Tagged U.S. Congress

Tax Bill Provision Designed To Spur Paid Family Leave To Lower-Wage Workers

Tucked into the new tax law is a provision that offers companies a tax credit if they provide paid family and medical leave for lower-wage workers.

Many people support a national strategy for paid parental and family leave, especially for workers who are not in management and are less likely to get that benefit on the job. But consultants, scholars and consumer advocates alike say the new tax credit will encourage few companies to take the plunge.

The tax credit, proposed by Sen. Deb Fischer (R-Neb.), is available to companies that offer at least two weeks of paid family or medical leave annually to workers, but two key criteria must be met. The workers must earn less than $72,000 a year and the leave must cover at least 50 percent of their wages.

If contributing at the half-wage level, a company receives a tax credit equal to 12.5 percent of the amount it pays to the worker. The tax credit will increase on a sliding scale if the company pays more than 50 percent of wages. It could go up to a maximum credit of 25 percent of the amount the employer paid for up to 12 weeks of leave.

Payments to full- and part-time workers taking family leave who’ve been employed for at least a year would be eligible for the employer’s tax break. But the program, which is designed to test whether this approach works well, is set to last just two years, ending after 2019.

Aparna Mathur, a resident scholar in economic policy studies at the American Enterprise Institute, says the new tax credit sidesteps a pitfall for Republicans. They are wary of any legislation mandating that employers provide paid leave. The tax credit also is appropriately aimed at lower-wage workers who are most likely to lack access to paid leave, said Mathur, who co-authored a recent report on paid family leave.

But it’s not a big enticement.

“Providing this benefit is a huge cost for employers,” Mathur said. “It’s unlikely that any new companies will jump on board just because they have a 12.5 to 25 percent offset.”

That view is shared by Vicki Shabo, vice president for workplace policies and strategies at the National Partnership for Women & Families, an advocacy group, who said it will primarily benefit workers at companies already offering paid family leave. The new tax credit “just perpetuates the boss lottery,” she added.

Heather Whaling said her 22-person public relations company probably qualifies for the new tax credit, but she doesn’t think it’s the right approach. Whaling, the president of Geben Communication in Columbus, Ohio, already offers paid leave. The company provides up to 10 weeks of paid leave at full pay for new parents. Four employees have taken leave, and by divvying up their work to other team members and hiring freelancers they’ve been able to get by.

“It is an expense, but if you plan and budget carefully it’s not cost-prohibitive,” she said.

The tax credit isn’t big enough to provide a strong incentive to provide paid leave, said Whaling, 37. Besides, “having access to paid family leave shouldn’t be luck of the draw, it should be available to every employee in the country.”

Still, the tax credit may be appealing to companies that have been considering adding a paid family and medical leave benefit, said Rich Fuerstenberg, a senior partner at benefits consultant Mercer.

By defraying some of the cost, the tax credit could help “tip them over” into offering paid leave, he said. But  “I’m not even sure I’d call it the icing on the cake,” Fuerstenberg said. “It’s like the cherry on the icing.”

Only 15 percent of private-sector and state and local government workers had access to paid family and medical leave in 2017, according to the Bureau of Labor Statistics’ National Compensation Survey. Eighty-eight percent had access to unpaid leave, however.

Under the federal Family and Medical Leave Act, employers with 50 or more workers generally must allow eligible employees to take unpaid leave for up to 12 weeks annually for specified reasons. These include the birth or adoption of a child, caring for your own or a family member’s serious health condition, or leave for military caregiving or deployment. An individual’s job is protected during such leaves.

A tax credit that can be claimed at the end of the year is unlikely to encourage small businesses to offer paid family and medical leave, said Erik Rettig, an expert on family leave policies at the Small Business Majority, which advocates for those firms on national policy.

“It isn’t going to help the family business that has to absorb the costs of this employee while they’re gone,” Rettig said.

A better solution, according to Shabo and others, is to provide a paid family leave benefit that’s funded by employer and/or employee payroll contributions. Sen. Kirsten Gillibrand (D-N.Y.) and Rep. Rosa DeLauro (D-Conn.) last year reintroduced such legislation. Their bill would guarantee workers, including those who are self-employed, up to 12 weeks of family and medical leave with as much as two-thirds of their pay.

A handful of mostly Democratic states — including California, New Jersey, Rhode Island and New York — have similar laws in place, and a program in the District of Columbia and Washington state will begin in 2020.

“We know from states that this approach works for both employees and their bosses,” Shabo said.

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CHIP Renewed For Six Years As Congress Votes To Reopen Federal Government

A brief, partial shutdown of the federal government was resolved Monday, as the Senate and House approved legislation that would keep federal dollars flowing until Feb. 8, as well as fund the Children’s Health Insurance Program for the next six years.

The legislation is awaiting President Donald Trump’s signature, expected later Monday evening.

The CHIP program, which provides coverage to children in families who earn too much to qualify for Medicaid but not enough to afford private insurance, has been bipartisan since its inception in 1997. But its renewal became a partisan bargaining chip over the past several months.

Funding for CHIP technically expired Oct. 1, although a temporary spending bill in December gave the program $2.85 billion. That was supposed to carry states through March to maintain coverage for an estimated 9 million children, but some states began to run short almost as soon as that bill passed.

The Georgetown University Center for Children and Families estimated that 24 states could face CHIP funding shortfalls by the end of January, putting an estimated 1.7 million children’s coverage at risk in 21 of those states.

Meanwhile, both houses of Congress had been at loggerheads over how to put the program on more firmer financial footing.

In October, just days after the program’s funding expired, the Senate Finance Committee approved a bipartisan five-year extension of funding by voice vote. But that bill did not include a way to pay the cost, then estimated at $8.2 billion.

In November, the House passed its own five-year funding bill for the program, but it was largely opposed by Democrats because it would have offset the CHIP funding by making cuts to Medicare and the Affordable Care Act (ACA).

Prospects for a CHIP deal brightened earlier this month when the Congressional Budget Office re-estimated how much the extension of funding for the program would cost. In a letter to Senate Finance Committee Chairman Orrin Hatch (R-Utah) on Jan. 5, CBO said changes to health care made in the tax bill would result in lowering the five-year cost of the program from $8.2 billion to $800 million — effectively a reduction of 90 percent.

The reason, explained CBO, is that the landmark tax bill passed in December eliminated the ACA’s individual mandate, which would likely drive up premiums in the individual market. Those higher premiums, in turn, would increase the federal premium subsidies for those with qualifying incomes. As a result, if kids were to lose their CHIP coverage and go onto the individual exchanges instead, the federal premium subsidies would cost more than their CHIP coverage.

Driving that point home, on Jan. 11, CBO Director Keith Hall wrote to Rep. Frank Pallone (D-N.J.) that renewing CHIP funding for 10 years rather than five would save the federal government money. “The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period,” the letter said.

That made it easier for Republicans to include the CHIP funding in the latest spending bill. But it infuriated Democrats, who had vowed not to vote for another short-term spending bill until Congress dealt with the issue of immigrant children brought to the country illegally by their parents.

Republicans, said Senate Minority Leader Chuck Schumer (D-N.Y.) on Sunday, “were using the 10 million kids on CHIP, holding them as hostage for the 800,000 kids who were Dreamers. Kids against kids. Innocent kids against innocent kids. That’s no way to operate in this country.”

Republicans, however, said it was the opposite — that Democrats were holding CHIP hostage by not voting for the spending bill. “There is no reason for my colleagues to pit their righteous crusade on immigration against their righteous crusade for CHIP,” said Hatch. “This is simply a matter of priorities.”

The CHIP renewal was not the only health-related change in the temporary spending bill. The measure also delays the collection of several unpopular taxes that raise revenues to pay for the ACA’s benefits. The taxes being delayed include ones on medical device makers, health insurers and high-benefit “Cadillac” health plans.

The bill does not, however, extend funding for Community Health Centers, another bipartisan program whose funding is running out. That will have to wait for another bill.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

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In The Event Of A Shutdown …

A government shutdown would have far-reaching effects for public health, including the nation’s response to the current, difficult flu season. It could also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services would send home — or furlough — about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

CENTERS FOR DISEASE CONTROL AND PREVENTION

According to the HHS plan, the CDC would suspend its flu-tracking program. That’s bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC’s updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states would still track flu cases, “they won’t be able to call CDC to verify samples or seek their expertise,” said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown could also affect the CDC’s involvement in key decisions about next year’s flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.

Beyond the flu, the CDC would provide only “minimal support” to programs that investigate infectious-disease outbreaks. The Atlanta-based agency’s ability to test suspicious pathogens and maintain its 24-hour emergency operations center would be “significantly reduced,” according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease “that are the earliest indicators of outbreaks,” Frieden said.

NATIONAL INSTITUTES OF HEALTH

Although the NIH would continue to treat patients at its clinical center in Bethesda, Md., the agency would not enroll new patients in clinical trials — which many people with life-threatening illnesses see as their last hope. The only exception would be an admission deemed medically necessary by the NIH director.

MEDICARE

Beneficiaries would be largely unaffected by a shutdown, especially if it is short. Patients would continue to receive their insurance coverage, and Medicare would continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown were prolonged.

MEDICAID

States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children’s Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry — its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds would continue to work during a shutdown.

COMMUNITY HEALTH CENTERS

According to the HHS plan, the Health Resources and Services Administration would continue to operate the nation’s 1,400 community health centers — clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It would also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall — a casualty of Congress’ fight over the CHIP reauthorization — so, they are operating on left-over funds.

ACA PREMIUM SUBSIDIES

The shutdown would not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through healthcare.gov or state marketplaces would not be affected, according to HHS.

VETERANS AFFAIRS

Staffing for the Department of Veterans Affairs will remain largely intact. “Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA’s operations would not be impacted,” said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, would continue working, according to the department’s contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

FOOD AND DRUG ADMINISTRATION

In the short term, the crucial activities that protect consumers would get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety would continue, as would positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. would continue to work. However, routine inspections and laboratory research would cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

NUTRITION SERVICES FOR SENIORS

The Administration for Community Living would not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there would not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

FOOD SAFETY

The FDA’s food safety programs would cease, according to the HHS plan, but inspections conducted by Agriculture’s Food Safety and Inspection Service (FSIS) would continue.

Meat and poultry inspections are “such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously,” otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are “career folks” who have worked there through previous government shutdowns. “There was a lot of built-in knowledge of how to function during the [2013] shutdown,” he said, adding that this expertise would help the agency if there is another shutdown.

Staff writers JoNel Aleccia, Julie Appleby, Carmen Heredia Rodriguez, Shefali Luthra, Liz Szabo, Jordan Rau, Stephanie Stapleton, Sarah Jane Tribble and Lydia Zuraw contributed to this report.

KHN’s coverage of these topics is supported by Laura and John Arnold FoundationCalifornia Health Care FoundationJohn A. Hartford Foundation, Heising-Simons FoundationGordon and Betty Moore Foundation and The David and Lucile Packard Foundation.

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Podcast: What The Health? Our First Live Show: What The Health Will Happen In 2018?

Congress is at the precipice of shutting down the government, unless lawmakers can quickly agree on another short-term spending bill. And this time, the Children’s Health Insurance Program is caught in the crosshairs. Republicans are offering six years of funding for CHIP as an enticement for Democratic votes on the spending bill, but Democrats are still balking because they want the bill to include protections for undocumented individuals brought to the U.S. by their parents when they were children.

Meanwhile, with the help of the Trump administration, states are looking at other ways to change the Medicaid program besides work requirements.

And Tom Scully, former head of the Centers for Medicare & Medicaid Services under President George W. Bush, offers his predictions for what might happen this year in health policy. His short answer: not much.

Julie Rovner of Kaiser Health News (left), Sarah Kliff of Vox.com, Paige Winfield Cunningham of The Washington Post and Alice Ollstein of Talking Points Memo speak at a live taping of this week’s “What The Health?” podcast. (Lynne Shallcross/KHN)

This week’s “What The Health?” panelists are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Joanne Kenen of Politico, Sarah Kliff of Vox.com, Alice Ollstein of Talking Points Memo, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post.

In the podcast’s first live taping before an audience, the panelists discuss these topics as well as whether states will pass their own individual insurance requirements now that the penalty for the federal “individual mandate” has been repealed, how the loss of that penalty will change the individual marketplaces and whether anyone will address the high cost of prescription drugs.

Among the takeaways from this week’s podcast:

  • Although CHIP has long enjoyed a reputation as having bipartisan support, it appears that House Republicans are less committed to the program than in past years.
  • The addition of a work requirement gained many of the headlines in the Trump administration’s Medicaid waiver for Kentucky, but other important changes were given a green light, too. They include jettisoning the long-standing practice of giving enrollees retroactive coverage if they were eligible for it at that time, charging premiums, and locking people out of coverage if they fail to provide required premiums or paperwork.
  • Maryland officials are weighing the option of setting up a state-based requirement that people get insurance since the federal government has repealed the Affordable Care Act’s penalties for not having insurance. If it passes, other states could follow suit.
  • Scully says one of the biggest issues facing policymakers is trying to fix the gross inequities in Medicaid as different states use it for different populations and programs.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

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Podcast: ‘What The Health?’ Should You Work For Your Medicaid Coverage?

The Trump administration this week told states they will be allowed to require some beneficiaries of the Medicaid program to work or perform community service in order to keep their health insurance — a break with long-standing policies of both Democratic and Republican administrations.

Meanwhile, the Congressional Budget Office said that renewing the Children’s Health Insurance Program (CHIP) for 10 years would actually save the federal government money, because alternative arrangements for the 9 million children now covered would be more expensive.

Plus, Paul Starr, Princeton professor and co-editor of The American Prospect, talks about his about ideas for expanding the Medicare program, if and when the political winds shift in that direction.

This week’s “What The Health?” panelist are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times.

They discuss these topics as well as the prospects for quick confirmation of former Health and Human Services Deputy Secretary Alex Azar to head the department. And Rovner interviews Paul Starr.

Among the takeaways from this week’s podcast:

  • The new work policy follows efforts to add a work requirement to Medicaid eligibility. But that change came through congressional action. The Trump administration’s decision to shift policy through the executive branch could complicate its legal arguments when advocates file their promised lawsuits.
  • Despite concerns about the historic nature of the change in Medicaid requirements, many people — including many Medicaid enrollees — say they support a work mandate.
  • The Congressional Budget Office’s revisions to estimates about the cost of the Children’s Health Insurance Program appear to be breaking the logjam on funding on Capitol Hill.
  • Alex Azar, the nominee to be secretary of the Department of Health and Human Services, appears on the glide path for confirmation, with at least two Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin of West Virginia, having already announced they will vote for him.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner:  Mother Jones’ “Go Fund Yourself,” by Stephen Marche

ALSO: The New York Times’ “You’re Sick. Whose Fault Is That?” by Dhruv Khullar.

Joanne Kenen: The New York Times’ “Baltimore Hospital Patient Discharged at Bus Stop, Stumbling and Cold,” by Jacey Fortin

Sarah Kliff: Marketplace’s “The Uncertain Hour, Episode 1: The Magic Bureaucrat,” by Krissy Clark

Margot Sanger-Katz: The Wall Street Journal’s “Trump Nominee to Lead Indian Health Services Faces Claims of Misrepresentation,” by Christopher Weaver and Dan Frosch.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

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Podcast: ‘What The Health?’ Should You Work For Your Medicaid Coverage?

The Trump administration this week told states they will be allowed to require some beneficiaries of the Medicaid program to work or perform community service in order to keep their health insurance — a break with long-standing policies of both Democratic and Republican administrations.

Meanwhile, the Congressional Budget Office said that renewing the Children’s Health Insurance Program (CHIP) for 10 years would actually save the federal government money, because alternative arrangements for the 9 million children now covered would be more expensive.

Plus, Paul Starr, Princeton professor and co-editor of The American Prospect, talks about his about ideas for expanding the Medicare program, if and when the political winds shift in that direction.

This week’s “What The Health?” panelist are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Sarah Kliff of Vox.com and Margot Sanger-Katz of The New York Times.

They discuss these topics as well as the prospects for quick confirmation of former Health and Human Services Deputy Secretary Alex Azar to head the department. And Rovner interviews Paul Starr.

Among the takeaways from this week’s podcast:

  • The new work policy follows efforts to add a work requirement to Medicaid eligibility. But that change came through congressional action. The Trump administration’s decision to shift policy through the executive branch could complicate its legal arguments when advocates file their promised lawsuits.
  • Despite concerns about the historic nature of the change in Medicaid requirements, many people — including many Medicaid enrollees — say they support a work mandate.
  • The Congressional Budget Office’s revisions to estimates about the cost of the Children’s Health Insurance Program appear to be breaking the logjam on funding on Capitol Hill.
  • Alex Azar, the nominee to be secretary of the Department of Health and Human Services, appears on the glide path for confirmation, with at least two Democratic senators, Heidi Heitkamp of North Dakota and Joe Manchin of West Virginia, having already announced they will vote for him.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner:  Mother Jones’ “Go Fund Yourself,” by Stephen Marche

ALSO: The New York Times’ “You’re Sick. Whose Fault Is That?” by Dhruv Khullar.

Joanne Kenen: The New York Times’ “Baltimore Hospital Patient Discharged at Bus Stop, Stumbling and Cold,” by Jacey Fortin

Sarah Kliff: Marketplace’s “The Uncertain Hour, Episode 1: The Magic Bureaucrat,” by Krissy Clark

Margot Sanger-Katz: The Wall Street Journal’s “Trump Nominee to Lead Indian Health Services Faces Claims of Misrepresentation,” by Christopher Weaver and Dan Frosch.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

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HHS Nominee Vows To Tackle High Drug Costs, Despite His Ties To Industry

Senate Democrats on Tuesday pressed President Donald Trump’s nominee for the top health post to explain how he would fight skyrocketing drug prices — demanding to know why they should trust him to lower costs since he did not do so while running a major pharmaceutical company.

Alex M. Azar II, the former president of the U.S. division of Eli Lilly and Trump’s pick to run the Department of Health and Human Services, presented himself as a “problem solver” eager to fix a poorly structured health care system during his confirmation hearing before the Senate Finance Committee. Azar said addressing drug costs would be among his top priorities.

But armed with charts showing how some of Eli Lilly’s drug prices had doubled on Azar’s watch, Democrats argued Azar was part of the problem. Sen. Ron Wyden of Oregon, the committee’s top Democrat, said Azar had never authorized a decrease in a drug price as a pharmaceutical executive.

“The system is broken,” Wyden said. “Mr. Azar was a part of that system.”

Azar countered that the nation’s pharmaceutical drug system is structured to encourage companies to raise prices, a problem he said he would work to fix as head of HHS.

“I don’t know that there is any drug price of a brand-new product that has ever gone down from any company on any drug in the United States, because every incentive in this system is towards higher prices, and that is where we can do things together, working as the government to get at this,” he said. “No one company is going to fix that system.”

Azar’s confirmation hearing Tuesday was his second appearance before senators as the nominee to lead HHS. In November, he faced similar questions from the Senate Health, Education, Labor and Pensions Committee during a courtesy hearing.

If confirmed, Azar would succeed Tom Price, Trump’s first health secretary, who resigned in September amid criticism over his frequent use of taxpayer-paid charter flights. A former Republican congressman who was a dedicated opponent of President Barack Obama’s signature health care law, Price had a frosty relationship with Democrats in Congress as he worked with Republicans to try to undo the law.

Price and the Trump administration often turned to regulations and executive orders to undermine the Affordable Care Act, since Republicans in Congress repeatedly failed to enact a repeal. “Repeal and replace” has been the president’s mantra.

But at the hearing, Azar was circumspect about his approach, noting that his job would be to work under existing law. “The Affordable Care Act is there,” he said, adding that it would fall to him to make it work “as best as it possibly can.”

Senate Republicans touted Azar’s nearly six years working for the department under President George W. Bush, including two years as a deputy secretary. Committee Chairman Orrin Hatch (R-Utah) praised Azar’s “extraordinary résumé,” adding that, among HHS nominees, he was “probably the most qualified I’ve seen in my whole term in the United States Senate.” Hatch, who is the longest-serving Republican senator in history, has been a senator for more than 40 years.

In addition to drug costs, Azar vowed to focus on the nation’s growing opioid crisis, calling for “aggressive prevention, education, regulatory and enforcement efforts to stop overprescribing and overuse,” as well as “compassionate treatment” for those suffering from addiction.

Pressed about Republican plans to cut entitlement spending to compensate for budget shortfalls, Azar said he was “not aware” of support within the Trump administration for such cuts.

“The president has stated his opposition to cuts to Medicaid, Medicare or Social Security,” Azar said. “He said that in the campaign, and I believe he has remained steadfast in his views on that.”

But Democrats pushed back, pointing out that Trump had proposed Medicaid cuts in his budget request last year. Sen. Sherrod Brown (D-Ohio) said such cuts would hurt those receiving treatment for opioid addiction.

“What happens to these people?” he said.

Despite such Democratic criticism, Azar is likely to be confirmed when the full Senate votes on his nomination. An HHS spokesman Tuesday pointed reporters to an editorial in STAT supporting Azar, written by former Senate majority leaders Bill Frist and Tom Daschle — a Republican and a Democrat. “We need a person of integrity and competence at the helm of the Department of Health and Human Services,” they wrote. “The good news is that President Trump has nominated just such a person, Alex Azar.”

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