Friday, November 15, 2019

Statement from Press Secretary Stephanie Grisham

Statement from Press Secretary Stephanie Grisham:

“The second public hearing of Speaker Pelosi and Congressman Schiff’s impeachment charade was as useless and inconsequential as the first. Zero evidence of any wrongdoing by the President was presented. In fact, Ambassador Yovanovitch testified under oath that she was unaware of any criminal activity involving President Trump. She was not on the July 25 phone call and had no knowledge about the pause on aid to Ukraine. It is difficult to imagine a greater waste of time than today’s hearing, and yet unfortunately we expect more of the same partisan political theater next week from House Democrats.” 

Statement from the Press Secretary Regarding Executive Clemency for Army First Lieutenant Clint Lorance and Army Major Mathew Golsteyn, and the Promotion of Special Warfare Operator First Class Edward Gallagher

Office of the Press Secretary
Statement from the Press Secretary Regarding Executive Clemency for Army First Lieutenant Clint Lorance and Army Major Mathew Golsteyn, and the Promotion of Special Warfare Operator First Class Edward Gallagher
Today, President Donald J. Trump signed an Executive Grant of Clemency (Full Pardon) for Army First Lieutenant Clint Lorance, an Executive Grant of Clemency (Full Pardon) for Army Major Mathew Golsteyn, and an order directing the promotion of Special Warfare Operator First Class Edward R. Gallagher to the grade of E-7, the rank he held before he was tried and found not guilty of nearly all of the charges against him.

In early July 2012, only days after Lieutenant Lorance had taken command of his platoon in one of the most dangerous battle zones in Afghanistan, a motorcycle with three men approached him and his men with unusual speed. Under difficult circumstances and prioritizing the lives of American troops, Lorance ordered his men to engage, and two of the three men were killed. Following these events, Lorance was convicted of several charges. He has served more than six years of a 19-year sentence he received. Many Americans have sought executive clemency for Lorance, including 124,000 people who have signed a petition to the White House, as well as several members of Congress, including Senators Bill Cassidy and John Kennedy, and Representatives Steve Scalise, Garret Graves, Duncan Hunter, Paul Gosar, Adam Kinzinger, Scott Perry, Brian Babin, Neal Dunn, Michael Waltz, Louie Gohmert, Daniel Webster, Steve King, Ralph Norman, Mark Meadows, Clay Higgins, Ralph Abraham, Mike Johnson, and Jody Hice.

Major Mathew Golsteyn, an officer of the United States Army and graduate of West Point, is currently set to stand trial for an allegedly unlawful killing in connection with one of the largest battles of the Afghanistan War. As our forces cleared the Taliban from the city of Marjah, an Improvised Explosive Device detonated, killing two Marines. The terrorist bombmaker, as identified by an Afghan informant, who had killed our troops, was detained and questioned. Golsteyn was compelled to release him, however, due in part to deficiencies within the fledgling Afghan detention system. Golsteyn has said he later shot the terrorist because he was certain that the terrorist’s bombmaking activities would continue to threaten American troops and their Afghan partners, including Afghan civilians who had helped identify him. After nearly a decade-long inquiry and multiple investigations, a swift resolution to the case of Major Golsteyn is in the interests of justice. Clemency for Major Golsteyn has broad support, including from Representatives Louie Gohmert, Duncan Hunter, Mike Johnson, Ralph Abraham, and Clay Higgins, American author and Marine combat veteran Bing West, and Army combat veteran Pete Hegseth.

Before the prosecution of Special Warfare Operator First Class Edward Gallagher, he had been selected for promotion to Senior Chief, awarded a Bronze Star with a “V” for valor, and assigned to an important position in the Navy as an instructor. Though ultimately acquitted on all of the most serious charges, he was stripped of these honors as he awaited his trial and its outcome. Given his service to our Nation, a promotion back to the rank and pay grade of Chief Petty Officer is justified.

The United States military justice system helps ensure good order and discipline for our millions of uniformed military members and holds to account those who violate the Uniform Code of Military Justice. Due in part to this system, we have the most disciplined, most effective, most respected, and most feared fighting force in the world.

The President, as Commander-in-Chief, is ultimately responsible for ensuring that the law is enforced and when appropriate, that mercy is granted. For more than two hundred years, presidents have used their authority to offer second chances to deserving individuals, including those in uniform who have served our country.  These actions are in keeping with this long history.  As the President has stated, “when our soldiers have to fight for our country, I want to give them the confidence to fight.” 


Resolute Reads
New Remarks From Top Ukrainian Official Damages Democrats’ Impeachment Narrative
-The Daily Wire
“Ukrainian Foreign Minister Vadym Prystaiko said on Thursday that the United States Ambassador Gordon Sondland did not link financial military assistance to a request for Ukraine to open up an investigation into former vice president and current Democratic presidential candidate Joe Biden and his son, Hunter Biden,” Ryan Saavedra reports.
Even Impeachment ‘Rehearsal’ Hearings Won’t Help Dems
-New York Post
“Clever: By having witnesses go through closed-door hearings first, Dems can get a sense of what witnesses have to say privately and then tailor their questions for maximum impact during the public spectacle,” the New York Post editorial board writes. “Trouble is, even rehearsals don’t seem to help . . . No matter how many auditions they hold, it’s no substitute for hard evidence.”

The Daily Signal: Meet the impeachment witnesses’ anti-Trump lawyers
The President, Not Diplomats, Sets 'Official Foreign Policy'
-The Hill
“There must be some confusion. Under the U.S. Constitution, it is the president of the United States who determines foreign policy. How can President Trump be ‘at odds with foreign policy’ when he’s the one who determines it?” Sharyl Attkisson writes. “Trump’s enemies may cheer on the idea of diplomats and other officials choosing to oppose or undermine his wishes. But based on our Constitution, the dissenting diplomats are the ones who are at odds with “official foreign policy”— not the other way around.”

🎬 Must-see: Ukraine got their lethal aid from President Trump, not Obama
Trickster Adam Schiff Conjuring ‘Guilt’ Out of Thin Air
-New York Post
“For those who find the hearings far from riveting but watch out of obligation or amusement, here’s a modest suggestion to pass the hours productively: Count the important things your representatives could and should be doing otherwise,” Michael Goodwin writes. Fix immigration, pass USMCA, rebuild infrastructure—take your pick.
Trump Delivers a Salute to Veterans at Historic NYC Parade
“President Donald Trump paid tribute Monday to all Americans who have worn a military uniform, from the Revolution through present-day conflicts. He spoke at the start of the annual New York City Veterans Day parade,” Richard Sisk reports. President Trump became the first sitting U.S. President to attend the parade. “Our veterans risked everything for us. Now, it is our duty to serve and protect them,” he said.

🎬 Watch: The President and First Lady attend the NYC Veterans Day Parade


Office of the Press Secretary

Roosevelt Room

2:12 P.M. EST

     THE PRESIDENT:  Thank you very much, everybody.  It’s a great honor.  The stock market is up big today.  It set a new record.  I think it’s the 22nd time this year, and it’s over 100 times for the time that we’re in office.  We’ve set over 100.  I think it’s substantially more than 100.  We’ll get the exact number because I know you wouldn’t want me to have that wrong.  They don’t like that.

     But we’re up over 100 times for the stock market.  And that means jobs.  That means companies are moving back into the United States that left.  We have many, many companies coming back.

The employment numbers are at a record.  The -- or very close.  And we just got a new number on African American employment.  It's the best it’s ever been.  You could say employment or unemployment -- they’re the best numbers they’ve ever been.

     So we’re very proud of what’s happened with our economy.  A few months ago, you were predicting a recession.  Perhaps someday there will be a recession, but we have a long way to go.  The consumer has never been stronger, and we’re going to make the consumer even stronger yet, with transparency, because they’re going to get much better pricing at hospitals.  So I think we can probably add this to the number.

     You saw median household income -- for President Bush, eight years -- was $450.  For President Obama, for eight years -- eight years, think of that -- was $975.  For President Trump -- a little over two and a half years -- when they did the final number, it was $5,000.  And they add to that $2,000, thanks to Kevin and everybody.  Thank you, Kevin.  You’re behind me someplace, right?  Add $2,000 or $2,500, Kevin.  What would you say?

     REPRESENTATIVE BRADY:  Yeah.  Right about there, Mr. President.

     THE PRESIDENT:  Right there?  So let’s add $2,000, and then add $3,000 for regulation, and add something for the energy savings.  So you have $10,000.  So it’s $400 and $975 -- that’s for eight and eight.  And then, for two and half years, it’s $10,000.  That’s not bad.  But the consumer is very powerful, and this is going to make them more powerful.

     So, welcome, everyone.  This afternoon, we celebrate something that I’m very proud of: another major victory in our mission to deliver great healthcare at a price that you can afford.  This will have a tremendous impact on prices.

     A certain gentleman, who is in the room -- who will say a couple of words -- actually said this is more important than healthcare.  And when he said that, my ears really perked up, and I listened.  And they were right, and they gave me plenty of examples.  And that person recently got the Presidential Medal of Freedom.  His name is Art Laffer, and he’s a very talented guy.

     Where is Art?  Is he here?  Yes?

     DR. LAFFER:  I’m sort of short today.  (Laughter.)

     THE PRESIDENT:  Hello, Art.  I didn’t see you.  I didn’t see you back there.  All right, stand up here.  A great gentleman.  And you brought a man here who's the king of that world.  And -- hello.  How are you?  That’s the guy.  And you made that statement to me: "More important than healthcare."  That was a big statement.  As soon as I heard that, I said, “That sounds good to me.”  It’s transparency.

     So I signed, as you know, an executive order -- historic.  And we’re requiring price transparency in healthcare, forcing companies to compete for your business.  It’s a very important thing that we’ve done here.  I don’t think it’ll be covered by you, but it will be in the years to come.

     Our goal was to give patients the knowledge they need about the real price of healthcare services.  They’ll be able to check them, compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost.  And this is about high-quality care.  You’re also looking at that.  You’re looking at comparisons between talents, which is very important.  And then, you’re also looking at cost.  And, in some cases, you get the best doctor for the lowest cost.  That’s a -- that’s a good thing.

     Today, I'm proud to announce two new actions implementing that order.  First, we are finalizing a rule that will compel hospitals to publish prices publicly online for everyone to see and to compare.  So you’re able to go online and compare all of the hospitals and the doctors and the prices, and, I assume, get résumés on doctors and see who you like.

And the good doctors -- like, I assume these two guys are fantastic doctors, otherwise you wouldn’t be here.  (Laughter.)  And the bad doctors, I guess they have to go and hide someplace.  I don’t know.  Maybe they don’t do so well.  I don’t know.  But if they’re not good, we -- we are more interested in the good ones.  It’s called “rewarding talent.”

Second, we're putting forward a proposed rule to require health insurance providers to disclose their pricing information to consumers.  We’re giving American families control of their healthcare decisions.  And the freedom to choose that care is right before them on the Internet and elsewhere, but on the Internet.  Very, very open.  Very transparent.  That’s why it's called transparency.

And this has been done on a small basis, on individual hospitals.  In fact, Art, you were telling me about that, with your hospital, that you're on the board of a hospital that did this.

I'd like you to actually -- before I go further, I'd like you talk about that just for a second.  Art Laffer.  Art, just mention that, if you could.

DR. LAFFER:  Yeah.  You've got to lower it really far.  (Laughter.)  Sorry about that.

Let me, if I can, just say I was the chairman of the board of Centennial Hospital.  We had some problems.  But when you look at this, this is the biggest revolution I've seen in generations.  I mean -- and as opposed to most revolutions, this revolution saves lives; it doesn’t cost lives.

And, in this revolution, it saves money.  You don’t have to spend money.  And what you've seen here before is that we have no transparency whatsoever in medical.  It's like the hermit kingdom of industries.  You don’t know what the price is.  You don’t know what the outcome is.  And you don’t know what the inputs are.

What this does is this pulls away the veil and allows people to see exactly what they can and what they do.  And if I can say, I think this will lead to a phenomenal change in the U.S. outcome of employment output production.  It's just one of the industries that desperately needs this.

I'll stop about here, but the last one I can remember being involved with was with Lady Thatcher when she privatized coal, steel, and the railroads.  I mean, the changes there with Sir Keith Joseph.  And this outdoes all of those revolutions, sir.  It's the most amazing of all time.

And it takes real leadership to do it and real practitioners to be able to get it through.  And Secretary Azar is a great practitioner, and my buddy Larry Ku- -- Larry Van Horn is also a great practitioner -- as well as Larry Kudlow, by the way.  (Laughter.)  Thank you, sir.

THE PRESIDENT:  And I'd like to have Larry maybe say a few words and explain what this is that we're being -- for the public.

DR. VAN HORN:  Sure, Mr. President.  This is a momentous day.  Americans, year over year, have been faced with higher and higher healthcare costs, facing higher and higher obligation to pay for those out of their own wallets without information around the price and the quality associated with that.

The charges that have been put out are fictitious.  Nobody pays the charges.  This effort is to make real prices transparent.  The net allowed amounts that drive the decision-making for patients every day will now be in their hands.  They can make better trade-offs and have, hopefully, more money in their wallets and their paychecks to pay for all of the goods and services they need to live their lives.

So this is a very momentous day.  And I appreciate the efforts of the administration all the way through in terms of being able to follow through and execute this.

THE PRESIDENT:  And it we did max, right?  We didn’t do a smaller version?

MR. VAN HORN:  We did it max.


MR. VAN HORN:  It's A-plus.

THE PRESIDENT:  I kept saying --

MR. VAN HORN:  A-plus.  (Laughter.)

THE PRESIDENT:  There are versions of this.  I said, "No, I don't want the C or the D.  I want the A-plus."  And we did it the A-plus, so I'm very happy with that.  And I think you're going to see things.  It's kicking in immediately.  It'll kick in as of today, but it's going to really start going during the course of the year, the following year -- this year coming.  And you'll see some results that are going to be actually incredible in terms of costs coming down and, I think, in terms of the quality of the care because you're picking people that you'd want to be with.

This afternoon, we're grateful to be joined by Secretary Steve Mnuchin -- wherever you may be, Steve.  Where is Steve?



Secretary Gene Scalia.  And I hear you're really doing a job over there.  Huh?

SECRETARY SCALIA:  We're doing our best.

THE PRESIDENT:  Labor is doing okay.  Your numbers are certainly doing very good.  It's a good time to be Department of Labor.  Right?  This is a --

SECRETARY SCALIA:  A great story to tell.

THE PRESIDENT:  Right.  Thank you very much.  Good.

Secretary Alex Azar.  Thank you, Alex.  Thank you.  Thank you, Alex.

And Administrator Seema Verma.  Thank you very much, Seema.  Where's Seema?  This is an unusual group today.  They're spread all over the place.

I also want to welcome Representatives Kevin Brady, Michael Burgess, and Greg Walden.  They've been so fantastic on getting us to a really good position with the taxes.

We're going to be doing a major middle-income tax cut if we take back the House.  And we'll talking about that sometime later.  But we're going to be doing a very major middle-income tax cut, mostly devoted to middle income who have really been big beneficiaries of the tax cut we did, which was the largest in the history of our country.  But we're doing a major tax cut for the middle income, and that'll be subject, obviously, to take -- taking over the House, because Democrats like tax increases, not tax cuts.

I also want to thank our state leaders.  We have a lot state leaders here today at the highest level, and I want to thank them for being here.  And a special thanks again to highly respected economists, Dr. Art Laffer and Dr. Larry Van Horn.

And, really, it was those two people that came to my office.  We were talking about Art, and we were all congratulating him because he did an incredible job over a lot of years with Ronald Reagan and beyond.  And when I said, "The Presidential Medal of Freedom," which is the highest civilian award you can get, he told me this little story about a certain hospital he was involved with where they did this.  And every hospital has had just incredible experience with it.  And I said, "Tell me more."  And then we got involved with Larry and Larry Kudlow also, by the way.  And we had a little group of four people that talked about it a lot.  And I think it's going to have a tremendous impact.

     And again, the statement was made: "This is bigger than healthcare."  And I think it will be.  I think it'll be more meaningful, in many ways.  You'll save so much money and you'll get the care that you want, and you'll choose the doctor you want, which was not possible despite the many pleas.  You know, "You can have your plan and you can have your doctor."  Well, they turned out to be untrue statements about Obamacare.

For decades, hospitals, insurance companies, lobbyists, and special interests have hidden prices from consumers so they could drive up costs for you.  And you had no idea what was happening.  You'd get bills that were unbelievable and you have no idea why.

For example, researchers found that for the same MRI at the same hospital, patients were charged anywhere from $248 to $2,500.  So, 10 times more, at the same hospital.  I assume that would be different doctors within the same hospital.  I don't know if the hospitals are going to like me too much anymore with this, but that's okay, right?  That's okay.  I think the doctors are going to, actually.

In the Boston area, the price of delivering a baby can cost anywhere from roughly $4,700 to nearly $16,000.  One survey found that within a single metro area, the highest negotiated price for a simple blood test was roughly 40 times more than the lowest price.  They were given exactly the same service -- in some cases, sent them to the same labs -- and were charged 40 times more money.

Under the new price transparency rule we are finalizing today -- and it will be all finalized -- it is finalized; it'll be put out today -- all of that will change.  Hospitals will soon be required to publish the price of everything from individual medical supplies to the total cost of common procedures.

Next, we will bring much-needed price transparency to insurance companies.  I'm sure they'll be thrilled.  This will allow you to see your out-of-pocket costs and other vital price information before you go in for treatment.  So you're going to know what it's going to be and you're going to be able to have lots of choices, both in terms of doctors, hospitals, and price.  And we're stopping American patients from just getting, pure and simple -- two words, very simple words: ripped off.  Because they've been ripped off for years.  For a lot of years. 

With us today is Melissa Ural who works for a company that benefits from price transparency.  And, Melissa, could you come up and say a few words?

MS. URAL:  Thank you, sir.

THE PRESIDENT:  Great.  Thank you, Melissa.  Thank you very much.

MS. URAL:  Thank you, Mr. President.  My name is Melissa Ural, and I am the vice president of human resources for HB Global.  We are an employee-owned mechanical contracting company.

Transparent pricing initiative aligns with our ownership model because it allows employees to get the care that they need at the cost that they want.

Currently, we are partnering with a broker to work and negotiate prices for surgeries and other procedures at local surgical centers.  This allows our employees to know what the procedure or what the cost will look like when they walk through the door.

This also allows our employees to get great care at a fraction of the cost, with the same quality and standard of care that they would have gotten, and they won't receive any surprise bills.

Right now, we have some price transparency behind the scenes, but with full price transparency up front, our employees can make the best decisions possible.

     We wouldn't expect our employees to go buy a car or a house without knowing the price up front.  Why should their healthcare be any different?

     I want to thank the President for bringing this important initiative to the front.  Thank you.

     THE PRESIDENT:  Thank you very much, Melissa.  (Applause.)

MS. URAL:  Thank you.

THE PRESIDENT:  Thank you.  Good job, Melissa.

     We're also joined by Kara Boeckel, who works for the same company and benefitted when her employer shopped for the best price on a surgery -- a surgery that she needed.  And I'd like to have Kara come up and please tell us about it.  Kara?  Please.

     MS. BOECKEL:  Thank you.

     THE PRESIDENT:  Thank you.

     MS. BOECKEL:  My name is Kara Boeckel and I work for HB Global, along with Melissa.  And in January of this year, I had surgery on my ankle.  I’m the sole provider of my two-year-old son, so this impact was huge for his and my day-to-day life.

     When I initially went to an orthopedic urgent care, I had no idea what I was going to pay, no idea what the costs were going to be.  I just know that I needed to get help.  I ended up with a bill for over $1,000.  This was an unexpected expense that my family now had to endure, and it had a huge impact on us.

     I would -- it was a huge stresser to know that I needed surgery and not know what the cost was going to be and how it was going to impact my life.

Thankfully, my company was able to work with a brokerage firm and shop around to know what prices were going to be beforehand.  With insurance, the claim my company would have paid was $19,500, and we wouldn’t have known that cost until afterwards.  By shopping around beforehand, we knew the claim was going to be $7,800, which is a 60 percent price difference.  And it was at zero cost to me.  I was even able to get the care out of the same facility that I was going to go to if I would have used my insurance.

I want to thank the President for making healthcare more transparent so that others in my situation don’t have to have these unexpected financial surprises and hardships.

THE PRESIDENT:  Thank you very much.

     MS. BOECKEL:  Thank you.  (Applause.)

     THE PRESIDENT:  Thank you very much, Kara.  Also with us is Dr. Rick Schultz, Chief Medical Officer at Texas Free Market Surgery.  Doctor, I’d like to have you come up and say a few words about what we’re doing and how we’re doing it.  Thank you, Dr. Rick.

     DR. SCHULTZ:  Thank you.  Well, thank you very much for having us here today.  This is a very exciting day.  I’d like to take a minute to talk about stewardship.

First, I’d like to thank Jesus for allowing me the opportunity and charging me with being a good steward of the opportunity and the abilities to practice orthopedic surgery in Texas for the last 20 years.

     I’d also like to thank the President for his leadership and stewardship in this effort and the fact that, since he’s been elected, he trusts Americans to be courageous and make smart decisions with their own money and their own healthcare.  And he knows that we’re smart enough to make good decisions now.

     This policy -- this transparency will be the fuel for healthcare innovation very similar to what we’re doing with Texas Free Market Surgery and Texas Medical Management.  Right now, every day, we take good care of patients at a very fair price, and it’s completely transparent.  This is not something in the future; this is something we’re doing today.  If you don’t believe me, just check out our website.

     Finally, I’d really like to challenge the Americans that this is a right that you’re getting back, to know the price of your healthcare.  This is going to be a fight.  This is very disruptive.  The people who are currently making a lot of money off of us are going to fight this tooth and nail.  If you aren’t ready to fight for this, then don’t complain when it gets taken away from you.

     Mr. President, thank you for stepping into the gap, taking the slings and arrows, and helping to get this going.

     THE PRESIDENT:  Thank you very much.  Thank you.

     DR. SCHULTZ:  Thank you.  (Applause.)

     THE PRESIDENT:  Thank you.  I think, if I could, I’d like to have Kevin Brady come up just for a second and talk about what we’ve done with the individual mandate and how that’s just a part of our -- a small part, but it’s a very big part in terms of healthcare; what we did with respect to our tax cuts and our reforms.  And you might want to discuss the individual mandate. Getting rid of it was such a big deal.  Thank you.

     REPRESENTATIVE BRADY:  So thank you -- thank you, Mr. President.  So, first, thank you for being the President who led on letting people keep more of what they earn so they can afford healthcare costs, utility costs, college costs, all of which has seemed to go up.

     Secondly, thank you for -- when we saw the failings of the Affordable Care Act, especially forcing average Texans, average Americans, into buying healthcare they couldn’t use and couldn’t afford, you stepped forward with Congress to eliminate, effectively, that mandate.  So -- which was another tax cut on the American people.

You’ve also created association health plans.  Because if you’re in a small business -- if you work for a small business or have one, you’ve been left behind under the Affordable Care Act.  Your plans that allow our small businesses to join together to afford healthcare the way the big companies do -- they’re cutting prices 30 and 40 percent, making healthcare affordable again.  Hugely helpful.

And then, today, as Art Laffer has pointed out -- and you too, Mr. President -- look, patients are confused.  Families don’t know what things cost.  You can’t shop around and don’t understand the price.  This, pulling back the curtain on healthcare prices, will help competition occur; give us, as families and patients, choices ahead of time; and will ultimately lower the healthcare costs.

     And I'll close with this: It's easy to have quality care or affordable care.  The goal is to have both.  Making these prices transparent allow our families and our businesses to have quality care and affordable at the same time.  This really is transformational.  Thank you, Mr. President.  (Applause.)

     THE PRESIDENT:  Thank you very much.  It all, sort of, fits in.  It's like a puzzle.  And I see my friend, Greg.  I can't believe you're going to be leaving Congress one of these days.  I was so disappointed to see that, but you're fantastic.  And we all work together with everybody -- all of us.

     Come on up here, the two of you.  I'd like you to discuss Right to Try a little bit.  And, I mean, you think about -- it's really a very important part of healthcare.


     THE PRESIDENT:  The ultimate part of healthcare.  And for 45 years, they've been trying to get it passed and they couldn't do it.  And Greg Walden, the three of us plus a lot, we've got it done. 


     THE PRESIDENT:  Congressman, thank you very much.

     REPRESENTATIVE WALDEN:  Hear, hear.  Thank you, Mr. President.

     THE PRESIDENT:  Go ahead.  Please.

     REPRESENTATIVE WALDEN:  Well, thank you, Mr. President.  We've never had a President lean further, farther forward on behalf of patients than President Donald Trump.  (Applause.)  And we finally got into law -- we finally got into law Right to Try.  Now you're going to get in place "Right to Know."  (Laughter.)  We should have the right to know what these things cost.

This is -- I was here with you when you talked about surprise medical billing.  And we are very close to legislating on that, Mr. President.  And that is a huge win for consumers.  This is a huge win for consumers.  You're doing the right thing.  And Dr. Mike Burgess, who was my Chairman of the Subcommittee on Health Care, now the top Republican on healthcare, has really been a leader in this effort as well, Mr. President.

And your team, working with the Secretaries and Seema and others, have been at the forefront of this.  And Americans are benefitting.  And the one thing I hear about is what Kevin Brady talked about: We want affordable care, we want innovation, but we have to be able to afford it.  And you can't know what things cost if they won't tell you.  And it's all hidden back behind the curtain.

     So, Mr. President, thanks for your leadership and your team's leadership.

     THE PRESIDENT:  Thank you.  Michael, say a few words, please.

     REPRESENTATIVE BURGESS:  Well, what I hear from constituents all the time -- I practiced medicine for 25 years -- they're concerned with the cost and complexity of healthcare.  This is a major step -- major step -- in delivering on that promise for patients.

     Look, there's another party in town that just wants to take away all your choices and give you one choice.  This President is trying to expand your choices.  That's a better choice.

     THE PRESIDENT:  Thank you, Michael.  (Applause.)


     THE PRESIDENT:  Thank you.  Thank you very much.

     So the actions that we're announcing today are only the latest steps in our campaign to deliver great healthcare for American patients.  Our efforts to reduce the price of prescription drugs -- and I don't know if you know that, but this is the first time, Secretary Azar, I think in 51 years, that prices have actually gone down --


     THE PRESIDENT:  -- for prescription drugs.  So, that's quite an achievement.

And if we had the help of the Democrats, which we don't -- it's a shame, because we could knock drug prices down so low.  We will be giving states the right to go to other countries to buy their drugs, because other countries -- because they don’t have these crazy, arcane rules that we could fix so quickly if we had the help of the Democrats.  But they want the price of drugs to say high, I suppose.

     But we brought it down the most in 51 years, and we're very proud of that.  But we can bring them down much more.  And one of the things I'm doing is, as an example, Canada will pay much less for drugs because they don't have to pay for research and development, so their pricing is much cheaper.  So we'll buy -- I'm working with Ron DeSantis in Florida and some other governors -- great governors.  And they're going to buy from other countries and skip all of the nonsense.  And I think, ultimately, what that's going to do is the drug companies will bring the price of their drugs down, or they'll buy from other countries.  That's okay, too.

     The same pill, made in the same factory, made by the same company, sells for 50, 60, and 70 percent less in one country than it does in another.  And we're always the high country.  So, I'm going to be giving governors the right, very shortly, to buy -- I've already given some the right -- to buy their -- their prescription drugs from other countries.  And we avoid -- we skirt a lot of -- a lot -- that probably sounds like a pretty good idea to you.  What do you think, huh?

     DR. LAFFER:  We love it.  (Laughter.)

     THE PRESIDENT:  You, as the great economist.  So, anyway.

     So, the actions that we're announcing today are the latest steps.  Our efforts to reduce the price of prescription drugs -- we're going to have some tremendous results.  We could do it so simply if we had any kind of help from the Democrats.  But they're doing so many other things, namely one: wasting a lot of time.  And very bad for our country, what they're doing.

And they should approve USMCA.  By the way, it's the greatest trade deal ever made.  (Applause.)  And they should stop playing games.  And, you know, Mexico signed it many months ago.  Canada keeps calling me: "When is this deal going to happen?  Is this deal going to happen?"  And it's sitting on Nancy Pelosi's desk for about three months, four months.  Nervous Nancy -- she needs a little nervous energy to get it done because all she has to do is put it up.  She's got plenty of Democrat votes.  A lot of Democrats are pushing her, but she doesn’t want to do it because she doesn’t want to have a victory for the American people.  And that’s all it is.  So either she does it or she doesn’t do it.

But Mexico wants to know what's happening.  Canada wants to know what's happening.  They could live without it.  Because it's a great deal for us.  They could live without it.  And they want to know what’s going on.

We eliminated the Obamacare individual mandate penalty, and we're expanding affordable alternatives which cost up to 60 percent less than Obamacare plans.  And it could be even quite a bit higher than that, in some cases.  And we will always protect patients with preexisting conditions, and, as I've been saying lately, and also patients with preexisting physicians.  (Laughter.)  I thought that was good.  I made it in one speech.  I said, "You know, people like that."  But it's true, because you didn’t have your doctor, you didn’t have your plan.  And now you have the plan and you have the doctor.  So, it's pretty good.
In everything we do, my administration is fighting for the rights of American consumers, the wellbeing of American patients, and the health of American people.  We're taking on the bureaucrats in more ways than one.  You probably notice that, right?  We're taking on a lot bureaucrats.  We're taking on the insurance companies, and we're taking on the special interests.

And that’s one of the difficulties I have in Washington because I've taken on a lot of the establishment.  And a lot of the politicians are taken care of by the establishment, and they don’t like that I take on the establishment.  But I'm taking it on for the consumer, for the American people.  And that’s why you see prices going down.  And you haven’t seen anything yet.  Things are going to happen that will be shocking.  But there are people in Washington -- as I say, there are people in the swamp that don’t like what I'm doing for that reason.

We will not rest until every American has access to the highest quality, most affordable healthcare anywhere in the world.

And, again, I want to thank you all.  And I'd like to ask Secretary Azar to come up and say a few words.  Thank you very much.  Thank you.  (Applause.)

SECRETARY AZAR:  Well, thank you very much, Mr. President.  And thank you for your leadership.  You asked us, as you said earlier, to deliver "A-plus" transparency in healthcare.  Well, right now, our system wouldn’t even get a passing grade on transparency.  Patients are at the mercy of a shadowy system with no control over their care.  But thanks to your leadership and your transparency executive order, we're changing that.

The changes you described, what we're doing at HHS, will be revolutionary to our healthcare system -- perhaps the biggest single change that President Trump has made to Americans' healthcare experience.  More than 70 percent of the most common hospital services are shoppable.  We're delivering American patients the information they need to make the right choices for themselves.

That’s crucial to the kind of system that we're building for American patients with affordable, personalized, patient-centric care that puts you in control and treats you like a human being and not like a number.

So thank you, Mr. President, for delivering American patients the affordability that you need, the options and control that you want, and the quality that you deserve.

A key leader in this work has been Administrator Verma, who will now say a few words.  Seema.  (Applause.)


First of all, I want to thank the President because people have been talking about price transparency forever.  We all know that what's been going on in the healthcare system has been wrong.  It's not fair that patients don’t know the cost of the services that they're going to get.  But only one man has been willing to stand up to special interests and do what's right for patients and put them back in control of their healthcare.  So, thank you, President Trump.

THE PRESIDENT:  Thank you very much.

ADMINISTRATOR VERMA:  Really appreciate it.

THE PRESIDENT:  Thank you very much.


THE PRESIDENT:  Thank you very much.  Thank you.  (Applause.)

So, after many, many years, we finally have transparency.  It's going into effect today.  It will have a tremendous impact.  It will, sort of, go in sections and stages, but it all begins today.  And within about 12 months, I think it'll be fully implemented -- and, we can even say, probably a shorter period of time than that.  Some of it's complex and some of it's very easy.  But it's all very good.  It's -- there's never been anything like this.

So the word is "transparency," and I love transparency in many ways.  And this is going to be something that’s going to be -- it's going to be incredible for the consumer, for the patient.  I think it’s going to be really good for the good doctors, maybe not so good for other doctors.  I think it’s going to be really good for the great hospitals, frankly.  And it's very exciting.

And it's something that again, Art, I want to thank you very much because you really did bring it to my attention and I appreciate it very much.  Thank you very much.

Yeah, please.

Q    Mr. President, what do you say to Democrats that say you were witness tampering this morning when you made that tweet (inaudible) Ambassador Yovanovitch?

THE PRESIDENT:  You don’t want to talk about transparency?

Q    Well, (inaudible).

THE PRESIDENT:  You know, I'll talk about transparency.  I like transparency here.  And I'm the most transparent President in history.

And I'll tell you about what tampering is.  Tampering is when a guy like Shifty Shift [sic] doesn’t let us have lawyers.  Tampering is when Schiff doesn’t let us have witnesses, doesn’t let us speak.  I've been watching today.  For the first time, I started watching and it's really sad when you see people not allowed to ask questions.  It's totally -- nobody has ever had such horrible due process.  There was no due process.  And I think it's --

Q    Republicans have been asking questions all day.

THE PRESIDENT:  -- I think it's considered a joke all over Washington and all over the world.  The Republicans are given no due process whatsoever.  We're not allowed to do anything.  It's a disgrace what's happening.  But you know what?  The American public understands it.  And that’s why the poll numbers are so good.  And that’s why other things are so good.  What they're doing in Washington with that hearing -- and, by the way, it's a political process.  It's not a legal process.

So if I have somebody saying, I'm allowed to speak up.  If somebody says about me, we're not allowed to have any kind of representation, we're not allowed to have almost anything.  And nobody has seen anything like it.  In the history of our country there has never been a disgrace like what’s going on right now.  So, you know what?  I -- I have the right to speak.  I have freedom of speech, just as other people do.  But they’ve taken away the Republicans’ rights.

And I watched today, as certain very talented people wanted to ask questions, and they weren’t even allowed to ask questions -- Republicans.  They weren’t allowed to ask questions.  It’s a very sad thing.

Go ahead.

Q    Why did you attack her?

Q    Sir, with your freedom, were you trying to intimidate Ambassador Yovanovitch?

THE PRESIDENT:  I just want to have a total -- I want freedom of speech.  That’s a political process.  The Republicans have been treated very badly.  And I watched a little bit of it today.  I wasn’t able to yesterday because we had the President of Turkey here, and I wasn’t able to watch much.  I watched some of it this morning.  I thought it was a disgrace.

When we have great Republican representatives -- people elected by the people -- and they’re not allowed to even ask a question, they’re not allowed to make a statement; we’re not allowed to have witnesses; we’re not allowed to have legal counsel, White House Counsel -- it’s a disgrace and it’s an embarrassment to our nation.

Q    Do you believe your tweets and your words can be intimidating, sir?

THE PRESIDENT:  Yes -- go ahead, please.

Q    Sir, do you believe your tweets and words --

THE PRESIDENT:  Quiet.  Quiet.

Q    -- can be intimidating, sir?

THE PRESIDENT:  Quiet.  Please.

Q    Sir, do you believe your tweets and words can be intimidating?

THE PRESIDENT:  I don’t think so at all.

Go ahead.

Q    Mr. President, do you think you’re going to get impeached?

THE PRESIDENT:  Well, I shouldn’t be.  In fact, I thought, last night, it ended.  Because last night, I was in Louisiana, where we’re going to hopefully elect a great governor -- a Republican governor.  And I was getting off the plane, and they handed me a statement that was just made by the Foreign Minister and President of the Ukraine.

And Ukraine -- they came out loud and clear that there was no linkage whatsoever, not even a little bit.  And you saw it.  You all saw it.  I said, “Oh, well, that ends the impeachment.”  And you people don’t even report it.

Look, the press is unbelievably dishonest.  That was a major statement put out last night by the Foreign Minister of Ukraine and also by the President of Ukraine, and you don’t even report it.  It’s a disgrace.  Because it’s sad.  There was absolutely no linkage.  We had a perfect conversation.

And I also, because of transparency -- whether it’s medical transparency or just transparency, generally -- I also put out, today, a statement.  And in the statement, we released -- and then Congressman Nunes read -- a call that I had with the President of Ukraine.  And it was a great call.  It was a very nice call.  Everybody said it was perfect.  I always say it was equally as good as the other call.

And I put it out today, and nobody even wants to report it.  Because it was so good, they don’t want to report it.

Look, if we had an honest press in this country, we would be so well served.  And you know what?  When I look at your approval numbers, they’re the worst they’ve ever been in the history of our country.  The media, the approval numbers -- they are horrible.  And you ought to get yourself back and you ought to put yourself back in a position where people respect the media again.

And I know some great journalists, I know some great people in the media, but there aren’t enough of them.  There’s a lot of dishonesty.  And many of you, I just consider members of the Democrats, and it’s a shame.

Okay.  Thank you all very much.  Thank you.  (Applause.)

END                                    2:47 P.M. EST


Office of the Press Secretary


“We believe the American people have a right to know the price of services before they go to visit the doctor.” – President Donald J. Trump


PROMOTING HONESTY AND TRANSPARENCY IN HEALTHCARE PRICES: President Donald J. Trump is taking bold action to give patients the information they need to find high-value care.

  • President Trump is announcing two historic rules to make healthcare prices more transparent than ever before.
  • The Department of Health and Human Services (HHS) is finalizing a rule that will require hospitals to make prices publicly available online  
    • Hospitals will display prices for shoppable services as a total package in an easy-to-read, consumer-friendly format.
  • The Trump Administration is also proposing a rule to require insurance companies and group health plans to provide cost estimates to enrollees in advance of care.
    • Additionally, we are proposing that these companies make a list of all of their pricing information available to the public.
  • Together, these two rules represent the most aggressive actions taken by any administration to put healthcare price information in the hands of patients.
IMPROVING TRANSPARENCY TO LOWER COSTS: Our healthcare system has long hidden the true cost of care, keeping critical information from patients and limiting competition.
  • For years, powerful interests have blocked patients from knowing the true price and quality of healthcare, denying them the information they need to make informed choices.
    • This lack of transparency has enriched industry giants at the expense of regular Americans.
  • Prices for the exact same healthcare services can vary significantly in the same area with little to no correlation to quality.
  • Armed with accurate information, patients can shop around for healthcare services and make the decision that is best for them.
  • By increasing price transparency and empowering patients we can help lower the cost of healthcare and drive competition.
  • Employers from around the country have already utilized priced transparency tools to reduce costs for their employees.
PUTTING AMERICAN PATIENTS FIRST: President Trump is working to protect the vulnerable, improve affordability, provide more options, and increase quality in American healthcare.
  • The President signed an executive order to protect and improve Medicare for American seniors.
  • The Trump Administration has taken aggressive action to drive down prescription drug prices and increase the availability of lower priced generics.
    • These efforts have contributed to the largest decrease in prescription drug costs in nearly half a century.
  • The President has empowered consumers by working to expand affordable options like Health Reimbursement Arrangements, short-term plans, and Association Health Plans.
  • The President is working to improve healthcare for Americans struggling with conditions like HIV/AIDS, kidney disease, pediatric cancer, Alzheimer’s, and more.


Office of the Press Secretary


Via Teleconference

9:03 A.M. EST

     MR. DEERE:  Thank you, Operator.  Good morning, everyone.  And thanks for joining today's briefing call on new actions the President will take to increase healthcare price transparency later this afternoon.

     You will be hearing from, today, White House Domestic Policy Council Director Joe Grogan, as well as HHS Secretary Alex Azar, and CMS Administrator Seema Verma.  All of them are on the record, including their opening remarks as well as Q&A when we get (inaudible).  Anyone else you will hear from in the Q&A portion will be subject-matter experts on background as administration officials.

     The contents of the call are embargoed until its conclusion.  With that, I will turn it over to our Domestic Policy Council Director, Joe Grogan.

     MR. GROGAN:  Thanks, Judd.  Today, the Trump administration is announcing groundbreaking action on healthcare transparency pricing.  At 2:00 p.m., the President will be announcing two rules, one final and one proposed, to give the American people more insight into the prices that they are being charged for healthcare procedures, the result of an executive order signed June 24th.

     Before we get into the details, I want to let you know how we got here with this President.  President Trump is consistently non-ideological in confronting difficult problems and directing his team to make sure that the American people are not getting taken advantage of.  While the last administration had a singular focus on the Affordable Care Act, this administration has a much wider aperture in confronting healthcare problems, many of which have been ignored by both Republican and Democrat administrations for decades.

     We are focused on protecting the most vulnerable, including those with preexisting conditions, protecting and improving Medicare, modernizing this program for the 60 million seniors and Americans with disabilities who are so dependent on the program.  And we're fighting to make healthcare more affordable, and we have lowered drug prices for the first time in 50 years, according to the consumer price index.

     We're increasing choices and control for patients' own healthcare decisions, and putting the patient at the center of every decision of every policy choice that we make.  The President has confronted numerous problems that are difficult and many administrations would have avoided tackling.  The opioid crisis has seen us devote tremendous amount of resources in dollars and bandwidth and personnel to drive opioid morbidity rates down.  We’re improving treatments for those with severe mental illness.

     And recently, Administrator Verma approved the first IMD waiver for those with severe mental illness in the Medicaid program in Washington, D.C.

     We’re advancing kidney health and improving that program for the first time since the Nixon administration.  The President has targeted eliminating HIV transmissions over 10 years, finding cures for pediatric cancer, modernizing flu vaccine development, amending Stark and anti-kickback rules to allow for value-based care and creative contracting.  And soon, in the next few months, we’ll be talking -- we’ll be unveiling and finalizing the interoperability rule for electronic health records, which has stymied the ability to share information among doctors.

     This President is willing to be disruptive if it means doing the right thing for the American people.  And make no mistake about it: This rule today will irritate many vested interests in Washington, D.C. who constantly lobby for more opacity in the healthcare system.

     What he’s doing today on transparency is a perfect example of his willingness to tackle tough problems.  What is more clear and more sensible than saying a patient should be able to know what their care is going to cost before they go to the doctor?

     The President is not going to be dissuaded by the special interests who will try and fight this.  And he’ll be announcing this action at 2:00 p.m. today.

     The President wants to give Americans more information and more control over their healthcare decisions, improve the ability of patients to identify high-value care, and force providers to compete on price as well as quality.

     In the long run, this will improve healthcare and make it much more affordable.

     With that, I’ll turn it over to Secretary Azar.

     SECRETARY AZAR:  Great.  Thank you, Joe.  And good morning, everyone.  Thank you for joining us on this call today.  As Joe just mentioned, President Trump has a huge range of healthcare accomplishments, and we’re announcing new ways to improve the American people’s healthcare and their health just about every single week.

     But our price transparency announcement may be a more significant improvement to American healthcare markets than any other single thing the Trump administration has done, and perhaps the most transformative shift toward patient control in healthcare that any President has ever enacted.

     The President has made four healthcare promises: protecting vulnerable patients like those with preexisting conditions, and delivering the affordability you need, the options and control you want, and the quality you deserve.  There’s only one way to deliver all of those outcomes at once, and that’s to drive better value from our system.

     Driving toward value-based care has been a bipartisan priority for some time, but too often these efforts have left the patients out of the picture.  American patients have been at the mercy of a shadowy system with little access to the information they need to make decisions about their own care.

     From the beginning of President Trump’s term and my tenure as Secretary, we have been clear: This shadowy system has to change; the patient has to be in control.  That requires giving the patient the right to know what they’re going to owe for a healthcare service before they ever get it.

     The vast majority of patients don’t have easy access to this information today, but when they do, we see prices drop.  In one study, when prices for imaging were made transparent, prices dropped almost 20 percent, while price disparities across providers also narrowed.

     We know that 70 percent of the most common hospital services already are shoppable.  We also know that in markets, it often takes only a minority of customers to be especially price-conscience consumers in order to drive price competition.

     Shedding light on price information is absolutely vital not just to delivering better care at a lower price, but also to building the healthcare system the President has envisioned -- a system that's not only affordable, but also personalized, patient-centered, puts you in control, and treats you like a person, not a number.
     That’s a stark contrast to the system we have today, which keeps patients in the dark about cost and quality information.

     According to one poll, 93 percent of us have found ourselves surprised by a healthcare bill in 2018.  Two-thirds of healthcare providers cite price transparency as a “limited or non-existent priority” within their organization.

     If you’ve ever tried to find out the price of a healthcare service and what you’re going to owe for it out of pocket, you will not be surprised by those findings.  I am the Health Secretary and I have found myself unable to get this information when I or a family member need care.

     We know this information matters to patients.  One poll found that almost two-thirds of patients now rate cost as “important or extremely important” when considering whether to follow a doctor’s recommendation.

     President Trump has heard how frustrating it can be for patients to be kept in the dark about how much their healthcare is going to cost.  The President has promised A-plus healthcare transparency.  Right now, our system is not delivering the information patients need.  President Trump is going to change that in what will be a transformative shift toward patient control of our healthcare system.

     First, HHS, the Department of Labor, and the Department of the Treasury are proposing today to require that your insurer provide you with real-time access via an online tool to cost-sharing information, an estimate of what you would owe for all covered healthcare items and services.  This is information patients typically receive after they actually get those services through an explanation of benefits.

     We’re also proposing to require that insurers’ negotiated rates for in-network services and their historically paid amounts for out-of-network services be made publicly available to consumers, employers, researchers, and app developers.

     Researchers and entrepreneurs would be able to use this data to deliver comprehensive information to consumers about cost information for the care they need.

     When I first identified transparency as a key part of value-based transformation, I said, "You should have the right to know what a healthcare service is going to cost and what it's going to cost you out of pocket."  That's what our proposed insurer rule will do.

     Second, we're finalizing a rule to require that, starting January 2021, hospitals will have to disclose publicly their negotiated rates for services as well as the discounted cash price they're willing to pay.  For the most common shoppable procedures, this information will have to be available in an easily accessible, patient-friendly format.  For all procedures, this information will have to be posted online in a machine-readable format so that it can be incorporated into third-party tools, such as smartphone apps.

     The top priority is making this information as accessible and usable for patients as possible.  Hospitals will have to place the price information for common procedures in a prominent place online, in plain language, in a searchable format.  A procedure's price will have to be grouped with the charges for any ancillary services the hospital customarily provides with that service.

     Our two announcements today are historic changes to the power of American patients to take control of their care and get better value in healthcare.  But there are more steps to come.  We're also working to put patients in control of their own health data through interoperable health IT, as Joe mentioned, to provide more usable, quality information and to reform payments so we're paying for outcomes rather than procedures.

     Putting all these efforts together, President Trump is delivering a new era of transparent, affordable healthcare with the American patient in control.
     CMS, our Centers for Medicare and Medicaid Services, has been pursuing every avenue we have to put patients in control.  So I'd now like to hand things over to Administrator Verma to explain more details on these two rules and also how they fit into all of CMS's comprehensive work on transparency.

     Administrator Verma?

     ADMINISTRATOR VERMA:  Thank you.  Well, first, I want to extend my gratitude to President Trump for leading with a bold vision to create a more competitive market and return patients to their rightful place at the center of American healthcare.
     The President's executive order on price and quality transparency is transformative, and I deeply appreciate the President's personal commitment to this issue.

     Our goal is straightforward: Patients need to have the right information at the right time and at the right place.  The healthcare system has a duty to ensure patients know the cost of their care before they receive it.

     Today's healthcare paradigm has too often catered to the demands of powerful special interests that profit from the status quo of hidden pricing.  Some will complain that price information is proprietary to their business, but I will remind everyone that this information is already available to patients in their explanation of benefits.  We are simply requiring that it be made available before they get their care, instead of after.
     As healthcare costs skyrocket, we stand in desperate need of the sort of system-wide downward pressure on costs that can only come from empowering patients with access to price-transparent options.

     The rules that we are announcing today represent the realization of that long-held objective.  As you know, we delay the final rule impacting hospitals because it was important to see how these complementary rules -- one applying to hospitals, the other to insurers -- work together.

     As I will explain, the hospital rule allows virtually every patient who receives care at the hospital, whether insured or uninsured, to know the price up front.  But we heard that insured consumers, not just those who are treated at a hospital, also need to know their potential out-of-pocket costs.  So our proposed rule, in turn, builds on that by requiring insurers to be transparent on out-of-pocket costs.

     Taken together, virtually all Americans will feel the benefits because now, whether you're insured or not, whether you're at the hospital or just planning a routine checkup, all the information you need to know about the hit to your pocketbook will be only a few clicks away.
     As you know, starting this year, CMS required hospitals to post all of their charge information online.  In keeping with the President's executive order, the rule finalized today makes that information more (inaudible) patients.

     Starting in 2021, hospitals across the country will be required to post publicly their standard charges for all hospital items and services, which include gross charges, the negotiated rates that insurers actually pay for services, the minimum and maximum negotiated charges, and the discounted cash price the hospital is willing to accept directly from a patient.

These prices must be posted online, in a single machine-readable file that also includes information such as common billing or accounting codes used by the hospital and a description of the item or service so that the public can make apples-to-apples comparisons.

     Consumers will particularly benefit from the second requirement we are finalizing.  Hospitals must share price information for at least 300 common shoppable services, which are services that can be scheduled in advance, including more complex bundled ones like joint replacements.  This will allow patients to go online and search the name of a service like "MRI" or "C-section delivery" and see how much it will cost.
     We heard concerns expressed by the hospital community about the tighter timeframe under the proposed rule and are responding by moving the effective date to January 1, 2021.  We want hospitals to have the time they need to deliver the high-quality, consumer-friendly product patients deserve.
     In short, under this rule, anyone walking into a hospital will be able to know the price up front.  But as I've mentioned, this doesn't tell someone how much they should expect to pay out of their own pocket.  And that's where the Transparency in Coverage proposed rule comes in.  The proposal would require that group health plans and issuers operating in the individual and group markets make available to patients a tool that offers a personalized, out-of-pocket cost estimate for all healthcare items and services so patients can know the price to expect and plan accordingly based on their insurance plan and where they are in their deductible.
     Additionally, plans and issuers would have to make public a regularly updated data file that provides allowed amounts and negotiated rates between payers and providers for all those covered items and services.

     Price transparency would be extended to every healthcare item and service that is covered by a health plan.  We recognize that the data made available under the final and proposed rules issued today is a large set for consumers.  Unleashing this data will unleash innovation.  Employers, researchers, and developers can use this information to develop tools that will drive down costs and improve quality.

     And, finally, we are proposing to enable health plans to incentivize consumers to use this data to shop for low-cost, high-quality healthcare.

     Ultimately, it's no secret that the foremost issue facing our healthcare system is cost.  Anti-competitive policies that concentrate control over the system with the big players -- whether it be powerful private interests or Washington, D.C. itself -- have already failed.  Doubling down will only make it worse.

     This administration is reversing course.  Instead of concentrating control, these rules disperse it to the people who should have had it all along: patients.  Unlike the many failed big-government experiments of the past and the ones looming on the horizon, these transformational price transparency rules get at the root of the problem of cost.  They empower consumers to seek higher value at more affordable prices.  The long-overdue result will be a vigorous, vibrant market that improves healthcare for all Americans.

     And before opening up for questions, I want to be sure to thank all of my CMS staff, our partner agencies, the White House team, the Departments of Labor and Treasury, and everyone who contributed for all the incredible work they did to make these rules a reality.

     MR. DEERE:  Thank you, Administrator.  Operator, we will now begin the Q&A portion.

     Q    Good morning.  This is Toby Capion calling from EWTN.  It seems like most of the savings from prescription drugs come from generics, which were already relatively cheap.  What are you doing to bring down the price of the brand-name drugs?

     MR. GROGAN:  This is Joe.  I think it's important to -- two points are important on that, and then if the Secretary wants to say something.

     One, it is a management achievement to have cleared out the generic backlog that existed at FDA.  And that's a testament to the Secretary's leadership and the leadership at FDA to get more competition into the drug market.  That is not to be minimized.  This is an administration that believes in choice and competition.

     The other important point is, the President's megaphone and focus on drug pricing has interjected more vigorous negotiations into the private chain.  And we've heard this from both payers and drug companies how much more difficult the price negotiations are.  And that is driving down prices as well.

     But we can get back to the subject of the call, on transparency.

     Q    Hi.  It's John Tozzi from Bloomberg News.  Thanks so much for taking the question.  Do you have an estimate or some kind of model that shows how much prices or how much total healthcare spending you project will decline once these transparency reforms are in place?

     SECRETARY AZAR:  We don't have that modeling of impact because, of course, we've never experienced this level of transparency that's being either implemented with regard to the hospital prices or proposed with regard to insurance disclosure across the whole healthcare system.

     We have examples, of course, such as the case I mentioned in my opening remarks out of New Hampshire, when transparent information around, say, MRI procedures was made available on prices and you saw a 20 percent price decrease and price compression among various providers reducing disparities.

     So that would certainly be, directionally, an example.

     ADMINISTRATOR VERMA:  (Inaudible), also the state of Kentucky, their public employee benefit program, they have price transparency, and their shared savings show that it saves state taxpayers about $13 million since they created that in 2015.  And almost $2 million in cash benefits have been shared with the state employees because of their transparency efforts.

     Q    Hi, this is Chelsea Cirruzzo from Inside Health Policy.  Thank you so much for having this call.  My question is: In comments on the proposed hospital price transparency rules, hospitals said CMS lacks the authority to implement the rule.  Are you expecting any litigation?

     SECRETARY AZAR:  We may face litigation, but we feel we’re on a very sound legal footing for what we’re asking.  And we certainly hope that America’s hospitals will want to respect their patients’ right to know what the price of the service is before they’re asked to purchase it.  I would certainly hate to see the hospitals take a play out of big pharma’s playbook and oppose transparent pricing information for the American patient.

     Q    Thank you.  This is Susannah Luthi with Politico.  My question has to do -- obviously, there is surprise billing legislation kind of stalling in Congress.  Do you see that these transparency rules -- especially like the cash price being required to be posted by the hospitals -- do you see that as eliminating the need for surprise billing legislation?

     And then, second part of the question, which part of ERISA law are you using to kind of secure the insurance rules against legal challenge?  Thank you.

     MR. GROGAN:  This is Joe.  On the first point on surprise billing: We don’t agree with the assessment that it's stalled.  We’ve actually been in very fruitful discussions with both the House and the Senate this week on surprise billing.

     And I think it is a great example of why we need to move in this space.  It’s outrageous that somebody would be going into an emergency room thinking they're covered, expecting some predictability in their price, and then they get walloped with a huge bill because somebody was out of network and they had no ability to bargain when they had to go into an emergency room and couldn’t sit there and try and figure out who’s in network and out of network.

     So, surprise billing is a great example of something that needs to be confronted, and this administration has been leaning in.

     This is a complement to our efforts in that area, and I think it’s important to realize that we are going to be pushing on transparency in all facets of healthcare.  There will be more -- whether it’s in the drug pricing chain, in some of the stuff that we’re working on, on the Hill, on the drug pricing legislation to improve transparency there, and other things that we’ll be doing in various roles.  But transparency is not a one and done for us.  It’s a charge in all the things that we’re pursuing.

     ADMINISTRATOR VERMA:  And also, speaking to the legal authority, we’re relying on Public Health Services Act 2715(a), not ERISA.

     Q    Hi.  Thanks.  This is Julie Appleby at Kaiser Health News.  So you mentioned that hospitals, starting in 2021, need to post all these different prices, including the gross charges, the negotiated charges, et cetera, et cetera.  Will those be -- how often will those be updated?  How current will they be, I guess, is my question.

     And then the second part of that question is: The industries have argued that this type of transparency may actually lead to higher prices in some cases, and I wondered if you would address that as well.

     So again, the questions are: How current will these numbers be?  And then, how do you address the concern from the industry that will actually cause prices to go up, in some cases?

     SECRETARY AZAR:  So the hospitals will need to update their information at least annually.  But, of course, they can do so more frequently, especially if they decide to move towards competing on price with each other for patient access.
     In terms of this argument that somehow disclosing prices leads to higher prices, this is a canard.  Point me to one sector of the American economy where having price information in a competitive marketplace actually leads to higher prices as opposed to lower prices.  When you have opaque pricing, when you have backdoor rebates and discounts, that’s what leads to higher list prices.  That’s, for instance, the example we see in the drug industry with their pricing practices.

     When we have transparent pricing information, we actually enable a marketplace.  We empower patients as consumers.  We create shopping, and prices go down.  Every example points to prices doing down in these instances.

     And this information -- you know, right now, this information is available.  This is important for everyone to realize: This is not secret information.  It is available.  This information is provided every time you go to the hospital and you get an explanation of benefits 30 days later in your mailbox.  It shows you the list price, the negotiated discount under your health plan, and what you would owe out of pocket.

     There actually are vendors who collect that information to provide competitive market intel among hospitals and insurance companies.  The only people who don’t know what the negotiated rates are and what they will owe out of pocket is the patient in our system.  And that’s what President Trump is working to deliver today.

     Q    Hi, this is Bertha Coombs from CNBC.  I’m just wondering whether you all have a cost estimate as to how much it will cost for hospitals and insurers to do this kind of overhaul for this.

     ADMINISTRATOR VERMA:  Yes, there is, in our rule, a regulatory impact analysis.  It’s a very tiny, you know, percentage of their overall revenue -- less than 1 percent.

     And I also will add that there are many hospitals out there and insurance companies that are already providing this type of price information.  They’ve already done it voluntarily.  And the impact analysis shows this is a very tiny list for hospitals.

     Q    Hi.  Thanks for taking my question.  This is Robert King with Fierce Healthcare.  I wanted to piggyback on that last question a little bit.  Is there going to be any consideration or exemptions for rural and smaller facilities, which might have a harder time complying with this rule compared to larger systems?

     ADMINISTRATOR VERMA:  So we did the regulatory impact analysis and we did look at the impact on rural areas as well.  And it was literally 0.03 percent of their revenues.  So it’s, again, a very, very tiny impact and effort required.

     I will also add that the administration has been very focused on regulatory burden at large.  Our Patients over Paperwork initiative has saved the healthcare system almost $8 billion, and so we are very conscious of this and did an extensive analysis, and the data show that this is a very tiny impact.

     Q    Hi, thank you for holding this call.  Two questions. One is: Will these estimates be in any way binding?  Because there have been complaints from people that they get an estimate -- you know, if they're having an elective procedure, they get an estimate from the hospital and sometimes open their -- I guess they get it from the hospital -- and sometimes what they actually get charged is wildly different, even though they didn’t have any consultations or any additional procedures done.

     And second of all, will this estimate for people who have co-insurance rather than co-pays, will the insurers be required to base these estimates specifically per hospital or per facility?  Because if you're trying to have consumers shop around, they need not only to be personalized to them, but personalized to the facility.

     ADMINISTRATOR VERMA:  So the rules work together in that, on that on the hospital side, they’re posting their standard charges in a variety of different ways, as we specified in the rule.  And then, the rule that applies to insurance companies is personalized for that person depending on their plan, depending on where they are with the deductible.  These are not binding, but they are required to be the best estimates, given the appropriate information at that time.

     Q  Hi, this is Samantha Liss with Healthcare Dive.  I just had a question.  For the insurers that are going to have to disclose publicly the negotiated rates, is that for every service or -- because I know for hospitals, it's the 300 shoppable services.  So I was just trying compare the two.  What will the insurers have to provide?

     SECRETARY AZAR:  Yes.  So, actually, just to correct on that: For both hospitals and insurance companies, it would be all services.  For hospitals, it would be the three hun- -- they also -- so there's a single data file with all services, negotiated prices, et cetera, that needs to be provided.  But in addition, for the 300 most shoppable services, those need to be provided in a consumer-acceptable format, not just in a single machine-readable data file.

     And the same with insurance companies -- that there needs to be disclosure of all their rates and negotiated information available so that consumers, data analytics, app developers, et cetera, have access, but also that they provide their information in a consumer-accessible format, as the Administrator was just discussing, for the patient to be able to go in an Internet-based approach to find out what a service -- the estimate of what a service should cost, what it should cost them in terms of where they are in their deductible period during the year, and depending on which facility your providers are going to.

     ADMINISTRATOR VERMA:  And the other thing I would just build on that is that, on the hospital side, all of these charges and services are going to be organized by CPT code.  And we recognize that not every consumer will know the CPT code, which is why we also have that separate list, which is shoppable services, so people can just put in the item -- like an MRI or a C-section, or you know, hip replacement surgery -- things like that, that are more, I would say, consumer-friendly terms.

     So that’s why we divided it in both.  I will also add that the list does include pharmacy services as well.

     Q    Hi, this is Shannon Firth from Medpage Today.  Can you talk a little bit about what new responsibilities, if any, doctors will have specifically while you're -- when hospitals are providing these services?  What duty will they have to explain all this to their patients?

     And also, can you explain -- I think someone mentioned that employers might be incentivized -- or employees might be incentivized by their employers after this information has disclosed to -- in a way that would drive down prices.  Can you expand on that piece of the rule?  Thank you.

     ADMINISTRATOR VERMA:  So to the first question, this administration wants doctors to be able to spend as much time with patients as possible, and their time shouldn’t be spent at a computer screen, but face to face with their patients.  So this does not impact doctors directly.

     For those hospitals that have employed physicians, those services would be required.  That information, in terms of the services that the doctor is providing, will be required to be posted online.  But this doesn’t impact doctors in any way.  So, I think that was the first question that you had.

     The other piece that we talked about in terms of the incentives is that we're allowing health plans to create the types of plans that would create incentives for people to (inaudible) this information.  So, for example, they could have a plan that says if you seek out the lowest-cost provider -- the high-quality, low-cost provider -- they could potentially reduce co-pays.  And as part of that reduction, they could include those costs in their medical loss ratio calculation.

     So I think one of the things that we said is we want to make sure people have the right -- you know, the information at the right place, at the right time.  But we also recognize that we want to give them incentives to use this type of information to make the best decisions that work best for them and to allow the insurance companies to actually create those incentives.

     MR. DEERE:  Thank you, Administrator.  Operator, with that, we will conclude today's call.

     Just a reminder to all those listening that it was all on the record, including the opening remarks, as well as the question-and-answer portion.  I do want to thank Secretary Azar, Administrator Verma, and Director Grogan for participating today.  And the information is embargoed until this conclusion.  So, thank you very much.

                                                      END                 9:38 A.M. EST