Health Secretary Kennedy testifies on HHS budget before Senate Appropriations

[0:00] Secretary Kennedy, thank you for being here. I understand this is your fifth of seven hearings, [0:04] so you should be all warmed up for us. I know that we all share the goal of improving the health of [0:10] Americans. This hearing is an important opportunity for the subcommittee to hear from you on HHS's [0:15] budget proposal and better understand your priorities for fiscal year 2027. You're now in [0:21] your second year at the helm of HHS. During your time as secretary, I know you've taken a careful [0:25] look at every program this committee funds, and I commend you for coming here today with a much [0:31] more reasonable budget request than last year. Congress has a responsibility to ensure that [0:37] limited taxpayer dollars are always well spent, and I look forward to hearing from you about ways to [0:41] improve the agency. One of the most important investments we make in HHS is in biomedical [0:47] research. That is why in fiscal year 2026, Congress provided a $415 million increase for NIH, [0:57] which all of us supported. NIH-funded basic research provides hope for American families [1:03] when a loved one faces a difficult challenge. New treatments, cures, clinical trials are available [1:09] because of funding Congress has provided. That record of success is why NIH has long-standing [1:15] bipartisan support in the Congress. Our nation's support depends on the medical researchers across [1:21] the country supported by NIH. America has long been the world leader in biomedical research, [1:26] and I look forward to hearing your proposals of how American can maintain our role as the world [1:31] leader in biomedical research. It is promising news that overdose deaths across the country are [1:37] trending downward, but sadly, substance abuse challenges continue to be a problem facing certainly [1:43] my state of West Virginia and the nation. I appreciate the administration's focus on combating addiction [1:49] and supporting recovery, and I'm grateful for your swift action to reverse the very questionable [1:55] SAMHSA grant cancellations that occurred earlier this year, so thank you for that. SAMHSA funding has [2:01] played an important role in West Virginia, and I would like to understand how the budget proposal [2:05] to reorganize substance use prevention and treatment programs into the proposed administration for a [2:11] healthy America would continue to help fight the scourge of addiction across the nation. As you know, [2:17] Congress continues to prioritize programs that support health care access in rural communities. CDC data [2:25] shows that diabetes is more prevalent in rural communities than in urban areas, and rural Americans are [2:30] much more likely to die from cancer, heart disease, and stroke than urban Americans. We experience these realities acutely [2:38] in my home state, which leads the nation in rates of diabetes and heart disease. Therefore, I appreciate [2:44] your focus on combating this chronic disease crisis in the U.S. To help improve physical and mental health [2:51] outcomes for rural Americans, we must continue investing in our health workforce and other rural [2:57] health initiatives that build capacity and strengthen our community institutions. HRSA has been a trusted federal [3:05] leader on these types of rural health activities for decades. You have also proposed moving HRSA to the [3:11] new AHA, and I would like to learn more about how your budget proposal would invest in rural America. As [3:18] always, the appropriations process this year will be challenging, but it is my hope that we will once [3:23] again come together to produce a bipartisan bill that uses our limited resources in the most efficient and [3:29] effective way to support the health and well-being of all Americans. Finally, I want to note that it [3:35] took almost nine months to receive responses to this subcommittee's questions for the record on the [3:40] fiscal year 26 request from last year. These responses arrived just last month, far after the statutory [3:48] requirement of 45 business days, and more than a month after the FY 2026 bill was signed into law. [3:55] I would urge you to respond in a more timely manner following this year's hearing. Secretary Kennedy, [4:00] I look forward to hearing from you throughout that process, and thank you again for being here, and now I turn to [4:06] the Vice Chair for her opening remarks. Thank you, Chair Capito, and good afternoon. [4:14] This, I want to start quickly by putting the HHS budget in a larger context because this is the [4:21] President's budget request, and it makes the Administration's priorities clear. More money for war, [4:28] less money for programs helping Americans here at home. It includes a 450 billion dollar or 42 percent [4:38] increase in defense spending, and it doesn't even include an expected supplemental funding request for [4:45] the war in Iran. At the same time, it slashes funding for the Department of Health and Human Services. For [4:52] programs within the jurisdiction of this subcommittee, by 17 billion dollars, or about 14 percent of the [5:00] overall HHS budget. It cuts funding for biomedical research, combating the opioid epidemic, lowering the [5:08] cost of heating and cooling bills for Americans, and so much more. Instead of fighting wars of choice [5:16] abroad, we should be fighting wars against addiction, against cancer, against Alzheimer's disease, and this [5:23] budget request proposes the opposite. I expect Congress to reject this budget request, just like we did [5:32] last year, but what I'm more concerned with right now is how the Administration is sabotaging important [5:40] health and human services programs, sort of outside of the appropriations and budget process. That's because [5:47] where this budget proposes cutting and eliminating programs, the Administration is currently actively [5:54] working to cripple them. These are programs that families rely on today and support the discovery of [6:01] new cures and treatments for devastating diseases in the future. For example, the budget proposes a nearly [6:09] $6 billion or 12 percent cut to the National Institutes of Health. I'm confident that Congress will reject that, [6:18] but the issue is what the Trump Administration is already doing to decimate America's biomedical research. [6:26] It's delaying billions of dollars of NIH funding while slashing the number of research grant awards. [6:33] Last year, NIH awarded 2,235 or 22 percent fewer new research grants than it did the year before. [6:44] This included 260 or 21 percent fewer new cancer research grants and 411 or 45 percent fewer new grants funded by [6:57] the National Institutes on Aging, the primary funder of Alzheimer's disease research. The NIH funding has been delayed [7:08] again this year, first by the White House and now by HHS. In the last 15 months, the White House and Health [7:16] and Human Services has slashed the number of NIH funding opportunities for new grants from the 700 to 800 issued [7:25] in a typical year to just 85. This Administration has tried out all sorts of excuses for why it's cutting funding [7:35] for life-saving research or tried to say it's just not true, but the numbers don't lie and we need to be [7:42] clear. That's exactly what's happening and it's an active choice to do it. This Administration is making [7:49] a choice to cut off funding for research and in turn cut off hope for millions of Americans with [7:55] life-threatening diseases. HHS is issuing fewer grants and delaying funding for research on cancer, [8:03] Alzheimer's disease, ALS, diabetes, mental health and other chronic diseases and I have fought to stop [8:12] the long-term damage that this Administration is inflicting at NIH and I'm disappointed that we [8:18] haven't been able to do more. The budget request also proposes to cut funding for CDC programs [8:25] by a third. This Administration says it wants to eliminate chronic diseases yet proposes a budget [8:33] that slashes the chronic disease center at CDC by nearly one billion dollars or more than 68 percent. [8:42] Health and Human Services has already fired and forced out thousands of CDC staff and scientists and as a [8:50] result CDC has 26 percent fewer employees today than it did 15 months ago. This includes firing the staff [8:59] who administer the safe motherhood initiative that helps reduce reduce maternal deaths, eliminating the [9:07] division of population health that helps increase early detection of Alzheimer's and other dementias, [9:14] and eliminating the office on smoking and health that reduces tobacco use, still the number one cause of [9:22] preventable death in the United States. If everyone from subject area experts to grant managers have been [9:30] fired, it raises serious concerns about Health and Human Services ability to carry out these and other [9:36] programs, such as the bold infrastructure for Alzheimer's Act, the pregnancy risk assessment monitoring [9:44] system, and the domestic violence and sexual assault prevention programs. These are all programs [9:51] Congress just funded in fiscal year 2026 in our appropriation bills that we passed just three months ago. [9:59] The budget also proposes cutting the funding for the Agency for Healthcare Research and Quality, [10:06] otherwise known as AHRQ, by a third and eliminating it as an independent agency. Congress rejected similar cuts last year, [10:17] but that did not stop HHS from firing a third of AHRQ's staff. As a result, AHRQ is effectively shut down and [10:26] has not awarded a new grant in over a year and has awarded only a fraction of existing multi-year awards that [10:36] researchers and patients were counting on. AHRQ won't even respond to questions from researchers about the [10:44] status of their funding. As one small but important example of what this means and the absurdity of what [10:52] is happening, right now Health and Human Services is highlighting on its website the work of a group of [11:00] researchers, including one from the University of Wisconsin, studying how to use data, AI, and family [11:07] engagement to improve the outcomes for children who are hospitalized. The researcher in Wisconsin, Dr. Michelle [11:15] Kelly, has a grant from AHRQ, but while HHS is touting and promoting her work, she hasn't received the [11:24] second year funding for her grant, which should have been awarded last August. As a result, she's had to [11:32] put her trial on pause and stop working with the families of hospitalized children. And AHRQ won't tell [11:40] her anything about what's going on, derailing promising research and leaving families without answers, all [11:47] because Health and Human Services has effectively shut AHRQ down, despite the Congress just funding it. [11:56] The impact of delaying research like this won't be immediately apparent because it isn't easily measured [12:03] or quantified, but we will be paying the price for it for decades to come. In this case, it means missed [12:11] opportunities to improve outcomes for hospitalized children. And this pattern is being repeated thousands of [12:18] times over across Health and Human Services. The budget request also proposes cutting funding for [12:25] substance use and mental health programs by over $500 million and eliminating SAMHSA as an independent [12:34] agency. This proposal comes even as President Trump issued the quote, Great America Recovery Initiative in [12:43] January, which is an executive order to ostensibly better address substance use disorders nationwide. Just as [12:52] the President announced that initiative, Health and Human Services tried to abruptly terminate, without any [13:00] notice or explanation, $2 billion in funding for 2800 SAMHSA grants across the country. For no reason, HHS tried to rip [13:12] funding away from local communities, working to help individual families suffering from substance use [13:19] disorder or in need of mental health care. This raises deep concerns about this administration's judgment and is yet another [13:27] example of how its rhetoric is wildly inconsistent with its actions. This is part of a pattern and in no way do I believe that that was a [13:39] simple mistake. The budget request also proposes to eliminate Title X family planning programs. And at the same time, Health and Human Services is [13:51] taking steps administratively to restrict women's access to reproductive health care, including contraception. These are only a few [14:01] examples of how this administration is crippling the important work that Health and Human Services does. [14:08] And that is on top of what the President's own Health Secretary is doing to undermine trust in vaccines, including [14:17] making changes to vaccine recommendations that go against decades of scientific consensus. The changes this administration is trying to [14:26] implement when it comes to vaccines are putting kids at risk of debilitating, fatal, and completely preventable diseases. Congress should reject this [14:39] budget request. But that's not enough. This administration continues to act with impunity, putting the health and well-being of [14:47] families across the country at risk. And Congress must stop it. [14:52] Well, thank you, Senator Baldwin. And our witness today, as I mentioned, is Robert F. Kennedy, Jr., the Secretary of the Department of Health and Human Services. [15:04] Secretary Kennedy, as I said earlier, thank you for joining us. You have five minutes for your opening remarks and you can begin. Thank you. [15:09] Thank you, Chairman Capito and Ranking Member Baldwin and members of the committee. Thank you for the opportunity to appear before you today to discuss the President's fiscal year 2027 budget requests. [15:23] We stand at a generational turning point. Our children of the sickest generation in modern history and decades of failed policies, captured agencies, and profit-driven systems caused it. [15:36] Parents across the country demanded change and we are delivering it. We're ending the era of federal policies that fueled this chronic disease epidemic and replacing them with policies that put the health of the American people first. [15:52] President Trump and I are challenging the status quo and the institutions that defend it as we work to make America healthy again. In just 15 months, HHS has delivered historic [16:05] wins. We negotiated most favored nation drug prices with 16 to the largest pharmaceutical companies so Americans no longer pay more than any other wealthy country in the world for the exact same product made in the same factories. We're bringing real transparency to health care pricing so patients know the cost before they receive it. I use the convening power of the federal government to bring together insurance CEOs to the table to reform prior authorization. [16:34] We're cutting red tape, speeding decisions, and demanding transparency. We're also cracking down on waste, fraud, and abuse. This year, HHS and USDA issued new dietary guidelines that put real, whole food at the center of the American plate. We flipped the food pyramid upside down and sent a clear message to God to the American people. Eat real food. [17:01] HHS has also opened the door to partnerships with industry, trade associations, nonprofits, and advocacy groups. More than 50 medical schools have committed to expand nutrition education from an average of just two hours to 40 hours. Food manufacturers are stepping up too. More than 40% of the food industry is committed to phase out petroleum-based dyes by year-end, and many have already eliminated them. I convene the largest, 400 largest tech [17:34] tech companies in our country to agree to stop information blocking so that by the end of next year, and it's already happening, people's health records, which they own, will be available to every American on their cell phone. In conjunction with these efforts, FDA has also approved six natural food colorings derived from fruits and vegetables. [17:41] Through President Trump's great American recovery initiative, HHS is matching compassion with action to help Americans break the cycle of addiction. [17:48] At HHS, we are a priority for the American recovery initiative. [17:50] By the end of next year, people's health records, which they own, will be available to every American on their cell phone. [17:53] In conjunction with these efforts, FDA has also approved six natural food colorings derived from fruits and vegetables. [18:01] Through President Trump's great American recovery initiative, HHS is matching compassion with action to help Americans break the cycle of addiction. [18:10] At HHS, we are prioritizing patients with ultra-rare diseases and their families driving faster access to life-saving treatments. [18:19] We're restoring gold standard science and integrity across the agency. [18:24] We're protecting children from sex-rejecting procedures that expose them to irreversible harm. [18:31] We're eliminating outdated and misleading warning labels on hormone therapies that treat women during menopause. [18:38] We're strengthening oversight of organ procurement. [18:42] We're implementing Operation Stork Speed to ensure the safety and quality of infant formula. [18:48] We're regulating television advertising by pharmaceutical companies for the first time since the 1970s. [18:55] We're applying that same focus and urgency to rural America. [18:59] The Rural Health Transformation Fund delivers the largest investment in rural health in our nation's history, $50 billion over five years, [19:08] to strengthen rural hospitals and ensure Americans can access the care they need no matter where they live. [19:16] Members of Congress on both sides of the aisle have made rural health a clear priority in their conversations with me [19:22] because every state is feeling the strain of hospital closures, workforce shortages, and gaps in access. [19:29] HHS announced more than $135 million investment this month to expand rural residency programs and nutrition services. [19:38] The data is clear. When physicians train in rural communities, they're much more likely to stay there. [19:45] The President's budget puts all of these priorities in action. [19:49] It invests in prevention because preventing disease costs a lot less than treating it. [19:54] As my uncle President John F. Kennedy said, progress is a nice word, but change is its motivator, and change has its enemies. [20:03] We see those forces clearly, entrenched interests, defenders of a failing status quo, and institutions that put profit ahead of the American people. [20:13] That resistance underscores the urgency of this moment. [20:19] We can reverse the chronic disease epidemic, improve public health, and lower costs. [20:24] I stand ready to work with this committee and Congress to seize this opportunity to implement and codify lasting generational reform of American health care [20:35] for our country, for our children, and for the healthy American people. [20:39] Together, we can make America healthy again. Thank you. [20:42] Thank you. [20:44] Thank you. [20:45] I want to welcome the chair of the full committee, the senator from Maine, Senator Collins, and I'm going to ask her to start off the questioning. [20:53] Thank you. [20:54] Thank you very much, Madam Chair. [20:56] Secretary Kennedy, before I get to my questions, I want to thank you for your efforts in securing the release of the low-income home energy assistance program funding [21:11] that had been held up and is very important to many of our states. [21:18] Now, turning to my questions. [21:20] Yesterday, the Washington Post published a story on NIH grants which documented a 31 percent decline in the number of research projects funded in 2025 that included the word women. [21:40] I brought up this exact issue with the NIH director at a recent hearing before the health committee because the administration's emphasis on canceling diversity-related grants has resulted in less research aimed at women's health. [22:03] It is well established that disparities in women's health exist. [22:10] For example, the incidence of Alzheimer's disease is higher in women than in men, and it is not explainable by the fact that women live longer than men. [22:25] There are also disparities within the female population. [22:30] For example, pregnant women who are black have a higher maternal morbidity rate than white women, while Asian women have a better outcome than white women. [22:48] Yet, it appears that the administration is looking at these health disparities and is not looking at them, is pulling back from these grants instead of figuring out why these health disparities exist and how to address them. [23:07] I know that your budget requests notes the importance of continued investment in maternal health, but how are you going to address other health disparities in women's health, such as the disproportionate burden of autoimmune diseases, Alzheimer's disease, as I mentioned, if diversity is no longer a criterion in making funding decisions? [23:35] Senator, thank you for that question. [23:38] Senator, thank you for that question. [23:39] We're about to announce in the next coming weeks a major program, major investment by ARPA to study Alzheimer's and to focus on new treatments and preventative treatments and ways to reverse Alzheimer's. [23:57] There are many, many grants at NIH now studying Alzheimer's and diabetes. [24:03] We're focusing for the first time on chronic disease and its etiology, which has been neglected by that agency for many generations. [24:14] We're going to identify the causes of chronic disease and how to eliminate the exposures that are generating this giant epidemic. [24:22] We're focusing on maternal health. [24:26] And I can read you a whole list of programs that we're doing on maternal health right now. [24:31] And you're right. [24:32] We have the worst maternal health outcomes of any of the Western countries. [24:37] And black women are 2.6 times more likely. [24:41] A college-educated black woman is 2.5 times more likely to die from maternal health mortality than a college-educated white woman. [24:55] One of the programs we have now is the perinatal pilot program where we've enrolled 220 hospitals in one year. [25:04] We've dropped the rate of maternal mortality by 42 percent. [25:09] Nobody's ever done that before. [25:11] And we're now trying to extend those protocols to all other hospitals. [25:15] I appreciate those efforts. [25:18] I still think we have a problem if grants are being scanned for the word women and then clawed back or not funded. [25:28] So I hope you look more broadly even though I support the initiatives that you've mentioned. [25:35] I do want to move to another issue. [25:38] As you have heard from the subcommittee chair, there has been strong bipartisan support on this entire committee for the investment in biomedical research. [25:52] In fact, it's hard to think of an investment that pays greater dividends to American families than that investment because it leads to life-saving and life-enhancing discoveries. [26:07] The administration's budget, much to my dismay, once again proposes an arbitrary one-size-fits-all 15 percent cap on indirect research costs, [26:23] despite the fact that Congress blocked an identical proposal last year that originated with OMB. [26:34] such a cap would harm cutting-edge research happening at universities and other nonprofit laboratories and medical centers across the country, [26:47] and undermine the foundation for our nation's global leadership in biomedical research and technological innovation. [26:57] Mr. Secretary, rather than continue to pursue a policy that Congress clearly rejected both sides of the aisle, both chambers, [27:10] will you work with us and the research committee to find a better way to increase transparency and accountability [27:20] that does not come at the expense of crucial biomedical research? [27:27] Absolutely. I look forward to working with you, Senator. [27:31] I would say this, that nobody in my agency wants to cut any of these agencies, any of these programs. [27:40] And I don't think Roswell wants to cut them either. We have a $39 trillion debt, and all of the agencies across the government have been asked to tighten their belt, [27:52] and my agency have been asked to cut 12 percent, and all of these cuts are painful. [27:59] But we are at the cutting edge right now in terms of revolutionizing biomedical research in our country. [28:10] We're losing our logic to China. China, last year, 50 percent of the new drugs that were approved were from China. [28:18] It went from 3 percent of the clinical trials to 30 percent, and another 30 percent are going to Australia. [28:26] So we're losing our IP, we're losing our best researchers, we're losing our scientists, and we're losing ground in terms of our biosecurity. [28:36] These are all things that we are focused on. We are compressing the pathways to approval and compressing clinical trials. [28:50] I think I'm out of time, but I will talk more about that later. [28:56] Thank you, Madam Chair. [28:57] Senator Baldwin. [28:58] Senator Baldwin. [29:00] Thank you, Madam Chair. I believe I heard you say just now that all departments were being asked to tighten their belts and make cuts. [29:09] The Department of Defense is being, the President's proposal increases that budget by, I think it was $450 billion, so I just want to correct the record here. [29:23] Secretary Kennedy, I do appreciate our recent phone calls to discuss the fiscal [29:29] year 2026 Labor HHS bill and its legal requirement for HHS to restore the [29:37] press 3 option on the 988 suicide and crisis lifeline specifically focused on [29:46] LGBTQ youth. Secretary Kennedy, do you commit to restoring the press 3 [29:53] option as required under that law? I do, Senator, and I want to say that President [30:01] Trump has a philosophy that we shouldn't be dividing people, that we should be [30:05] being inclusive. But I did hear you just say yes. Yes, we are working on getting it [30:10] up now. All right, I will continue to be vigilant until I hear that it has been [30:15] restored. Switching topics, Mr. Secretary, is it this administration's goal to reduce [30:24] the number of women using birth control in this country? Not that I know of. Okay, [30:30] nearly all women in the United States will use contraception at some point in their [30:37] lifetime and they deserve to have facts and I'm deeply concerned by the extreme [30:43] steps that I've been hearing about this administration taking including the [30:48] continued crusade for a national abortion ban. It's been widely reported that EPA is [30:56] considering testing wastewater for Mifepristone, the drug widely used for [31:02] medication abortions. Have you spoken with Administrator Zeldin about this effort? I have not spoken to him specifically about Mifepristone, but I have spoken to him about the program and [31:20] urged him to conduct a program to look for pharmaceutical drug artifacts in our water. A lot of that water gets into drinking water. There's hormones in it, there's antidepressants, there's all kinds of drugs in it, and we have no idea how much or what impact that is happening. [31:40] You have spoken with Administrator Zeldin about that general topic. CDC also has a wastewater monitoring program [31:50] that also can be used to track the presence and spread of dangerous infectious diseases at a very localized level. Will you use the CDC's wastewater monitoring program to track the use of Mifepristone? [32:08] I have no plans to do that at the moment, Senator. [32:14] I care deeply about women's health, safety, and choices, and this administration has tried, as I mentioned in my opening comments, to cut off funding for family planning clinics, has tried to make it harder for women to access birth control, [32:31] and has reportedly been exploring efforts to monitor the water supply to track women's use of abortion medications. [32:41] Turning to another issue, the Trump administration's continued undermining... [32:47] By the way, I've never heard of that program, Senator, but... [32:51] That's reassuring. There's been reporting, and so I'm sharing that with you. [32:59] Secretary Kennedy, do you think that NIH should fund less cancer research? [33:05] No, I think they should fund more, and the budget proposal... [33:11] One of the few agencies that's gotten a raise in the budget proposal is NCI... [33:17] And that increase is less than $1 million for an institute with a $7 billion budget. [33:25] That is a .01% increase. It would not even cover the cost of one additional grant. [33:33] But, Mr. Secretary, NIH's own budget documents show that last year the National Cancer Institute funded 260 fewer new cancer research grants. [33:46] Secretary Kennedy, do you think NIH should fund fewer Alzheimer's disease research grants? [33:56] I think they should be funding more. [33:58] Well, NIH's own budget documents show that last year the NIH Institute on Aging, which administers the bulk of NIH's Alzheimer's disease research funded 411 or 45% fewer new grants. [34:17] And this is true for every disease in NIH's research portfolio. [34:22] I am running...I have run out of time. [34:26] I hope we might get another round, but I will stop at this point. [34:31] Thank you. Secretary Kennedy, by your...I'm looking at the number of employees. [34:36] This is a quick question, I hope. [34:38] At the end...by January 2020, 2025, there were 93,153 employees at HHS. [34:46] There are now 74,313, so that's a big difference. [34:53] Do you feel that there has been any abatement of service or quality of service delivery under these conditions? [35:03] I do not. [35:04] You know, during COVID, my agency grew by 38%, and we are now right-sizing it. [35:13] We're in the process now of hiring about 12,000 more personnel to make sure that we have people to do every job. [35:22] But the agency was not functioning well when I got there. [35:27] It had presided over the largest increase in chronic disease in human history. [35:33] So the agency that's supposed to be protecting us from chronic disease had failed abysmally. [35:38] Yeah. At pre-COVID levels, it was 82,000, so it went up 11,000 during COVID. [35:44] Let me ask you about NIOSH because you know and I know that this is very important to the coal miners and firefighters of West Virginia. [35:54] The investment for NIOSH, it's, you know, for respiratory illnesses, particularly on the job. [36:00] The mission is specially trained NIOSH employees is not duplicative of any government program. [36:06] If they don't do it, it doesn't get done, and the benefits don't come towards those who are suffering from black lung. [36:11] So we were able to work together to get 400 of our NIOSH employees back in Morgantown. [36:16] How would HHS continue to support this important work with the significantly reduced funding levels? [36:23] And also I think it's going to be folded into other things with CDC. [36:28] I just don't want to lose the core mission here. This is really important. [36:31] And I want to thank you, your leadership, Senator, in making sure that we got those jobs restored. [36:40] And as you know, it's an important issue to me. [36:43] I've spent a lot of times in the gold fields. [36:46] And I've spent a lot of time with people who sort of suffer from black lung my entire life. [36:51] But also my professional career, I represented them in litigation. [36:55] So I'm deeply committed to making sure that we're doing the right thing for them. [37:01] Thank you. Thank you. That's important to me as well. And thank you. [37:04] I mentioned in my opening statement, rural health programs. [37:08] The budget proposes to cut $1.3 billion from current HRSA, including $102 million from rural health programs, [37:18] and consolidates what's left into the Administration for Healthy America, the AHA initiative. [37:25] It also cuts state offices of rural health, rural hospital stabilization program, rural hospital flexibility grants, rural hospital provider. [37:36] You mentioned the rural health transformation in your opening statement. [37:41] It seems to go counter to this. [37:43] What would you say and how is AHA going to be able to, how does that fit into that? [37:49] And what kind of future do you see for your rural health programs? [37:53] Well, we're very committed to rural health. [37:56] Both sides of the aisle have made it clear to me that it's a priority for all of you. [38:00] You know, prior to the Rural Health Transformation Fund, we put about 7% of Medicaid dollars went into rural hospitals and rural areas. [38:12] That's about $20 billion a year. [38:15] The Rural Health Transformation Fund increases that by 50% for the next five years, $10 billion a year. [38:23] And that is to go to renovate infrastructure, rural hospitals, to retain frontline personnel, to integrate telehealth and AI into their systems, to revolutionize them. [38:38] In addition to that, I'm always on the lookout for new ways of assisting rural health care. [38:47] Where last week I went to Arizona and announced $135 million program to community development health centers, which there are, which serve 32 million people, mainly in rural areas, to provide nutrition, but also to provide nutrition infrastructure like kitchens and home gardens, et cetera. [39:10] But also for rural residency, because we know that when doctors train in rural areas, 30% of them end up staying there. [39:21] And that's one of the big problems with rural health. [39:23] It is. It's a different delivery system, and it is hard to attract. [39:27] I mean, telehealth is great, and we've done a lot together, all of us, to try to increase telehealth, but there's still a lot of hurdles. [39:35] So I will go to Senator Durbin. [39:37] Thank you very much, Madam Chairman. [39:38] Mr. Secretary, thank you for being here. [39:40] In preparing for this hearing, I came to realize we have something in common. [39:47] Both of us lost our fathers when we were 14 years old. [39:51] I remember your loss. [39:54] I was a second-year law student at Georgetown. [39:56] It broke America's heart for you and your family. [39:59] Well, thank you, Senator. [40:01] My loss was similar in that my father, who was 53 years old, died of lung cancer, two packs of Campbell's a day. [40:10] And it changed my life, as I'm sure your father's loss changed yours. [40:16] And so I've taken tobacco pretty seriously as a member of Congress now for 44 years. [40:21] And the one thing I did that seemed small at the time, but maybe has impact behind, and that was to ban smoking on airplanes. [40:29] Once we raised the question of the danger of secondhand smoke on an airplane, Americans asked the obvious question. [40:36] Well, how about a train, or a bus, or an office building, or a hospital, or a restaurant? [40:42] And we've seen dramatic reductions in tobacco addiction. [40:46] Still, the reason for moving forward on that was not just to make the situation more pleasant on an airplane, [40:55] but also to protect children who were smoking and using tobacco products in school. [41:00] That number is down dramatically. [41:02] We're told by experts that if we want to save more lives in America, we need to do less. [41:09] We need to do more in stopping smoking and have fewer people smoking than we do today. [41:14] Your report on the state of health in America, I looked through it, and it never mentions the words tobacco or cigarette. [41:22] I think it's such a priority, I hope you'll reconsider. [41:25] And I hope you'll also consider what the tobacco companies have done to this new generation of children. [41:32] They're now not peddling tobacco successfully, they're peddling vaping. [41:36] Vaping and cigarettes. [41:38] E-cigarettes. [41:40] I visit schools in Illinois and the principals pull me aside and say, [41:43] Senator, what are you doing about this? [41:46] These kids are doing too much in vaping. [41:48] Instead, however, your FDA just approved the e-cigarette responsible for igniting this youth vaping epidemic jewel [41:57] and announced plans to permit big tobacco to sell more kid-friendly flavors. [42:02] This FY27 budget request would also eliminate the CDC's Office of Smoking and Health. [42:10] This $246 million program helps adults to quit smoking and make sure that kids have fewer chances of ever doing it themselves. [42:21] You tell us, sir, the sickest generation of children we've had. [42:24] How can vaping make them any healthier? [42:26] Well, first of all, I agree with you, Senator, and I want to thank you for the work that you did on airplanes and restaurants. [42:36] And, you know, I was on a lot of those airplanes as a kid and it made no sense to me that if you moved that you could smoke in the back but you couldn't smoke in the front because the smoke was everywhere. [42:47] Oh, that was extraordinary leadership. [42:50] And I want to thank you. [42:51] And I want to thank David Kessler, who was the FDA commissioner, who did an extraordinary job. [42:56] FDA, and I talked to you about this on the phone, that there was a FDA career staff, career scientists, have made certain decisions about vaping. [43:10] There is controversy in my agency because the approval included approval of certain or the request included a request for certain flavors that, in my view, were directed at children, bubble gum and cotton candy. [43:29] The career reviewers have to make a determination because the threshold for tobacco is much higher than it is for drugs. [43:39] They have to make sure not that that drug is safe and effective for a particular individual, that it's better for society as a whole. [43:48] And I think one of the – I don't know about the deliberations there, but I know that they had to make a decision based upon the science that vaping was going to reduce combustible tobacco use. [44:03] That was the scientific finding they had to make. [44:06] I don't know – I don't know the details. [44:09] I've never read the studies. [44:12] But that is the process that they had to go through. [44:16] If I could say this, I want smokers to quit too. [44:19] If there was something that could have saved my father's life, I would have supported it. [44:24] But I learned a long time ago you can't trust big tobacco's promises. [44:28] In the meantime, we can't risk a new wave of children addicted to this poison. [44:32] The law is crystal clear. [44:35] The Tobacco Control Act requires an e-cigarette manufacturer first prove to the FDA that its product is, quote, [44:44] appropriate for the protection of public health before it can go into market. [44:49] You're an attorney. [44:50] This is a condition proceeding. [44:52] The law has no special treatment for American vapes or Chinese vapes. [44:56] If we're serious about protecting kids, I hope you'll reconsider any decision which allows the expansion of e-smoking. [45:02] Thank you, Senator. [45:03] Senator Kenney. [45:05] Thank you, Madam Chair. [45:08] Mr. Secretary, one of the more beneficial things that I think your agency has done under your leadership, in my judgment, [45:21] is to educate the American people about ultra-processed foods. [45:29] But it's still too complicated. [45:36] How can your department go about uncomplicating it? [45:45] I mean, the American people are busy. [45:47] They're busy earning a living. [45:50] And they don't have time to sit down and research the definition of an ultra-processed food. [45:58] Rather than listing all the ultra-processed foods, which, of course, would invite litigation and consternation and gnashing of the teeth, [46:08] how can you come up with a list of things that people should look for on the label to know if it's ultra-processed? [46:25] For example, sodium. [46:26] If it's got more than this amount of sodium, it's ultra-processed. [46:32] Does that make sense? [46:33] Do you understand my question? [46:35] I think it's not only a question I understand, but it's a question that my agency has put a lot of thought into. [46:44] There has been no workable definition of ultra-processed foods before we came in here. [46:49] That's regulatory malpractice. [46:51] There has or hasn't? [46:54] There has not. Never. [46:56] Well, why don't you do it with respect? Why don't you do it? [47:00] Well, we already did it. [47:02] So, our regulations are now, you know, we've developed the definition within our agency. [47:10] It's now, before the rule gets finalized, it's in the interagency process. [47:15] There are other agencies that have equities like USDA, Department of Commerce, OMB. [47:21] They have to review our proposal and then approve it. [47:26] And I would say, Senator, in the meantime, people should eat real food. [47:31] Bobby, let me stop you because I'm going to run out of time. [47:34] Look, here's the problem, and I commend you for what you've done. [47:39] But the American people don't have time to sit down and read a rule or regulation by the federal government. [47:46] Where I'd like to see you end up on this is not list any particular food items, but say, here are the ten, here are ten ingredients that constitute ultra-processed food. [48:04] And if it's got sodium above a certain level, it's ultra-processed. [48:11] If it's got such and such, such, I mean, something real simple that can be communicated. [48:16] Does that make sense? [48:17] It makes a lot of sense, and we're doing exactly that. [48:20] Once we get that definition of ultra-processed food, then we're going to go to mandatory front-of-package labeling. [48:29] And it will be a very simple label, something like they use across Latin America very, very successfully, red light, green light, yellow light. [48:38] And so people will be able to see the green light, and that's food that's good for you. [48:43] And if they do the red light, don't eat it. [48:45] If it's the yellow light, you know, if it's late at night and, you know, you're watching the football game, maybe you can... [48:51] Okay. Let me stop you. I like the way you're headed. I'm sorry, but my time's limited. [48:57] Please continue with that. It will be enormously beneficial to the American people. [49:04] Your agency, across all the sub-agencies, grants a lot of grants. Are all of them... Do all of them have provisions that overhead is capped at 15%? [49:18] Well, those would be the grants to the universities. [49:22] No, your department issues a lot of grants. [49:25] Yeah. [49:26] And the agencies under your department. Are all of them... Do all of them contain the 15% cap? [49:32] They will contain a 15% cap. [49:35] Okay. Finally, this is a question for CMS. Dr. Oz isn't here. [49:41] An executive order was issued some time ago that says every hospital has to publish conspicuously a list of 30 main procedures and the cost. [49:52] Most of the hospitals haven't done that. [49:55] Those that have done it, you have to click 27.3 times in order to find it on their website. [50:02] Only 27 hospitals have been fined for not doing it. [50:08] Why don't we do... Why aren't we doing more? [50:11] The hospitals are... The regulation was passed during the last days of the Trump administration. [50:17] It was not enforced during the Biden administration. [50:21] We now have promulgated final regulations. [50:25] They're already promulgated. [50:27] That requires the hospitals not only to post, but to certify. [50:31] So they're legally bound by that. [50:34] And there are draconian punishments for them. [50:36] And we've already sent out, I think, a thousand warning letters. [50:40] I'm out of time. Thanks, Madam Chair. [50:43] Thank you, Mr. Secretary. [50:44] We've been joined by the Vice Chair of the full committee, Senator Murray. [50:47] So I'm going to go to you next. [50:48] Thank you for coming. [50:49] Thank you very much, Madam Chair. [50:50] And thank you to you and the ranking member for working on a very tough bill last year and doing a good job with all the circumstances. [50:57] It's going to be even harder this time around. [50:59] And we all look forward to working with you. [51:02] So thank you. [51:03] Mr. Secretary, I don't think it's any secret that you and I disagree on a lot of things. [51:08] But I think we might actually agree that our taxpayer dollars should be spent here at home, not on wars abroad. [51:16] That's not what the President thinks. [51:18] He made clear that just before his budget was released, he said, and I quote, [51:22] we're fighting wars, we can't take care of daycare. [51:25] And he backed it up with the numbers in this budget. [51:28] His budget increases war funding by half a trillion dollars. [51:33] But he does not increase childcare funding by a penny. [51:36] And it actually slashes funding for preschool programs by $315 million. [51:42] Now, I know you don't get to decide defense spending. [51:46] But I remember our first meeting when you told me that you supported expanding childcare access. [51:52] So I wanted to ask you today, as families, everyday costs are getting higher and higher. [51:57] Do you think we should be spending money on foreign wars instead of making money, making childcare more affordable for people here at home? [52:05] Senator, do you really want me to defend the Iran war right now? [52:09] Is that what you want me to spend my time doing? [52:13] Because I can, but I would rather talk about health. [52:17] I'm asking you personally whether you think we should be spending more on foreign wars or on childcare. [52:22] I mean, you know, the Democratic Party for the last 20 years, Senator Rand, cannot have a nuclear weapon. [52:28] And they've kicked that down the road. [52:31] Well, I don't think you're here to defend that. [52:33] I'm just asking you, what happened to childcare in this budget? [52:36] Okay, let's talk about childcare then instead of the war. [52:40] Well, what's happened, Mr. Secretary, just so it's clear, the reason this budget is going to be, and appropriations is going to be so hard to write, [52:49] is that the president is requesting a trillion and a half in new funding for defense, which cuts our non-defense incredibly. [52:56] So we're here not able to help our families because of the president's request. [53:01] So that's that's why we're asking about this. And I just I think we're asking about this because we have a thirty nine trillion. [53:06] I'm asking about this. Somebody else ran up, not this president. [53:10] Well, let's put this in perspective. I think this is important. [53:13] The president spent more on bombs in just the first week of the war in Iran than we spend in an entire year for parents to afford childcare. [53:22] And I will just say for all of us out here struggling with this and the people we see struggling, we need childcare in this country. [53:29] And we have to make choices when we make our budget and the budget that is presented to us makes the choice of a war rather than helping our families here at home. [53:37] And I think that's important for us to understand from the president. [53:40] Now, meanwhile, while this budget bankrolls Trump's war agenda, it is also cutting crucial lifesaving health investments. [53:48] It slashes NIH funding by more than five billion dollars, which would mean delayed cures. [53:54] It means canceled studies. It means no hope for patients who are fighting for their lives. [54:00] The president seems to be comfortable increasing his war budget by 100 times that amount. [54:06] So I just want to ask you, did you push back on the NIH cuts to the president? [54:11] On the NIH cuts, did you push back to the president and the White House about cutting that budget? [54:17] As I said, long before the war, we were told we need to tighten our belt at this agency. [54:24] As I said before, nobody in the agency wants to cut these programs. [54:28] If you end up funding the programs, I'll spend the money. [54:31] It's Congress's choice about whether to do it or not. [54:35] It's not my choice. [54:36] We gave you a proposed budget that does what the president wants, which is to have broad cuts across the agency. [54:42] My question to you actually was, did you push back on the president when he said he wanted to cut NIH? [54:48] Did you push back in any meeting? [54:51] Do you want me to tell you why I think those cuts are justified at NIH? [54:56] I'd like to hear your rationale. [54:58] We are providing now at NIH almost 80 percent of the biomedical research on Earth. [55:09] A lot of the money there was wasted, and I can read you the kind of studies that NIH, the insane studies that NIH was doing before I got there. [55:20] We are now recalibrating at NIH. [55:22] What I'm hearing is that women's health is being decimated. [55:25] I'm hearing a lot of the people who are in clinical trials being decimated. [55:29] You just throw out a, we're cutting waste, and I don't know what you consider waste. [55:34] Let me give you some examples of waste. [55:38] At NIH. [55:39] Yeah, at NIH. [55:41] $800,000 to the Medical College of Wisconsin to study cardiometabolic impact of gender-affirming [55:52] hormone therapy on trans maculant masculine adults. [55:56] $650,000 to Georgia State University, an intersectional approach linking minority stressors experienced [56:02] by transgender and gender-diverse adults to alcohol and drug use. [56:07] Comorbid mental and physical health outcomes. [56:11] None of the, I've got hundreds of these. [56:13] Do you? [56:14] None of them developed a drug. [56:15] So I noticed that you focus on gender identity. [56:16] None of them did research that told us the cause of a disease. [56:19] I know there is a debate in this country, but boy, you are picking on an agency that funds research that finds cures every day. [56:28] There are families, there are doctors, there are providers who are counting on getting the answers to these researchers. [56:34] So to me, cutting NIH by $5 billion just seems to be cutting our families out, cutting hope out, cutting medical research out. [56:42] We are known in the world for our medical research. [56:45] And to me, devastating cuts like this mean that we're cutting hope for the future. [56:51] So you and I disagree on that priority. [56:54] And my time is about up. [56:55] And I just have to say, we have a measles and we have a whooping cough ripping through our communities. [57:01] We've got trusted vaccines that have been undermined. [57:04] We have cancer and disease trials that are being upended. [57:07] We have patients being left without options. [57:10] Researchers having to pay expenses out of their own pockets. [57:13] I hear this from them directly. [57:15] We have grants being frozen, turned on and off. [57:18] You actually canceled more than a half a billion dollars in cutting edge vaccine research only to fund a dangerous, unethical HPV vaccine study. [57:27] And redirected funding from the state of the art vaccine development to replace it with your handpicked vaccine project that uses technology from the 1950s. [57:37] So the workforce has been gutted. [57:39] We are seeing canceling of billions of dollars in substance use, mental health. [57:45] We see you pausing $5 billion in public health funding and terminating grants in blue states only. [57:51] So I just have to say here loud and clear, this is hurting public health. [57:57] It is hurting our families. [57:58] It's hurting our research. [57:59] It's hurting the future of the country. [58:01] And you and I disagree on this priority. [58:03] Thank you. [58:07] Senator Hyde-Smith. [58:10] Thank you, Madam Chairman, and certainly thank you for holding this hearing. [58:14] And I appreciate everything you are doing, and thank you for making necessary cuts where we agree that they are definitely needed. [58:22] I want to discuss CMS area wage index. [58:31] I've had so many people come into my office to discuss this. [58:35] I had two different groups today. [58:37] It is destabilizing hospitals and rural healthcare. [58:42] AWI disadvantages rural hospitals. [58:45] because they're locking them into a system that suppresses reimbursement and limits their ability [58:50] to recruit and retain medical staff and specialists. And as you know, during Trump's [58:56] first administration, policy was implemented that helped raise Medicare payments for hospitals in [59:02] that lower quartile. This policy was huge for rural health care, but the court-ordered demise [59:09] of that policy has led to financial distress and recruitment challenges when they're trying to [59:15] recruit doctors to Mississippi, and they can get so much more for the exact same procedure [59:20] in other states. This is not a one-time gap. It compounds every year. Hospitals like Forest [59:27] General, a Level 2 trauma center in Hattiesburg, Mississippi, are expected to deliver complex [59:33] specialist-driven care, but they're reimbursed as if costs are low, absorbing an $8 million [59:42] annual loss due to this disparity. And obviously that gap is just unsustainable. If this continues, [59:52] it won't just affect one hospital. It will weaken the entire 19-county rural network, roughly serving [59:58] 700,000 Mississippians. Without immediate changes to AWI methodology, to create a more level playing [1:00:06] field, rural hospitals will face an unsustainable future, and obviously it's the patients that are [1:00:12] going to suffer. Mr. Secretary, would it be fair to say that the current area wage index creates a [1:00:18] compounding disadvantage for hospitals in persistently low wages states like Mississippi? And how willing [1:00:26] is the administration to work with Congress to provide the necessary direction and funding to [1:00:32] appropriately evaluate near-term adjustments in order to provide this much-needed relief to states [1:00:38] that are persistently low AWIs? Senator, before I answer that very good question, do you mind if I [1:00:46] spend a minute just addressing one of the points that was made by Senator Baldwin? Sure. I have [1:00:53] authorized funding for half a billion dollars in cancer vaccines and another, almost another half a [1:01:01] million in a universal flu vaccine. So I'm not anti-vaccine. The 500 million that we canceled were [1:01:09] for vaccines that don't work. And if they did work, these were for COVID vaccines. And MRNA, we now know, [1:01:16] does not work for respiratory illnesses. These are for vaccines that the industry made almost a hundred [1:01:23] billion dollars on. Why are we financing it? If anybody thought it worked, the industry would pile [1:01:29] in and make it work now on the way it ends. And so it's a waste of government money to pay something [1:01:34] that the industry won't pay. The wage area index is destroying rural areas in this country. And we know [1:01:43] it's a problem. As you know, under the Social Security Act, any changes we make in it have to be budget [1:01:50] neutral. So if you give more to one area, you have to take from another. And the political blowback, [1:02:01] even if we could do it, the political blowback is very loud, let me say this. The change has to come [1:02:08] from Congress. And we want to work with you to make changes that we think make sense, which means [1:02:15] getting more money to rural areas. Thank you. And I think that we just [1:02:21] wanted to verify because it will have to come from Congress. But thank you for your willingness [1:02:25] and your commitment to work with us to get there. The second question is, I have a few minutes left. [1:02:32] The CDC congressional justification in your budget list of accomplishments related to the CDC Office of [1:02:39] Rural Health, which Senator Merkley and I worked to get established in 2023. But despite this work to [1:02:46] benefit the health of rural Americans, the future of the Office of Rural Health is unclear, given proposed [1:02:53] HHS reorganization plans and the President's FY27 budget request. And this is concerning to a lot of [1:03:00] people, including me and for stakeholders like National Rural Health Associations. So what assurances [1:03:07] can you give me and others that the Office of Rural Health will remain within the CDC and that its mission to [1:03:14] improve rural health outcomes will remain a priority to you in this administration? [1:03:19] I mean, our reorganization tries to return CDC to its core mission, which is infectious disease. [1:03:29] And a lot of the programs in CDC, we are moving out under the proposal that the Agency for Healthy [1:03:36] America, the AHA Agency, is this a proposal for Congress. We're not doing anything unilaterally. [1:03:43] We've offered it to Congress. We expect congressional feedback on it. We expect a dialogue. And there's [1:03:51] some things that we may do. There's some things that we won't do. All we know is that CDC has not [1:03:57] done a good job on chronic diseases, which disproportionately impact rural communities in this [1:04:06] country. The highest diabetes rates, cardiovascular cancer rates are in rural areas. And CDC just is [1:04:14] not equipped to handle those and has done a miserable job at doing it. And that's why we have the highest [1:04:20] chronic disease burden of any nation in the world, with CDC presiding over that decline. [1:04:26] Thank you very much for that answer. And I'm out of town. I do have another question that I will submit [1:04:32] on the nursing shortages that are very concerning to me. Thank you very much. [1:04:37] Thank you. Senator Shaheen. [1:04:40] Thank you, Chair Capito and Ranking Member Baldwin for holding this hearing today. And thank you, [1:04:44] Secretary Kennedy, for being here. I'd like to ask you about Gavi, Secretary Kennedy. [1:04:50] About? [1:04:51] Gavi, G-A-V-I, which I know you know is a vaccine alliance. It's a public-private partnership that's [1:04:58] helped reduce child mortality by half in lower-income countries since 2000. And it's done that by [1:05:05] immunizing an entire generation. In addition to helping vaccinate 1.2 billion, with a B, children, [1:05:14] it's the world's leading purchaser of U.S. produced vaccines. So Gavi supports American manufacturing jobs, [1:05:23] it helps prevent outbreaks from reaching the United States shores, and it strengthens global health [1:05:28] security. I think it's one of the clear examples of a win-win investment for the American taxpayer. [1:05:35] And yet, despite a congressional appropriation of $300 million in FY25 and 26, Gavi has not received [1:05:44] its funding. Funding for Gavi comes from the State Department, which I have a chance to oversee as the [1:05:51] ranking member on the Senate Foreign Relations Committee. But yet, I'm asking you about Gavi because [1:05:57] I understand from those people who have worked on this in the past that it is your department and you [1:06:02] personally who's holding up funding for Gavi. I had a chance to meet with some of the representatives [1:06:09] from Gavi last week. And what I understood from that meeting is that if this funding is not released, [1:06:19] millions of children will die. In fact, Gavi estimates that loss of funding could result in 75 million children [1:06:28] not receiving routine vaccinations over the next five years. And that will lead to the deaths of more [1:06:33] than 1.2 million children. So, Secretary Kennedy, I ask you, are you willing to release this funding [1:06:42] that helps vaccinate millions of children? We're in discussions with Gavi in the State Department. [1:06:49] Gavi has been in transit. And I'll tell you three of our concerns. One is that the money that we give to [1:06:56] Gavi is fungible. Gavi has a tremendous amount of money. In fact, Gavi is giving hundreds of millions [1:07:03] of dollars to the WHO, which we got out of because it was doing such a miserable job. Oh, I want to, [1:07:09] I asked them, is our money going to you so that you can funnel it to WHO? They refuse to answer that. [1:07:16] That is not, I appreciate that you have that concern. That is not the conversation that I had with them. [1:07:25] Well, I was not. I believe that. There were two other concerns. And their biggest vaccine is now [1:07:33] a DTP vaccine, a version of it, an old version. I was discontinued in this country because it was [1:07:41] causing brain injury to one in every 350 people, according to an NIH study. So we discontinued it. [1:07:48] Europe discontinued it. They're still giving it to 161 million African and Asian children a year. [1:07:54] And I said to them, why don't you use the safer version, the DTP vaccine? And they said they didn't [1:08:01] want to do that. Well, Secretary Kennedy, perhaps you could appoint somebody from your office [1:08:07] who'd be willing to work with my office and representatives from Gavi and see if we can settle [1:08:12] this problem. Because when 1.5 million children are at stake, it seems to me like those are issues that [1:08:20] we ought to be able to resolve. I'm out of almost out of time. So I want to go on to another issue. [1:08:25] But can I ask you, are you willing to appoint somebody from your office who can work with us [1:08:31] to see if we can resolve those questions? Yes, I am, Senator. Okay, thank you. We will be in touch with you. [1:08:38] I want to talk about diabetes, because Mr. Secretary, you've called diabetes a national crisis. And I agree with [1:08:44] you. I have a granddaughter who has type 1. And right now, 42 million Americans are living with [1:08:50] the disease, including hundreds of thousands of children. And yet your proposed budget cuts [1:08:56] diabetes prevention and research. You're eliminating CDC education programs. You're slashing the special [1:09:03] diabetes program for Native Americans by 75%, despite the disproportionately high rates in those [1:09:11] communities. You've terminated a major study on diabetes and dementia, not because of the science, [1:09:17] but because of a dispute with Columbia University. You talk about diet and lifestyle, and I agree with you. [1:09:24] That's important. But that does nothing for the millions of Americans who are living with type 1. [1:09:31] That's not done. That's not the result of diet and lifestyle. So I guess I have to ask you, [1:09:40] Secretary Kennedy, are those cuts that you've proposed in diabetes, are those the result of [1:09:45] scientific evidence? Or is that because you're just trying to cut across the board? Well, of course, [1:09:53] I'm not. I don't want to cut diabetes research. You know, the dispute with Columbia University is on [1:09:59] another issue. And it's a dispute between the administration and Columbia. And Columbia just [1:10:06] has to come into compliance with the president's executive order. That didn't answer my question [1:10:12] about diabetes. But I'm out of time. So we will submit the further questions for the record. Thank [1:10:18] you, Madam Chair. Thank you. Senator Husted. Thank you, Madam Chair. Secretary Kennedy, [1:10:23] thanks for being here today. I want to talk with you about the 340B program. It was created in 1992 [1:10:30] by Congress with the noble cause of helping low-income patients and safety net providers have [1:10:36] the resources to provide care. CBO and GAO said HRSA does not collect the data on how hospitals spend the [1:10:46] money. And it's not uncommon for a hospital system to receive $100 million to $500 million [1:10:53] out of the program annually. And it does not, in those cases, provide auditable data to know how [1:11:02] those dollars are being spent. And so I just have been concerned, as we've talked about affordability [1:11:09] and healthcare access, is, frankly, is the money going to really help the people that the program was [1:11:16] designed to assist? And CBO has also found that the program encourages behaviors that cost the [1:11:26] taxpayers, the federal government, increase funding. So I'm interested in the issue of program integrity [1:11:33] and auditable metrics. And the President's budget includes a provision to move the oversight of the [1:11:40] free 340B program from HRSA to CMS. And so I think it's important that we understand what's happening [1:11:50] with it. Well, how's the money being spent? Is it going to help the people in the institutions it was [1:11:55] designed to help? And I'm interested to know what you think you can do to help make sure that the [1:12:01] drugs purchased through the program match the eligible patient encounter rather than the current [1:12:08] system, which largely relies on self-reporting. Yeah, Senator, there's all kinds of problems with [1:12:15] the program. There's all kinds of benefits. And there's a lot of hospitals and safety net regions [1:12:20] that absolutely rely on that funding source. Originally, it was just for safety net hospitals and for poor [1:12:27] patients to lower drug cause for them. Originally, there were only 90 entities that were receiving [1:12:33] 340B. Today, because of the potential for abuse, there's 12,000 and 50,000 outpatient offices. [1:12:42] And I'll give you an example of the abuse. We found a Virginia hospital in a low-income area that was [1:12:50] charging patients, that was getting 90% off the list price of the drug, charging patients the list [1:12:58] price of the drug, and then using their profit margins to build a hospital in a wealthy community. [1:13:05] In another case, in New Mexico, a hospital got a cancer drug for a patient. The cancer drug cost [1:13:13] $22,700. The cost to them at the discounts, the 340B discount was $2,000. They charged the patient [1:13:23] $22,000, kept the margin, and then sued the patient when he couldn't pay. Those are the kind of really [1:13:35] horrible abuse that we see in the system. But we also see a lot of really good uses by some. [1:13:40] Well, there are like the FQHCs and other, there are many people who are doing great work [1:13:46] under the program. But then it appears, as you listed, that there is a lot of abuse under the [1:13:51] program. How can we use some of the new oversight to try to fix it so that the money goes where it's [1:13:58] supposed to go? I mean, it's a mess, and it's in litigation, and the pharmaceutical companies are [1:14:04] suing. And the only thing that can fix it is Congress. We are exercising all of our authority, [1:14:13] but we really, you know, we have authority to negotiate. And I have one last question I want [1:14:21] to get to, but I appreciate that. Anyway, I look forward to working with you. Yeah, [1:14:26] so I hear constantly from you, there's a lady in town today who I've come to know very well [1:14:32] who lost her son to sextortion. And you see all the things that are, the terrible things that are [1:14:38] happening to kids through online exploitation. Just quickly, what can you do? What are you going to do [1:14:49] at Health and Human Services to try to address this new phenomenon that is clearly an epidemic of [1:14:58] physical health and mental health challenges for kids? [1:15:01] It's an epidemic that we don't have much power over. That has to be regulated by the FTC or by [1:15:10] Congress. We don't really have authority to regulate communications. And we can do studies to show [1:15:20] how dangerous it is. And we're doing those kind of studies now, but we really have no capacity. [1:15:25] Is there an emerging health crisis that you can think of that has come from nowhere that is [1:15:31] impacting kids more than this one? Well, social media is the same thing. [1:15:35] Yes. We don't have the power to regulate it. [1:15:37] Okay. Thank you, Madam Chair. Senator Schatz. [1:15:40] Thank you, Madam Chair, Ranking Member, Secretary. Good to see you. [1:15:45] We just had a series of storms and flooding events. And President Trump just signed a major [1:15:52] disaster declaration. In particular, the Kula Hospital has 105 long-term senior care beds, [1:15:59] and it's not any longer operational. The governor just submitted a request for a public health [1:16:06] emergency declaration. Do I have your commitment to work together to make sure there's continuity of care [1:16:11] for all the people who have been impacted by the floods? You do, Senator. And my staff is already [1:16:17] working with the governor's office to make sure that happens as expeditiously as possible. [1:16:21] Thank you very much. I want to ask you about glyphosate. I know you have deep experience in [1:16:29] this area, so I'm going to ask you a couple of factual questions to the best of your knowledge. [1:16:34] Does glyphosate cause cancer? Yes. Is it healthy for people to be around? [1:16:42] I would say no. It's not healthy for them to consume. Is it safe to use? [1:16:48] You mean safe, or does it kill, or does it kill weeds? It kills weeds. And, uh... [1:16:58] Is it safe for humans to use? I would say it's important to minimize consumption of glyphosate [1:17:05] as much as possible. You are being uncharacteristically diplomatic about glyphosate. I'll just say it that [1:17:11] way. I don't think I'm being diplomatic. I just said it caused cancer. Okay, fair enough. [1:17:15] You know, I didn't vote for you for confirmation. I'm sure you're tracking that. I got a lot of [1:17:25] friends back in Hawaii who supported you because of issues such as this. And they were hurt, shocked, [1:17:36] confused when you were explicitly in favor of Trump's executive order. And I'll just quote you in a tweet. [1:17:50] I support President Trump's executive order to bring agricultural chemical production [1:17:55] back to the United States and end our near total reliance on adversarial nations. I'm just wondering, [1:18:02] what would you say to those folks who were kind of animated by this idea that we are too reliant [1:18:09] on these dangerous chemicals? And then the president does a thing, and obviously you and the president [1:18:16] are not generally always on the same page about everything, but this seemed like an opportunity for [1:18:21] you to really stand up for your agenda, especially given your successful litigation in this space. [1:18:25] And so I just wanted to give you a chance to speak to those people back home who are very animated [1:18:30] by glyphosate, but also the rest of the sort of agenda around reducing our exposure to toxic chemicals. [1:18:40] Yeah, and I'm glad you asked that question. I was very clear with the president about my own [1:18:46] displeasure with the executive order. The president felt it was necessary for national security reasons. [1:18:55] Actually, the proposal came from the Pentagon, and the reason for that is a problem that President Trump [1:19:02] didn't create, which is that 97% of corn production in our country is reliant on glyphosate, 98% of soy [1:19:11] production, about 80% of agricultural production. According to the industry, 100% of that is coming [1:19:18] from China. You have an adversary that could literally shut down the American food supply overnight. [1:19:25] There was another issue, which is elemental phosphorus is also produced in the mining process, [1:19:31] and that also is controlled by Congress or by China, and it is a critical resource for weapons production. [1:19:40] Okay. And so his executive order does not increase the use of glyphosate. All it says is, [1:19:46] as long as we're dependent on it, we're going to make it here. He's authorized my agency to spend [1:19:52] hundreds of millions of dollars to look for alternatives so we can transition off of glyphosate [1:19:57] as quickly as possible. Just a final question. When we met in this hearing room last year, we talked [1:20:02] about placebo-controlled trials. I said, and I'll quote myself, you know the placebo-controlled trials are in [1:20:08] the existing vaccine approval process. Are you suggesting something different from that? And you [1:20:13] said, I do not think it is ethical to go back and test approved vaccines against a placebo, but [1:20:20] in December of last year, CDC posted a notice in the Federal Register awarding $1.6 million to quote, [1:20:26] study the optimal timing and delivery of monovalent hepatitis B vaccinations in newborns in Guinea-Bissau, [1:20:33] activities that will include conducting a randomized control trial. So there's a contradiction here. [1:20:42] I know it was removed from the Federal Register, but what happened? [1:20:46] There's no contradiction. And we hope to go forward with that trial. The hepatitis B vaccine was tested for [1:20:55] four days that we're giving to hundreds of millions of kids. There was no placebo in that, [1:21:01] so we have no idea what the risk factors are. In Guinea-Bissau, they don't give the birth dose. [1:21:07] They're going to start giving it in 2028. We asked the government of Guinea-Bissau, can we go there [1:21:13] with the proper INDs, all the ethical guidances, and give it to 14,000 kids a year early? [1:21:20] And not give some, and have a placebo group? It's not our job to give it to the whole country. [1:21:26] We can give it to 14,000 kids early, which helps them. And then we have a placebo group. For the [1:21:32] first time in history, we can actually look at the impact. [1:21:35] A placebo group that doesn't get the medicine. This is the thing we talked about before, [1:21:40] and I thought we were on the same page, and I thought the entire medical establishment was on [1:21:44] the same page. We may disagree about the efficacy of certain vaccines, but we have all agreed, [1:21:50] all of us, that you do not withhold medicine, especially from children. [1:21:56] We're not withholding it. We're giving it to people who otherwise wouldn't receive it. [1:22:00] And then there's a control group that doesn't get the medicine. [1:22:02] Well, they weren't going to get it anyway. Nobody in the country was going to get it. [1:22:06] Well, thank you. [1:22:07] Okay, I'm going to go to Senator Murphy. We're running up against a five-minute break at 4 o'clock, [1:22:13] and then we have a vote at 4.05. So, Senator Murphy. [1:22:16] Thank you, Madam Chair. We have an epidemic of low-quality care in our nursing homes today, [1:22:26] increasingly because we have a lot of for-profit operators, a lot of private equity-owned nursing [1:22:33] homes today. It's a real issue. I hear about it all the time in Connecticut. In 2023, President Biden [1:22:40] issues this rule to require minimum staffing in nursing homes. At the beginning of the Trump [1:22:46] administration, the administration defends that rule because the industry brought a case against it [1:22:53] in court. And then in the summer of 2025, the industry starts pumping a lot of money into the [1:23:02] president's political operation, almost $4 million. They have a meeting with him, and then a couple [1:23:09] months later, the Trump administration stops defending the rule. I understand you're going to [1:23:18] tell us that there's no connection between the donations and the decision to withdraw defense of [1:23:23] the rule. But why side with the industry here? Why not side with patients and patient advocates who have [1:23:31] been asking for just basic minimum staffing ratios in nursing homes to make sure the patients get the [1:23:39] care that they need? What's the reason to withdraw support for that rule? I mean, I can't tell you [1:23:44] whether industry pressure helps way. President Trump, I know that he doesn't really give a, I would say, [1:23:54] he doesn't care about industry pressure normally. The real pressure was coming from congressmen and from [1:24:01] senators who are in rural areas. And I traveled across rural areas, and I saw the damage that that rule was [1:24:07] going to cause to rural areas. A lot of these rural areas, they cannot get people, and they'd have to close [1:24:14] the nursing home. And then the elderly parents would be shipped to a city that is hours away and not be [1:24:22] near their families. And there was going to be massive, according to what I was being told and what made [1:24:29] sense to me, there was going to be massive closures in rural parts of this country of nursing homes. [1:24:34] These are not owned by private equity. Well, that's not true. There are plenty of nursing homes in rural areas [1:24:40] that are owned by for-profit companies. I want to submit for the record a pretty comprehensive study that [1:24:48] shows that that industry argument, that there will be undue impact on rural areas, actually has no basis in [1:24:55] fact. Why? Because we have states that already have minimum staffing rules with big rural [1:25:00] constituencies, and there's actually no correlation between increasing staffing ratios and clotures in rural areas, [1:25:08] without objection. Do you have any data that shows that there would actually be impact on rural areas? [1:25:16] Because that's just the argument that's made by the industry in order to avoid industry-wide [1:25:21] accountability. You know, I'm happy to provide you with what we have. Okay. I don't think the data is [1:25:29] there, but I'm happy to take that for the record. Second line of inquiry, Mr. Secretary, this [1:25:36] Maha PAC thing just seems like a moral and ethical mess. You know, this is a PAC run by acquaintances and [1:25:46] allies of yours. Your face is plastered all over its literature. They advertise that they are in existence [1:25:56] to try to influence you. You said in the outset that your entire mission is to try to take on the [1:26:02] the failing status quo, the industries that have profited off of bad medicine. The companies that [1:26:10] donate to Maha PAC, it's like a who's who of the pharmaceutical industry, including a ton of [1:26:16] companies that literally have business before you. And the whole purpose of Maha PAC seems to be [1:26:23] to interact with you in your office. I mean, I don't think we've ever seen this before. [1:26:27] A political action committee affiliated at the very least with the branding that is central to your [1:26:33] persona, taking huge amounts of money from the industry. Again, I know you're going to say that [1:26:39] there's no connection between all these donations and what happens inside HHS, but why do you suspect [1:26:45] all of these pharmaceutical companies, I mean, it's a, and they're not given small amounts. They're [1:26:50] giving $20,000, $100,000 to Maha PAC. Why are they putting all this money into Maha PAC, if not to [1:26:57] try to influence your decision making? Do you have a single instance where the Maha PAC has taken a [1:27:05] position that is not consistent with my values? I don't run the Maha PAC. I have no idea who's [1:27:11] contributing to them. Yeah, but why do you think, just take a guess, I mean, you know this is happening, [1:27:16] why do you think that they're contributing? I mean, this company, Vivix, donated $10,000 to Maha [1:27:22] when they had a very important case on skin substitutes before the agency. [1:27:30] Look what we did on skin substitutes, we put out of business 80% of the industry. [1:27:35] But why do you think these companies are making these huge donations to this company? [1:27:38] Well, I don't, well, I have no idea what companies are making any donations. I've never been told that's [1:27:43] the first time I've ever even heard that. I have no idea who's giving money to them. I don't run it. [1:27:50] Other people run it. Tell me an instance where they've done something that is underhanded or that [1:27:57] is against my values. Yeah, I'll be happy to submit to you and to the committee the instances in which [1:28:04] the companies that are making donations to this PAC did so at the exact moment that they had business [1:28:09] before your agency. Well, I don't know about their business. I, you know, I, I have no idea [1:28:16] about that. This is really messy, Mr. Secretary. I can tell you that you take a look at what we did [1:28:19] with skin substitutes. I think it would be better if you told them to shut this thing down because [1:28:21] it just, it's, it's, it smacks of, of, of corruption and I just think you'd be, you'd be much better [1:28:28] served if you just told them to shut that down. You have a PAC, Senator, who supports you? [1:28:30] You have a PAC that supports you? So you'd be much better, yeah, it doesn't, I don't take any corporate [1:28:35] donations or any PAC donations. Your friends would be better off not taking these donations either. [1:28:41] Thank you, Ms. Okay. I am going to, I agreed to a four o'clock, five minute break, so we're going [1:28:46] to go ahead and do that. Be back in four or five. I agreed to four, four o'clock, five minute break. [1:28:52] I'm sticking to my agreement. Some folks coming in and out because we have that four or five vote. [1:34:31] So I'm going to go to, uh, Senator Rounds and then to Senator Merkley. Thank you, Madam Chair. [1:34:36] Uh, Mr. Secretary, first of all, thanks for coming in and visiting with us today. I know you've had a [1:34:41] long day already, so I, I want to give you an opportunity maybe to follow up on a couple of [1:34:45] thoughts. Uh, I'm going to start with the 340B program and I know that, uh, Senator Husted asked [1:34:52] you some questions with regard to the 340B and there's a lot of, uh, interested entities out there [1:34:58] that, that, that rely on the 340B, regardless of if it's a good program or not. It funds a lot of [1:35:04] local community, uh, programs. Federal health centers receive some of it. Uh, critical access hospitals [1:35:10] receive some of the funding on it. But community hospitals really rely on it right now. And I know [1:35:16] that you've been trying to make some changes on it. Uh, the concern a lot of them have is, is that [1:35:23] there's a, a, a plan right now to transition, uh, to a, a rebate model instead of the current upfront [1:35:31] discount. And it's got a lot of them concerned. Uh, are you familiar with where that sits right now? [1:35:37] And have you had any feedback, uh, Mr. Secretary? Senator, I don't know where that's the proposal [1:35:46] sits right now. And I am not, you know, Dr. Oz has not raised it with me. I don't know how serious [1:35:52] it is. Okay. It, it, in rural areas, it's a really big deal. And it's probably, as you know, [1:35:59] during flying time, we get lots of the different healthcare organizations in, and there's a big time [1:36:06] concern across the rural parts of the country with regard to if the 340B funding is changed, [1:36:11] that there be some other alternatives. And I, I think all I would ask is, is I wanted to bring [1:36:16] it up. But second of all, I would just hope that you would be willing to address the concerns that [1:36:21] these reforms might disproportionately benefit some pharmaceutical companies to the detriment [1:36:28] of some of these, these necessary entities that are out there right now that need it in some [1:36:33] of the rural areas. And I would just ask is, I wanted to bring it to your attention. But second [1:36:37] of all, I'll ask if you would work with us to see if before we make these significant changes on it, [1:36:42] that we recognize just how big of a deal it's going to be to some of those healthcare facilities. [1:36:46] Yeah. And I, and of course we'll work with you, but I can tell you, we are very conscious of how [1:36:55] important it is for, for the population that was built for, and that absolutely relies on it. The problem is, [1:37:04] expansion of the program to some facilities that are already doing very well. And the abuses that [1:37:12] we see in the program. But I think everybody wants to continue to support those communities. [1:37:17] And, and I think that their concern is, is that if there need to be reforms made, [1:37:22] it's simply a matter of, they've now grown to the point where they need this particular program, [1:37:28] or some of them are going to shut their doors. And we've got to have another alternative for them [1:37:32] that will still work for them. And I just appreciate your, your help in addressing those [1:37:36] before it becomes an item, which is in place and the problems start to develop. So I appreciate your [1:37:43] offer to, to look into that with us. [1:37:44] Dr. We understand. Thank you. [1:37:46] Dr. Thank you, sir. [1:37:47] Dr. Let me touch base, uh, on another one. Throughout your first year in office, you've [1:37:52] made making America healthy again and eating real food a priority. South Dakota farmers and ranchers [1:37:58] work tirelessly to produce some of the safest and highest quality products in the world. [1:38:03] I've concerns regarding lab grown cells or cell cultivated products, attempting to enter the U.S. food [1:38:09] system, the U.S. food system posing as meat. One example of these experiments takes pork fat cells [1:38:16] grown in a lab and combines them with plant protein. This product is sold to consumers at the grocery [1:38:22] store as a meatball, uh, meatball. Um, my question I guess for you is, is do you share my concerns with [1:38:31] these ultra processed lab grown fake meat products? And with your prioritization of real food, how is HHS, [1:38:40] through the FDA monitoring and evaluating the health and safety of these particular types of products? [1:38:45] Dr. I share your concern, Senator. I probably have an amplified concern. [1:38:51] And, uh, you know, we're going to do, we're going to exercise FDA's oversight over them. There's, [1:38:58] they're going to have to show us, they're going to have to, they're going to have to get through a [1:39:02] lot of skepticism to show that they're safe. Thank you, sir. Um, NIH, you've talked a lot about [1:39:08] NIH today and I, and you've heard some concerns in here with regard to funding on NIH and some of [1:39:13] the grants and so forth. Uh, Mr. Secretary, I, I'm as concerned as anybody else about the fact that [1:39:18] when we talk about biomedical research and the opportunity to really cure some cancers in [1:39:24] particular and others, uh, as these different proposals are out there, I would just hope that [1:39:32] we can work together to make sure that those that are really making progress [1:39:35] and ways to cure some of these dread diseases, that those are not the ones that are being [1:39:40] canceled and that we continue to try to find a path forward to actually not only save taxpayer dollars [1:39:45] long-term, but actually find a way to improve the quality of life for Americans using these, uh, [1:39:51] these programs that might already be in place. Yeah. I mean, Jay Bhattacharya tells me that he has not [1:39:56] canceled a single study with the exception of the hospitals that are violating the executive order, [1:40:03] that no study of that kind has been canceled. And the, uh, the, um, JAMA, the Journal of the American [1:40:11] Medical Association recently did a, a report that said that we had canceled 346 grants. But when we [1:40:19] actually looked at the report, the actual number is 14 and there were good reasons for canceling those. [1:40:25] I just wanted to make sure you had an opportunity to respond to that. Yeah. Thank you, Mr. Mr. Madam Chair. [1:40:30] And thank you, Mr. Secretary. Senator Merkley. Oh, thank you very much, Madam Chair. And thank you, [1:40:35] Mr. Secretary. And, uh, seven years ago, I introduced a, a bill that was the most favored nation [1:40:41] bill saying Americans should get the best price in drugs in the developed world because we spend more [1:40:47] as taxpayers on the R and D than any other nation. And I think the conversations we've had, this is [1:40:53] generally, uh, uh, an idea that, that you support. Absolutely. And we did the negotiation with 16, [1:41:00] the largest pharmaceutical companies and we will be adding more and more drugs to that list. But [1:41:07] the agreement is we get the lowest prices in the world, in the developed world. [1:41:12] What I appreciate that very much, your pursuit of this, this vision. Uh, we are here in Congress, [1:41:19] of course, like to legislate. Uh, we haven't seen these, these 16 agreements in order to understand how [1:41:25] we might expand the principles in them. Is it feasible for those to be shared with Congress? [1:41:31] Uh, in, uh, some of the information can be shared. Some of the information is proprietary, [1:41:40] um, and, uh, affects business secrets. And in that case, we couldn't. And in fact, in the, in the IRA, [1:41:49] in the, uh, on the inflation reduction act, where we were ordered to do negotiations with the drug [1:41:56] industry, there is an NDA, uh, uh, uh, an NDA recommendation in that, in that language. There's [1:42:07] a recognition that some of that information is going to be proprietary, but otherwise, [1:42:11] I, I take that point. Uh, but I guess because the president has said he'd like to see [1:42:18] these agreements codified, which I think means put it into law. The only way that we here in Congress [1:42:24] can work on it. Obviously, we're not looking for the, the, you know, the secret formulations or [1:42:30] anything that would be proprietary, but certainly the drug pricing strategy. So I'd like to encourage [1:42:36] you, if possible, to share that so that we could work on that codification. Senator, I'd like to offer, [1:42:42] um, the, uh, the guy who did the negotiations, Chris Klump, who's, uh, who is now, um, the operational [1:42:51] chief of the agency, uh, to talk directly to you about, um, how to structure it. Because I think [1:42:57] he could be very helpful and we can provide you legislative language. Because I think you also [1:43:04] have, I don't know if you have or the, the president did, but also talked about [1:43:09] having a set of, um, proposals, uh, related to, I think, uh, three other areas to try to [1:43:22] enter, uh, time-limited models for Medicare Part B, Medicare Part D, and, and Medicaid that I think [1:43:29] are separate from those 16 agreements, if I understand right. Also the goal of putting those [1:43:34] into law? To put them in, we're certainly going to implement them in, in Part D. In fact, the GOP's [1:43:43] go up this summer in, in Part D. Um, but I'm not sure if that's part of the actual agreement or if [1:43:50] it's just CMS policy. I'm happy to find that out for you. Because what I'm trying to do is, is craft [1:43:56] bipartisan support while we have your support, the president's support, for really comprehensive, [1:44:02] that no matter where you buy a drug, anywhere in our system, whether it's in Medicaid, Medicare, [1:44:06] Veterans Administration, whether it's regular pharmacy, that, that our citizens get the best [1:44:12] price. And it would be an incredible accomplishment, uh, to be able to do that, not just with an [1:44:18] agreement that is, I'm not sure, the proposal there was for five years, but actually to create a [1:44:24] framework where we can adjust as the international prices are, are adjusted. And this is our moment. So, [1:44:30] uh, I'm just, um, I, I, I'm trying to encourage that, that we go beyond the idea of individual [1:44:38] drug company agreements or time limited, uh, models to try to create a, a legislative framework that would [1:44:45] ensure, uh, that, uh, Americans do get the most favored nation price on all drugs in all places [1:44:52] into the future. Uh, absolutely. And we're very grateful for your leadership, Senator. I, [1:44:58] for us at, uh, at HHS, this is, you know, one of our most important legacies and we want to make [1:45:07] sure that it endures and, uh, we need it. We need the language codified. Okay. Well, I guess my core [1:45:13] point is without the actual details of the agreements or the other pieces and time will run out very fast [1:45:20] on every, every four years evaporates, uh, uh, uh, quickly. So I'm encouraging as much information to [1:45:26] be shared as, as possible. Thank you. Thank you, Senator Merkley. Senator Merkley, thank you. Senator [1:45:32] Bozeman. Thank you. Uh, thank you, Mr. Chairman. Thank you, Secretary, for being here and spending so [1:45:40] much time. I know this has been a long day. Uh, as you know, Arkansas is home to the FDA's National [1:45:47] Center for Toxicology Research, uh, in, in Jefferson, Arkansas. During a recent visit, [1:45:57] I met with the NCTR scientists and discussed their unique regulatory science mission as well as [1:46:03] concerns about a potential transfer of the center to CDC. We discussed this, uh, earlier in the year. [1:46:10] You and your staff have been very helpful. Um, I've expressed my opposition to changes that would, [1:46:18] weaken its distinct and essential capabilities. Um, what I would like is that as the conversation [1:46:26] goes forward, uh, that certainly if you have any updates or, uh, any changes that are about [1:46:33] to occur that we would be allowed to, uh, to be part of that discussion. That is a very important [1:46:39] program to us and I expect to continue to support it and we'll let you know if anything changes. [1:46:46] Chairman. Very good. Thank you very much. Uh, over 50% of Arkansas counties are considered [1:46:52] maternity care deserts, meaning expectant mothers lack access to birthing facilities or obstetric [1:46:59] providers. Data from the maternal mortality review committees supported through the CDC's safe [1:47:08] motherhood initiative shows that women in these areas receive less prenatal care and face higher [1:47:15] rates of preterm birth. Earlier this year, I worked with Senator Bennett to pass the preemie [1:47:22] reauthorization act to strengthen federal efforts to reduce preterm best deaths, births, preterm [1:47:32] births that have complications. Can you clarify how HHS is going to allocate those funds and how the [1:47:41] department will continue supporting state led maternal mortality review committees to ensure care is [1:47:49] informed by local data and improves outcome for mothers and infants. This is really a critical [1:47:57] problem in Arkansas. 53% of our counties in America lost population last census and as a result, uh, this is [1:48:05] an area that's really, really been affected. Um, we, uh, I can't specifically answer your question. I know [1:48:15] that, um, we have a $767 million block grant from HRSA for maternal health and I imagine it's funded through [1:48:25] that, but I don't know, but I will. I'm happy to work with you on that, Senator. It's an important issue to [1:48:33] us and I'm happy to work with your office. Yeah. If you could get them to look at the state-led maternal [1:48:39] mortality review committees, I would appreciate it very, very much. One final thing, um, uh, our, [1:48:47] our agriculture sector now is in such a difficult situation. If you're growing something out of the [1:48:52] ground, you're losing a lot of money. And because of that, we're doing everything we can to, to help [1:48:58] them. Um, I agree with you. The department's recent initiative encouraging medical schools to implement [1:49:05] comprehensive nutrition education training. The Walton School of Medicine is a good example of [1:49:10] that in Arkansas. They're taking the lead. So, I, I very much believe that, uh, nutrition is so, [1:49:18] so very important. At the same time, growers in my state and across the country face real challenges. [1:49:24] So, can you ensure them, ensure the American growers that the goals of making America healthy [1:49:32] do not unintentionally create barriers to crop protection tools that are already undergoing a [1:49:38] rigorous science-based review process at EPA? Are you committed to working with our farmers? [1:49:43] Before we issued the Maha report, we had over a hundred meetings with farmers and all the leading farm [1:49:54] organizations in this country. I met with them again last week, representatives of all the major farm [1:50:00] organizations. And we collaborate with them very well. They've been very supportive of the Maha agenda. [1:50:08] And, um, so, and I expect that to continue. And, you know, everywhere I go in the country, [1:50:17] the reaction that I get from the farm community is very, very positive. And I'm very grateful for that. [1:50:23] I know. And, you know, for most farmers, they're losing money seven out of 10 years. And, uh, [1:50:29] and we want to make sure to keep the farm economy intact. We know that Maha is dependent on our food [1:50:36] production and we, we can't afford to lose any more farmers in this country. Thank you. That's just [1:50:42] what we wanted to hear. We appreciate it. Senator Reed. Thank you, Senator Morin. Um, [1:50:48] Mr. Secretary, one of your most important duties is to assure the health of the American people, [1:50:55] in fact, improve it. But the one big, beautiful bill seems to be completely antagonistic to your [1:51:02] major duty, uh, particularly, uh, in the cancellation of the affordable tax credits, uh, [1:51:09] and also the other Medicaid reduction provisions. Already in my home state of Rhode Island, 10,000 [1:51:16] people have lost their coverage. Uh, the ex, the expected cuts will go up next year, 30,000 more. [1:51:26] And in private insurance, the price is going up dramatically. And so, uh, we know that inevitably [1:51:35] many of these people will show up in the emergency room because that's the only place they have to go. [1:51:39] And the cost is much higher to us. So from a cost standpoint, from a protection standpoint, from, uh, [1:51:46] preserving the health of the American people, that seems to be the wrong decision. So [1:51:51] what are you going to do? Uh, do you approve of this, uh, reduction of health insurance across America? [1:51:58] Uh, well, first of all, I would say there's no cuts to Medicaid. The Congressional Budget Office, [1:52:05] you know, just issued its report last week on Medicaid. And the increase in Medicaid spending [1:52:11] is 47% over the next 10 years. Well, there are no cuts. Nobody's losing Medicaid. Excuse me. [1:52:18] We've had already 10,000 people that have dropped their affordable care coverage. Well, [1:52:23] affordable care. And also as the Medicaid cuts roll in, it's estimated the state of Rhode Island next [1:52:29] year will lose $200 million. And that is funds in Rhode Island. That is [1:52:35] virtually impossible to make up without cutting other key programs. So you are basically through [1:52:43] the administration, uh, cutting health care throughout the United States. Well, we're not cutting health [1:52:50] care. Well, you're cutting access to health care. Okay. Again, there are no cuts to Medicaid there. [1:52:57] We did not extend the premium tax credits, which were not extended by the Democrats either. During the three [1:53:04] times that they had the chance to extend them because they don't actually- I recall that actually, [1:53:10] we proposed a vote to extend the, uh, the credit and was defeated. When the Democrats were in power [1:53:16] and controlled both houses, they had three opportunities to permanently extend them and they did not. [1:53:20] They expired during the Trump administration, didn't they? The money was going- They expired during [1:53:26] the Trump administration? The, the, the stock price of the insurance companies went up a thousand percent [1:53:32] of, uh, uh, um, following that its passage because they were getting the money and we were taking money [1:53:39] from taxes, the same people, and putting it into reducing the, uh, giving them the illusion [1:53:46] and their premiums were decreasing. Most people still have it. 87% of the, of the people on Obamacare are [1:53:55] still getting coverage for $96 a month or less. 54% of them for $50 a month or less. There will be, [1:54:03] will be people who experience much higher coverage in the upper areas, um, but- So you don't believe that [1:54:13] health care coverage has been diminished under the big, beautiful bill that people, in my state, [1:54:19] 10,000 people lost their health care insurance. 30,000 will lose it next year. As I said, [1:54:25] people at the upper end will experience much higher premiums. We are doing more to lower premiums and to [1:54:32] open up new opportunities for low premiums. How are you going to lower premiums if you cut one of the [1:54:37] most, I think, effective means, which is the affordable tax credit? This means the people working because [1:54:43] they're paying taxes. So this is not one of those welfare deals. And you take it away, these people [1:54:49] literally cannot afford health care insurance. And they will end up in the emergency room. We do it by [1:54:54] the MFNs, by, um, by transparency, which we are implementing for the first time, by car share [1:55:00] reduction, which will reduce, uh, 10% the premiums by low premium plans, like catastrophic plans, direct [1:55:08] primary care. I got to tell you, Mr. Secretary, if you go out to any state in the union and you ask [1:55:13] people, real people, what's bothering them most, they'll say, well, it's affordability. And number [1:55:18] one or two is health care. And that's a direct result of the big affordable bill. Let me change [1:55:24] gears for a bit. Uh, everyone knows, front page news, energy costs are going up about 13% across the [1:55:30] country. Uh, home heating oil is going up 44%. And yet once again, the administration is trying to [1:55:37] zero out LIHEAP. LIHEAP is a strongly bipartisan program. We all support it around here because [1:55:45] it helps people who need the help to survive, literally survive the winter and in the south, [1:55:50] the summers. Uh, it's, uh, it's unconscionable to me that they'd make these cuts. Why, why are you [1:55:59] supporting these cuts? I've been involved in LIHEAP my whole life. My brother is the biggest supplier [1:56:08] to home heating oil to poor people in New England. I go on the Indian reservations and people tell me [1:56:14] that people will die if we cut LIHEAP. I've spent all the money that has been sent me for LIHEAP this [1:56:21] year. Yeah, we, uh, Senator Collins and I and Senator McAuliffe just had to write you a letter last week [1:56:26] to get the money out the door this week. So your, uh, uh, sort of enthusiasm spending money wasn't [1:56:33] evident. Well, my enthusiasm has always been in evidence, but it was held up in an interagency [1:56:39] process. I spent all 90% that I had control over and now I'll spend the remaining 10%. And if Congress [1:56:47] funds the program, I will spend the money. Uh, well then have you talked to the president [1:56:53] about why he wants to zero it out? The president's looking at 39 trillion dollar budget. He's got to [1:56:59] cut somewhere everywhere they cut is painful. Well, I, uh, it's particularly painful working [1:57:08] people and low income people who don't have access as they did before to health care, don't have access [1:57:14] perhaps this winter to heating assistance. And I don't think that's the same problems they're seeing [1:57:19] down in Mar-a-Lago. Thank you. Senator Moore, Moran, thank you. Senator Reed, thank you. [1:57:25] Mr. Secretary, thank you for your presence this afternoon. I want to comment on, uh, Senator [1:57:30] Rounds's conversation with you about 340B and let you know that there's a bipartisan three [1:57:36] Republican senators, three Democratic senators, including the chairwoman and ranking, uh, member [1:57:42] of this, uh, committee who have, uh, come together to try to find a, uh, path forward on 340B that makes [1:57:50] it solid, works in the way it should. And, uh, we would, we, we are working well with your department [1:57:56] in that regard. I would ask you if you would ask, um, uh, HRSA if they would come brief me and the [1:58:03] working group on, uh, this issue of the rebate that Senator Rounds raised. If you could, uh, prod them [1:58:10] to provide us with information and have a conversation, uh, I'd be grateful. Well, God bless you, Senator. [1:58:16] I hope you find a solution. I'm glad you're working. We're trying to make the job easier, sir. [1:58:20] And yeah, thank you. And I absolutely can get HRSA to come brief you. [1:58:25] Great. Thank you. Um, I was involved in the reconciliation process process last year and [1:58:31] particularly worried about small and community with hospitals, rural health care. Uh, Kansas has, [1:58:38] uh, we have about 130 hospitals. 90 of them are probably critical access hospitals. All of them are [1:58:46] fragile, uh, and any change can make a difference, including what happens to 340B. So it's like every [1:58:52] component, every piece of the puzzle, uh, matters in the, in the bottom line of whether or not a [1:58:58] hospital has a future, their doors remain open. One of the things we worked on, uh, with your [1:59:04] department and with my colleagues was the rural health transformation program. Uh, Kansas has, uh, made, [1:59:10] uh, submitted their application. We've received the, the, uh, approval to proceed. We're using our [1:59:16] program to expand primary and secondary prevention programs, secure local access to primary care, [1:59:23] build a sustainable workforce, uh, and enable value-based care and harness data and technology. [1:59:30] What's the reaction to, by HHS, to the way that, uh, this program, the RHT, is unfolding? [1:59:37] Uh, you have an opinion about what's happening yet? I don't think we could be happier. Okay. [1:59:42] The proposals were outstanding. Um, they went to blue states and red states, I think. [1:59:49] The top two states, uh, were Texas and Alaska, and then the third state was California. And, [1:59:57] you know, um, the, the applications were, uh, were better than we could have imagined. Uh, [2:00:03] we're really happy with the program and the money is out the door. [2:00:07] We are jealous of those states you mentioned because we're only number six. Uh, but we were [2:00:11] pleased with that, that opportunity to try to make a difference for the long-term, the immediate, [2:00:17] you have to, you have to stem the flow, the immediate challenge that hospitals [2:00:21] face in providing healthcare with the goal of making sure that when you do that, you create also [2:00:27] a long-term opportunity to continue to provide care to the community. And, um, we look forward to the [2:00:34] evaluation. I guess there'll be an evaluation based on state standards to make sure our state and others [2:00:40] are complying with the plan. And that program will continue to provide Kansans, uh, and their healthcare [2:00:46] providers with a, with a brighter future for the next, uh, five years. I've, I have visited every hospital [2:00:52] in Kansas numerous times. Uh, I visited 50 some hospitals last year. And while we'll have a conversation [2:00:59] about 340 B or Medicare advantage or Medicaid, uh, private insurance, all the components of how, [2:01:09] uh, dollars, uh, are to be derived in providing healthcare, the basic bottom line challenge for [2:01:15] every hospital I talk to is workforce, the ability to find and hire to employ. It's more challenging in [2:01:23] rural areas, but it's a problem everywhere. And I've tried in this job as a United States Senator [2:01:29] over a long period of time to do all the things I know that would be supportive of investments in [2:01:36] that solving that problem support for the national health service corps versus nursing workforce program, [2:01:42] rural residency programs, direct investment in universities. We're using our congressionally [2:01:48] designated spending opportunities in particular to support, uh, workforce training at community and [2:01:53] technical colleges, but universities as well. And particularly in the arena of healthcare, any [2:02:00] university, any community college, any technical college, it's trying to meet the healthcare workforce [2:02:05] needs of healthcare providers in Kansas. That's the, that's the place we want to try to help invest. [2:02:11] Do you have other suggestions, what you, the department or what we as Congress could do [2:02:17] to better ensure that there are people who are able, willing and trained to meet the workforce [2:02:23] needs of healthcare? I mean, you mentioned most of the programs. I would add the GMA program, which [2:02:30] is really an important program for rural hospitals because if we can get, um, medical grad school [2:02:38] graduates to do their residencies there, a lot of them are going to end up staying there. I just gave 135 million [2:02:45] dollars to, um, uh, uh, community health centers. And a large part of that is for, uh, rural residency [2:02:56] programs. So we know, and we know how important these hospitals are to these communities. It's not [2:03:01] just for healthcare, but they're the central economic driver for the communities. They have the, [2:03:07] a lot of them the biggest employers, they have the best paying jobs. When they shut down, no business wants to [2:03:13] move there anymore. So it's absolutely critical to keep them open. Mr. Secretary, you said something [2:03:19] that I'd highlight because I mostly mentioned about rural and small community healthcare providers, [2:03:25] our teaching hospitals in particular, this topic of teaching, educating residents and fellowships. [2:03:32] It is also another reason that, uh, federal support, financial stability is important in our largest [2:03:38] hospitals as well, because that's where we train many of our physicians and other healthcare providers. [2:03:44] Is that true? You agree with me? I agree. Yes. Mr. Secretary, thank you. [2:03:49] Thank you very much. You're very welcome. Senator Britt. [2:03:53] Thank you, Madam Chairwoman. Uh, Secretary Kennedy, it's great to see you. Thank you so much for [2:03:57] being in front of this committee. And, um, I know we have a number of things to talk about, [2:04:02] so I'll get right to it. I enjoyed my conversation last week with Dr. Casey Means. I had an opportunity to [2:04:08] visit with her and hear about, um, her vision and, and what she'd like to do as, um, you know, in the, [2:04:15] in the role of surgeon general and, and really kind of cementing obviously, um, choices for, for parents, [2:04:22] mothers, um, good products in front of them. So many things that we feel like no one has been willing [2:04:27] to tackle. And one of the things that I talked with her about was told her I really appreciated [2:04:31] her support of stop the scroll. Um, just talking about the negative mental health effects of on [2:04:37] children. I mean, it happens obviously across the board, social media wise, but specifically, [2:04:42] but children, I think a lot of times we talk about the things that people know, whether it's bullying or [2:04:47] sextortion or, um, different things that are happening online. But one of the things I think [2:04:53] that we miss and I think that you have focused on is the, the, the health effects and mental health [2:04:58] effects that occur from things like lack of vitamin D deficiency, um, because the lack of outside [2:05:05] exposure when you have children that are on right now on devices about seven and a half hours a day. [2:05:12] We know they're missing that critical element of, of growing up. Um, when you're looking at social media [2:05:17] too, the diminishing of real world socializing skills and the ability to communicate with one [2:05:22] another in person, um, higher rates of anxiety and depression and weaker physical and cognitive [2:05:29] skills. And when, when we're looking at that, I am deeply concerned about those effects, not only on [2:05:35] everyone, but especially on the next generation. Uh, can you tell me what does the evidence show about [2:05:41] the down downstream impacts of the things that I just mentioned and what targeted steps would you [2:05:46] recommend, whether through congressional action or HHS guidance, school policies, parental empowerment, [2:05:52] um, that we can do to reverse the trends that we're seeing in our children right now. [2:05:56] Yeah. And thank you for meeting with Casey Maines. Casey was, um, was number one in her [2:06:04] Stanford medical school graduating class. She was a brilliant physician. She left a practice in order [2:06:12] to devote her life. She saw that our system was broken and that people were coming in because they were [2:06:19] eating the wrong stuff. They all were metabolically challenged and that her job was just to patch them [2:06:26] up at the end. And she decided to devote, devote her life, getting Americans to change their behavior. [2:06:32] She's not partisan. I hope she gets support from both Democrats and Republicans. She is the most eloquent, [2:06:39] articulate, erudite evangelist for the Maha movement. She has nothing to do with vaccines, [2:06:46] never going to talk about them. She just wants to change the attitude toward metabolic health in [2:06:52] this country. And I think she will have a revolutionary effect on this country. [2:06:58] We don't have much jurisdiction at HHS to alter cell phone use. We have a Maha agenda for the states [2:07:07] and we're asking them to pass a, uh, a retinue of laws to protect children that they have the power [2:07:15] to do that we don't. And a lot of that is, like, continuing medical education to teach nutrition [2:07:22] in schools. But one of the primary ones, and now 50 percent of the states have adopted it, [2:07:27] is bell-to-bell legislation so that in high schools and public schools that the cell phones, uh, are left [2:07:37] in the backpack. And the, um, the transformation of those schools, and I've toured a number of them, [2:07:44] including in Loudoun County, Virginia, recently, is transformative. Um, the, the students support it [2:07:51] now. I went to a cafeteria. The kids were all talking to each other on the run and looking at [2:07:57] their laps. The testing scores for the school have gone up. The disciplinary problems have gone down. [2:08:04] The parents love it. They say the kids are now learning to drive. They're driving without using [2:08:09] their cell phones. They're coming home and eating dinner with the family without being on the cell phone [2:08:14] the whole time. And we're doing everything. I'm touring all the states to urge them to, uh, to pass that [2:08:22] legislation because I think it's the best thing that we can do. Absolutely. I think we should do more [2:08:26] here in Congress. Um, a couple of things real quick. I know I only have a little bit of time left. Um, nearly 14 [2:08:34] million children in the United States live in food insecure households and roughly one in five children [2:08:40] may not have consistent access to enough food. Head Start plays a critical role in providing [2:08:46] nutritious meals to low income children during their most important developmental years. Given the [2:08:52] scale of child hunger, what specific steps has the department taken to strengthen and expand Head Start's [2:08:58] nutrition services? And do you believe the current level of funding is sufficient to meet those needs? [2:09:04] You know, my family started Head Start and, uh, I have a deep nostalgia, but also there are 660,000 [2:09:12] kids in Head Start, the poorest kids in our country. Its impact on them is demonstrable. It's been shown in [2:09:20] study after study. Um, this year I've toured a lot of Head Start facilities since coming into office and the food [2:09:28] was appalling. It was all ultra processed food. We just gave it $62 million. In addition to maintaining, [2:09:37] um, uh, the budget at 2025 levels, um, we are in 2026 levels now for a new budget. We, we gave 62 [2:09:49] million dollars to Head Start as a one-time investment to make sure that they can build kitchens, that they [2:09:54] can build home gardens, that they can develop the infrastructure for feeding the children right, [2:10:00] and we're, we're requiring them now to provide nutritious food, fresh food to their children. [2:10:07] Wonderful. Thank you so much. I am out of time, but I appreciate your service and look forward to [2:10:11] continuing to work with you. Thank you, Mr. Secretary. That leaves the two of us. I think [2:10:15] Tammy had one more question and then I'm going to wring it down. Uh, thank you so much, um, Madam Chair. [2:10:22] I wanted to just correct, uh, the record or have the full record. Um, uh, earlier, uh, Mr. Secretary, [2:10:31] I believe I heard you say that MRNA vaccines are not effective for respiratory illnesses. And I wanted [2:10:39] to just submit to, uh, New England Journal of Medicine, uh, uh, large clinical trials that show that [2:10:48] they are, uh, safe and effective against COVID and RSV. Um, as to my question, uh, Secretary Kennedy, [2:10:56] in January, HHS, uh, uh, terminated virtually every discretionary grant funded through, uh, SAMHSA. Um, [2:11:05] this amounted to roughly two billion dollars in funding for mental health and substance use treatment [2:11:10] and prevention programs. After a very chaotic 24 hours, those grants were reinstated. And less [2:11:18] than two weeks later, CDC abruptly paused approximately five billion dollars in funding to [2:11:24] states to help, uh, bolster public health infrastructure. Those grants were also reinstated [2:11:31] within 24 hours. A couple weeks later, HHS terminated CDC grants in just four states that happened to have [2:11:39] Democratic governors. Did you approve these grant terminations in any of those three cases? [2:11:47] Uh, I did not approve the SAMHSA. And as soon as I, the SAMHSA termination notices, as soon as I [2:11:56] found out about them, I reversed them within 24 hours. And, and if you did not approve those SAMHSA grant [2:12:02] terminations, who did? Uh, they, somebody in the agency, you know, the agency at that time [2:12:09] was, um, was a, every aspect, every sub-agency was involved in, um, in reversing the corruption [2:12:22] from the Biden administration. So there was so much fraud. So every discretionary grant, um, [2:12:26] roughly two billion dollars, uh, uh, was in that bucket. Um, did the White House know about these [2:12:33] terminations before they occurred? I can't tell you. How did HHS evaluate these grants [2:12:42] to determine that they were not aligned with administration policy? As I said, the moment I [2:12:48] found out about the grant terminated was a mistake. It was an overcorrection. And that's what happened. [2:12:54] It was an overcorrection. We made a mistake and I reversed it as soon as I found out about it. And [2:12:58] the CDC grants that I referenced? I can't talk about those, unfortunately, Senator, because those are [2:13:04] under litigation. All right. Thank you. Thank you. I have one more question that I'm not going to ask, [2:13:11] but for the record. And that is, you mentioned it in part of your, uh, testimony about young [2:13:17] researchers. And there is a concern, uh, with NIH and the flow of dollars as to whether we're getting [2:13:22] the researchers. I guess we're going to try and, uh, other countries are trying to poach our young [2:13:26] researchers. And I don't think any of us want to see that happen. So that, that's a source of concern [2:13:31] for me. So, uh, that ends our hearing. I'd like to thank my fellow committee members [2:13:36] and, uh, and for the conversation and thank you in particular, secretary Kennedy for any senators [2:13:41] who wish to ask additional questions, questions for the record will be due April 28th. The hearing [2:13:46] record will remain open until then for members who wish to submit additional materials for the record. [2:13:51] And this, uh, subcommittee will stand in resource and thank you very much.