▶ 0:20:52Chair Crapo: This hearing will come to order. Today we meet to consider the nominations of Mr. jim o'neill to serve as deputy secretary of the U.S. to of health and human services and Mr. gary andres to serve as department assistant secretary for legislation. Congratulations on your nominations. Thank you both for meeting with bipartisan members and our staff throughout this process.
▶ 0:21:20Chair Crapo: These conversations have provided us the opportunity to highlight our priorities and learn more about how each of you will approach your roles and hhs. During the hearings for secretary kennedy and centers for medicare and medicaid services administrator, I noted the size and scope of the department as well as the importance of the programs in overseas to millions of americans. It confirmed, you will play an integral part in managing the department, coordinating and communicating across often siloed agencies on capitol hill.
▶ 0:21:53Chair Crapo: In many ways come our health care system reflect a bureaucratic disjointed department. Well intended programs and initiatives can be conflicted, confusing, and in practice ineffective. While this dynamic presents significant challenges, it also offers opportunities for transformative solutions that benefit patients, providers, innovators, and taxpayers. Much like hhs, patients are best served when our health care system functions as a team.
▶ 0:22:25Chair Crapo: Relying on a variety of perspectives and talents to deliver patient centered high-quality outcomes. By rethinking the strategy of late stage care, we can outline the underlying causes of conditions that drive up costs for patients and taxpayers. Having previously served at the department, Mr. o'neill understands the multifaceted nature of the hhs and the importance of internal collaboration to accomplish and shared goals.
▶ 0:22:55Chair Crapo: If confirmed, he will have crosscutting insight into the efforts of each division within the department, allowing him to integrate effective actions and make our health care system more proactive. Mr. andres is a veteran of capitol hill and has a deep understanding of how to implement a successful legislative agenda. I am confident he will be an asset to congress as we seek input on development of legislation and updates on departmental actions.
▶ 0:23:24Chair Crapo: Americans deserve a transparent responsive health care system that empowers consumer choice, drives competition, and spurs innovation, and rewards values. This committee has taken bipartisan steps to achieve these goals by acting to reform our prescription drug supply chain, fix our broken clinician payment system, and expand access to mental health in rural areas, including through telehealth. If confirmed, I look forward to continuing these efforts with each of you.
▶ 0:23:56Chair Crapo: Thank you both for your willingness to serve. I now recognize our ranking member, senator wyden, for his opening remarks.
▶ 0:24:02Sen. Wyden: Thank you very much, Mr. chairman. Mr. chairman and colleagues, it has been 82 days since robert kennedy junior westward and as america's chief health officer -- junior was sworn in as america's chief officer. In my opinion, his tenure has been nothing short of a disaster. The united states is now on track to experience the worst measles outbreak since 1992.
▶ 0:24:29Sen. Wyden: As of friday, there have been 930 five cases reported across 30 states. Two children have died. Yet robert kennedy continues to offer applies and junk science dissuading parents from vaccinating their kids. 96% of the cases are among unvaccinated individuals.
▶ 0:24:53Sen. Wyden: Robert kennedy continues to cherry pick scientific studies, and then he twists them to promote his own viewpoint on issue after issue. From vaccines to fluoride in drinking water. Unfortunately, Mr. o'neill, who has been nominated to serve as Mr.
▶ 0:25:17Sen. Wyden: Kennedy's right-hand man, has been cheering him on every step of the way, including as recently as last week when he told my staff he thought robert kennedy was doing a "good job" on addressing the measles outbreak. I want members of the committee to stop and listen to robert kennedy's own words, words I think that are vile about americans living with autism. I will quote here. "these are kids that will never pay taxes. They will never hold a job. They will never play baseball.
▶ 0:25:48Sen. Wyden: They will never write a poem. They will never go out on a date ." his job is to speak to the american people about their health care. His words matter. When parents of a child with autism hear him say things like that, it matters. I am confident that every member of the committee has met with a family or individual with autism.
▶ 0:26:12Sen. Wyden: The things robert kennedy has said about these americans is not only false, it demonstrates that he views those with autism as somehow being less than a person. This reckless rhetoric also stokes fear. Robert kennedy is talking about a national registry, a national registry for kids with autism.
▶ 0:26:34Sen. Wyden: If you are a parent, what I supposed to think when an individual thinks autism destroys families and wants to create a national registry for their kids? In my view, this is bone chilling behavior from somebody responsible for americans's health and well-being. The consequences are already sadly coming into view.
▶ 0:26:58Sen. Wyden: Parents who think their kids might have autism are scared to seek a diagnosis or treatment out of fear of what this administration might do to them. Democrats on this committee worn the public about -- warned the public about robert kennedy's views and blatant disregard for science.
▶ 0:27:19Sen. Wyden: It is equally clear some republicans on this committee shared those views, but that concern was not great enough to overcome the overwhelming pressure from donald trump and his allies to rush through the nomination. All of that takes place amid a sweeping entry attica people at the department of health and human services. That is where Mr. o'neill is nominated to be deputy secretary. This position amounts to the chief operating officer at the agency.
▶ 0:27:46Sen. Wyden: Let's just kind of added up what is going on over there. Over the past several weeks, health and human services has lost 20,000 workers. That ranges from cancer researchers to those who help seniors access meals on wheels. I was at meals on wheels in portland recently.
▶ 0:28:08Sen. Wyden: We have a wonderful person who says he sees nobody during the week except the person who delivers the meals, but for some reason we will go after meals on wheels with the trump crowd. One fired public health expert put it as we do not know what is killing us. Unsurprisingly, this meekly proposal resulted in critical personnel and essential research getting cut, including national priorities like eliminating lead exposure for kids.
▶ 0:28:39Sen. Wyden: Robert kennedy has set as many as one in five workers at hhs could be reinstated while media reports confirm there are no such plans. Either robert kennedy has no idea what is going on in the agency or he is lying once again. I suspect both are true. Mr. o'neill sounds like, based on what I have learned, that he will be another yes-man for trump and kennedy. It is worth noting Mr.
▶ 0:29:03Sen. Wyden: O'neill's views made him too extreme already once in the trump tenure. Made him too extreme to be confirmed in a position in the fda during donald trump's first term in office. While historically the fda evaluates products for safety and efficacy, Mr. o'neill has said that only safety should be considered.
▶ 0:29:25Sen. Wyden: In effect, the fda with this view would be rubberstamping drug approvals regardless of whether there is evidence that the drugs work. Mr mif Mr. o'neill had his way, americans would be using soothing bombing oils -- balming oils to cure cancers. It is in center focus now.
▶ 0:29:53Sen. Wyden: That is because republican's are finalizing their plans to cut hundreds of billions of dollars from medicaid. That would terminate health insurance and medicaid benefits for millions of americans, including kids and seniors. Let me wrap up by touching on the nomination of gary andres. He has been nominated to be congressional liaison to hhs.
▶ 0:30:14Sen. Wyden: Since donald trump's inauguration, senators on this side of the committee dei side of the committee de dais have not received a single response to our inquiries. Not a single one. It seems clear the majority has surrendered any pretense of congressional oversight. In my state and the states of my democratic colleagues, the american people are demanding answers. Robert kennedy promised radical transparency.
▶ 0:30:44Sen. Wyden: Those were his words when he came before the committee. But what the country has received instead is radical secrecy. Mr. andres will be responsible for course corrections on that front. I hope we will hear about a bipartisan commitment that hold him accountable for that. In his current role, Mr.
▶ 0:31:02Sen. Wyden: Andres released house republicans's wish lists of more than $2 trillion in proposed medicaid cuts and hundreds of billions more for programs that help families afford food, energy bills, and childcare. Mr. andres should also answer for this antifamily grab bag of cuts targeting the most vulnerable kids in america. So we have a lot to talk about today. I look forward to it. Mr. chairman, thank you.
▶ 0:31:31Chair Crapo: Thank you, senator wyden. In a moment, Mr. o'neill and Mr. andres will share their opening statements. Before doing so, I will provide a short introduction of both nominees. Mr. o'neill we shall be served as ceo of a research foundation where he led efforts to research and develop regenerative medicine solutions for age-related diseases such as alzheimer's, cancer, and heart disease.
▶ 0:31:57Chair Crapo: He was previously a managing director at a global macro investment fund and was ceo of the thiel foundation. Mr. o'neill also previously served at hhs from 2002 2008, eventually becoming the principal associate deputy secretary. Mr. andres is currently in the republican staff for the house budget committee. Mr.
▶ 0:32:23Chair Crapo: Andres previously served as the republican staff director for the house ways and means committee from 2018 to 2022 and for the house energy and commerce committee from 2011 to 2017. He has also worked in the white house office of legislative affairs and has years of experience in the private sector. Mr. o'neill and Mr.
▶ 0:32:44Chair Crapo: Andres, before you give your opening statements, I will have four obligatory questions we ask all nominees before the senate finance committee. First, is there anything that you are aware of in your background that might present a conflict of interest for the duties of the office to which you have been nominated?
▶ 0:33:03Mr. O'Neill: Note.
▶ 0:33:04Mr. Andres: No.
▶ 0:33:06Chair Crapo: Do you know of any recent personal or otherwise that would prevent you from fully and honorably discharging the responsibilities of the office to which you have been nominated?
▶ 0:33:14Mr. O'Neill: No.
▶ 0:33:16Mr. Andres: No.
▶ 0:33:17Chair Crapo: Third, do you agree with that reservation to respond to any reasonable summons to appear and testify before any duly constituted committee of congress if you are confirmed?
▶ 0:33:27Mr. O'Neill: Yes.
▶ 0:33:28Mr. Andres: Yes.
▶ 0:33:29Chair Crapo: Finally, do you commit to providing a proper response in writing to any questions addressed to you by any senator of this committee?
▶ 0:33:36Mr. O'Neill: Yes.
▶ 0:33:37Mr. Andres: Yes.
▶ 0:33:39Chair Crapo: Thank you very much, and we will begin with you, Mr. o'neill. You may make your opening statement, followed by Mr. andres.
▶ 0:33:46Mr. O'Neill: Good morning. Chairman crapo, ranking member wyden, distinguished members of this committee, thank you for inviting me here before you today. Imagine every american waking up vibrant and energetic, and free of disease. That is president trump's vision to making america healthy again. I am honored to be nominated to help enter it into reality.
▶ 0:34:11Mr. O'Neill: I am also grateful to secretary kennedy for his bold leadership and his trust in my experience to deliver results. My children are in school in california today, but they are why I am here. I want them and every child to inherit a healthier nation. Mr. chairman, I believe that all americans deserve to be healthy, happy and prosperous. Most families try to make other choices, but our food system pushes ultra processed foods.
▶ 0:34:39Mr. O'Neill: Our nutrition advice creates confusion. Our health-care care system is difficult to navigate and prioritizes pills over prevention. They fight through screens instead of looking patients in the eye. Federal policies can break this cycle. If confirmed, I will pursue transparency and ghosted in science and champion healthy lifestyles and prevention so americans can thrive.
▶ 0:35:10Mr. O'Neill: For three decades I have worked to improve health care. As a senate staffer in the 1990's, I helped shape bipartisan reforms including hepa, collaborating with lawmakers. During the bush administration, I had a pleasure of working for six years for thousands -- with thousands of career appointed colleagues.
▶ 0:35:35Mr. O'Neill: I learned a great deal about their responsibilities and structures of each of the operating divisions of the department. As well as how those divisions can best serve the american people and improve their health and welfare. At hhs, I hope congress passed the medicare modernization act. I prepared to help establish the administration for strategic preparedness and response.
▶ 0:36:05Mr. O'Neill: I connected help the policy by visiting allied countries and working with ministers of health. I served in the president's management council and led hhs to earn the highest possible score. Most recently in california, I partnered with entrepreneurs to advance cutting-edge research, technologies, and therapies. This experience has reinforced my conviction the government must not hidden very -- must not hinder but rather support innovators to get results that are better every year. I have seen what happens when you pair the brightest minds with the best tools and data.
▶ 0:36:38Mr. O'Neill: It is bringing that same dynamism to the government. Sadly, america's health is in crisis. Three quarters of americans are overweight or obese, leading to chronic disease like diabetes, high blood pressure, and overtime heart attacks and kidney failure. Diabetes alone costs us $400 billion a year and has exploded in prevalence tenfold since 1960. All ravages our cities and countryside. Addiction and mental health are urgent unsolved problems.
▶ 0:37:11Mr. O'Neill: Since 2000, suicide has increased by 37%. Medicare hospital insurance is headed to insolvency. Families struggle to avoid individual insurance. We spent $4.1 trillion on health care, double the average. Yet our life expectancy is actually shorter than it was in 2010. These are not just numbers. They are a call to action. Overall, what we have been doing is just not working.
▶ 0:37:41Mr. O'Neill: That is why I am so grateful to president trump and secretary kennedy for taking on these challenges and promoting a vision for change. Mr. chairman, we have a century scale opportunity to act. If confirmed, I am eager to rejoin hhs and reform our food system to prioritize health for our children and parents pursue gold standard basic and transitional research that replicates, you science and economics and artificial intelligence to improve the quality and affordability of health care, and its ultimate
▶ 0:38:11Mr. O'Neill: Development and access to lifesaving and health extended treatment. I am ready to work with this committee to make a generational change in our nation's health. I pledge to fight for a future where everybody can enjoy a long, vigorous, and prosperous life. And either forward to your questions.
▶ 0:38:30Chair Crapo: Thank you. Mr. andres.
▶ 0:38:32Mr. Andres: Thank you, chairman crapo and ranking member wyden and members of the finance committee for inviting me before the committee today. I want to first of all express my gratitude to president trump for nominating me to this federal role. I also want to extend my appreciation to secretary kennedy for entrusting me with the responsibility to execute this critical mission. Finally I want to thank my family for their unwavering love and support. I am blessed to have some of them present today.
▶ 0:39:04Mr. Andres: I would like to introduce my wife sue, my partner of 29 years this year, three of my five children, doug, tatum, and joe. My other two children could not join us in person today, but I know they will catch the highlight reel, I hope. Their affection, support, and encouragement have consistently brought me happiness and comfort and joy. I am happy they are here today. Mr. chairman, my entire professional career has involved working in and around the U.S.
▶ 0:39:34Mr. Andres: Congress. I hold immense respect for the legislative branch, and I eagerly anticipate executing innovative approaches to promote transparent and respectful collaboration between these two branches of government. Congress is an institution along with the numerous lawmakers and staff I have worked alongside, also deserve my profound gratitude.
▶ 0:40:03Mr. Andres: They have imparted valuable lessons, shared countless lessons of joy and laughter and offered me unique opportunities to contribute modestly to shaping this great nation's history. Fresh from earning a phd in public policy from the university of illinois in chicago, I arrived in washington as a congressional fellow on capitol hill.
▶ 0:40:24Mr. Andres: What I initially planned as a 12 month stint evolved into a multi-decade career that has allowed me to observe the legislative process from nearly every perspective. I completed two terms in the white house office of legislative affairs, one concentrating on the house of representatives, and another aiding the confirmation process for several cabinet and sub cabinet nominees like me.
▶ 0:40:54Mr. Andres: Additionally, I served as a staff director for three congressional committees, the committee on energy and commerce, the energy on ways and means, and currently the house budget committee. My private sector jobs focused on government affairs, strategic communications, and public policy research. All of these experiences have enriched my understanding and respect for managing interbranch relations and prepared me for this role.
▶ 0:41:24Mr. Andres: The late bryce harlow, who established the first white house office of legislative affairs for president eisenhower, crafted one of my favorite metaphors. He said successful legislative affairs built an ambulatory bridge across a constitutional divide, serving a dual purpose conveying congress's preferences to the white house and administration, and then articulating the white house and administration's positions back
▶ 0:41:54Mr. Andres: To congress. His goal was to nurture a productive, civil, two-way dialogue. And if confirmed, I aspire to emulate this model. I am also passionate about health care reform and eagerly anticipate working on an agenda to make america healthy again.
▶ 0:42:15Mr. Andres: Much of washington's debate centers around what I would term the supply side of health care, tracking the number of providers, coverage levels, health care spending overall. These metrics are all important, and they matter and they warrant our attention. However, equally critical is the demand side of health care.
▶ 0:42:38Mr. Andres: We must prioritize keeping people healthy, emphasizing preventative care, screenings, reducing chronic illnesses, and taking proactive steps to foster wellness. If confirmed, I would pursue these objectives with enthusiasm and vigor.
▶ 0:42:59Mr. Andres: One of your former colleagues, former senator lamar alexander of tennessee, remarked in the final speech that he gave on the senate floor that he arrived at work each day striving to improve america slightly, and he left each night believing that maybe he succeeded.
▶ 0:43:22Mr. Andres: Those aspirational words have inspired me and my approach to this role that I hope to pursue if I am confirmed by the senate. I feel humbled and honored by this nomination. And I respectfully request your vote of support in this committee and on the senate floor. Thank you very much, and I will be glad to answer any questions.
▶ 0:43:42Chair Crapo: Thank you, Mr. andres. I will start with you, Mr. o'neill. I would like to talk about artificial intelligence first. You referred to that in your testimony. Ai provides vast opportunities across all sectors of american society, and that includes health care. Ai enabled innovations can enhance provider clinical decision-making and expand access to health care in rural areas.
▶ 0:44:06Chair Crapo: It can also be helpful in bolstering program committee practices and programs by curbing the waste, fraud, and abuse that harms patients and taxpayers. Mr. o'neill, you are a leader in health care and aging research with valuable experience in working with emerging health technologies. How can congress support the department's efforts to develop and deploy ai tools within the medicare and medicaid programs?
▶ 0:44:30Mr. O'Neill: Thank you for the question, senator. It is true. Artificial intelligence as well as neural nets and other machine learning technologies have an immense potential in improving the delivery of health care and the accuracy and speed of research and the operations of the department. It is something I heard about from many of your colleagues in meetings over the past month.
▶ 0:44:59Mr. O'Neill: So you asked specifically about medicare and medicaid. It is important that all decisions made by cms as well as by other affiliated mds involved in delivering and reimbursing medicare and medicaid are able to make quick and accurate decisions for millions of beneficiaries.
▶ 0:45:21Mr. O'Neill: And I think artificial intelligence always has the potential in helping human actors be faster and make better informed and more objective decisions.
▶ 0:45:30Chair Crapo: Thank you. Mr. andres, I would like to talk to you about timeliness. I suspect you are familiar with the dynamic I am going to describe to you but the secretary of dhs testifies on the budget blueprint. During a tenure, responses were not delivered in a timely manner. The most egregious example occurred last year.
▶ 0:46:01Chair Crapo: The fy 2024 hhs budget hearing took place on march 22, 2023. Answers to members's questions were not submitted for the record, were not received until february 22, 2024. 11 months later. Even more troubling, former secretary becerra was scheduled to testify on president biden's fy 2025 budget blueprint 10 days later in march of 2024.
▶ 0:46:33Chair Crapo: Understanding that hhs staff needs efficient time to prepare clear responses, a year seems to be pretty excessive. Do you commit to responding in a more timely fashion to questions?
▶ 0:46:47Mr. Andres: Senator crapo, thank you for that question. One thing I wanted to add to incontext, as I have got around and met with senator ernst on this committee and with their staff, the concern you are raising has been something I have heard over and over and over again. Number one, I am aware of that, and I am sensitive to it.
▶ 0:47:11Mr. Andres: Number two, I think both from my positions as working as a congressional staffer, I understand the importance of timely responses to congressional inquiries. I also know that from my white house tenure that was something you always heard about from the agencies as well.
▶ 0:47:34Mr. Andres: I do commit I will try to the best of my ability to be as responsive and accountable and timely and transparent as possible.
▶ 0:47:44Chair Crapo: Thank you very much. That question and your response focused on the response to us, to our questions and concerns. I would like to ask about another aspect. Given your extensive experience on capitol hill, how do you plan to continue fostering strong relationships, and I am focusing on this, how would you ensure that our concerns as we raise them are clearly and efficiently communicated to the secretary?
▶ 0:48:11Mr. Andres: So, one of the things I would like to do if confirmed in this position, senator, is be more available and present myself up here on capitol hill.
▶ 0:48:26Mr. Andres: I think a lot of times one of the things I have observed over the years is that in positions like this, you can tend to get pinned down very much inside the department were inside the building and not have the kind of visibility that I think is important to hear what the preferences and needs are of the folks on the hill.
▶ 0:48:50Mr. Andres: That is one way I will try to do that and try to be more present to you and other senators in this committee and the senate overall as well as your staff.
▶ 0:49:00Chair Crapo: Thank you very much. My time has expired.
▶ 0:49:03Sen. Wyden: Thank you very much. Mr. o'neill, let me start with you. Republicans are trying to rush through now the largest cuts to medicaid in history, yet I have been trying to figure out the positions of republicans on medicaid, and I would like to see if you can help us. Your colleagues sitting next to you, Mr.
▶ 0:49:33Sen. Wyden: Andres, signed off on a house budget committee wish list of $2 trillion in cuts. Senator hawley on the floor of the senate joined me in an amendment to strike republican medicaid cuts from their budget. Mehmet oz, who now oversees cms, came before the committee, and he endorsed taking nurses out of nursing homes. That is a medicaid cap.
▶ 0:50:03Sen. Wyden: And donald trump said if her pumpkins in their bill cut medicaid, he would not approve it. He said he would veto it. My friend and seatmate over here said he is not for cutting medicaid. So those are five separate positions with respect to one of the biggest health decisions facing our country in years and years.
▶ 0:50:30Sen. Wyden: Since we are trying to sort all of this out, you would be the nominee for the number two spot at hhs. Why don't you give us a hand? Why don't you tell us what the republican position of these medicaid cuts is? Since I just told you there are five, five separate positions on medicaid. What can you tell us about what the position actually is? Because it is coming up quick.
▶ 0:50:54Mr. O'Neill: Thank you for the question, senator. By the way, I really enjoyed our phone call last week. Thank you for taking the time. You know, not every member of every party always agrees. That is why we have so many wonderful members of this chamber and the other chamber. People are allowed to have their own opinions about the best way to move forward.
▶ 0:51:20Mr. O'Neill: So medicaid was created in the 1960's to serve some vulnerable populations that needed help. It is important to continue to serve those populations.
▶ 0:51:30Sen. Wyden: My time is very short. Why don't you tell me since not answering my question about the five different positions, do you support cutting medicaid? Yes or no?
▶ 0:51:41Mr. O'Neill: Senator, I was not involved in the house proposal.
▶ 0:51:45Sen. Wyden: I asked you about you. Do you support cutting medicaid? Yes or no question?
▶ 0:51:51Mr. O'Neill: Senator, I support focusing medicaid on protecting the most vulnerable populations, the ones that it was created to support in the 1960's.
▶ 0:52:01Sen. Wyden: I am going to move on. Let the record show that I ask you yes or no if you support medicaid and you did not answer. Mr. andres, same question.
▶ 0:52:12Mr. Andres: Senator, I am not sure that that can be entered in a yes or no way. The budget proposal that you referred to originally was really a set of options that were developed by a host of different people, including the congressional budget office.
▶ 0:52:32Sen. Wyden: I understand that, but you want a key position in the health care field. You are going to be shaping health care policy in a very dramatic way so I am try to figure out what you guys actually think because I said there are five separate positions. So why don't you tell me yes or no, are you in favor of cutting medicaid?
▶ 0:52:51Mr. Andres: If you are talking about taking away benefits from the most vulnerable people in this country, the answer would be no.
▶ 0:52:58Sen. Wyden: That is like the argument that was made on the floor of the senate that would open up the prospect for cutting a lot of other medicaid services to a lot of other people. Do you want to enter yes or no for whether you are for cutting medicaid?
▶ 0:53:11Mr. Andres: I thought I just answered that. For cutting the benefits to the most vulnerable, no.
▶ 0:53:20Sen. Wyden: What constitutes a vulnerable person is not decided by law. Question for you, Mr. o'neill, before my time is up. I was recently in medford, and what I had to deal with there is the fact that the headstart benefits for folks there had essentially been frozen, and I had to unfreeze them, so people where ecstatic I was there and we made all of these calls to
▶ 0:53:50Sen. Wyden: The administration for children and families, but they are worried about what is going to happen now because it is not clear that the administration will support headstart in the future. Can you explain to oregon families why your department would be putting those young people, those young families at risk?
▶ 0:54:08Mr. O'Neill: Senator, I don't work at the department. I am not aware of any decision to reduce headstart. If confirmed, I would definitely be involved in any decision like that.
▶ 0:54:24Sen. Wyden: Do you support headstart or not? Are you for cutting that too?
▶ 0:54:29Mr. O'Neill: Senator, I do. I had the pleasure of working at headstart before. There are always ways to make it better and for ways to improve early childhood development through a variety of means. I think those continue to be essential.
▶ 0:54:45Sen. Wyden: I will hold the record open so you can answer my question, yes or no. I am glad you are interested in all kinds of concepts about headstart, but what I saw in medford is the program had been frozen. People were going to get hurt until I stepped in. We got that resolved, but they are still worried. I will hold the record open with respect to the questions I ask you. If you want to enter directly yes or no question, I look forward to it. Thank you.
▶ 0:55:15Chair Crapo: Senator grassley.
▶ 0:55:16Sen. Grassley: I am not going to ask questions. I am going to list some of my priorities for the department of hhs. When I am done, I am going to save some time for you to respond if you want to respond of agreement or disagreement. My first point is something that senator crapo ended with. A key responsibility of each member of congress's oversight.
▶ 0:55:42Sen. Grassley: Oversight allows us to hold bureaucrats accountable to the rule of law and helps keep faith with the taxpayers. I expect hhs to provide timely and complete responses to congressional oversight. Secondly, dealing with pharmacy benefit managers since 2018, I have been working to hold pharmacy benefit managers accountable to lower prescription drug costs.
▶ 0:56:10Sen. Grassley: I expect hhs to work with congress to do the same thing, accountability, hopefully even support legislation that I hope comes out of this committee later on like it did last year. On rural health care, I expect prioritizing health care needs for rural americans, including support for rural hospitals, clinics, rural pharmacies, rural health care workforce, and improving maternal and child health care.
▶ 0:56:40Sen. Grassley: Organ transplant system reform in a bipartisan way. We need confidence that our organ transplant system is efficient and fair. I would like to see hhs fully implement the bill U.S. oregon procurement and transplant network law and do it properly.
▶ 0:57:07Sen. Grassley: This law improves the management of our organ transplant system and establishes some competition. The fifth one would be qualified foster families across the united states. There is a shortage of such families and retention challenges among families that open their homes to children in foster care.
▶ 0:57:32Sen. Grassley: Senator hassan and I have introduced a bill using data to help address this and avoid unacceptable temporary placements of children in settings such as office spaces, hotels, and the like.
▶ 0:57:51Sen. Grassley: I expect hhs to help states address the challenge of recruitment and retention of foster families so the children are not in a place of unacceptable settings. And lastly, improving outcomes for youth aging out of foster care.
▶ 0:58:14Sen. Grassley: In january, the government incredibly office published a report to understand how states are using funding from the john h chafee foster care program for successful transition to adulthood. That is a long name of a program that we have in place. I requested this report after I became aware that some funding was going unused and being returned.
▶ 0:58:42Sen. Grassley: I expect hhs to work with me to build on the successes of programs like chafee to ensure our resources provided are used to effectively support older children in their transition to adulthood. 17 seconds if you want to respond -- one minute and 17 seconds if you want to respond.
▶ 0:59:09Mr. O'Neill: Thank you, senator. If I can say when I worked at hhs under the bush administration, I vividly remember you were always a very consistent voice on congressional oversight of hhs and the whole government. I thank you for that. I think that is an appropriate focus. I look forward to working with you to make sure that all members of congress and their staffs get prompt and consistent and accurate information about the department. I am sure gary would agree with that.
▶ 0:59:38Mr. O'Neill: On foster care, the administration for children and families has a deep response ability to make sure state and other programs related to foster care are ensuring that all foster children have access to good loving families. That is a priority for me, and I look forward to working with them.
▶ 1:00:00Mr. Andres: Senator grassley, thank you for stating those priorities. I know those are consistent with when I met with your staff and they emphasized all of those things as well, so I appreciate you reiterating them. I do know you have a long history of interest in oversight. I look forward to working with you on that. I know there is bipartisan interest on ddm reform. I look forward to working with you on that.
▶ 1:00:31Mr. Andres: I know from speaking with a lot of members of this committee that rural health is a priority for you as well as others, so I look forward to working with you on those things.
▶ 1:00:41Sen. Grassley: Mr. chairman, thank you.
▶ 1:00:43Chair Crapo: Thank you. Senator cassidy.
▶ 1:00:46Sen. Cassidy: Thank you both. Thank you for your willingness to serve. Mr. o'neill, there has been a lot of reorganization. But I am told, and I only know what I am told, not what I know, that there has been people whose positions they have been let go but it has left a gap in the ability to provide service that is a gap.
▶ 1:01:18Sen. Cassidy: It was not like we had 100 people doing one job but we only needed two. No, we had five people doing a very important job. It has been unclear to me who actually has the priority for this reorganization.
▶ 1:01:36Sen. Cassidy: So as we do reorganize, first, how do we replace those folks if it is true, first determine if it is true, and if it is true, how do we replace those positions? And how do we kind of avoid cutting the bone burner when we should be focused?
▶ 1:01:57Mr. O'Neill: Thank you for the question, senator. If I may come I really enjoyed our conversation a few weeks ago in your office. I appreciate how you brought your experiences and learnings of the position into your role as senator. I really respect you for that. I am also operating unlimited information obviously.
▶ 1:02:17Mr. O'Neill: From what I can tell about the proposed reorganization of hhs, I think the secretary laid out some reasonable principles in his announcement speech, namely that the essential functions hhs has, that the operating divisions have through statute, as well as custom should be preserved.
▶ 1:02:39Mr. O'Neill: If there are two functions that make more sense to be conducted in the same agency or office, then that is a reasonable thing to move towards. Combining relevant agencies -- relevant functions into the same office makes logistical sense in terms of ensuring that a majority of all hhs resources are devoted to serving the functions that serve patients,
▶ 1:03:09Mr. O'Neill: Beneficiaries, research entities, universities, grantees, and other entities that depend on hhs for inspections, regulations.
▶ 1:03:19Sen. Cassidy: That is kind of a generic answer. I don't mean to challenge you, but it seems as though we have an issue where we are -- I am told, and I am not sure if it is true, critical functions are being not met.
▶ 1:03:43Sen. Cassidy: Maybe you have an ability to do that, but I would say if you were approved, that would be something that I think is important to get ready. We discussed vaccinations, and you mentioned your opposition to mandates. We now I think have had 19 kids die of flu. I saw a report yesterday on children dying from flu. We have had two or three kids die in the louisiana. I am looking for the report right here.
▶ 1:04:14Sen. Cassidy: I think with protesters. And we know there are kids dying of measles in west texas. What can the department do to promote immunizations? We are having people die from vaccine preventable diseases.
▶ 1:04:35Sen. Cassidy: If you are going to go to school, there would be a premature condition requirement to enroll, there would be an aggressive promotion of immunizations. How would you approach that issue?
▶ 1:04:48Mr. O'Neill: Thank you for the question, senator. As you know, I am an advisor to a vaccine company and am very much in favor of vaccines. Vaccines are one of the greatest health inventions in human history. They save millions of lives and will continue to save millions of lives. You mentioned pertussis. That does not mean the vaccine is not good to get.
▶ 1:05:14Sen. Cassidy: The case was mitigated. People are confused and think it is gone. I only have 20 seconds. If you are against having a requirement, what can we do to stop more kids from dying in texas or more kids dying from flu or pertussis?
▶ 1:05:34Mr. O'Neill: Thank you, senator. As I expend, if I was a printable of a school, I would require cdc vaccinations. I would require all workers to be vaccinated. It is a separate question on whether the federal government should be mandating.
▶ 1:05:48Sen. Cassidy: The federal government puts out a recommendation that it should. Those principals and administrators are more likely to adopt it.
▶ 1:05:56Mr. O'Neill: Agreed.
▶ 1:05:57Sen. Cassidy: And so would you agree or oppose such recommendations?
▶ 1:06:01Mr. O'Neill: I support cdc's recommendations for vaccines. I think that is a central role cdc has. It is mandated in law and also a principal responsibility to recommend good, safe vaccines to everyone.
▶ 1:06:16Sen. Cassidy: I yield.
▶ 1:06:17Chair Crapo: Thank you. Senator hassan.
▶ 1:06:20Sen. Hassan: Thank you for this hearing. Thank you Mr. o'neill and Mr. andres for being here. Congratulations on your nominations to you and both of your families. To both of you, if directed by the president to take action that would break the law, would you follow the law or follow the president's directive? Mr. o'neill?
▶ 1:06:42Mr. O'Neill: Thank you further questioned, and I enjoyed our meeting at your office. It is always my directive to follow the law and the president would not ask me to break the law.
▶ 1:06:52Sen. Hassan: I am glad you are willing to follow the law. The president just said week he does not know he has to follow the constitution so it raises an issue. Mr. andres?
▶ 1:07:02Mr. Andres: I agree that it is important to follow the law. I do not believe the president would ask me to break the law.
▶ 1:07:08Sen. Hassan: That defies credulity I am sorry to say because he always already has and has just parted people who attacked police officers at the capitol in january. Go to a question about hhs. Mr. o'neill, since the president took office, this follows up on senator cassidy's line of questioning, nearly 1000 americans have contracted measles and two children have tragically died. The first child dying of measles in the united states in more than 20 years.
▶ 1:07:39Sen. Hassan: Measles is almost entirely preventable with the measles vaccine, by secretary kennedy refuses to say clearly the vaccine is the best and only way to protect our children from measles. Mr. o'neill, do you think secretary kennedy's leading an effective response to the measles outbreak?
▶ 1:07:54Mr. O'Neill: Senator, thank you for the question. As you know, I strongly support the mmr vaccine. I received it, so have my children.
▶ 1:08:04Sen. Hassan: Right, but I have limited time. Do you believe senator kennedy's response is effective?
▶ 1:08:10Mr. O'Neill: Senator, he has been surveilling the measles situation. He has advocated parents get the mmr vaccine. I completely agree with him on that.
▶ 1:08:19Sen. Hassan: So you believe children dying of measles for the first time in more than 20 years reflects an effective response by this administration?
▶ 1:08:27Mr. O'Neill: Senator, I don't know what is causing the current situation with measles, but the secretary has advocated for the mmr vaccine. I think he is correct to do so.
▶ 1:08:37Sen. Hassan: How many children would have to die for you to characterize secretary kennedy's response as ineffective?
▶ 1:08:45Mr. O'Neill: Senator, he has been secretary for a few months. Cdc has been overlooking disease outbreaks for decades. I think he is doing a good job.
▶ 1:08:57Sen. Hassan: I appreciate that answer. Senator kennedy has repeatedly gone on to promote unproven remedies. So you may say he is doing a good job, but he has affirmatively gone on television to promote unproven remedies such as telling parents vitamin a can lead to "almost miraculous and instantaneous recovery" from measles.
▶ 1:09:21Sen. Hassan: This claim is simply not true, and now doctors in texas say they are treating children with liver damage from overdoses of vitamin a. If confirmed, will you ensure medical professionals lead the department's medical guidance on measles instead of secretary kennedy?
▶ 1:09:36Mr. O'Neill: Senator, I am not familiar with the study you are citing. I would be happy to read it, but absolutely, I think both the department as well as physicians should always pursue the best science in all of the recommendations of treatments.
▶ 1:09:50Sen. Hassan: So I secretary kennedy refuses to follow recommended guidance, which a lot of us think he is refusing to follow right now, as has happened time and time again, will the medical professionals get final say, or will secretary kennedy?
▶ 1:10:04Mr. O'Neill: Senator, physicians have a responsibility to make the best recommendations and decisions to their patients based on the best information that they have. They always have the response abilities given to them in the states that license them.
▶ 1:10:17Sen. Hassan: This is a different question, and I will move onto another one in a minute, but this is about whether hhs will follow science and follow the advice of the medical professionals that work at hhs. I know very well where physicians are licensed to do at the state level at their practices. This is about whether secretary kennedy and you in your role will accept the medical -- the best medical opinions and advice and guidance from the physicians and scientists work at hhs.
▶ 1:10:49Sen. Hassan: I would suggest you secretary kennedy is not following that advice for those directives now. He is not following science. And he is doing grave harm. Now I will turn quickly in my last one for seconds to the issue of the low income home energy assistance program, which was established more than four decades ago and helps more than 25,000 granite staters pay their heating bills. President trump and secretary kennedy recently fired the entire staff who administered this program at hhs.
▶ 1:11:19Sen. Hassan: And without liheap, many seniors and families with children are at risk of not being able to afford heat given dangerously cold winters. Do you support secretary kennedy's decision for seniors to choose between food on the table or heating in their homes?
▶ 1:11:34Mr. O'Neill: Senator, I had the pleasure of working with liheap when I was at hhs in the bush administration. I know that it is very hard to stay warm in the winter if you are on a limited income, but I was not involved in the decision to have rifts with people that work at liheap, and I don't know the reasoning.
▶ 1:11:56Sen. Hassan: I doubt there was much reasoning at all, which is the point, but will you urge the secretary to reverse his cuts to the liheap program?
▶ 1:12:04Mr. O'Neill: Senator, if I am confirmed, you could hold me responsible for all of the activities of the entire department, including all of the agencies and offices. My very strongly held view is if the department has made a mistake, it should correct the mistake properly.
▶ 1:12:20Sen. Hassan: Thank you.
▶ 1:12:23Sen. Cortez Masto: Thank you. To the nominees, congratulations on your nominations. Welcome to the family members here and watching as well. Stir o'neill, let me follow up on some of the programs I have concerns about at hhs.
▶ 1:12:43Sen. Cortez Masto: One of them is the national firefighter registry for cancer, which is the largest effort to date to understand and reduce cancer risk among firefighters, risks that are especially severe for firefighters we see in nevada increase exposure to dozens of known carcinogens on the job.
▶ 1:13:02Sen. Cortez Masto: But today, the program's website if you go to that website, it states "due to the reduction of workforce, firefighters can no longer enroll in the national firefighter registry for cancer. Despite the urgent need, this program has been effectively halted due to staffing cuts at cdc. Enrollment is shut down. Research is paused. And it was no timeline for resuming these operations.
▶ 1:13:34Sen. Cortez Masto: The trumpet ministers and claims mass firings and reorganization will not impact hhs but that is clearly not true. Despite these assurances, the firefighter cancer registry is at a complete standstill muscle Mr. o'neill, if confirmed, how will you ensure that the programs get back up and running without delay?
▶ 1:13:55Mr. O'Neill: Thank you for the question, senator.
▶ 1:14:01Mr. O'Neill: Thank you, senator. I agree with your premise that firefighters take on an extremely risky career to save lives. I respect them for that. It is important that they have good health care and that we understand the best way to care for them and the best way to prevent any diseases that are particularly prevalent in their profession. My understanding of the proposed reorg is that the heads of the operating divisions decided which people would be perfect.
▶ 1:14:33Mr. O'Neill: That seems to be a reasonable level of -- level of - decision-making. I believe the secretary said -- I would certainly agree -- that if there were any mistakes in the proposed reorgs, the department should correct them. The secondary also said the goal of the reorg was to observe the essential functions of the department, sometimes by combining duplicative functions into one place --
▶ 1:15:02Sen. Cortez Masto: And I appreciate that, I appreciate your value statement and repeating what the secretary said. But when you are in that position, you get the discretion to decide whether this is an essential program. Do you think it is an essential program and should be appropriately staffed?
▶ 1:15:17Mr. O'Neill: Senator, things related to research might be best located within cdc. There might be best located within nih. I have not looked at the arguments --
▶ 1:15:29Sen. Cortez Masto: Yeah, I didn't talk about the location. I just said it do you think it is an essential program for our firefighters and should continue and be adequately staffed?
▶ 1:15:40Mr. O'Neill: Senator, it is important to do research to understand the best ways to mitigate the risks firefighters face, and I've not had the chance to review the particulars of that program.
▶ 1:15:51Sen. Cortez Masto: Let me ask you this. In response I heard you talking -- some comments with respect to senator grassley and senator grassley's an advocate for organ donation.
▶ 1:16:05Sen. Cortez Masto: In the past, you have stated that people should be free to sell their organs, and that it should be monetized, and "there are plenty of healthy kidneys walking revenues." do you still agree that kidney organs or organs in general should be monetized and people should be free to sell them?
▶ 1:16:29Mr. O'Neill: Senator, I had a chance to work on organ donation policy at hhs before. There were a lot of shocking facts around organ donation. When is that tens of thousands of people --
▶ 1:16:41Sen. Cortez Masto: I didn't ask about the status of organ donation, I just asked if you still feel the same way in that statement that people should be free to sell organs. Cynthia yes or no question.
▶ 1:16:50Mr. O'Neill: Senator, therare many barriers in the law, last time I looked, that make it difficult for recipients of the kidney donation to compensate donors for the follow-up medical care for their donation.
▶ 1:17:05Mr. O'Neill: I think it is reasonable to look at improving these policies so that someone who makes the very generous decision to donate a kidney or another organ will not suffer financially, will have the follow-up medical care compensated by the recipient if the recipient is able to do so.
▶ 1:17:23Sen. Cortez Masto: Mr. chairman, my time is up. I will submit the rest of my questions for the record.
▶ 1:17:28Chair Wyden: Thank you very much senator wyden --
▶ 1:17:34Sen. Wyden: I have one question and then I will --Mr. o'neill, I saw a comment about wanting every american -- this is your quote -- every american to make up vibrant, energetic, and free of disease, and that that is president trump's vision to make america healthy again.
▶ 1:17:58Sen. Wyden: But what we have seen in the last three months and what we have talked about this morning as recently as my colleague talking about the safety of firefighters is we have seen unprecedented efforts in one way or another to derail the ability of americans to get good health care.
▶ 1:18:21Sen. Wyden: So if republicans are gut ting medicaid can terminate in coverage for millions of children, families, seniors, and in the discussion with my colleague about firefighters, those firefighters and the people are going to make up the next morning feeling vibrant?
▶ 1:18:40Mr. O'Neill: Senator, as I told your colleague, I have not had a chance to review the particular program, but in general to answer the first part of your question, it's been frustrating to a lot of people for years that junk food is cheaper than healthy food, that nutritional guidelines --
▶ 1:19:01Sen. Wyden: I didn't mention junk food, I talked about the programs that are being cut, being waylaid, the programs that used to help people but now they are being studied. You said that americans are to wake up vibrant. Of course I'm excited about that. That would be a great idea. I just don't see how that is consistent with these cutbacks in essential healthcare services.
▶ 1:19:26Sen. Wyden: You can tell me specifically how those two are reconciled that everybody is going to be vibrant when health care is cut. Measles, all these cancer programs, how's that going to work?
▶ 1:19:38Mr. O'Neill: I would be happy to try, senator. The vision the secretary laid out for proposed reorganization is that functions of hhs be preserved and be carried forward in the most efficient way possible, sometimes by combining related functions in the same place, by reducing duplication, by eliminating middle-management where that is not a good use of money, and leveraging the department's money and people towards succeeding in the most
▶ 1:20:09Mr. O'Neill: Essential functions. From what I can tell on the outside, that is the vision that has guided the proposed reorganization.
▶ 1:20:16Sen. Wyden: Mr. chairman, we have got colleagues on the way. I just want to say for this last area of questioning, I think what the witness -- both of them are really doing is they are ducking on the question on whether anything is going to be done to make america healthy again, and I think what they are offering up is an approach that is going to leave people sick or, a-- sicker, nation living in
▶ 1:20:46Sen. Wyden: Fear, confusion with unprecedented levels of disease in a modern era where we are supposed to be making progress, guys, in terms of people dealing with these diseases and what we have cited in my opening statement, areas where it is getting worse. And you all are doing studies and you are looking at various agencies. Meanwhile, people are getting sicker. That is not what we want in america, that is not what we were told we were going to get. It certainly doesn't seem to be consistent with making america healthy again.
▶ 1:21:16Sen. Wyden: I appreciate your courtesy, Mr. chairman, with respect to my colleagues. I believe this one is on the way.
▶ 1:21:22Chair Crapo: We will pause for a few minutes to see if another colleague shows up for questioning. If we don't get some attendance soon, we will wrap up.
▶ 1:22:25Sen. Wyden: Mr. chairman?
▶ 1:22:26Chair Crapo: Yes?
▶ 1:22:28Sen. Wyden: Very briefly while we await our colleague and we appreciate your courtesy, representing the fact that we cannot get answers to any the major questions, I just received from senator gillibrand a letter with respect to medicaid directed to Dr. oz, very specific asking specific questions related to the support of these programs that are crucial.
▶ 1:22:54Sen. Wyden: We got back one paragraph basically saying that the secretary was willing to work with states to ensure that the program is well administered, effective, and available for eligible beneficiaries. That is any symbol of not being responsive to senator's questions and I ask unanimous consent that that be presented in the record.
▶ 1:23:17Sen. Wyden: Senator warren is here and I will send you colic that I was told others are coming and I am --and I will say that other colleagues -- I was told that others are coming.
▶ 1:23:29Chair Crapo: Without objection thes letter will be in the record. Senator warren.
▶ 1:23:36Sen. Warren: I apologize for the delay. Like many, I'm trying to cover multiple hearings today. Senate republicans confirmed rfk, jr., despite warning signs that he would put americans at risk. So far, the deadliest measles outbreak in decades has left two children dead a serious avian flu outbreak has driven farmers to call 30 million chickens this year, and second 70 people and killed one.
▶ 1:24:05Sen. Warren: Secretary kennedy has fired the experts, pedaled dangerous-- peddled dangerous conspiracy theories come and move hhs decision-making into the shadows. Mr. o'neill, if confirmed as deputy secretary, you would be kennedy's number two, responsible for overseeing hhs responses to public health crises. I want to know if you would do anything to reduce the damage that secretary kennedy is doing.
▶ 1:24:35Sen. Warren: Let's start with measles outbreak. In just the last week secretary kennedy has made multiple inaccurate claims about the measles vaccine. Meanwhile, under his leadership, hhs has censored cdc analysis on the importance of diesels vaccinations, cancel -- measles vaccinations, canceled research unpacking hesitancy, and pulled funding local health department used to help parents vaccinate their kids. Mr.
▶ 1:25:04Sen. Warren: O'neill, if confirmed, your job will be to advise secretary kennedy. Help us understand, would you have advised against any of the actions tha' secretary kennedy has taken in handling the measles outbreak?
▶ 1:25:19Mr. O'Neill: Thank you for the question, senator. It's lovely to meet you. I strongly support vaccines.
▶ 1:25:26Sen. Warren: That's not my question. My question is -- I told you what it is, you have seen it. What secretary kennedy has done -- you will be his number two and you will offer him advice. I'm asking what, do -- what kind of advice you would offer on any of the actions he has taken. Would you have advised against any of them, or to embrace them all?
▶ 1:25:51Mr. O'Neill: Senator, I was not involved in the decisions. I support the mmr vaccine, I've taken it myself, I think it is safe and effective, I recommended it to others, the secretary has done the same.
▶ 1:26:03Sen. Warren: So you are saying everything secretary kennedy has done in handling the measles vaccine and this crisis you are fine with yakking line is that right-- fine with? Is that right?
▶ 1:26:18Mr. O'Neill: Senator, I think he is sincerely concerned about measles --
▶ 1:26:22Sen. Warren: I'm n -- that's not my question. Are you ok with all this?
▶ 1:26:30Mr. O'Neill: I think he is a great job.
▶ 1:26:31Sen. Warren: Ok. The avian flu outbreak is destroying farmers livelihoods and jacking up egg prices and leading to another bag and humans. Secretary kennedy has a fire top fda staff tracking the outbreak. He has canceled scientific meetings on preventing human infections. And he has suggested that poultry farmers should consider letting b virus "run through the flock," a strategy experts say would be a genuine health disaster. Mr.
▶ 1:27:01Sen. Warren: O'neill, would you have advised against any of the actions that secretary kennedy has taken in handling the avian flu, or would you say on avian flu you also think he has done a great job?
▶ 1:27:11Mr. O'Neill: Sender, ivan -- senator, I've following the avian flu outbreak the past year. It's been a significant concern. Also people are watching it, cdc is tracking it, canadians are tracking it. The kind of thing everyone is watching for --
▶ 1:27:28Sen. Warren: My question is about secretary kennedy and the actions he has taken. I am just identify the actions he has taken. -- I have just identify the contest taken. Would you advise them to take any different actions than those he has taken?
▶ 1:27:44Mr. O'Neill: Senator, the avian influenza strain that is prevalent among domestic fowl and wild fowl seems to be optimized for avian systems. If it were to appear to have evolved --
▶ 1:27:59Sen. Warren: Mr. o'neill, none of this is my question. You are going to be the number 22 kennedy --number two to kennedy and to advise him. I am saying here I think kennedy has done I asked you the question, which I think is perfectly reasonable, when you have given different advice, and you told me on measles you think he has done a great job, which I assume means not different advice. How about avian flu? Do you think he has done a great job there?
▶ 1:28:29Mr. O'Neill: Senator, the department of agriculture makes decisions regarding vaccination of wildlife. Of course I will always give the secretary if confirmed my honest opinion.
▶ 1:28:41Sen. Warren: Sen. warren: you have done a great job of trying to avoid this question, because the one thing you're trying to determine is what kind of advice this guy is going to give, an all you can do is mumble around and say kennedy is doing a great job. I don't think that is somebody that is going to help herd the worst risks kennedy is pumping into our health care system. Thank you, Mr. chairman.
▶ 1:29:05Chair Crapo: Thank you, senator blackburn.
▶ 1:29:09Sen. Blackburn: Thank, Mr. chairman, and to each of you, congratulations on your nomination, and I know that you are going to serve well. I want to come to you, Mr. andres, first. I had such a wonderful experience serving with you when I was on the energy and commerce announced. -- in the house.
▶ 1:29:34Sen. Blackburn: One of the things my democratic colleagues would benefit from knowing is the way you brought a bipartisan readership to your role as you supported the chairman and you helped us work in a bipartisan manner to accomplish some very significant things. We think about 21st-century cures and the difference that has made.
▶ 1:30:02Sen. Blackburn: The position -- medicare physician payment work that we did on those payment rates and protecting of medicare act. And then of course with the opioid epidemic, the support act.
▶ 1:30:18Sen. Blackburn: Speak for just a minute so that my democratic colleagues can hear about your approach to lead ing a team at energy and commerce, supporting the chairman and the ranking member, an acorn pitching -- an accomplishding these things in a bipartisan manner.
▶ 1:30:39Mr. Andres: Senator blackburn, thank you very much, and is is good to see you again, and thank you for the kind remarks. Yes, I was very involved in the 21st-century cures bill when I was at energy and commerce physician payment reform, as you mentioned.
▶ 1:30:58Mr. Andres: I was at the ways and means committee, we also worked on the no surprises act that was a bipartisan bill and also worked with this committee as well on that, and also retirement security reform. I you have a lot of background working in a bipartisan way.
▶ 1:31:18Mr. Andres: I think one general comment I would make about that that I observed from the processes that we are right in the middle right now of the reconciliation process. I think both parties over the years have used that process to advance their own party-specific priorities. But once you get beyond that, particularly when we're are talking about the U.S.
▶ 1:31:44Mr. Andres: Senate, literally everything that has to get done, whether it is in the spending area or regulatory area, it does require bipartisan cooperation and bipartisan support. I am a big believer in getting things done and getting accomplishments under our belt.
▶ 1:32:05Mr. Andres: I look forward to working with you and with other members of this committee and her democratic colleagues to advance a number of the priorities that I think could be bipartisan. I know from having met with many if not most of the senators on this committee or their staff in preparation for this, there are a number of areas that are already underway that could be worked on in a bipartisan way, whether it be in preventative health, whether it be in pbm
▶ 1:32:37Mr. Andres: Reforms, in areas related to chronic disease. That seems to come up over and over again.
▶ 1:32:44Sen. Blackburn: And we do have some good legislation we are moving forward in those areas. Another area --Mr. o'neill, I want to come to you on this, because health care technology and health I.t. Nashville is a great example of where health I.t. Is advancing rapidly, and our responsibility is the regulatory measures around that, and that is to be a part of your portfolio.
▶ 1:33:14Sen. Blackburn: We are looking so carefully -- I hear every single week something in ai, something in predictive diagnoses, disease analysis, data analytics, and their applications are ways that we are using, telehealth, remote patient monitoring, all of these provisions.
▶ 1:33:43Sen. Blackburn: Talk to me a little bit about how your experience in different roles at hhs will help you to keep pace on a regulatory basis with the innovation that is out there.
▶ 1:33:55Mr. O'Neill: Thank you for the question, senator. You are absolutely right about nashville. Many of my talented friends from california have moved to nashville.
▶ 1:34:05Sen. Blackburn: Oh yes, we have welcomed them. And of the free.
▶ 1:34:10Mr. O'Neill: It's a city doing innovative things with the technology and will have good surprises in the future. There are so many ways technology can improve health care, health research, the operation of the department, large language models could play a huge role in preventing decision support for doctors so that they are aware of edge cases and the risks of those edge cases, neural networks, foundation models, ai and
▶ 1:34:41Mr. O'Neill: Machine learning technologies can improve medical research, a dd more accuracy to drug trials, insure more rapid and more accurate decisions --
▶ 1:34:52Sen. Blackburn: Don't want to cut you off, but my time has expired. I will send you something on cmmi.
▶ 1:35:00Mr. O'Neill: I would love to work with you on that.
▶ 1:35:02Chair Crapo: Thank you. Senator lujan.
▶ 1:35:06Sen. Lujan: Thank you both for coming today. Mr. o'neill, in your role as deputy secretary, you will serve as second in command to secretary kennedy, is that correct?
▶ 1:35:17Mr. O'Neill: That is correct.
▶ 1:35:19Sen. Lujan: Yes or no, do you disagree with any of the secretary's actions or statements during his tenure so far?
▶ 1:35:27Mr. O'Neill: I do not.
▶ 1:35:29Sen. Lujan: Do you agree with the secretary's statement that people with autism will never pay taxes?
▶ 1:35:36Mr. O'Neill: Senator, I have a lot of friends in san francisco who love math, love physics, they are very able to narrowly focus their attention, they consider themselves socially awkward, and a lot of them identifies mildly autistic. That is a very different phenotype, very different experience than severe autism. Is there a spectrum? Possibly we don't know what autism is, we don't know what causes it, we don't know what treats it.
▶ 1:36:07Mr. O'Neill: The experience of severe autism and the extremes of mild autism are very different. I believe the sector was speaking about severe autism.
▶ 1:36:14Sen. Lujan: Given your response, yes or no, do you agree with that statement about people with autism?
▶ 1:36:20Mr. O'Neill: The secretary is clearly talking about severe autism, and yes, I agree.
▶ 1:36:25Sen. Lujan: Do you agree with the secretary's statement that people with autism will never hold a job?
▶ 1:36:32Mr. O'Neill: Senator kim again --
▶ 1:36:33Sen. Lujan: You can just say yes or no. We have a qualification.
▶ 1:36:37Mr. O'Neill: Some people, yes.
▶ 1:36:40Sen. Lujan: Do you agree with the secretary same and that people with autism will never play baseball?
▶ 1:36:45Mr. O'Neill: I think that is true for some people.
▶ 1:36:47Sen. Lujan: Do you agree that they will never write a poem?
▶ 1:36:50Mr. O'Neill: Senator, I believe that is true for some people with off autism.
▶ 1:37:00Sen. Lujan: Do you agree with the secretary's statement that people with autism will never go on a date?
▶ 1:37:02Mr. O'Neill: Senator, again, autism is a spectrum that extends from very mild symptoms, often undiagnosed, to very severe. The severe end of the spectrum is something we need to absolutely do serious research on figure out what causes it and figure out how to treat it and improve the quality of life for people with severe autism and their families.
▶ 1:37:26Sen. Lujan: Would you like me to repeat the question or would you like to answer it?
▶ 1:37:29Mr. O'Neill: Senator, I think that statement is true for some people with severe autism.
▶ 1:37:34Sen. Lujan: Do you agree with the secretary's statement that autism destroys families?
▶ 1:37:38Mr. O'Neill: I believe that is true in some cases.
▶ 1:37:41Sen. Lujan: Autism does not destroy families. I don't know why that is not an easy one to answer. In administration's cuts to special education funding and medical research dismantles the very program families rely on in this narrow space do you agree with the secretary's statement that autism is caused by environmental toxins?
▶ 1:38:01Mr. O'Neill: Senator, I do not know what causes autism. I don't think anyone really has gotten to the bottom of it. It is important to do serious research to figure out what causes autism, what has caused the increase in autism, what is the best way to prevent it --I would support all that research.
▶ 1:38:17Sen. Lujan: Would you like me to reask the question, or would you like to answer it?
▶ 1:38:25Mr. O'Neill: I believe your question was about a particular treatment --
▶ 1:38:26Sen. Lujan: Do you agree with the secretary's statement that autism is caused by "environment of toxins"?
▶ 1:38:32Mr. O'Neill: Senator, I do not know what causes autism.
▶ 1:38:36Sen. Lujan: Is that a yes or no?
▶ 1:38:37Mr. O'Neill: That is and I do not know.
▶ 1:38:40Sen. Lujan: Do you believe fluoridation causes autism?
▶ 1:38:44Mr. O'Neill: I don't know. I do know that nih published a study of toxicity and floored in water in august was a dead toxicity of -- toxicity of fluid in water in august.
▶ 1:38:58Sen. Lujan: I would like to enter into the record a letter by 230 organizations identifying the safety and effectiveness of water fluoridation.
▶ 1:39:05Chair Crapo: Without objection.
▶ 1:39:06Sen. Lujan: Do you agree with this t the secretary's statement that autism comes from vaccines?
▶ 1:39:13Mr. O'Neill: Senator, I do not know what causes autism.
▶ 1:39:17Sen. Lujan: Mr. chairman, there is no scientific evidence supporting the correlation between vaccines and autism. Do you agree with the secretary's statement that measles, mumps, and rubella vaccines contains "aborted fetus debris"?
▶ 1:39:33Senator Mr. O'Neill: ,
▶ 1:39:36Senator Mr. O'Neill: I do not know what is in it. Many would not use a vaccine that has connection with abortion --
▶ 1:39:43Sen. Lujan: I would like to enter into the record a unanimous statement from the children's hospital that vaccines are vaccines a do not contain fetal cells.
▶ 1:39:53Chair Crapo: Without objection.
▶ 1:39:56Sen. Lujan: You have stated that you support the secretary's response to the measles outbreak. Two children in texas and one adult in new mexico have died. Do you think that is acceptable?
▶ 1:40:07Mr. O'Neill: Senator, every death is one too many. I support the mmr vaccine, I think it is safe and effective, I would recommend it, I've taken it myself. The secretary has also said he supports it.
▶ 1:40:20Sen. Lujan: Mr. chairman, I have other questions, about submitted for the record.
▶ 1:40:24Chair Crapo: Thank you. Senator warnock.
▶ 1:40:28Sen. Warnock: Thank you, brother chairman. The cdc is headquartered in atlanta, georgia. I am proud to continue the legacy of our great georgia senator johnny isakson, who made it his mission to champion the important work of cdc when you serve on the committee. Mr. o'neill, welcome, congratulations on your nomination.
▶ 1:40:54Sen. Warnock: If confirmed as deputy secretary of hhs, you would be the number two person to secretary kennedy, responsible for the inward- facing operations and day-to-day management of personnel and hhs including the cdc. It would be stepping into an agency that is mired right now in chaos, following the exodus of 20,000 staff through resignations, unjust firings, including over 3000 dedicated cdc experts during an historic measles outbreak. Mr.
▶ 1:41:23Sen. Warnock: O'neill, these folks are my constituents. I know them. They are my neighbors. I bump into them at the grocery store. Many of them have just gotten performance evaluations and saying doing an outstanding job.
▶ 1:41:40Sen. Warnock: Going to be fired weeks later for "-- only to be fired weeks later for "performance issues." desarno, do you think it is -- yes or no, do you think it is appropriate to fire cdc and public health experts for " performance issues" who had just gotten positive performance evaluations?
▶ 1:42:01Mr. O'Neill: Thank you for the question, senator. I had the pleasure of working at hhs for six years in the bush administration and I enjoyed working with cdc officials --
▶ 1:42:13Sen. Warnock: I read your bio and I'm going to run out of time. Do you think it is appropriate to fire these officials woho had gotten a great evaluation?
▶ 1:42:25Mr. O'Neill: Senator, my understanding about the proposed organization is the decisions about which personnel should be retained is made by the heads of the operating divisions. I don't have any inside information on how the agency -- I believe that the leadership of cdc decided which people should be rift.
▶ 1:42:48Sen. Warnock: Do you think it is appropriate just from an issue of fairness -- I've talked to these folks one on one. Cdc workers share with me that they have gotten positive performance evaluations weeks early only to be given notice that they were fired -- not only were they given notice they were fired, weeks later they get a poor performance evaluation. You are in charge of personnel.
▶ 1:43:18Mr. O'Neill: Senator, I'm not familiar --
▶ 1:43:21Sen. Warnock: Do you think that would be if you're just as someone who has managed personnel? Does that strike you as dealing with people in an honorable way who are serving the country? Even if you had to fire them, even if you felt like you needed to streamline for whatever reason, do you think it is fair for someone to get a great performance evaluation and weeks later hear they are doing poorly even as doge says we are dealing with waste?
▶ 1:43:48Mr. O'Neill: Senator, it is always unpleasant to fire people. Even if their function is no needed or they are not performing --
▶ 1:43:55Sen. Warnock: Do you think it is an honorable way of handling people, sir? Yes or no?
▶ 1:44:01Mr. O'Neill: I don't know the particular's of the situation they had a different supervisor the second time --
▶ 1:44:06Sen. Warnock: If confirmed, will you commit to restoring the full functionality of each congressionally mandated cdc office that provides life-saving services and programs to the american people? Will you and your staff report directly to this committee on the status of restoring the programs?
▶ 1:44:23Mr. O'Neill: Senator, it is vitally important that every function and responsibility of hhs be conducted and aim toward success. If there are two functions that are appropriate that make more sense to be done within the same agency rather than separate agencies, it makes sense to put them together. If they duplicate of functions being performed by more than one part of hhs, it makes sense to combine them.
▶ 1:44:53Mr. O'Neill: That seems to be the philosophy stated behind the proposed reorganization. It seems like a reasonable philosophy to me. That does absolutely preserve the essential functions of hhs that you cited.
▶ 1:45:02Sen. Warnock: So even as this process -- and I think it is charitable to call it a process, it's been awfully chaotic -- even as this ensues, this administration claims its goal is radical transparency. But there has been no transparency around cdc cuts. I wrote to the secretary in march, who I met with in my office, demanding specific information on cdc firings, and I still haven't gotten a response from the secretary.
▶ 1:45:33Sen. Warnock: Let me ask, Mr. andres, if confirmed to be the primary liaison between hhs and congress, will you ensure that I finally get a complete and thorough response to this and all of my letters? Will you commit to ensuring that hhs communicates timely and transparently with me and my staff on cdc reorganization plans? The secretary still hasn't answered my letter.
▶ 1:46:00Mr. Andres: Thank you for the question, senator warnock. I know that as a top priority for you --
▶ 1:46:06Sen. Warnock: Is a top priority for my constituents.
▶ 1:46:09Mr. Andres: And your constituents, and your staff communicated to me how important cdc and the employees are to you. I will say this, I understand the importance of developing a relationship with trust, accountability, and getting back to you. I will commit to work with you on those things.
▶ 1:46:28Mr. Andres: I think that when we talk about congressional letters, they will vary in terms of their level of complexity, and so it is hard to come up with some specific timeframe. But I understand the importance, I will commit to working with you.
▶ 1:46:46Sen. Warnock: Tell the secretary to answer my letter. Thank you.
▶ 1:46:50Chair Crapo: Senator warner.
▶ 1:46:52Sen. Warner: Not to pile on, but I want to add to senator warnock's comments. Mr. andres, you know, it has been awful the lack of responsiveness. I have a series of letters as well. The fact is, I even have evidence that republican vendors get the responses answered by the secretary is republican senators get their response was -- republican senators get there there's answered by the secondary.
▶ 1:47:23Sen. Warner: I'm curious if any democratic senators get any response from the secretary. It is outrageous. It is not the way the government is supposed to operate. Whether we vote for a nominee or not, the secretary has absolute responsibility to respond to members of congress, and frankly, it has reaffirmed why I am so proud I did not vote for the secretary, he did not do that. Mr. o'neill, it's good to see you again.
▶ 1:47:51Sen. Warner: I want to bring up an issue we talked about online, cybersecurity. I think we bring up what happened last year with the unitedhealth group and the subsidiary and the fact that you had operation, one of the biggest providers of coverage in the country, and they had taken change health care for a couple years. They still have not even put in basic things like multifactor authentication.
▶ 1:48:20Sen. Warner: As we discussed candidly, frankly, even trying to figure out who's is in charge on cyber within hhs has been a challenge. We spent a lot of time on this. I know a lot of colleagues on both sides of the aisle recognized that this is a huge problem. Candidly, on the dark web, as we know, personal health information has a higher value even then financial information.
▶ 1:48:45Sen. Warner: We do make a little bit of progress -- I mentioned in our call your predecessor in the biden administration, who finally took up this is one of her priorities. We did try to update and make sure there were mandatory minimum cyber hygiene standards. There is a rule that needs to be prioritized. I confirmedf, we urge the secretary to go ahead and finalize that rule?
▶ 1:49:16Mr. O'Neill: Senator, I also enjoyed our conversation, especially about cybersecurity. As we discussed, cybersecurity is an unsolved problem. Everyone that has custody of health data has a responsibility to keep it secure, both legally in terms of the hipaa law also morally, and also technologically. If the technology is not there to provide excellent cybersecurity, my sense is that technology still has a lot of room to grow.
▶ 1:49:49Mr. O'Neill: Then regulateds then regulateions or mandates can only do so much until the technology is there. I would like to bring a lot of cybersecurity and ai --
▶ 1:49:59Sen. Warner: Automated -- I don't mean to interrupt, because I don't want to filibuster here. As we discussed, this is an area, unless there is minimum standards, and because we have such a complex health care system with large players to tiny players to equipment vendors, the market is going to respond. We have standards in place.
▶ 1:50:29Sen. Warner: There is a rulemaking process, I hope that you would encourage the secretary kennedy to finalize that rule. I also want to raise another thing, we didn't get a chance to talk about this, but we have more information today about the continued misuse, careless, sloppy treatment of secured and information.
▶ 1:50:56Sen. Warner: I see this a lot from my position as chair and now vice chair of the intelligence committee. Should you be confirmed, there is an enormous amount of classified information within hhs. It can move markets. We talked about if it -- for abili -- vulnerabilities run cybersecurity.
▶ 1:51:19Sen. Warner: Let me give you any z1 as my time win -- an easy one as my timelines down where you commit to ensure that as classified information is being discussed within the hhs world, that you will not default to nonsecure communications like signal?
▶ 1:51:38Mr. O'Neill: Senator, I am actually happy to make you that --
▶ 1:51:41Sen. Warner: I would please urge if you are going to be confirmed that you do a thorough review of this. There has been -- I am particularly perturbed about what has happened in the intel and dod world with sloppiness about secure information. Candidly, as more and more information becomes secure, I would make this critique of the last administration as well, we have to make sure we do basic security 101 on this type of information.
▶ 1:52:12Sen. Warner: I know that the chairman and senator cantwell share this. I would like to work with you very much on that.
▶ 1:52:18Mr. O'Neill: Thank you, senator, I would love to work with you wanted.
▶ 1:52:23Chair Crapo: Senator cantwell.
▶ 1:52:25Sen. Cantwell: Thank you, Mr. chairman. Mr. o'neill, gzip you support the proposed $18 billion in cuts to nih funding?
▶ 1:52:37Mr. O'Neill: Senator, I had no involvement in the developing of proposed budget. I think it is important to pursue gold standard research. Anything we can do to improve nih, ensure it is promoting gold standard research can ensuring it is funding research that replicates, seems completely reasonable to me.
▶ 1:52:59Sen. Cantwell: Does that mean the proposed cuts seem reasonable? There is some stuff we are doing that isn't gold standard?
▶ 1:53:06Mr. O'Neill: Senator, I believe the president's proposal for nih suggests combining some separate institutes of nih into single institutes, where the functions belong together --
▶ 1:53:19Sen. Cantwell: $18 billion?
▶ 1:53:21Mr. O'Neill: Senator, I haven't had a chance to review the details that went into the budget. All I can say is I did not participate in the decision.
▶ 1:53:29Sen. Cantwell: Ok, well, I'm looking for a little bit of philosophy here. I come from a part of the world worry like innovation, we certainly --where we like innovation, we certainly like nih investment. We say how are we going to reduce the unbelievable costs of a baby boomer operation reaching retirement and having huge demands. Places like the university of washington have done incredible work on alzheimer's research.
▶ 1:53:55Sen. Cantwell: We are going to strive to solve these huge health-care costs by innovation, not by shortcutting innovation. Can I ask you about pbm's? They are a similarly challenging issue as more and more people reach retirement. We have to figure out ways to lower costs. According to the federal trade commission, the largest pbm's imposes significant price markup.
▶ 1:54:20Sen. Cantwell: In one example, pbm's marked up a drug to treat hypertension by 7736%. The report found that pbm's generate $1.4 billion from spread pricing, practice that basically the pbm's and the payer such as medicare basically -- they basically pocket the savings themselves as opposed to passing them on.
▶ 1:54:46Sen. Cantwell: That is why senator grassley and I have supported legislation, this committee has supported legislation. Do you support efforts to increase transparency and accountability in the pbm market, including things like senator grassley and I's transparency act?
▶ 1:55:04Mr. O'Neill: Senator, I think health care is too expensive, the cost of drugs is part of what is to extensive. I would support with more competition in drugs to drive down prices. And competition and transparency throughout the drug supply chain and pharmacy supply chain is very reasonable.
▶ 1:55:22Sen. Cantwell: Ok. So that's a yes?
▶ 1:55:29Mr. O'Neill: I haven't read your exact proposal.
▶ 1:55:32Sen. Cantwell: If you would, for the record, that would be helpful. Did someone ask you about price negotiation earlier? Senator wyden, I would assume?
▶ 1:55:41Mr. O'Neill: No, senator.
▶ 1:55:43Sen. Cantwell: What are your thoughts on the legislation we passed and the notion that we, too, can be a market just as we are with being able to negotiate?
▶ 1:55:51Mr. O'Neill: Senator, it's an interesting experiment. Allowing and authorizing cms to negotiate prices for them drug. I think cms and nhs overall should do its best with the power that congress has given it to bring down costs of drugs for taxpayers as well as for the patients whose prices depend on cms decisions.
▶ 1:56:20Mr. O'Neill: As long as that is the law, I will support enacting it as vigorously as possible to promote competition.
▶ 1:56:25Sen. Cantwell: Thank you. There is a similar market creation power we came to states like the basic health plan to negotiate on behalf of basically bundling up a population that probably didn't have market clout. Would you similarly support that?
▶ 1:56:41Mr. O'Neill: I am not as familiar with that, but I support the principal th-- principle that states are laboratories of innovation. It is good for them to innovate to improve delivery for their residents as well as use of their funds. I'm probably synthetic to the philosophy your -- I am broadly sympathetic to the philosophy.
▶ 1:57:05Sen. Cantwell: I will get you more detail over the record, but cms could be -- the basic bundling of the customer base in my opinion is way more effective than telling people to go search on an online site. That bundling allows you to then get those who want to serve that ability to have the certainty of a customer base, and so you drive down the price.
▶ 1:57:32Mr. O'Neill: I love the philosophy, senator.
▶ 1:57:35Sen. Cantwell: Thank you. Thank you, Mr. chairman.
▶ 1:57:39Chair Crapo: Thank you. Senator whitehouse.
▶ 1:57:42Sen. Whitehouse: Thank you both for being here. Mr. andres, let me start with you. One of the predicaments the minority party on finances to get answers from the executive branch. Actually, it is a problem often shared by both parties in congress.
▶ 1:58:02Sen. Whitehouse: I'm wondering what assurances you can give me that you will be responsive to questions and queries from senators irrespective of which side of the aisle they sit on.
▶ 1:58:17Mr. Andres: Senator whitehouse, thank you for that question, and if I could add in the beginning, I want to say how much I've enjoyed working with you when you were chairman of the budget committee and I was working on the house aside that. I also know from the meeting that we had together how passionate you are about some of these issues, particularly cms payment issues for your hospitals in rhode island and neighboring states.
▶ 1:58:44Sen. Whitehouse: That is exactly why I want to make sure you will take my calls and answer my questions.
▶ 1:58:48Mr. Andres: I am very well aware, you made your point very clear, so thank you for that. And I will say, and I've said before, I bring to this potential job, if confirmed, a commitment to work with both sides of the aisle, to be accountable, responsive, and timely in my responses.
▶ 1:59:08Sen. Whitehouse: I appreciate that. Mr. o'neill, how many cases of measles is ok in the united states?
▶ 1:59:18Mr. O'Neill: Senator, measles is never ok.
▶ 1:59:22Sen. Whitehouse: How many deaths from measles is ok?
▶ 1:59:26Mr. O'Neill: Senator, every death is one too many.
▶ 1:59:30Sen. Whitehouse: So is there a number of cases or a number of deaths that would cause you to reconsider whether the present hhs strategy is working vs. Failing and cause a reconsideration of the present strategy? Or are you want to follow this however leads, however many cases, however many deaths?
▶ 1:59:58Mr. O'Neill: Thank you for the question, senator. I'm concerned about the outbreak of measles. I think the best way to prevent further growth of measles is the mmr vaccine, which I received my cell. I believe the mmr vaccine is safe and effective, and the secretary and said the same thing --
▶ 2:00:17Sen. Whitehouse: But the numbers continue to grow, that's the problem. What somebody believes is one thing. It is the effect on the population that makes the difference. Is there a point in this trajectory of worsening measles cases and increasing debts where you -- increasing debts where you rethink hhs's present strategy would be appropriate?
▶ 2:00:38Mr. O'Neill: The secretary and the department have recommended the mmr vaccine. If there are others you should be taking, I would be happy to hear about them.
▶ 2:00:50Sen. Whitehouse: It is very much a mixed message on the vaccine as far as I can tell. Let's move onto another topic, musk, doge, doggy, whatever you call them, about access to hhs data sets?
▶ 2:01:05Mr. O'Neill: I don't know, senator.
▶ 2:01:06Sen. Whitehouse: If they do have access to the data sets can would you support during an audit to make sure that if they have been harmed from the harms are corrected, if there has been exultation of personal data -- exfiltration of personal data, that is acknowledged and remedied, and if there are backdoors left for private sector access to data systems, that those will be remedied as well?
▶ 2:01:29Mr. O'Neill: Senator, I'm a strong advocate for medical privacy, supported the passage of the hezbollah of the hezbhipaa law in the 199, supported the publication of the privacy rule and the bush administration. Medical privacy is an important legal principle as well as moral principle. Patient data should never be abused and it never viewed by unauthorized parties.
▶ 2:01:54Sen. Whitehouse: Will you look at the questions to see if it has been?
▶ 2:01:57Mr. O'Neill: Absolutely I will, senator.
▶ 2:02:00Sen. Whitehouse: Thank you. Rhode island wants to be a model for end of life care. There are very stupid things that exist in the present system. For instance if you are dying and the family needs you to have to go to a nursing home, there is an intermediate two days and three nights you have to spend in the hospital, which creates nothing but drama and added costs.
▶ 2:02:22Sen. Whitehouse: If you need respite care, and ambulance comes to the house and with all the drama of greenies and all that, granny gets dragged off to the hospital, where it is very expensive. It is hard to feel that the family got a whole lot of respite when they subjected their loved one to that. Instead you could have a nurse or social worker come to your house and solve the problem of respite. There is another flaw in the system for people at the end of life.
▶ 2:02:51Sen. Whitehouse: And palliative medical treatment ought to be able to go on at the same time. We are eager to work with that. I mentioned that to the secretary and the administrator. So I'm mentioning it again to make sure it is in your consciousness as well. You said states can be laboratories. We want to be one. The existing system for the treatment of people facing the end of life is not humane, not wise, not cost-effective.
▶ 2:03:21Sen. Whitehouse: I look forward to working with you on that if I can get the organization's attention enough to work with me.
▶ 2:03:25Mr. O'Neill: I love the idea, senders.
▶ 2:03:31Sen. Whitehouse: My time is up.
▶ 2:03:33Chair Crapo: Senator wyden has one more --
▶ 2:03:37Sen. Wyden: Senator crapo had to get to vote. Mr. andres, you have a lot of chutzpah. I heard senator blackburn asked to about bipartisanship and you mentioned a number of things including the ppm legislation, which I wrote with senator crapo. Do you know how that got derailed? At the end of the year, elon musk, backed by donald trump, objected. We had it to go. Do your best to get the facts right and get your bosses to help us on things that are truly bipartisan like the vote.
▶ 2:04:09Sen. Wyden: Thank you, Mr. chairman.
▶ 2:04:10Chair Crapo: Thank you, senator wyden, and we plan to get that legislation over the line this time and look forward to the administration's help. Mr. o'neill and Mr. andres, thank you again for your before us today. You're clearly qualified for the respective positions to which were nominated and I look for to voting in favor of your nominations. I encourage all of might colleagues to do the same. With that, I remind my colleagues that the deadline for the many questions for the record is 5:00 p.m.
▶ 2:04:37Chair Crapo: On friday, may 9, and I will be scooting out of here as soon as I hit the gavel to get to a vote. This committee stands adjourned. >> thank you so much, senator. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]