[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.