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tv   Politics and Public Policy Today  CSPAN  February 11, 2016 9:00am-11:01am EST

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we are captioning performed by vitac for our civilization in the first time we are seeing a explosion in the tropical regions of the world and increasing need demand. urbanization changes in global travel and the like. ecological transformation and climate weather pattern change are increasingly interconnected in our world. mosquito borne squeezes such as zika can appear in areas they hadn't before. this rapidly changing dynamics means we have to be prepared for what is seemingly unpredictable. when we have a response, we seem to be smart about these viruses. a recent report from the national academy of medicine of global health estimates the annualized cost of pandemic risk is about $60 billion a year. other estimates are actually higher than that. so we need to make sure that we are prepared because both the cost of life and the cost in the
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economy is likely to grow in coming days. coming decades. as we address the immediate needs of the zika-affected population, we must underscore the need to improve national systems to prevent and dictate response to these pathogens. and i think this is the effort at the heart of the global health security agenda launched in early 2014. beyond dealing with individual outbreaks we are seeing as dr. fauci put as a perpetual challenge, one come after the other, we need to also pay attention to the land scape, better understand the territory where the usaid has supported work that builds capacity and helps predict and mitigate the impact of noble high consequence pathoges. each year we take hundreds of pathogens and screen and make sure they don't jump into the human space. we find them in primates, in birds, we find them in bats,
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with he find them in rodents. but it's not an infinite landscape. there is a logic to it, and we want to make sure science is brought to bear to address and indeed prepare and predict these challenges. we must keep this bigger picture and the long-term view if we are to prevail against this rapidly evolving what i call the microbiome of the world. in conclusion, mr. chairman, usaid is strongly committed to combating the zika virus outbreak of today and in strengthening the capacities to ensure future threats will be rapidly and effectively controlled at their source and before they pose a threat to the global community. we look to your partnership and your leadership as we continue this fight. i appreciate the opportunity to share the contributions we are making in this battle. thank you very much. >> dr. mendez, thank you very much. the committees will be following the five-minute rule for member questioning. i'd like to begin, i'll throw out some questions, then yield to my colleagues and good friends. first on vector control capacity, in africa it took
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years to build up that capability. especially with the malaria efforts. i know than safe and effective is important so we don't have obviously unintended consequences from unsafe pesticides, for example. i know personally we use -- my wife and i use diatemacious earth for certain bugs and insects. but the question would arise what are you suggesting that they use? is there an adequate supply in these countries and an adequate delivery mode? secondly on brazil, this seems that the areas of the highest prevalence is in areas of extreme poverty. i know because we work on stunting and other issues in this subcommittee all the time. the first thousand days of life in my opinion is one of the most transformative efforts where nutrition, micronutrients and other kinds of assistance, prenatal efforts, increases the immunity on the part of the baby. it also makes the mom healthier. so from conception to the second
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birthday, those first thousand days are absolutely transformative. are you looking into vulnerabilities based on weak or pro mcompromised immune systems and certainly children where there is extreme poverty and lack of nutrition are likely to have that problem. mother to child transmission is that a way are you welcoming to develop a way, like you, the pharmaceuticals and others did so effectively with regards to mother to child transmission with hiv/aids? and finally in the united states, landmark civil rights legislation, the americans with disabilities act ensures that persons with disabilities are fully enfranchised into society. dr. pa low mendez you mentioned in your testimony looking to encourage other countries to adopt best practices for supporting children with mic microcephaly. you might want to explain how -- what that will look like in
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terms of helping those countries care for children with disabilities. >> maybe i can start with your first couple of questions. on vector control, our approach is to reduce mosquito populations by integrated comprehensive approach. that means reducing standing water, using larvacides. there are various forms of larvacides. we've looked at outdoor spraying. many. countries use outdoor spraying because the vector bites indoors and because of some other characteristics, there may be limited effectiveness of outdoor spreading. and one approach has been used in some places is targeted indoor residual spraying. it is a different type of spraying than spraying done with malaria, different areas of the house. but there may be efficacy there. that is a labor-intensive and complex area and underlying all four of those critical approaches is rigorous surveillance for where the mosquitoes are and which insecticides they may be resistant to. we have those studies now under
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way in puerto rico. we don't know the resistance yet. in terms of traditional and cofactors and impact of poverty, that's exactly one of the things we'll be studying in the case control study. there is a lot we don't know. if there is a causal association, we don't yet know which trimester of pregnancy is the highest risk and within that, whether it is all pregnancies or a small proportion of them that are affected. and if it is fewer, what might be the risk or protective factors. that's a critical thing that we're investigating now. >> thank you, mr. chairman. let me just address the question of mother to child transmission which is really important. the major difference between mother to child transmission and the advances that we've had made with hiv/aids and the particular challenge of zika infection in a mother and the transmission to the baby is the chronic nature of the viremia in hiv. you could suppress it in the mother by treating the mother.
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we know when you bring that level of viremia in the mother to below detectible level you dramatically decrease the likelihood the mother will transmit to the baby. because you have a lot of time because it is chronic. when you are dealing with an infection like zika, which is a flash infection. it comes, it is a few days, and then it is gone in the person who gets infected. the way to prevent mother to child transmission is exactly what we did with the rubella model. you recall that in the '60s, there were 20,000 cases of congenital rubella syndrome in the united states. that's astounding. 20,000. leading to blindness, deafness, heart disease, mental retardation and other types of congenital abnormalities. if you look at the curve of the epidemiology, when we instituted the rubella vaccine, it was
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really essentially targeted everyone, but it was specifically targeted to women of child bearing age because rubella is a relatively mild disease, very similar to zika. so i would answer your question about mother to child transmission the best way to do that is get an effective vaccine and make sure in the target countries women of child bearing age are protected by a vaccine. >> mr. chairman, i would like to address two of your points, one on nutrition, and the other on children with microcephaly and disabilities. we fully agree. we just yesterday were having a review of our nutrition portfolio. 1,000 days have been the way in which our work has been best framed. those 1,000 days seems to be crucial, crucial both to the prevention, because as you said, malnutrition will expose you to severe infection and thus the complications you may be seeing.
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malnutrition may play a role itself leading to undernutrition utero and other complications and the like. the experience in the world in nutrition around the 1,000 days also bring to bear the measurement of the head for example is something we need to do better. we need surveillance and reporting system that allows to do such and the experience and the community levels we have in nutrition can be mobilized in this regard. as you know, we have been very successful with child survival. 100 million children's lives have been saved in the last 20 years. in a way we are looking to the end of chilt child death and as we do that we move from survival to well-being. we pay attention to many of the factors for nutrition education. disability is very important an.
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we pay attention to many of the factors for nutrition education. disability is very important and the u.s. leadership is in that space for americans but also in the u.n. there's been an awakening of the importance of paying attention to support for children with disability. the experience we have built on hiv and more recently on ebola in terms of those who are affected in terms of education on the stigma, medical care and research as to what would be the spectrum of the impact of these phenomena today and social work to support those families. there is a lot of needs. we do a center for children in usaid that's been working in this area. we look forward to continue to work with you. we will have all of these to mobilize in a region that we have, in a way, not been as present because of the success in development of this region. we've moved most of our resources to africa and asia where we have the most deaths in child health as well as aids and tuberculosis. >> thank you, mr. chairman. i'm try to keep my remarks tight. we've got a number of members.
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dr. frieden pointed out, the difficulty of vector control with this particular mosquito, obviously that's one of our primary tools, but again not as easy as with certain other types of mosquitoes. dr. fauci, you touched on the importance of developing a vaccine and perhaps the rapidity of developing that vaccine. you're pretty optimistic that we might be able to develop something fairly quickly. expound. >> let me explain that so that it's clear. in general, vaccines take anywhere from three to eight years to get all the is dotted and ts crossed full safety and approval, be approving efficacy. when you're dealing with a situation like this, we have the advantage that you already need, the candidate vaccine platform. so if you look at the timetable,
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you always know that in vaccinology you have to be careful that things can slip. but we feel pretty confident that we'll have enough construct to do preclinical tox by the summer with i means we could start a phase one trial say in august. they usually take three to four months which means we'll be finished by the end of 2016. now the critical issue, if it is safe and immunogenic, and the outbreak is still raging, then you could go into an accelerated phase 2a, 2b, which means you could likely determine if it is effective within six to eight months. and if it is, you can get an accelerated approval from the regulatory bodies. however, if when we get to 2017 all of the cases go down, which is what we faced with ebola. we had an ebola vaccine, then all of a sudden the cases disappeared and it was difficult to definitively prove. if it goes down, then you
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stretch it into several years. but if i'm talking to you in february of 2017, and we still have a massive outbreak in south america, we likely would approve safety and efficacy within six to eight months. >> are we going to run into terms of commercialization of that vaccine, wrapping up that vaccine, working with the private sector to get that vaccine commercialized and distributed. will that be a problem? >> i do not think so. the reason i do not think so is because we are already, unlike other emerging infections, having calls from pharmaceutical companies, big pharmaceutical companies, very interested in partnering with us. so i don't think we're going to have that problem. >> and again, all three of you touched on the importance of funding global health, the importance of funding global disease surveillance. this is just another case of the interconnected world, disease is going to travel a lot faster and so forth. i would just put out there, the importance of funding and making
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those funds available and working together, this again is just -- we had ebola last year. we got zika virus today. we'll have another infection next year an again. i'd emphasize the importance of this funding. mr. chairman, i'll yield back. >> i'm not sure what your availability is to say. from will be a series of votes. we could be back in 15 or 20 minutes. would that be okay? i deeply appreciate it. we stand in brief recess.
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the subcommittee also reconvene and as soon as my colleagues come because i've already. my turn i will yield to them. i asked the question earlier and maybe if you could just elaborate a bit on it. the volume of potential pesticides dr. frieden you talked about the utter importance of draining sitting water. and i know even in the big island in hawaii there's just a new emergency call because of dengue to go after spare tires that are housing water and becoming breeding grounds for mosquitos. and, you know, i get that. that's labor intensive but not necessarily, you know, doesn't require chemicals per se. but what are the actual pesticides that are considered safe and what is the potential supply of those? >> thank you very much.
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i'm glad you came back to that because i wasn't able to address some of the really critical issues there in my earlier reply. the u.s. capacity for mosquito control is quite variable. so, some parts of the u.s. do this extremely well. some parts not so well. and one of the critical components of the supplemental emergency supplemental request is to strengthen mosquito control in the parts of the u.s. that have mosquitos that could spread the zika virus. and here we look at a comprehensive approach. so, on the one hand there's the things that you can do to reduce larval populations and the use of bti and two different bacteria that infect and kill the larval are very effective and used pretty widely not just human health but agriculture and on other ways.
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there are other ways to reduce the population, but that's one of them. for the adult mosquitos there are three broad classes of insecticide and within those there are many different types of insecticides. not all are licensed for use in the u.s. and we're looking very carefully at what's been done in other countries including australia with targeted indoor residual spraying of insecticides and seeing what would be safe and effective here. so that's something that we're in frequent discussions with industry partners as well as epa and other entities. but there are issues of what we could do that's safe and effective. the mosquito control efforts are also more than just chemicals. it's about having a surveillance system. cdc has invented a type of trap
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which is currently in use in california and elsewhere that can monitor what the mosquito populations are. cdc laboratories have developed a simple way of testing for insecticide resistance so that we can get a better sense of which should be used, because we are seeing reports of insecticide resistance and then looking at where the mosquitos are and what insecticides they're susceptible to. we would proceed with recommendations for mosquito control. but this is all quite labor intensive. it needs to be done in the same way that you need a public health system to stop, find and control problems and you need a mosquito vector control systems to track where they are and respond in real time. >> i appreciated your comments on the rush to get to a safe and effective vaccine. as you pointed out in your testimony and comments and i heard you on the radio talking about this recently, it may not be through the normal channel
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but we are in an emergency. how quickly could such a vaccine be available? >> so, if you -- thank you for the question. if you go to a continually emergent situation and all things work well, if we finish the phase one trial as i predict we will by the end of 2016, and we still have literally thousands of cases into 2017, you could go into an accelerated phase 2-a, 2-b which if you do the math and the statistics depending on the number of cases and how effective the vaccine is "in anywhere from six to eight months you may be able to show that it is, in fact, effective and safe. at that point, even though it would take maybe a few years to get the ultimate final stamp of approval, there is a mechanism of accelerated approval and accelerated access that you could implement if, in fact, you
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have a good safety profile and you've shown efficacy. so, you could conceivably have it by the end of 2017. which is really rocket speed for a vaccine. >> can i just ask anyone who would like to respond to this, there are about 25,000 children and adults with microcephaly today in the united states. obviously there are support groups. there's a great deal of knowledge that has been gleaned from their experiences and as i said earlier, you know, the spectrum, you know, it's not unlike maybe it's not a good comparison but it reminds me of the autism spectrum. the fact that there are people that are severely atistic and some that are higher functioning. and i wonder from those groups like boston children's hospital which has done wonderful work in that area, are you looking to tap that so that we share best practices with these countries which may not have that experience?
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>> yes, thanks for the question. as you know, mr. chairman, from your past work, the centers for disease control and prevention includes the national center for birth defects and developmental disabilities. and in our emergency response there are fully integrated including clinical geneticists who are traveling to brazil and colombia to assist with assessment and plans. and we need to learn more about what the spectrum is in this case. as noted we may well see a broad spectrum of some more severe, some less severe and this is something that we want to provide all of the expert assistance we can to support women, families and communities that are dealing with this very challenging situation. >> yes, doctor? >> one of our partners in the birth initiative is emory pediatric association and they can help us bridge domestic lessons to the programs we are deploying internationally. >> i appreciate that very much.
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i'd now like to yield to the distinguished chairman of the western hemisphere committee. >> thank you, mr. chairman. a lot of folks traveling to brazil this summer. what steps are being taken in brazil that you can tell us about? you know, we've even heard calls for canceling the olympics. because people are concerned. so, what are the brazilians doing? what are you doing to help? and what do we need to know? >> so, brazil has taken this very seriously. they consider it i think an absolute top national priority and as the chairman mentioned, the other chairman mentioned in his opening remarks, they have deployed hundreds of thousands of people in the response. they're working to reduce mosquito populations. they're trying new forms of mosquito control. they point out that the season
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of the olympics is a cooler season so generally has less mosquito activity, though, not none. but i think from our standpoint at cdc our role is to give travel advice to people, regardless of why they're traveling. whether someone is traveling for the olympics or any other reason our advice would essentially be the same. and from the very first days when we had strong evidence suggesting a link between the presence of zika virus and microcephaly, we've advised that pregnant women strongly consider not going to a place that has zika spreading, so that is our advice from cdc and that for women who live in such areas or people who go there, to take really good steps to prevent mosquito bites. and things you can do applying deet multiple times a day, mosquito repellant, wearing long sleeved shirts and long pants. using clothing that has treatment so that it repels mosquitos. and to the extent possible staying indoors within
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air-conditioning and screen -- or at least screened and enclosed spaces. and i think as we learn more in the coming weeks and months more will be understood about what can be done to keep any risk that might be there to the absolute minimum. >> i think it will definitely smell like deet down there sure enough. so, i was in peru, there's a mosquito and dengue research project going on. and tracking individuals that may have been contracted and where they have traveled to and who else may have been exposed or mosquitos in that area. a lot of folks in my district are concerned, mr. chairman, about unaccompanied children coming north from latin america. it's been an issue and now it's been exacerbated with zika. do we need to know anything? how prevalent is it for a child,
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a minor, to carry a disease? i know you said it's got a very short period where its symptoms are prevalent. but are we researching how long an adolescent would carry the disease and whether, you know, say, they come north of the border and are bitten, do you see where i'm going with that? so, what do we need to know about that? >> we've studied this in a variety of prior outbreaks as have others. the virus stays in the blood for about a week after people begin to get sick. we don't see long-term persistence, unlike, for example, hiv and hepatitis which can stay in your blood really for life, this is a short-lived -- a virus that doesn't persist in the blood beyond a week. and if you think about the numbers, they're really quite striking, but there's a lot of travel from americans going to central and south america and
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the caribbean on the order of 40 million visits per year. so, lots of travel. and if you think about the different types of travel, that's a very large number compared to a different type of risks. the one area i would just to give full information, what we don't yet know is how long the virus can persist in semen and we're doing studies on that. but that's the one area where we might see the potential for transmission through sexual contact for more than a week. and we won't know until we do the studies. that's why we've recommended that for men who have sexual contact with women who are pregnant that to avoid the transmission of zika. >> you mentioned that earlier. i get that. so, when ebola outbreak was happening, we were doing airport screening of folks who had traveled to the african
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continent especially those three main countries. latin america travel's much broader than that. is there any proposal or any talk about doing airport screening for potential symptoms that you know of? >> yeah, as you point out, the situation is very different. we have roughly 20,000 visitors versus 40 million. we have a disease which is spread from person to person in the case of ebola, whereas it's not with -- other than the rare sexual -- >> other than sexual activity, right, right. >> so, i think the situation is really very different in terms of zika and our goal really is to protect pregnant women. that's the key priority now. >> right. so, we have an el nino going on. it's very wet across the south. the amount of water i've seen in arkansas and louisiana and texas, south carolina and alabama, mississippi, north carolina means that there's going to be a lot of standing
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water in the south this year. that means mosquitos are going to be very prevalent whether they are the no seeum variety or the tiger type you mentioned. >> this is a core component of the emergency supplemental request. we would be issuing to grants to states at risk and southern states as well as u.s. territories to better control mosquito populations. >> right. i think -- historically that's been a winning strategy against malaria and other with mosquito-borne viruses. well, listen as someone who chairs the western hemisphere subcommittee who will be continually focuseded on this who may see congressional travel in that area, individual congressmen are going to be concerned that, you know, they're wanting to know what level of information we have and how can we allay their fears and the general public that continually travel in that area. this has been very helpful, mr. chairman, and with that i'll
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yield back. >> thank you very much for your questions and for this collaboration of the two subcommittees. i'd now like to yield to the gentleman from staten island. >> thank you, mr. chairman. and thank you, panelists, for sharing your expertise with us. and welcome, my friend, tom freiden, it's been a long time. i look forward to visiting you in atlanta. thank you for all the work you did for the people of new york city when you were health commissioner there. i think we were fighting west nile at that time. it was in its infancy stage in new york when you were the health commissioner. i know that you need more resources. until we figure that out, is there an ability for you to redirect some resources that you have to address this? >> we'll do everything within our power to address the zika challenge. but the supplemental calls for $828 million for cdc in three broad areas. emergency response in puerto rico, which has a significant risk of seeing widespread
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transmission of zika. support for the continental u.s. for states at risk including mosquito control diagnostics and a series of other measures and then international support. while we can get started with that, we can't do it at scale to the level that we would need and we've already had to curtail some other activities such as our activities that deal with lyme disease. >> i ask that we've only passed the 21st century cure act to fund cdc and nih to come up with remedies and vaccines for some of the diseases that are known in the world. i also realize that it takes a while even after you've done your work for the fda to approve a lot of these things. is there any mechanism in place, tom, that we could help you speed that up whether it's through legislation or something of that nature? >> we've been working very closely with the fda on both ebola and zika they've been able
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to rapidly allow us to use effective test technologies within a day or two of us asking. that's worked very well. dr. 235u67ie can comment further. >> we really want to tip our hat to the fda and what they helped us with, with ebola. when we really needed to get the vaccine trial out quickly and go from a preclinical to a phase one without cutting corners of safety or anything, they greatly expedited to us to get the phase one trial done here in the united states and in europe and in africa. and then we went into a phase two trial. so, we're working very closely with them right from the get-go. and one of the really productive interactions you have is that you involve the fda right from the very beginning of a project. you don't do it and then go to the fda and see how you can get something approved. they work with us right from the beginning and that's exactly what they're going to be doing as we start developing things
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like vaccines for zika. so, we're very optimistic about that relationship. >> that's very comforting. the last comment i have is dr. fauci i was dismayed that you worked so hard to find a vaccine i think it was for west nile and that no pharmaceutical wanted to produce it because there wasn't a profit. all you doctors take a hippocratic oath to serve people. i'm just dismayed, but thank you for sharing that with us. >> you're welcome. and that is frustrating for us because we think in terms of what's good for the public health and the global health. and sometimes when you get involved in things that are profit developing, that that comes in and gets in the way of that. having said that, i feel confident that from the indications we're currently getting from pharmaceutical companies that we won't have this problem with zika. >> so, we should be blessed that there's a profit in the zika
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virus. >> well, unfortunately that's a perverse way of doing it, but you're quite correct. >> thank you. thank you. >> let me add, the region may have more resources but also -- we are also exploring financial mechanisms that we had used in the past for vaccines where market failures prevent the final development by the companies and we have an experience with the vast market committee that has been done through the global alliance which allows production at scale for the pneumococcal vaccines for children. >> the chair recognizes mr. c klausen. >> thank you for coming again, guys, i'll ask for quick answers and i have several questions and i think people are ready to go, okay? first of all, it's the same mosquito that does -- that carries dengue, chikungunya and
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zika much of the time, is that correct? >> that's correct. >> is anybody thinking about a genetic therapy fix here? i mean, i don't want frankenstein mosquitos, but it seems to me that you get the trojan horse and the soldiers inside the trojan horse are going to die with it. and so as i thought about my own legislation for this obvious problem being from southern florida, it seemed to me that genetic fix ought to be something that is thought about and if you all tell me it's practical, then with my team i'm going to keep pursuing what we can do legislatively to motivate that. you all are in agreement with me on that? >> it's a promising technology. the biggest challenge is scaleability and community acceptance. >> agreed. but multinational -- companies work all over the world and that acceptance factor might be different as we get closer to the equator.
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you would agree with that, too, right? because you got a bigger outbreak, you got a bigger problem. okay. thank you for that. we have vaccination for dengue in brazil, right? >> correct. >> i know they were working on one in southeast asia for a long time. i don't remember where it got. do they go quicker on this sort of thing to get vaccines in brazil? would americans worried about dengue fever, should they go to brazil for a vaccination or are you all -- are you all hesitant about, you know, the safety of this? it just seems like the obvious question. >> no, actually it's a good question. there is an approved vaccine by mexico and brazil for a dengue vaccine. that's about 60-plus percent effective. >> there's four different types of dengue to my -- >> you are correct. >> is that -- if you get a vaccine for dengue fever in mexico, is -- would it be -- would it work in india?
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it's a different strain and sometimes a different mosquito. >> it's the relative proportion of the sera type that's dominant in a particular area. the one that didn't quite get off the ground in asia didn't have a good protection against evenly all four sera types. the one that's in brazil now. and i'm saying that -- >> so, it works better with whatever the mosquito here is and maybe the one adjacent. >> right. >> that's closer in the serum as you say, right? >> and we actually have a phase three trial that's ongoing that started just about four weeks ago in brazil in collaboration with the institutes that the nih is actually running the trial with them. >> is anybody working in asia now so that if somebody gets off a plane during the rainy -- in the monsoon in india they don't bring a different strain to mexico or brazil? >> well, i don't think it's a question of a different strain because you have four sera types they are essentially universally seen all over. so, even in india there will be all four.
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rather than one strain or the other it's the one that's dominant. >> got it. >> sera time two is the one of the most problematic ones. >> got it. okay, look, for me that's a big deal. i've had break bone fever and i don't want number two and have a hemorrhagic complication here, guys. >> you got it. >> through my own experience i say okay, in a world of international travel, second time is going to be worse. i'm in the 50 and older crowd, right? which makes my liver even more susceptible to swelling so, you know, we also have to think about the global nature of this. am i right about that or am i missing -- >> you are. >> okay. do you -- you know, my idea -- our idea legislatively was, you know, we could always get -- use government money here. it seems to me that as long as to mr. donovan's point, as long as drug companies see a profit motive -- and i'm always worried about that with zika because i've got one of the few
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districts that might be actually impacted here. it's not going to get impacted in new hampshire, right? but it could be impacted in my district. naples. nonetheless, i mean, if we gave somebody tax credits for their r&d in order to expedite research into, you know, battling this virus, or coming up with a vaccine, you see any downside on that? trying to accelerate the private sector to jump in the game here? because it feels to me like they set out dengue fever. it feels like they're sitting out chikungunya and we don't want them to sit out zika. am i right about all of that? >> incentives to pharmaceutical companies are often helpful in getting them engaged. we have another way to incentivize them which is what we do at nih. we do what is called derisking. we do a lot of the work that they would otherwise pay for themselves.
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so their investment risk is less. some companies take the vaccine from the concept to the product. they don't need anybody. they don't need the nih, they don't need anybody. but when something is a public health imperative and they're not interested and if we push the envelope to the point that, here, we know this product is good and it's safe and they are much more enthusiastic about getting involved because we made a major investment. that's a good way to incentivize them. >> can i have one more question, mr. chairman? pdiseases as if e malaria. outdoor, nighttime. daytime, inside mosquitoes. country and in my district, we do not have as much fresh water sitting around like
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you would find in the caribbean or the -- or brazil. if we do a good job making sure we don't have a lot of pooling water around, is that ok? director frieden: it will depend on the local environment. >> >> it's really going to depend ? on the local environment.eden: so, how -- >> how about southwest florida? >> well, this is one of the reasons we need a supplemental to give resources so we can looo trap at mosquito populations, trap them, analyze them and then sometimes larva siting can have an impact on mosquito populations. your point is quite correct thae the outdoor spraying may have limited impact, if any, on the mosquito population, but we're a looking at different ways of doing mosquito control. and in some circumstances what they've done in australia, for example, is use targeted indoort residual spraying for this particular mosquito with as far as we've seen some pretty effective results.
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but all of that is quite complex to do. >> and let me see if -- just taking off on that point so that i understand it correctly. because, again, we want to get in the game here legislatively so i'm not just asking to take your time here.r like a lot of things it always impacts the poor. and people that, you know, life's never fair.say and so, you know, in my house, i have air conditioning. if i see a mosquito inside, i say to myself it's not chikungunya, it's not zika so if i get bit i don't have to worry about it.t.ik but someone else who may not bee able to afford that is more at risk. am i right about that? do i understand the information correctly? >> you are exactly right. if i -- >> but that should drive some og our policy here as well, i mean, pooling water at my house is not as much of a problem as it will be at someone less fortunate. am i right about that? economically speaking.en: >> if we look at a study done by
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cdc doctors, scientists of a dengue outbreak in brownsville, matamoros, some years back, the rate of infection was eight hig times higher than it was in wnse brownsville and the two driving brownsville and the two driving factors for that were air duced conditioning -- r >> really.isk >> -- reduced people's risk lerw 15-fold and smaller house plots which increased crowding and increased risk seven-fold. >> right.bathroom and then even if they have ac, they often don't have it in the bathroom where the water is or in the kitchen where the water m heard am i right about that, too? so, it complicates it. dr. mendez, you have -- is there anything on my line of questioning that you've heard me say or -- [ speaking spanish ] >> muchas gracias. you are so knowledgeable. we discussed this last time we were talking about dengue. you were almost prescient that clearly the scenario, the
9:43 am the i just want to report under the malaria initiative we work with the gates foundation and many we other partners on an the vectorw control program. we are looking at new insecticide and tools. that capability can be deployed to address this need in the region. >> can i interrupt -- you're making a great point. i got bit at 9:00 in the morning at an auto parts plant that youn are never going to we air-conditioning. the work environment is an area that we got to keep in e i think that's a great point. >> you are correct also that is usually the poor. it's a section of brazil, a poorer air, more tropical area,l so, yes, there are local conditions that make it more moe likely that you will get the disease.a the other point i would like to just mention is, of course, we do have for a while now the -- orphan drug act that provides some incentives for industry to develop vaccines where otherwise
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market failure would prevent them. we have some tools and we have different things as dr. fauci has alluded, we are looking to see that industry is engaged to finally developing these products so they can reach the poor in particular. >> you all keep talking. you all are great. and, you know, we need to spend some money on this. real life impact on a lot of people. so, thanks for what you're doing. and thanks for being so patient with me here asking all these o questions. >> thank you very much, mr. clawson. my fi two final quick questions. first i remember my first trip d to el salvador in the early '80s being struck by how many people -- i remember being in dr the ambassador's home, the president duarte and there the wasn't a screen in the place that i recall and many times in central and south america people do not have screens and even the foreign service officers risk
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obviously in their homes, they are at risk it would seem to me if there's no screens. is that something being looked at to promote screening as one of the best practices? secondly, there are press reports that some ngos are planning to exploit child disability and the potential link of microcephaly with zika to promote abortion. and i'm wondering and i'm hoping and maybe you can verify that none of the $1.8 billion and the president's strategy does not have that agenda. >> thank you very much. yes, we do believe screens may play a role. there are also treated screens u that may be even more effective and this is something we're very actively looking at now.mental i can assure you that the emergency supplemental request does not contain any proposal to change in any way current policy regarding abortion. >> yes, doctor. >> thank you very much.
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indeed usaid fully advised by the u.s. law which includes thee helms amendment that precludes us from using any foreign assistance resources to pay for the performance of abortion as a method of family planning or to motivate, of course, any person to practice abortions. we don't do abortions. >> the amendment makes clear that even the promotion is ful i not -- >> correct. even the promotion. the only thing i would say we are so careful with this, we monitor this very carefully everywhere we do work, so one thing we will need to do is part of the request includes some requests because we'll need to t have staff deployed to ensure, to ensure, that our partners and the work that gets deployed does not go into areas of the laws . that are not allowed. >> appreciate that. you've been tremendous in providing information to both the subcommittees, insights, and i thank you for your service, ao which is extraordinary, and for allowing us to benefit from that expertise and that knowledge. the hearing's adjourned. >> thank you.
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i'm an undecided voter right now. one of biggest issues in the
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election that isn't being talked about on the democratic side is the education. i'm a union president. one of the things that should be talked about is shame, blame and punish regime of testing, accountability that's pervasive. we need to rein that in. i hope candidates can talk about that. >> the candidate we're supporting is bernie sanders. >> bernie, bernie! >> he's the only one who will make the major changes need to get back our country back to becoming a democracy again. >> we need to make it right for the average american. >> he speaks the truth. >> i believe it is important for young voters to care about the economy. because we're the ones who are affected by it. rubio is a great candidate and he's able to fix the economy and be good for us to live in. here on c-span 3 we are live on capitol hill where the senate finance committee will hear from sylvia burwell. she's going to explain and take
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questions about the president's 2017 hhs budget request which increases cancer funding, it addresses the opioid drug addiction issue and adds funding to deal with the zika virus. it should get under way shortly. one of several cabinet secretaries testifying on the budget proposal this week and over the course of the next couple of weeks as well. the house and senate are both in session today. the senate gavelled in about half an hour ago. and today, they will vote on whether to move forward on a customs and trade conference report. the house meanwhile debates today a bill that would require the treasury secretary to appear before congress, before the government reaches the debt ceiling limit. and a report on the -- on what causes the increase in debt. the house gaveling in at 10:00 eastern over on c-span. so the senate in session already, they're on c-span2.
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center of your screen is health and human secretary sylvia burwell. the senate finance committee hearing again this morning from secretary burwell. she'll be talking about the president's proposed 2017 budget
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request. including issues like cancer funding and of course the zika virus and they heard -- congress heard yesterday from the head of the infectious diseases, dr. anthony fauci and dr. frieden, the head of the centers for disease control. orrin hatch, the chairman of the senate finance committee. live coverage here on c-span3.
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this is the senate finance committee. normally chaired by orrin hatch. and perhaps will be but he's right now on the senate floor speaking about the measure the senate -- the trade enforcement measure the senate is taking up. that's pat roberts in the chairman's position there.
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>> come to order. it's going to be my distinct privilege to introduce secretary burwell. it would appear that senator wyden, senator grassley, senator grapo, senator schumer are not here. they have conflicts. none intended. and i'm going to ask unanimous concept that the statements by the distinguished senator from oregon, mr. wyden and our distinguished chairman mr. hatch be inserted into the record at this point without objection. our witness today is health and human services secretary sylvia mathews burwell. secretary burwell has been leading the department of health and human services since june of 2014. ms. burwell has a long history
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of public service including her previous positions serving as director of the office of management and budget. under president obama. in the clinton administration, she served as the deputy director of omb, the deputy chief of staff to the president, chief of staff to the treasury secretary and staff director at the national economic council. she has not served as the secretary of agriculture, however. she has extensive private sector experience including serving as president of the walmart foundation and before that as the president of the global development program at the bill and melinda gates foundation. ms. burwell received her degree from harvard university and a bachelor's degree from oxford university where she was a rhodes scholar. thank you for being here today. and we would invite you to please proceed with your five minutes opening statement. we have inserted the statements by the ranking member and the chairman for the record.
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and we will proceed with questions following the secretary's statement. please proceed. >> thank you, senator roberts and thank you members of the committee. i want to thank you for the opportunity to present the president's budget for the department of health and human as much as and as many of you all know, i believe that we have common interest and share common ground. and the last legislative session this committee embraced that view of bipartisan and leadership when it took historic steps to pass the medicare access and c.h.i.p. re-authorization agent of 2015. i want to thank you for that piece of legislation. the budget before you today is the final budget for this administration and my final budget. the budget makes critical investments to protect the health and well-being of the american people, it helps insure
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to do our job to keep people safe and healthy, accelerates our medical innovation and expands and strengthens our health care system. it helps us continue to be responsible stewards of the taxpayers dollars. for hhs the budget proposes $82.2 billion in discretionary authority. our request recognizes the constraints in our budget environment. and includes targeted reforms to medicare, medicaid as well as other programs. over if next ten years these reforms to medicare would result in savings of $419 billion. this budget invests in the safety and health of all americans. let me start with an issue we have been working on here at home and abroad as we work to stop the spread of the zika virus. the administration is requesting $1.8 billion with 1.4 for the department of health and human as much as. we appreciate this timely request as we implement the
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essential strategies to fight this virus. i know that the rise in opioid misuse and abuse has also affected many americans as well and every day in america, 78 people die of on yoid related deaths. that's why this has significant funding over $1 billion to compact the opioid epidemic. today, too many of the nation's children and adults with diagnosable mental health disorders don't receive the treatment that they need and so this budget proposes $780 million to try to close that gap. research shows that early interventions can set the course for a child's success. and that's why we propose extending and expanding the home visiting program to help even more families in need to support their child's growth. while we invest in the safety and health of americans today, we must also relentlessly push forward. the frontiers of science and medicine. this budget invests in the vice
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president's cancer initiative. this is a vital investment for our future, each 1% drop in cancer deaths saves our economy approximately $500 billion. not to mention the comfort and security it brings to families across the country. today, we're entering a new era in medical science. with proposed increases of $107 million for precision medicine initiative and $45 million for the administration's brain initiative, we can continue that progress. but for the americans to benefit from these breakthroughs in medical science, we need to ensure that all americans have access to quality, affordable care. the affordable care act has helped us make historic progress. today more than 90% of americans have health coverage. the first time in the nation's history that this has been true. the budget seeks to build on that progress by improving the quality of care that patients receive, spending our health care dollars more wisely and putting in an engaged, empowered
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consumer at the center of the care. by advancing and improving the way we pay doctors, coordinate care and health information we're building a better system. finally, i want to thank the employees of hhs who in the past year have helped end the ebola outbreak in west africa, have advanced the frontiers of medical science and have helped millions of americans enroll in health coverage. they have done the quiet day to day work that makes our nation stronger. i'm honored to be part of that team. i'm personally committed to working closely with you and your staff to find common ground and deliver impact for the american people. with that, i'd be happy to take your questions. thank you. >> thank you very much for your statement. madam secretary, you recently stated that you believe we have
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more work to do with the affordable care act, but the marketplace is stable. i'm going to take the opportunity to remind you that one of the five insurers offering coverage in the marketplace for my home state of kansas left the exchange this year and that insurer provided coverage for nearly half of all kansans last year. and when we hear stories like this, when we say we have assured stability, it becomes a problem. i think that data of your own department released late last year premiums for the benchmark will increase 16% in kansas and that's an increase that's causing a great concern. so with insurers already parking -- pardon me, pulling out of the marketplace, i'm
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troubled that cms is taking steps to increase government control of the plans available on the exchanges and ultimately reduce consumer choice through the new notice and payment parameters. the notice claims that an excessive number of health care plans makes consumers less likely to make a selection that leaves them satisfied. so my question is, does cms believe there are too many plan choices available on the exchanges? i can't imagine you would say anything else but no. >> so with regard to the question of the stability in the marketplaces, in the marketplace this year, most of the folks that came into the marketplace, nine out of ten actually had an ability to be in a market where there are three or more issuers and that that's where we believe the competition occurs. i believe we need to take steps to further stabilize and make
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sure the market stays stable. we're stable now with those numbers. but need to take steps. with regard to the payment notice i think you know we're in the middle of that and we'll be cleating that -- completing that payment notice. our objectives aren't about limitingngngngng for the consumer but instead making it easier for the consumer to make choices. a number of the steps that we took this year in open enrollment are about that. we created tools in the marketplace this year. you could actually search plans and understand if you could -- if the providers are part of that. the other part is created a tool called -- it's called the total cost tool. and it's a tool that allows you to figure out your deductibles and premiums for the year. so our rule making which we will complete is to continue to proette moe stability in -- promote stability in the market and make sure there's consumer choice, not to limit it. >> i appreciate that. acting administrator announced the creation of the rural health
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council to review all regulations that the agency promulgates for their impact on rural providers. i know that you haven't had time to get up to speed on all the details but i'd appreciate any more information you could provide the committee. after this hearing. i'm very much interested in how you see this effort functioning. the distinguished senator franken is the co-chairman of the rural health care caucus. i need to know or we would like to know how they will utilize the work already done by the hhs rural health task force and the hhs national advisory committee on rural health and human services. we have a lot of folks interested but there may be some duplication. i hope we can pull that together. >> with regard to the council, the council that acting
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administrator slav it has pulled together is in response to the topics that we have discuss in this committee. i think you know my personal interest in rural issues so any regulation that was coming through to cms to me, there were a series of questions about rural america that i would ask every time. i think what we are now doing is formulizing the analytics that i think are important for us to understand because i believe that rural markets and urban markets are different. as we consider our rule making we need to consider both. so it is formulizing a process that we had been doing up informally over the past year in terms of that rule making. but we'll be happy to work -- i think you hear that it's an issue of interest and we'd like to work with congress as we ask these questions about the impact on rural america. >> i appreciate that. thank you. >> thank you for all your work on the budget. i wanted to go over a couple of thing, one, the implementation of the basic health plan which now some states have taken up and i want to get your commitment that you're going to
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continue to implement those plans across america. my understanding with new york it's already targeting lower premiums and plans of -- that are better drivers of driving down costs in the marketplace so i want to get your commitment on that. >> yes, i think you know in the time that i have been here we have engaged in a number of these and now with new york and minnesota in terms of the two places. but we look forward to other states coming forward with proposals that do a number of things. one it has to meet the basics of ensuring that the people would have access would have access. it needs to meet the requirements of the health benefits that are required already. and in terms of deficit neutrality for the federal government. but at the same time, we know these plans are about access, but they're also about states coming to approaches that are doing delivery system reform and thinking of more efficient ways to provide quality care. so we look forward to working with states as they come forward
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with their plans. >> well, i think it's very telling when you look at this model because clearly, we're talking about the lower income population that was always hard to serve in general. and that is to get them on an affordable plan, maybe because their employer didn't offer it or didn't have market leverage. looking at new york with low monthly premiums of only $20 it's quite astounding that we can provide great coverage for a huge population and as i have been a fan focused more on managed care which also drives down the cost as well. so i look forward to your commitment to working with other states on that. and as the administration also looks at alternative payment models to properly incentivize care providers, how are we making sure we're moving ahead, particularly for low medicare rate states like washington that wants to see the improvements, wants not to be penalized but rewarded from that how are we making sure that we're
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transitioning off of fee for service and on to this payment model in a rapid fashion? >> so a number of things we are doing. last year in january, we committed as an administration and at hhs we would transfer 30% by the end of 2016 of our payments in medicare to payments based on value, not volume. that and by 2018 it would be 50% of the payments. what we are doing is we are on track to meet that goal for this year. which is important, it's important because we're a large portion of the dollars but it's important because of the signal that it's sent the market in terms of other people coming to that space. and whether that's private players or medicaid like the state of new york where in medicaid that happens. additionally to your point of rewarding those who are making advances in quality and affordability, we also with our accountable care organizations, we took the feedback that we had received and in the next round
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of those we have put forward changes that hopefully will protect and reward those who are already leading in this space. >> okay. on graduate medical education, you know, there's something that you guys have entailed on setting the standards for emerging needs in health care as it relates to medical education. how -- what are those standards going to entail? >> so what we're trying to do on -- this is on the medicare side, is we do want to make sure that the monies that are for graduate education in the medicare space are targeted towards those serving the medicare population and in addition, we want to make sure that we are focusing on primary care where we know -- we need more services, as well as the issue of specialties where we do not have enough people. so what we're going to try to do is create standards that target the money and guide it to the places where "a" it serves the population it's supposed to in
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terms of medicare and "b," in places where we have shortages. >> right. i think the problem that we have that we need to focus on is that given a state criteria, we're not -- you know, you can be in seattle and be well served but be in spokane and have a shortage. so need focus on the fact that, you know, even within a state, you could have great geographic differences and what you're doing to serve graduate medical education so it's a big priority for us to have that graduate medical education in spokane. thank you. then my colleague i'm sure is going to ask you about puerto rico but the bottom line is our colleagues here have to understand while there's a cap on medicaid rate expenses right now in puerto rico, if tens of thousands of people come to the united states there's no cap on that. so we are just digging a deeper, deeper hole in our budget by not fixing the problem in puerto rico. so thank you. i'll let my colleague when he gets to that address it.
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>> [ inaudible ]. >> i appreciate that very much. particularly your understanding of the need to be absolutely objective on the analysis and we thank you for that. as you know, cbo recently came out with an estimate that -- that said by in -- in ten years without addressing mandatory spending and other issues, the mandatory and interest will consume 99% of all federal revenues. obviously that's unsustainable. you and i have been together in rooms talking about budget issues. when you were omb director we weren't able to reach an accommodation ongoing big so i decided i would go small.
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so every week i'd go down and talk about waste, fraud and abuse and how we can save taxpayers' money and better use that. one of the issues that i have been going to be talking about actually today is the i.g.'s report regarding improper payments through cms. and it's my understanding that inspector general listed 25 implemented recommendations for improvement in protecting taxpayers' dollars with cms. cms wants to address this, but it's short on resources. this is kind of a catch 22 because there's an estimate that cms could save $1.76 billion if it had followed the installation of improving automated claims. in a -- and a number of other things. so my question here is you're asking for more resources.
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i'd like to bring this to your attention. there are ways to free up money for absolutely necessary functions for cms. and some of these recommendations if -- all of the recommending as if they're implemented can help with that process. so i wanted to bring that to your attention. i'd like to get your response to that in terms of the ability to go forward and get these recommendations implemented. >> with regard to -- we agree and you know the 7 to 1 statistic in terms of every $1 we believe we can save seven. last year together with the justice department we had the largest takedown we have had in the fraud area. it was over $700 million in one takedown. and so it's a combination that i think of things we can do, the technology portion of it. we do believe we need finances to change and do some of that automation. we have asked for those resources. we are in terms of acting
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administrator slavette, i think you spoke to him about it, it's an issue that's on our regular dashboard of things we're talking about. because i think we believe just as you articulated, fraud is a very important part but i think question go at and go at aggressively. with data getting ahead of it, instead of chasing it. the other part that i think we need to consider is with improper payments there's fraud and then there's that whole category that people aren't providing the right data and information. as we have tightened the requirements, in order to do things like requiring paperwork before payment so that we get in front of it, we find that we are seeing greater numbers of people not getting the right paper. so we are focused on that technical assistance to providers to get the information to us. but that's also a place where the resources are important. >> well, given your experiences as omb director, i know this is in your wheelhouse. so as secretary of hhs and overseeing cms you're the right person in the right place to get
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this done. we wish you success in getting these things implemented here because it can free up necessary funds for programs that may be waiting for those funds. >> absolutely. that's why we're hopeful that our budget request -- because that particular part results in greater savings. the 7 to 1 number is what we have seen on the average of the last three years. >> thank you. mr. chairman, i have 40 seconds left which i yield back in the interest of the vote coming up. >> well, you're just great to do that. who's next? senator wyden, i guess. >> thank you, mr. chairman. i will only ask one question on this round given colleagues being here. we're very pleased the secretary is here, secretary burwell in my view gives public service a good name and we are glad she is here. the issue of opioid abuse is widespread across the country, and it is of particular concern
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to oregon. i think the colleagues know that i have opened an investigation into potential conflicts of interest between opioid manufacturers and the pain industry. the concern here is that the manufacturers may be trying to influence opioid prescribing practices and we'll have more to say on that in the days ahead. now, oregon has been among the states with the highest nonmedical use of prescription pain relievers. the cd c estimates that one in 15 people who take prescription pain killers for nonmedical purposes are going to try heroin within ten years. nationally, health care providers write enough prescription for opioid pain reliever for every adult american to have a bottle of pills. physicians are inadequately trained on pain management. this past week i sent a letter
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to the cdc director to offer my support for the cdc's draft guidelines for prescribing opioids for chronic pain which will help prescribers to have appropriate opioid prescribing. so set aside for the purposes of this morning, madam secretary, this question of the investigation into potential conflicts of interest. we will talk about this more in the future. but for purposes of this morning, what is hhs plan to do to ensure that opioids are prescribed more appropriately and what is the plan to reduce the number of people using prescription pain relievers for nonmedical purposes? >> so when i came to hhs in june of 2014, this was one of the priorities i chose as secretary because i'm from the state of west virginia where i think many of you know the problem is acute.
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like neighboring states, but also all over the country. i have visited in colorado, pennsylvania, too. across the country. so we put together a three-part strategy. based on the evidence that we had seen to date in terms of the most important levers that the federal government and hhs had. it was three parts with number one being the issue you just touched on. and that is prescribing. prescribing is how this starts, it's how it starts in terms of the prescription medication. it is after they have done prescription med -- drugs. in colorado i met a young woman who said after three months, heroin was cheaper, easier to get and a better high. so we see that -- she had started with her wisdom teeth being pull and taking the drugs. so first prescribing practices that's the work that cdc is doing. second, medication assisted treatment and this is the approach that i think there's broad bipartisan support and it's support at the state level with the governors, with
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sheriffs, with everyone, with everyone making sure we're getting treatment for people. right now in our states, we have so many people who are already addicted. that's what the vast majority of the monies that we have in this proposal and our budget do. it's important to note that is money that will go to states and communities. it will go through samhsa, it will go through hrsa, but the vast majority of the dollars will get out and we can build in states and communities to do medication assisted treatment. the third part of the strategy is that loexen. people overdose and 78 people a day in the country dying of an opioid related death that overdose can be prevented by applying naloxen, also called narcan. so we want to help and support communities to get access to the drug. to the first responders as well as we recently saw organizations
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like cvs and walgreens working to making this an over the counter drug in other states. >> i'll ask some others on the future rounds. >> well, thank you, senator. senator thune is next. >> thank you, mr. israel cha. -- mr. chairman. madam secretary, nice to have you here and i appreciate being able to discuss the issues with you previous by. but i wanted to raise some concerns we have had about the great plains area indian health service. the reports coming out of there have been unacceptable unfortunately there has been a failure to deliver on the promises, reports of ihs's failures were issued in 2010, 2011 and in 2014 i was informed a contractor was in place to strengthen the development of the effective patient care processes. the report after report uncovers
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the same issues when its comes to fixing the issues the administration seems to continuously fail. i would like to know from you what the administration's done in the past few years to engage the tribes in the great plains area to make meaningful reforms to the system and to ensure that patients receive the quality care they deserve. if you could talk a little bit about that. >> yes, thank you, senator. i share your concerns. in terms of the progress that has not been made that needs to be made. there are a number of changes we are taking right now in terms of trying to get a different result where from we are. i think it was important though that when cms said that we didn't have safety and quality issues that we acted upon that, to protect the health and well-being of the folks. that means they need access to quality care, how do we get there? first in the region itself, we think i think you know we have changed the leadership in the region and we're sending some of our public health commission core officers who work on quality issues and to supplement the ihs folks on the ground.
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in addition, at the department itself in terms of making sure that we're doing quality and management changes because i think it's both about meeting the quality standards but management and culture that we need to make some changes in. and we have hired a deputy, dorothy dupree, who's come from the field to work on the quality issues and brought in mary smith as another deputy to work on the management issues. in addition, i think you saw in the hearing which you were in, i specifically asked the acting deputy and thanked this committee for her hearing, dr. mary wakefield to actually put together an interagency group within the department of health and human services that met yesterday to see and set specific goals of what we can achieve during our time. >> thank you. we'll look forward to continuing to follow up on those issues. i wanted to change gears for just a moment and ask about -- this is kind of the more forward looking, i hope.
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on how we can make reforms at the ihs. i'd like to follow up on at least an issue that i have addressed with the officials at ihs, but late last year i requested an update on when the administration would finalize the regulation that was initially published in 2014 which would expand medicare like rates for physician and nonhospital based services under the purchased and care program. i understand that this regulation is awaiting approval at omb and i'm encouraged by what we're hearing about the progress and i'm interested in when you believe that this regulation will be posted and additionally would like to know how the administration plans to conduct its consultation with the nine tribes in south dakota. >> so with regard to the specific regulation that you're speaking of, yes, it's at omb under the review process and that's generally a 90 day process. the comments come back to us and the question is how extensive those are in terms of the timing but it is at a late stage of a
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regulatory process. it is one that's a priority for us in terms of those that we have gotten to omb. so we're hopeful that soon we will get it out. i think it's also related to the issue that i think you know because your state and your governor have been an important part as has alaska. of changing the way we do payment issues that aren't a part of that regulation. but i think are important to the payment system of how we provide health care so we are working both on the regulatory front, but working on something that doesn't -- i think you know require the same process in terms of the payment and i think you know we're changing some of the matching rates. >> right. i appreciate the effort there and we could encourage you to continue to push omb and -- to be able to move forward with the finalization of that regulation. i have written you in the past regarding the electronic mechanism exchanging the information and in the purchase and referred care program claims are still being mailed back and forth.
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my understanding is the administration is considering a move to electronic claim payments and would be interested in an update if that's something that the administration believes is feasible. >> with regard to the specifics of where that one is, i'd like to get back to you on it. i think you know with the emphasis in our delivery system, one of the anchors of the strategy there is electronic health benefits and data and information and the ability to move that more quickly so we improve quality and we improve affordability. so it fits within that overall involvement, where it specifically is at this moment i'll get back to you. >> thank you. my time is up. thank you. >> senator nelson? >> under the aca, 17.6 million people now have health care. louisiana is expected to expand medicaid in their legislative session. that's another 400,000 people.
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that's 18 million. the republican governor states that have refused to expand medicaid and will eventually is another 4 million. so 18 million plus 4 million is 22 million. 22 million people will have health care out of an eligible population that did not have health care of 34 million. that's two-thirds. that's to use the lexicon of today, that's a huge success. i don't think that that story is really understood, how successful the aca is. now if you wonder where i got the $34 million, i'm taking 45 million was the population.
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that didn't have health care and i'm subtracting the -- those that are here illegally, 11 million to get 34. 22 out of 34 million will have health care. that's a success. i want you all to chronicle that story. >> i think when we think about the issue of the success, it's around affordability, access and quality. as you appropriately reflect on the access point as i mentioned in the opening testimony, we're at a place where over 90% of americans have insurance in the country and that is a very big change from where we were. you know, for medicaid, 14 million additional folks are in medicaid from 2013 to now. and we know that in the
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marketplace that 17.6 as well as other numbers in terms of the reduction. the other thing that's important to reflect, when we have low unemployment that people have health insurance through that as well. so all those things are coming together to put that downward pressure but i don't think we can forgot the other things like pre-existing conditions. so many people who have had cancer and asthma, that's been a very important change that many people think is beneficial, as well as preventative care and conditions answer that gets to senator cantwell and some of the issues we have discussed about downward pressure on price. >> okay. puerto rico, the mosquito that is in puerto rico that has spread a lot of dengue fever is the same mosquito that carries the zika virus. now, fortunately, the zika virus produces a flu-like symptom that is relatively moderate. but where it's having these tragic results is on pregnant
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women with children that are deformed. puerto rico needs help and lo and behold, if puerto rican pregnant women are being exposed and they have this tragic result of these defective births, that's going to be an additional expense upon the health care system to take care of these babies. i know you put $250 million in your budget to curb what is expected to be in puerto rico this outbreak of zika. you want to comment about this? >> yes. with regard to the zika virus, the concern that we have right now and the plan that we have put in place is about preventing further damage and focusing specifically on pregnant women. on the island of puerto rico this mosquito is a very dominant
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presence, it's a mosquito that will sometimes bite four humans in one feeding. therefore, it spreads the disease quickly. and so also, because 80% of the people actually aren't symptomatic, you don't necessarily know if you have had it. so the importance of getting resources to puerto rico in terms of pregnant women and taking care and protecting us and doing mosquito control. it's not just for puerto rico. puerto rico is the place where we expect that we will see the most and we have had mosquito transmission already. but in the continental u.s., in states like florida and texas, we're also concerned because this mosquito is prevalent as well. and want to make sure we're putting the resources against preventing as much spread as we can of the zika virus. >> thank you, mr. chairman. thank you, secretary, for your public service and your leadership.
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i wanted to continue along the lines that senator nelson was talking about with respect to zika virus and broaden the question a little bit. as you know, the cdc's division of vector borne diseases in ft. collins, colorado, has been on the front line of studying and monitoring this issue of this disease for years. the president as you mentioned in your budget -- opening presentation what proposed $1.8 billion to respond to the zika virus. can you give us more detail about how you propose to spend that money and what role the division of vector borne diseases would play and respond to the virus? >> we're appreciative of the work they have done to date. because the issue of testing for zika is occurring with the cdc and in terms of ft. collins, that's where the testing is occurring, we are trying to move the testing out to states so it will be more proximate to those in need. that's what the money is about,
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that states have the capacity to test. because any woman who has gone to mexico and the estimates are about 450,000 pregnant women travel to these regions where zika is. if they come back, they won't necessarily know because 80% of people don't know if you have had the disease. so if you're pregnant and come back, you're most likely will be tested and we recommend you're tested. if you have gone to this region. therefore, a lot of the money is about making sure that the states are going to have that testing capability. >> thank you. then i wanted to shift gears a little bit. senator grassley and i along with senators nelson, brown and portman introduced the ace kids act. it has 30 cosponsors. it would help the children with cancer, congenital heart disease and down's syndrome. those with medically complex conditions are covered by medicaid and they account for 6% of the medicaid enroll lees and
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30% of medicaid costs for kids. it would have the world class providers in medicaid program that would coordinate care on behalf of the children. i know hhs has worked with -- within certain states to test these types of models. we hope to develop it nationally and work across state likes. senator grassley and i are working with the cosponsors and senators hatch and wyden to try to pass the bill. i'm bringing it to your attention because operating medicaid across state lines is not easy and we need assistance to pass the law this year. is this something you would be willing to prioritize? >> yes, we want to work with the authorities we have to do some of the things that we can do that are ideas and concepts and we want to work with you on ensuring we can do all the work we can to make sure that these kinds of children are -- >> great. i appreciate that.
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i think we can do a much better job of providing better care at a lower cost if we could coordinate it. so thank you. with that mr. chairman, i'll yield back because i know there's a vote. >> thank you, i appreciate it. we'll go to senator portman. i'm going to -- i apologize to you, madam secretary, i will be back. but the bill on floor is my bill. i'm going to have to at least go vote on it. senator portman will take over. and then my staff will say who's next. if any republican senators are here, they can direct who's next. senator portman? >> thank you, mr. chairman. it's a privilege to have the gavel, i won't abuse it. and thank you, madam secretary, for seeking my counsel. i had none for you, except do say that we have differences on this budget. i agree with what senator bennett said about the importance of the ace act that will reduce costs. we have differences on the big
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picture, $3.3 trillion on new taxes. we have talked about the fiscal challenges that we faced and aren't resolved in the budget. but i want to talk about something that like in the budget. and that's the work on opioid addiction. so prescription drug and heroin addiction is at epidemic levels in my state around around the country and we're losing lives every single day. we lost over 2,300 ohioans last year alone. we have over the last three years been working on legislation that is bipartisan, comprehensive. we have had over a dozen meetings up here with experts from around the country who tried to bring in the best people to figure out how do you get at this problem? you and i have talked about it and you've reached out to me on this issue. that just passed the judiciary committee while you were testifying and it passed by a voice vote. in other words, it was unanimous. that doesn't happen around here.
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and so i'm going to thank you for what's in the budget because what you put in the budget is consistent with cara and provides more funding specifically for treatment. one of the things i like about your budget it also provides some funding to look at -- i'm reading from your budget, evaluating the effectiveness of the treatment programs. so it's research and best practices because not all treatment programs are equal. some work better than others. some that i visited in ohio have incredible results. others are frankly struggling. so i think that's important too at the federal level to provide that. so i encourage you to continue to do that. i know you have a passion for that. senator whitehouse is the other co-author of this, but we have over 120 groups around the country who have supported us including the national association of district attorneys, the attorneys generals, i think 38 now endorse the bill. the groups represent the people who work in the trenches every day in the states. they have endorsed it. this is one we can get done and i know that the white house has
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said generally good things about the bill. but has not been willing yet to say they support it. i hope you will support it. i hope you will get behind it. we understand there has to be funding that goes along with it that's why i think the budget is a step in the right direction. the funding we got in at year end will help, but we need additional funding to be sure the legislation can be implemented. i wonder if you had any thoughts on cara you could share with us today. >> thank you for your leadership in the space. it's important to the progress we can make. you've been a strong leader and appreciate our conversations about these issues. it aligns with the strategy i articulated. i think we want to continue to work. i'm hopeful. i think you know i just have 11 months and so the idea we can put in place the things. i hope we'll start to see the results of our efforts.
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the idea we can put in as many as possible of the things i think we need to do. as well as these prescriber issues that we're going to face when we get to new guidelines. glad to hear about the vote. >> we are encouraged by the amount of support we're getting. i think the administration weighing in, you know, more precisely on this legislation would help us to get it through the process without with off happens around here which is political games. people will say this is about politics. it's never been about politics. we've kept it not just bipartisan but nonpartisan. we'd love your help to get this to the president's desk. the federal government play a more important role, a partnership role. to address what is a crisis in our communities. there's other legislation as you
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know that senator toomey and myself have introduced. it's called the stopping medication abuse and protecting seniors act. by reducing the likelihood that there is doctor shopping, multiple doctors, multiple pharmacies. we know these programs work in the private plans. cms administrator testified that medicare is prohibited from using this important tool. i wonder if you could comment on that legislation and your view on this and whether we can also move that legislation forward to avoid some of this prescription drug abuse. >> as was commented by cms in terms of our ability to do it, i think you know, it would could statutorily. the one thing we want to make sure is we don't make access too hard. pain is an important issue. i think we agree we can do a
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much better job, which i think is what the objective of the bill is, in terms of controlling this access to these drugs. in terms of providers and pharmacies. just want to do it in a way that didn't inhabit access for those who actually need it. >> look forward to working with you on that as well because it does require a statutory change. thank you, mr. chairman. >> senator mendez. thank you, mr. chairman. rotating chairmanships today. madam secretary, thank you for your service to our country. as you know, congress passed the autism cares act in august of 2014. the research, the intervention, support programs that existed under the old named combating autism act. while the cares act contains requirements that hss, chief
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among them is a report focused on young adults and youth with autism who are transitioning out of school-based support services into the larger community. according to the cdc data, 1 in 68 children nationally and unfortunately 1 in 45 in my home state of new jersey are identified with an autism spectrum disorder. early diagnosis and interventions have come a long way to support these children but unfortunately youth and adults don't have the same access to support and services after they leave the school so the happenstance of the date on the calendar changes their lives dramatically. after the law's passage, i convened a roundtable discussion with key autism community leaders in new jersey. this issue of aging out and transitioning to community-based services was something that was consistently mentioned as an area in dire need of attention which is exactly why i mandated this report which would provide congress the agencies
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researchers and providers with a comprehensive understanding of not only what services are currently available but what we need to do to ensure that every individual with an autism spectrum disorder can succeed in adulthood. now the report on young adults and transitioning youth is due to congress this upcoming august two years after the autism cares act was signed into law. can you provide us with an update on the progress of the report and confirm it will be completed by the statutory deadline? >> thank you for your leadership in the space because it's important to helping us, the work that we do. we are working in terms of this report. i will get back in terms of the specific question you're asking on august exactly and come back -- >> my understanding may be wrong. that this has not been started. i don't know how we make the august deadline. i hope i'm wrong. if not, then i'd like to get a sense -- i'd live to give it a
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sense of urgency. i know many of my colleagues have talked about the opoid epidemic. last year in new jersey, heroin deaths are up 160% since 2010 and we suffered more than 1,200 overdose related deaths, so this is really an epidemic. i recently held a listening session with stakeholders in new jersey to address this growing crisis. to a person the issue that came up most frequently, there are many, but the one that came up across the spectrum as the mouch substantial barrier was the limitation on provider's ability to conduct medication assisted treatment. as you may know, these limitations cap a provider's ability to treat at most 100 patients. with a number of people seeking
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treatment far outpacing the number of providers who can help, it seems to me this is an outdated limitation and tying provider's hands and limiting treatment to those who need it the most. i would certainly like to see a broader provider universe. when something is an epidemic, you need to figure out that maybe an artificial cap at one time is now not the reality of the moment. so while i appreciate the administration's bold request for additional funds in this area, intend to be supportive vigorously of it as i can, what can we do to increase the access to medication assisted treatment and what further efforts can the department take under its current authorities? >> i think that specifically in the case of that specific drug in terms of the medication and that specific type of medication assisted treatment. we are actually in the middle of changing our regulations.
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using as much of our administrative authority as possible to take it. with buponorphrene, it is something we want to make sure. i think we can expand those caps and move those numbers without creating that problem but that's what we're working on now. as part of the budget, in the budget, there's a proposal to expand the ability for trained people in correct settings. in other words, making sure that beyond physicians might be able to use it meeting certain c criteria. >> i want to mention i know my colleagues have brought it up. i hope your department will do everything you can to take the
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administrator steps that are possible within your wherewithall on the health care crisis in puerto rico. i listened to their families and p in new jersey and it is getting out of hand. i hope that you will see what administrative powers you have to help the people, the 3.5 million american citizens. >> we are very focused in terms of the administration administrative actions we can take. i think as you know, the medicaid space is where large dollars and large amounts of care are very important and it's on an equal footing. i'm sure this committee spent time yesterday with my colleague secretary lou on important legislation that needs to occur in his area. but i would be remiss if i did
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not emphasize the importance of some of the help and what we're trying to do is make sure that americans in puerto rico have equitable care with regard to medicaid in terms of those rates and that's what the proposal and the budget at the same time we will do everything we can from an administrative perspective. i also thing the issue that was just raised about zika is particularly important. when one things about the cost that senator nelson was mentioning, cdc estimates for children born with some of these severe birth defects depending on the severity that the cost is 1 million to 10 million per child. so making sure we're doing everything we can right now to help and assist and support puerto rico in preventing cases of zika in pregnant women that could lead to these additional uses is a place that it's a priority focus. i've spoken to that in the past several days. in terms of the urgen


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