exchanges were with organizations not using Epic EHRs. Last year, more than 750 thirdparty apps used Epic's publicly available tools to help patients retrieve their own health data.
▶ 0:46:53And health systems using Epic responded to more than 111 billion interoperability calls, enabling a broad range of novel app integrations. We believe that TEKA as a federally endorsed trust framework has great potential to expand interoperability. The Epic community has connected more than a thousand hospitals and 25,000 clinics through TUKA and more are being added each month.
▶ 0:47:19As data exchange grows, so does the need for strong, consistent privacy protections. Today's privacy protections vary depending on who holds the data. Many people believe HIPPA requires that their medical information be kept private no matter who is accessing it. That is not the case. HIPPA only covers actors like health systems, insurers, and their contracted business associates such as Epic. This is confusing for patients.
▶ 0:47:47They may not understand that their data is subject to different rules depending on where it goes. One reason we support TUKA is that it requires participants to adhere to higher privacy standards. Having said that, we encourage the federal government through legislation or regulation to close potential gaps under HIPPA to better meet patients Anyone sending or receiving health data through TESCA or any other exchange network should be held accountable under HIPPA.
▶ 0:48:17In closing, Epic is driving the next wave of innovation through digital health, AI, and interoperability. These innovations are helping us care for our patients better by delivering safer, smarter, and more patient centered care. Thank you. And thank you, Miss Colette. You're recognized. Thank you, Chairman Buchanan, Ranking Member Dogget, and members of the Subcommittee on Health.
▶ 0:48:41My name is Sabrina Corlet, and I am a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University's McCort School of Public Policy. Thank you for inviting me to testify today. My comments here reflect my own views and do not reflect the views of Georgetown University or the McCort School of Public Policy.
▶ 0:49:01Unfortunately, having a hearing about digital health technologies at a time when 16 million people are about to lose their health insurance coverage, premiums are projected to skyrocket and millions of people with insurance will face higher out-ofpocket charges is akin to Marie Antuinette telling the people of France to eat cake.
▶ 0:49:23People cannot take advantage of technological advances in health care if they do not have health insurance coverage or face insurmountable financial barriers to health care services. Therefore, I will be focusing my remarks today on how proposed federal policies in particular the House passed HR1 will affect people's access to affordable highquality health insurance.
▶ 0:49:46The $1 trillion dollar in cuts to healthcare programs in this bill will lead to an over 50% increase in the number of people who are uninsured. HR1 amounts to a stealth repeal of the Affordable Care Act, a law that now covers roughly one in every six people under the age of 65.
▶ 0:50:07The people covered under the ACA are early retirees, gig economy workers, small business owners, self-employed entrepreneurs, students, caregivers, and millions more who work hard but whose employers don't provide health insurance. HR1 would also have a devastating impact on health care providers, particularly those serving rural and underserved communities. I will just touch on a few damaging provisions in this bill.
▶ 0:50:37Under HR1, states must implement a work requirement for their Medicaid programs. There is broad consensus across the research literature that the proposed work requirements will do nothing to increase the amount that people work. Instead, it saves the government money because millions of people who are working get cut off because they cannot navigate the red tape. HR1 would also require all states to charge cost sharing to Medicaid enrolles.
▶ 0:51:07Again, the research is clear. These financial barriers will lead many to forego needed services leading to worse health outcomes and higher costs in the long run. Touching now on the marketplace provisions in the bill, 8.2 2 million people are projected to lose insurance due to the combined impact of Congress's failure to extend the enhanced premium tax credits and the marketplace provisions in HR1.
▶ 0:51:36The changes on the horizon will not only increase uninsurance, but have a significant destabilizing effect on the marketplaces and tie the hands of states that have until now had the primary authority to regulate their insurance markets to meet the needs of their state Indeed, in states with early filing deadlines for insurance companies to submit premiums for 2026, this is why we are seeing eyepopping increases.
▶ 0:52:05For example, insurers in Tennessee have proposed a 24% premium increase, 19% in Pennsylvania, 13% in New York, 13% in Massachusetts. The provisions in HR1 would limit eligibility for marketplace premium tax credits and impose burdensome new paperwork requirements.
▶ 0:52:27Lastly, although there has been considerable rhetoric suggesting that the budget reconciliation package does not include cuts to the Medicare program, that is simply not true. In fact, the bill would cause significant harm to millions of Medicare enrolles and the providers who serve them. In particular, under statutory payo, HR1 would trigger a mandatory sequestration resulting in, as um Congressman Dogget noted, a 4% reduction in pay to providers every single year.
▶ 0:52:57In closing, coste effective and innovative technologies that can help people better track and control chronic conditions are exciting opportunities, but people need to be able to access and afford health coverage in order to take advantage of such technologies. As drafted, HR1 would actually make it harder for people to obtain health care, tying them up in a maze of bureaucracy, raising their premiums, and imposing new federal mandates. Thank you.
▶ 0:53:27and thank you. Uh we'll now proceed to questions and answer this session. Dr. Holmes, let me ask you, there's been a lot of progress made uh with multiple companies and as well as yours. Uh what do you see as the future in the next three to five years, seven years, but let's say next two to four years. I'm very excited about the possibilities because I'm a big person in prevention. I don't want people to get heart attack and cancer in the first place.
▶ 0:53:54Any way we can minimize that is a great thing to the country. We're spending5 trillion dollars and people are getting sicker. What we've got doesn't work. So I think this will move us somewhat in the right direction. Give people a choice and I hope employers pick up what Mr. Phelps doing because we need to have companies investing in their employees. But why don't you tell us your thoughts and where you your vision about where this industry is going to go?
▶ 0:54:19And I was excited to hear the secretary yesterday mentioned that he'd like to see everybody with some kind of a medical device that they can monitor their own activity uh in the next four years. So we'll we'll see how that works out. But I'm excited about that. But go ahead, doctor. Thank you for the question, Jerean. Um yeah, I mean I think at a very basic level uh helping people understand their baseline is very much what gets us excited in terms of helping people manage their own individual health. We have to make that the norm.
▶ 0:54:50No one is coming to save us, right? We have to be and you said it yourself, Mr. Buchanan, that we have to be the CEO of our own health, right? I mean, that is the that is the promise of wearable technology is that you can understand changes in baseline and how they might be linked to various lifestyle factors. Right? So, this is I think for me at a basic level, that's what's exciting.
▶ 0:55:14I think there's also an opportunity to tie together um blood biomarkers with the physiological data to give people a more holistic picture and get ahead of what are preventable diseases. Mr. Phelps, uh I' I've been an employer for 30 years before I got here. Your biggest asset, as you know, are your employees.
▶ 0:55:36You want them to be as well and be able to perform their job at a high level and also big benefit to them and their family and everything else. What can we do to try to get more small businesses? And by the way, how many employees do you have? We're 46 employees. Okay. How do we get other businesses involved? Because it just seems like it's such a the right thing to do. Uh, and I I've always heard if you help other people get where they want to go, if they want to go that way, uh, it it puts you in a better position yourself.
▶ 0:56:06So, I'm excited to hear what your company's doing, but we need to have more small businesses and more companies. A lot of the large companies are doing some of it, but we need more to encourage it. Someone doesn't have to do it, but we want to make sure that they're educated. They got an opportunity to hear the message and see if they can if that makes sense to them. But what's your thoughts on what more we could be doing or encouraging people to do? Yeah, the f the first thing is just get over this fear that there's there's conversation you're not allowed to have as an employer with an employee is talking about their health.
▶ 0:56:36It's something that uh for some reason we just feel like it's not part of our uh daily role as a as an employer or a manager. The second is that it's not expensive. It doesn't have to be expensive. You can make it as elaborate as you might want, but um stopping somebody for or a group of four or five people for 15 or 20 minutes and having a simple conversation about, you know, using glass instead of plastic or uh or a wearable, those kind of things are not things that disrupt your really your workday. They do not have to cost you a lot of money, lots of productivity, etc. And who knows what impact you want to make.
▶ 0:57:06Um and third, I think there are resources out there if you look for them probably in your own communities. And I mean know my community is not a big big community. small, but I had choices when I started looking for coaches and other people to bring in to help us with this. Just did a little bit of shopping, a little bit of, you know, elbow grease and got it figured out. Uh, and then educate yourself that, you know, I got myself certified as a health coach just in case the stuff with our wellness coach we hired didn't work out, I could do this do the stuff myself. Um, that was that was the impetus of of us doing it.
▶ 0:57:35And I think other employees can do the same thing. It's not it's not that Thank you, Mr. Dogget. You're Uh thank you, Mr. Chairman, and and to all of our witnesses. Professor Carlet, let me begin with you. Uh you and begin where you left off, which was on Medicare uh sequester.
▶ 0:57:55Uh President Trump of course promised earlier this year that he would quote, "Love and cherish Medicare and Medicaid." Uh this bill appears to me to be taking a wrecking ball to both.
▶ 0:58:08You talked about the Medicaid part, but on Medicare, what are the effects of the sequester that is triggered under this bill that begins in a very short time October 1st to begin cutting the payments that go to all health care providers, independent physician practices, we've heard about uh hospitals, uh labs, everyone.
▶ 0:58:32uh and at a time that we know that many practices are already closing, it's become increasingly difficult to have independent practices because hospital-based or uh facilities are becoming increasing. Uh those considering medical school that come to see me, the students uh whether they're physicians or dentist or any number of other health care providers uh are talking about the immense amount of debt that they incur in medical school.
▶ 0:59:00What's the effect of beginning to cut year after year the payments uh as a result of the incredible debt that's being added from this bill? What impact does that have on providers and on those who rely on those providers? Uh thank you ranking member Dogget for the question.
▶ 0:59:18Um, under statutory PIGO, the budgetary effect of HR1 would trigger a mandatory sequestration to reduce federal spending, totaling 45 billion in 2026 and roughly 490 billion between 2027 and 2034. And as you noted in your opening statement, that means that each year providers would face a 4% cut in their reimbursement.
▶ 0:59:44When you combine that with policies that increase the numbers of uninsured um and limit the ability of states to raise revenues to increase provider payments, these cuts would have severe financial consequences for providers, particularly those in rural and underserved communities.
▶ 1:00:03Um, these financial pressures are likely to harm the quality of patient care, limit the availability of critical services, result in layoffs of key personnel at um, facilities and and other practices, and in some cases lead to hospital closures, and in fact, there's an analysis out from the um, University of North Carolina finding that an estimated 300 rural hospitals would be at disproportionate risk of closure, uh, conversion or force reduction.
▶ 1:00:33in critical services as a result of this bill. Thank you. And it's great to hear about the innovations, the opportunities to for improving care with personal devices. Of course, none of those would be available to us if we hadn't had someone who was creative uh and given an opportunity to do that combined with a risk taker to put those products out on the market.
▶ 1:00:57Uh I'm concerned about the research cuts that are being made uh in the president's budget and through his bill uh at the University of Texas. I talked recently with a professor who has already earned more than $100 million for the University of Texas in royalties from his viral research. His project, his grant was cut off just a few weeks before uh it was to be completed with one week's notice.
▶ 1:01:25and he told me of other uh folks around the country relying on federal research dollars from the National Institutes of Health. Some had animal studies, some had patient studies on many of the dread diseases that we all fear and cut off with similar lack of notice.
▶ 1:01:44uh NIH has funded at the University of Texas research on ultra ultrarocessed foods uh and the impact on diabetes, educational tools to slow the decline of Alzheimer's uh and new discoveries discoveries on anti- microbial research. Uh these are just a few of hundreds of projects that place UT Austin as the 14th in the world for interdisciplinary science. A position that's clearly endangered.
▶ 1:02:13Uh have one department after another expressing concern about cuts from the National Science Foundation, the National Institutes of Health, and what impact that will have on whether we have future generations of new technologies that we will be able to benefit from. Can you discuss a little what the impact on these cuts for scientific and medical research? Absolutely.
▶ 1:02:37Um and uh I think uh you know it's well documented that for every $1 that uh we spend on the NIH, it returns $2.56 in economic activity. So it's a it's a great investment. Unfortunately, the president's budget includes a 43% cut to next year's NIH budget, amounting in about 20 billion of lost research opportunities each year.
▶ 1:03:00Um, this means that research labs are implementing hiring freezing freezes, laying off staff, clinical trials are being put on hold. um the ripple effects are absolutely enormous and and you know we know 99% of new drugs that were approved between um 2010 and 2019 were developed thanks to seed funding from the NIH. Um the proposed cuts by one estimate would destroy the equivalent of one quarter of our annual GDP in the US. So really biting off our nose despite our face.
▶ 1:03:30I'll also note that um you know my colleague here um mentioned that the remote monitoring technology relies on FDA approval um many of them and I will just note that the layoffs um and turmoil at the food and drug administration are likely to slow down the review and approval process for drugs and medical devices leading to delays in bringing these vital new technologies to patients. Thank you very Thank you Mr. Smith. You're recognized. And thank you Mr. Chairman.
▶ 1:03:59Thank you to our witnesses as well. Uh these are exciting uh topics to to discuss and you know looking back at what has been done in healthcare or what has not been done. Certainly I'm glad that the last witness to testify has expressed her indignation at increased insurance premiums and uh we've seen a lot of those over the last few years.
▶ 1:04:26I I think of in in Nebraska, we had a high-risisk pool with a high premium. Yeah, I understand that. Now, everyone in the individual market has to pay those high premiums. What has been the solution out of Washington? We subsidize premiums. This is not I might even suggest that double payments and duplicate payments, some would consider very good for the economy. and yet is it sustainable?
▶ 1:04:56So, how can we work together to find more efficient means of delivery of health care that actually results in better health? What a concept. I I'm concerned that the federal interventions in health care of the last several years has just shifted around who pays how much.
▶ 1:05:17No apparent improvement in health across And yet patterns, fiscal patterns across America that are not sustainable. And I think we need to pay very close attention to this. So that's why I'm excited about new technologies.
▶ 1:05:35I I suppose uh there some of these newer technologies will be a little bit disruptive to billing patterns and we'll hear from some folks who say, "Oh, this is this could be dangerous." And yet it's oftentimes the right thing to do and to uh pursue innovations for the future that that help people and uh quite honestly I yes I want to save taxpayer dollars too but it's in the dignity of helping people get to a better place with their
▶ 1:06:05health care with their financial uh situation and and others and I have one of the most rural districts in America uh that where teleaalth uh we've done some work on that for the purposes of rural application but co showed us that we need it in urban areas too and so um remote patient monitoring monitoring is a form of teleaalth that uh I'm very excited about so we can have that very valuable visit to
▶ 1:06:35a physician perhaps can mean more when data is already available even before the patient walks in the door and So, I'm very interested in terms of, you know, there are some moving parts here of how can we make sure folks have access in rural America. You know, uh broadband coverage and internet access is not what it is uh in other places. So, I want to be uh working on that as well, but obviously there are going to be some some barriers.
▶ 1:07:06And so, uh Mr. Dr. Zengalowski, I was wondering given your experience in in integrating remote patient monitoring into smaller practices, what barriers other than connectivity perhaps would you say you've encountered with expanding the usage and utility of RPM? Yeah, thank you for the question, Representative Smith. I appreciate it. Comments as well. Um, a quick note on connectivity.
▶ 1:07:32I I do think industry has largely been able to identify various different devices for patients in different areas. Whether they have internet access or not, we have a device that will work for the patient. In terms of what when we think about the rural patients, what is preventing an expansion of remote monitoring services to that patient population? It is the disparity, the geographic disparity in reimbursement rates.
▶ 1:07:58rural populations, rural physicians are reimbursed significantly less for the same services than physicians in other areas. And Representative Kustaf has introduced HR 3108, which aims to solve that problem. Thank you. Well, the uh the challenges that we face in terms of actually increasing access and and having positive outcomes to where the American people are healthier.
▶ 1:08:25You know, I think discussions like we are having today are what we need to do. The American people want to see results. They don't want to just see more centrally planned healthc care coming out of Washington DC that delivers exactly no improvements across America and certainly a more efficient application of of tax dollars. So really it's what we we should be keyed in on what the American people want us to do and expect us to do in a very efficient manner and and to show results. So thank you Mr.
▶ 1:08:55Chairman again for this hearing. Very timely and appropriate. I look forward to the continued discussion. Thank you. Thank you, Mr. Thompson. You're up. Thank you, Mr. Chairman, and thank you to the witnesses uh for being here today. I want to associate myself with Mr. Dogget's comments about uh all the great technology gain that we've seen and the potential for even more.
▶ 1:09:16But today's hearing, health at your fingertips, is really hard to take seriously when Republicans are ripping health care out of the hands of millions of hardworking Americans. How can we talk about digital health management tools when people won't even be able to see a doctor? This hearing is a distraction from the damage the Republicans one big ugly bill will have on our health care system.
▶ 1:09:42Under the big ugly bill, some hospitals and clinics in my district and across our country will shut down. Others will have to reduce and lay off staff. More than 16 million Americans, including kids, will lose their health care coverage. All to give tax breaks for wealthy people who don't need tax breaks in this current environment. This is the largest act of healthc care theft in modern history.
▶ 1:10:10Hardworking families don't need more apps and futuristic health uh gadgets. They need access to affordable health care. They need prescription drugs that don't break the bank and they need hospital visits that won't lead to This technology that we're experiencing in today's world is good stuff. There's no question about that. But you need people to make it happen.
▶ 1:10:39Someone mentioned the remote monitoring. I can't tell you how many nights I was woken up uh because someone on a health uh monitor uh was having problems and my wife had to go and respond to those problems. There's a a person attached to all of that. It just doesn't uh the machine just doesn't do it all and that needs to be recognized.
▶ 1:11:05There's also privacy concerns with the uh digital health technologies that we're discussing. Uh when Doge gained access to sensitive personal information of millions Americans, this issue was truly highlighted uh for all of us. This is not to say that digital health care technologies don't have benefits.
▶ 1:11:28We all kn know that they do and I'm a strong supporter as my colleagues know I've been pushing it for a long time on this committee of uh tellaalth and we've worked to expand teleaalth services and we're really seeing the benefits of that but none of these tools matter if Americans can't afford to go to the doctor if they're being stripped of their coverage or if their private health information becomes compromised and we need to recognize that upfront. Dr.
▶ 1:11:58Gearhart, many Americans are rightly concerned about how their sensitive health data is collected, shared, and potentially misused. As a family medicine uh physician, do you think that Doge should have access to the medical data of the patients that you care for?
▶ 1:12:19I can't speak specifically to Doge, but we do feel that it's confusing for patients what happens to their health data and we believe that HIPPA should be expanded to cover all entities exchanging patient health data. You don't think that just anybody should be able to come in and collect these data uh from people's personal health care We feel that HIPPA should be expanded to be able to cover all of those entities. I agree with you. Thank you very very much.
▶ 1:12:44Uh, Miss Colette, uh, there's no doubt that digital health tools have the potential to help individuals improve their health and overall well-being, but they only help people who can actually I believe they can only help people who can actually access care.
▶ 1:13:01Given the Republican proposal that would cut over $1.5 trillion dollars from the health system and kick 16 million Americans off their coverage, how do you believe their policy would impact the ability of Americans, especially lowincome and rural communities, to benefit from digital health technologies? Thank you for the question, Mr. Thompson.
▶ 1:13:24Um unfortunately um one of the um first effects of the bill is to terminate insurance coverage for um as many as 16 million people. Um when you don't have insurance coverage um the evidence is clear. You don't have access to a regular source of care. Um you wait till the last minute to seek care and certainly you don't have access to some of the technologies that we're talking about today.
▶ 1:13:51Um the second thing that I um would like to mention and one thing that's sort of um fallen under the radar screen with respect to this bill is it that it would also increase annual cost sharing for people with employerbased insurance by for families by $900 a year. Okay. Thank you. Uh Mr. Mr. Chairman, I'd like to submit to the record, if you would, uh, these sheets of the different technologies ranging from $500, $800.
▶ 1:14:18The ring that you're wearing, $520, uh, $525. Mine was only 300. So, yours is only 300. All right. I got the cheap one, but that's good. But even the the people who are losing their health care because of the big ugly bill can't even afford the $300 cheap one. I'd like to submit this to the record, Mr. Chairman. Uh, yeah. Without objection, so ordered. Thank you.
▶ 1:14:43Thank Thank you, Doc. Go ahead. I was talking about an ectopic pregnancy. Um, thank you, Mr. Chairman. This is an excellent uh uh hearing. Um, it goes it it brings me back to the to the fact that actually the world is not round anymore. It's turned flat because it's on our phones. It's on our TV screens and that's the way we're actually conducting healthcare. I uh I practice in a very rural part of eastern North Carolina.
▶ 1:15:12Our payer mix is truth be told horrible. Close to 75% Medicare, Medicaid and no insurance. These are impoverished rural individuals. But the thing the fact that our health care system has done a unbelievable job in turning teleaalth and telea medicine into allowing impoverished individuals to get health care truly is to be lauded. I'm going to give you a few examples. electrophysiology.
▶ 1:15:35We have an implanted cardiology devices which can follow patients that live an hour and a half away and see exactly what their their their rhythms are, fluid retention, etc., etc., so we can intervene early in heart failure and doing so many different things. Telecardiology visits, um, we're able to talk to patients either via their phone, TV, or if they go to the library, they can get on a computer, save thousands of dollars in travel, but more importantly, actually keep them healthier.
▶ 1:16:03And this is done in a rural impoverished area um where people have access to care because of the things that we do. Same thing with tea neurology um stroke intervention as you guys may or may not know the earlier you get in on strokes the infinitely um greater chance of survival and and less defects that people have. Um it is unbelievable what's happened in the last three years.
▶ 1:16:27I've practiced medicine close to now 35 years and we are in and we are in warp speed now as to what we're able to do. Um let me go a little bit Dr. Ghart because I our system was actually one of the first users of Epic. I cussed and fussed and it pissed me off for days on end trying to work with a computer about 20 years ago. Thankfully things have changed tremendously since then. Now um even though our system I don't know why has not uh adopted ambient listening.
▶ 1:16:55I'd love you to just comment briefly on what ambient listening is and how it changes healthcare how it changes the uh the uh experience for actually the people providing the healthcare the physicians. Yes, thank you for the question. So ambient technology is as when I'm the physician, I can take my phone, place it between myself and my patient and I can ask for the patient's consent to record and that allows me to focus on the patient, look them in the eyes, actually have reconnection with the humanistic type of medicine and
▶ 1:17:26the visit is recorded for me and my note is written for me. And that is one of the biggest things that we've noticed to be helpful from a burnout perspective that we've ever seen. And it's been saving marriages. It's been some people say it's res. I love my wife has survived 35 years as a surgeon. God bless her. Um and I don't know how many hours of my life that I've lost dictating and now I'm coming at the towards the end of my career and it's finally occurred. One thing there is a caveat here guys. There is a caveat.
▶ 1:17:56you you have wearable devices and then you don't have doctors or even clinical nurses sitting in rooms all the time looking at hundreds of different EKGs labs etc etc there's a major liability issue because we know our wonderful trial lawyers are swirling around ready to jump in at any moment in time you talk about wanting to expand HIPPA I can't agree with that look HIPPA I I can't if if a 19-year-old college student comes in with a kidney stone I can't talk to her parent without me getting expressed consent I think we've gone a little bit too far on some of the
▶ 1:18:26hipper things. Quickly, if you can, I want to talk ask you about interoperability with other systems. Oracle for example, because this was one of the few one of the things that actually was good with the ACA. It said systems had to communicate with others. Here we are a decade later, still not happening. Can you help me out with that? Because I asked Judy about that about two years ago and I didn't get a great answer. Okay. Well, thank you for the question. Epic does exchange 700 million patient records a month and half of those are with non-Epic EHRs.
▶ 1:18:56So, an example being Oracle. I I I think that's a good step in the right direction. Our VA, I serve on Veterans Affairs, our VA needs to get it's ridiculous. They've been working with now Oracle for 15 years and we have nothing to show from it. And I still see veterans. Um, and it needs to happen across all systems. One thing I wish you would do and carry this back to the Epic people. I'm an old person. I've been practicing medicine a long time. I have to look at a computer screen. Every year you guys change the color of the screen.
▶ 1:19:25Move the things around. I'm used to pushing up here to order things and now it's down here. Stop it. I'm old. Okay? Stop doing that stuff. Just give me the same damn screen every year. I'll be a happy camper. Okay? I know that's the secret sauce how you come in and charge $70 million for a new screen every year. Stop doing that. It's annoying. All right. Thank you very much. shall yield back. Yes.
▶ 1:19:52Um, Miss Corlette, now I wear an Apple smartwatch. It measures my heart rate, wrist temperature, and blood But even though I appreciate that information, I must point that out out that if my heart rate is too high, you would think I should see a doctor.
▶ 1:20:12But with the devastating cuts to health care that would come about because of HR1, in fact, we would have the most devastating cut to health care in our nation's history. And in fact, you laid out that the Republican reconciliation bill would slash more than $1 trillion from our health care system, gut Medicaid by over 800 billion, and would cause 16 million people to lose their coverage.
▶ 1:20:40At the same time, this bill undermines the very pillars of the ACA that have helped millions of Americans access care, including by eliminating the premium tax credits that makes the ACA plan affordable for so many. So, Miss Corlette, if Republicans succeed in eliminating the ACA tax credits, millions of people could see their premiums rise by up to 64%. And that's exactly what my constituent Jacob in Pasadena fears.
▶ 1:21:09He's relied on ACA coverage since 2014, and the enhanced tax credits are the only reason his monthly premiums remain manageable. I also heard from Davis, another one of my constituents from Pasadena, who told me that a 77year-old mother relies on both Medicaid and Medicare, as well as the assisted living waiver provided through Medic for affordable housing.
▶ 1:21:33He told me that if she loses her Medicaid, he will have no choice but to move her into his apartment, get a second job, and become her full-time caregiver. So, Miss Corlet, if my constituents, their families, and millions of Americans across the country get kicked off health care under the Republicans big ugly bill, how are they supposed to pay out of pocket for wearable technology or digital health tools?
▶ 1:21:59How much harder would it be for the them to reap the benefits of those tools, let alone then follow up with a doctor's appointment? Uh, thank you, Congresswoman Chu, for the question. I I think the simple answer is that most of them won't um be able to pay for um these technologies, which I I think are very exciting and hold a lot of potential.
▶ 1:22:26Um but um we know that particularly for lowincome folks, even small dollar amounts um that they have to pay out in order to access care result in them just not getting the care at all and delaying it or foregoing it completely. And then of course what happens is um that what the condition that they have gets worse and it becomes an emergency and they end up in the emergency room.
▶ 1:22:51So um the bottom line is that when you take away health care from people uh or impose large financial burdens on them to access care, they simply don't get it and health outcomes get worse and um uh costs go up. Thank you for that. Um now I'd like to ask you about privacy protections because most digital health apps are not subject to HIPPA standards.
▶ 1:23:17Consumers are often misled into thinking their data is protected when in fact these apps can collect, store, and even sell personal health information to third parties, including law enforcement. Yesterday marked the three-year anniversary of the DOS decision, which eliminated the constitutional right to abortion and stripped millions of Americans of the freedom to make choices over their own bodies.
▶ 1:23:40Since then, we've seen growing efforts to criminalize abortion and a dangerous new reliance on digital data to survey and prosecute women. Concerningly, a 2024 Forbes investigation found that period tracking apps routinely obscure their privacy practices and enable thirdparty data sharing, failing to disclo disclose when law enforcement requests user data.
▶ 1:24:06So, Miss Corlet, can you address these issues about privacy concerns and how Republicans massive cuts to Medicaid and the ACA further restrict Americans access to reproductive health care? Yeah, thank you uh again for that question.
▶ 1:24:22Um I uh am um very very concerned about um the privacy risk that people take on with some of these wearables um particularly in an environment um where you could be um prosecuted for um exercising bodily autonomy. Um, I'll also note that unfortunately the HR1 also defunds Planned Parenthood, which means that the patients who rely on these critical healthcare services will be blocked um from things like family planning, prenatal care, in addition to abortion.
▶ 1:24:52Um, also women make up over half of adult Medicaid and marketplace enroles. Um, and so they will be disproportionately impacted um by uh the termination of health insurance under this bill. And when you don't have insurance, um, it's difficult or impossible not only to access your reproductive health services, but all healthcare services. Thank you. I go back. Thank you, Mr. Yeah. Go ahead. Thank you, chairman.
▶ 1:25:19And, uh, we'll try to get back to the whole reason we're having the hearing today. U Coach Holmes, congratulations. Uh I grew up in an era where uh our gymnastics coach was also our football coach and he started using tubing instead of lifting weights in order to get flexibility and strength at the same time. So it was always you got to keep you can't make the club in the tub. The idea was you got to be on the field. You got to be moving. Mr. Phelps the worst thing that can happen to any employer is to lose somebody productive on the line.
▶ 1:25:49The idea is productivity all the time. If you're if you can't if you can't work, you can't produce. If you can't produce, then somebody else has to pick up the tab. All of you are doing the same thing. Um, I had the privilege of sitting beside a doctor. Uh, not every day, but on meetings like this. I really would like to get back to what it is we're doing that makes it much easier, much quicker, much more efficient.
▶ 1:26:13In the automobile industry, all the technology was about keeping people out of the shop so their warranty costs would be lower, including offering free lubrication, tire changes, and everything else because the cost of replacing far exceeded the cost of keeping them active. So, at this point, uh, chairman, I'm going to pass my time on to Dr. Murphy. This is what he's done his whole life, and I I'd rather listen to experts and people who stay true to their cause. Thank you, um, my good friend.
▶ 1:26:42You look very well today, by the way. Um, just a a question I have, you know, because I think we got a little bit sidetracked about this. It is amazing that we have the information and the technology to do the things that we couldn't do 5 years ago. But is it government's role to be everything for everybody? Miss Corlet, I I got a question. Do you think people who are not veterans should receive health care from the Veterans Sorry, could you repeat the question?
▶ 1:27:08So, do you believe people who are not veterans should receive health care from the Veterans Association? From the Veterans Association Administration, sorry. Um, that is not something I'm qualified to answer. I'm not familiar. Well, it's just kind of the same thing if you can you define a woman. It's just it's the same kind of thing. People who are not veterans should not receive health care from the Veterans Administration. And they talk about people losing health care. We have Medicaid. And I hope just this isn't news to to people.
▶ 1:27:36Medicaid is for pregnant females, the impoverished children, disabled, and those with dual eligibility when they are seniors. Those are the eligibility criteria for Medicaid. We have now people who for the Biden administration did not allow the uh states to audit their Medicaid roles for several years. So people were on Medicaid who did not deserve by eligibility criteria to be on Medicaid. So those people don't need to be on Medicaid. Number two is we had an influx.
▶ 1:28:05We had an invasion, the greatest invasion of this nation occur during the last administration. Anywhere between 13 and 20 million individuals came into this country. I want to take I've taken care of individuals who cannot pay my entire life, not only here in this country, but abroad. Is it the taxpayers's responsibility to default on this nation's debt because we had people come into this country illegally? No, it is not. No, it is not.
▶ 1:28:31And then finally, able-bodied individuals who I see in my clinic who are receiving benefits from this government while they could be having a job because good lord, there are jobs out there who could be getting health insurance. As you pointed out, Mr. Phelps, the largest people, the largest supplier of health insurance in this country is the private sector. Why is it that the ineligible, the illegal, and the able-bodied are receiving health care benefits on the back of the taxpayer? So, we talk about these people losing healthcare.
▶ 1:29:00they were not eligible to begin with. So we don't as a business of a government need to be supplying resources and benefits for individuals who do not meet eligibility requirements. Sorry, that's just a fact of government. And if we want our government to default and become everything for everybody, we continue on this track. Look, I've taken care of people that don't have a damn dime in their pocket. And there are resources that I have used out of my own pocket to do it. We can't do that as a country.
▶ 1:29:29So yes, it has to be certain cuts and it has to happen in every single segment. And yes, the top 10% of earners in this country pay 75% of the taxes. Why don't we just make them pay 100%. Then people wouldn't have any argument about it. Then you kill the the inabil or you kill the incentive actually to work harder. It's called government. It's called accountability.
▶ 1:29:49And I for one am damn glad that we finally have an administration over Republican and Democrat administrations for years prior that actually cares about the future of this country by putting our pocketbook and our wallet in the right place and stop spending money on things that people are not eligible for. Thank you, Mr. Chairman. I'll yield back. Thank you, Mr. Hearn. You're recognized. Thank you, Mr. Chairman. Thank the witnesses for being here today and for sharing your your thoughts on this really incredible topic.
▶ 1:30:17We should all be supporting and employing new types of technology in the health care space and it's a great sign that we're talking about this in the halls of Congress. Uh I'm particularly interested in digital therapeutics FDA authorized evidence-based software that delivers clinical intervention used to treat conditions like PTSD and veterans insomnia and chronic disease. These are great tools that are often paired with teleaalth and remote monitoring to offer personalized continuous care.
▶ 1:30:46That's why I introduced HR 3288, the access to prescription digital therapeutics act to provide coverage for these new health technologies that can help PTSD and veterans and so much more. Uh my colleague on the other side of the aisle, Mike Thompson and I have been champions of this for the last few years, have won awards for this and we really uh we need to work in a bipartisan manner to continue to move this. This is not something that we should be politicizing. This is something we should work together on.
▶ 1:31:14Uh, unfortunately in this day and age, so many things are politicized and the American people are sick of it and I'm sure you all are as well. Mr. Zenowski, how I got close on that. Uh, I appreciate you educating us on the landscape surrounding technology enabled care and just I'm going to run these two questions together. So, can you tell us how these technology enabled devices, especially those that can be used at home, affect patient adherence to treatment and how does this affect our health outcomes?
▶ 1:31:44Thank you for the question and excellent pronunciation of my last name. Thank you. Uh so your two questions, how does how do these devices impact adherence to the treatment program uh for for patients on a remote monitoring program? And uh Dr. Murphy made a point that I think is relevant to your question.
▶ 1:32:07So in addition to providing one or more devices to a patient, we are also monitoring the data coming back from those devices in real time. So my company employs approximately 150 licensed vocational nurses, nurse practitioners, registered nurses, and medical assistants. And so if we see a reading that's out of range, we are contacting the patient. We are discussing first we start with are they experiencing symptoms?
▶ 1:32:32If it's a hypertensive patient and we see an increase in blood pressure, we're asking are they feeling lightheaded? Are they having neurological symptoms and making a determination? Do they need to go to the emergency room right now or is this an issue we can triage and address? Uh immediately after determining asking the questions around symptoms, we're talking about causes. So, did you take your medication or not? And a colleague of mine on the remote monitoring leadership council, uh, Healthn Snap, they had a patient, a great example, patient that was struggling to take their medication.
▶ 1:33:02And what what Health Snap ultimately found out was the patient, an elderly patient could not open their pill bottle and was struggling to open their pill bottle. And so the the nurse contacted the pharmacy and got easy open pill bottles for this patient filled so this patient could now actually take their medication.
▶ 1:33:20And so in addition to having the data, seeing the data, and the data encouraging the behaviors we want, both medication adherence, but also lifestyle change adherence, the intervention of the the the clinical staff that work directly with these patients drives compliance with the treatment protocols. Thank you. Uh Mr. Phelps, uh myself being a business guy for over 35 years, I really appreciate your concern for your employees.
▶ 1:33:44Uh there's nothing more important contrary to what uh someone on the other side of the aisle might say about business owners that there's nothing more important about your business than the people who work in your business and work alongside you to make you successful and to help them become successful as well. Applaud uh your ideas about how you get health care and better health outcomes for your employees. As Mr. Kelly said, there's nothing more important to a business than making sure everybody has a part of the success.
▶ 1:34:10Could you um could you talk to us about the barriers that you originally faced when you wanted to switch to this type of of model that you expressed to us in your testimony? Really, the only barriers are um just your own willingness to be able to just dive in as an employer and spend the time and resources to make it happen. The the problem is there's no incentive on the other side to do that. There's no incentive from the insurance companies to offer a program. Believe me, I've asked uh hey, we're doing this really unique, interesting program.
▶ 1:34:40And the answer is usually, well, all you got to do is go on our website and click these buttons and you get $200 off your deductible. And to me, I just immediately knew that was not the way I was going to go. So, it was just a motivation on on that part. Um, from a policy perspective, the only thing I could think that we the tools are already out there in my in my estimation. HSAs, I think, are one of the most underutilized tools that we have. But there's so many restrictions on uh the way that monies in HSAs can be spent.
▶ 1:35:07Um these devices we're all talking about, why can't I use my HSA money to buy a Whoop or an order ring? Um that that would make a lot of sense to me to be able to allow employer employees and participants to do that kind of thing. So, I think the tools are already there. I don't know that we need anything new. I think we need to just recognize the tools we have. maybe ease some of the restrictions that we have on those types of pre-tax dollars that employees have access to.
▶ 1:35:30And maybe if the insurance companies could find a way to recognize that employers that are being innovative and creative and invest in investing in the health of their employees uh might have an opportunity for some sort of relief on their premiums be nice. Thank you, Mr. Chairman. I go back. Mr. Davis, you're Thank you, Mr. Chairman, and let me thank all of our witnesses.
▶ 1:35:51Uh let me just state from the offset that I am a strong supporter of telea medicine and tella health both are very valuable and greatly used when I read the title of this hearing health at your fingertips harnessing the power of digital health data I couldn't help but remember a book titled 1984 by George Orwell well with a
▶ 1:36:21slogan in the book which said big brother is watching you. This phrase has become synonymous with the idea of excessive government surveillance of people.
▶ 1:36:36Collecting health data on people is always subject to questions about privacy rights with respect to knowing how the data is being used and what type of monitoring and tracking people will be subjected to.
▶ 1:36:54For example, the Department of Government Efficiency has been allowed to access federal data and share information without any explanations, or oversight to Congress and the American people.
▶ 1:37:12And I'd also have to ask the question, how would people with no insurance afford to pay for digital health Professor Klette, let me thank you for joining us and for sharing your I think we can agree and I certainly believe that health care is an in the quality of life for all people and not
▶ 1:37:42just an expenditure that we look at and wonder whether or not we ought to be paying it. As Congress debates cutting more than $1.5 trillion dollars in spending from our safety net programs such as disproportionate share hospitals, federally qualified health centers, Medicaid, Medicare, changes to the Affordable Care Act,
▶ 1:38:12and providing premium health tax credits for those who purchase insurance through our marketplace with 16 million American Americans being purged. My question really becomes, how will these cuts and changes impact the health status of individuals who need these services?
▶ 1:38:38And what impact will they have on our overall economy? as we look from both our own national perspective as well as globally. Thank you for the question, Congressman Davis.
▶ 1:38:57Um, so first of all, I just want to address um this question of eligibility that has been raised um and whether or not um the bill would affect people who are eligible for health coverage programs. Um I'll just give one example. Um, the state of Arkansas implemented work requirements in its Medicaid program.
▶ 1:39:19A study found that 27% of people lost their Medicaid coverage despite survey data showing that only 4% were actually ineligible under the work requirement rules. That means that as many as 85% of the people who lost insurance coverage were actually eligible for that coverage. they just got tied up in the red tape that was required of them to prove their eligibility.
▶ 1:39:49Um, so does three primary things to take healthcare away from people. Number one, it makes people ineligible for the coverage even though they are eligible and this includes people who are legally present in this country and are hardworking taxpaying people. Um secondly, it increases the paperwork they have to go through to get that coverage uh tying them up in a maze of red tape before they can access it.
▶ 1:40:20Thirdly, for people who are able to navigate that maze and maintain their insurance coverage, they have to they they have to face higher premiums and higher cost sharing um to access health care services.
▶ 1:40:33So when people are um facing these kinds of barriers, they don't get the care they need, they delay the care they need, they have worse health outcomes, they show up in the emergency room, which as we've talked about today is far more expensive than trying to prevent or amilarate the condition um on an ongoing basis and that just raises costs for everyone. Thank you very much, Mr. Chairman. I y Thank you. Mrs. Mrs. Miller, if you're recognized.
▶ 1:41:03Thank you, Chairman Buchanan and Ranking Member Dogget, and thank all of you all for being here today. The majority of my work in the health care space is really focused on ensuring a robust patient access to care, particularly for rural patients. In my district, many of the patients have to travel hours, like even five hours, to see a physician or a specialist.
▶ 1:41:2970% of the people in West Virginia have at least one chronic disease. This leaves the vast majority of our patients in my state with some really tough decisions to make on how they can manage their health care. So many patients actually don't even seek it as much as they really need to because of transportation or the cost or inability to even take the day off from work.
▶ 1:41:57Wearable devices seem to me to be a very good solution to some of these problems. If a patient can have a device tracking their vitals, their glucose levels or their heart raced on their wrist or even their finger, they can have some peace of mind about their health because they're very aware of it and they also have a better picture of what it might when it might be time for them to really go to the doctor. Dr. homes.
▶ 1:42:23I'm sure you've worked with many patients to help them get the most out of your company's technology. What are some of the benefits rural patients can see with wearable health devices? And are the patients able to see and share that data from your device with their physician? Yes, we have mechanisms inside the app that allow for really easy sharing with your healthcare provider. I think one really good example um is actually uh pre-term pregnancy research we did with Dr.
▶ 1:42:50Sean Rowan at University of West Virginia Medical where we were able to actually identify a digital biioarker that um can basically diagnose or um alert to potential pre-term birth like preeacclampsia or something like that. Yeah.
▶ 1:43:08Well, there's so what's happening physiologically is is 7 weeks prior to delivery, we were able to notice that there is a sharp increase in one of the metrics that we track, heart rate variability, and a sharp decrease in resting heart rate 7 weeks prior to delivery regardless of gestational age.
▶ 1:43:28So you can imagine a woman in rural West Virginia who sees this inflection point and can then at least call a doctor and say, "Hey, what's going on here?" Um, so that was I think a really neat breakthrough. Um, this uh these data are published in plus one.
▶ 1:43:45Um and uh and and this I think was a really great example of how we can um help in this case women specifically um understand their bodies a bit better and and use the data to uh get ahead of what could be a a serious issue. Wow. Things have changed since the 1980s when I had children.
▶ 1:44:05My constituents take their data privacy very seriously and I think patients being able to share their data with their physician is important but many of them are reluctant to simply give their data like to a device company. Mr. Zen I know I'm going to mess this up. Zenalinowski I did it.
▶ 1:44:25What are some of the common misconceptions about data privacy with wearable technology and how do remote patient monitoring companies which facilitate the exchange of information from the device to the provider ensure patient data is protected? Thank you for the question. I appreciate it. And patient security, patient information security is paramount.
▶ 1:44:46So first just to understand there is a difference between a consumer wearable device and a device you a medical grade FDA cleared device used in in a remote patient monitoring program. We coach Carare sign business associate agreements with all of the practices and hospitals that we work with which make us a covered entity under the under HIPPA regulations. So we are required to follow HIPPA.
▶ 1:45:13I will share with you uh CPT code 99454 reimbures for the technology for remote patient monitoring and the average Medicare reimbursement is approximately $45. We spend $10 per patient on security on IT infrastructure security. So just to give you a sense of the of what we're investing to protect the patient data that we collect. Okay. Thank you. Another issue I take seriously is falls prevention and detection.
▶ 1:45:41In my state and country, people are rapidly aging and unintentional falls are a leading cause of injury and death among seniors. Many seniors don't know that they're at a falls risk and can suffer a fall. So, Dr. Holmes, do you think that wearable technology can help with this issue among seniors? And what types of technologies exist to track balance or falls or alert someone? Dr. Holmes. Dr.
▶ 1:46:10Holmes, I'm so sorry. Can you repeat the question? Oh, it's a long one. I'm so sorry. The technology, how can this help them know that they're going to be at risk for falling? Yeah. I I mean, I think this whole conversation um really needs to go back to prevention. We need to help seniors understand earlier what is going to prevent a fall. You know, we need to get I I think the national conversation has to shift, right? A lot of the things that we're talking about are absolutely preventable.
▶ 1:46:39We just need Americans to understand that they need to lift heavy weights. I And it sounds so simple, but everything that we're talking about here is democratically available and free. It doesn't cost a dime, right? You can do body squats. You can Americans just need to understand that they have the power to take control of their own health. And so I think we need to get that information out there. Okay. Thank you so much. I yield back. Thank you, Mr. Chairman, and the ranking member. Um, thank you all for being here today.
▶ 1:47:09Uh, according to CMS, approaching 60% of Americans uh have at least one chronic disease. And the rapid growth in uh wearables uh and access to remote patient monitoring services, uh has been discussed robustly here allows individuals to lead uh healthier lives uh with increased access to uh vital health information.
▶ 1:47:31uh wearables and RPMs have been shown to improve treatment adherence uh for certain chronic diseases such as diabetes uh and also better inform health care providers of their precise patients needs. These are important advances in patient care uh and in creating health care savings and um as patients and providers utilizing digital data uh have improved chronic disease management and as we all know chronic diseases are a major major cost driver in American healthcare.
▶ 1:48:01Uh Dr. Dr. Ghart uh in your testimony uh you shared that your patients have uh the ability to sync their wearable devices uh to their patient portal my chart uh so their physicians can monitor their daily health data and their daily care. uh can you share more about how um this specific practice has improved patient care um for your patients with chronic diseases and also uh what are the main barriers um that healthcare providers have in adopting the use of these digital tools?
▶ 1:48:34Thank you Congressman for the question. So, a great example of how this has been affecting chronic care is with pre-diabetes and diabetes specifically in rural health areas and and frankly anyone that is interested in understanding their health. Uh you're able to get real time information now that you can share with your clinician that actually helps you be able to understand if you're going to get a disease perhaps even before you get it.
▶ 1:48:59So we have some early work that we recently started uh with Abbott where we are able to in working with them have the continuous glucose monitoring data flow into the EHR first as a PDF but then also as multiple discrete uh pieces of information. And the idea there is not only can I monitor it and monitor trends but also over time I can look at my population health, my family practice and see how my population is doing with their diabetes. Thank you. Thank you. And to follow up on a separate uh question, Dr.
▶ 1:49:29Ghart, um I want to discuss uh uh patient privacy as it relates to these digital devices. Um given how quick uh the development has been and changing in this field, um obviously uh security is a is a major major concern for patients across America, certainly in in our district, in Pennsylvania as well. Uh patient records have become increasingly more vulnerable.
▶ 1:49:50I think that's an obvious um data we have suggests that uh close to 275 million American patient records have been compromised just uh last year alone. uh given these recent developments in wearables and RPMs, um obviously um um if you could, you know, expand on um on the role uh that HIPPA uh has within this conversation of digital health data and what may be the best practices
▶ 1:50:21um adopted to prevent bad actors both uh here and abroad from compromising health records uh to use for nefarious purposes. Yes, thank you for the question. So, it is confusing for patients what happens to their data and we believe that HIPPA should be expanded to cover all entities exchanging health patient patient health data and to the cyber security and security question we can look at both before something happens.
▶ 1:50:48So in epic customers and our health systems, we are looking at what do we do if the system goes down? How can we run downtime? What does it look like to be on paper and so forth? And then also if something is breached, what are the what is the root cause of that breach and how can we get to a place where most quickly patients and their providers can again access their health data. And on that topic, uh Dr.
▶ 1:51:10In Galowski, um as someone who facilitates a transfer of patient data from devices to the providers, um what resources um have you devoted to privacy protections and what have you seen as a best practices in preventing bad actors to access sensitive healthcare records? Well, thank you for the question and first I I do have two great regrets. Um one is I I did not serve in the military and I did not go to med school. I am not a physician. I'm not a doctor.
▶ 1:51:34Um our investment in security is really around so we exchange data with with EHRs such as Epic um and so we are in possession of we collect directly and also receive from EHR's patient data and so we invest uh significantly in preventing those bad actors access to our system.
▶ 1:51:53That includes uh first hiring some of the best and brightest in the engineering space, which is incredibly expensive, but it also includes going out and hiring outside parties to try to penetrate our system. We call them pentests. We do them regularly. That's the that's how we can determine do we have vulnerabilities and how do we fix them? Thank you all. I yield back. Mr. Chairman, Mr. Evans, you're recognized.
▶ 1:52:24Thank you, Mr. Chairman. Thank you, ranking member target for holding this hearing today. Technology can bring a lot of great opportunities for patients and providers and homebased home hospital care using food as medicine and monitoring health care for health risk conditions like strokes. However, many Americans can only have access to these services through Medicare enrollment.
▶ 1:52:55For example, the Pennsylvania Council of Long Living provides teleare through Medicare home carebased services. Medicaid provides elderly disabled Pennians with technology to monitor vital signs to assist Medicare compliance and even to notify emergency expense.
▶ 1:53:17Unfortunately, the Republican budget can take away this lifealtering technology with billions of dollars Medicaid cuts. Americans should be able to benefit from new technology. So, I continue to fight for Medicare. I would like to ask a question to Miss um the name right Miss Colette. Give me a reaction to what I just said and what your thoughts are.
▶ 1:53:49Yeah, certainly. Um and thank you, Congressman Evans. Um, I think the the concern that I have, uh, and I think that many of us have is that HR1, the budget reconciliation bill, by slashing over $1 trillion in, uh, healthc care funds um, from the budget. It's going to result in 16 million people losing health insurance.
▶ 1:54:16It's going to result in people who are on health insurance programs, Medicaid, Medicare, and employer sponsored encourage insurance facing increasing costs. And we know when people lack health insurance, um they uh do not get needed healthcare services, particularly the primary and preventive care that will keep them healthy and um part of the workforce. Um, we also know that when they do ultimately get care, it's often too late.
▶ 1:54:44Um, or the the um condition or disease that they have has gotten to such a point that it's very expensive to Any suggestions that you have relating to what you just said? Um well, my first suggestion would be to go back to the drawing board uh and try again on um a different budget bill that doesn't result in millions of people losing their health insurance.
▶ 1:55:18I'd like to go to Dr. who talked about health care. Can you talk a little bit about you talked about people having the ability to deal with their health care? You mentioned that a little bit earlier. I heard you say that. Yeah. And sorry, what is your question? You just asked the question. I heard you mention about individuals having the ability to deal with the health care. You speak a little bit to that issue. Would you say it?
▶ 1:55:48Yeah. I mean, I think at at the core I think it's really about people understanding how to take control of their own individual health. understanding what are the levers and what are the metrics that you can track to help you understand if you're applying your effort in a way that is improving your health and reducing the chance of chronic disease. And I think my point earlier was that a lot of these behaviors are free.
▶ 1:56:19They are democratically available to all Americans. It's about helping Americans understand how to apply their effort. And I think that's where digital technologies have been so impactful is that they understand they cut through the noise and help people understand how it is they not need to apply their effort with regard to sleep, with regard to circadian alignment, with regard to exercise and movement, right? Reducing stress, right? All of these things that are going to lead eventually to decline.
▶ 1:56:50So, I guess my whole point is that digital technologies help us get upstream of all of this, right? It's going to help prevent falls. It's going to help prevent metabolic and cardiovascular disease, right? If we can help people understand how to how it is they need to apply their effort in using digital health as a companion tool to support them. Like to thank you, Mr. Chairman. Thank you, Mr. Moore. You're recognized. Thank you, Mr.
▶ 1:57:19Chairman, um appreciate this uh conversation today on matters that are, you know, kind of happening now and important to the healthcare community. Uh Mr. Zingals Zengalowski, as you may know, uh seniors wait on an average of five to six years from when the FDA authorizes a breakthrough technology until Medicare covers it.
▶ 1:57:43So the FDA authorizes it and it's five to six years later till it's covered by Medicare. RPM devices like the one in your company's lineup don't require breakthrough designation, but they do need to be cleared by the FDA. Both Presidents Trump and Biden recognize the problem posed by needless delays in establishing Medicare coverage and addressed it through their respective MSIT and TET policies. I'm actually hopeful that the administration chooses to return to its successful MSIT regulations.
▶ 1:58:14We live in really upsetting time uh really exciting times on the cusp of so many new health tech data wellness products coming to the market. Can you speak to what it would mean to patients to remove barriers to access to the latest products, especially regarding CMS coverage and I I sure can.
▶ 1:58:36I mean in many cases it's the difference between life and death and when it's not it's the difference between a high quality of life while managing one or multiple chronic conditions and a very low quality of life. One of the primary benefits to these technologies the technologies you're discussing patients can manage these conditions at home and so what we see there are better outcomes and a better quality of life also of course lower cost.
▶ 1:59:04Um, look, we'll be putting for we're putting forward some legislation and it's it's gone through iterations. Um, my colleague, my former colleague from Cincinnati area had had led it before. Um, this legislation is going to ensure that our most innovative and breakthrough devices have a clear roadmap to Medicare coverage so patients can reap the benefits sooner and so we can encourage this kind of innovation.
▶ 1:59:26the delay between having these two organizations, FDA and Medicare, having such a massive delay, it it's it's it makes no sense to folks back home. They just don't get it. Um five to six years. So, I appreciate the Trump administration's MSID policies. Uh and we're hopeful that they'll be able to quickly advance and get get back to that and we're providing legislation that would that would help codify it. U Dr. Holmes, thank you for being here.
▶ 1:59:56A couple weeks ago, I had an ECG performed in my office just down the hall uh by one of your company's devices. It's incredible to see the progress the market is making in bringing up these once costly procedures to the customer's literal fingertip or um even wrist on the device. Whoop memberships and other wearable devices are eligible for reimbursement through health savings accounts, HSAs.
▶ 2:00:18The House passed several HSA provisions in the uh in our reconciliation process this uh this last month, including expanding eligibility for HSAs to more groups of people like seniors. Do you know what portion of your customers use HSAs to pay for memberships? Would you agree that expanding HSA accessibility could help more people take control of their healthcare? I don't have the number.
▶ 2:00:41Um, but there's no question that more accessibility to these type of technologies is only going to improve the health of American people. So, you know, completely agree that um more access the better. Yeah. I mean, we I I I see it more ubiquitously in in our daily life that people are taking advantage of these types of products. They're seeing value to it. Um they're monitoring their sleep. They're know they're noticing that things that we've intuitively known for a long time.
▶ 2:01:11Yeah. But you just really didn't pay a lot of attention to it are now, you know, literally at their at their fingertips. And um if we're unwilling as legislators to recognize that um there's an enormous cost to an unhealthy lifestyle. Yeah. And if we give up a little bit of cost to expanding HSAs to encourage people to live more healthy lifestyles, we're saving an enormous amount of money. I I I Utah is a unique state.
▶ 2:01:39It it's one of the largest penetrations of HSAs. I think uh uniquely Minnesota is another state. Um there there's no reason for uh states not to recognize and individuals not to recognize the importance of this. It's all about reducing costs overall and HSAs have been a a nucly um important aspect. We've uh we've got a huge opportunity to help more people take control of their health care by expanding this HSA eligibility.
▶ 2:02:07I was disappointed to see that HSAs were excluded in the Senate's first draft of the reconciliation bill and I'm working to ensure these provisions are included in the final version and I yield back. M Tenny, you're recognized. Thank you, Chairman Buchanan. I appreciate it. Thank you to our witnesses. Um, this is uh been just uh just a great topic. I I I have to echo the sentiment. Uh I as a owner of a small business, uh HSAs are terrific for us. We're hoping to advocate to get that added back in the Senate as well.
▶ 2:02:36Uh wonderful options for people to to really control their health care, which I think is one of the big issues that we have now. And I know somebody was referring to earlier about the ability of patients to actually get, you know, pill bottles opened and everything. And I I do remember the day when I was very young and my mother used to say, "Can you open these bottles for me in these jars?" Now I'm at that age. You know, I'm one of those people that, you know, where's my son open the jars and bottles and containers for me?
▶ 2:03:00But, uh, I hate to admit that, but I'm I'm coming I'm heading in on Medicare and, uh, and and and to that, uh, my district in upstate New York is rural and and, uh, we're in crisis with a lot of healthcare. We have a terrible uh state government uh which is concerning and and their their delivery of health care is is confusing and and unfair to patients in many ways. Uh and almost 240,000 people in my district of less than 800,000 are on Medicare.
▶ 2:03:28So Medicare is hugely important and uh that's why we think that uh what you guys are doing in this field uh especially with my rural district and on dealing with uh you know using AI uh to capture data. I mean all these things are really important and uh we really appreciate you know the technology the the rural nature of people can't get to the doctor they need to have some kind of access uh to have a delivery of care and uh you know I love the idea I know Mr.
▶ 2:03:56Phelps, I think believe you mentioned uh you know, HSAs to be able to buy a loop and or a ring. I know this this watch kind of controls my life. It tells me when to stand and tells me I'm not at my move goal yet. And uh you know, for some sometimes it's annoying, but it probably does make me do more. And I think about taking the stairs instead of the elevator. So, I think all these things are are good personal devices to get people focused on their own health care and and the importance of taking their own healthcare back. And I think that's a mission of the chairman is always is trying to get everyone healthier.
▶ 2:04:25he's always got great uh wonderful people coming to talk about health and uh so I wanted to may maybe give my first question to Dr. Ghart and uh I you know Epic obviously is an industry leader in electronic health records um can you just tell us real briefly what Epic is doing to ensure the true of these p these products that patients can get the data that they need and and get it without uh the barrier to the information sharing. How is that something that you deal with on this access point?
▶ 2:04:56Yes, thank you for the question. Our customers and their patients have access to over 750 apps using Epics's publicly available. Wait, that sounds like a lot of apps. I don't know if I can handle all that. Last year, our customers used our software to respond to over 111 billion interoperability calls with thirdparty apps. So, even more. Oh, wow. That's incredible. So, are you I mean, obviously the I see the benefit.
▶ 2:05:21Do you think your patients are seeing the benefit in the ability to access these apps and being able to deal with their own personal health issues and they're capable of doing that as well? Some patients may not have that same type of aptitude for it. Yes, thank you for the question. Yes, absolutely. They are finding value from it and so is the health system. We're able to manage manage population health at levels that we haven't been able to before. And that's something I I think doctors are also happy with this in rural areas. I've I've heard this uh from an anecdotal basis. You could say that from a maybe more empirical basis.
▶ 2:05:51Yes, correct. Family physicians especially, we struggle to be able to uh provide care to large populations. So, being able to have access to information and remote patient monitoring is very helpful. So, quickly, I'm running out of time, but uh let me see if I can do the Is that good? Uh you mentioned your testimony that Coach Care works with providers across the country.
▶ 2:06:11How has your company ensured that remote patient monitoring services are accessible to patients served by small rural hospitals or independent practices, especially not too many left in our area, but those that are left in places like rural upstate New York around the country, you dealing with broadband gaps, uh, you know, we have workforce shortages, we have financial constraints. This stuff is really real. How how does your your your product uh help us in that way? Absolutely. It's it's a great question.
▶ 2:06:38uh and we work primarily with independently owned and operated family pract practitioners. Um one of the main challenges they face in delivering a service like remote patient monitoring or managing chronic conditions across a broad population is they don't is staffing shortages. It is very difficult to to hire and retain NPs, RNs, MAS. And so that is a service we provide alongside the the hardware and software to collect the data. We actually are that first line of defense that triage.
▶ 2:07:06And so the the physician really only has to focus on the 10% of patients that are struggling versus 100%. And the real quick question as I'm running out of time, how can Congress and uh the Centers for Medical, how can CMS help us? What can we do as a as a as an entity to help make this happen in Congress with laws or regulations to help the the rural practitioners pass Representative Kustaf's bill HR 3108? U CMS encourage them to stop the astounding and continued cuts to reimbursement rates for remote patient monitoring. Great. Thanks so much.
▶ 2:07:36I yield back. Thank you, Mr. Horster. Thank you, uh, to Chairman Buchanan and to the ranking member. Uh, good morning to our witnesses. Uh, we really appreciate your testimony. And uh while I'm all for digital health and data and these tools and technology driving people's uh opportunity to improve their health, I I have to say that I feel like I'm a bit in the Twilight Zone.
▶ 2:08:05Uh because at the same time we're here talking about this issue, uh my colleagues on the other side just passed a bill that would effectively take away health care for 16 million Americans. um people who are on the brink of losing their health care coverage when premiums soar, when millions face crutching out-of-pocket cost, all because we want to give tax breaks uh to billionaires.
▶ 2:08:33The truth is it doesn't matter how much cutting edge our health care technologies become if working families cannot afford to access them. We're very privileged here. We can talk about our devices. I've got mine, but that's not the majority of the folks that I'm here to represent, and I've got to make sure that their voices are heard as well.
▶ 2:08:53In fact, Miss Corlette, you put it best in your testimony when you said uh that today's healthc care policy uh hearing is quote akin to Marie Antuinette telling the people of France to eat This hearing feels like a distraction, an attempt to shift focus away from the devastating impact of the big, beautiful bill that's making its way through the Senate, which guts the health care system to
▶ 2:09:24fund tax cuts for billionaires. According to the Congressional Budget Office, if this bill is enacted as currently written, 16 million people will lose their health care insurance. This is in part because of the Medicaid cuts, the failure to extend the enhanced premium tax credits, and other attacks to the affordable care marketplace.
▶ 2:09:49The Urban Institute found that the one big beautiful bill will slash provider revenues by over $1 trillion in the next decade. In Nevada, total healthc care spending would drop by $4.4 billion alone. And as revenues drop, the cost of uncompensated care will explode upwards of $283 billion including $2.5 billion in Nevada.
▶ 2:10:20Last week, I hosted a round table with healthc care leaders from across my district to discuss these cuts and the impact that they would have on my constituents. Mr. Craig McCoy, the chief executive officer of Centennial Hills Hospital, made a powerful point when he said that the biggest misconception of the big beautiful bill is that people with private insurance think that it won't affect them. The truth is these cuts hurt them, too.
▶ 2:10:50Cuts to Medicaid and the Affordable Care Act will increase uncompensated care, strain providers, and ultimately raise costs for everyone. The bottom line, hospitals will close in rural Nevada and rural America as well is as as well as in cities. Pro providers will shut down. Services will be scaled back.
▶ 2:11:13I have a rural community in Perump that ha does not have a birthing center and limited OBGYn services. So, Miss Carlet, in your written testimony, you outlined the various impacts of the one big beautiful bill on healthcare access and affordability. Can you outline for for those who are listening the impact of the various health care cuts to the health care system at large and what changes should patients expect?
▶ 2:11:44Yeah, thank you for the question and I I think we've talked a fair amount about the numbers of people who are going to lose uh health insurance under this bill, but I want to thank you for also talking about what it will mean for healthc care providers and for the broader population that they serve. Um, this bill reduces provider revenue by 1.03 trillion over the 10-year budget window. 40% of that decline is attributable to hospitals and 11% to physician services.
▶ 2:12:12Um providers will also face a $278 billion increase in uncompensated care costs. And that doesn't even account for the Medicare or sequestration that we talked about. Um when providers have a big increase in uncompensated care costs, they have to look for other ways to raise revenue. They're going to look to their commercially insured population. These are people with employer sponsored insurance um and and other forms of commercial insurance.
▶ 2:12:41um and they are going to demand higher reimbursement rates um when they can or they will consolidate or they will close or they will shut down service lines. Those are really the options. So, it's higher costs for those of us with employer sponsored insurance and it means that particularly in rural and underserved areas, you're going to see reduced um reduced access to to care. Yeah, Mr. Kustoff, you're recognized. Thank you, Mr. Chairman.
▶ 2:13:12Thank you for holding today's hearing and thank you to the witnesses. Mr. uh Zill Zingosski, close enough. Fair enough. Close enough. Uh first of all, thank you for your uh testimony about my bill. I think your testimony has been brilliant all day. So, thank you. If I could follow up on on that bill. So, the the the bill is the uh Rural Patient Monitoring Access Act. to your point is HR 3108.
▶ 2:13:43It is bipartisan. Can I can say it as a member of Congress, but if you could in in practical terms, can you talk about why the legislation is important and necessary? I sure can. And it's not complicated. CMS adjusts reimbursement rates for the same services based on on geographies.
▶ 2:14:08And so rural districts tend to receive fewer dollars for the same services from Medicare and Medicaid than for example a practitioner in San Francisco who may be paid 30 or 40% more than a practitioner in rural Nevada. Um in this case the services that we provide remote patient monitoring services cost approximately the same wherever we deliver them.
▶ 2:14:35We I mentioned before we employ approximately 150 nurses and they live in approximately 35 different states. Uh we don't employ them in very high cost of living areas generally. U but the and we provide the same technology to patients whether they're in New York City or whether they're in rural West Texas.
▶ 2:14:55So, if you're a physician in New York City, is it fair to say that he or she may be dissuaded from treating a patient in rural Idaho versus New York or San Francisco or Chicago? I would I would say the issue is probably bigger than that.
▶ 2:15:14If you're a physician in rural Iowa or like I said, West Texas, you're facing a decision right now of do I even consider offering remote patient monitoring to my patients or not? Because where the adjusted rate is so low, it's a it's a no margin service for for independently owned and operated physicians. And so they're faced with a very difficult decision. Those practices cannot afford to subsidize health care for their patients.
▶ 2:15:42And so they're really fighting a a a difficult situation. So you would encourage Republican and Democratic members to support this legislation wholeheartedly. Thank you very much. I appreciate your response. Dr. Hehart, if I if I could with you, you uh mentioned in your testimony about the glucose monitoring devices, the CGM devices.
▶ 2:16:05There was an article in the past few weeks in the Wall Street Journal uh by one of their technology reporters here. Here's the headline. A glucose monitor for someone without diabetes, optimal or overkill. Do you have any thoughts about people using glucose monitors who either may not be diabetic, may not be pre-diabetic, but want to keep up with their health?
▶ 2:16:35Yes, thank you for the question. As a practicing family medicine physician, I focus very highly on preventive care. And one of the things that individuals can do the best to help prevent something from happening is by understanding their bodies and their data better. And so when it comes to continuous glucose monitoring, when patients use it, I want to see what they plan to do with the results. If they plan to take the results and bring it to one of their physicians to help them manage perhaps pre-diabetes for example, then that's a win.
▶ 2:17:04Or if they bring it to say their ger and they decide what they want to have for food or change their exercise for example, again that's a win. So really anything that's allowing change for behavior that will then prevent disease. What if someone is not the article talks about this somebody's not pre-diabetic but they're interested in uh when their when their uh blood sugar spikes because of certain foods they eat or certain times a day.
▶ 2:17:33Is that is that beneficial or is it overkill? It's a good question. It's on the spectrum. On one end of the spectrum, people come in for medical care for diabetes, which is a diagnosible disease. And then on the other spec end of the spectrum, there is how are you going to live your life to the healthiest that you can and what empowers you to do so? And diabetes, pre-diabetes or no diabetes, if that device allows you to help inform you and educate you as a patient to be able to better take care of yourself, then I think it's worth it.
▶ 2:18:02Thank you very much, Mr. Chairman. I'll yield back. Mr. Su Stwie, you're recognized. Thank you, Mr. Chairman. Uh, as someone who represents a large number of rural Flidians, veterans, and seniors, I recognize the importance of innovative tools that can improve health outcomes if they are accessible, secure, and don't add new burdens. Digital health has great potential, but it won't mean much if it's out of reach for rural providers or puts patient privacy at risk.
▶ 2:18:25As we explore remote monitoring, AI, and wearable tech, we must ensure our small clinics and rural hospitals aren't left behind, and that patient data is treated as sacred, not a commodity. Mr. Phelps, I'll start with you. What lessons would you share with other small businesses who are hesitant to adopt wellness or wearable Again, I just would go back to my earlier remarks that it's a vital uh it's a vital conversation to have with your employees.
▶ 2:18:52If you want to find ways for them to not burn their time from being sick, but rather than use that time when they're scheduled to be on vacation or spending time with their families, then this is a conversation to have. If you want to make sure that when you're trying to meet deadlines for your um or deadlines for a new client or things like that, but your employees are out because they're sick or they're missing extra time, not feeling well, um then it's a conversation worth having.
▶ 2:19:18The return on that investment, it's really hard to measure in real dollars, but it is is very real and it's very critical. And it's another part of it is just building culture. You know, in our in our business, one of the neatest things about our whole initiative has been the conversations that we never would have had with our employees that we now are having. You ribbing each other about what you packed for lunch or uh what you're bringing. Did you get your steps in today? Hey, we we got a competition coming starting next month. We in our marketplace, we got four businesses competing for a step contest.
▶ 2:19:47And we're already contacting each other through Facebook and everything else, starting to give each other a hard time about how bad they're going to lose and how they're going to have to buy us lunch. So I mean it's just this this whole different ecosystem is starting to come out of this whole program that I never expected that is just something that uh never would have happened if we hadn't taken those first initial steps. Thank you Dr. Holmes. Uh wearable tech is largely underused by seniors. I represent the largest senior district in the country um and in those rural areas.
▶ 2:20:16What can be done to improve adoption across those populations? Yeah, my dad lives in Fort Pierce, Florida. And um and of course he has me uh to help him understand the the the power of of monitoring data. Um but I think I mean a lot of it is just education and and making um these technologies feel less intimidating.
▶ 2:20:36Um, so I think it, you know, it's kind of boots on the ground, you know, um, getting going to where the seniors are and um, and holding sessions where we can educate seniors on on how to use these technologies and how to think about the behaviors that we know are going to really move the needle um, with regard to uh, their health. Um, you know, when we think about just the cumulative lifestyle exposures of things like alcohol, for example, right?
▶ 2:21:02um you know if you want to increase the base of your aging and make yourself v more vulnerable drink alcohol right I mean there's a lot of simple things again that are free that our seniors can be adopting to improve their situation um so I think it starts with a national conversation that hits every single age demographic on the levers that we know are most powerful and I I will say that you know folks on our platform when um we see decreases in alcoh alcohol by 89%.
▶ 2:21:33And that's not us shouting at at at our members. It it's them seeing the impact alcohol has on their physiological data, on their sleep. I mean, my dad is some, you know, he's drank wine his whole life and and you know, now he has maybe a glass of wine a week, right? And that's not because anyone told him not to drink wine, but it's seeing the data has made all the difference in the world.
▶ 2:21:54So, I think that's really um the power and I think we need to as a country normalize these conversations in our workplaces with our That's how we're going to make change. Thank you, Dr. Ghart. Um many Florida providers, especially in rural and underserved areas, struggle with the cost and integration of electronic health records.
▶ 2:22:16Uh what actions can the federal government take to help improve update of electronic health record software among smaller struggling Thank you for the question. In small and rural health communities, one of the ways that Epic helps to challenge this is by creating a a program called Community Connect. It's one of the ways that we can extend our software from one of the other customers to the community around us.
▶ 2:22:40And our key at Epic is to try to innovate to allow for our clinicians and our patients to be able to take the best care of their of their patients and their the rest of their population. So the goal really that I'm here to talk about today is the innovations that Epic provides to the community. My time is almost expired. I think I'm the last person on the dis. So I want to thank each of you for being here today and uh thank you for your time. I yield back. Miss Sanchez.
▶ 2:23:11Thank you, Mr. Chairman. Um, it's no surprise, I think, that the Republicans are once again attempting to distract the American people while conveniently ignoring the 16 million people that are about to lose their healthcare coverage. Um, and although we heard some misinformation on the other side about it's it's all illegals, most the vast majority of the people that will lose their health insurance are eligible for that health insurance.
▶ 2:23:39Um, don't get me wrong, uh, I appreciate this hearing because there are numerous benefits to tracking your physical activity level, your heart rate, your sleep patterns, and sharing that data with your doctor. Um, but there's, you know, the house is on fire and we're talking about holes in the in the window screens right now. Um, Dr. Ghart, I want to thank you for your testimony today.
▶ 2:24:04Um, we've heard a lot um about people's data and keeping it secure. You stated that we need policies to manage the risk of patients unknowingly losing control of their own data, especially to actors that are not covered under HIPPA. Who are some of the other actors that you referred to in your testimony, and what are they doing with that data? Yes, thank you for the question.
▶ 2:24:32We've seen class action lawsuits from law firms accessing patient data claiming to be physicians treating patients, but instead they're using data to recruit patients for lawsuits. Law firms are not covered by HIPPA, so there are no consequences to them. That's one example. Are there others? Yes. Oftentimes, patients are very confused about where their data go.
▶ 2:24:56And so as they look across the ecosystem, they will not know whether it's going to a HIPPA defined entity or not unless that's disclosed by the specific app. So there are many others that aren't covered under HIPPA. So there is the potential for many people to get this very private personal data from folks that are not subject to confidentiality. Thank you. Um as we know, Secretary Kennedy yesterday stated that he wants everybody wearing a wearable within four years. Um, Mr.
▶ 2:25:26Chairman, I would like to submit a Financial Times article into the record with details the members of the Trump administration who have ties to the wearable business, many of whom coincidentally saw their stock shares jump up in price yesterday after Mr. Kennedy made those statements. Without objection, so ordered. Thank you.
▶ 2:25:46And I think, you know, if the government wants us all wearing wearables, we should all take take note that both the CDC and HHS are integrating their data storage to Palunteer's platform. Dr. Gart, is a company like Palunteer covered under Thank you for the question.
▶ 2:26:07Palanteer may be operating under a business agreement that I'm not specifically aware of, but really the most egregious situation that we've seen so far are those class action lawsuits where law firms try to recruit potential uh but that wasn't the question. My question was is it subject to HIPPA? It's a business. Is it subject to HIPPA? Yes or no? We'll do as an answer. To my knowledge, HIPPA covers only HIPPA defined entities.
▶ 2:26:34And what I know of Palanteer, I don't know that they provide specific HIPPA covered entities, but that's not my answer. I believe the answer is no. Thank you. Um, it's very important that we protect patient data under federal law in the way that it is currently protected with any health care provider or health plan so that businesses can't do an end run around that.
▶ 2:26:56Um, on the innovation side, while wearable technologies can detect arrhythmias, monitor hypertension, and detect anxiety, I don't think that that data is really worth much if you don't have health insurance. How is a woman whose insurance coverage premium increases by $500 going to manage her through fertility and menstrual cycle cycle tracking, for example?
▶ 2:27:22Or how is someone who is kicked off their Medicaid coverage going to manage his diabetes solely by monitoring his glucose level or reaching his step goal if he has no access to insulin? I think it's innately um that while we are slashing health care for millions of people, we are talking about the health benefits of of wearables.
▶ 2:27:45Um, the expansion of the Affordable Care Act's premium tax credits reduced premiums for plans to $10 or less per month for four out of five people in the market place. U, Miss Colette, would failing to renew these tax credits and cutting Medicaid increase our uninsured rate? A simple yes or no answer will do. Yes, it would. Yes, it would. Thank you.
▶ 2:28:09And what effect does a higher uninsured rate have on our health care system in terms of Ultimately, it increases costs because these are folks who still need health care um but they'll wait uh to get healthcare services often until the disease condition is progressed to a state that it's very expensive to treat. And if they go to say the emergency room because they've waited until they've gotten so sick and they don't have health insurance, who ends up paying for that care?
▶ 2:28:38uh taxpayers, uh commercially insured people, uh and and hospitals and other providers that have to eat the uncompensated care costs. Thank you. I appreciate all of you for being here and I appreciate your testimony today. I yield back, Mr. Chairman. Mr. Byer, you're recognized. Mr. Chairman, thank you very much. Uh thank you for staying. Um, one of the great promises to me of of the digital health data is reducing the rate of medical misdiagnosis.
▶ 2:29:08Uh, we have various bills out there addressing it, bipartisan bills that talk about 10,000 unnecessary deaths a year, uh, maybe up to 10 billion dollars in lost revenue. And everyone I know has a friend or family member who's dealt with a delay and get a diagnosis.
▶ 2:29:25side constituent case a month ago a woman who'd been diagnosed with ALS and was preparing for the end of her life and six months into the diagnosis they ran different numbers and found out she did actually didn't have ALS and and she's not going to die. Um studies have found that um something like 12 million Americans annually um are have some kind of misdiagnosis since breakdowns of communication coordinating care other problems in the health care system.
▶ 2:29:54Um but at the end of the day you can't get a diagnosis in the first place or apply digital health technologies to patient care if they can't get health care in the first place which is the big concern we have right now about um the bill that's in the Senate. Professor Corlette, the nonpartisan career survey office found that um the budget bill right now that we just passed in the House found that 16 million Americans roughly will be kicked off the health insurance.
▶ 2:30:21I talked to Frank Palone, the ranking member on energy and commerce this morning said 8 million will lose it because the because of Medicaid, the new rules, another 8 million because the advanced tax premiums, the credits for the Affordable Care Act will go away. Um, I've had every rural hospital in Virginia come to visit me saying their hospital's going to close.
▶ 2:30:43I do want to submit a record record for the r record a letter from the Virginia Health Hospital Association talking about the devastating health cuts, but professor, I'd love to know from your perspective from academia, what's it going to mean for Americans if this goes through? Um, thank you, Congressman Byer, and as your constituent, it's um, great to be before you today. Um you're absolutely right.
▶ 2:31:08Um the Congressional Budget Office has projected that this bill combined with the expiration of enhanced premium tax credits will result in 16 million people um the vast majority of them eligible for health coverage programs um losing their health insurance.
▶ 2:31:24I think what is less talked about uh is how difficult it will be for people to maintain the health insurance that they do have because of the thicket of red tape um that this bill creates um for people to try to maintain their eligibility. Um it's that shoe box full of documents you're going to have to bring and upload and go through hours of red tape to try to maintain your coverage.
▶ 2:31:48It also increases the outofpocket costs that people have when they try to access healthcare services, whether that's through deductibles or other forms of cost sharing. Yeah, thank you very much. You know, one of my favorite agencies is ARC, the Agency for Health Care Research and Quality because there's they're the poster child for federal efficiency in government. And one of their examples of their work um is hospitalacquired conditions is eliminating the unnecessary and costly expense there.
▶ 2:32:16But unfortunately, this is one of the big targets of Doge and it got gutted. They rifted apparently many of the people the office of chief information officer. Um they tried to outsource IT services but then realized that they couldn't outcharge the people in charge detect policy and cyber security. Dr. Ghart, I turn to you in your testimony. You talk about interoperability and ARC has long been one of the key agencies to help support and advance EHR adoption and the interoperability needs.
▶ 2:32:46Can you talk to why it's so important to have individuals in the administration who are experts at the interoperability Yes, thank you for the question. We at Epic also consider ourselves experts in interoperability and we find that interoperability, speaking as a family medicine physician, is key for me having all of the data that I need to be able to make the right information and the right decision on my patient.
▶ 2:33:08So, it's critical that we have good and my family physicians keep retiring on me and the whole notion of being able to carry those records forward um and understand what happened 10 years ago and 25 years ago seems seems critical. Um, but Professor Corlette, how might the federal workforce firings, the funding cuts, the hiring freeze affect our future workforce?
▶ 2:33:36I think we're in the middle of a massive loss, a generation loss of um, public servants. Um, and we talked earlier about the massive cuts to NIH and FDA are going to have a direct impact on some of the very innovative and exciting technologies that we're talking about. Um, because um, there won't be that bench research that gets us to this place and there won't be the process the the speed to market with respect to FDA Thank you very much.
▶ 2:34:07And Mr. Chair, I yield back. Thank you. Uh, I want to thank everybody, but way I look at it, we're spending5 trillion dollars, and that number just goes like that. And we're getting sicker every year. We're 66 in the world. Our children at 20% obesity. Used to be 3%. Can't serve in the service because 31% of the folks that would like to get in can't get in. They're obese.
▶ 2:34:36Seniors are a lot of people are obese. 50% the population. I'm just looking at the raw data. We've got to start taking more responsibility. You got to encourage more people if they can to be CEO of their own life. It's not their problem. Many ways it's not it's everybody's problem and as a community we want to look after each other. I remember someone told me stuck with me that's why I'm such think about prevention.
▶ 2:35:03But he said that 50% of the pe people that have their first heart attack never see the next day. Whether that's right or wrong, I don't know. But he was very legitimate. Said that number and it just stuck in my mind. I don't like those odds. And you know, I know everybody's on yo-yo diets. I've been on them and all that, but I found a system 10, 15, 20 years ago and it was a formula and it made everything very simple for me. glad to give someone the book if they want to get it.
▶ 2:35:32But the bottom line was is an equation. The top of the equation is nutritional food. How nut nutritional is the food you're about to eat? And and that's nobody's problem. That's what I meant because a lot of people don't mean well, but a lot of the food we eat is garbage. It's overprocessed. There's no value to it. And underneath the formula, it's calories. So the essence is make the choices. what is the most nutritional food with the fewest calories?
▶ 2:36:00And if you know what that is and you're able to make those choices, then you never have to worry about your weight or your health in in many ways. Again, that's just my own philosophy. But let me close it out by saying I'd like to thank our witness for appearing before us today. Please be advised that members have two weeks to submit written questions to the rec to the to be answered later in writing. Those questions and your answers will be made part of the formal uh record uh today. With that, the subcommittee stands a