BACKGROUND PRESS CALL BY SENIOR ADMINISTRATION OFFICIALS ON THE PRESIDENT'S PRINCIPLES TO ADDRESS THE PROBLEM OF SURPRISE BILLING IN HEALTHCARE

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019

BACKGROUND PRESS CALL BY SENIOR ADMINISTRATION OFFICIALS ON THE PRESIDENT'S PRINCIPLES TO ADDRESS THE PROBLEM OF SURPRISE BILLING IN HEALTHCARE Via Teleconference   11:05 A.M. EDT      MR. DEERE:  Thank you, Operator.  And good morning, everyone.  Thank you for joining us for today's call on the President's principles to address the problem of surprise billing in healthcare.      Before we get started, the call is embargoed until the top of the President's remarks, which are currently scheduled for 11:45.  But again, everything on the call is embargoed until he begins those remarks.      You'll be hearing today from our Director of the Domestic Policy Council, Joe Grogan, as well as [senior administration official].  Joe's remarks are on the record.  And then, when we go to Q&A at the conclusion of his remarks, that will be on background attributable to senior administration officials.      With that, I will turn it over to our Director of the Domestic Policy Council, Joe Grogan.      MR. GROGAN:  Thanks.  The President had a roundtable discussion here in the White House at the end of January in which he met with patients -- American citizens -- who had struggled with the issue of surprise billing.  There were a number of stories recounted to the President about outrageous billing practices for people confronted with bills that they had not consented to take on themselves.      The President, coming out of that meeting, directed his staff to work closely to figure out what, administratively and legislatively, could be done to increase transparency in the medical system and address, specifically, surprise billing.          We are continuing to work on our transparency efforts.  And we've done some things at CMS, like post hospital rates, and we will be doing more over the coming months on transparency. But today we are unveiling principles that will be sent to the Hill for a legislative package that we hope will be bipartisan, House and Senate, to address the problem of surprise medical billing.      Specifically, this occurs in two instances.  One is somebody is taken to the emergency room; they are not able to consent because obviously it's an emergency, so they don’t get to choose what emergency room they go to.  They're not able to choose the contractual relationship that they're going to enter into with a physician.  And after the fact, they can get surprised with a bill when they discover that they are being charged an out-of-network rate for this service.      So we want to get at that problem and make sure that these payments are -- while they need to be negotiated between providers and private insurance, the patients would be responsible for the co-insurance or co-payment that would've been applied had it been in network.  So they're not surprised because it's not their failure that the hospital is not in network.      The other situation is elective surgery, where you go in for surgery, you're under the impression everything is in network, you choose the hospital and the practice group that you're going with, based upon the fact that it's in network, and then another physician is brought in -- oftentimes an anesthesiologist or a radiologist -- and you get an out-of-network bill.  We are hoping to address that problem as well, where you wouldn’t get an out-of-network bill absent specific consent to that.  You would have to -- your portion would be limited to fees associated with in-network charges.      The other thing to keep in mind is that we want to make sure that federal expenditures should not increase when Congress does its work here.  We think that we can get at this problem without throwing additional taxpayer dollars into the problem.  And we also want to make sure that out-of-network providers cannot separately bill patients.  So if you go to the hospital, you're in network, you pay the hospital bill, and then suddenly, weeks later, sometimes months later, you get an out-of-network bill from somebody, and we want to prohibit that practice.  It should all be reflected in the one bill at the service where it was provided and not have an out-of-network provider seek to chase a patient down for that fee.      We are focused on this problem because some of the data here is pretty alarming, although the anecdotes are perhaps even more so.  Most people here on the White House staff and at HHS can recount stories from their personal lives or those of a family member.  We've had conversations with members of Congress that have dealt with surprise billing with no explanation as to why these bills are so big, and an intense amount of work to track down the source of these large bills.      Some research shows that 14 percent of out-patient emergency room visits, 20 percent of hospital admissions through the emergency room, and 9 percent of elective in-patient admissions generate surprise medical bills.      Also, it's important to understand that this problem could be localized or most egregious in a small number of providers.  Fifteen percent of hospitals have more than 80 percent of emergency department visits producing out-of-network bills.  So the data would seem to indicate that there are a small number of facilities that are taking advantage of this situation and taking advantage of patients, and not protecting the economic wellbeing of their patients.      And the last thing I'll say before we open it up to questions is this is an indication that the administration continues to work hard on healthcare issues that are important to the American people.  There are a number of things that we are addressing in Medicare, Medicaid -- the exchanges, rules, transparency.  There's a ton of work going on, and this proves that we can walk and chew gum at the same time, and we're not ignoring big problems that affect people and frustrate people that have lingered for too long. Q    Hi, this is Andrew Feinberg with Breakfast Media.  Thanks for doing this call.  Can you clarify something about what you're going to do to solve this problem with out-of-network billing for ER admissions and elective surgeries?  Are you going to mandate that hospitals or providers contract with all insurance companies?  And how are you going to do this?  Do you have any details to give?      SENIOR ADMINISTRATION OFFICIAL:  Yeah.  So for the emergency services, the principle is that patients cannot receive balance bills.  So the -- and this is just for out-of-network emergency services -- so that the co-payments, the cost sharing that the patient is responsible for, would be the same for an out-of-network emergency service as for an in-network emergency service.  The overall payments would be determined with negotiation between the provider and the private insurer.      Q    Yeah.  This is Alex Ruoff with Bloomberg Government.  I was wondering if you could just go over what other principles you'll be sending to the White House.  In particular, I think you just mentioned banning balance billing for emergency services.  Can you go over the full list here?  Like what exactly are the demands you're going to make of -- or, you know, the principles you want to see in a surprise billing, you know, bill?      SENIOR ADMINISTRATION OFFICIAL:  So we went through -- we just went through the ones for emergency services. For scheduled care, we think that much of this problem can be solved by upfront information.  So when you go to a scheduled care at a facility, they need to tell you, for reasonably expected services, if there's going to be care that's out of network.  They need to provide you with an estimate with the out-of-pocket costs.  They should provide you a written estimate in advance of the service.  And there should be no separate bills from out-of-network providers absent advance informed consent.  We want to take the surprise out of the care that people receive when they go to in-network facilities.      Q    Hi, this Ariel Cohen from Inside Health Policy.  Thanks for doing the call.  A lot of these principles that you mentioned have been discussed by senators on the Hill, House members, but a lot of it has been held up by disputes from insurers and providers.  And that's been holding up a lot of the legislation.      What exactly will you be directing members of Congress to do to sort of get around this in-fighting that's happening right now?      SENIOR ADMINISTRATION OFFICIAL:  I think you just hit on a lot of the problem.  Providers point figures at payers.  Payers point fingers at providers.  And the American people are left really getting the shaft.  So it's a cruel and indifferent process, and it needs to change.  So the President is going to put a bold call that we need to take legislative action along the lines that were outlined at the top of this call.      SENIOR ADMINISTRATION OFFICIAL:  And we definitely think that the time is right for presidential leadership here, and that with it, we'll get momentum.      We have had similar conversations that jived with what you just said, members saying, "Listen, we want to address this, but there are special interests that are prohibiting us from -- some members from getting behind it.  And we need the White House's help."  We've worked with staff and with members, and we think it's time for the President to (inaudible).      Q    Hi.  Thank you.  This is Susannah Luthi with Modern Healthcare.  Just getting back to the mechanism that you're discussing to ban balance billing, will it be something like addressing contract reform between providers and insurers?  Or are you not getting that specific?          SENIOR ADMINISTRATION OFFICIAL:  I mean, I think contracting reform is certainly part of it, right?  We don't think that there should be separate bills from out-of-network providers unless the patient has given their consent.  So if they're choosing an in-network facility, they should know exactly what they're going to be charged before they receive that service.      So, yeah, I mean, I think there's part of it here where there's got to be contracting reform between hospitals and the doctors that provide care in those hospitals.      SENIOR ADMINISTRATION OFFICIAL:  But we do want to see Congress step forward and provide more details underneath our principles.  And it will be an iterative process back and forth between us and Congress as they take steps forward in response to the President's call for action.      Q    Hi.  This is Rachel Roubein with Politico.  I was curious: So, you mentioned that overall payments would be determined with negotiations between the provider and the insurer.  So I wanted to clarify if you were talking about an arbitration process similar to what some other states like New York have done.          SENIOR ADMINISTRATION OFFICIAL:  So I don't think that's necessarily the way this needs to go.  There are a number of different models that have been tried in states, as you've noted.  And we're not specifically endorsing arbitration in this approach.      Q    Hey.  Thank you.  This is Jon Healey with the LA Times.  Appreciate you doing the call.  Just to be clear, I take it you're not including in the proposal any requirement for ensuring network adequacy?  There's going to be no guarantee that somebody have access to an in-network anesthesiologist or whatever when they go to an in-network facility?  And also, just on top of that, how do you feel about (inaudible) of the state laws that already exist on this issue?          SENIOR ADMINISTRATION OFFICIAL:  Well, as we said a little bit earlier, the important thing here is the President stepping forward and calling for action.  Congress needs to react to that call and move forward.      I'm not going to necessarily negotiate through this call and through the press with Congress here this morning.  We want to see them take action.  There are a lot of Americans, lots of families, who need Congress to step forward and actually react and serve to respond to significant challenges that families and individual Americans face when these surprise bills pop forward.      And so we're hopeful that Congress will actually react to the President here.  We expect Congress to react to the President here.  And then we will work with Congress on the details so, at the end, we can deliver a bipartisan, bicameral reaction that ensures that patients and Americans are protected from surprise medical billing.      Q    Thank you for holding this call.  This is Tami Luhby with CNN.  My question is, you know, Congress has been looking at this.  So, under what authority or effort do you think either the President or lawmakers can do to actually, you know, bridge the gap between -- or bridge the differences between all of the players here?          SENIOR ADMINISTRATION OFFICIAL:  Well, listen, I mean, anytime you have a legislative effort -- and certainly in healthcare is no exception, or perhaps the best example: there has to be tradeoffs.  The key thing here is that people have thrown up their hands for far too long and said, "Nothing can be done about this."      We have had very fruitful conversations with members and staff.  There are a number of different legislative options here to get at this problem.  And we look forward to working with the Hill -- as I said, both Democrats and Republicans -- in order to get a bill that will provide the (inaudible).      Q    Hi.  This Sarah Kliff with Vox.  Thanks for doing this call.  I was curious -- you know, there's obviously a lot of things the President can focus his time on, even within the healthcare space.  What is it about surprise medical bills that has gotten the President interested?  You know, why this issue, of all the issues he could work on?          SENIOR ADMINISTRATION OFFICIAL:  I think it's a good question.  I mean, it goes to the types of things that animate the President.  I can tell you, as somebody who's been in Washington, D.C. for a long time, there are -- you know, in the previous administration, there were a number of issues that were left to fester and linger and grow into bigger problems because they were so focused on the ACA.  They had complete and total tunnel vision.  And we've been working on Medicare, Medicaid, and a whole host of other issues and improving health outcomes.      We've got a robust HIV elimination project, pediatric cancer initiative -- a number of things ongoing.  And this is an example of something where the President was presented with real human beings who were getting screwed over by the system because people have been too indifferent for far too long to their plight.      This is something that should get fixed.  On its face, this is a simple problem.  And while there needs to be some tradeoffs in finding the right legislative solution, and we have to make sure we don't have unintended consequences, Republicans and Democrats should be able to figure this out so the American people aren't getting screwed.  And you’ll hear from people today that will be with the President, talking about examples of their surprise bills. You know, we’ve heard in the past about people getting diagnostic tests that cost $18,000 and they had -- and they get the bill three months after the fact and they had no idea.  And of course, at this point, they have no recollection of having consented to or what the urine test was for in the first place.      So this is just right up the President’s alley.  Something that can be fixed, should be fixed.  And he’s excited to wade into it.          SENIOR ADMINISTRATION OFFICIAL:  And, Sarah, thank you for your reporting in this area.  I think you’ve done as effective job as anyone at highlighting many of the more egregious problems.  And just to, you know, echo what my colleague said, this is an area where there should be bipartisan agreement.      If you look at surveys, it’s one of the main concerns, if not the main concern, that people have about the healthcare system, is getting one of these surprise bills. And we know that at a majority of hospitals, this isn’t a problem.  But at a minority of them, it is a real big problem.  An opportunity here to advance good healthcare policy and protect patients from being bankrupt by these outrageous medical costs. SENIOR ADMINISTRATION OFFICIAL:  Okay, one last thing to be reminded about: I mean, I’d mentioned the roundtable but I did forget to mention he called for this in the State of the Union Address too, at the beginning of the year.  So he’s been focused on it for some time. Q    Hi, this is Evan Brown from Fox News.  Speaking as a patient who has had to navigate the financial waters of the healthcare system for both me and my wife and my child, I can tell you the biggest frustration I have isn’t so much the surprise or sticker shock, but it’s the fact that accounting is horrible in the healthcare industry. Oftentimes, I’m finding that people who have trained to be nurses or medical technicians are left to do medical billing in the doctor’s office and they often don’t know what they’re doing. And between that and insurance companies not really updating their publicly available records to the doctor or to the patient about whether or not deductibles have been met or how close you are to reaching your out-of-pocket care maximums, has left to a lot of confusion.  And often, the doctor -- when you’re going in for elective or routine care -- the doctor’s office will charge you what they’re told based on records which are not up to date.  So if you’ve already actually satisfied your deductible but it’s not reflecting on the record, you’re still getting charged a higher amount than what you should be. And to get a refund, you have to fight like heck.  And there’s really not a lot of recourse.  And oftentimes the doctors don’t tell you that you have a credit balance and they sit and hold on to your money.  Now, if you owed them money, they'd, of course, be knocking down your door every day. So how can a patient actually, with what the President is planning to do -- how can the patient have some recourse and some help?  Because there’s nobody out of the state attorney general’s office to help you with this.  There’s no real advocate for you at the insurance company.  They say they’re an advocate but you’re going to be sitting on hold, you know, when you’re at work.  And that’s just unacceptable.  If I sound like I’m a little passionate about it, it’s because I’ve been fighting an insurance company lately.      SENIOR ADMINISTRATION OFFICIAL:  So, first off, thanks for that.  I think your remarks are really -- speak to the visceral nature of a lot of this and why we’re so focused on it.  I will say that this proposal is not meant to solve every problem in the healthcare system.  But the President does have a comprehensive approach and there are steps being taken on a number of different areas -- protecting Medicare, on Medicaid as well -- where we want to make progress.      In this part, the thing that I think is most relevant to your question is that we do really want to have one price and that estimate up front so that there’s no sticker shock surprises coming at you.  And that’s the element that we really think that is important to highlight here.      MR. DEERE:  Operator, we’ll take one last question.      Q    Hi, this is Caitlin Owens with Axios.  I just wanted to follow up.  I know you said that you are not endorsing arbitration specifically.  Is that kind of a mechanism for figuring out, you know, how much the insurer will pay the provider in an out-of-network situation?      Another solution that has been talked about pretty frequently is creating some kind of bundle payment where, instead of the hospital and the doctor getting paid separately, there’s just one bill to kind of clean up this issue of surprise medical bills.  Are you supportive of that as a solution?  Or are you not endorsing any solution at all?      SENIOR ADMINISTRATION OFFICIAL:  Hey, Caitlin, thanks for the question.  Appreciate it very much.  Yes, as you picked up earlier, we do not have a lot of enthusiasm for arbitration.  We believe that that would be disruptive.  We believe that that would get in the way of solving this problem.  And we believe it would be an unnecessary distraction that insurers -- the end of the day, a lot of potential abuses disguised in a different form would nevertheless still be inflicted against patients and Americans.      Your observation about bundling is of interest.  Again, we’re not going to negotiate through the media.  We’re going to be working directly with Congress.  Fruitful, profitable ideas such as that, and others, I’m sure will be on the table.  And we’ll work through those in the upcoming months as Congress responds to the President’s call.      SENIOR ADMINISTRATION OFFICIAL:  And I would just add to what my colleague said.  We will -- I mean, one of the principles the President is going to put out is that there are no separate bills from out-of-network providers absent advance informed consent.      MR. DEERE:  Operator, that will conclude today’s call.      I do want to thanks our subject matter experts for joining us.  Just a reminder that Joe Grogan’s opening remarks were on the record.  The Q&A was on background attributable to senior administration officials.  And the call is embargoed until the President begins his remarks shortly.                                    END                11:29 A.M. EDT

A Proclamation By the President of the United States of America - Military Spouse Day, 2019

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019 Military Spouse Day, 2019 - - - - - - - By the President of the United States of America A Proclamation        Military spouses share an admirable legacy of unwavering devotion to their loved ones in uniform and to the cause of freedom.  Wives and husbands stand faithfully beside their beloved service members and play a critical role in their ability to safeguard our country.  They shoulder tremendous burdens and responsibilities and face demands that most families will never endure.  Military spouses earn no rank or compensation, yet their contributions to our military might are invaluable.  On Military Spouse Day, we honor our Nation's military spouses and express our deep appreciation for all that they do.      The nomadic nature of military life places tremendous pressure on military families.  Frequent relocations, which require leaving behind the familiar -- home, school, work, church, and friends -- are commonplace.  Military spouses nevertheless find ways to improve their communities, on and off the base, and to thrive in spite of the numerous hardships.  Military spouses also demonstrate sacrificial love and provide essential support and encouragement to their service members during deployments.  They comfort fearful and anxious children, balance work and school demands, and keep things going on the home front with uncommon grace and resourcefulness, despite the loneliness and anxiety that often accompany an extended absence.      Frequent relocation also imposes substantial economic costs on our military families.  For example, it results in unemployment and underemployment of military spouses.  My Administration, therefore, is committed to enhancing opportunities for our Nation's military spouses.  Last year, I was pleased to sign an Executive Order requiring Federal agencies to promote the use of existing military spouse noncompetitive hiring authority to the greatest extent possible, providing significantly greater opportunity for military spouses to be considered for Government positions.  The Department of Defense's Military Spouse Employment Partnership has brought together more than 390 companies and organizations committed to recruiting, hiring, promoting, and retaining military spouses.  Since the initiative's inception in 2011, these devoted partners have hired more than 130,000 military spouses.  Employers who hire these spouses benefit from the tremendous talent, breadth of experience, and determination these men and women have learned from navigating the demands of military life.      I encourage all who enjoy the blessings of freedom -- preserved and defended by our Nation's military and their families -- to find ways to support our incredible military spouses.  I applaud local government officials who have helped advance workforce freedom and mobility for military families.  I encourage States and occupational licensing boards to build on these efforts and do more to improve license portability, removing barriers to military spouses remaining in the workforce following a change in duty station.  Community leaders can also raise awareness about programs like Military OneSource, a one‑stop resource for information, support, and referrals on every aspect of military life.  And in neighborhoods nationwide, families can reach out, in word and deed, to spouses who are working to meet the unique challenges of military life.      Military spouses are among our country's unsung heroes and are at the heart of our Armed Forces.  They embody strength and resilience, and represent the best of American patriotism, courage, character, and pride.  As a Nation, we must ensure our military spouses receive the unparalleled and unwavering support they deserve.  On this Military Spouse Day, Melania and I salute the extraordinary women and men who serve as military spouses and offer our prayers, respect, and gratitude on behalf of a grateful Nation.      NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 10, 2019, as Military Spouse Day.  I call upon the people of the United States to honor military spouses with appropriate ceremonies and activities.      IN WITNESS WHEREOF, I have hereunto set my hand this ninth day of May, in the year of our Lord two thousand nineteen, and of the Independence of the United States of America the two hundred and forty-third.                              DONALD J. TRUMP

1600 Daily The White House • May 9, 2019 Border Patrol Chief: Our National Security is at Risk

The White House • May 9, 2019 Border Patrol chief: Our national security is at risk  If there was ever a moment for a sense of urgency from Washington about America’s border crisis, that time is now. “As of Sunday, only seven months into the year, we have now surpassed the total southwest border apprehensions of every fiscal year since 2009,” U.S. Border Patrol Chief Carla Provost told members of a U.S. Senate Judiciary subcommittee yesterday.    Watch: Border Patrol chief explains our immigration crisis in 6 minutes   Because of dangerous loopholes in American immigration laws, today “family units” and unaccompanied children account for 64 percent of all apprehensions at the southern border. Illegal immigrants and human smugglers “have received the message loud and clear,” Provost says. “Bring a child—you will be released.” That policy creates an unmitigated humanitarian and security disaster. One problem is that illegal immigration is dangerous and often relies on criminal smugglers to breach the border. Bringing young children along in that journey puts them at grave risk. An even more pressing danger comes from “fake families”—a growing phenomenon where children are unwillingly paired with nonparent adults to game U.S. asylum laws. Once entry is granted, those children become expendable, sometimes being appallingly “recycled” back across the border for use by another asylum-seeker. Congress needs to take action—and that doesn’t simply mean building more temporary facilities, Provost said. “It’s like holding a bucket under a faucet. It doesn't matter how many buckets you give me if we can't turn off the flow.” President Trump is calling on Congress to respond to this humanitarian crisis. More: Feds released 168,000 illegal immigrant family members into communities President Trump hosts the 2018 World Series Champion Boston Red Sox  A time-honored tradition took place at the White House today as President Trump welcomed last year’s World Series baseball champions, the Boston Red Sox. The Red Sox have been one of America’s most storied franchises. In 2004, they captivated the Nation by rallying for the biggest playoff comeback in baseball history, defeating the New York Yankees in the American League Championship Series. A near-century long championship drought ended as they went on to win the title that year. And in 2013, the Red Sox brought unity and joy to a Boston community still healing after the tragic events of the Boston Marathon bombing that April, winning the organization’s eighth championship that fall. Watch President Trump welcome the 2018 champion Boston Red Sox. Photo of the Day Official White House Photo by Shealah Craighead President Donald J. Trump welcomes the 2018 World Series Champion Boston Red Sox to the White House | May 9, 2019

BACKGROUND PRESS CALL BY SENIOR ADMINISTRATION OFFICIALS ON THE GLOBAL HEALTH SECURITY STRATEGY

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019 BACKGROUND PRESS CALL BY SENIOR ADMINISTRATION OFFICIALS ON THE GLOBAL HEALTH SECURITY STRATEGY Via Teleconference   5:33 P.M. EDT SENIOR ADMINISTRATION OFFICIAL:  Hey, everybody.  Thanks for joining us this afternoon as we talk about the Global Health Security Strategy. I’m joined today with briefers from around the interagency. We’re joined today by [senior administration official].  We have two other briefers.  A reminder:  This briefing is provided on background.  There is no embargo, so you can use the material as it comes out. And you may notice that there’s already a factsheet that is posted about the Strategy that is coming out.  And the Strategy itself should post momentarily. Right, this is on background.  And, with that, we’ll go ahead and start.  And I’ll turn it over to my colleague. SENIOR ADMINISTRATION OFFICIAL:  Well, thank you.  I’ll just provide a few topline notes here.  We’ve got a team of interagency experts on this topic to help explain what the President is rolling out today and to help answer any questions. So our National Security Strategy specifically identifies combatting biological threats and pandemics as a cornerstone of national security.  Biological threats, like infectious disease outbreaks, are a national security priority for the United States government. And you may recall that, last year, the President rolled out the National Biodefense Strategy.  We have been actively implementing that strategy.  This was a presidential priority, and continues to be.  And I think it’s part and parcel of a total national security enterprise focus on biological threats and global health challenges. The United States, in close cooperation with its international partners, will work to prevent, detect, and respond to infectious diseases threats at home and abroad, whether naturally occurring, unintentional, or deliberate. The Global Health Security Strategy released today outlines a coordinated United States government approach that focuses on three interrelated goals: strengthen partner country global health security capacities, increase international support for global health security, and a homeland prepared and resilient against global health threats. The approach that we lay out here today in the GHSS will ensure that we maximize impact through collective global action and create a safer world by closing the gap that diseases exploit.  The Strategy’s activities will be multisectoral, leveraging the strengths of numerous United States departments and agencies, and will reflect the contributions of a broad set of health security-related programs and funding streams across the United States government. Now, since its launch in 2014, for example, we’ve also been focusing on the Global Health Security Agenda.  And this -- this itself is something that we are using to make significant progress towards stronger country-level health security capacity. So if you take a look at what we’ve been doing with the National Biodefense Strategy, you take a look at what we’ve doing with the Global Health Security Agenda, and you take a look at what we’re doing today with the Global Health Security Strategy, I think what you see is a fairly cohesive, integrated, and systematic focus on the challenges posed by biological threats, biological security, and global health challenges. And so, with that, what I’d like to do is I’d like to turn it over to my colleague with CDC to provide that agency’s views on (inaudible). SENIOR ADMINISTRATION OFFICIAL:  And real quick, just wanted to reinforce that this is on background.  Attribution is “senior administration official.”  Just want to clarify that. Over to you. SENIOR ADMINISTRATION OFFICIAL:  Okay, thank you very much.  This is [senior administration official] at CDC.  CDC’s primary mission is to protect the health, safety, and security of the American people.  And in order to do that effectively, we work globally to ensure that health threats do not reach U.S. borders. I want to talk a little bit about our approach, especially through the Global Health Security Strategy.  From domestic preparedness and responding to the measles outbreaks in the U.S., to responding to the challenging Ebola response in DRC, CDC plays a unique role in global health security, and will continue this work as described in the Global Health Security Strategy.      CDC is engaged in all three goals outlined in the Global Health Security Strategy: strengthening partner-country capacities, increasing international support for global health security, and a homeland prepared for and resilient against global health threats.      While CDC has expertise in and conducts activities across all 16 technical areas that are outlined in this Strategy, our global health security work focuses on the core foundation for strong public health systems, surveillance, laboratory workforce, and emergency operations, which are some of the key technical areas in this strategy.      For example, we work in antimicrobial resistance by improving laboratory capacity and surveillance for drug-resistant pathogens.  We also work on zoonotic diseases by including veterinarians and animal health workers in our workforce development programs, and by improving detection and response to zoonotic pathogens through laboratory surveillance and emergency management activities.      These are some of the core functions that we focus on as the U.S. public health agency when we work very closely with state, local, tribal, and territorial governments and organizations to help them build their capacities.      CDC has world-class scientists and public health professionals who implement key disease detection activities and train the public health workforce for the future, diagnose novel and reemerging pathogens with our world-class labs and deploy laboratory assets to the field where our innovative technology can yield high-quality results even in resource-constrained environments.      And another important component of our global health security work is the agency’s ability to monitor threat -- monitor threats globally from headquarters and provide rapid response through deployment of staff across the agency.      And we’ve developed a system -- the Global Emergency Alert and Response Service -- to do that.  We monitor between, on average, 35 to 45 outbreaks a day through event-based surveillance, and support emergency deployments to respond to these outbreaks or public health events, such as natural disasters or displaced populations due to conflict or strife.      CDC has rostered over 500 deployers that have provided nearly 17,000 person days of support for response activities.  And this includes staff who have deployed to Democratic Republic of Congo, surrounding countries, and WHO headquarters to assist with the response to this Ebola outbreak in DRC now.      It’s critical for CDC is continue to help countries to develop their own global health security capacities so we can control these deadly outbreaks at their source, which protects Americans and also protects countries -- helps other countries protect their own citizens.  Pardon me.      CDC’s investments in global health security, especially border health activity, will strengthen countries’ capacities to detect infectious diseases at the borders and prevent their spread to neighboring countries.      We’ve seen this in action in Uganda, during the current Ebola outbreak in DRC where several suspect Ebola cases have been detected and monitored.      So just to wrap up, global health security is national security.  And it’s important to continue to make progress toward a world that’s safer and more secure from public health threats.  And the Global Health Security -- this Global Health Security Strategy will assist us in doing that.      Thank you very much.      SENIOR ADMINISTRATION OFFICIAL:  Hi, good afternoon.  This is [senior administration official] in the Bureau for Global Health at the U.S. Agency for International Development, or USAID.  We want to express our thanks to you for your interest in U.S. government global health security efforts. Under the leadership of the National Security Council, we’ve worked closely with the interagency to help develop the Global Health Security Strategy.  Although many departments and agencies contribute to the Global Health Security Agenda -- or GHSA -- CDC and USAID are the principal implementers of international GHSA capacity-building activities for the United States government.      Programing is designed to be complementary, responsive to country technical priorities -- as detailed in the National Action Plan for Health Security -- and builds off of each of our unique investments and experience in global health security.      USAID’s GHSA program builds upon our multisectoral development mission, especially our global health, food security, economic growth, and environmental portfolios; our longstanding work at the community level with local organizations; and our foreign disaster assistance and global resilience programs.  We integrate with these programs, often using the same implementing partners, which promotes efficiency and sustainability.      In line with our agency’s focus on the journey to self-reliance and supporting increased country-level capacity and commitment, USAID builds upon our relationships with partner country ministries, including health, agriculture, finance, forestry, and our strong links with international organizations including the Food and Agricultural Organization and the World Health Organization.      We support GHSA countries in a broad range of technical areas central to improving health security in these focus countries. One of our focal areas is addressing zoonotic diseases and animal health services.  This is critical because about 70 percent of new outbreaks emanate from animals.  USAID does this work by preparing the next generation of health, agricultural, and environmental professionals to deal with zoonotic diseases.  We help countries detect viruses and wildlife that have the potential to cause the next epidemic or pandemic.  The point is to stop these threats at their source by designing interventions, like communication materials, early on to reduce the risk to humans.      We strengthen more than 40 animal health and other national laboratories in (inaudible) countries, including reestablishing central veterinary laboratories. USAID also has a major focus on promoting health security and services at the community level by helping countries to establish risk communication programs that provide individuals and communities with the information needed to reduce the spread of diseases and outbreaks, including safe and dignified burials when needed; helping communities at high risk of infectious disease events to develop preparedness plans; and training community volunteers to detect and respond to infectious disease threats in their own neighborhoods. We know all of this does take place in communities.  We help develop an emergency supply chain program especially designed to distribute commodities, like personal protective gear, that are critically needed during outbreaks.      Finally, USAID builds upon more than more than two decades of work addressing antimicrobial resistance by promoting stewardship in antimicrobial resistance and preventing healthcare-associated infections. We'll continue to respond to international outbreaks in ways that build long-term capacity.  For USAID, this includes through the emergency reserve funds for infectious disease outbreaks; a stockpile of emergency nonmedical commodities; on-the-ground activities that can be quickly reprogrammed; and technical experts in water, sanitation and hygiene, communication, and other areas.  USAID looks forward to the next stage of GHSA implementation as outlined in the Global Health Security Strategy.      At this point, I'll ask the operator to open the line for question and answers.  Thank you.      Q    Good evening.  This is Toby Capion calling from EWTN.  Why doesn’t the U.S. confront the security challenges in Congo so it can insert more healthcare workers into the area affected by Ebola?      SENIOR ADMINISTRATION OFFICIAL:  So, I guess I would disagree that we're not confronting them within reason.  So, I'll make a couple points.      One, we have significant support for the WHO and for the U.N. UNESCO missions, which are endeavoring to provide security in the Congo.  But ultimately, the security in the Congo is the responsibility of the Congolese government.  They've recently elected a new President.  And they -- let's be clear, they have significant security challenges on the ground.  And so, within the bounds of our ability to work with the Congolese government and to support the requests of the Congolese government, we are doing literally everything we possibly can to prioritize our efforts with the outbreak of Ebola.      It is clear that this is not Ebola 2014 through 2016 in West Africa.  This is a -- this is an epidemic in a region that is an unprecedented, unstable security environment that we are doing everything we can to address that, within the bounds of what is possible in that security environment.                              END                5:48 P.M. EDT

REMARKS BY PRESIDENT TRUMP WELCOMING THE 2018 WORLD SERIES CHAMPION BOSTON RED SOX

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019 REMARKS BY PRESIDENT TRUMP WELCOMING THE 2018 WORLD SERIES CHAMPION BOSTON RED SOX South Lawn 3:44 P.M. EDT      THE PRESIDENT:  Well, there's nothing like the White House.  And a little rain is okay.  We might wipe out a suit, but that's all right, too.  It's raining a little bit, fellas.  Nobody told me about that.  You don't need umbrellas, I know that. Well, good afternoon.  It's my pleasure to welcome to the White House the 2018 World Series Champion, the Boston Red Sox.  A very special group of people.  (Applause.)  A very special team.  Thank you. With us this afternoon are some of your biggest fans in my administration and on Capitol Hill, including Administrator Andrew Wheeler.  Where's Andrew?  Andrew?  A lot of deputy secretaries.  A very great senator, Senator Tom Cotton.  Tom.  Ah, look at that beautiful boy is a big fan -- right, Tom?  Tom was a good player. We're also delighted to be joined by the senior leadership of Fenway Sports Group and the Boston Red Sox, John Henry.  A great, great businessman.  John, thank you very much.  (Applause.)  Great businessman. Tom Werner, a man who has done a fantastic job in life.  Where the hell is he?  Tom.  (Laughter and applause.)  Mike Gordon, Sam Kennedy, and David Dombrowski.  Thanks, fellas.  Fantastic.  (Applause.)  Fantastic job.  Great.  To all the coaches and players of the Red Sox: Congratulations on your incredible victory. The team has just come from the Walter Reed National Military Medical Center, where they visited our wounded heroes and wounded warriors.  (Applause.)  And they believe very strongly in that. I want to thank the entire Red Sox organization for your longstanding support for those American service members who have suffered the wounds of war to keep our country safe and strong and free.  And we've never had a stronger military, right now.  This is the strongest it's been -- $716 billion we spent last year, John.  That's a lot of money, even for you, right?  Would you say?  (Laughter.)  That's a lot of money. Over the course of the 2018 season, the Red Sox were -- frankly, they were unstoppable.  I watched.  You outscored your opponents by 229 runs and won 108 games in the regular season -- the most in Red Sox history.  (Applause.)  You’ve got a lot of fans over here.  You’ve got a lot of fans, huh?  That's a lot of fans they have. In the playoffs, you bested your archrival, the Yankees.  (Applause.)  I think I'll be a neutral on this one, huh?  (Laughter.)  But you did.  You beat them, and beat the defending champions, the Astros -- another great team -- taking home the American League pennant and clinching a spot in the World Series. After taking a two-game lead at historic Fenway Park to start the Series, you headed to Los Angeles for Game 3.  I was at Fenway Park; I threw out the first pitch a long time ago.  And George Steinbrenner was not happy about it.  (Laughter.)  That cooled my relationship with him for about two days.  But he forgot about it.  That was good. But you headed to Los Angeles for Game 3.  For 7 hours and 20 minutes, you faced the Dodgers in one of the most exciting games in postseason history. It was in the 12th inning that relief pitcher Nathan Eovaldi -- where's Nathan?  (Applause.)  Where is Nathan?  That was -- that was a good job he did.  Did you ever see such good-looking people behind me, too?  (Laughter.)  Not the owners; forget the owners.  (Laughter.) He stepped up to the mound.  Over the final seven innings, Nathan threw 97 pitches, allowed only 3 hits, and struck out 5 batters.  Nathan, that's a great performance.  We watched it.  It was a dominant performance.  Congratulations.  (Applause.) MR. EOVALDI:  Thank you. THE PRESIDENT:  Though you ultimately lost Game 3 by a single run, Eovaldi’s tremendous effort inspired the whole team.  You knew what a World Series victory was, you knew it was in reach, and you didn't want to do anything to blow it.  And that's what happened.  But then in Game 4, after the Dodgers scored four unanswered runs, things were looking very grim.  In the dugout, your starting pitcher, Chris Sale -- who, by the way, last night, struck out 14 batters.  (Applause.)  That's pretty good, right?  No, I said, "How's Chris doing?"  "Well, he struck out 14 last night."  I said, "Fourteen?"  I never heard about 14.  I said, "Was that your best?"  He said “No.”  Fifteen is your best, right?  (Laughter.)  That's called a power pitcher, by the way. In the dugout, your starting pitcher, Chris, decided to give the team a little pep talk.  Are you an emotional guy?  Pretty much, huh?  Because I heard it was a hell of a pep talk.  Give us a little pep talk every once and a while.  (Laughter.)  With great passion, Chris shouted, pointed to the field, and rallied the Red Sox.  And, Chris, I know what you said.  I heard little things about your -- what you said.  And we have children here, so I'm not going to talk about it.  (Laughter.)  But it worked.  It really worked. World Series MVP Steve Pearce tied it up.  (Applause.)  He tied it up and -- with a home run.  You're doing well this year?  Pretty well this year, right?  Huh?  (Laughter.)  He's doing well this year.  When it counts, he really does well.  Those are the ones we really like, huh?  Followed by three RBIs in the ninth, the Sox won -- 9 to 6 -- and never looked back. Chris Sale then returned to the mound for the final game. With two outs and a one-and-two count in the bottom of the ninth, against a great hitter, Sale stared down the batter, wound up, and delivered an amazing slider.  Was that a slider?  (Laughter.)  You gave up the fastball?  And the batter went down swinging and the Red Sox won the World Series.  (Applause.)  Right?  It’s pretty good, huh?  It’s pretty good. In 2004, the Red Sox achieved their first World Series victory in 86 years.  You quickly won two more in 2007, 2013. With your victory over the Dodgers, you now have won more World Series than any other team in this century.  That’s pretty good, huh?  (Applause.)  Must be the ownership, too.  I don’t know.  I know these owners are great. In the same period, Boston teams have won six Super Bowls, as well as an NBA and an NHL championship.  And this has to be a great time for Boston's fans.  If you think of it, what Boston has done in a short period of time is pretty amazing -- in a lot of ways, but in sports, certainly.  Congratulations.  That’s great. Each Red Sox player is a shining example of excellence, living out an American sporting tradition that goes back many generations.  From the open fields of our rich farmlands to the playgrounds and the vacant lots of our great cities, kids everywhere learn to catch fly balls, swing for the fences, and race to home plate.  Baseball is truly America’s pastime. I love it.  I don’t know -- I guess everyone out there loves it.  You wouldn’t be here if you didn’t.  But I love it.  It's a special -- it's a special game, a special sport.  I played on a slightly different level.  It's called “on high school.”  A little different level, but every spring I loved it.  The smell in the air, right?  Does that make sense?  The smell in the air, right?  It's an amazing feeling. Through every pitch, inning, game, and series, the 2018 Red Sox never gave up and never backed down.  You always played like champions.  This is a great champion right here, too.  This is some champion.  I want to congratulate you all on your spectacular victory. And I just want to have Chris Sale and J.D. Martinez -- two outstanding players and athletes and people -- come up and say a few words.  And then, after that, I'm going to take -- unless the team doesn’t want to do it -- you know, they never get to see Lincoln Bedroom.  It's like, sort of, you're not supposed to be showing it.  So if the press, the media, doesn't report me for this, I'm going to take them up and show them the Lincoln Bedroom.  They wanted to see the Lincoln Bedroom.  So I'm going to give the tour myself.  Okay?  (Laughter.) But, J.D., if you and Chris would come up and say a few words.  Thank you.  Thank you very much.  Great job.  (Applause.) Thank you, Chris.  Please. MR. SALE:  Well, Mr. President, on behalf of the Boston Red Sox organization, we'd like to thank you for having us here to celebrate our 2018 World Series Championship team.  We'd like to thank our -- obviously, our spouses, our family members, and friends, and our fans for coming here.  This is a very high honor.  It's something that we appreciate very highly.  And thank you again. THE PRESIDENT:  Thank you very much.  Congratulations.  (Applause.) MR. MARTINEZ:  I just want to say thank you, Mr. President, for this once in a lifetime opportunity to be honored today here at the White House.  And I know celebrating a Red Sox victory is tough for you, given that you're a Yankee fan and all.  (Laughter.) But we really want to say thank you for your hospitality today.  And we brought you a gift: this Red Sox jersey. THE PRESIDENT:  Wow. MR. MARTINEZ:  For you. THE PRESIDENT:  Beautiful.  Thank you very much.  (Applause.) MR. MARTINEZ:  Thank you. MR. HENRY:  Well, once again, I want to congratulate this group of men who -- and women -- who put together the best Red Sox team in history last year.  And I -- (applause) -- thank you. But, of course, we -- we would not have been successful over the years in winning these titles without the fans of the Red Sox who are global.  We often hear and see service men who are serving across the world who are tuning in to Red Sox games.  And it's a truly remarkable phenomenon around the world and throughout the United States that -- how loyal and how committed Red Sox fans are.  And they're the reason that we have the resources to be successful. And thank you, Mr. President, for this honor today.  It really is an honor.  And thank you. THE PRESIDENT:  Thank you very much, John.  Thank you, fellas. (Applause.) So, again, I want to thank everybody for being here.  A very, very special group.  And I want to thank the families of the players -- because without the families, it just wouldn’t work.  You know that.  They wouldn’t be up here.  It would never work. Thank you all for being here.  It's a tremendous honor to have you in the White House.  And we're going to look at the Lincoln Bedroom.  (Laughter.)  Thank you. Thank you everybody.  (Applause.)                         END                3:56 P.M. EDT

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019 PRESIDENT DONALD J. TRUMP IS PROTECTING THE HOMELAND AND THE WORLD FROM GLOBAL HEALTH SECURITY THREATS   “We must protect the American people, the homeland, and our great American way of life.” – President Donald J. Trump PROTECTING AGAINST GLOBAL HEALTH SECURITY THREATS: President Donald J. Trump is taking action to protect America and our partners from infectious disease threats. Today, the Trump Administration is releasing its Global Health Security Strategy (Strategy), the first full-fledged strategy of its kind. The Strategy defines the actions the Administration will take to prevent, detect, and respond to infectious disease threats, whether naturally occurring, accidental, or deliberate. The Strategy adopts a whole-of-government approach to health security by leveraging the strengths of many different Federal departments, agencies, and funding streams. Combating biological threats and pandemics are a cornerstone of President Donald J. Trump’s National Security Strategy. President Trump released the National Biodefense Strategy in September 2018 to prepare for and combat biological threats.  STRENGTHENING GLOBAL HEALTH SECURITY CAPACITIES: The United States is working to help ensure that partner countries can respond to health security threats. The United States is working with international partners to help improve the world’s ability to stop and contain infectious disease outbreaks before they spread between countries. Under our new Strategy, the United States will work to ensure that every partner country has a plan to achieve self-reliance in the critical area of health security. The Administration strongly supports the Global Health Security Agenda as a mechanism to accelerate progress addressing infectious disease threats. Nations, international organizations, and the private sector established the Global Health Security Agenda, laying out specific targets to reduce infectious disease threats. The Global Health Security Agenda was first launched in 2014 and re-affirmed in 2018. The United States supports the use of the World Health Organization’s Joint External Evaluation process to help implement the International Health Regulations. Using this process, the United States will assist our international partners to help improve their performance in priority areas. We will encourage countries to strengthen their technical capacities and will support select partner countries in areas such as emergency preparedness and disease surveillance. INCREASING INTERNATIONAL SUPPORT: The United States is creating a safer world by utilizing collective global action to combat global health security threats. Under this Strategy, the United States will use bilateral, regional, and multilateral engagements to encourage countries to make health security a national priority. The United States will coordinate with partner governments, nongovernmental organizations, and the private sector to promote sustainable financing to build health security capacity. The United States will push for a transparent and accountable framework to encourage donors and countries to fulfill their financial commitments to global health security. By increasing international support, we will be able to enhance preparedness and response mechanisms to combat infectious diseases at home and abroad. ###

Readout of the Second Meeting of the Presidential Task Force on Protecting Native American Children in the Indian Health Service System

Office of the Press Secretary FOR IMMEDIATE RELEASE May 9, 2019 Readout of the Second Meeting of the Presidential Task Force on Protecting Native American Children in the Indian Health Service System The Presidential Task Force on Protecting Native American Children in the Indian Health Service System (Task Force) convened its second meeting from May 6 to 8, 2019, in Albuquerque, New Mexico. On Tuesday, the Task Force visited the Navajo Nation Dzilth-Na-O-Dith-Hle Health Center in the Navajo Nation—an Indian Health Service (IHS) healthcare facility primarily providing care to Navajo patients.  While there, the Task Force met with health officials and tribal leaders. The Task Force continued its focus on the IHS, discussing concerns about its culture, protocols and practices, ability to recruit and retain quality healthcare professionals, and employee familiarity with mandatory reporting requirements for child abuse.  The Task Force also met with Dzilth-Na-O-Dith-Hle Tribal School officials and Navajo officials, including Navajo Nation Council Delegate Amber Kanazbah Crotty, who also chairs the Navajo Sexual Assault Prevention Subcommittee.  Their discussion included tribal school processes and protocols for handling child abuse reporting as well as recruitment of Native American doctors and medical professionals. On Wednesday, the Task Force met with the United States Attorney for the District of New Mexico, John Anderson, and Supervisory Assistant US Attorney Kyle Nayback, who leads the Indian Country Crimes Section, to draw upon their on-the-ground experience with child abuse investigations, including cases that involved mandatory reporters, as well as reporting in IHS facilities and tribal schools. On Wednesday afternoon, the Task Force met with tribal leaders, including the All Pueblo Council of Governors at the Indian Pueblo Cultural Center in Albuquerque, to discuss institutional challenges within the IHS system that impact the safety of Native American children.  The Council Chairman is Governor Paul Torres of Isleta Pueblo and Vice Chairman Michael Chavarria of Santa Clara Pueblo. The Task Force will convene again in Montana in the coming weeks.  Individuals wishing to provide information or commentary to Task Force members are encouraged to contact the White House Office of Intergovernmental Affairs at IGA.state@who.eop.gov. Please note: This Task Force’s focus is separate and distinguishable from other investigations into the IHS.  Specifically, the work of the Task Force will not interfere with: (1) the criminal investigation of one particular pediatrician; (2) a review underway at the Department of Health and Human Services (HHS), including a review by HHS’s Inspector General, which HHS Secretary Azar ordered earlier this year; or (3) a review conducted by an outside, independent contractor retained by IHS. For additional information about the task force and its members, please visit https://www.whitehouse.gov/briefings-statements/white-house-announces-presidential-task-force-protecting-native-american-children-indian-health-service-system.     ###