[Congressional Record Volume 164, Number 16 (Tuesday, January 23, 2018)]
[Senate]
[Pages S460-S463]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
EXECUTIVE CALENDAR
The PRESIDING OFFICER. The clerk will report the nomination.
The legislative clerk read the nomination of Alex Michael Azar II, of
Indiana, to be Secretary of Health and Human Services.
The PRESIDING OFFICER. The Senator from Massachusetts.
Ms. WARREN. Mr. President, I rise today to urge my colleagues to vote
against the confirmation of Alex Azar to serve as Secretary of the
Department of Health and Human Services, or HHS. When Congress confirms
somebody to be HHS Secretary, they are putting that person in charge of
some of the most important decisions made by the Federal Government--
decisions that touch the lives of every family in America. The safety
of the food inside our refrigerators, the quality of our nursing homes
where our grandmothers live, the price of our health insurance policy,
the government's response to a flu outbreak--on these issues and many,
many more, the HHS Secretary calls the shots.
When Congress debated Tom Price's nomination to be Secretary of
Health and Human Services 1 year ago, I said that we should not hand
over the keys to this agency unless we were absolutely sure that he
would put the American people first every minute of every day. And
let's be honest: Tom Price did not clear that bar; he didn't even come
close. No. When he was nominated, Tom Price already had a track record
of using his position in government to help exactly one person: Tom
Price. But Senate Republicans were so excited to get started gutting
the Affordable Care Act and ripping up Medicaid that they jammed his
nomination through without a single Democratic vote.
It turns out we are looking at someone whose record is a pretty good
way to judge how they are going to fight for the American people. Tom
Price didn't spend his time as HHS Secretary working for American
families; he spent it burning taxpayer dollars as he flew around on
private jets and military aircraft. During the 8 months Tom Price was
on the job, he put his own interests before those of the American
people--again and again.
Now President Trump has nominated Alex Azar to be Tom Price's
replacement as Secretary of HHS. Republicans have been trying to spin
Mr. Azar as a breath of fresh air--someone who can be trusted to stay
off private jets while he helps them carry out their plans to gut the
Affordable Care Act and Medicaid without attracting quite so much
unwanted attention.
The American people aren't fooled by the spin because in the ways
that matter most, Alex Azar is like Tom Price. Mr. Azar's resume reads
like a how-to manual for profiting off government service. About a
decade ago, he worked in government, helping regulate the Nation's most
profitable drug companies. When he left, he shot straight through the
revolving door and became an executive at Eli Lilly drug company. Last
year, they paid him more than $3.5 million. Not bad. Now he wants to
swing right back through the revolving door again and once again
regulate those same drug companies--regulate them at least until he
decides to spin through the revolving door again and make more money
from drug companies.
I don't think private sector experience should disqualify anyone from
serving. I am rooting as hard as anyone for an HHS Secretary who
actually cares about the job. But the American people deserve to know
that the person running HHS is looking out for them and not for his own
bank accounts or for the profits of his former employer or what makes
him more marketable to his next employer.
That is why Mr. Azar faced some very tough questions in his
confirmation hearing before the HELP Committee about whether he would
be willing to hold giant drug companies accountable when they break the
law. After all, he worked for Eli Lilly while they were cleaning up the
mess after being forced to pay the largest criminal fine of its kind in
U.S. history--a punishment for lying about one of its drugs and
peddling that drug to nursing homes as a treatment for dementia and
Alzheimer's with no proof that it worked. The word for that, by the
way, is ``fraud.'' Eli Lilly's scheme cost the government, and
taxpayers, billions of dollars.
Mr. Azar started out by saying the right thing about this. He said:
Oh, that sort of behavior is unacceptable. Of course,
anyone who breaks the law should be held accountable.
[[Page S461]]
Sounds great. But then I scratched the surface just a little. When I
pressed just a little bit harder and asked him to give the American
people something more than a polished talking point, he started dancing
around in his chair, bobbing, weaving, doing everything he could to
avoid answering the question. Mr. Azar said he believed lawbreakers
should be held accountable. I asked him five separate times during his
confirmation hearing whether he thought Eli Lilly's settlement
represented adequate accountability for the company's illegal
behavior--five times in a row. He dodged, he danced, and he refused to
give a straight answer. I asked him twice whether CEOs should be held
personally accountable when drug companies like Eli Lilly break the
law. Both times, he squirmed away from the question like it was some
kind of snake that would bite him.
The American people deserve better than an HHS Secretary who
struggles to answer the question of whether giant drug companies and
their CEOs should face the music when they cheat taxpayers and lie
about drugs.
On the topic of the Affordable Care Act, it is the same story all
over again. Mr. Azar spent his whole confirmation hearing before the
HELP Committee pretending that the Trump administration hasn't been
trying to rip up healthcare coverage for tens of millions of Americans.
He sat before the committee, like butter wouldn't melt in his mouth,
saying things like ``Oh, I don't think the Administration wanted fewer
people to enroll in health insurance coverage. I'm sure they just cut
the enrollment period in half because they thought it would improve
access to insurance.'' He actually said that.
When I heard that, I wondered if he thought we were stupid. His
answer was so ridiculous that I even asked him a followup question in
writing to make sure I had it right, and he responded--think about
this--that when the Trump administration cut the period of time that
people could enroll for health insurance, he said, ``I do not agree
with the characterization that the Administration or the Department has
made an effort to undercut open enrollment.'' You can't make this stuff
up.
Republicans want to pretend that Alex Azar is totally different from
Tom Price because Tom Price was a terrible HHS Secretary who didn't put
the American people first. I don't see the difference. I see someone
who doesn't want to say it out loud but who intends to behave exactly
like Tom Price when he sits down behind Tom Price's old desk. He will
support efforts to repeal the Affordable Care Act, gut efforts to
enroll people in health insurance, and take Medicaid away from people
who need it the most.
No one here should be fooled. This week is the 1-year anniversary of
Tom Price's confirmation hearing before the Senate, and we know how
that ended.
The American people deserve better. They deserve an HHS Secretary who
will put them first. I will be voting against Alex Azar because I don't
believe he meets that standard.
Mr. President, I yield.
The PRESIDING OFFICER. The Senator from Michigan.
Ms. STABENOW. Mr. President, I rise today to speak about why I, too,
will be opposing Alex Azar to be the Secretary of Health and Human
Services.
I appreciate, as always, my great friend from Massachusetts and her
advocacy for the people of her State and all of the country.
Perhaps more than any other agency, the Department of Health and
Human Services touches the lives of people in Michigan and across the
country every single day. It provides families access to Head Start and
other early childhood education programs that help our youngest
learners get off to a strong start. It helps ensure that families have
health insurance, whether through Medicare, Medicaid, children's health
insurance, or private insurance. It administers the Food and Drug
Administration, which makes sure that medications are safe and
effective. It works to ensure that health insurance and prescription
drugs are affordable because the best medication and health coverage in
the world will not help anyone if they can't afford them.
In short, this position is all about people. I expect our next
Secretary of Health and Human Services to, above all, put people before
politics or profits. Unfortunately, I do not have confidence that Mr.
Azar will do that.
Some of my biggest concerns come in the area of prescription drugs
prices--an issue that is extremely important in Michigan. I have spent
a tremendous amount of time focused on that over the years, on what
needs to happen. Bringing down costs for families is a very, very
critical issue for so many, if not every family in Michigan. Far too
many of our families are struggling to keep up with the rising cost of
prescription drugs.
Take Patricia, who is 73 years old and a retired nurse. Patricia's
doctor prescribed Humira for her severe rheumatoid arthritis. When she
called the pharmacy, she learned the prescription would cost $1,405.
Patricia told me:
There is absolutely no way I can afford this amount on a
monthly basis. Someone somewhere is getting extremely wealthy
off of seniors. These companies should be called to task for
their greed.
I agree with Patricia.
We know that Patricia is not alone in her struggling to afford her
medication. Between 2008 and 2016, prices on the most popular brand
name drugs rose over 208 percent--more than double in the United
States.
I can tell you that the average Michigan family's income didn't
double during that same time. These outrageous price increases force
people in Michigan and across the country to do things we have heard so
much about--split pills in half, skip doses, and even go bankrupt--just
to stay on the medications they need to stay healthy or to even stay
alive. These folks are spending money on prescriptions that they could
be using to save for their retirements or to pay for college for their
kids. That is wrong, and it needs to change.
I don't believe that Mr. Azar--a long-time pharmaceutical company
executive with a track record of dramatically increasing drug prices--
is the person who can make that change.
Here is an example: insulin. People who have diabetes, as we know,
need it to stay alive--children, adults, seniors. Yet staying alive has
become increasingly unaffordable, in part, thanks to Mr. Azar, the
former president of Eli Lilly USA. The price of one vile of Eli Lilly's
Humalog increased from $21 in 1996 to $123, when Mr. Azar became its
President, to $255 in 2017, when Mr. Azar left. As we know, people need
more than one vile.
Mr. Azar says he agrees that prices are too high, but he does not
seem ready or willing to do much about it. I want to know, if he
thought they were too high, why he didn't lower them rather than raise
them when he was in his position as president of Eli Lilly USA. I told
him that the National Academies of Sciences, Engineering, and Medicine
at our Finance hearing recommended allowing HHS to negotiate prices. He
said they were wrong, that the Federal Government shouldn't negotiate
prices for people to get the best deal. Common sense tells us that that
is what should be happening and should have been happening for years.
Mr. Azar also opposes the importation of safe and affordable
prescription drugs from Canada. That is despite the fact that his
former company, Eli Lilly, sells the identical insulin product in
Canada and around the world for less than it sells it for here.
Now, let's get this picture. One can go across a bridge from Detroit,
into Windsor, which is 5 minutes, 10 minutes across the bridge, and
dramatically drop the cost of one's insulin from the same company. Eli
Lilly and other drug companies argue that the problem is it is not
safe. So are they saying that Eli Lilly's insulin on one side of the
bridge, in Windsor, is not safe to take across to the other side of the
bridge? We open our bridges, and we export and import every single day
most everything but prescription drugs. Why does Mr. Azar think people
in Michigan should pay more for a decades-old drug than the people who
are just a few miles away in Canada?
By the way, insulin has been around for--what?--I don't know--100
years or something. I mean, at some point, you recoup your costs, but
this particular brand of insulin is sold on one side of the bridge in
one country, in Canada, for less than it sells it on the other side.
People in Michigan need to know why they think that makes any sense. It
sure doesn't make any sense to me, and it sure doesn't make any sense
to Steven from Michigan.
[[Page S462]]
Steven is a 47-year-old veteran from Swartz Creek, who has type 2
diabetes. His doctor prescribed an Eli Lilly medication called
Glyxambi, which has worked really well to control his blood sugar, but
he cannot afford it. The medication costs more than $2,000 for a 90-day
supply, and there is no generic equivalent. Hmm. I wonder what it costs
in Canada.
In Steven's words:
The drug companies are holding us hostage! I now see why
some seniors cut their meds in half. Something has to be
done.
I couldn't agree more. Something has to be done, as Steven has said.
Unfortunately, I don't believe that Mr. Azar will do it.
Drug prices aren't the only issue that concern me about this
nomination. Last week, we learned that 3.2 million more Americans were
uninsured at the end of last year, in December, than at the end of the
year before. There were 3.2 million more people who didn't have
insurance. It was the largest single year drop in the number of people
who have insurance. It was the highest increase since 2008 of those who
don't have insurance. This was a huge step backward from just a year
earlier when the United States hit an all-time low of 10.9 percent of
the number of people who didn't have insurance. Recently, we saw the
passage of a tax bill that, among other things, will leave 13 million
more Americans uninsured and will drive up the premiums--even higher--
by double digits.
They are not done yet.
Right now, the HHS and the Trump administration are considering rules
that would expand the availability of insurance plans that don't cover
essential health benefits. At another time, they were called junk
plans. I can remember before we put in place the requirement for basic
health benefits to be covered that someone would call me and say: I
have had insurance for years and have never needed it. I got sick and
discovered--oh, my gosh--it would only cover 1 day in the hospital. I
didn't know. Those are called junk plans. You think you are OK until
you actually need medical care, until you actually need coverage. Then
you find out you were paying for something that was just a bunch of
junk.
We now have in place consumer protections. We have in place consumer
requirements that are called essential benefits. Why? Because they are
essential. Emergency room coverage is pretty essential as well as
hospitalization. Everybody assumes, if one has insurance, one is
covered in the hospital for the amount of time one needs to be in the
hospital. Mental health and substance abuse treatment, prescription
drugs, and maternity care are basic things that every person may need
in one's lifetime as it relates to one's health.
When I asked Mr. Azar if he believed plans should have to cover
essential health benefits, he avoided really answering the question. He
said that he would ``work to ensure the least disruptive approach to
implementing these policies and to appropriately consider the concerns
expressed by stakeholders''--called people who need healthcare--
``during the rulemaking process.'' We don't need the least disruptive
approach to implement bad rules. Instead, we need an approach that
doesn't disrupt people's healthcare. This is a matter of life and death
every day for someone in Michigan and across the country.
I also asked Mr. Azar whether he believes that all health plans
should be required to cover maternity care and newborn care at no
additional cost. It is pretty basic. If you are a woman, it is pretty
basic in terms of coverage. Once again, he ducked, saying, ``It is
critical that every woman have access to high-quality prenatal care.''
We know what that means because, before the Affordable Care Act, only
12 percent of the plans in the individual market covered maternity and
newborn care.
You find yourself in a situation as a young woman--a very common
situation that will happen--where you are newly married and struggling
to get started. You don't plan to get sick, and you are not planning to
have a baby, so you get the skimpiest health plan that you can have
that you think will kind of cover you. Then something happens. Fifty
percent of the time, we know that in young couples, there are
unexpected pregnancies. Then whoops. It is prior to the Affordable Care
Act. Oh, now you have a preexisting condition. You are going to have to
pay more if you can get coverage at all.
I cannot tell you how many times I have heard that from women I know,
from people I represent in Michigan. It is pretty basic for women that
maternity care and newborn care should be covered, and it is now
without extra cost because it is basic care for women. Yet we have an
HHS nominee who is not willing to say: Yes, maternity care is basic for
women, and women shouldn't have to pay more to get basic healthcare,
like maternity care and newborn care.
Let me speak about another issue. If confirmed, Mr. Azar would also
be in charge of Medicare and Medicaid, which raises additional concerns
for me about the people whom I represent.
Thanks to Michigan's Medicaid expansion--a bipartisan effort in
Michigan--660,000 more people have insurance, and uncompensated care
has been cut by 50 percent--cut in half--which means 50 percent more of
the people who walk into the emergency room can actually pay for the
care they are getting. It is not rolled over onto everybody else. It
used to be, if somebody could not pay, everybody else would see his
insurance rate go up, and taxpayers would pay more. Those costs have
gone down 50 percent, and 30,000 jobs have been created as part of that
process. Projections show that last year, the State of Michigan ended
up saving money for the taxpayers; $432 million was saved because more
people had insurance and could pay for the medical care they were
getting. I thought that was what we wanted--for people to be able to
pay for their medical care.
Despite the President's promise not to cut Medicaid, every Republican
health proposal that came before Congress last year had one thing in
common--huge cuts to Medicaid. Then-Secretary Price pushed for the
passage of these bills, and during that time, Mr. Azar said he
supported those bills to gut Medicaid. In fact, the current budget
resolution that we are under, which was passed by this Senate, has $1
trillion in Medicaid cuts, as well as almost one-half trillion dollars
in Medicare cuts. It has not yet taken effect because they have to take
another step to actually pass the bills in the Senate, but it is ready
to go. It is in the budget resolution.
Mr. Azar said he supported the bills, and it would put Medicaid on a
more sustainable footing. Three out of five seniors in Michigan who are
in nursing homes get their nursing home care through Medicaid health
insurance--three out of five seniors. A more sustainable footing? Not
for them and not for their families. I will tell you what is not
sustainable--Michigan families trying to survive without health
coverage, the medical care that they need.
In conclusion, the people in Michigan know what the next Secretary of
Health and Human Services needs to do. It is a pretty big job that
affects part of everyone's life in some way.
That person needs to, among other things, bring down the cost of
prescription drugs immediately through the power of negotiation. He
needs to take the shackles off in terms of exporting and importing
prescription drugs. Just like any other product, we ought to have safe
importation and competition across the border to bring down prices. We
ought to have increased transparency, not the nominee's history of
raising prices over and over. That person needs to protect and
strengthen Medicaid and Medicare, not cut benefits, and that person
needs to enforce patient protections, like the essential health
benefits, like the ability for a woman to know that her basic
healthcare--and, if she has a baby, prenatal care or postnatal care--
will be covered without her having to pay more because she is a woman.
That is what should be happening--patient protections. We do not need
someone who thinks it is OK to go backward and erode them.
That is why I am voting no on Mr. Azar's confirmation. I hope my
colleagues will take a serious look and do the same. The health of the
people of Michigan and the people of this country depends on it.
I thank the Presiding Officer.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
[[Page S463]]
Mr. DAINES. Mr. President, I ask unanimous consent that
notwithstanding the provisions of rule XXII, all postcloture time on
the Azar nomination expire at 2:15 p.m. tomorrow, January 24, and the
Senate vote on confirmation of the Azar nomination with no intervening
action or debate; finally, that if confirmed, the motion to reconsider
be considered made and laid upon the table and the President be
immediately notified of the Senate's action.
The PRESIDING OFFICER. Without objection, it is so ordered.